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USER GUIDE Cardiology Suite 4.06 Resting, Stress, Holter, and

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1. aynpeerg ist AH HE FULL DISCLOSURE RHYTHM TREND Stress Data View Page Rhythm Trend June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 28 STARTING A STRESS ECG TEST Stress ECG Advance Begin Enter eg ma Demand Pause Finish Stage Recovery BP j Strip Print Protocol Test N KS Ne mg 2 I AVERAGE 3 COMPLEX lt x O Q S o SPEED ELEV d D i Bani DI ARRHYTHMIA RHYTHM rd adr ET ine Trace b inasa alo Protocol prise Stave NN Stress ECG Acquis ition age l e erd asg ed METS m Stage Time T HR or Recovery Elevation DEEN Heart Rate RE 100 Clicking on the blue Q in the upper right hand corner of the window will display the toolbar Clicking on the crossed out GG will hide the toolbar June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 29 Tasks Performed During a Stress Test D gt Advance Stage ER Begin SE i Blood Pressure Save Strip KA Print ECG Pause Protocol Ae Finish Test Print ECG Pause or Advance Begin Maa er Save Strip an Demand Finish Stage Revovery amp Annotate Manual Protocol Test Single Style Report Stress ECG Test comprises of various Phases and Stages In general QRS Card Stress ECG Test has three phases 1 Pre Test Phase 2 Exercise Phase 3 Recovery Phase Note User Intervention is
2. June 24 2009 PBI select Report June 24 2009 QRS Card Cardiology Suite 4 06 Rev A 12 Lead Standard 12 Lead Standard Detail 3 Lead Standard Brief 3 Lead Standard 3 Lead Standard Detail box 12 Lead Standard bee 2 Page 12 Lead Standard 1241 12 Lead Standard 3 Lead Serial Comparison Show Details Printer Cancel Output HP Lasernet P10 PELE Printer PDF File Viewer CO MS Word File Views Use Color 300 DPI 300 OFI vi Print Using HF LasenJet P1006 Copy 1 16 PPM ORB 7 Printer outputs black and white only Printer permits I resolutions DUU DPI v 600 DPI 66 PBI QRS Card Cardiology Suite 4 06 Rev A 67 UTILITY Topics Configuration Physicians Clinics Technicians Import Reports Queue System Rebuild VVVVVV V CONFIGURATION The Configuration Section is used to set up various default parameters of using QRS Card Cardiology Suite Software These options include e Reporting e Database e Measurements e Options e GDT Interface e Real Time Print e Email REPORTING Use the Reporting Configuration Property Sheet to set the default values for reporting ECG results Access the property sheet by the following method Select Utility gt Configuration and click on the Reporting tab in the Configuration Setup property box Reporting Database Options EMR Real Time Print Email Medication Reset Speed 507s vi Le
3. 20 2k 20 PASA QRS Card Cardiology Suite 4 06 Rev A 4 Due to the shock hazard that can exist within the PC when the cover is removed only qualified service personnel should perform service Never use extension AC power cords with the PC computer chassis leakage current may increase In case of ECG leadwire replacement use ONLY Pulse Biomedical recommended ECG lead wires Erratic and or non rhythmic heartbeats or artifacts can result in inaccurate ECG readings ECG lead changes during measurements can cause artifacts that can result in inaccurate readings Changing patient positions e g supine sitting etc during measurements can cause artifacts that can give inaccurate readings Choose an ECG lead other than V5 for patients experiencing cardiac occlusion Use during fibrillation or with cardioplegic agents will result in artifacts that can result in inaccurate readings For better measuring results select the optimum signal lead for monitoring Avoid nearby electrical noise sources 1f possible If questionable readings are obtained re check the patient s cardiac rhythms by an alternate means before administering any medication Routinely inspect cables leads assemblies for cracks holes tears cuts etc that could present problems to the system Secure the PC Monitor with the computer on the cart if used so that it does not tip over Consult the PC Monitor book for proper connection between the computer and th
4. BB Holter ECG Mrs Tahira 3 29 2004 7 49 00 PM 94 95 95 94 DM Ia 95 95 94 142 EE EE EE EE EE SE SA SR RT RR BG FG ARP FOI JA PER FE ENG RER A RD AR So FOR fr ER MS EK Rd RF ED GR AE Cae eneren eg CHERIE E EDEN ESS HP AE Er E EA p E EED di EE EE EE nn RYT KOL SC OU IN TP ON NABA BA ES ang fen IK Ee pa ER ba ga ko ba b i a GITT EST EES SIS EGGE pn pe SHA SE DS EES ER ES ES ES DS ES ES ES RS ES ER DS EE SES ES EESZSERE H RR EU SE SE HEH ZS E SE E E A PE anunua ES ai Ge pa pi apes pa eg SE bi SS papa ai ken pen pu SES ES par eli ji gt June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A am Strips let Mark All mL SN alee Hist Clear AN Add Strip EE Update Strip e E Delete Strip June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 46 Onset Duratinn 3 gt DE s 5 S wh 2 8 es 2 Delete T 8 37 AM 1 12 37 PW 1 4 37 PM 1 8 37 PM 1 12 37 AM 2 4 37 AM 2 8 37 AM 1 25mi N V 8 B Pi P BB A X ki ou set onset Ui set offset Mesue print anser ES selen 69 8 71 o 62 a 69 73 70 69 74 69 DA Z PA EL EIER E TETT IGG GI STAT TETTE ase Emami mAn MENE RET PRR EET GETS we MALU Bug DECH BEG a ULIT T HEBRE NEL Ela KA er Paa sa kA ai e Kal a Man at met Lard Medel ht Noord ki e Nei ve pal ond b i pna VAN AN Madekoaj art est Ai e md a TU EUREN bitze Etat Ke Aeddi Pakia Pate
5. S D Acquire Exercise Phase ECG Phase ECG a S E Acquire Recovery Phase ECG ER F Complete Stress Test Advance STAGE El I 5s E G Print Stress Summary Reports tage Y Perform L o Exercise D 5 Phase ECG a ES STAGE E3 Blood Pressure Input is automatically prompted on the computer screen as per protocol in use Perform Recovery Phase ECG Complete Note Complete ECG for the COMPLETE Stress Test is SAVED Stress to computer hard disk which can then be EDITED VIEWED Test PRINTED manually or automatically Print Stress Sumary Reports Multiple Style Reports Task Performed During a Stress Test DD Advance Stage ER Begin kann Pause Protocol Save Strip KA Print ECG Blood Pressure KS j Finish Test Advance Begin Pen yon Save Strip ki Pause or Finish Stage Revovery KR amp Annotate Manual Protocol Test Single Style Report June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A Quick Start 1 Record patient s Holter ECG data for 24 or 48 hours For setting up using the recorder see Recorder Operator guide 2 Connect Holter recorder or flash card to the computer See Quick Reference Installation Guidefor hardware setup Start QRS Card Cardiology Suite Software Perform one time Holter Setup File Holter Setup or Press CTRL F5 See Quick Reference Installation Guide for more details Press HiRes Button or Hot Key F5 from Main Software Scre
6. June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 80 Available Oueue Options Print Queue To add to the Print Queue double click on Printer under Available Queues in the Queue Detail Dialog Box or highlight Printer and click on the Add button The Add Entries to QRS Print Queue Dialog Box will be displayed Select the test and the type of report desired add any comments necessary and click on Add Click on the Close button to exit this dialog box The selected traces will be copied to the Print Queue Select Dump and the traces will be printed To aid in finding an encounter the user may sort the database by name ID or date time the encounter was obtained by clicking on the appropriate heading name Mail Out The Mail Out option allows the user to e mail ECG traces Note For best results connect to the Internet before entering the Queue System To add to the Mail Out Queue double click on the Mail Out option under Available Queues or highlight Mail Out and click on the Add button The Add Entries to QRS Mail Out Box Queue dialog box will appear Highlight the encounter to be e mailed and using the directory option enter the recipient s e mail address Click on Add to the queue Click on Close to exit the dialog box Click on Dump Queue to start the e mail process Mail In The Mail In option allows the user to receive ECG traces via e mail Note For best results connect to the Internet before entering the Queue System As t
7. Output f Samsung ML 1740 Series f PELS Printer PDF File Viewer 34 PBI QRS Card Cardiology Suite 4 06 Rev A UI CA STRESS ECG SETUP The Setup command is used to select options for running a Stress ECG Test The Setup command can be accessed by two ways From the Standby Screen select File gt Stress gt Setup OR Click on the Stress ECG icon If the Show This Window in the Stress Setup has been selected the Stress Setup dialog box will automatically be displayed See below Executing Setup makes the system display this Stress dialog box Demand 7 Pape vi I Fratocol LI Final Hep Jip Ee wo ka 11000 Stress ECG Segment 3 lead E 1001 Stress ECG Segment 12 lesd pCa 10 plane Um Specs ECG Rest Table WM Show thie window Save Stings Oi Stress ECG Surrey Report bg Show electrode position diagram kal 1004 Chess ECG Summa Repat Classic O Anbytha Screen ele 01005 Stress Stage ECG Complex Summary Si E Trend Screen mas LA FA Bi ee gab E a J Target Heart Rate Pee Calculate P0 ape gs K TOU Manimum Sie Elevation ot Decression Lead Casio Je C Masimum STe Elevation Lead C Masimum STe Depression Laad Bee ECG Acquisten ES Fiber Receede QRS Cad USB Ty Demo est Electiical interference 60 Hz Sample Rate 240 BREwERER Artact rejection Ca Filter Length 00 EES PET Baseine Deft Fedaction On Average Cyces 5 Stress Property
8. 5 3 2004 test 121 1 Select Type of Report 8 to Print List GF Saved Tesis b View Edit Typing of Notes comments From Main menu Select a desired Patient Test i Press Open View Test Button Se E View Test and Type Notes Press Print Button Select Type of Report to Print Print Report s EGGERS EE ES E Multiple Style Reports ER SE j View Type Notes Task performed during a Resting ECG Print ECG Finish Test Save Strip Print ECG Finish Only When No Auto Save on Demand Test Single Style Report Se If No Auto Save June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 12 Stress ECG Quick Start mmmmn m onmnnnnnnnnnnnnnnnn STRESS ECG 1 Connect QRS Card ECG machine to your computer USB port or serial port See Quick Reference Installation Guide for more help 2 Start your QRS Card Cardiology Suite Software on your computer 3 Perform one time Setup for your Stress ECG File Stress Setup or Press CTRL F3 See Quick Reference Installation Guidefor more details 4 Press Stress ECG button or hot key F3 from the Main Software Screen 5 Type in Patient demographic data if Setup screen show then press OK to go to patient demographic data 6 Press OK button to start acquiring Stress ECG 7 ECG report will be printed after the completion of the Stress Test Advance Begin Enter A Gre l Demand Pause Finish Stage Recov ery BP Strip SC Pro
9. 9 I 999 4344 1 9 New Pat 222 2 Ji 9 Master Faraz 2118 1 B3 o G I ME MF 4444 1 m NASIR WAQAS 2212 1 Configure Holter Download Procedure Device AEREAS ii Record e braemar res Browse IV Show this window IV Enter patient demograhics After Download Exit Edit Print Episodes Upload Patient Data o 13000 Holter ECG Summary Report 13010 Holter ECG Result Summary Report 13011 Holter ECG Result Summary Report B 13020 Holter ECG Hourly Summary Report 13030 Holter ECG Trend Report 13040 Holter ECG Selected Segments Report 113041 Holter ECG Selected Segments Report 13050 Holter ECG Full Disclosure Report 113070 Holter ECG Result Summary Report pa June 24 2009 38 PBI QRS Card Cardiology Suite 4 06 Rev A 39 to download Holter ECG data Press hot key Ctrl F5 to perform Holter ECG From the toolbar press Device defines the recorder type to download from Record defines the path for the Holter data file Show This Window If selected the Holter dialog box will appear when accessing the Holter Test File gt Holter gt Perform Test or clicking on the Holter ECG icon If not selected the Holter ECG Download dialog box will appear first when accessing the Holter Test Enter patient demographics If selected the Holter ECG Patient Information dialog box will appear during Holt
