Working with ECGs. Philips HeartStart Event Review Pro
Below you will find brief information for HeartStart Event Review Pro. HeartStart Event Review Pro captures, reports, and manages cardiac arrest information. The software has tools for collecting and analyzing information, reviewing cases, identifying trends, and evaluating the emergency response. All information relating to a specific cardiac emergency is created in a case by downloading ECG information, shock decisions, and recorded audio from Philips and Laerdal automated external defibrillators (AED). HeartStart Event Review Pro also allows users to annotate case details.
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Working with ECGs
Use the ECG tab in Cases to add, review, and print ECG waveforms. You can also use the ECG tab to enter information and review events.
You can complete the following tasks on the ECG tab:
• View an attached ECG
• Add notes to an ECG
• Modify the display properties of an ECG
The ECG waveform includes recorded defibrillator events as well as reviewer and responder notes. For information on attaching an ECG, see
For details on the displays and functions of the ECG tab, see
Working in the ECG tab on page .
If the case includes 12-lead information, click the 12-lead tab within the ECG view to see a separate waveform and accompanying information. For details, see
Working with 12-lead ECGs on page .
Working in the ECG tab
To display an attached ECG, open a case and click the ECG tab. For more information, see
Displaying case details on page .
Events pane
All defibrillator events and notes appear in chronological order on the Events pane.
You can expand events or notes in the Events pane to display additional details. For more information, see
Using the Events pane on page .
.
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Use the Events toolbar to search for specific events or notes. You can also add a note for an ECG. Use the event filter to control the display of events and notes on the waveform. The event filter displays all possible event types and categories.
Check or uncheck them to control whether they appear.
Overview pane
The Overview pane displays the ECG waveform with flagged events and notes for each channel.
You can use the Overview toolbar to:
• Select the channel displayed on the Overview pane
• Select portions of the ECG for detailed view on the Channels pane
• Change the time scale for the ECG
For more information, see
Working with waveforms on page .
Waveforms (Channels) pane
The Waveform pane provides a more detailed view of waveforms. Event Review Pro can display multiple waveforms in separate channels on this pane.
Use the Waveforms toolbar to
• Zoom in on a channel waveform
• Zoom out on a channel waveform
• Change the time scale for the channel waveforms
You can also use the Waveforms pane to do the following:
• Add, edit, or delete notes
• Control the display of waveforms in the individual channels
• Analyze the quality of the CPR administered
Transport pane
The Transport pane at the bottom of the ECG view displays the ECG lead information, the sweep bar time, and the cursor time relative to the sweep bar location on the ECG. Use the Play button to play the entire ECG. For more information, see
Reviewing channel information on page .
.
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If an audio recording is associated with the ECG, you can use the audio controls to play the audio while viewing correlated events on the waveform on the Channels pane. For more information, see
Reviewing channel information on page .
.
You can also use the controls on the Transport pane to find and select events on the waveform for review. For more information, see
Reviewing channel information on page .
The following illustration identifies the components of the ECG view
Key to illustration numbers
3
4
5
1
2
Events
Overview
Channels
Vital Trends
Transport
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Using the Events pane
A list of defibrillator events and notes associated with an ECG appears in an expandable tree structure on the Events pane. Defibrillator events can include items such as the following:
• Shocks
• Alarms
• Monitor settings
• Equipment status
• Q-CPR events
In the Events pane, you can identify types of events, view them, search for them, and display/hide them. You can also manage the notes that are attached to each case.
Identifying types of events
Event Review Pro displays the notes that were entered when the case was added to the Event pane. For more information, see
.
The following icons identify event entries:
Symbol Meaning
Note: A user-input observation about the patient's status or the responder's intervention made on the Timeline tab.
Note: A user-input observation about the patient's status or the responder's intervention made on the ECG tab.
Shock: The delivery of therapy by the defibrillator.
Device On: The time the defibrillator was turned on or returned to use.
Device Off: The time the defibrillator was turned off.
Defibrillator alarm: An alert provided by the defibrillator. The alarm calls attention to a patient vital sign that is beyond a preset threshold.
Error condition: An error related to the ability of the defibrillator or part of the defibrillator to perform its intended monitoring function.
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Viewing events
When you click an event in the Events pane, the sweep bar automatically moves to the location of the event on the ECG strip on the Overview and Channels panes. You can expand the event in the Events pane to view event details.
To view event details, in the Events pane, click Expand .
next to the event you want to view. Event details appear. You can also double-click the event label to view details.
To expand an Events pane node
1.
Click an event or event node.
2.
Click the P
LUS SIGN
(+).
To collapse an Events pane node
1.
Click an event or event node.
2.
Click the M
INUS SIGN
(-).
To find and view an event using the scroll bar
1.
Click and drag the scroll bar down the Events pane to find an event.
2.
Click the event .
The sweep bar moves to the location of the event on the waveform.
3.
Double-click the event .
The event expands to display event details.
Searching for events
Use the Search .
button on the Events toolbar to search for events or notes.
To search for an event
1.
Type or select the event name in the text box on the Events toolbar.
The search text can be any portion (substring) of the event name as it appears in the event label. For example, to search for "patient age," you could type
"patient," "patient age," "age," or even just "patien."
