Panorama ® PATIENT MONITORING NE T WORK Training Work book

Panorama ® PATIENT MONITORING NE T WORK Training Work book
Tr a i n i n g Wo r k b o o k
Panorama® PAT I E N T M O N I TO R I N G N E T W O R K
C E N T R A L S TAT I O N
Inservice Objectives
• The Panorama Training Workbook is intended to review the features and functions
of the Panorama Central station. A complete description of all features can be found
in the Panorama Central Station Operator’s Manual.
• The Panorama Training Workbook is an adjunct to clinical inservicing and is
designed to assist in meeting the educational objectives for the use and application
of the Panorama Central Station.
• E ach topic in the Panorama Training Workbook contains assessment and
performance criteria areas to familiarize the clinician with each listed topic.
• N
ot all topics covered within the Panorama Training Workbook may apply.
Hospital Name:............................................................................................................................
Department:.................................................................................................................................
Completed By:..............................................................................................................................
Date: ............................................................................................................................................
1
2
Table of Contents
Inservice Objectives......................................................................................................................... 1
Table of Contents.............................................................................................................................. 3
Introduction........................................................................................................................................ 5
ECG Lead Placement Procedure................................................................................................. 6
Ambulatory Telepack (Optional).............................................................................................. 12
Panorama Central Station Overview..................................................................................... 16
Automatic Admit............................................................................................................................ 20
Alarm Behaviors............................................................................................................................. 21
Patient Selection............................................................................................................................ 22
Menu Bar........................................................................................................................................... 23
TOUCH SCREEN ON/OFF MENU BUTTONS........................................................................... 23
PATIENT SETUP MENU BUTTON.................................................................................................... 24
Demographics Tab..................................................................................................................... 24
Transfer Tab..................................................................................................................................... 32
Discharge Tab................................................................................................................................ 36
Display Tab....................................................................................................................................... 38
Standby Tab.................................................................................................................................... 41
Wave Gain Tab............................................................................................................................... 43
Print Setup Tab.............................................................................................................................. 44
PATIENT ALARMS MENU BUTTON............................................................................................... 45
Patient Alarms Setup Tab....................................................................................................... 45
Alarm Limits Tab........................................................................................................................... 46
Alarm Responses Tab................................................................................................................ 50
REPORTS MENU BUTTON................................................................................................................. 54
Patient Reports Tab.................................................................................................................... 54
System Reports Tab................................................................................................................... 58
Print Status Tab............................................................................................................................. 59
SYSTEM SETUP MENU BUTTON.................................................................................................... 60
Parameter Colors Tab................................................................................................................ 60
Recalibrate Touch Tab............................................................................................................... 61
Installation Tab.............................................................................................................................. 61
PAGING MENU BUTTON (Optional)............................................................................................ 62
Paging Menu.................................................................................................................................. 62
3
Table of Contents
View Tabs.......................................................................................................................................... 70
BEDSIDE TAB.............................................................................................................................................. 70
TRENDS TAB............................................................................................................................................... 74
GRAPHIC TRENDS TAB......................................................................................................................... 76
EVENTS TAB................................................................................................................................................ 77
EVENTS VIEW WAVEFORM TAB....................................................................................................... 81
DISCLOSURE TAB.................................................................................................................................... 87
DISCLOSURE ZOOM IN TAB............................................................................................................. 89
ST TAB (Optional)................................................................................................................................... 95
ViewStation (Optional)................................................................................................................. 98
NETWORK MENU ...................................................................................................................................98
CONSIDERATIONS............................................................................................................................... 102
Arrhythmia Definitions.............................................................................................................. 103
Appendix A (Arrhythmia Analysis Frequently Asked Questions)........................... 105
Appendix B (Panorama Central Station Guideline)...................................................... 109
4
Introduction
5
ECG Lead Placement Procedure
Site preparation and ECG electrode placement directly impact the quality of an
ECG signal. Optimizing an ECG signal is imperative for accurate monitoring.
The processes involved in successful lead placement include:
• Skin Preparation
• E lectrode Patches
• L ead Placement Methods: AHA
Skin Preparation
Proper skin preparation is essential to obtain accurate ECG data. Electrode sites
should be clean, dry and should provide a smooth flat surface. Incidental electrical
activity and inaccurate readings may occur due to incorrect skin preparation. The
following skin preparation is recommended for secure patch application:
1. Clip the chest hair in a 2-4 inch diameter of the electrode site.
2. U
se a dry gauze pad to remove excess skin oils, skin cells and residue from the
electrode sites. Never rub the skin until it is raw or bleeding.
NOTE: Prepare the electrode site with alcohol only if the skin is extremely greasy.
If alcohol is used as a drying agent, always allow the skin to dry before placing the
electrode patch on the skin.
Electrode Patches
NOTE: Store electrode patches at room temperature in a sealed package until just
prior to use.
NOTE: Avoid more than one type of electrode on a patient because of variations in
electrical resistance.
6
ECG Lead Placement Procedure
NOTE: Avoid placing electrode patches directly over boney prominences or over
any areas that move during activity such as shoulders or arms because muscle
motion produces electrical activity. If an electrode patch is placed over a large
muscle such as the pectorals, the monitor may detect this additional muscle
activity which could lead to false arrhythmia calls.
1. P
eel the backing off of the electrode patch only when it is ready for use to
prevent evaporation of the contact gel medium. Visually inspect the contact
gel medium for moistness. If the gel medium is not moist, do not use the
electrode patch. Dry electrode patches are not conductive.
NOTE: If using the snap type electrode wires, attach the electrode patch to the
lead wire before placing patch on the patient.
2. A
ttach the electrode patch to the skin at the prepared site. Smooth the
electrode patch down in a circular motion to ensure proper skin contact.
If using soft gel electrodes, never push down directly over the contact gel
medium as this may displace the gel and cause monitoring artifact. If using
hard gel electrodes, it is recommended that during application, the center of
the electrode should be slightly pressed onto the skin to ensure direct contact.
Consult the electrode patch manufacturer’s instructions for specific use.
3. S ecure the lead wires to the patient according to hospital practice. For
additional information, refer to “Lead Placement Methods: AHA” on page 4-3. If
using a Panorama Telepack, always secure the device to the patient according
to hospital standard.
WARNING: As with all medical equipment, carefully route cables and connections
to reduce the possibility of entanglement or strangulation.
NOTE: It is recommended that electrode patches be changed at least every
24-36 hours to maintain proper contact with the skin. Some patients may require
electrodes to be changed more often. Electrode patches are disposable and
should not be reused or reapplied. Try to avoid reusing the exact same electrode
site during reapplication. If an electrode becomes wet with fluid, change the
electrode patch.
7
ECG Lead Placement Procedure
Lead Placement Methods: AHA
The lead placement procedure that is utilized has a direct impact on the quality
of an ECG waveform. The algorithm works best when a patient’s R wave is
significantly larger than the P or T waves to avoid difficulty in identifying the
appropriate waves. On some patients, electrode patch placement and/or the ECG
lead viewed may need to be adjusted to obtain a more prominent R wave.
The following section outlines lead placement procedures for the American Heart
Association (AHA).
3-wire Lead Set
A 3-wire lead set can monitor one of three ECG vectors (I, II, or III). The
recommended 3-wire ECG lead placement is as follows.
3-wire Lead Placement (AHA)
• P
lace RA (white) electrode under right
clavicle, mid-clavicular line within the
rib cage frame.
• P
lace LA (black) electrode under left
clavicle, mid-clavicular line within the
rib cage frame.
RA
(white)
LA
(black)
• P
lace LL (red) electrode on the lower
left abdomen within the rib cage frame.
LL
(red)
5-wire Lead Set
A 5-wire lead set can monitor seven ECG vectors (I, II, III, aVR, aVL, aVF, and V)
simultaneously. The recommended 5-wire ECG lead placement is as follows.
5-wire Lead Placement (AHA)
• P
lace RA (white) electrode under
the right clavicle, mid-clavicular
line within the rib cage frame.
• P
lace LA (black) electrode under
the left clavicle, mid-clavicular
line within the rib cage frame.
RA
(white)
2nd ICS
Chest – V1
(brown)
RL
(green)
6
LA
(black)
2nd ICS
LL
(red)
ECG Lead Placement Procedure
• P
lace LL (red) electrode on the lower left abdomen within the rib cage frame.
• P
lace RL (green) electrode on lower right abdomen within the rib cage frame.
• P
lace V (brown) chest lead in the proper positioning for desired lead V1-V6.
12 Lead utilizes a 10-wire ECG lead set that can monitor 12 ECG vectors (I, II, III,
aVR, aVL, aVF, V1, V2, V3, V4, V5, and V6) simultaneously. The recommended
AHA lead placement for a 12 lead ECG is as follows.
View 12 Lead Placement (AHA)
• P
lace RA (white) electrode under the
right clavicle, mid-clavicular line within
the rib cage frame.
• P
lace LA (black) electrode under the left
clavicle, mid-clavicular line within the rib
cage frame.
• P
lace LL (red) electrode on the lower left
abdomen within the rib cage frame.
RA
LA
V6
V5
V4
V1
LL
RL
V2 V3
• P
lace RL (green) electrode on lower right abdomen within the rib cage frame.
• P
lace V1 (brown) chest lead in the fourth intercostal space, right sternal border.
• P
lace V2 (brown) chest lead in the fourth intercostal space, left sternal border.
• P
lace V3 (brown) chest lead midway between V2 and V4 on a straight line.
• P
lace V4 (brown) chest lead in the fifth intercostal space, mid-clavicular line.
• P
lace V5 (brown) chest lead in the fifth intercostal space, anterior axillary line.
• P
lace V6 (brown) chest lead in the fifth intercostal space, mid-axillary line.
7
ECG Lead Placement Procedure
Lead II Monitoring
The recommended lead placement for Lead II monitoring is as follows.
Lead II Monitoring (AHA)
• P
lace RA (white) electrode under right
clavicle, mid-clavicular line within the
rib cage frame.
RA
(white)
• P
lace LA (black) electrode under left
clavicle, mid-clavicular line within the
rib cage frame.
• P
lace LL (red) electrode on the lower
left abdomen within the rib cage frame.
LA
(black)
LL
(red)
Select the ECG Lead II at the bedside monitor. Lead II is the direct electrical line
between the RA (white) electrode and the LL (red) electrode.
Neonatal Electrode Placement
When using a 3-wire lead set, ECG lead placement on a neonate is usually directed
towards obtaining the best possible respiration data through the ECG thoracic
impedance technique. Thoracic impedance is usually measured between the Right
Arm and Left Arm electrode patches. These patches should be placed on the chest
directly across from each other to optimize the measurement of the neonate’s
chest movement. The recommended lead placement for neonate monitoring is as
follows.
Neonatal 3-wire Lead Placement (AHA)
• P
lace RA (white) electrode under patient left
clavicle, mid-clavicular line within the rib cage
frame.
• P
lace LA (black) electrode right sternal border,
fourth intercostal space within the rib cage frame.