10. QRS Card Cardiology Suite software master screen is divided into the following sections 1 Pull down menu selection for various items File Utility Logs and Help 2 Buttons to QUICKLY access Test or to obtain Help Resting Stress HiRes Holter AMPB Spriometry amp Help 3 Folders for Patient Names and Test Database 4 Patient Database tools Search Open Print Email Add New Patient Delete Patient 5 Test Report Preview Database Tools Sort Test The ECG Tests can be sorted by name patient ID or date acquired by clicking on the respective buttons Partial name or date sort can be typed in the empty space between the database listing and the tool bar buttons e To sort Tests by Name press D Name e To sort Tests by patient ID press pi June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A BY Date e To sort Tests by Date press Open Test e After selecting Test press database to retrieve a previously saved test from the QRS Print Test e Press to save and print the selected ECG test to the QRS database and local printer Mail Test e Press to e mail the ECG test Compare Le Compare e Press to compare patient ECGs Add New Patient FF Add to add a patient before testing them rir e Press Delete a Patient e Press ES Delete to remove a patient or a test from the database to the closest match fee ae You Bon Note To quickly search fo
11. Summary I 1008 Stress Phase ECG Rhythm Summary 1009 Stress ECG Full Disclosure 1010 Stress Test Trends O 1011 Stress Stage ECG Rhythm Summary 31 1012 Stress Phase ECG Rhythm Summary 31 1013 Stress ECG Selected Segments 1014 Review Screen O 1015 Stress ECG Summary Report Europe 1016 Stress Stage ECG Rhythm Summary Cla O 1017 Stress Stage ECG Rhythm Summary Cla Output June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 31 STRESS TEST DATAVIEW SCREEN To view or edit a stress test go to the Master Screen and select the desired Stress ECG Test and click the button on the toolbar OR Double click on the test to be viewed The test record will be displayed in the Dataview screen HM 1727 2005 dafa 1212 1 01 27 2005 dddfadf 1212 1 El 1 27 2005 sdadD 121 1 S5tress ECG 1127 2005 10 27 PM a 1127 2005 fo sti tL This screen allows the user to e View edit patient data e View test data e Print reports W Stress Test Kevin Miller CROCHET AMA ye EE Edit Selection This selection is used to review and edit any patient demographics information and ECG device information Information is subdivided into Patient Tab for patient demographics Test Tab for additional patient info Medication medication information Signal Tab information on how the ECG was obtained i e the sampling rate and use of filters N
12. Test When Measurements Valid If selected the test will automatically start once it is determined that the blood pressure measurements are valid If not selected the ECG will begin but the test will not start until the Save Strip icon is clicked on the Resting ECG toolbar Provide Automatic ECG Interpretation If selected automatic ECG interpretations will be supplied Print ECG Report If selected an ECG Test report will be printed automatically at the end of the test and will be saved to the computer hard drive If the Print ECG Report option is selected select the desired type s of reports to be printed View Test Record If checked the ECG record will be displayed immediately after the data is collected Exit When All Tasks Complete If selected the program will return to the Standby mode when all the tasks selected for the Resting ECG test are completed NOTE This feature unchecked can be used to save multiple Resting ECGs from the same patient June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 26 Screens Defines Default parameters for Screen display values e g Gain Speed Lead Display etc for Acquisition and Dataview Screens See Quick Reference Installation Guide for more help and details ECG Filter Electrical Interference Allows the user to apply a SOHz or 60Hz filter to smooth out the signal If desired the filter can also be turned off by selecting None Artifact Rejection If the Art
13. eart Reports Help Pa Blood Pressure WA Rosting Hu AN BEE y Edt p ta an Dan e Rezort Heb aed paneer Brena iter p Sa a AWe lZLead 7 fs mim hus E EE A wa W797 KUA KG SR eet ees eae E E EE pe 1 ke SS ko a y e 1 1 l v l 1 ja V3 Ul SY MIABJEG Resting DataView June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 11 Resting ECG Flow Chart Easy Steps To Perform Resting ECG A Press Resting Button to Start a Test 2 B Enter Patient Demographic data ey C Auto or Manual Print Test Report SETUP FOR AUTO PRINT For Auto Report Print to work a Printer MUST be attached to the computer b Under Resting Restup CTL F2 1 Print ECG Report must be selected 11 Type of Report e g 12 Lead Standard must be selected Start Resting Test i el AUTO PRINT Enter Patient Data Must be defined in Resting Setup MANUAL PRINT o o o o o o o o o o o o o o o 6 5 2004 Manning Mike 1212 1 A Stress ECG 6 5 2004 2 52 PM 6 5 2004 Hasan Saleem 12343 3 6 5 2004 Stressi 1212 1 MANUAL PRINT of reports can be done A EE a fl 6 sj2004 test 1212 2 a From Main Menu 1 5 31 2004 DOB 113 1 5 30 2004 SinghBP 12121 1 Select a desired Patient Test 9 5 9 2004 tat 554 1 3 5 9 2004 notches 121 1 Press Print Button 07
14. ha EH an an Labalan Kick beads n e Go paid A ek Oo e a A G dl rte ur MGA Greet raw aal El PANG PELS PE age PANPI T GET Ti G rtolterProcedure ve E lul AFIB synchronize this data with the Rhythm Edit Screen After pressing F7 the first tab is This screen displays the patient s atrial fibrillation The user can Above the Rhythm Edit Screens are the options to change the leads and reclassify the beats as well as the following options kl Set Onset o Marks the start of an episode run Da Set Offset E o Marks the finish of an episode run 5 Measure e Measures the beats Print Prints the displayed page DL nsen o Inserts beats Ca Select Adds a custom episode to the selected strips EF Eee Grid Displays Rhythm Edit Screen default setting June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A AT lul AFIB de ST ia OT g HRY db Respiration Superinposition Onse Dur m Max5Te mm STeHC1 STeHC2 STeHC3 DEZ C uuz YH STe mm 0 HR amp ST Trend t o 8 37 AM i1 12 37 PW 1 437 PM D 8 37 PM 1 12 37 aM 2 4 37 AM 2 8 37 AN 2 Add Delete amp HolteProcedur pa 1 de ST Print ai Insert ea Select June 24 2009 PBI QR
15. hour BP and Spirometry W 1 Write down the Product ID PID of your ORS Card M ECG device written on the USB Security Key and also on the back of your QRS Card or provided by dealer or distributor For Demo software Tutorial the PID is 0001 0001 2000 DEMOU 2 See Quick Reference Installation Guide for Hardware hookup and setup Product License and Registration Screen License Registered Company Serial Number SN Name PID Product ID Modules Activated Bought Acquired Register About Cardiology Suite 311411 Product Details O License Registered Installed Products Cardiology Suite Resting Test Stress Test HiRes Test Holter Download Warning This Computer program is protected by copyright law and international treaties Unauthorized reproduction or distribution of this program or any portion of it may result in severe civil and criminal penalties and will be prosecuted to the maximum extent possible under the law WWW OSC an COM Press CTRL F1 or Select from pulldown menu HELP then About June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 10 Quick Start 2 RESTING ECG 1 Connect QRS Card ECG machine to your computer USB port or serial port See Quick Reference Installation Guide for more help 2 Start QRS Card Cardiology Suite Software on your computer 3 Perform one time Setup for your Resting ECG File Resting S
16. in the Acquisition Screen after the ABPM file is downloaded gt Edit If Edit is selected the ABPM file will be downloaded and then the Dataview screen will appear to allow review and editing of the data gt Print The Print option will download the ABPM file and proceed with printing the report selected Default Report Allows for selection of a default report at the time of download The type of report can be changed after the download by opening the ABPM test and selecting File gt Print Report in the ABPM Dataview screen Upload Patient Data Allows the upload of ABPM data from the QRS system to the ABPM Device BB ABPM Download June 24 2009 PBI Jameson Milda 5 7 2001 8 45 00 AM TUT ays map De TH QRS Card Cardiology Suite 4 06 Rev A 65 12 28 2004 Burdick 3453 1 6 25 2005 mahdavi mahdavi 201 SIYIZOOI ABPM 46461 SIYIZOOI Jameson Milda 12121 P ABPM 5 7 2001 8 45 AM 8 00 12 30 17 00 Systolic All Systolic Night neg mmHg 8 96 Gaman 11 oe ani FK Benn aed 20 mmHg 53 Diastolic Day Diss sin B3 mmHg 18 a mmHg 20 6 B3 mmHg 29 95 a mmHg 38 96 BO mmHg 53 DU mmHg 42 Yo Systolic Day 20 Diastolic all we mme 26 Yo 31 Systolic Day NG Systolic Night Diaslolic Day Diastolic Night uw t 50 20 30 40 Measurements 10 21 50 2 00 6 30 11 00 Blood Pressure Range mmHg Abpi Pruteyue
17. installation of Adobe Acrobat Reader 6 0 or higher on user computer is required also make sure that correct version of Acrobat Reader is selected under Utility Configuration Option PDF To make sure select Detect PBI QRS Card Cardiology Suite 4 06 Rev A 25 RESTING ECG SETUP The Setup command is used to select various options for running a Resting ECG Test Resting Setup can be accessed two ways e From the Standby Screen select File gt Resting gt Setup OR e Click on the Rest ECG icon If the Show This Window in the Resting Setup has been selected the Resting Setup dialog box will automatically be displayed 12 Lead Standard 12 Lead Standard Notes 12 Lead Standard Detail 3 Lead Standard 3 Lead Standard Notes 3 Lead Standard Detail 6x2 12 Lead Standard IV She Iv W W Ste Vv w m w T Re Show This Window If selected the Resting dialog box will appear when accessing the Resting Test File Resting Perform Test or clicking on the Resting ECG icon If left unselected the Resting setup box will not appear when performing resting tests Show Electrode Position Diagram If selected the electrode positioning diagram will be displayed when performing resting tests Collect Blood Pressure Measurement If selected the Blood Pressure dialog box will be displayed after the Resting patient information has been entered Enter the patient s blood pressure and click OK to continue Start
18. on the Stress ECG icon If it is not selected the Stress setup box will not appear at the start of a Stress test Show Electrode Position Diagram If selected the electrode positioning diagram will be displayed Arrhythmia Screen If selected the Arrhythmia screen will be displayed during the Stress test Trend Screen If selected the Trend screen will be displayed during the Stress Test ST Segment Display This option selects the display lead for the ST Trend Window Selecting Normal provides the display of ST for the user selected lead The Maximum ST Elevation or Depression Lead option automatically displays the ST values for the lead that has either the maximum elevation or the maximum depression The Maximum ST Elevation Lead option automatically displays the ST values for the lead that has the maximum ST elevation The Maximum ST Depression Lead option automatically displays the ST value for the lead that has the maximum ST depression ECG Filter Electrical Interference This allows the user to apply a 50Hz or 60Hz filter to smooth out the signal If desired the filter can also be turned off Artifact Rejection If the Artifact Rejection option is chosen artifacts like those caused by muscle twitches will not be assigned as peaks Baseline Drift Reduction Drift of the baseline will be minimized Reports Demand If desired a printout of the ECG trace can be obtained while the test is running Chose the number of pag