2.
Click Search .
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If the search finds an event, it appears selected in the event tree, and the sweep bar moves to the location of the event on the waveform.
Hiding or displaying events
Use the Filter tab to display or hide events on the waveform on the Overview,
Channels, and Events panes according to criteria that you choose.
You can display or hide events either by category or by type. If you filter by category
(for example, if you filter by Q-CPR), then all event types in that category
(CPR Pads Off, CPR Intubated, etc.) are hidden as well.
By default, all events appear except CPR compression events.
The caution icon appears on the Filter tab when there is at least one event type or category that was filtered. See the procedure below to display some or all of these events.
To use the event filter
1.
On the Events pane, click the Filter tab.
A list of event categories appears.
2.
Click Expand .
next to an event category.
The event types in the selected category appear.
3.
Uncheck the box for any event type or event category that you want to remove from the display.
The following results occur:
• The event or events disappears from the Overview and Channels panes.
• The event or events disappears from the Events pane.
• The caution icon on the Filter tab appears.
Managing notes
You can add, modify, and delete notes in the Events pane. You can also add, edit, and delete notes directly on the ECG on the Overview or Channels pane. For more information, see
Managing notes on the waveform on page .
To add a note in the Events pane
1.
Click the part of the Events pane where you want the note to appear.
2.
On the toolbar, click Add Note .
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The Note window appears, with a table similar to the table on the Timeline tab.
3.
Click in the Annotation Type field.
4.
From the list of events in the pop-up window, click and complete an event the same as when you add events on the Timeline tab.
For more information, see
5.
Complete the fields, as appropriate.
For example, for a Reviewer Note, type Reviewer name , Reviewer title , and
Reviewer department .
If you click Custom, type the event name and unit, if appropriate.
6.
Click OK.
The note now appears on the event tree, the ECG waveform, and the Timeline tab.
To modify a note in the Events pane
1.
Click the note you want to modify.
2.
On the toolbar, click Edit Note .
3.
In the Note window, modify the note.
4.
Click OK.
To delete a note in the Events pane
1.
Click the note you want to delete.
2.
On the toolbar, click Delete Note . The note disappears from the Event pane, the ECG waveform, and the Timeline tab.
Viewing waveforms
You can see the entire ECG as a continuous strip on the Overview pane. It includes markers and labels for recorded events and notes. You can point to event labels on the ECG on the Overview pane to view event details. In the Channel view, you can zoom in to see an ECG segment of interest.
On the Overview and Waveforms (Channels) panes, a vertical sweep bar indicates the current ECG time. The sweep bar provides a visual cue to the current position on the waveform. Click the ECG on the Overview pane to move the sweep bar to the pointer location on the Waveforms pane. For more information, see
Working with waveforms on page .
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You can see a closeup view of a segment of the ECG waveform, as well as a closeup of compression waveforms, on the Waveforms pane. The channel displays the waveform in a grid, indicates the selected scale,and displays events and notes with markers.
Working with waveforms
You can manage notes on the Overview and Waveforms panes.
On the Overview pane, a dashed box (arrow, below) identifies the waveform that appears on the Channels pane.
To add and manage notes on the waveform, see
Managing notes on the waveform on page .
This ECG is intended only for basic rhythm identification. It is not intended for diagnostic and ST segment interpretation,
By default, the primary defibrillator channel appears on the Overview pane.
To select a channel
1.
On the Overview toolbar, click the Channel drop-down list.
2.
From the list of all recorded channels, click the channel that you want to view on the Overview pane.
To view event details on the waveform, hover the mouse over the event marker on the ECG waveform. Event details appear in a pop-up window.
To select an event on the waveform, click on or near the event marker on the waveform on the Overview pane. The sweep bar moves to the location of the event on the ECG waveform on the Waveforms pane.
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Magnifying waveforms
Use the magnifier to get a detailed view of a section on the waveform.
An asterisk appears for each incomplete release on the compression waveform, similar to the view on HeartStart MRx.
To use the magnifier tool
1.
Hold down S
HIFT and press the mouse button as you point to the area on the waveform that you want to magnify.
A magnified view of the waveform appears, with crosshairs at the location of the pointer.
2.
While continuing to press the mouse button, move the pointer to another location on the waveform for closer inspection.
The elapsed time and waveform values appear for the magnified section, as well as the endpoints of each axis.
Displaying and hiding channels
If the ECG has multiple channels, you can select which channels to display or hide on the Channels pane. You can also increase the display area of the Channels pane to accommodate multiple channels.
To display additional channels on the Channels pane, click Expand .
on the
Channel Properties tool for the channel you want to show. The selected channel then appears. You can use the vertical scroll bar to see additional channels. You can also drag the border to increase the size of the Channels pane.
To hide a channel on the Channels pane, click Collapse .
on the Channel
Properties tool for the channel you want to hide.
For information on docking/undocking and pinning/unpinning areas of the
ECG display, see
Arranging sections of the ECG display on page .
Arranging sections of the ECG display
You can use the pinning function to customize the display of sections in the ECG display.
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If you ever need to put the sections back to their default locations, on the
Configuration menu, click Reset Panel Layout.