• P
lace LL (red) electrode on the patient’s lower left
abdomen within the rib cage frame.
8
ECG Lead Placement Procedure
Monitoring A Pacemaker Patient
A Pacemaker patient usually requires a different electrode patch placement
configuration than a non-pacemaker patient.
Do not place an ECG electrode directly over the pacemaker generator. Place the
electrode patches 3-5 inches away from the pacemaker generator area to avoid
electrical interference. If the electrode patches are placed closer to pacemaker
generator, the ECG will contain artifact, sometimes called “picket fence syndrome.”
For example, if the pacemaker generator is located in the right subclavian area,
relocate the Right Arm (white) electrode closer in towards the center of the chest.
WARNING: PACEMAKER PATIENTS – Indication of the heart-rate may be adversely
affected by cardiac pacemaker pulses or by cardiac arrhythmias. Keep pacemaker
patients under close surveillance. Refer to ‘‘ECG Performance Requirements’’ in
section 16 of the Panorama Operators Manual for disclosure of the pacer rejection
capability.
CAUTION: Some pacemakers may contain a respiratory sensor that may produce
artifact on an ECG waveform.
The recommended lead placement for a pacemaker patient is as follows.
RA
(white)
Pacemaker
LA
(black)
RA
(white)
2nd ICS
Pacemaker
LA
(black)
2nd ICS
Chest – V1
(brown)
LL
(red)
Placement for a Pacemaker Patient –
3-wire Lead (AHA)
RL
(green)
LL
(red)
Placement for a Pacemaker Patient –
5-wire Lead (AHA)
9
ECG Lead Placement Procedure
Example of “Picket Fencing” – electrode too close to pacer
Corrected Lead Placement
Artifacts
Scenario 1:
In these clinical scenarios either the pacemaker detection is turned on but the
patient does not have a pacemaker or the patient has a pacemaker and the lead
closest to the pacemaker is too close. The monitor is picking up an electrical signal
from an alternative source.
Problem: ELECTRICAL INTERFERENCE
Solution: Turn the pacemaker detection off if no pacemaker or move electrode 3-5
inches down and away from pacemaker.
• Does patient have a TENS unit or other nerve stimulator?
• TENS units transmit electrical impulses; avoid placing ECG electrode patches
near TENS electrodes. ECG electrode patches may need to be repositioned and
the ECG “lead viewed” may need to be adjusted until the optimum ECG tracing is
obtained.
10
ECG Lead Placement Procedure
Scenario 2:
The ECG tracing is “Railing” all over the place. Monitor is constantly alarming.
Problem: POSSIBLE BROKEN LEAD WIRES
Solution: To target the broken lead wire, verify the leads you are able to monitor in.
Examples:
• If you can monitor in Lead I but not Lead II > check left leg wire
• If you can monitor in Lead III but not Lead I > check right arm lead wire
Scenario 3:
The patient is febrile, diaphoretic or the electrodes are dried out
Problem: DRY OR NON-ADHERING ELECTRODES
Solution: Change electrodes daily and PRN
• Prepare skin for electrode application
11
Ambulatory Telepack (Optional)
3- or 5-wire ECG lead sets
Battery compartment
Nurse call button
Lead quality indicators
System check button
Attendant
present buttons
Lead select button
(For use with 3-wire
lead set only)
Remote print button
SpO2 Module
12
Ambulatory Telepack (Optional)
Electrode Patch Placement
All electrode patches should be placed on the patient to maximize signal and
minimize interference. Refer to Electrode Patch Placement section for further
details.
The Panorama Telepack can use a 3-wire lead set or a 5-wire lead set.
Battery Insertion
The telemetry telepack requires 2 AA Alkaline batteries. Batteries inserted with
positive end facing upwards. Refer to marking on telepack battery compartment
for further details.
• A
utomatic admission with battery insertion
• S ecure the batteries by twisting the cap in a clockwise direction
Note: Avoid storing batteries in telepack when storing telemetry telepacks.
Nurse Call Button
Pressing Nurse on the Ambulatory Telepack activates a Nurse
Call alarm event at the Panorama Central Station.
The Nurse Call event will store 20 seconds of waveform data
and can be configured to automatically print a report. It can also be configured
to generate a page for Central Stations that are equipped with RA
the Paging option. LA
V
LL
RL
13
Ambulatory Telepack (Optional)
Attendant Present Function
Simultaneously pressing and holding Attendant Present buttons
for 5 - 6 seconds activates an Attendant Present event at the
Panorama Central Station. Pressing and holding the Attendant
Present buttons simultaneously for 5 - 6 seconds acknowledges
the Nurse Call alarm on the selected patient.
LED Indicators
The ambulatory telepack uses LED indicator lights to verify the telepack’s
functionality.
Press the System Check button to verify function:
• E CG Electrode placement diagram:
• Steady green light = Good impedance
• Unlit = No impedance, no batteries
RA
RA
RA
V
• C
entral Station Communication Link Status:
• Steady green light = Good communication
• Flashing = Limited communication
RL
RL
• Unlit = No radio communication with antennae system
• B
attery Status:
• Steady = Good battery status
• Flashing = Less than 2 hours of battery life remain
• Unlit = No battery status
14
LA
LA
RL
LL
LA
V
V
LL
LL
Ambulatory Telepack (Optional)
Printing an All Strip Report
Press the Remote Record button to print an All Strip Report at the Panorama
Central Station on the selected patient.
Changing an ECG Lead Vector when using a 3-Wire Lead Set
Pressing the Lead Select button on the telepack changes the active lead
displayed in the patient’s tile on the Panorama Central Station.
• P
ress repeatedly to toggle between leads I, II, and III
• L ED indicator lights illuminate on the electrode patches corresponding to the
selected lead
Cleaning the Ambulatory Telepack
• R
emove batteries and reattach the battery compartment’s cap.
• Wipe telepack; do not submerge.
• D
isconnect lead wire sets from telepack when vigorous cleaning is required.
• A
llow to air dry before inserting new batteries
Note: Refer to the Panorama Operator’s Manual for further details.
Cleaning the SpO2 Module
• R
emove the SpO2 Module from the Ambulatory Telepack.
• Insert the SpO2 Module cleaning plug into the telepack/module connector at
the lower inside of the module.
• Wipe module; do not submerge.
• Allow to air dry before use.
15
Panorama Central Station Overview
Digital Data Area
View/Mute Button
Care Group Indicator
REC Button
Patient Status Line
Waveform Area
Patient Tile
Continuous
Monitoring
Area
Interactive
Area
System
Status Line
Menu Bar
System Date/Time
16
Panorama Central Station Overview
Main Screen
• E ach patient tile can display all numeric and waveform parameters utilized on
the patient
• U
ses a split screen display for entering and modifying patient information
• T op Half: Continuous Monitoring
• Bottom Half: Interactive area
• Touch screen or mouse interface
• P
atient Tiles
• M
enu Bar
• S ystem Status Line
• S ystem Date/Time Area
Patient Tile
Each Tile is specific to one patient and one monitoring device. A patient tile
includes:
• VIEW/MUTE Button
• C
are Group Indicator
• D
igital Data Area
• R
EC Button
• Waveform Data Area
• P
atient Status Line
17
Panorama Central Station Overview
VIEW/MUTE Button
The text of this button is either VIEW or MUTE depending on the patient’s state
• VIEW:
• During a non-alarm state
• Is used to gain access to patient’s historical information
• MUTE:
• During an alarm state
• Used to silence the audio portion of an alarm
Care Group Indicator
The indicator is a colored rectangular bar, located
between VIEW and the patient’s HR tile, illustrating
the care group assigned to the patient. It can be used
to signify a diagnostic grouping, clinician assignment,
etc.
Digital Data Area
The Digital and Waveform Data Area includes:
• Up to 5 Digital Parameters Displayed
• ECG Lead Indicator
• Arrhythmia and ST Indicators
• Alarm Icons/Visual Indicators
• Parameter units of measurement
18
Panorama Central Station Overview
Waveform Data Area
Configurable to display up to two waveforms. Includes the Patient Status Line.
REC Button
Selecting REC prints an All Strip Report for the patient. The All Strip report
contains 10 seconds of waveforms.
Patient Status Line
Configurable to display patient demographic information. Displays physiological
and technical alarm text strings.
System Status Line
Displays system events, transfer messages, and other system-wide information.
Menu Bar
Located at the bottom of the display and are used to navigate the system.
• Touch Screen On/Off Menu Button
Note: With the Panorama software version 8.6 and above, the Touch Screen
On/Off function has been moved to the System Setup Touch Screen tab.
• Patient Setup Menu Button
• Patient Alarms Menu Button
• Report Menu Button
• System Setup Menu Button
• Paging Menu Button (Optional)
• Print Menu Button
19
Automatic Admit
Auto Admit
If a patient is connected to a monitoring device assigned to the Panorama
Central Station, the patient is automatically admitted for immediate monitoring.
Demographic information is NOT needed for auto admit. Alarms, parameters,
options and other settings are initially configured based on default settings
configured in the System Setup Menu.
Note: Patient must be discharged to ensure Auto Admit for next patient.
Ambulatory Telepack
Auto Admit occurs once the batteries are inserted into the ambulatory telepack
and the battery door is secured.
Note: Remember to discharge previous patient prior to attempting auto admit.
Bedside Monitor
Auto Admit occurs once the bedside monitor becomes active.
Note: Remember to discharge previous patient prior to attempting auto admit.
Ambulatory Telepack with Nonin SpO2 Module
With the Nonin SpO2 Module attached, the Ambulatory Telepack must be
powered down and back on to enable the SpO2 module. This will allow for the
Auto Admit of the telepack and the SpO2 module.
Note: Remember to discharge previous patient prior to attempting auto admit.
20
Alarm Behaviors
Visual and Audio Alarm Indicators
As configured, the Panorama Central Station can produce visual and audio
notifications upon identification of certain alarm conditions. The Panorama
Central Station has three types of alarm condition categories:
• Physiological Alarms – Such as Arrhythmia alarms, numeric parameter alarms, etc.
• Technical Alarms – Such as Leads Off, Sensor Off, etc.
• System Alarms – Such as laser out of paper, etc.
These alarms produce varying visual and audio alarm notifications based on
configured importance. Consult your system administrator and the Panorama
Operator’s Manual for further details.
Note: Ensure that the volume level of the audio alarms is set high enough to be
heard above the ambient noise level of the monitored area. For assistance 24
hours a day with emergency clinical issues, call 1-800-288-2121 (press 0) ask the
operator for "Clinical Support."
Latched Alarms
A latched alarm is an alarm which will continue to produce visual and audio alarm
notifications after the condition that produced the alarm has resolved until it is
acknowledged by a clinician.
Asystole, V-Fib, and V-Tach are latched alarms. They will continue to produce
sound and flash the alarm message until acknowledged by the clinician.
To acknowledge a latched alarm that has subsided, select over the digital or
waveform data area of the patient tile.
Note: Some technical alarms (i.e. Lead Off ) will continue to alarm until
acknowledged. The alarm message will remain until the condition is resolved.