19. or the heart rate meter for Pacemaker patients during cardiac arrest Pacemaker patients must be closely observed LOW BATTERY If the QRS Card Cardiology Suite System is used with a battery operated computer the low battery indicator warning of the computer must be checked before using the system on any patients PROPER ELECTRICAL GROUND Proper electrical grounding to the AC lines is an absolute necessity for acquiring noise free ECG recordings PATIENT DATA BACKUP It is important for users to backup their patient ECG data regularly In the case of accidental hard disk data loss backup data can be restored to the hard disk MODEM USAGE DURING ELECTRICAL STORMS For patient s safety during Electrical Storms the telephone line to the modem and the patient ECG cable should NOT be hooked up at the same time SCREEN SAVER software programs that blank the computer screen must not be used while the QRS Card Cardiology Suite ECG system software is running Use the QRS Card software as stand alone software Do not run multiple software applications simultaneously under Window 95 while running the QRS Card software UL Listed PC computers must be used for noise free recording of ECG s Do not use this device in areas where flammable explosive or anesthetic agents are used The device is not intended for use during anesthesia June 24 2009 PBI IBA 13 14 15 16 17 18 19 20 21 22 23 24 29
20. required in moving during Stages while in Pre Test mode While Exercise and Recovery stages are timed e g Each Exercise Stage in Bruce protocol is 3 minutes each Each Phase can have multiple stages Pre Test Phase User intervention is needed to complete forward Pre Test Stages Supine Hyperventilation Warm up Exercise Phase Stage El Stage E2 Stage Ex Recovery Phase Stage R1 Stage Rx Note The Advance Stage command can only be accessed when a Stress Test is running Use the Advance Stage command to advance the Stress Test to the next Stage The Advance Stage command can be accessed the following way e Press the Advance Stage button on the Stress Status Bar to advance the Stress Test to the next Stage as defined by the protocol This button can be used to acquire Pre Test Stage ECG s This button can also be used to advance Stages while in Exercise Phase or in Recovery Phase To begin Recovery press the button on the Stress Status Bar e To manually enter blood pressure press the button on the Stress Status Bar e To annotate or mark a Strip to print during final reports press the button on the Stress Status Bar Se w n NA e To print a real time ECG Report press the button on the Stress Status Bar Note 1 Number of pages or continuous print to print under Stress Setup 2 HP PCL5 Printer is REQUIRED to perform real time print June 24 2009 PBI QRS Card Cardiolog
21. the Statement Library on the right of the screen Select the statement desired and click on the arrow to transfer it over to the Physician s Interpretation box If the computer interpretation is not appropriate and no statements from the library can be found to describe the test record the physician can add a personal interpretation by simply clicking in the Physician Interpretation box and typing In a view only box at the bottom of the screen the date and time of the computer generated interpretation is displayed If the computer interpretation is not used the name of the analyst who overread the interpretation and the physician that confirmed it along with the date and time can be entered in the Overread Report box June 24 2009 PBI Report June 24 2009 QRS Card Cardiology Suite 4 06 Rev A 24 Selected reports can be printed automatically or manually to any printer attached to the computer Select Report 12 Lead Standard 12 Lead Standard Notes 12 Lead Standard Detail 3 Lead Standard 3 Lead Standard Notes 3 Lead Standard Detail 6x2 12 Lead Standard 6x2 Page 12 Lead Standard 12x1 12 Lead Standard If the PDF File Viewer is selected the report will print as a PDF file to the computer screen The Save option button from Adobe Acrobat Reader will save the report in PDF format which can be printed or emailed by the user if required Note In order to print PDF File Viewer to computer screen
22. 1 PBI WW Log View Description GEN Start StressProcedure HEN Stop StressProcedure GEM DEM Error dataview cpp 324 No eps HEN Start HolterProcedure GEN Stop HolterProcedure GEM DEM Error dataview cpp 324 No eps HEN Start HolterProcedure QRS Card Cardiology Suite 4 06 Rev A GEM Start QraCommonDialogLibrany1 40000 Feb 24 2005 08 38 34 SEM DEM Error print cpp 542 reports not printed user cancel x Cannot create a file when that file already exists GEM Stop QrsCommonDialogLibrany1 40000 Feb 24 2005 08 38 34 SEM Stop HolterProcedure GEN Stop SpirometryControlz 40000 Feb 24 2005 08 38 11 GEM Stop Spiromety Procedure 40000 Feb 24 2005 08 41 19 GEM Stop Pie printing interface 40000 Feb 24 2005 08 42 30 GEM Stop AbpControls 40000 Feb 24 2005 08 38 06 GEM Stop AbpmProcedure 40000 Feb 24 2005 08 40 47 June 24 2009 Print Help Options Delete 3156 2005 31542005 31572005 31572005 31642006 3156 2005 3156 2005 3415 2005 3165 2005 31542005 31542005 3165 2005 31642005 31572005 3156 2005 31542005 3715 2005 4 46 42 PM 4 46 45 PM 4 46 50 PM 3 46 53 PM 4 47 22 PM 4 43 11 PM 4 43 14 PM 4 43 16 PM 4 54 18 PM 240415 PM 4 54 19 PM 24 54 27 PM 12 50 PM 13 50 PM 13 50 PM 13 50 PM 13 50 PM kwa 82
23. B Total VPB Pauses 8 37 AM 1 64 69 71 1563 0 0 0 8 9 00 AM 1 64 70 83 4200 0 0 0 0 e 10 00 AM 1 68 73 83 2682 0 0 e From the View drop down menu select Summary OR e Press the Hot Key F4 To view a table e Click the table tab you want to display To zero table values e Select the hour in the table that has values you want to zero e Select Zero e Select the check boxes for the values you want to zero e Click OK To edit table values e Select the hour in the table that has the values you want to edit e Select Edit e Edit the values e Click OK June 24 2009 62 Edit Zero PBI June 24 2009 QRS Card Cardiology Suite 4 06 Rev A a Configure Ambulatory Blood Pressure Download Device fi KA Ek e Port COM vi Record lw Show this window lw Enter patient demograhics r After Download Ze Exit Edit Print Default Report ID Name o O ooo O 12001 Standard ABPM Report 112002 ABPM Trend Report 112003 ABPM Distribution Report 112004 ABPM Pie Report 12005 ABPM Hourly Summary Report Log Communications Initialize Recorder 63 PBI QRS Card Cardiology Suite 4 06 Rev A 64 Enter Patient Demographics Checking this box will allow for the entering of patient demographics while the ABPM data is being downloaded Click on the Finish button when data entry is completed After Download gt Exit If the Exit option is selected the program will wait in standby
24. Customers will be supplied with ONLY software supplied by the device manufacturer and not the Cardiology Suite ABMP software module e CAE Record patient s Ambulatory Blood Pressure ABPM data for 24 hours For Using Setup the ABPM Recorder see Recorder Operator Guide Connect Blood Pressure recorder to the computer via serial or USB Port See Quick Reference Installation Guidefor hardware setup Start QRS Card Cardiology Suite Software Perform one time Ambulatory BP Setup File Ambulatory BP Setup or Press CTRL F6 See Quick Reference Installation Guide for more details Press ABPM Button or Hot Key F6 to start Ambulatory BP data download Press OK button to start downloading Ambulatory BP data Type in the Patient demographic data Highlight the patient test from database listing then double click to view ABPM data Print Summary Report MN ABPM Download A DER Configure Ambulatory Blood Pressure Download Press Finish when data entry complete Device PEN vi Port COM1 vi Cancel Patient Test Medication Record Identification 5 M Show this window IV Enter patient demograhics Upload la Browse r After Download Jane Last First Exit Edit Print Date ofBithf NG M d pyyy 12001 Standard ABPM Report Address Street City State Zip Telephone Log Communications a Finish 350 ot TWE TET TE Systolic TAN Systolic Day Systolle Night 39 mmHg peg mmHg D
25. EDICAL INC MAKES NO WARRANTIES EITHER EXPRESSED OR IMPLIED REGARDING THE QRS Card CARDIOLOGY SUITE 4 06 ITS MERCHANTABILITY OR ITS FITNESS FOR ANY PARTICULAR PURPOSE WITH THE EXCEPTION OF ANY LIMITED WARRANTIES WHICH ARE DISCLOSED IN THIS MANUAL THE EXCLUSION OF IMPLIED WARRANTIES IS NOT PERMITTED BY SOME STATES THE ABOVE EXCLUSION MAY NOT APPLY TO YOU THIS WARRANTY PROVIDES YOU WITH SPECIFIC LEGAL RIGHTS THERE MAY BE OTHER RIGHTS THAT YOU MAY HAVE WHICH VARY FROM STATE TO STATE CAUTION 10 11 Federal Law restricts this device to be sold by or on the order of a physician Use the ORS Card ST device under the direction of a physician The Operator should read and thoroughly understand the manual before use The intended use of this device is for Patients undergoing ECG Testing and or ECG Stress Blood Pressure and Breathing analysis The intended locations for use are in a physician s office hospital exercise rehabilitation facilities or similar areas 7 WARNINGS ISOLATION TRANSFORMER It is required that all equipment attached to the patient be electrically isolated An Isolation Transformer is needed to isolate the computer and the operator from the AC main for safety purposes QRS Card ECG device must be at least 6 feet away from the computer PACEMAKER PATIENTS The QRS Card Cardiology Suite hardware and software does not provide or detect pacemaker pulses Do not rely on the QRS Card Cardiology Suite output
26. OF3 Outgoing Mail Sk TF Incoming Mail Server Account Name Password Qubgoing Mail Information E Mail address domain T My outgoing server SMTP requires authentication June 24 2009 PBI June 24 2009 QRS Card Cardiology Suite 4 06 Rev A FE Ca nfiguration Setup Reporting Database Options EMR Real Time Print Email Medication Drug Class Buste Reset Unspecified Digoxin Lanoxin Digitoxin Digitalis Ei SOP SCP ROY SCP SOP OCP ec Soy SCP ec pe Digitalis Preparation Edit Instructions Left Click any button to edit text Remove all characters to hide a button Those buttons displayed with a red X will be hidden Cancel Apply Help 74 PBI QRS Card Cardiology Suite 4 06 Rev A 75 PHYSICIAN Select Utility Physician then property box will appear Names of attending and referring physicians are stored in the database using this option E Physician Database an Male Joseph kline MD Gi ka Ei Cardilogy Susan Hakida DO Interneral Medicine Add select to enter a new or referring physician s name Update select to update an existing entry in Physician Database Delete select to delete an entry in Physician database Export select to Export a listing of an existing Physician database in text format Import select to Import an existing text format Physician list into Physician database June 24 2009 PBI W Clinic D
27. PBI QRS Card Cardiology Suite 4 06 Rev A 1 USER GUIDE Cardiology Suite 4 06 Resting Stress Holter and ABPM US Customers supplied with software from device manufacturer and not Cardiology Suite4 06 Software Pulse Biomedical Inc 1305 Catfish Lane Norristown PA 19403 USA 610 666 a 5510 Tel 610 666 5630 Fax www qrscard com June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 2 Pulse Biomedical Inc Corporate Summary Pulse Biomedical Inc PBI is a manufacturer of computer based electrocardiogram ECG products PBI is located outside Philadelphia Pennsylvania USA PBI designs develops manufacturers and markets both the hardware and software components of a twelve lead diagnostic quality ECG device for use with an IBM or Microsoft Windows compatible personal computer The company received FDA clearance to market its resting QRS Card ECG product in November 1991 and its Stress ECG in July 1998 During the initial years PBI invested in research and development while establishing a corporate presence in the ECG marketplace through exhibiting at the American Heart and the American Cardiology conferences The initial product consisted of a separate card that was inserted into the PC with DOS based software running in the PC Through R amp D the product QRSCard Cardiology Suite has evolved to an external hardware module about the size of a small cellular phone with communication to the PC via the serial port Th