"Pinning" and "unpinning" refer to the size of an ECG section. A pinned section might look like the illustration below:
When you click the pin for the section, it is minimized; all that you see is a marker for it at the edge of the display, as in the figure below.
Click the marker to pin it again.
Changing the display time
At the top of the Channels pane, a ruler indicates the time scale of the waveform displayed in elapsed time or real time. Use the channels ruler to change the time scale between elapsed time or real time.
• Real time is the actual clock time based on the Adjusted Time.
• Elapsed time is the time since the defibrillator was turned on.
The time scale appears with divisions for seconds and fractions of seconds.
If an audio clip is associated with the waveform, the channels ruler displays a blue overlay where the audio is present, in relation to the waveforms.
To change the display time
1.
Right-click the channels ruler.
2.
On the shortcut menu that appears, click one of the following time formats:
• Elapsed Time
• Real Time
The display time changes according to your selection.
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Changing the time scale
Use the time scale slider on the bottom left side of the Waveforms (Channels) pane to select the time scale in mm/sec. The default time scale is 25.0 mm/sec. You can also use the mouse wheel to change the time scale if the Channels pane is currently in use.
The time-scale grid adjusts according to the time scale selected. At the default time-scale setting of 25.0 mm/sec, the grid marks indicate 1-second intervals.
If you decrease the time scale, the grid marks indicate larger intervals. For example, if you decrease the time scale to 12.5 mm/sec, the grid marks indicate 5-second intervals.
To change the time scale using the time scale slider, click the time-scale slider and complete one of the following procedures:
• To increase the scale, drag the slider to the right.
• To decrease the scale, drag the slider to the left.
The adjusted scale appears in mm/sec., and the waveform display adjusts accordingly.
To change the time scale using the mouse wheel, use one of the following methods.
Point to the waveform and click the mouse wheel to complete one of the following actions:
• To increase the scale, roll the mouse wheel forward.
• To decrease the scale, roll the mouse wheel backward.
The adjusted scale appears in mm/sec.,. and the waveform display adjusts accordingly.
To reset the time scale to default, hold down C
TRL and click the time-scale slider.
The time scale resets to the default scale (25.0 mm/sec.).
Scrolling through the channel
Use the channel scroll bar at the bottom of the Channels pane to scroll through the waveform strip. You can also scroll through the strip using key command shortcuts.
For more information, see
Using key command and mouse shortcuts on page .
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To scroll through the waveform, drag the channel scroll bar to the desired location on the waveform.
Customizing channels
Event Review Pro provides a channel properties tool for each channel. This tool displays information about the channel waveform and provides features to modify the waveform display. You can select to display or hide the tool. By default, the tool is closed; click the arrow key on the left (see below) to open the tool.
When the properties area is closed, it looks like this:
When the area is open, it might look like this:
The channel properties tool displays the following information about the current waveform:
• The waveform type or source
• The sample rate in Hz
• The current vertical offset and scale
• The scale in millivolts per millimeter
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If multiple waveforms are associated with the channel, you can select the waveform to display in the channel. You can control the vertical offset and can scale the waveform displayed in a channel. You can also control the color of the waveforms displayed on the channels.
If the ECG has multiple channels, you can change the display order for the available channels.
• To display the channel properties tool, click Expand . To hide the tool, click
Collapse .
• To move a channel up on the Channels pane, click Move Up .
• To move a channel down on the Channels pane, click Move Down .
To change the color of the waveform
1.
Click the color selector to the right of the waveform ID strip.
2.
In the Color window, click the desired color and click OK.
The waveform appears using the selected color.
Changing the waveform offset
The Baseline field, available in the ECG channel when you expand the Properties area with the arrow, controls the vertical offset for the waveform. The Baseline field displays the current vertical offset in the relevant waveform units, for example, mV for an ECG. Use the Center button to center the waveform segment displayed in a channel. The waveform appears with the offset determined by the average of the waveform values in the segment currently displayed in the channel.
The image below shows a display before centering:
The image below shows a display after centering:
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You can adjust multidigit scale values based on the digit selected. For example, if the value in the Range field is 100 mV and the third digit is increased by 1, the scale increases to 101; if the second digit is increased by 1, the scale increases to 110.
To change the waveform vertical offset gradually, single-click the specific digit you want to change in the Baseline field (for instance, if you want to change 125.63 to
125.69), click the 3 so that it is highlighted, and complete one of the following procedures:
• To increase the vertical offset, turn the mouse scroll wheel forward, or move the mouse so that the cursor moves upward on the screen.
• To decrease the vertical offset, turn the mouse scroll wheel backward, or move the mouse so that the cursor moves downward on the screen.
The adjusted vertical offset value appears in the Baseline field, and modifies the vertical offset of the waveform displayed in the Channels pane, accordingly.
To specify the waveform vertical offset, double click the Baseline field and type the offset value. The waveform in the Channels pane appears with the specified offset.
Changing the waveform scale
The Range field, available in the ECG channel when you expand the Properties area with the arrow, controls the scale of the waveform.
You can adjust multidigit scale values based on the digit selected. For example, if the value in the Range field is 100 mV and the third digit is increased by 1, the scale increases to 101; if the second digit is increased by 1, the scale increases to 110.