Refer to the Panorama Operator’s Manual for further details.
21
Patient Selection
Selecting a Patient Tile
To choose a patient, select the digital or
waveform area of the patient tile. This will
highlight the selected tile’s digital area in
a white background. A tile can be selected
once the Menu Button is open, a monitoring
device is assigned to the patient tile and
admission has occurred.
The Panorama allows for navigation between patients simply by choosing another
patient tile.
22
Menu Bar
System Date/Time Window
System Status Bar
Menu Buttons
TOUCH SCREEN ON/OFF MENU BUTTONS
Note: With the Panorama software versions 8.6 and above, the Touch Screen On/
Off function has been moved to the system setup Touch Screen tab.
When the text displays “Touch Screen On”, the touch screen is
active. When the text displays “Touch Screen Off”, the touch
screen is disabled to allow for cleaning of display.
To clean the screen:
• S elect “Touch Screen On” button to change button label to “Touch Screen Off”
thereby disabling the touch screen interface.
• C
lean screen according Panorama Operator’s Manual guidelines
Note: Remember to select the “Touch Screen Off” button to change button label
to “Touch Screen On” after cleaning to re-enable the touch screen interface.
23
Menu Bar • Patient Setup Menu Button
PATIENT SETUP MENU BUTTON
DEMOGRAPHICS TAB
The Demographics Tab allows for entry and modification of patient demographics
information. It can only be accessed if a monitoring device is assigned to a patient
tile.
24
Menu Bar • Patient Setup • Demographics Tab
Entering Patient Demographics using Keyboard
(Name, ID Number, Gender, DOB, Doctor, Comment)
To enter patient information:
• S elect PATIENT SETUP menu button
• S elect DEMOGRAPHICS tab
• S elect the patient tile
• S elect the white edit
box to display the on
screen keyboard
• T ype in the patient’s
information using the
on screen keyboard
• S elect ENTER to
accept the information
• L ast Name, First Name and/or ID number are necessary for patient retrieval after
discharge. Refer to Retrieving Discharged Patient section for further information.
BIDIRECTIONAL
Entering information at the central station enters it at the bedside monitor and
entering information at the bedside monitor enters it at the central station.
Note: Bed numbers can only be entered at the Panorama Central Station for a
patient on an Ambulatory Telepack. Bed numbers for monitors must be entered at
the bedside monitor.
Simultaneous Patient Demographic Tab Editing
If using a bedside monitor with the Panorama Central Station, patient
demographic changes cannot be made at the bedside monitor and the central
station simultaneously. Refer to the Panorama Central Station Operator’s Manual
for further details.
25
Menu Bar • Patient Setup • Demographics Tab
Entering Patient Demographics using Round Dial Controls
(Height, Weight, Date of Birth)
To enter patient information:
• Select PATIENT SETUP menu button
• Select DEMOGRAPHICS tab
• Select the patient tile
• S elect the white edit box to display the round dial
controls
• U
se the dial control to enter the value by rotating it
clockwise or counter clockwise. Arrows below the dial
control allow for incremental changes.
• S elect DONE to enter information and return to the
DEMOGRAPHICS tab.
BIDIRECTIONAL
Entering information at the central station enters it at the bedside monitor and
entering information at the bedside monitor enters it at the central station.
26
Menu Bar • Patient Setup • Demographics Tab
Pacer Sidebar Button
To adjust Pacemaker settings:
• S elect PATIENT SETUP menu button
• S elect DEMOGRAPHICS tab
• S elect the patient tile
• S elect PACER sidebar button
• When enabled, the Pacer Enhancement places:
• A √ mark in the Pacer Enhancement checkbox in the Pacer Setting dialog.
• A
above the Heart Rate tile in the Bedside Tab.
• A
colored (yellow or green) spike is displayed before all pacemaker-induced
ECG complexes.
• T he Pacer Filter adjusts the blanking period for filtering of the ECG data.
Care Group Sidebar Button
The “Care Group” button is used to
associate a patient tile with a specific
care group.
To assign a patient to a care group:
• S elect PATIENT SETUP menu button
• S elect DEMOGRAPHICS tab
• S elect the patient tile
• S elect CARE GROUP sidebar button
• Select color/care group name
• Select DONE to complete
This will place the colorized Care Group indicator next to the VIEW button on the
selected patient’s tile.
27
Menu Bar • Patient Setup • Demographics Tab
Arrhythmia Sidebar Button (Optional)
The arrhythmia algorithm is enabled at the Panorama Central Station when
the assigned device for the selected tile is an Ambulatory Telepack. Enabling/
Disabling arrhythmia analysis must be done at the bedside monitor when the
assigned device for the selected tile is a bedside monitor. Refer to the bedside
monitor operator’s manual for details.
To adjust Arrhythmia settings:
• S elect PATIENT SETUP menu button
• S elect DEMOGRAPHICS tab
• S elect the patient’s tile
• Select ARRHYTHMIA sidebar button
• A
rrhythmia
checkbox: Select
the Arrhythmia
checkbox to
enable/disable
the arrhythmia
analysis when
the assigned
device for the
selected tile
is an Ambulatory Telepack. A checked Arrhythmia checkbox means that
arrhythmia analysis is enabled. This checkbox will not appear when the
assigned device for the selected tile is a bedside monitor.
• V-Tach Rate: establishes the heart rate required for V-Tach to occur
• V
-Tach Threshold: establishes the number of consecutive PVCs required for
V-Tach to occur
• Asystole Delay: establishes the delay period for an Asystole event
• ECG Noise Delay: establishes the delay in the notification of ECG Noise
• Select DONE to enter adjustments made in the Arrhythmia dialog
28
Menu Bar • Patient Setup • Demographics Tab
When Arrhythmia analysis is enabled:
• A
√ mark appears on the Arrhythmia checkbox
• A
n
is placed in the HR digital parameter tile for the selected patient
BIDIRECTIONAL
Adjusting arrhythmia settings at the Panorama Central Station enters it on the
bedside monitor and adjusting arrhythmia settings at the bedside monitor enters
it on the Panorama Central Station.
Simultaneous Patient Arrhythmia Editing
If using a bedside monitor with the Panorama Central Station, patient arrhythmia
changes cannot be made at the bedside monitor and the central station
simultaneously. Refer to the Panorama Central Station Operator’s Manual for
further details.
Settings Sidebar Button
(Optional)
The ST algorithm is enabled at
the Panorama Central Station
when the assigned device for the
selected tile is an Ambulatory
Telepack. Enabling/Disabling
ST analysis must be done at
the bedside monitor when the
assigned device for the selected
tile is a bedside monitor. Refer to
the bedside monitor operator’s manual for further details.
29
Menu Bar • Patient Setup • Demographics Tab
To adjust ST settings:
• S elect PATIENT SETUP menu button
• S elect DEMOGRAPHICS tab
• S elect the patient’s tile
• S elect SETTINGS sidebar button
• S
T checkbox: Select the ST checkbox to enable/disable the ST analysis
when the assigned device for the selected tile is an Ambulatory Telepack. A
checked ST checkbox means that ST analysis is enabled. This checkbox will
not appear when the assigned device for the selected tile is a bedside monitor.
• Monitor Filter: Adjusts the ECG filter to a monitor range.
• ST Filter: Adjusts the ECG filter for an ST diagnostic range.
When ST is enabled:
• A
√ mark appears on the ST checkbox when the assigned device is an
Ambulatory Telepack.
• A
n
30
is placed in the HR digital parameter tile for the selected patient.
Menu Bar • Patient Setup • Demographics Tab
Retrieve Discharged Patient Sidebar Button
To retrieve a discharged patient:
• S elect PATIENT SETUP menu button
• S elect DEMOGRAPHICS tab
• S elect the patient’s tile
• S elect RETRIEVE DISCHARGED PATIENT sidebar button
• Select patient to be retrieved (Last Name, First Name and/or ID will be displayed)
• S elect DONE to retrieve patient information into the selected tile
A patient can only be retrieved into an unmonitored tile with an assigned
device. The patient can only be retrieved if at least two demographics fields (Last
Name, First Name and/or ID) were entered on the patient prior to discharge. The
retrieved patient’s data is seen once the destination device is activated.
Normal Screen Sidebar Button
Select to close tab and return to Normal Main Screen.
31
Menu Bar • Patient Setup • Transfer Tab
TRANSFER TAB
The Transfer Tab allows for the transfer of patient information from a source tile to
a destination tile.
• S elect PATIENT SETUP menu button
• S elect the patient tile
• S elect TRANSFER tab
A patient can only be transferred if at least two demographic fields (Last Name,
First Name, and/or ID) are entered.
32
Menu Bar • Patient Setup • Transfer Tab
Room to Room without Device allows for the transfer of patient monitoring
information to a different destination tile on the same central station.
• S elect Room to Room without Device push button
• S elect unmonitored patient tile
• A
ctivate destination device to see transferred information
Central to Central without Device allows for
the transfer of patient monitoring information
to a different central station.
To initiate a Central to Central without
Device transfer at the source
central station:
• S elect Central to Central without Device push button
• S elect networked destination central station
• S elect Done to start transfer process
To accept the Central to Central without Device transfer at the destination
central:
• T ransfer In request message shall appear in the System Status line at the
destination central station.
• O
pen the Transfer tab and Accept incoming transfer
• S elect destination tile
• C
onfirm “Yes” to begin receiving the transferred patient’s monitoring data
• W
hen the transfer is complete a message will appear in the system status
line of both the source and destination central stations.
33
Menu Bar • Patient Setup • Transfer Tab
Recovering, Deleting, and Transferring Failed Transfers
To Recover a patient from the Failed transfer list:
• S elect PATIENT SETUP menu button
• S elect TRANSFER tab
• S elect RECOVER PATIENT sidebar button
• S elect patient to be recovered from list
• S elect the destination tile on the source central station
• S elect RECOVER to initiate the recovery process
This will place the failed transfer patient into the selected destination tile.
To Delete from the Failed transfer list:
• S elect PATIENT SETUP menu button
• S elect TRANSFER tab
• S elect DELETE FAILED PATIENT sidebar button
• S elect the patient to remove from list
• S elect DELETE to initiate the deletion process
This will delete the failed transfer patient from the system.
34
Menu Bar • Patient Setup • Transfer Tab
To Transfer from the failed transfer list:
• S elect PATIENT SETUP menu button
• S elect TRANSFER tab
• S elect TRANSFER FROM FAILED LIST sidebar button
• S elect the patient to transfer from list
• S elect TRANSFER
• S elect destination from list using the arrows
• S elect DONE to initiate a transfer
This will initiate a transfer for the selected patient tile.
Normal Screen Sidebar Button
Select to close tab and return to Normal Main Screen.
35
Menu Bar • Patient Setup • Discharge Tab
DISCHARGE TAB
The Discharge Tab clears all patient information and places the patient in the
Retrieve Discharge Patient list if the required demographic information has been
entered.