28. S Card Cardiology Suite 4 06 Rev A 48 8 Holter ECG PATIENT NAN File Measure View Log L A d ra zm Vi Lal AFIB ge ST ro QT ID HRV db Respiration Superimposition QT Table T Trend QT HR Plot QT Time Table Time Beats HRav QT QTav QT QTsd QTcb QTcs QTch QTcf 260 lt 300 lt 340 380 420 460 lt 500 540 5540 8 37 AM 1563 69 414 414 44 0 443 414 429 433 0 0 0 0 1406 0 0 0 0 9 00AM 4200 70 414 414 44 0 47 44 431 435 0 0 0 0 4076 0 0 0 0 0 10 00 AM 2682 713 414 414 414 0 457 44 437 442 0 0 0 0 2645 0 0 0 0 e From the View drop down menu select Tools OR e Press the Hot Key F7 The QT option displays the measurements from Q to T and offers three different viewing options 1 QT Time Table 2 T Trend Table 3 QT HR Interval Plot June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 49 HRV Plot f lal aria b ST Ju or f t HRV Remiaton be Supermposien Lorenz Plot General Table RR Table Spectral Table IAIN V S 1s 2s 4 E Yahoo Search From the toolbar press This screen gives the user a graphical display of the ECG data through different parameters This tool assists the user to get an overview and analyze the ECG data at first glance The HRV screen functions give the user several options to view and analyze the ECG data with the help of several graphical and statistical data views The lists of ava
29. Sheet Protocol defines the Stress Test Protocol to be used in the Stress Test Controlled Device defines the Stress Test Exercise device Test tests the functionality and the connection between the computer and the Exercise device To test a device select it under the Device option o Test Property Sheet In testing a Treadmill Device clicking on the arrows under Speed should increase and decrease the speed of the Treadmill Using the arrows under Treadmill should increase and decrease the elevation of the device In testing an Ergometer Device using the arrows under Ergometer should increase or decrease the load The Blood Pressure can also be measured to verify the BP aspect of the test 1s functioning properly June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 36 o Limits Property Sheet Lists the limits of the driver Metric If selected Exercise device measurements in will be given in Metric units Blood Pressure defines whether or not a Blood Pressure reading will be used and if it is whether it will be taken automatically by the machine or whether the program will prompt the user to enter the BP manually If NO BP is selected the user will NOT be prompted for blood pressure input unless the blood pressure tool button is manually executed Display Options Show This Window If selected the Stress dialog box will appear when accessing the Stress Test File gt Stress gt Perform Test or clicking
30. V cc Statements related to ectopic rhythm abi Statements related to predominant con Pacemaker types and pacemaker functi other rhythm related statements lt gt Descriptive axis statements ST T descriptive statements ischemic ST T changes compatible with ST T changes compatible with subepice GS non specific ST T changes alternative other ST T descriptive statements Atral statements lt gt Statements related to pediatric ECG ana Statements related to the ECG calibratio lt gt Technical problems test exercised on a Treadmill Simulated Treadmill for 1 49 minutes The total exercise time was 0 00 minutes during which the patient acheived a maximum heart rate of 70 BPM which was 39 of the age predicted target heart rate of 180 BPM i E tt The patient test s maximum exercise effort was 0 0 mi hr 0 0 grade 1 0 METS The maximum blood pressure was 178 67 The maximum double product was 12460 i i The patient test s ECG showed 8 leads with ST elevation variation greater than 1 mm These are IL Ill aVF Y2 V3 Y4 YO VE The maximum ST elevation variation was 2 4 mm 0 17 i M3 The patient test s ECG showed 1 leads with ST depression variation less than 1 mm These are aYA The maximum ST depression variation was 1 0 mm 0 17 avR 4 4 4 4 4 l Ga 8 14 12 Computer Interpretation T Kevin Miller exercised on a Tr
31. ad1 fi DI Lesdilv v Leaddlvs Le IV Print Grid ST Values Gain 10 mv DI Speed 257 s DI ST Point STED DI Lead fi DI LaadZiv2 Le Lead3 V5 DI mm mi uv Hi Res Complex Vector Magnitude li Trend Gain 10007mv v Speed 200 s e Leadi v2 _ Location Hewlett Packard Large Logo C Program FilesyPulse Biomedical 400 pbilogo2 bmp 2304 x 360 Small Logo C YProgram FilesPulse Biomedical 400 pbilogo1 bmp 608 x 232 Cancel Apply Help Complex e Gain defines the Gain for ECG complexes to be printed on the Stress or Hi Res ECG reports Options are 5 10 20 or 40 mm mV June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 68 Speed defines the Speed for ECG complexes to be printed on the Stress or Hi Res ECG reports Options are 25 50 or 100 mm sec Lead 1 defines the Ist complex lead to be printed on the Stress or Hi Res ECG reports Lead 2 defines the 2nd complex lead to be printed on the Stress or Hi Res ECG reports Lead 3 defines the 3rd complex lead to be printed on the Stress or Hi Res ECG reports Gain defines the Gain for the ECG to be printed on the ECG reports Options are 5 10 or 20 mm mV Speed defines the Speed for the ECG to be printed on the ECG reports Options are 5 10 25 or 50 mm sec Lead 1 defines the 1st ECG Lead for the three lead ECG reports Lead 2 defines the 2nd ECG Lead for the three lead ECG reports Lead 3 defines the 3rd ECG Lead for the t
32. ailable an Prints the displayed page S Inserts beats Selec _ Adds a custom episode to the selected beat Scans beats When pressed twice it stops scanning Allows toggling with rhythms and complex screens Measures beats rid Enables grid display Default setting Displays heart rate values instead of RR intervals Default setting Mrs Tahira 3 29 2004 7 49 00 PM El TREE Becca LL Le mj 5 2 1 a fe a sO EES BES ee SS dE HEBEEEEBE E Aa pon i fre Rhyt SZ 2 Edit Ser S EE Ah gn ky rain sg Pt Ng HIT Tl maa a aa ASHA AE HEB EE AE GE SE PO oe Go EE E eee E e Eo n ren ven ze ee pen men rem ann Yon EEIZ ET FEY ESEYE Fee kaan revere AA KR a eee GE bt LANA RA June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 44 Episodes e From the View toolbar press M a OR e From the Dataview Screen select View gt Episodes OR e Use the Hot Key F3 The Episodes Screen enables the user to review ECG data through the R R interval window and the trend window Data in both windows is synchronized with the Rhythm Edit Screen as the user highlights the data As the ECG data is analyzed the Episodes are evaluated against predefined criteria and are stored in the following categories Fastest Rates Slowest Rates Bradycardia m Pause Isolated VEB m VEB Pair m VEB Run Bigemny m SVEB Pair L SVEB Run Recorder Episode STe Abnormalities
33. an nnaman p 19 c Data View p 21 e SAVUP aa p 25 10 Stress ECG as Modes EE p 27 b Starting EE p 28 Data VIENNE p 31 AG SAUP E p 35 11 Holter System a Downloading Holter Data p 38 De Ua 2 Aune isete p 40 c SU iia aaa taaa p 52 d Reclassifying ennenen p 55 e Screen Functions p 58 12 ABPM a Downloading Data p 63 b Data View Screen p 65 Ce SOU EE EE p 67 d Logs Menn p 82 QRS Card Cardiology Suite 4 06 Software Installation June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 9 The first time you use the system you need to install the QRS Card Cardiology Suite software by using the Setup file on the QRS Card Cardiology Suite software CD Once the software is installed you will be able to use the QRS Card Cardiology Suite for Resting Stress Holter Ambulatory BP and Spirometry It will take approximately 3 to 5 minutes for all of the directories to be created and for all of the files to be copied to your computer hard disk In order to install the QRS Card Cardiology Suite software the following steps are required 1 Switch on and boot up your computer with Windows XP Window 2000 or Windows Vista 2 Insert the QRS Card Cardiology Suite software CD into the CD drive 3 Follow the instructions on the screen 4 Once the installation is complete you are ready to start using your computer for Resting ECG Stress ECG Holter ECG 24
34. ark Strips These control which ECG strips are marked or unmarked Marked strips are included the Holter report When a strip is selected marked it s start time is highlighted in yellow e Mark All Used to mark all strips in a category e Unmark All Used to unmark all strips in a category e Toggle Used to Mark or Unmark the current highlighted strip Click on a strip to highlight it Strip Sorting Criteria These controls are located above the top most ECG strip These are used to control the order that strips are displayed in the window e Time Used to sort the strips in chronological order e Prematurity 7o Used to sort the strips according to the degree of prematurity e Duration seconds Used to sort the strips according to the strip duration June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 59 The Rhythm Edit Screen contains the following controls along the top of the window e Reclassify Buttons N V S B Pa Pv Pav A X Used to reclassify beats e Gain Used to select the ECG gain Choices range from 1 50mm mV e Speed Used to select the ECG time interval displayed in each pane Choices range from 7 5 60 seconds e Measure Used to activate on screen calipers for interval and amplitude measurements e Print Used to print one page review screens e Insert Enables you to insert new beats by clicking in the Edit pane e Select Used to manually select ECG strips to be included i
35. ary button provides summarized data for ECG measurements and automatic ECG Interpretation Table provides different amplitude measurements from all 12 ECG leads General provides ECG Complex measurements Moving measurements marker using left mouse button user can manually over ride the automatic ECG measurements P Wave provides P wave measurement markers Use the left mouse button to move the marker to override automatic P wave measurements ORS Wave provides QRS Complex measurement markers Use the left mouse button to move the individual marker to override automatic QRS Complex measurements T Wave provides T wave measurement markers Use the left mouse button to move the marker to override automatic T wave measurements Hypertrophy provides Hypertrophy scores for Sokolow Lyon Cornell and Estes Interpretation provides computer generated Automatic ECG Interpretation Typing free text or accepting statements from the Statement Library can override this Automatic ECG Interpretation box Note For the Automatic Computer Interpretation to work in the Resting test this option has to be selected in the Resting Setup The Interpretation property sheet shows the computer generated interpretation The user can also enter a personal interpretation Click on the arrow from the computer interpretation box to enter that into the Physician s Interpretation box Other interpretations are available in
36. atabase Berwick Scranten North Philadelphia June 24 2009 QRS Card Cardiology Suite 4 06 Rev A Update Delete Export Import 76 PBI QRS Card Cardiology Suite 4 06 Rev A W Technician Database June 24 2009 A John Mabrito Christine Hilante A Henry Muller Ai Update Delete Export Import TI PBI June 24 2009 Import ORS Report Look ir YANO w Mu Recent Documents Desktop Mu Documents Mu Computer Mu Network Places Ahaler 7 G tter 8 Ahalter 9 Gitokter a File name Files of type Eh 0 Dt abpm RApy_hires Git halt Dit rest RApy_spiro pw stress spiro 1 spiro spira 3 Eistd3 n Aistaz 1 RAstd3_2 RA tdox 0 SA td6x 1 RAstdi2_0 GAstdi2 1 GAstdiz 2 RA stdi2x1_0 GA str 1000 eal str 1001 RA str_1002 Astr 1003 Astr 1004 RA str_1005 GA str_1006 QRS Card Cardiology Suite 4 06 Rev A Astr 1007 SA str 1008 RA str 1009 Astr 1010 str 1011 RA str_1012 Astr 1013 Astr 1014 Astr 1015 Git 1016 ed str 1017 DAS Reports rpt Open as read only Cancel Help 78 PBI QRS Card Cardiology Suite 4 06 Rev A 79 Queue System Select Utility gt Queue System then the property box will appear The Queue System places the ECG traces from the Patient Tests database in the queue system At a later time the user can dump the queue to a printer E mail the traces or exp