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To change the waveform scale gradually, single-click the specific digit that you want to change in the Range field (for instance, if you want to change 125.63 to 125.69), click the 3 so that it is highlighted, and complete one of the following procedures:
• To increase the waveform scale, turn the mouse scroll wheel forward, or move the mouse so that the cursor moves upward on the screen.
• To decrease the waveform scale, turn the mouse scroll wheel backward, or move the mouse so that the cursor moves downward on the screen.
The adjusted scale value appears in the Range field, and modifies the scale of the waveform displayed in the Channels pane, accordingly.
To specify the waveform scale, double-click the Range field and type the scale value in mV
. The waveform appears in the Channels pane according to the specified scale.
To restore the default waveform scale, press C
TRL
, and click in the Range field.
Reviewing channel information
Use the transport control (shown below) to navigate through events on an ECG waveform, play the waveform, and play an associated audio clip while reviewing the waveform.
You can also review information about the current sweep bar and pointer locations in an information pane at the bottom of the ECG view.
Navigating ECG events on the waveform
• If you click Next .
, the sweep bar moves to the location of the next event on the ECG waveform and displays the event time on the information pane.
• If you click Previous .
, the sweep bar moves to the location of the previous event on the ECG waveform and displays the event time on the information pane.
• If you click Play , the waveform moves at the speed of real time.
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Playing the ECG audio
If audio clip was recorded with the ECG, you can play the audio and move along
(traverse) the waveform on the Channels pane. The sweep bar indicates the location on the waveform corresponding to the current audio. You can also play and pause the audio by pressing the spacebar if the Channels pane is currently in use. For more information, see
Using key command and mouse shortcuts on page .
.
• To play the ECG audio, click Play .
. The audio clip, and the sweep bar moves through the waveform on the Channels pane and indicates the real time on the information pane. If a section of the ECG has no audio, you will see a flashing indicator that displays "No audio."
• To pause the ECG audio, click Pause .
. The audio pauses, and the sweep bar stops at the current location on the ECG waveform.
• To change the volume of the ECG audio, drag the Volume slider to the level you want. This adjustment is relative to the volume that you set in the Windows audio control. If your Windows audio is muted or the volume is very low, the
Event Review Pro volume setting cannot override it.
• To reset the ECG audio volume to the default level, hold down C
TRL and click the Volume slider.
Viewing ECG information
The date of the ECG, and the real time and elapsed time for the sweep bar location, appear in an information pane at the bottom of the ECG view.
The waveform type and value for the current pointer location also appears, as well as the cursor delta time. The cursor delta time is the difference in milliseconds between the current pointer location on the waveform and the sweep bar location.
To measure the cursor delta time, click a location on the waveform. The difference between the pointer location and the sweep bar appears in the Cursor time field on the information pane.
To measure the waveform value, click a location on the waveform. Event Review
Pro dynamically assigns a name to the waveform type field, according to the waveform type or source, and displays the waveform value in the waveform value field.
The waveform value is displayed in units appropriate to the waveform type, as in the following examples:
• mV for leads
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•
•
• mmHg for blood pressure and CO2 mm for compression mOhms for ventilation
Event Review Pro User Guide
Defining and viewing ECG selections
ECG selections are portions of the ECG that you need to reference for future examination--like bookmarks. You can mark any part of an ECG as a selection and give it a name; you can also assign it a distinctive color to set it off. With selection templates, you can set up a process to create selections automatically when a specific event in the ECG occurs. Once you have more than one selection, you can sort them for quick reference.
You can also print a strip report of the ECG from the File menu or the application toolbar. For more information, see
and
Shortcut menu commands on the Channels pane assist in these tasks.
Creating ECG selections
If you want to isolate a section of ECG data for separate attention (such as focused analysis during debriefing, or printing it by itself and inserting it in slide presentations, documents, or emails), you can create a "selection." You can do this three different ways:
• To create an ECG selection manually, click where you want the clip to begin on the waveform, and press and hold the mouse button as you move the pointer to where you would like the clip to end. A green overlay (the default color; you can change this) highlights the selection.
• If you want to create a single selection of a predetermined length in the part of the ECG that is on the screen at the moment, use the Auto-selection feature,
You can set the length in seconds before you create the selection.
• If you want to set a template to create a selection automatically every time a certain event occurs (like an alarm, a defibrilllation, or a ventilation), see
Using selection templates on page .
.
To automatically create ECG selections
1.
In the Auto-selection (secs) text box, type the ECG automatic selection length in seconds.
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2.
Hold down C
TRL and click the ECG where you want to create an automatic selection.
A selection appears that is centered on the pointer location. A colored overlay highlights the selection.
Managing ECG selections
Use the ECG menu or shortcut menu on the Overview or Channels pane to manage
ECG selections. To display the shortcut menu, right-click the ECG.
In addition to printing and copying ECG selections, you can do the following tasks:
To create an ECG selection using the shortcut menu
1.
Move the sweep bar to the point in the waveform where you want the selection to begin.
2.
On the ECG or shortcut menu, click Selections, and then click Set Selection
Start.
3.