To Discharge a patient when the selected device is an Ambulatory Telepack:
• S elect PATIENT SETUP menu button
• S elect the patient tile
• S elect DISCHARGE tab
• S elect DISCHARGE PATIENT
• S elect YES to confirm or NO to cancel discharge
36
Menu Bar • Patient Setup • Discharge Tab
To Discharge a patient at the central station when the selected device is a
Bedside Monitor:
• S elect PATIENT SETUP menu button
• S elect the patient tile
• S elect DISCHARGE tab
• S elect BEDSIDE AND PANORAMA DISCHARGE
• S elect YES to confirm or NO to cancel discharge
• S elect YES will discharge the patient tile at the central station and will discharge
the bedside monitor.
Note: When the assigned device is a bedside monitor, the discharge function may
be performed at the bedside monitor using the bedside monitor’s DISCHARGE
FROM BOTH feature. This action will discharge both the bedside monitor and the
patient tile at the central station.
Normal Screen Sidebar Button
Select to close tab and return to Normal Main Screen.
37
Menu Bar • Patient Setup • Display Tab
DISPLAY TAB
The Display Tab allows the clinician to modify the digital and waveform data in
the patient’s tile. Regardless of display, all digital and waveform data on a patient
can be viewed and is being stored.
Modifying Display of Digital Parameters
To change the digital data displayed:
• S elect PATIENT SETUP menu button
• S elect the patient tile
• S elect DISPLAY tab
• S elect the digital parameter to change
• C
hoose the new parameter to display from the parameter list box
• U
se the arrows to scroll and highlight the parameter
• C
hoose SELECT to confirm
Note: The central station will automatically configure the display based on the
parameter’s size. HR is always located in the first tile and cannot be changed.
38
Menu Bar • Patient Setup • Display Tab
Modifying Display of Waveform Parameters
To change the displayed waveform:
• Select PATIENT SETUP menu button
• Select the patient tile
• Select DISPLAY tab
• Select the waveform parameter to change
• Choose the new waveform from the waveform list box
• Use the arrows to scroll and highlight the waveform
• Choose SELECT to confirm
Note: The first waveform is always ECG with the lead displayed in the HR tile.
Restore Previous Settings Sidebar Button
This sidebar button will return the settings to the ones assigned prior to opening
the tab.
39
Menu Bar • Patient Setup • Display Tab
Modifying Display of Stored Trends
To change the interval the Trends are displayed:
• Select PATIENT SETUP menu button
• Select the patient tile
• Select DISPLAY tab
• Select TREND DISPLAY sidebar button
• Select interval
• Choose DONE
Trends storage continues at every one minute interval while Trend Display allows
configuration to display those trends. Trend Report intervals will print trends
based on the Trend Display setting.
The Trend Display dialog is also located in the Trends tab.
Normal Screen Sidebar Button
Select to close tab and return to Normal Main Screen.
40
Menu Bar • Patient Setup • Standby Tab
STANDBY TAB
The Standby Tab allows the clinician to suspend monitoring on a patient. While
in standby, the patient is not monitored. All previous data and settings are
preserved.
To place a patient into Standby:
• Select PATIENT SETUP menu button
• Select the patient tile
• Select STANDBY tab
• S elect “Panorama Standby Only” (Bedside monitor) or “Standby” (Ambulatory
Telepack) to place only the central station into standby
OR
BIDIRECTIONAL
Select “Bedside and Panorama Standby” to place both the bedside monitor and
the Panorama Central Station into standby. Selecting “Standby” at the bedside
monitor will also put both locations into Standby.
41
Menu Bar • Patient Setup • Standby Tab
Standby Location
To enter a location once in Standby:
• Select the location from the Patient Location list using the up and down arrows
• Choose SELECT to confirm
Resume Monitoring from Standby Mode
To Resume Monitoring from a Standby mode:
• Select PATIENT SETUP menu button
• Select the patient tile
• Select STANDBY tab
• Select RESUME MONITORING button
Note: If both the bedside monitor and central station are in standby, resume
monitoring must be initiated at the bedside monitor by selecting the STANDBY
quick key on the front of the bedside monitor. Refer to the bedside monitor
operator’s manual for further details.
Normal Screen Sidebar Button
Select to close tab and return to Normal Main Screen.
42
Menu Bar • Patient Setup • Wave Gain Tab
WAVE GAIN TAB
To adjust a patient’s wave gain:
• Select PATIENT SETUP menu button
• Select the patient tile
• Select WAVE GAIN tab
• Select the wave repeatedly to scroll through the gain values
• Select DONE to accept
Note: Adjusting the wave gain does not impact arrhythmia analysis.
Restore Previous Settings Sidebar Button
This sidebar button will return the settings to the ones assigned prior to opening
the tab.
Normal Screen Sidebar Button
Select to close tab and return to Normal Main Screen.
43
Menu Bar • Patient Setup • Print Setup Tab
PRINT SETUP TAB
To select a waveform to print on all the patient’s reports:
• Select PATIENT SETUP menu button
• Select the patient tile
• Select PRINT SETUP tab
• Select the waveforms for printing. A √ mark appearing on the wave checkbox indicates that the waveform is chosen for printing.
Normal Screen Sidebar Button
Select to close tab and return to Normal Main Screen.
44
Menu Bar • Patient Alarms Menu Button
PATIENT ALARMS MENU BUTTON
PATIENT ALARMS SETUP TAB
A password may be required to access the Patient Alarms tabs. Please consult your
system administrator for details.
45
Menu Bar • Patient Alarms • Alarm Limits Tab
ALARM LIMITS TAB
To adjust alarm limits:
• Select PATIENT ALARMS menu button
• Select the patient tile
• Select ALARM LIMITS tab
• Select the Parameter to be adjusted using the
or
buttons
• Select the “High” (upper) or “Low” (lower) alarm limit button on the slider
• Use the up and down arrows or drag and drop the scroll box in the slider control to change the limit to the desired value
BIDIRECTIONAL
Changing alarm limits at the Panorama Central Station will automatically change
alarm limits on the bedside monitor and changing alarm limits at the bedside
monitor will automatically change alarm limits on the Panorama Central Station.
Note: Simultaneous Patient Alarm Limits Editing
If using a bedside monitor with the Panorama Central Station, patient alarm limit
changes cannot be made at the bedside and at the central station simultaneously.
Refer to the Panorama Central Station Operator’s Manual for further details.
46
Menu Bar • Patient Alarms • Alarm Limits Tab
Auto Set Button
Selecting “Auto Set” automatically recalculates the alarm limits for most
parameters based on their current values, varying from 3 – 30%. Please see the
Panorama Operator’s Manual for complete details.
Restore Previous Settings Sidebar Button
This sidebar button will return the settings to the ones assigned prior to opening
the tab.
Suspend All Alarms Sidebar Button (Optional)
If available, selecting "Suspend all alarms" suspends ALL alarms on the selected
patient including lethal arrhythmias.
To suspend All Alarms:
• Select PATIENT ALARMS menu button
• Select the patient tile
• Select ALARM LIMITS tab
• Select SUSPEND ALL ALARMS to suspend all alarms
The message All Alarms Suspended shall be displayed in the selected patient’s
tile and the SUSPEND ALL ALARMS sidebar button will turn white when the
function has been enabled.
Note: When in an All Alarm Suspended mode, no alarm notification of any kind
will occur at the Panorama Central Station for the selected patient tile.
Selecting the SUSPEND ALL ALARMS sidebar button a second time will turn the
button blue again, will disable the function, remove the All Alarms Suspended
message from the patient tile, and resume all configured alarm notifications.
47
Menu Bar • Patient Alarms • Alarm Limits Tab
Suspend Non-Lethals Sidebar Button
Selecting “Suspend Non-Lethal Alarms” suspends all alarms on a selected patient
except alarms with a priority 1.
To Suspend all non-priority 1 alarms:
• Select PATIENT ALARMS menu button
• Select the patient tile
• Select ALARM LIMITS tab
• Select SUSPEND NON-LETHALS to suspend all non-lethal alarms
The message Non-Lethal Alarms Suspended shall be displayed in the selected
patient’s tile and the SUSPEND NON-LETHALS sidebar button will turn white
when the function has been enabled.
Note: When in a Non-Lethal Alarms Suspended mode, only Lethal alarms will
produce alarm notification at the Panorama Central Station for the selected
patient tile.
Selecting the SUSPEND NON-LETHALS sidebar button a second time will turn
the button blue again, will disable the function, remove the Non-Lethal Alarms
Suspended message from the patient tile, and resume all configured alarm
notifications.
Relearn Sidebar Button (Ambulatory Telepack)
Selecting “Relearn” updates the ST and Arrhythmia templates.
48
Menu Bar • Patient Alarms • Alarm Limits Tab
Print Menu Button
To print a patient’s Alarm Report:
• Select PATIENT ALARMS menu button
• Select the patient tile
• Select ALARM LIMITS tab
• Select PRINT menu button
Note: This Report can also be printed from the Report Menu.
Normal Screen Sidebar Button
Select to close tab and return to Normal Main Screen
49
Menu Bar • Patient Alarms • Alarm Responses Tab
ALARM RESPONSES TAB
The Alarm Responses Tab adjusts the response of the central station when an
alarm condition exists.
To adjust a patient’s Alarm Responses:
• Select PATIENT ALARMS menu button
• Select the patient tile
• Select ALARM RESPONSES tab
• Select the parameter to modify by tapping over the field or using the Up/Down
arrows
• PRIORITY: Defines the importance of the alarm. The lower the priority the
higher the severity.
• Priority 1: Red visual alarm notifications. High level audio alarm notifications.
• P
riority 2: Yellow visual alarm notifications. Mid level audio alarm
notifications.
• P
riority 3: Yellow visual alarm notifications. Tertiary level audio alarm
notifications.
Note: Alarm Priorities apply if alarm limits are set for numeric parameters.
50
Menu Bar • Patient Alarms • Alarm Responses Tab
• PRINT ON ALARM: Determines if an automatic recording is produced upon
identification of alarm condition.
• ON – Automatically produces a print out
• OFF – Does not produce a print out
• SAVE TO EVENT: Determines if the event is saved in the Events Tab at the
Panorama Central Station allowing for retrieval at a later time.
• ON – Automatically saves the event
• OFF – Does not save the event
• PAGE ON ALARM (Optional): Determines if the alarm event sends a paging
message to the assigned pager(s) once the paging delay criteria has been met.
• ON – Automatically pages on the alarm event
• OFF – Does not page on the alarm event
Restore Previous Settings Sidebar Button
This sidebar button will return the settings to the ones assigned prior to opening
the tab.
51
Menu Bar • Patient Alarms • Alarm Responses Tab
Suspend All Alarms Sidebar Button (Optional)
If available, selecting “Suspend All Alarms” suspends ALL alarms on the selected
patient.
To suspend All Alarms:
• Select PATIENT ALARMS menu button
• Select the patient tile
• Select ALARM RESPONSES tab
• Select SUSPEND ALL ALARMS to suspend all alarms
The message All Alarms Suspended shall be displayed in the selected patient’s
tile and the SUSPEND ALL ALARMS sidebar button will turn white when the
function has been enabled.