37. d Cardiology Suite Enu 4 d NG S D i A nt Referred By Recorder qrs demo adv SN GE rev NG ES Record 5 25 2004 8 09 PI Medication HR 86 BP 5 25 2004 test10 1212 Ee 5 23 2004 cvb 7 121211 MEAN PR 150 ms A Stress ECG 5 23 2004 9 37 PM ORS 92 ms OT OTC 329 ms 394 Speed 25 mm s Gain f mm mY STOP ms STe unit mm STm unit my s Filter Gt Hz Ba avR vi va Technician we 5 23 2004 nml 435511 EN 5 20 2004 CopyDXP 1212 1 BE 5 20 2004 7 rest2 1 za Resting ECG 5 20 2004 7 57 PM 5 20 2004 testingl 232 1 5 20 2004 tesiDSP 4 121201 5 20 2004 test9 212 1 LAN 5 17 2004 jack 4 34311 S 5 17 2004 Check 3434 1 Gi 5 17 2004 itp 8908 1 5 17 2004 go 08001 5 17 2004 hhh 35345 1 5 17 2004 ggg 24201 5 13 2004 testSP 121 1 5 13 2004 vw 21212 j 00 5 1 2004 naf 121 2 Patient Preview A Stress ECG 4 22 2004 7 49 PM gh Stress ECG 5 1 2004 10 29 PM SEN n testben 1201 Database EE 4 26 2004 hhh 4 242 1 AN Stress ECG 4 26 2004 6 30 AM EN 472572004 mB 5576 1 Dou AA Stress ECG 4 25 2004 10 54 PM HO 4 25 2004 Xiao mb 23234 1 4 25 2004 sde 121211 sy 4 22 2004 W 1234987 1 aE 4 22 2004 uuu 121 1 m 41872004 XaioAT 121212 1 m 471872004 testa 12121 0 471672004 AHAI 142454e 1 EN 4 1 2004 testsh 7 7801 DOO a a a D
38. dard desktop or notebook computer Results of the tests can be viewed on the computer color screen and printed automatically or on demand at any time during a test The results of the tests can be saved on the computer hard disk for future referencing or report generating The QRS Card Cardiology Suite is programmable for treadmill and Ergometers controls Input of blood pressure can be performed automatically screen prompts or direct interface to BP device at predefined intervals QRS Card Cardiology Suite Components and Assembly Depending on the total number of Cardiology Suite Modules you have purchased the suite includes the following hardware and software components Resting and Stress ECG System 1 QRS Card ECG device 2 ECG Patient Lead Wires 3 QRS Card M data cable USB or Serial 4 QRS Card Cardiology Suite Software CD 5 User s Guide 6 Quick Reference Card 7 USB Security Key with Product ID Number PID See Quick Reference Installation Guide for Hardware Installation and Setup Holter ECG System 1 Holter Recorder 2 Holter ECG leadwires 3 Holter Recorder Pouch 4 Holter recorder data cable or flash memory card reader 5 QRS Card Cardiology Suite Software 6 User Guide 7 Quick Reference Card 8 USB Security Key with Product ID Number PID See Quick Reference Installation Guide for Hardware Installation and Setup June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 7 Ambulatory Blood Pr
39. der this setup Print ECG e This Print button is only applicable if the Exit When All Tasks Completed box under the Resting Setup is not selected e During Normal Resting ECG this option is not necessary because the 10 Seconds ECG trace is automatically saved and can be printed automatically or manually Note Only one kind of report can be printed with this option and it requires a HP PCLS printer attached to computer for printing this report Finish Test e This Print button is only applicable if the Exit When All Tasks Completed box under the Resting Setup is not selected e During Normal Resting ECG this option is not necessary because after ECG Trace Resting ECG Acquisition is automatically terminated after 10 seconds June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 21 I 11 28 2005 tesat 112101 5 11 28 2005 Hz500 121 613 OG 1 28 2005 stadrer 1212 13 a BSE EC a 1 28 2005 test 1121 1 H ECG Patient Tabular Heart Reports 4 Blood P D at a a D ata H Help Pa Rate bs ressure H uges Karen 6 7 2004 7 21 07 PM 3unsaY n Ie ja co EE PA bt td KALA dd MAI A EA Resting DataView June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A i 12 Id yi 10 mm m Print F DD ard HRA June 24 2009 22 PBI QRS Card Cardiology Suite 4 06 Rev A 23 Summary Pressing the Summ
40. drag the R waves that you want to include e Click the desired reclassify button to reclassify to reclassify the beats e The selected beat s will be reclassified or deleted if you click on A or X The beats can also be viewed in the multiple view mode To Reclassify Multiple Beats 1 Select the template class VE Normal SVE etc 2 Select the desired bin 3 Click view button to Toggle view single multiple template beats in the Rhythm Edit Screen 4 Select the template beats you want to edit by clicking on multiple beats or clicking Mark Row Mark Page Mark All 5 Click N V P A S B or X to reclassify the beats The selected beats will be reclassified and the Rhythm Edit Screen will be updated with the remaining template beats in the selected Template pane Click to Toggle between ge Multiple Beat view heal rom S June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 56 Reclassifying Single and Multiple Episodes The Episodes Edit window allows the user to edit Episode data and reclassify Episodes Episodes classifications are indicated as follows N Normal v Ventricular Ectopic Beats H a Supreventricular Ectopic Beats Aberrant R Atrial Paced echt Ventricular Paced 2 v Atrio Ventricular Paced Beats that are in segments too noisy to process To Reclassify Single Episodes e Select the Episode s from the Episodes list that you want to reclassify in Rhythm Edit Screen To se
41. e N Beat Detect Pacemaker Leader ms 1000 Trailer ms 1000 Minimum Seperation ms 5000 Configure Beat Detection From the Dataview Screen select the Measure drop down menu and select Configure Beat Detection Parameters This option allows the user to edit beat template parameters Switch between tabs to set parameters for desired beat types June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 54 Configure Episode Detection ea kl Mel br VEBiso Ah VEB par Ab VEB Tipt venn ii Bigeminy Bei Trigeminy al Guadrigeminy IL Il SVEB pair IL sveeTnpiet LU SVEB run N Pace WY Pace NM Pace DE Pace H Pace ULE Pace a STe O fast e sou M Tahy UI Brady E Pause ao YA a Reset NESEN Geen AHHH Consecutive Beats 10 Interval m 15 June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 55 RECLASSIFICATIONS The Rhythm Edit Screen allows the user to edit ECG data and reclassify beats Beat classifications are indicated as follows N Normal E E Ventricular Ectopic Beats Ss Supreventricular Ectopic Beats f D Aberrant I wa Atrial Paced D Ventricular Paced AV Atrio Ventricular Paced A Beats that are in segments too noisy to process To Reclassify Single Beats e Select the beat s from the Bins that you want to reclassify in the Rhythm Edit Screen To select a single beat click on the R wave To select multiple beats
42. e monitor Operation of the computer under low mains voltage conditions is established by the user s computer choice Use only UL listed computers to avoid this potential problem If the QRS Card fails please refer to the troubleshooting section in the user manual To acquire good quality ECGs only use AAMI EC 12 approved electrodes Before cleaning the QRS Card disconnect it from the PC To clean the QRS Card use warm soap and water and surface disinfectant only Do not immerse the QRS Card in the cleaning solution Permanent damage to the QRS Card may occur June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A NG IMPORTANT NOTICE Acquiring good quality ECGs depends upon 1 ECG equipment quality of equipment 2 ECG technician operator experience 3 Patient patient electrode preparation 4 Environment low electrical interference PBI has provided you with a high quality QRS Card Cardiology Suite device When the QRS Card Cardiology Suite is used in conjunction with a computer to acquire ECG data from a patient 1 Itis important that the computer you are using with the QRS Card Cardiology Suite be of high quality with low electrical noise generation If you have not purchased your computer system from PBI or do not have the list of approved low noise computers in the marketplace please call us for assistance 2 Itis important that the Electrical Ground to the AC mains be properly grounded and in good working
43. e system is a fully integrated true 32 bit Microsoft Windows product In addition to the current Resting ECG and Stress ECG the company has developed software for signal averaged high resolution ECG PBI s Resting Stress and High Resolution ECG use the same QRSCard hardware components PBI owns all proprietary hardware design and has complete ownership to the source code for its software including its own automatic ECG measurement algorithms automatic ECG interpretation algorithms and high resolution signal averaging ECG software PBI sells its products through independent dealers on a worldwide basis In addition to the U S FDA clearance the company s products are approved in Japan and China and have the current European CE mark The company has sold its products on an OEM basis to a number of companies including Ergoline exercise bicycles and Jaeger pulmonary stress in Europe and for use with catheter laboratory products by EP Medical and by Cortet in the U S PBI has licensed its technology to Intermedics for use with their new pacemaker programmer The company works closely with its OEM customers and in particular has integrated its stress product very closely with the Jaeger pulmonary stress product OxyconTM The QRSCard Cardiology Suite is currently used in the United States Canada and over 50 countries around the world June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 3 DISCLAIMER OF LIABILITY PULSE BIOM
44. eadmill Simulated Treadmill for 1 49 minutes The total exercise time was 0 00 minutes during which the patient acheived a maximum heart rate of 70 BPM which was 39 of the age predicted target heart rate of 180 BPM pa Original Report not overead F Overread Report not confirmed Confirmed Report ORS Card Cardiology Suite Enu 4 00 T Analyst vi I Physician D 3 14 2005 gt 3 14 2005 gt 3 14 2005 D 8 45 40PM 3 14 2005 8 45 40PM Se I pe ES lt Ka ji E Summary Table Interpretation June 24 2009 33 PBI June 24 2009 S Report QRS Card Cardiology Suite 4 06 Rev A Select Report m 1000 1001 1002 1003 kal 1004 11005 O 1006 1007 O 1008 kal 1003 kal 1010 11011 11012 fa 1013 11014 11015 1016 1017 Gs stress ECG Segment 3 lead Stress ECG Segment 12 lead Stress ECG Result Table Stress ECG Summary Report Stress ECG Summary Report Classic Stress Stage ECG Complex Summary Stress Stage ECG Rhythm Summary Stress Phase ECG Complex Summary Stress Phase ECG Rhythm Summan Stress ECG Full Disclosure Stress Test Trends Stress Stage ECG Rhythm Summary 3 L Stress Phase ECG Rhuthm Summary 31 Stress ECG Selected Segments Review Screen Stress ECG Summary Report Europe Stress Stage ECG Rhythm Summary Cla Stress Stage ECG Rhythm Summary Cla Show Details Cancel
45. en to start Holter ECG procedure Press OK button to start downloading and Analysis of the Holter ECG Enter Patient demographic data while Holter data is being downloaded Highlight patient from database listing then double click to View Edit and Print reports Edit any Bins Episodes and Strips if necessary 0 Print Reports Ee a PO NAN ki Configure Holter Download Procedure x Device IR ge KANG Record C Documents and Settings PBI SHAJANI Desktop OMI ECG IV Show this window IV Enter patient demograhics After Download C Exit Edit C Print Default Report Holter ECG Summary Report 13010 Holter ECG Result Summary Report 13020 Holter ECG Hourly Summary Report 113030 Holter ECG Trend Report 113040 Holter ECG Selected Segments Report 113050 Holter ECG Full Disclosure Report 13070 Holter ECG Result Summary Report pa 13080 Holter HRY Report QT Report MM Holter ECG Mrs Tahira 3 29 2004 7 49 00 PM File Measure View Logs Help CS ladde e d Me Isle view A summary TA Sin Ge report delle PA HAN PAN NG Ay Beats Ja Episodes L Page Strips Nuas Y 7 Sss Bo Po Poo Ba A115 Qs 1 22 1 6877 1710 1 125 Sr Be were en rer aden Cadet Ss coun Mn 6 17 46 AM m it HalterProcedure June 24 2009 re HOLTER ECG 14 PBI QRS Card Cardiology Suite 4 06 Rev A 15 Quick Start WARNINGS US