Move the sweep bar to the point in the waveform where you want the selection to end.
4.
On the ECG or shortcut menu, click Selections, and then click Set Selection
End.
To change the color of the ECG selection
1.
Click the selection on the waveform.
2.
On the ECG or shortcut menu, click Selections and then click Selection Color.
3.
In the Color window, click a color and click OK. You can also click Define
Custom Colors to create your own colors; type values in the boxes for Hue,
Saturation, Luminosity, and RGB, preview the results until you have the color you want, click Add to Custom Colors, and click OK.
4.
On the File menu or toolbar, click Save.
You can now export and import the case with the current ECG view. Event
Review Pro also saves the color for future selections.
To convert an ECG selection to a Q-CPR exclusion
1.
Click the selection on the waveform.
2.
On the ECG or shortcut menu, click Selections, and then click Convert to Q-
CPR Exclusion.
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The selection is now a Q-CPR exclusion and is available on the shortcut menu.
For more information on Q-CPR reports, see
Working with Q-CPR reports on page .
110 . For more information on Q-CPR exclusions from reports, see
Removing Q-CPR exclusions on page .
To clear an ECG selection
1.
Click the selection on the waveform that you want to remove.
2.
Use one of the following methods:
• On the ECG menu, click Selections.
• Right-click the selection to display the shortcut menu and click Selections.
3.
From the list of selection commands, click Remove Selection.
The selection disappears.
To clear all ECG selections
1.
Use one of the following methods:
• On the ECG menu, click Selections.
• Right-click the selection to display the shortcut menu and click Selections.
2.
From the list of selection commands, click Remove All Selections.
All selections disappear.
Naming, finding, and sorting ECG selections
All ECG selections appear in tabular form on the Selections tab. Use the Selections tab to sort, assign names to, and search for selections.
You can use selection names as bookmarks. The selection name appears at the bottom of a named selection in the Channels pane.
To name ECG selections
1.
Click the Selections tab.
All selections appear, sorted according to time of creation.
2.
Click the name field for a selection to highlight the number assigned at creation.
3.
Type a name or unique ID for the selection.
4.
Repeat steps 2 and 3 for each selection.
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To search for a selection
1.
On the Overview toolbar, type search criteria in the Search selections field.
Event Review Pro searches for selections based on the name field. The search text must match the selection name in the same order as it appears on the
Selections tab and cannot include a "wildcard" (that is, a placeholder for an unknown part of the search string). For example, to search for Shock 1 delivered, you can type “shock” or “Shock 1”. Case does not matter. However, if you type only “Shock delivered,” you will not get results. If you want to search for Shock 2 delivered, you must specify “Shock 2” to find the subsequent selection.
2.
Click Search .
The waveform selection matching the search text is now highlighted in the
Channels pane.
To change the sort order
1.
Click the Selections tab.
All selections appear,sorted according to time of creation.
2.
Click the heading of the field you want to sort by.
The selections sort themselves by the field that you chose.
3.
Click the field heading again to toggle between ascending or descending order.
To move quickly from one waveform selection to the next, use the U
P ARROW and
D
OWN ARROW keys.
Using selection templates
Use selection templates to create event-based ECG selections automatically. For instance, you can create a template that will mark all shocks delivered, showing you
2 seconds before and after the event, and make the selection blue.
To create a selection template
1.
Click the Selection Templates tab.
The headings for a selection templates table appear.
2.
Click New.
A new row appears in the selection templates table.
3.
From the Event Category drop-down list, click an event category.
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4.
Click in the Event Type field for the new selection template.
5.
From the Event Type drop-down list, click an event type.
6.
In the Pre-seconds field, type the number of seconds you want to precede the event in the selection.
7.
In the Post-seconds field, type the number of seconds you want to follow the event in the selection.
8.
In the Color field, select the color you want to highlight the selection.
9.
Click Create.
ECG selections appear according to your criteria.
To delete a selection template
1.
Click the Selection Templates tab.
The headings for a selection templates table appear.
2.
Click a template and click Delete.
Copying ECGs to the Clipboard
You can copy ECG strips and ECG selections to the Clipboard. You can then paste the strips and selections into documents created by a word processing or graphic application. Copy the ECG strips and selections from the ECG view.
To copy an ECG strip to the Clipboard
1.
Right-click the strip in the Overview or Channels pane.
2.
On the menu that appears, click Copy to Clipboard.
3.
Paste the contents of the clipboard into a document.
To copy an ECG selection to the Clipboard
1.
Right-click the selection you want to copy.
2.
On the menu that appears, click Selections.
3.
Click Copy Selection to Clipboard.
4.
Paste the contents of the clipboard into a document.
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Exporting waveform data
To export a case with the .
wfdb format, which is used for data analysis, use the
Export option on the File menu or toolbar. For more information on this format, see http://www.physionet.org
.
Event Review Pro cannot import .
wfdb files. For more information, see
Importing case files automatically on page .
.
To export only ECG data
1.
Open a case. For more information, see
Displaying case details on page .
.
2.
Click the ECG tab.
3.
Click the ECG view tab.
4.
On the ECG menu, click Export to WFDB.
The Save As window opens.
5.