Note: When in an All Alarms Suspended mode, no alarm notification of any kind
will occur at the Panorama Central Station for the selected patient tile.
Selecting the SUSPEND ALL ALARMS sidebar button a second time will turn the
button blue again, will disable the function, remove the All Alarms Suspended
message from the patient tile, and resume all configured alarm notifications.
Suspend Non-Lethals Sidebar Button
Selecting “Suspend Non-Lethal Alarms” suspends all alarms on a selected patient
except alarms with a priority 1.
To suspend all non-priority 1 alarms:
• Select PATIENT ALARMS menu button
• Select the patient tile
• Select ALARM LIMITS tab
• Select SUSPEND NON-LETHALS to suspend all non-lethal alarms
52
Menu Bar • Patient Alarms • Alarm Responses Tab
The message Non-Lethal Alarms Suspended shall be displayed in the selected
patient’s tile and the SUSPEND NON-LETHALS sidebar button will turn white
when the function has been enabled.
Note: When in a Non-Lethal Alarms Suspended mode, only Lethal alarms will
produce alarm notification at the Panorama Central Station for the selected
patient tile.
Selecting the SUSPEND NON-LETHALS sidebar button a second time will turn
the button blue again, will disable the function, remove the Non-Lethal Alarms
Suspended message from the patient tile, and resume all configured alarm
notifications.
Alarm Setup Sidebar Button (Ambulatory Telepack)
The Alarm Setup sidebar button will be displayed
when the assigned device for the selected tile is an
Ambulatory Telepack. Alarm and ST Delays can be
adjusted via this sidebar button. The time selected is the
amount of time required for an alarm response to occur.
Normal Screen Sidebar Button
Select to close tab and return to Normal Main Screen.
53
Menu Bar • Reports Menu Button
REPORTS MENU BUTTON
PATIENT REPORTS TAB
The Patient Reports Tab contains a variety of reports a clinician can print on a
specific patient. The waveforms to be printed are configured in the “Print Setup”
Tab.
Print All Strips Button
This laser printout contains all patient demographics, all real time digital data and
10 seconds of waveform data.
To print an All Strip Report:
• Select REPORT menu button
• Select patient tile
• Select PATIENT REPORTS tab
• Select PRINT ALL STRIPS button
54
Menu Bar • Reports • Patient Reports Tab
Full Disclosure Report Button
This laser printout contains all patient demographics, HR, PVC and a
compressed view of waveform data for the selected time period.
To print a Full Disclosure Report:
• Select REPORT menu button
• Select patient tile
• Select PATIENT REPORTS tab
• Select FULL DISCLOSURE REPORT button
• Select time period
ST Report Button
This laser printout contains all patient demographics, the current averaged ECG
complex, the referenced average ECG complex and digital ST value. The number
of available leads determines the number of complexes.
To print an ST Report:
• Select REPORT menu button
• Select patient tile
• Select PATIENT REPORTS tab
• Select ST REPORT button
55
Menu Bar • Reports • Patient Reports Tab
Trend List Report Button
This laser printout contains all patient demographics and all the digital trend
data for the selected time period.
To print a Trend List Report:
• Select REPORT menu button
• Select patient tile
• Select PATIENT REPORTS tab
• Select TREND LIST REPORT button
• Select time period
Event List Report Button
This laser printout contains all patient demographics, the date, time and the
event list for the selected time period.
To print an Event List Report:
• Select REPORT menu button
• Select patient tile
• Select PATIENT REPORTS tab
• Select EVENT LIST REPORT button
• Select time period
56
Menu Bar • Reports • Patient Reports Tab
Patient Alarm Report Button
This laser printout contains all patient demographics and current alarm settings.
To print an Alarm Report:
• Select REPORTS menu button
• Select patient tile
• Select PATIENT REPORTS tab
• Select PATIENT ALARM REPORT button
Normal Screen Sidebar Button
Select to close tab and return to Normal Main Screen.
57
Menu Bar • Reports • System Reports Tab
SYSTEM REPORTS TAB
All Strips/All Patients Report Button
All patients currently assigned to the central station will have an All Strip Report
printed when this button is selected.
Equipment Report Button
This laser printout contains a list of devices currently assigned to the central
station, including the device label, the type of device, the assigned tile, the device
ID, and the current patients’ names and IDs.
Normal Screen Sidebar Button
Select to close tab and return to Normal Main Screen.
58
Menu Bar • Reports • Print Status Tab
PRINT STATUS TAB
This tab displays all pending print requests. This tab can be used to cancel print
requests.
• Select Cancel Selected Print job to remove a select report
OR
• Select Delete All Print Jobs to cancel all print reports waiting to be printed
Normal Screen Sidebar Button
Select to close tab and return to Normal Main Screen.
59
Menu Bar • System Setup Menu Button
SYSTEM SETUP MENU BUTTON
System Setup Menu
This tab allows adjustments to be made to the touch screen and parameter colors.
Advanced functions are found behind a password-protected area.
PARAMETER COLORS TAB
To change a parameter color for all patients:
• Select SYSTEM SETUP menu button
• Select PARAMETER COLOR tab
• Select the color
• Scroll using the arrows and highlight the parameter
• Select SELECT to complete
60
Menu Bar • System Setup • Recalibrate Touch Tab/Installation Tab
RECALIBRATE TOUCH TAB
Note: With Panorama software versions 8.6 and above, the Recalibrate Touch
function has been moved to the System Setup Touch Screen Tab.
To recalibrate the touch screen:
• Select SYSTEM SETUP menu button
• Select RECALIBRATE TOUCH tab
• Touch the red targets on the screen
• Touch the screen for verification
• Select YES to complete
Note: Remember to complete the recalibration of the touch screen once
initiated. The recalibration process should take less than 15 seconds. During the
recalibration process, real time monitoring of patients is obscured.
INSTALLATION TAB
This tab provides access to password protected areas of the Panorama Central
Station. Consult your system administrator for details.
Normal Screen Sidebar Button
Select to close tab and return to Normal Main Screen.
61
Menu Bar • Paging Menu Button
PAGING MENU BUTTON (Paging Optional)
The Paging Tab allows for the configuration of pager information for the
Panorama Central Station.
PAGE SETUP TAB
A password may be required to access the Page Tab. Please consult your system
administrator for details.
62
Menu Bar • Paging Menu
Add Pager Sidebar Button
This sidebar button allows a pager to be added to the Panorama Central Station.
To add a pager:
• Select PAGING menu
• Select Add Pager
• S elect the white edit box to display the on
screen keyboard
• T ype in the Pager Number and Pager
assignment
• S elect Done to enter information and return to the Paging Tab
Edit Pager Sidebar Button
This sidebar button allows a pager’s information to be edited on the Panorama
Central Station.
To edit a pager:
• Select PAGING menu
• Select Pager from Paging List
• Select Edit Pager
• S elect the white edit box to display the on
screen keyboard
• Type in the Pager Number and Pager assignment
• S elect Done to enter information and return to the Paging Tab
63
Menu Bar • Paging Menu
Edit Pager Sidebar Button
This sidebar button allows a pager to be removed from the Panorama Central
Station.
To remove a pager:
• Select PAGING menu
• Select Pager from Paging List
• Select Edit Pager
• Select Remove Pager
• Select Yes to accept
Add Tile Button
The Add Tile button adds a monitoring device (patient) to a pager in the paging
list on the Panorama Central Station.
To add a tile to a pager:
• Select PAGING menu
• Select Pager from Paging List
• Select Add Tile
• S elect tile to add
• S elect Done to accept
Note: A pager is assigned to a tile until removed. Each tile can be assigned to a
maximum of 10 pagers.
64
Menu Bar • Paging Menu
Add All Tiles Button
The Add All Tiles button adds all monitoring devices (patients) to a pager in the
paging list on the Panorama Central Station.
To add tile to a pager:
• Select PAGING menu
• Select Pager from Paging List
• S elect Add All Tiles
• S elect Done to accept
Remove Tile Button
The Remove Tile button removes a monitoring device (patient) from a pager in
the Paging List on the Panorama Central Station.
To remove a tile from a pager:
• Select PAGING menu
• Select Pager from Paging List
• Select Remove Tile
• S elect tile to remove
• S elect Done to accept
65
Menu Bar • Paging Menu
Remove All Tiles Button
The Remove All Tiles button removes all monitoring devices (patients) from a
pager in the Paging List on the Panorama Central Station.
To remove a tile from a pager:
• Select PAGING menu
• Select Pager from Paging List
• Select Remove All Tiles
• Select tile to remove
• Select Yes to accept
66
Menu Bar • Paging Menu
Printing A Page List Report
This laser printout contains a list of all pager numbers, pager assignments and tile
assignments on the Panorama Central Station.
To print a Pager List Report:
• Select PAGING menu button
• S elect PRINT menu button
Failed Pages Sidebar Button
The Failed Pages Sidebar button displays a list of pages that failed to be sent.
It contains the date/time, event, pager number, pager assignment, and tile
assignment.
Paging Sidebar Button
Select to close the Failed Pages List and return to Paging List.
67
Menu Bar • Paging Menu
Resend Sidebar Button
To resend a failed page:
• Select PAGING menu
• Select Failed Pages
• Select specific failed page event
• Select Resend
Note: The failed page event will be removed from the
Failed Pages List if successfully resent.
Delete Failed Page
To delete a failed page:
• Select PAGING menu
• Select Failed Pages
• Select specific failed page event
• Select Delete
• Select Yes to delete
Delete All Failed Pages
To delete all failed pages:
• Select PAGING menu
• Select Failed Pages
• Select Delete All Events
• Select Yes to delete
68
Menu Bar • Paging Menu
PAGING FOR PHYSIOLOGICAL ALARM EVENTS
All physiological alarm events can be configured to send a message to the
assigned pager for a specific tile (patient). Refer to the Alarm Response Tab section
for further details.
PAGING FOR TECHNICAL ALARM EVENTS
The following technical alarms can be configured to send a message to the
assigned pager for a specific tile (patient).
These include:
• Comm. Loss
• Leads Off
• Low Battery
PAGING MESSAGE CONFIRMATION
A Page Marker (*) is placed next to the alarm event in the Events Tab and
Disclosure Zoom In Tab. The Comment Sidebar button provides additional
information related to the paging message. Refer to these Tabs for further
information.
69
View • Bedside Tab
B EDSIDE TAB
Selecting the VIEW button in the patient tile displays the Bedside Tab. The
Bedside Tab provides an expanded view of the patient’s waveform and numeric
data. The upper and lower arrows allow for scrolling through all the waveforms.
Note: All available waveforms can be viewed in this area even if they are not
being viewed at the bedside.
Lead Sidebar Button (5-wire lead set or 12-lead card only)
Select to change the top lead of ECG displayed in the Bedside Tab.
70
View • Bedside Tab
All ECG Sidebar Button
Select to view all available ECG waveforms in the Bedside Tab. When selected, the
ALL ECG button will turn white. To resume viewing all waveforms, select the ALL
ECG button to turn button blue again.