46. er ECG download After Download e Exit If selected the main software screen will be displayed after download e Edit If selected the Holter test will open for editing after download e Print If selected default reports will be printed after download Default Report The reports that will print after Holter ECG data is analysed Selected reports can be printed automatically or manually as default reports to a printer attached to the computer Upload Patient Data Patient data can be uploaded to the recorder Note Only if recorder supports this option Beats Opens the Configure Beat Detection dialog box Episodes Opens the Configure Episode Detection dialog box Reset Resets setup to default positions June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A HOLTER SYSTEM FEATURES Standard features include Accurate arrhythmia analysis Preset artifact detection Simple user interface Fast load and analysis Color coded beats and trends Full disclosure 24 or 48 hours 3 channel ST analysis Split screen superimposition Multiple report formats Multiple format page mode Network compatibility Optional features include For the Tools option select the Toolbar icon Select this to view or edit information about the patient and trace recalled from the database HRV Heart Rate Variability analysis 12 lead ECG analysis Pacemaker function analysis QT analysis Holter ECG data and access the fo
47. es to be printed 1 to 6 pages or a continuous printout Start the Stress test Click on the Print ECG icon and June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 37 the printout will start from that point If Continuous is chosen the printout will continue until the Print ECG icon is clicked again Protocol If selected an ECG trace will be printed for each time specified by the protocol Final Specifies the type s of final reports Target Heart Rate Defines whether the Target Heart Rate is to be calculated from the patient s age or be manually assigned ECG Acquisition Recorder Defines if the signal is coming from a QRS Card a simulated device QRS demo or a remote QRS Card Sample Rate Defines the sampling rate per second Length Defines the length of the ECG trace in seconds that is saved Average Cycles Defines the number of beats averaged to make a complex ECG Save Strips Allows the user to mark and annotate abnormalities during a Stress ECG Test Terminate Strings Screens Ends the Stress ECG Test so the user can review any annotations that have been made Defines Default parameters for Screen display e g Gain Speed Lead Display etc for Acquisition and Dataview Screens See Quick Reference Installation Guide for more help and details Protocol Editor See Protocol Editor Defining a New Protocol Protocol Information Updating a Protocol J
48. essure LC WARNINGS US Customers will be supplied with ONLY software supplied by the device manufacture and not the Cardiology Suite ABMP software module Ambulatory Blood Pressure Recorder 2 Blood Pressure Cuff 3 Recorder Carrying Pouch 4 Data Cable serial or USB 5 QRS Card Cardiology Suite Software 6 User Guide Supplied on Software CD 7 Quick Reference Card 8 USB Security Key with Product ID Number PID For Hardware Installation and Setup see Quick Reference Installation Guide Spirometry LC WARNINGS US Customers will be supplied with ONLY software supplied by the device manufacture and not the Cardiology Suite Spiromtery software module 1 DE TS AN CO June 24 2009 Spirometer Disposable Mouth Piece Data cable Serial or USB QRS Card Cardiology Suite Software User Guide supplied on software CD Quick Reference Card USB Security Key with Product ID Number PID For Hardware Installation and Setup see Quick Reference Installation Guide PBI QRS Card Cardiology Suite 4 06 Rev A Table of Contents 1 Software Installation p 9 Quick Start 2 ROSU EE p 10 3 Resting ECG Flow Chart p 11 di Sres E EE p 12 5 Stress ECG Flow Chart p 13 6 Holter BEER p 14 Te ABEM de p 15 8 Master Screen p 16 Full Instructions 9 Resting ECG a NG Co eege deeg p 18 b Starting a Test an
49. etup or Press CTRL F2 See Quick Reference Installation Guide for more details 4 Press Resting ECG button or Hot key F2 on the Main Software Screen 5 Type in Patient demographic data If Setup screen is displayed press OK to go to patient demographic data input 6 Press OK button to start acquire Resting ECG 7 ECG report will be printed manually or automatically Select printing preferences under Resting Setup l Print ECG ECG Heart Blood Save Strip fnot Auto Print Finish Test Measurements Rate Pressure If not Auto Save If not Auto Save J EB acquire Kesling LCG gaan d HENS e e de a PRET Sch Pous YA di fr KAT A EM otan VISS 76 4187 78 0 37 fre bumiugt 25 mund TEM n RT Ve DAA LOMAA LOM AARM i ii i LI I dt Lines Leas E Cones Lo CARA ROMMEN maai kumi ER At ka EL HI ki Na ka d la E A Tut Nd NG it C ki fs es EE EEE d HaHa di Ce EEE EE EE HHH Co TE i EEN A bech m l a EEE i gm a en i i om i a AAA LG Ili ya Sal k Bi a L pa La m LUES di DIL Ik z YA PE gt Hr ree 8 at Aye AE NA der Kl Seene NANG H KTT sf Ka l pR CEET 5 vo e jwi e D Ht 2 AA ye ent AN onon Ve a E a GN nd ila HEH SEE E ER Ee EG EE r At oH RA n CH 4 ik Lace ara e A NG MENTI Resting ECG Acquisition Patient ECG Tabular Data ata Data ges Karan 6 7 2004 7 21 07 PM
50. he Queue System is accessed a message Retrieving message X or X will appear if an e mail has been sent since the last log in onto the Internet The Mail In option in the Available Queue box will show the number of messages Highlight Mail In and click on Dump Queue The messages will be dumped directly into your database Note Be aware that the time on the encounter is when the test was taken and not when it was e mailed or dumped into the database Queue Export Selecting the Export Queue option will allow the user to export ECG traces to an external file To export a file or files double click on Export under Available Queues or highlight Export and click on the Add button The Add Entries to QRS Export Queue Dialog Box will be displayed Select the file s to be exported and click on Add Encounter Click on the Close button to exit this dialog box The files will be copied to the Export Queue Select Dump The selected files will be exported into the Windows Temporary TAMP Directory Queue Import Selecting the Import Queue option will allow the user to import ECG traces from an external file To add to the Import Queue double click on Import under Available Queues or highlight Import and click on the Add button The Add Entries to QRS Import Queue Dialog Box will be displayed Select the file to be imported and the format to be used and click Apply June 24 2009 PBI June 24 2009 QRS Card Cardiology Suite 4 06 Rev A 8
51. hree lead ECG reports Hi Res Complex Vector Magnitude June 24 2009 Gain defines the Gain to be printed on Hi Res reports Options are 50 100 500 or 1000 mm mV Speed defines the Speed to be printed on Hi Res reports Options are 50 100 or 200 mm sec PBI QRS Card Cardiology Suite 4 06 Rev A 69 DATABASE The Database Property Sheet allows the user to select the location of ECG data files and the names of the individual files This property sheet can be accessed by the following method Select Utility gt Configuration and select the Database tab in the Configuration Setup property box Reporting Database Options EMR Real Time Print Email Medication Root C GRSDB4 Reset Browse Logging Root defines the default root directory for all ECG data files Below the Root are all the default database file names Browse allows change of the root directory Reset sets all parameters back to their factory set defaults Logging Customer Support may ask for this to be checked in order to pinpoint a problem Note ECG database is in published SCP format Each test is a separate file These files are stored in the qrsdb4 files folder It is important that the user backup these individual SCP files for data security purposes June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 70 wn mg oy agian Si 28 Reporting Database Options EMR Real Time Print Email Medicat
52. icular Ventricular Supraventricular Runs Ventricular Runs Bigeminy Tachy Brady Atrial Fibrilation Paced ST Interpretation Each table contains hourly results for each measurement and summary information for the entire record June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 53 Show Details mji3000 Holter ECG Summary Report Sie SC Holter ECG Result Summary Report Pier Cancel Holter ECG Result Summary Report B Output Holter ECG Hourly Summary Report Holter ECG Trend Report HP LaserJet P10 Holter ECG Selected Segments Report PCLS5 Printer Holter ECG Selected Segments Report PDF File Viewer Holter ECG Full Disclosure Report MS Word File Viewe Holter ECG Result Summary Report pac Holter HAV Report QT Report Holter HAY Spectral Report FT Use Color Henn Sipe 300 DPI x 300 DPI Print Using HP LaserJet P1006 Copy 1 16 PPM 0 KB 4 Printer outputs black and white only Printer permits 1 resolutions 600 DPI x 600 DPI Reports Dialog Box The reports dialog box is used to generate printed Holter reports Press the Report icon When the Print command is executed the Print report dialog box will be displayed The type of report desired can be selected here The system will then print the ECG Report This report format can also be customized For details on customized formats please contact a member of the PBI technical support team L 7 all Conte be Deresan a A Nois
53. ifact Rejection option is chosen by selecting Standard artifacts like those caused by muscle twitches will not be assigned as peaks Baseline Drift Reduction Drift of the baseline will be minimized Default Reports Selected reports can be printed automatically or manually as default reports to printer attached to the computer ECG Acquisition Recorder Defines if the signal is coming from a QRS Card a simulated device QRS demo or a remote QRS Card Selecting Try allows you to confirm the signal Sample Rate Defines the sampling rate per second Length Defines the length of the ECG trace in seconds that is saved Average Cycles Defines the number of beats averaged to make a complex ECG Demo Runs a demo of the test Reset Button Resets the setup to its default positions June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 27 Stress ECG STRESS ECG Topics Modes of Operation Starting a Stress ECG Acguisition Viewing a Stress ECG Dataview Stress ECG Setup MODES OF OPERATION During normal operation of the ORS Card ECG the system performs in either of three modes e Standby Mode The QRS Card Cardiology Suite Master screen is open and no selection of a test new or review has been made In standby mode certain operations like patient search adding a new patient or deleting a patient can be performed e Acquisition Mode The patient is attached to the QRS Card and the ECG data is d