In the Save inbox, navigate to the location where you want to save the exported
ECG data.
6.
In the File namebox, type a name for the data files.
7.
Click Save.
Event Review Pro exports the files to the folder that you name.
Managing notes on the waveform
You can add, edit, and delete notes on the waveform. You can also use the application toolbar to add notes.
If you want to add a note that is "fixed" on the ECG waveform—that is, its time and date do not change—use the Timeline tab. If you want to add a note whose time and date move according to the Adjusted "On" time, set on the
Defibrillators section of the Overview tab, use the ECG menu.
To add a note
1.
Click the waveform where you want the note to appear.
The sweep bar moves to the pointer location.
2.
Use one of the following methods:
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• On the ECG menu, click Add Note.
• On the Events pane toolbar, click Add Note .
• Right-click the waveform to display the shortcut menu, and click Add Note.
The Note window opens, with a table similar to the table on the Timeline tab.
3.
Click the Event Name field.
4.
On the list of events, click and complete an event from the list the same as when you add events on the Timeline tab.
For more information, see
5.
Complete the fields, as appropriate.
6.
Click OK.
The note now appears on the waveform, the event tree, and the Timeline tab.
To modify a note
1.
On the event tree, click the note that you want to modify.
2.
Use one of the following methods:
• On the Events pane toolbar, click Edit Note .
• Right-click the waveform to display the shortcut menu, and click Edit Note.
3.
In the Note window, make your modifications to the note.
4.
Click OK.
To delete a note
1.
Click the note that you want to delete.
2.
Use one of the following methods:
• On the Events pane toolbar, click Delete Note .
• Right-click the waveform to display the shortcut menu, and click Delete
Note.
The note disappears from the waveform.
Zooming in and out of the waveform
Use the ECG menu or shortcut menu to zoom in and out of the waveform.
To zoom in or zoom out
1.
Click the waveform.
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2.
Use one of the following methods:
• On the ECG menu, click Zoom In or Zoom Out .
• Right-click the waveform to display the shortcut menu, and click Zoom In or
Zoom Out.
• On the numeric keypad, press P
LUS
(+) to zoom in or M
INUS
(-) to zoom out.
To zoom in or zoom out fully
1.
Click the waveform.
2.
Press S
HIFT and, on the numeric keypad, press + to zoom in fully or - to zoom out fully.
Customizing the ECG display
You can configure the display of the waveforms in the Waveforms pane according to your preferences. You can control the display of device events, notes, and labels.
You can also configure the display of the grid and the gradient background in the channels.
To remove ECG information from display
1.
Click the Waveforms pane.
2.
Use one of the following methods:
• Click the ECG menu.
• Right-click the ECG.
3.
Click Display Items.
The display items menu opens.
4.
Click the item that you want removed from display.
The item disappears from the ECG. For additional information, see
Reviewing case events on page .
.
To restore ECG information to the display
1.
Click the Waveforms pane.
2.
Use one of the following methods:
• Click the ECG menu.
• Right-click the ECG.
3.
Click Display Items.
The display items menu opens.
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4.
Click the item that you want restored.
The item reappears in the ECG.
Event Review Pro User Guide
Reviewing vital trends data
On defibrillator/monitors like the MRx, vital trends data is associated with the ECG.
You can view this data in Event Review Pro in a table or on a chart.
In Table view, you can select the time interval for the vital trends information.
On the Vital Trends toolbar, click the Interval: drop-down menu and click 5, 10, 15,
30, or 60 minutes from the list that appears.
In Chart view, you can select the duration of the vital trends data.
On the Vital Trends toolbar, click the Length: drop-down menu and click 10, 30, or
60 from the list that appears.
You can also choose the color and point style for each trend displayed.
To change the point style in Chart view
1.
If you are not already in Chart view, click the Chart tab.
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2.
On the configuration pane to the left of the vital trends chart, click the style button to the right of the trend you want changed.
3.
On the shortcut menu that appears, click Point style.
4.
Click a point style from the list.
To change the trend color in Chart view
1.
If you are not already in Chart view, click the Chart tab.
2.
On the configuration pane to the left of the vital trends chart, click the style button to the right of the trend you want changed.
3.
On the shortcut menu that appears, click Color.
4.
In the Color dialog box, click a color from the BasicColorslist.
You can also click Define Custom Colors to create your own colors; type values in the boxes for Hue, Saturation, Luminosity, and RGB, preview the results until you have the color you want, click Add to Custom Colors, and click OK.
5.
Click OK.
To remove trends from display in Chart view. on the vital trends configuration pane, click the box to the left of the trends (arrow, below).
Working with 12-lead ECGs
12-lead data acquired during use of a defibrillator is automatically attached to the case along with continuous ECG. You can also attach 12-lead data that was transmitted through the
Bluetooth transmission and XML methods.
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The 12-lead ECG and associated data appear on the 12-Lead tab. You can also double-click a 12-lead acquisition event in the event pane to display the data on the
12-Lead tab.