When the assigned device is an Ambulatory Telepack which is not using an SpO2
module, the Bedside Tab is always in an ALL ECG mode.
Note: The number of ECG lead vectors displayed depends on the utilized lead wire
set.
Freeze Sidebar Button
Select to freeze the Bedside Tab’s waveforms. When the waveforms are frozen the
FREEZE sidebar button turns white and the Measure sidebar button appears.
Select FREEZE a second time to turn the FREEZE sidebar button blue and to
display real-time waveforms.
71
View • Bedside Tab
Measure Sidebar Button
To measure intervals and use the on screen calipers:
• S elect VIEW on the patient’s tile
• S elect BEDSIDE tab
• S elect FREEZE sidebar button
• S elect MEASURE sidebar button
• S elect the measurement to be taken:
• PR
• QRS
• QT
• R to R
• ST
• S elect the waveform or use the arrows to adjust the first line (dotted)
• S elect the same measurement as above
• S elect the waveform or use the arrows to adjust the second line (solid)
• S elect CALCULATE to perform the calculation
Repeat above steps for additional measurements.
72
View • Bedside Tab
Mark Event Sidebar Button
Select to store a Central User Marked Event in the Events Tab and mark the event
in Full Disclosure.
Note: Selecting MARK EVENT at the Panorama Central Station will mark the event
time in the bedside monitor’s Trends menu.
Using the MARK EVENT quick key button at the bedside monitor, will mark a
Bedside User Marked Event in the Events Tab at the Panorama Central Station.
Print Menu Button
Select the Print menu button to print an All Strip Report for the selected patient
tile.
Normal Screen Sidebar Button
Select to close tab and return to Normal Main Screen.
73
View • Trends Tab
TRENDS TAB
Select to view trended digital data in either list or graphic form. The stored data is
updated every 1 minute and includes all utilized parameters. The interval the list
trends are displayed is based on the Trend Display setting.
Displaying List Trends
To display trends on a patient:
• S elect VIEW on the patient’s tile
• S elect TREND tab to display the most recent digital data in List format
• S elect the arrows to scroll through the list:
• T o scroll one entry at a time
• T o scroll one page at a time
• T o scroll to the top or bottom of the list
• T o view more parameters
• S elect “Previous/Next Event” to scroll to trend times based on alarm
conditions
• A
larms are color-coded based on priorities:
• Priority 1: Red
• Priority 2, 3: Yellow
74
View • Trends Tab
Modifying Display of Stored Trends
To change the interval the Trends are displayed:
• Select PATIENT SETUP menu button
• Select the patient tile
• Select DISPLAY tab
• Select TREND DISPLAY sidebar button
• Select interval
• Choose DONE
Trends storage continues at every one minute interval while Trend Display allows
configuration to display those trends. Trend Report intervals will print trends
based on the Trend Display setting.
The Trend Display dialog is also located in the Trends tab.
Printing List Trends Reports
To print the List Trends Report on a patient:
• S elect VIEW on the patient’s tile
• S elect TREND tab
• Select Print Menu button
• S elect the interval
Note: This Report can also be printed from the Report Menu.
75
View • Graphic Trends Tab
GRAPHIC TRENDS TAB
Graphic Sidebar Button
Selecting this button allows for access to the Graphic Trends tab.
Page Left
Zoom In
Scroll Left/Scroll Right
Zoom Out
Page Right
Scroll Up/Down
To display and print Graphic Trends on a patient:
• S elect VIEW on the patient’s tile
• S elect GRAPHIC sidebar button
• Select the arrows to scroll through the graphic display:
• T o scroll through the available parameters
• T o scroll forward and backward in time
• Select “Zoom In/Zoom Out” to view 2-8 hour time intervals
• S elect PRINT menu button to print the Graphic Trend Report
Note: The List and Graphic Trend Report can be printed from the bedside monitor.
Refer to bedside monitor’s operator’s manual for further details.
76
View • Events Tab
EVENTS TAB
The Events Tab stores all physiologic and technical events on a patient.
Physiologic events are stored based on the settings in the Alarm Response Tab
(see Patient Alarms Menu Button).
Displaying Events
To display a patient’s stored events:
• S elect VIEW on the patient’s tile
• Select EVENTS tab to display the most recent event digital data in a list format
• S elect the arrows to scroll through the list:
• T o scroll one entry at a time
• T o scroll one page at a time
• T o scroll to the top or bottom of the list
• T o view more parameters
• Select “Previous/Next Event” to scroll to trend times based on alarm conditions.
• A
larms are color-coded based on priorities:
• Priority 1: Red visual alarm notifications. High level audio notification
• Priority 2: Yellow visual alarm notifications. Mid level audio notification
• Priority 3: Yellow visual alarm notifications. Tertiary level audio notification
77
View • Events Tab
Deleting an Event
To delete a patient’s stored event:
• S elect VIEW on the patient’s tile
• S elect EVENTS tab to display the most recent event digital data in a list format.
• Select and highlight the event to be deleted
• Select “Delete Single Event” to erase the event
• Select “Delete Events” to erase events older than the highlighted event
• Enter the number of events to be deleted
• Select “Delete”
• Select “Yes” to confirm
Note: Not all events can be deleted. If an event is
deleted it will be unmarked in the Disclosure Tab.
Print
To print an Event list:
• Select VIEW on the patient’s tile
• Select EVENTS tab
• Select print menu button
• Select the interval
Note: This Report can also be printed from the Report Menu.
78
View • Events Tab
Event Filter Sidebar Button
To adjust the list seen in the Events Tab:
• Select VIEW on the patient’s tile
• Select EVENTS tab to display the most recent event digital data in a list format
• Select EVENT FILTER sidebar button
• Select ALL sidebar button to view all events
• S elect TIME sidebar button to view events occurring during a specific time
period
– Select “Start” and “End” Time
– Select “Done”
• Select DONE to display the filtered Event list
79
View • Events Tab
• Select PARAMETER to view specific physiologic and/or technical events
– Select “Physio” and/or “Tech”
– Select the parameter from the list
– Use the arrows to select (add) or deselect (remove) the parameter in
the filtered list
• Select DONE to display the filtered Event list
80
View • Event View Waveform Tab
EVENT VIEW WAVEFORMS TAB
To view and print a specific physiological event that is associated with a
waveform:
• Select VIEW on the patient’s tile
• S elect EVENTS tab to display the event conditions collected for the selected
patient tile
• Select the specific event to view
• S elect VIEW WAVEFORMS sidebar button to show an expanded view of the
event
Note: All available waveforms can be viewed in this area even if they are not
being viewed at the bedside.
81
View • Event View Waveform Tab
Navigational Arrows
Select the arrows to scroll through the event data:
• Select the Double Up arrow to display the previous page of waveforms
• S elect the Up arrow to move the group of waveforms displayed up one position
• Select the Double Down arrow to display the next page of waveforms
• S elect the Down arrow to move the group of waveforms displayed down one
position
• S elect the Double Left arrow to display the previous nine seconds of event data
• S elect the Left arrow to move the colored vertical cursor line one second back in
time
• S elect the Right arrow to move the colored vertical cursor line one second
forward in time
• S elect the Double Right arrow to display the next nine seconds of event data
Next Event Button
Select the NEXT EVENT button to locate and display an event that occurred later
than the current event time began.
82
View • Event View Waveform Tab
Previous Event Button
Select the PREVIOUS EVENT button to locate and display an event that occurred
earlier than the current event time began.
ST Push Button (Optional)
• S elect VIEW on the patient's tile
• S elect EVENTS tab to display the event conditions collected for the selected
patient tile
• S elect the specific event to view
• S elect VIEW WAVEFORM sidebar button to show an expanded view of the event
• S elect ST button to display the ST Dialog Box
The ST Dialog Box will display the ST numerics data associated with the event.
• S elect the Left Arrow to view the ST data for the previous second of the event
• S elect the Right Arrow to view the ST data for the next second of the event
• S elect the DONE button to close the ST Dialog box
View List Sidebar Button
Select to return to the EVENTS tab.
83
View • Event View Waveform Tab
Lead Sidebar Button (5-wire lead set or 12 lead card only)
Select to change the top lead of ECG displayed in the EVENT VIEW WAVEFORM
tab.
All ECG Sidebar Button
Select to view all available ECG waveforms in the EVENT VIEW WAVEFORM tab.
When selected, the ALL ECG button will turn white. To resume viewing of all
waveforms, select the ALL ECG button to turn button blue again.
When the assigned device is an Ambulatory Telepack which is not using an SpO2
module, the EVENT VIEW WAVEFORM tab is always in an ALL ECG mode.
Note: The number of ECG lead vectors displayed depends on the utilized lead wire
set.
84
View • Event View Waveform Tab
Measure Sidebar Button
To measure intervals and use the on screen calipers:
• S elect VIEW on the patient's tile
• S elect EVENTS tab to display the event conditions collected for the selected
patient tile
• S elect the specific event to view
• S elect VIEW WAVEFORM sidebar button to show an expanded view of the event
• S elect MEASURE sidebar button
• S elect the measurement to be taken:
• PR
• QRS
• QT
• R to R
• ST
• S elect the waveform or use the arrows to adjust the first line (dotted)
• S elect the same measurement as above
• S elect the waveform or use the arrows to adjust the second line (solid)
• S elect CALCULATE to perform the calculation
Repeat above steps for additional measurements.
85
View • Event View Waveform Tab
Comments Sidebar Button (Paging Option)
Select the COMMENTS sidebar button to view paging text associated with paged
event.
Print Menu Button
Select the PRINT menu button to print an Event View Waveform strip for the
selected event.
Normal Screen Sidebar Button
Select to close tab and return to Normal Screen
86
View • Disclosure Tab
DISCLOSURE TAB
The Disclosure Tab stores continuous digital and waveform data for the specified
time period.
Displaying Disclosure Data
To display waveforms in the Disclosure Tab:
• Select VIEW on the patient’s tile
• Select DISCLOSURE tab
• Provides a 10 minute view of waveform data at one time
• Use arrows to scroll:
• Forwards/backwards 1 minute in time
• Forwards/backwards 10 minutes in time
• Select “Previous/Next Event” to scroll based on alarm conditions
• Select “Skip To” to enter a specified day and time period to view
87
View • Disclosure Tab
Display Choices Sidebar Button
To change the waveform displayed in the
Disclosure Tab:
• Select VIEW on the patient’s tile
• Select DISCLOSURE tab
• Select DISPLAY CHOICES sidebar button
• Select waveform
• Select DONE button
Skip To Sidebar Button
To skip to a specific time in the Disclosure record:
• Select VIEW on the patient’s tile
• Select DISCLOSURE tab
• Select SKIP TO sidebar button
• Enter the specific time and date
• Select DONE button
Print Menu Button
To print a Disclosure Report:
• Select VIEW on the patient’s tile
• Select DISCLOSURE tab
• Select PRINT menu button
• Select the interval
Note: This Report can also be printed from the Report Menu.