54. ilable options are The HRV Lorenz plots General Tables RR Tables Spectral Tables June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A p Lu AFIB Aer Ins OT fa HRV Respiration Superimposition 50 Events 5 min F 12 00 AM 1 4 00 AM 1 8 00 AM 1 12 00 PM 1 4 00 PM 1 rome REN VS BBR BA Xo re ow jon Som ff LS UCI d Se BES mec TT EECH Hali JE TAHE kan hay ga Nan hj de Sekt ge ind Wee Lal Wain ett lan fi bcs tetas EE ETT EICH JANA Bunga OU AA i AG Et a Sanon a EN gaang Li ALA aj SIE m ba Mon kan WA Se Babe a RE RE EFE ETA e e A se GG HolterProcedure e From the View drop down menu select Tools OR e Press the Hot Key F7 KN e Select the tab that says Gen MANG LUHA el LE wa Iw al w l PN kwe MINE pues oo mwe g gen pay PETT naaa BASED EGG GANA KN t l Burak EE 8 00 PM 1 Alleged AN ANGER O TAR TANAY bill WE EAR Net BEEN SEA A SERIES SEBES SES SR fa a ee Above the Rhythm Edit Screen are the options to change the leads and reclassify the beats as well as the following wae De CC Print Prints displayed page a Insert Inserts beats E ji Adds a custom episode to the selected strips A Measure SE Measures beats Displays the Rhythm Edit Screen default setting Displays the heart rate default setting June 24 2009 Aal AA EASE DO PBI QRS Card Cardiology S
55. ion Reset Display Multi Tasking Warning Message PDF Program erch d32 exe Detect Command C Program Files Adobe Acrobat 7 0Reader coos wa June 24 2009 PBI June 24 2009 QRS Card Cardiology Suite 4 06 Rev A pp tre Configuration Setup Format None k Record Format C DCOM fF HL7 lw SCP File e grsdb4 Viles vec sop Template Record File Directory iri Report Format BMP IT Dicom PDF TIFF JPEG File c gredb4 reports ung fi Template Record File Directory w Demographic Window lw Display jw Edi Reference Format T ent TH lw PBI File Template Record File Name FTP Enable 19216801 Local n Remote wem User anonymous Password quest unknown 71 PBI QRS Card Cardiology Suite 4 06 Rev A 72 Configuration Setup Reporting Database Options EMR Real Time Print Email Medication Printer HP REZO g Format pcl5 hel Report pelbus rtt w Reset Scale Install Print Channels Gain 10 rann mA vi n Number 12 Speed 25 MME vi Install TM e Report aa e FWI w 104 e 11 v5 vi 121V6 e Cancel Apply Help June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A Ea Configuration Setup Reporting Database Options EMR Real Time Print E mail Medication Ce Disable E mail Internet E mail MAFI E mail Reset Server Information Incoming Mail P
56. isplayed in In Acquisition Mode Stress ECG data is acquired in real time The monitor mode displays an icon in the left hand corner of the title bar NG Begin Enter Save Demand Pause Finish nnotate Print Protocol Test Strip Advance Stage Recovery BP J WA Acquire Stress ECG Fis MAT Hd r koli KINANA NG na AN Gem SE Hp ITT Si 3 VE KUYA KKH ei A L LA S 12 LEADR Lo AVERAGE SI ER PIPI COMPLEX po LI Sin HR BP ST 2 FEE i efe Me aler pa SPEED ELEV O EE es EES eee fa EE A 7 i EER a KA E EE EECH ARRHYTHMIA E Bruce ET H Ju 10 0 4 6 0 53 Trace b Protocol KS rotoco ese Stress ECG Acquisition A Pre Exercise Snead METS Stage Time or Recovery Elevation Phase Time Heart Rate a JI 1505 e Dataview Mode In Dataview mode one can view previously acquired Stress ECG data Open a patient record to access the Dataview Screen For more details see Open Test Record d Full Page Rhythm View Complex _ Strips _ Trend ERPATS Mary 6 7 2004 7 29 14 PM PILI UA BAHALA Hel NET VETT TE ANNET RET A e CEET Hede budde OR KIRIA AR GA meee we see bg le lb bay bly bit KING pa LL PE EAR CLOSURE gt ybdebblekte KILI JANA AA Demand Print User Select User Select Strip Strip Ce HR or RR 3 eed 0 0 Elev vaton de HR 75 Systolic 178 Dia HR Syslulic Diasluliv a Eluvaliun RHYTHM F HAHHA
57. lect a single Episode click on the R wave To select multiple Episodes drag the R waves that you want to include e Click on the desired reclassify button to reclassify the Episode e The Episode s will be reclassified or deleted if A or X are selected Follow these steps to edit multiple Episodes using the Episode R R Interval Histogram e In the Episode List box select the Episode type that you want to edit e Drag the Episodes in the Episode R R Interval Histogram to select the range of R R intervals to edit e Click Toggle to view multiple Episode in the Rhythm Edit Screen if the screen is not already displayed e Select the Episodes to be edited by clicking on multiple Episodes or by clicking Mark Row Mark Page or Mark All e Click the reclassify buttons N V P A S B or X to edit the Episodes The selected Episodes will be reclassified and the ECG Edit window will be updated 7 Ee TINI NA 100 131 ms 8446 Events R R Intenral mms m 8 gt 0297 AM 1 42 27 PM 4 37 PM 4 az j 0 37 AM 2 8 59 52 AMIN ie n smi NVS BE Fk RA X wo o inn Zot Select ET san Blue A Measure fora Pin 99 n UE E Lt RAL He ET E NE STENEN SED EN it EN AU tle MAS ANT IT men HEAT HE NR EAT Mem n oct CIE TT TT FETT MD AR ge me Si pa TAI ae NLA AN TL et Se NA rN I a need Jer bn etd ae NA or HRDSER SEES RSRALRaa ed EE de ES HHHH SC EE eee IER al la June 24 2009 PBI QRS Card Cardiol
58. llowing options Beats Episodes WA Episodes Strips Strips June 24 2009 40 PBI QRS Card Cardiology Suite 4 06 Rev A A p bbolbes EOG PATIENT HAME Tuesday April 11 504 8 37 13 AM File Werme View Log Help Patent Tost Diay Modcaton signal Lag PATIENT MAME Fre Dwe of Dh NG kan SH BAN seff Telephone June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 42 In Holter ECG data view mode click View button to view downloaded Holter ECG data and access the following e Beats e Episodes e Strips The View Holter ECG module has been divided into the above parts to allow for easy navigation and reclassification of the Holter ECG data Beats e From the View option toolbar press r Beats OR e From the Dataview Screen select View gt Beats OR June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A A3 e Use the Hot Key F2 The Beats that match a particular template can be viewed by selecting the desired tab displayed above the template view window Beats are classified according to the software s algorithms and are defined as follows L Normal e Vv Ventricular Ectopic Beats o S Supreventricular Ectopic Beats D HE Aberrant e Bi Atrial Paced e n Ventricular Paced e AV Atrio Ventricular Paced e EX Beats that are in segments too noisy to process The Leads can be changed above the Rhythm Edit Screen and below the bins The following options are also av
59. m pa mmHg LI 4 39 mmHg 32 4b AA Se ba pa lt Aa ta U mmHg 61 Yo Diaslolic AN RA Day Dlastolic Sc pa mmiig 10 os mmg 20 nm 11 ba mmlig 29 03 mmikg 30 3 mmilg 63 po mmlig 53 loo mmi 42 a mma 26 oS medi D s Bit Blood Pressure Distribution Systollc Day Dlastollc Day Syslolic Night Diastolic Night G EI 50 42 30 40 Measurements 20 1D 0 fay gt Emm FEN e PON g Py PR SET Le En Pe PPP BPP 8 00 12 30 17 00 21 30 2 00 6 30 11 00 Blood Pressure Range mmHg June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 16 MASTER SCREEN Resting Stress ECG ECG Hi Res Holter Ambulatory Spirometry ECG ECG Blood Pressure Help EV a a a A3 QRS Card Cardiology tuite pls Le e JI JI ANN wei E y Oo E W m lt lt ame SYD pate Open E Print Gail I dd Spelet wo 6 6 2004 7 7 G Fe Delet Ei 6 6 2004 Stressl 776511 i gt Stress ECG 6 6 2004 4 53 PM Search by Print Add e ba 5 3 09 6 2 200 L 122 A 7 a a Wer PM Name ID Open Patient Re ori N p a Patient mi 5 26 2004 7 LLL 7 34343 1 me 5 26 2004 KKK 797901 or Date a ew Fatient G 5 26 2004 res size 123 1 3 Lap Resting ECG 5 26 2004 7 12 PM E 5 26 2004 enfct 8886 1 TEEN aminan i A Stress ECG 5 26 2004 5 13 PM Age NG Height NG Test pate ORANA 11 46 PM H je eight Ve gt AA A er m Sex NA Weight NG Software QRS Car
60. n the Holter report e View Switches the edit window between single and multiple Edit panes on the beats and Episodes tabs EWO rel fm N V SBP RE A Ko o Borin Hamer ne sen Bu The multi edit pane mode also contains the following additional controls e View Used to select the number of panes displayed when the window is toggled to the multi pane mode Choices include 2x2 4x2 8x2 and 12x3 panes e Mark Row Mark Page Mark All In the Beats and Episodes mode you can use these buttons to select multiple Edit panes during the editing process ks EmA Mm NV SB PRE PR X m o BI MakPage ER Makal p seet E Tip Double click in the ECG Edit window to toggle between single and multiple Edit panes June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 60 Editing Rhythm Data You can reclassify individual beats displayed in the Page window using the procedure described in Lessons Reclassifying Beats Follow these steps to edit multiple beats on the Page screen 1 Drag the beats on the page window that you want to edit 2 Click N V S B Pa Pv Pav A or X to reclassify the beats The selected beats will be reclassified and the Rhythm window will be updated Cranner 15 5 mmmv 1m 5 Press to view hide the Rhythm Edit Screen June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 61 Scanning ECG data Click Scan to s
61. n the resting setup mode click OK to start the test Patient Te Test ST Medication denbficabon ld 18773678 Browse Last Miter Fisi Michael Date of Bith fi D 31951 kisa iya Address Sie Church Road City Makta Stee CA Zip 09797 Telephone 714 666 6783 Cancel June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 20 Print ECG ECG Heart Blood Save Strip If not Auto Print Finish Test Measurements Rate If not Auto Save If not Auto Save ml Acquire Resting ECG Miller Michael ME R 0R CA RA 75 d is 34 KG POR F ze W 187 78 Pressure ae TE AAA ee is a bere uer L lt S ann Hai TEE HAT BEES Ges 594 suysay Epi AA E Halip pa papa SA pf id D SE EE oo NE se E ESE GE E Ka Resting ECG Acquisition Save Strip e The Save Strip option is only applicable if the Exit When All Tasks Completed box under the Resting Setup is not selected e Pressing this button Saves a 10 second ECG Strip e During Normal Resting ECG Test selecting this button is not necessary as 10 Seconds ECG trace is automatically saved Note Multiple Resting ECG traces can be saved un
62. ogy Suite 4 06 Rev A 57 8 Holter ECG PATIENT NAME Tuesday April 13 2004 837 13 AM delen ed File Measure View Logs Help Me elk View Gg Report si Save Help Ay Beats Al Episodes SS Strips 100 1317 ms 8446 Events RI R R Interval ms Events 0 267 533 800 9 49 AM 1 216 Events 8 37 AM 1 12 37 P 12 37 AM 2 4 37 AM 2 8 37 AM 2 8x2 D 5 mn gt 10m gt N V S B P R By A x Ki Ca SS Mark Page SG Mark All F Select scan Cl View Ti 1 EE 100 200 300 a S E Wi KN L mw A ES g HI a HolterProcedure June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 58 HOLTER SCREEN FUNCTIONS The Strips window contains the following controls Strip Category List Box The Strips list box is located above the ECG Data View window The list box displays ECG strips from the following categories e VPB e VPB Pair e VTAC e SVPB a OE eem e SVPB Pair e SVT Sense Failure o Lo e Pause Asystole a e Patient Event e Selected Strips e STe Deviation e Tachy Brady STe deviation 0 0 e Fast Rate Patient Event I a Slow Rate Display Strips These control which ECG strips are displayed in the Strips mode e All Use to display all strips for a category e Marked Used to display all marked strips from a category e Unmarked Used to display all unmarked strips from a category Mark Unm
63. order 3 Itis important that no electrical noise be generated by any equipment in the vicinity of the QRS Card Cardiology Suite ECG machine PBI has tested your QRS Card Cardiology Suite for the best ECG performance If you find electrical noise in the signal during a patient ECG please check the following before calling PBI s technical support line a Check that the patient is properly prepared and the lead connections are tightly installed b Check the ECG environment to see if there is other electrical equipment present that may be creating the electrical noise c Check your computer brand and model to make sure they are from an approved manufacturer Electrical noise can be controlled if the above noise detection steps are investigated and corrected For any further help please call Pulse Biomedical Inc at 610 666 5510 Before calling PBI please note the serial number of your QRS Card Cardiology Suite June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 6 System Setup QRS Card Cardiology Suite 4 0 Overview The QRS Card Cardiology Suite combines state of the art ECG devices which when interfaced to a Windows compatible personal computer convert the computer into a highly sophisticated Cardiology Suite Resting ECG Stress ECG system Holter ECG Ambulatory Blood Pressure Measurement and Spirometry System Physicians can run Resting Stress Holter Blood Pressure and PFT tests on patients using a stan