This ECG is intended only for basic rhythm identification. It is not intended for diagnostic and ST segment interpretation
Event Review Pro supports HeartStart MRx, version 9.0 or later with the event sum option, for Bluetooth transmission. The 12-lead ECG, along with associated summary data, appears in a 12-lead report. When a 12-lead report contains Acute Cardiac Ischemia Time-Insensitive Predictive Instrument (ACI-
TIPI) and Thrombolytic Predictive Instrument (TPI) data, the data appears in the summary text box above the waveform.
The 12-lead ECG appears in the middle section of the 12-Lead view. A summary section at the top of the 12-Lead view shows the following 12-lead data:
• Patient demographic information
• Global measurements (Rate, PR, QRSd, QT, QTc)
• Axes (P, QRS, T)
• ECG summary interpretations
• You can use the configuration section at the bottom of the 12-Lead view to control the display of the 12-lead ECG and display additional 12-lead ECGs attached to the case.
You can print 12-lead reports from the File menu or application toolbar. For more information, see
.
You can do the following tasks on the 12-Lead tab:
•
Configuring the 12-Lead view on page .
•
Reviewing the 12-lead ECG on page .
Configuring the 12-Lead view
Use the configuration section of the 12-Lead view to control the display of the 12lead ECG.
To select another 12-lead ECG, click the 12-lead drop-down list and click a different
ECG. The selected 12-lead ECG and its associate summary information appear.
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To change the time format
1.
Click the Timing drop-down list to change the time format.
The following time formats appear:
• Simultaneous (European standard)
• Time Sequential (United States standard)
2.
Click the time segment that you want.
The 12-lead ECG appears in the selected time format.
To scale the report display
You can scale the 12-lead report from 1x, with the Scale control in the far left position, to 3x, with the Scale control in the far right position. You can also use the magnifying tool in the 12-Lead view, when the Scale control is in the 1x position. For more information, see
Magnifying 12-lead ECGs on page .
• Complete one of the following procedures:
• To increase the scale of the 12-lead ECG displayed, drag the Scale control to the right.
• To decrease the scale of the 12-lead ECG displayed, drag the Scale control to the left.
Reviewing the 12-lead ECG
Use the scroll bar to move through the 12-lead ECG.
If the scale has been increased so that sections of the 12-lead ECG are outside of the current view area, drag the ECG to view the obscured sections. A location key indicates when you have reached the limit of the 12-lead ECG in any direction.
To scroll through the 12-lead ECG, drag the scroll bar to the desired location on the
12-lead ECG.
To use the location key
1.
Click a position on the 12-lead display and press the mouse button.
A four-arrow location key appears.
2.
Drag the 12-lead ECG display up, down, or to the right or left to display any obscured sections of the 12-lead ECG.
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The location key indicates when you have reached the limit of the 12-lead ECG in any direction by dimming the corresponding arrow.
Magnifying 12-lead ECGs
You can use the magnifier tool for a detailed view of the 12-lead ECG waveform.
To use the magnifier tool
1.
Hold down S
HIFT and click the area on the waveform that you want to magnify.
A magnified view of the waveform appears.
2.
While continuing to hold the mouse button, move the pointer to another location on the waveform for closer inspection.
Customizing Q-CPR episodes
You can customize the Q-CPR reports that you create. For example, you can use commands on the shortcut menu or the Q-CPR menu to define an episode for Q-
CPR reporting and to mark sections of the waveform to exclude from Q-CPR reports.
Q-CPR events appear on the Compression channel.
For information on excluding sections of the waveform from Q-CPR reports, see
Creating Q-CPR exclusions on page .
.
For more information on generating and printing Q-CPR Details and !-CPR Report
Card reports, see
Working with Q-CPR reports on page .
.
To customize a Q-CPR episode
1.
If necessary, click the ECG tab and display the ECG view.
2.
Click the waveform at the point where you want the episode to begin.
3.
Use one of the following methods:
• On the Q-CPR menu, click Set Episode Start.
• Right-click the waveform to display the shortcut menu, click Q-CPR, and click Set Episode Start.
A vertical bar marks the start of the episode.
4.
Click the waveform at the point where you want the episode to end.
5.
Use one of the following methods:
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• On the Q-CPR menu, click Set Episode End.
• Right-click the waveform to display the shortcut menu, click Q-CPR, and click Set Episode End.
A vertical bar marks the end of the episode.
Creating Q-CPR exclusions
A Q-CPR exclusion identifies the areas of the waveform that you do not want to analyze. Any data inside the exclusion area is excluded from the analysis. Use the
Q-CPR menu, the shortcut menu on the ECG tab, or shortcut keys to create Q-CPR exclusions.
You can also convert an ECG selection to a Q-CPR exclusion.
To create a Q-CPR exclusion from the Q-CPR menu or shortcut menu
1.
If necessary, click the ECG tab and display the ECG view.
2.
Click the waveform at the point where you want the exclusion to begin.
3.
Use one of the following methods:
• On the Q-CPR menu, click Set Exclusion Start.
• Right-click the waveform to display the shortcut menu, click Q-CPR, and click Set Exclusion Start.
4.
Click the waveform at the point where you want the exclusion to end.
5.
Use one of the following methods:
• On the Q-CPR menu, click Set Exclusion End.
• Right-click the waveform to display the shortcut menu, click Q-CPR, and click Set Exclusion End.