88
View • Disclosure Zoom In Tab
DISCLOSURE ZOOM IN TAB
To view and print a specific waveform data:
• Select VIEW on the patient’s tile
• S elect DISCLOSURE tab to display 10 minutes of waveform data collected for
the selected patient tile
• S elect the specific waveform data to view
• S elect ZOOM IN button to show an expanded view of the waveform data
Note: All available waveforms can be viewed in this area even if they are not being
viewed at the bedside.
89
View • Disclosure Zoom In Tab
Navigational Arrows
Select the arrows to scroll through the event data:
• Select the Double Up arrow to display the previous page of waveform data
• S elect the Up arrow to move the group of waveforms displayed up one position
• Select the Double Down arrow to display the next page of waveform data
• S elect the Down arrow to move the group of waveforms displayed down one
position
• S elect the Double Left arrow to display the previous waveform data
• S elect the Left arrow to move the colored vertical cursor line one second back in
time
• S elect the Right arrow to move the colored vertical cursor line one second
forward in time
• S elect the Double Right arrow to display the next waveform data
Next Event Button
Select the NEXT EVENT button to locate and display an event that occurred later
than the current event time began.
90
View • Disclosure Zoom In Tab
Previous Event Button
Select the PREVIOUS EVENT button to locate and display an event that occurred
earlier than the current event time began.
ST Push Button (Optional)
• S elect VIEW on the patient's tile
• S elect EVENTS tab to display the event conditions collected for the selected
patient tile
• S elect the specific waveform data to view
• S elect ZOOM IN sidebar button to show an expanded view of the event
• S elect ST button to display the ST Dialog Box
The ST Dialog Box will display the ST numerics data associated with the waveform
data.
• S elect the Left Arrow to view the ST data for the previous second of the event
• S elect the Right Arrow to view the ST data for the next second of the event
• S elect the DONE button to close the ST Dialog box
Zoom Out Sidebar Button
Select to return to the DISCLOSURE tab.
91
View • Disclosure Zoom In Tab
Lead Sidebar Button (5-wire lead set or 12 lead card only)
Select to change the top lead of ECG displayed in the DISCLOSURE ZOOM IN tab.
All ECG Sidebar Button
Select to view all available ECG waveforms in the DISCLOSURE ZOOM IN tab.
When selected, the ALL ECG button will turn white. To resume viewing of all
waveforms, select the ALL ECG button to turn button blue again.
When the assigned device is an Ambulatory Telepack, which is not using an SpO2
module the DISCLOSURE ZOOM IN tab is always in an ALL ECG mode.
Note: The number of ECG lead vectors displayed depends on the utilized lead wire
set.
92
View • Disclosure Zoom In Tab
Measure Sidebar Button
To measure intervals and use the on screen calipers:
• S elect VIEW on the patient's tile
• S elect EVENTS tab to display the event conditions collected for the selected
patient tile
• S elect the specific event to view
• S elect VIEW WAVEFORM sidebar button to show an expanded view of the event
• S elect MEASURE sidebar button
• S elect the measurement to be taken:
• PR
• QRS
• QT
• R to R
• ST
• S elect the waveform or use the arrows to adjust the first line (dotted)
• S elect the same measurement as above
• S elect the waveform or use the arrows to adjust the second line (solid)
• S elect CALCULATE to perform the calculation
Repeat above steps for additional measurements.
93
View • Disclosure Zoom In Tab
Comments Sidebar Button (Paging Option)
Select the COMMENTS sidebar button to view paging text associated with paged
event.
Print Menu Button
Select the PRINT menu button to print a Disclosure Zoom In strip for the selected
waveform data.
Normal Screen Sidebar Button
Select to close tab and return to Normal Screen
94
View • ST Tab (Optional)
ST TAB (OPTIONAL)
The ST Tab displays the ST templates for the selected patient. The ST data is
dependent upon the lead set utilized.
• 3
-Wire Lead Set – 1 vector of ST data
• 5
-Wire Lead Set – 7 vectors of ST data
• 1
2 Lead Card – 12 vectors of ST data
Note: When using a WMTS 608 bedside monitor, the ST Tab will not display ST
current or ST referenced templates.
Displaying the ST Templates
To view all leads of ST:
• S elect VIEW on the patient’s tile
• S elect ST tab. The ST templates are displayed:
Current
Reference
• The current ST template is yellow
• The reference ST template is white
• T he digital data for the reference and current ST templates is displayed
below the corresponding templates
95
View • ST Tab (Optional)
Config ST Sidebar Button
Note: The Config ST Sidebar Button is not available when the assigned device is a
WMTS 608 bedside monitor.
To adjust the ST measurements:
• S elect VIEW on the patient’s tile
• S elect ST tab. The ST templates will be displayed.
• Select CONFIG ST sidebar button
• Select the
below ISO to adjust the Isoelectric reference line (white)
• Select the
below J/ST to adjust the J reference line (yellow) and ST reference line (green)
• Select “ST Point” to change time period from the J reference line to the ST reference line
BIDIRECTIONAL
Configuring the ST at the bedside monitor will configure at the Panorama Central
Station and configuring the ST at the Panorama Central Station will configure the
bedside monitor.
96
View • ST Tab (Optional)
Print
Note: The Print Menu Button is not available when the assigned device is a WMTS
608 bedside monitor.
To print an ST Report:
• S elect “View” on the patient
• S elect “ST”
• S elect “Print” Menu Button
Note: This Report can also be printed from the Report Menu.
97
ViewStation (Optional)
VIEWSTATION
The ViewStation allows a clinician to view any patient on the Panorama Central
Station Network:
• Display real time information
• Print real time waveforms on a patient
• Print historical data and waveforms
• Display patient information and settings
NETWORK MENU
The Network Menu displays a list of all monitoring devices (patients) on the
Panorama Central Station Network. The Network Menu is used to add or remove
patients displayed on the ViewStation.
98
ViewStation (Optional) • Network Menu
Sorting Monitoring Devices (Patients)
The Network List can be sorted by patient information, bed number, or host
Panorama Central Station.
To sort the Network list by category:
• S elect NETWORK menu
• Use the arrows to scroll to the category
• S elect the category
Note: If a monitoring device (patient) is added or removed, the Network is
resorted based on the tile assigned on the ViewStation.
99
ViewStation (Optional) • Network Menu
Adding a Monitoring Device (Patient)
To assign a monitoring device (patient) for viewing on the ViewStation:
• S elect NETWORK menu
• S elect monitoring device (patient)
• S elect ADD
• S elect tile
• S elect Done
Note: The monitoring device (patient) is assigned to
tile until removed.
Removing a Monitoring Device (Patient)
To remove a monitoring device (patient) from being displayed on the
ViewStation:
• S elect NETWORK menu
• S elect monitoring device (patient)
• S elect REMOVE
• S elect Yes to confirm
Note: Removing the monitoring device (patient) does not discharge it from the
Panorama Central Station.
100
ViewStation (Optional) • Network Menu
Removing all Monitoring Devices (Patients)
To remove all monitoring devices (patients) from being displayed on the
ViewStation:
• S elect NETWORK menu
• S elect REMOVE ALL
• S elect Yes to confirm
Note: Selecting Refresh will update the Network List while the menu is opened.
Selecting a Patient on the ViewStation
Selecting a patient on the ViewStation is the same as selecting on the host
Panorama Central Station. Refer to Patient Selection for further details.
101
ViewStation (Optional) • Considerations
VIEWSTATION CONSIDERATIONS
When using a ViewStation there are a few important considerations:
• Initial settings on a monitoring device (patient) are determined from the host
Panorama Central Station (Central Station with monitor assigned to it)
• P
atient must be displayed on host Panorama Central Station to be displayed on
ViewStation
• A
djustments made on ViewStation do not impact host Panorama Central Station
• A
ny monitoring interruptions will make ViewStation re-poll host Panorama
Central Station
102
Arrhythmia Definitions
Asystole
An absence of detectable QRS complexes for a user-defined period of time in the
absence of V-Fib.
3 - 8 seconds (12-Wire Lead Set)
3 - 10 seconds (3- or 5-Wire Lead Set)
V-Fib
An absence of recognizable P, QRS, and T waves for four consecutive seconds.
V-Tach
Number of consecutive PVCs equal to or greater than the user selected “V-Tach Threshold”
at a rate equal to or greater than the user “V-Tach Rate”.
Run
The number of consecutive PVCs at a heart rate equal to or greater than the user defined
“V-Tach Rate”.
Trigeminy
Three or more cycles of one PVC followed by two normal beats.
Bigeminy
Three or more cycles of one PVC followed by one normal beat.
Couplet
Two consecutive PVCs between two normal beats.
V-Rhythm
The number of consecutive PVCs greater than two and the ventricular rate is less than the
user defined “V-Tach Rate”.
High PVC
A total number of PVCs exceeding the set threshold value.
103
Arrhythmia Definitions
Bradycardia (3, 5 wire lead sets only)
Heart rate 10% lower than selected low heart rate limit.
Pause (12 wire lead set)
No beats detected during 1.8 times or more of the current R-R interval and the next beat
is not a PVC.
104
Appendix A
ARRHYTHMIA ANALYSIS FREQUENTLY ASKED QUESTIONS
What ECG vectors are used for Beat Detection?
3-wire lead set
Viewed ECG vector
5-wire lead set and 12 lead
II and V
What ECG vectors are used for Beat Typing?
3-wire lead set
Viewed ECG vector
5-wire lead set and 12 lead
I, II, and V
What ECG vectors are used for V-Fib Detection?
3-wire lead set
Viewed ECG vector
5-wire lead set and 12 lead
II and V
How is the Heart Rate calculated?
Leads use the mean R-R interval of the last 16 beats if the HR > 48 bpm. If the Heart Rate
derived from the last 4 beats is ≤ 48 bpm, then that rate is used for HR. PVCs and Paced beats
are included.
What is the algorithm’s definition of Asystole?
No QRS detection for a configurable time period (3-10 Seconds)
What is the algorithm’s definition of V-Fib?
Presence of a Fib waveform with no recognizable P, QRS, or T waves in a 5 second window
What is the algorithm’s definition of V-Tach?
hen the rate and number of consecutive PVCs for the configurable V-Tach setting have been
W
met.
What are the user configurable options for the V-Tach rate?
The V-Tach rate can be set between 100-180 bpm.
What are the user configurable options for the V-Tach threshold?
The V-Tach threshold can be set between 3-15 consecutive PVCs.
105
Appendix A • Arrhythmia Analysis Frequently Asked Questions
What is the algorithm’s definition of Run?
The PVC Rate meets criteria for V-Tach rate but did not meet the number of consecutive PVCs
to be called V-Tach
What is the algorithm’s definition of Ventricular Rhythm?
Number of consecutive PVCs is >2 and the V-Tach rate is not reached
What is the algorithm’s definition of Irregular Heart Rate?
hen the measured variations in the R-R interval over a period of time exceed a preset limit
W
established by the arrhythmia analysis algorithm
What is the algorithm’s definition of Bigeminy?