64. ort the traces to an external file one not connected to the QRS databases Using the Queue system the user can also receive ECG traces via E mail or import a trace from an external file After the test is complete the Queue System command can be executed by the following method E ORS Queue System The system will display the QRS Queue System dialog box e Dump Queue will dump the entire selected queue to the appropriate output device and the Queue Dump dialog box appears The Queue Dump dialog box shows the status of the queue dump Any errors that occurred will be listed e Delete Queue will delete all items in the type of queue selected e Reset Errors will reset any errors that occurred when dumping a queue e Add will display the appropriate Add dialog box for the selected output device See the Available Queues below for more information e Update will bring up the Update QRS Queue Entry dialog box Details of the selected item can be edited in this dialog box In particular the type of report selected for a particular queue item can be edited using this option e Delete allows the user to delete individual items from a particular queue 1 27 2005 9 54 PM 1 27 2005 9 55 PM 1 27 2005 9 57 PM 1 27 2005 10 00 1 27 2005 10 2 6 25 2003 10 11 1 27 2005 11 44 1 27 2005 11 45 1 27 2005 11 50 1 28 2005 8 04 AM 1 28 2005 8 06 AM ion E SDOCUME ICARDI ILOCAL S Temp
65. ote To see more about Editing and Viewing of Patient demographics information see Quick Reference Setup Guide June 24 2009 PBI June 24 2009 QRS Card Cardiology Suite 4 06 Rev A Full Page hythm Page e Trend View Complex Strips dem Stress Test Miller Mary 6 7 2004 7 29 14 PM V5 v 2mmimv z 15m v EBenem pA nd WAA AA A AE In NAA A Gabi g t Ltd tee av Demand Print User Select User Select Strip Strip 0 10 5 mm mv v 75s v 5m leasure print P Select EE Grid HR BJ x A eer Elevation 00 oos 5 TU ER NG HR Systolic Diastolic Speed Elevation RHYTHM TREND SE 08k 91 opseIg IYOJSAS YH oer e FULL DISCLOSURE RHYTHM TREND A StressProcedure Page Complex 32 PBI QRS Card Cardiology Suite 4 06 Rev A Strips Summary BB Stress Test Miller Kevin 3 14 2005 7 25 04 AM es Deen e a Me JC view Summary ye Report G Help aie l p Alaala Summary Table Interpretation Physician Interpretation Statement Library lt Normal Abnormal lt gt Ventricular Hypertrophy lt Myocardial Infarction lt gt Conduction disturbances Other QRS morphology or general descr Statements related to impulse formation lt gt Sinus node dysfunction atrial and A
66. r a Name ID or Date in a large patient database type partial name ID or data to jump June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A RESTING ECG Topics Modes of Operation Starting a Resting ECG Acquisition Mode Viewing a Resting ECG Dataview Mode Resting ECG Setup MODES OF OPERATION During normal operation of the QRS Card ECG the system performs in either of three modes Standby Mode This mode occurs when QRS Card Cardiology Suite Master screen is open and no test is selected In standby mode certain operations like searching for adding or deleting patients can be performed Acquisition Mode In acquisition mode the patient is attached to the QRS Card and the ECG data is seen in real time on the computer screen This mode supplies the functionality to acquire Resting ECG data The monitor mode displays an icon in the left hand corner of the title bar RK Print ECG ECG Heart Blood Save Strip If not Auto Print Finish Test M R a easurements ate If not Auto Save If not Auto Save Pressure IDA ABG Bail 2258 p ees el VE ae petra Sei use TELE A 76 d 187 78 0 37 fiz immy zamafe z 2 I YA 1 1 n se KE t 1 he io t taht t Pie on H H NAA E ES a ERE pe KA Les bk konmin dik ea an ce Wa Ve H Pte aces es E ren T d 5 Ve NI v3 es l A mn mu L 5 A AL 1 UR H L Q avRI YA gt i CC IK th ie il are ga es EE ERR a ki 7 Ng spe HH i i l i l E e
67. t v5 a 4 5 Ho HII ME Fantasia tun HI SEL SI EE EE Di une BB SEH la aVE V6 a n iA HEHHEHE a ARAL EH EL Ch AO aor CH pi EH Resting ECG Acquisition Dataview Mode This mode supplies the functionality to view previously acquired ECG data Open a patient s record to access the Dataview Screen For more details see Open Test Record Patient ECG Tabular Data 7 a Data t Reports Help Pa Blood Pressure VA Mala BIE SUNSA EEE DON d N 1 we Ty EN p EN ME H Resting DataView June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 19 STARTING A RESTING ECG TEST Start a Resting Test by using one of the following methods e From the standby screen select File gt Resting gt Perform Test OR e From the toolbar select OR e Use the Hot Key F2 Start a Resting Test by one of the above methods will cause the Resting Setup dialog box to be displayed IF the Show This Window box has been selected in the Resting Setup See Resting Setup After the Resting Setup dialog box the screen will display the Resting ECG Patient Information property box Fill in the appropriate Information in the Patient Test Information and Medication tabs If the patient has previously been tested the Browse option can be utilized Click OK The Electrode Placement Diagram will be displayed If the Show Electrode Position diagram box has been selected i
68. tart and stop scanning ECG data The current time in the record and heart rate are displayed in the top left corner of the Superimpose window The ST markers are displayed as vertical lines in the Normal Beats pane During scanning the position of the slider at the bottom of the display is continuously updated to reflect the relative position in the ECG record Tips e Use the slider to jump to different times in the record e To quickly re scan a section of ECG while scanning move the slider back the desired amount Superimpose Settings Change the scan rate and enable or disable individual panes in the Superimpose mode To change the scan rate e Move the Scan Rate slider up to increase the number of beats second bt s or down to decrease the number of beats second e The new rate is displayed above the slider Note that with the scan rate set to 250 bt s and an average heart rate of 70 BPM it would take 6 minutes to scan an entire 24 hour record To hide individual superimpose panes e Click the appropriate toggle button to hide unhide individual panes June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A Summary Screen Functions E Holter ECG PATIENT NA File Measure View Logs Help o General Supraventricular Ventricular Supraventricular Runs Ventricular Runs Bigeminy Tachy Brady Atrial Fibrillation Paced ST Interpretation General Interval Table Start Time Mm HR Avg HR Max HR Total Beats Total SVP
69. tocol Test ll Ser Jha at po D el IL kk Serre ete 3 S ee Ot a HL OC uer I EEA il a I H 12 LEAD RHYTHM AVERAGE St OI en REN IIPRENAEEN COMPLEX I de O Q Iy HR BP ST E KA eHh SPEED ELEV Ea Bai Ge h CC a HHH mn RHYTHMIA RHYTH Hang e 7 10 0 0 53 3 ga 53 D Trace being sav Li Protocol Stress ECG Sain pe Stage ed METS Stage Time a Se geg E Phase Time Target HR n Elevation Heart Rate Reference 85 7o 100 Page Full Page N HOW Complex Strips Na Ho _ Trend WA Stross Tost Millor Mary 6 7 2004 7 29 14 ny EIS 0 00 zmmimv hom gt Berth eared Slee es ere ee ace ee ee ce WA OU AN A A ONA AN Da EN AU FON A A DCS ML FA WI MI SEET AA kok A AA ALA Lb HETE NE Me Demand Print User Select User SE Strip 0 10 Speed 0 0 Elevation 0 0 A dra HR 75 Systolic 178 Diastolic 67 Ove ODE or os Dyogseig OA an FULL DISCLOSURE RHYTHM TREND Stress DataView Page Rhythm Trend June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 13 Stress ECG Flow Chart Start Stress Test A Easy Steps To Perform me 4 A Stress Test Patient Data BI 5 A Press Stress button to Start Test B Input Patient Demographic Data KT S C Acquire Pre Test Phase ECG Perform Gett Advance d 2 Zan Pre Test VENT F Stage y vi
70. uite 4 06 Rev A 51 Superimposition File Measure View Logs Help o ME e aw lal AFIB de ST la QT f HRV I Respiration ap Superimposition 8 38 31 AM 1 E scale scan la Aha Adar Zap Pifo bs fiso bys amp _HolterProcedure From the Tools option toolbar press ha Superimposition This screen allows the user to easily identify many kinds of ECG abnormalities such as changes in P R intervals Q waves QRS conduction and ST elevation by rapidly displaying QRS complexes on top of the preceding complex against a scale Therefore the user can use the Superimpose mode to quickly determine if beats have been classified correctly as any major fluctuations can be identified easily with the help of the scale June 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A 52 SUMMARY Holter ECG PATIENT NAME Tuesday April 13 2004 8 37 13 AN Measure View Logs Help General Supraventricular Ventricular Supraventricular Runs Ventricular Runs Bigeminy Tachy Brady Atrial Fibrillation Paced ST Interpretation General Interyal Table Edit Zero Start Time Total Beats Total SVPB Total VPB Pauses 8 37 AM 1 69 1563 0 0 0 9 00 AM 1 4200 0 0 0 10 00 AM 1 2682 0 0 0 e From the View drop down menu select Summary OR e Press the Hot Key F4 The Summary Screen displays useful quantitative data about individual parameters and includes the following tables e General Supraventr
71. une 24 2009 PBI QRS Card Cardiology Suite 4 06 Rev A HOLTER SYSTEM Topics Downloading Data Features Summary Reclassifying Beats Screen Function Download Holter Data Button 18 x HA QRS Card Cardiology Suite File Utility Logs Help Ahmed Bashir 2125 1 I Brohi Yasser 05151 1 004 TI 1111111 1 ISI2004 SHOHABE JHAINGER 11122291 gl gt ORS Card Cardiology Suite 3 20 Enu 3 20 005 M YASIN 10018 1 21 Holter ECG 1 18 2005 5 14 PM Patient M YASIN Test Details iji I5 ZIL E HUMA 10017 1 PID 10018 Test Site PBI Technician e 1 1 Hanif Mohamad 10016 1 Age 52 y Height NG Test Date 1 18 2006 5 14 PM 1 Raheela 10014 1 Sex Male Weight NG re PBI Holter S Cf i I Raheela 1014 1 Referred By der DXP1045 SN 13862 rev 4 0 1001 3 1 Yousuf Kheraty 1012 1 Medication 1 l var Hussain 1012 1 CSN D d Suleman 1 11 I Mohamad Al Zahid 10010 1 BEE Ch 117 Khatoon Hameed 1009 1 10 i Gi Speed 25 mat 8 Gam 1 mm mi utca Mone d 10 Hussain Abid 1007 1 hi 10 11 ABIDA 33215 1 oe 10 Raheem A 3612 10 Rafigan Bibi 9 Dr Khalid 9 Mrs Bliques 9 f Mrs Bilques 3442 1 H 9 9 h2 9 5654665 546 6546546 2 9 ahah fahfghah gfhfghfgh 1 d 9 test3 232 1 EH 9 9 f test f 232 1
72. y Suite 4 06 Rev A 30 To pause and manually control the exercise stage and the protocol press the button on the Stress Status Bar Note Pressing this Pause Protocol Button will display four additional buttons on the Stress Status bur These additional buttons are then used to manually control the Exercise Device Treadmill or Ergometer A To complete or stop the test press the button on the Stress Status Bar This button is usually pressed while in RECOVERY phase However this button can be pressed anytime during a test to FINISH a test or to STOP a Test NOTE In order to stop a Test in an EMERGENCY SITUATION use TREADMILL EMERGENCY STOP BUTTON REPORTS Selected reports can be printed automatically or manually to a printer attached to the computer If the PDF File Viewer is selected the report will print as a PDF file to the computer screen Installation of Adobe Acrobat 6 0 or higher on the computer is required The Save button from Adobe Acrobat Reader will save the report in PDF format to be printed or emailed if required Select Report Show Details B8 1000 Stress ECG Segment 3 lead Cancel O 1001 Stress ECG Segment 12 lead I 1002 Stress ECG Result Table O 1003 Stress ECG Summary Report 1004 Stress ECG Summary Report Classic Samsung ML 1740 Series I 1005 Stress Stage ECG Complex Summary PELS Printer O 1006 Stress Stage ECG Rhythm Summary C PDF File Viewer I 1007 Stress Phase ECG Complex

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