A red overlay highlights the exclusion.
To create a Q-CPR exclusion using shortcut keys
1.
If necessary, click the ECG tab and display the ECG view.
2.
Click the waveform where you want the exclusion to begin.
3.
Hold down A
LT and press the mouse button.
4.
Drag the mouse to where you want the exclusion to end.
5.
Release the key and mouse.
To create a Q-CPR exclusion from an ECG selection, see
Managing ECG selections on page .
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Removing Q-CPR exclusions
You can remove a single exclusion or all exclusions.
To remove a Q-CPR exclusion
1.
If necessary, click the ECG tab and display the ECG view.
2.
Click the waveform where you want the episode to begin.
3.
Use one of the following methods:
• On the Q-CPR menu, click Remove Exclusion.
• Right-click the waveform to display the shortcut menu, click Q-CPR, and click Remove Exclusion.
The highlighted exclusion disappears.
To remove all Q-CPR exclusions
1.
If necessary, click the ECG tab and display the ECG view.
2.
Click the waveform.
3.
Use one of the following methods:
• On the Q-CPR menu, click Remove All Exclusions.
• Right-click the waveform to display the shortcut menu, click Q-CPR, and click Remove Exclusions.
All Q-CPR exclusions disappear.
Adding notes to the Ventilation channel
The notes in the calculations appear in the Q-CPR Report Card report.
To add notes to a ventilation channel
1.
If necessary, click the ECG tab and display the ECG view.
2.
On the Waveforms pane, expand the ventilation channel.
3.
Click the ventilation waveform at the point that you want to add the note.
4.
Right-click the mouse to display the shortcut menu.
5.
Click Q-CPR, and then Annotations.
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6.
Click one of the following options to add a note, both of which appear at the cursor:
• Ventilation
• PR (Perfusing Rhythm).
To add notes using keyboard shortcuts
1.
If necessary, click the ECG tab and display the ECG view.
2.
On the Waveforms pane, expand the ventilation channel.
3.
Click the ventilation waveform at the point that you want to add the note.
4.
Press the following key combination:
• Press A
LT
+V to add a Ventilation note.
• Press A
LT
+R to add a PR (perfusing rhythm) note at the cursor location.
To move a note to another location on the waveform, click the note on the waveform and drag it to another location using your mouse.
Using key command and mouse shortcuts
You can use the shortcuts in the table below to complete many of the operations on the ECG tab:
Key command shortcuts
Audio
Play/Pause audio
Click the ECG waveform, and then press S
PACEBAR
.
Reset audio volume to default level
Hold down C
TRL and click the Volume slider
Event tree
Expand selected event tree nodes
S
HIFT
+ P
LUS SIGN
Collapse selected event tree nodes
S
HIFT
+ M
INUS SIGN
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Q-CPR
Annotate compression waveform with ventilation event
A
LT
+ V
Annotate compression waveform with Perfusing Rhythm.
A
LT
+ R
Selections
Create an automatic selection centered on the pointer location
C
TRL and click waveform
Add a note on a ventilation channel
A
LT
+ V to add a Ventilation note
A
LT
+ R to add a PR (perfusing rhythm) note
Sweep bar
Move sweep bar one minute backward
P
AGE UP
Move sweep bar one minute forward
P
AGE DOWN
Move sweep bar one strip backward in the W
AVEFORMS pane
S
HIFT
+ P
AGE UP
Move sweep bar one strip forward in the W
AVEFORMS pane
S
HIFT
+P
AGE DOWN
Move sweep bar to beginning of recording
H
OME
Move sweep bar to end of recording
E
ND
Move sweep bar one second backward
L
EFT ARROW
Move sweep bar one second forward
R
IGHT ARROW
Move sweep bar to previous selection
U
P ARROW
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Move sweep bar to next selection
D
OWN ARROW
Time scale
Time scale expand
C
TRL
+ P
LUS SIGN
(+)
Time scale compress
C
TRL
+ M
INUS SIGN
(-)
Zoom
Zoom in
P
LUS SIGN
(+)
Zoom out
M
INUS SIGN
(-)
Zoom in fully
S
HIFT
+ P
LUS SIGN
(+)
Zoom out fully
S
HIFT
+ M
INUS SIGN
(-)
Mouse shortcuts
Magnification
Display magnified view of waveform
Click the waveform; then hold down S
HIFT and press the mouse button.
Q-CPR exclusion
Create Q-CPR Exclusion
Hold down A
LT and drag mouse over waveform .
Time scale
Expand time scale
Press the mouse wheel and rotate it backward.
Compress time scale
Press the mouse wheel and rotate it forward.
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Vertical offset
Increase vertical offset
Click the B
ASELINE field and rotate the mouse wheel forward.
Decrease vertical offset
Click the B
ASELINE field and rotate the mouse wheel backward.
Waveform scale
Increase vertical waveform scale
Click the R
ANGE field and rotate the mouse wheel forward.
Decrease vertical waveform scale
Click the R
ANGE field and rotate the mouse wheel backward.
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Key features
- Captures and reports cardiac arrest information
- Reviews cases and identifies trends
- Manages ECG information and monitoring data
- Annotates case details