Three or more N-V or V-N consecutive sequences
What is the algorithm’s definition of Trigeminy?
Three or more N-N-V or V-N-N consecutive sequences
What is the algorithm’s definition of Bradycardia?
Heart rate 10% lower than selected Low HR alarm limit
What does Relearn do?
Selecting "Relearn" updates the ST and Arrhythmia templates
Note: Relearn sets new ST baselines and the ability to compare to initial baseline will be lost.
Note: Ensure waveform being learned is the patient’s baseline rhythm and not a lethal
arrhythmia or artifact.
When does an Automatic Relearn occur?
3-wire lead set
• Change in viewed ECG vector
3-wire lead set, 5-wire lead set and 12 lead
•
•
•
•
106
Initial admission
Resume monitoring after a Standby mode
Arrhythmia and/or ST is enabled
After correction of lead fault of >60 sec
Appendix A • Arrhythmia Analysis Frequently Asked Questions
When should a Manual Relearn be done?
• Suspected false alarm calls
• Change in patient’s dominant beat and/or rhythm occurs
What arrhythmia calls can be made during a Learn period?
Only calls during Learn:
• Asystole (once 3 beats have been detected)
• V-Fib (once 3 beats have been detected)
What does the message “ECG Noise” mean?
The algorithm has detected noise in the ECG waveform and cannot perform arrhythmia
analysis during this time. Correct the noise to return to arrhythmia processing.
Does adjusting the wave gain (size) of the ECG waveform impact algorithm performance
or heart rate calculation?
No.
The monitor is calling “Asystole” or “Low Heart Rate” despite the visual presence of an ECG
waveform. What could be the issue?
• Alarm may be latched (Asystole)
• A
cknowledge a latched alarm by selecting over the patient’s digital or waveform area
to clear the latched alarm if condition is resolved.
• The QRS complexes are too small for detection by the algorithm.
• M
ove ECG patches closer together to increase the voltage of the QRS complexes.
• S elect “Relearn” to establish new baseline templates
• C
hange displayed lead (3-wire lead set)
107
Appendix A • Arrhythmia Analysis Frequently Asked Questions
Why is the V-Tach alarm called when V-Tach is not present in the waveform?
• Alarm may be latched (V-Tach)
• A
cknowledge a latched alarm by selecting over the patient’s digital or waveform area
to clear the latched alarm if condition is resolved.
• Baseline rhythm has changed and arrhythmia templates need to be updated
• S elect “Relearn” to establish new baseline templates
• Artifact may be present
• P oor connectivity or skin contact
– Secure ECG lead wires and cables
• E lectrocautery interface
• The algorithm may not clearly distinguish the QRS complexes from T waves that are similar
in height
• R eposition ECG patches to establish taller QRS complexes
Are there any special considerations for patients with permanent Pacemakers?
• HR is calculated from the patient’s QRS complex, not the Pacemaker enhancement.
• R eposition electrodes away from the pacemaker device to reduce “pacemaker noise”
108
Appendix B
PANORAMA® CENTRAL STATION GUIDELINE
This document is a guideline only to be used as an aid to comprehensive Inservice training.
Name: .................................................................................. Hospital: ...............................................................
Validator: ...............................................................................
A. NORMAL SCREEN
Date: ...............................................................
PERFORMED
NOT
PERFORMED
NOT
APPLICABLE
1. Turn Touch Screen On/Off
2. Discuss proper procedure for cleaning Touch Screen
3. Record a waveform on any patient
4. Locate and discuss the Mute/View Button
5. Locate Menu Bar
6. Locate Date/Time
7. Discuss resources available for assistance
8. Discuss the available options available for each patient
B. PATIENT SETUP
1. Discuss skin prep
2. Discuss auto admit for bedside monitor –
What is required for auto-admit to occur?
3. Discuss auto admit for ambulatory telemetry pack
a. Perform a battery and electrode status check
b. Discuss the Nurse and Attendance Present button
c. Initiate a recording
d. Change lead to Lead I (3-lead)
e. Discuss proper cleaning of telemetry pack
109
Appendix B
B. PATIENT SETUP (continued)
4. Discuss SpO2 module for telemetry pack (optional)
a. Enabling/Disabling SpO2 module
b. Cleaning SpO2 module
c. Connecting SpO2 patient cable and SpO2 sensors
5. Enter the following Demographics:
a. John Smith
b. Dr. Jones
c. Height: 160cm
d. Weight: 75 kg
e. What demographic information is necessary to retrieve a discharged
patient or transfer a patient to another central station?
6. Activate/Deactivate Pacer Enhancement
7. Assign Mr. Smith to a Care Group
8. Verify Arrhythmia analysis is enabled and adjust the V-Tach settings to:
a. V-Tach rate of 100bpm
b. V-Tach Threshold of 5 PVC
9. Enable/Disable ST analysis (Optional)
10. Transfer Mr. Smith to another tile on same Panorama Central Station –
What message is displayed once transfer is complete?
When will all patient information be displayed?
11.Transfer Mr. Smith to another tile on a different Panorama Central
Station (Advanced) –
What message is displayed once transfer is complete?
When will all patient information be displayed?
12. Upon transfer completion, what is required to auto admit the next
patient on the source bedside monitor?
110
PERFORMED
NOT
PERFORMED
NOT
APPLICABLE
Appendix B
B. PATIENT SETUP (continued)
PERFORMED
NOT
PERFORMED
NOT
APPLICABLE
13. Place Mr. Smith into Standby:
a. With X-Ray as his location Resume monitoring (telemetry pack)
b. At both locations with X-Ray as his location. Resume monitoring
(bedside monitor)
14. Discharge a patient from a:
a. Telemetry pack
b.Bedside Monitor
1. At the bedside monitor
2. At the central station (optional)
15. Retrieve a previously discharged patient (Advanced) –
What message will be displayed once retrieval is complete?
When will all patient information be displayed?
16. Rearrange a patient’s tile to display:
a. HR, PVC, Battery Percentage (telemetry pack only)
b. HR, NIBP, SPO2, and RESP
17. Rearrange a patient’s waveforms to display ECG1 and:
a. SPO2
b. Lead V (5-Lead)
18. Adjust the ECG wave gain to 20 mm/mV
19. Adjust the printing on a patient to print Lead I, II, and V ( 5-Lead)
C. PATIENT ALARMS
1. Adjust High HR limit to 135
2. Adjust the Low SPO2 limit to 87%
3. Discuss Priority 1, 2, and 3 alarms
4. Adjust the alarms to automatically print for Asystole, V-Tach and V-Fib
5. Adjust the alarms to store Bigeminy but not to produce an alarm sound
6. Mute an alarm
How long is the alarm muted?
111
Appendix B
C. PATIENT ALARMS (continued)
7. Discuss latched alarms. Which alarms are latched?
8. (Optional) Discuss Suspend All alarms/Suspend Non-lethal alarms.
Does this include lethal alarms?
9. Print an Alarm Report for the selected patient tile
D. VIEW
1. Display all leads of ECG
2. Mark an event for future review
3. Print a strip in the Bedside Tab – What waveforms will be printed?
4. Display the Trend List information
5. Adjust the list to display every 30 minutes
6. Display graphic trends – Return to list trends
7. Print the last 2 hours of Trend information
8. Display a list of all events stored on a patient
9. Print a 1 hour Event List Report
10. Delete an event
11. Filter the list to include physiological events only (Advanced)
12. Filter the list to include only arrhythmia events (Advanced)
13. Highlight the marked event and display its waveforms
14. Display all leads of ECG
15. Use on screen calipers to measure a PR interval (Advanced)
16. Print the Event Zoom In Report – What waveforms will be printed?
17. Change to Lead V in Disclosure (5-Lead)
18. Skip back in time 30 minutes
19. Discuss the color coded events in Disclosure
20. Highlight and zoom in to show an expanded view
112
PERFORMED
NOT
PERFORMED
NOT
APPLICABLE
Appendix B
D. VIEW (continued)
PERFORMED
NOT
PERFORMED
NOT
APPLICABLE
21. Print a Disclosure Zoom In Report
22. Discuss the ST Tab (Optional)
23. Print an ST report (Optional)
E. REPORTS
1. Print a Current Trend list report on a patient
2. Discuss how to print a strip on all the patients
F. VIEWSTATION (OPTIONAL)
1. Discuss the interaction between the Panorama Central Station and
ViewStation
2. What menu button is used to add and remove patients for display at
the ViewStation?
3. Add a monitor (patient) to view at the ViewStation
4. Adjust the printing on a patient to print Lead II, and III ( 5-Lead) –
What happens to these settings if the monitoring is suspended or
interrupted?
5. Sort the ViewStation network list based on bed number
6. Print an All Strips report at the ViewStation
7. Print an Event Zoom In report at the ViewStation
8. Silence an alarm at the ViewStation. How long does it remain silenced?
9. Silence all alarms at the ViewStation. How long do they remain
silenced?
10. Remove a patient from being displayed at the ViewStation.
Does that discharge the patient at the host central station?
11. Remove all patients from being displayed at the ViewStation
12. How can the network list at the ViewStation be updated while the
Network tab is open?
113
Appendix B
G. PAGING (OPTIONAL)
1. What menu button is used to add, assign and remove pagers?
2. Add a pager with the following information:
a. Betty Smith
b. 2882121
3. Edit Betty’s pager with the following information:
a. Betty Smyth
b. 9958000
4. Assign Betty’s pager to monitoring devices (patients) on tile 1 and 4
5. Remove tile 4 from Betty's pager
6. Betty is covering shift report – Assign all the tiles (monitoring devices)
to Betty’s pager
7. Print a Page Report
8. Display a list of pages that were not delivered
9. Resend a failed page
10. Delete a failed page – How can all failed pages be deleted?
11. Discuss the paging delay – Adjust Mr. Smith’s alarm settings to
automatically page for Asystole, V-Tach, V-Fib, and HR
12. Discuss mute and acknowledging latched alarms with respect to
paging
13. What is a page marker? Where can it be viewed?
Confirm a stored strip set for paging was sent
14. Remove all tiles assigned to Betty’s pager
15. Remove Betty’s pager from the list
114
PERFORMED
NOT
PERFORMED
NOT
APPLICABLE
Appendix B
H. SYSTEM SETUP
PERFORMED
NOT
PERFORMED
NOT
APPLICABLE
1. Adjust the ECG color to yellow
2. Recalibrate the Touch Screen (Advanced)
I. DISPLAY SETUP
1. Discuss Side Monitor Buttons
2. Discuss On/Off Power Switch
3. Discuss locking and unlocking Side Monitor Buttons
• OSD locked
• OSD unlocked
4. Discuss shortcut to Display input
• Verify display is in Analog mode
5. Discuss ability to return to original settings if inadvertently changed
6. Verify external speakers are active
7. Verify Side Monitors Buttons are in the “OSD locked” position
115
Panorama® is a registered trademark of Mindray DS USA, Inc.
PN: 0002-08-7569 Rev D
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