Home

HeartStart MRx EMS Monitor / Defibrillator Manual

1. Main Menu Displayed Waves Wave 1 II Size Start Data Transmit Pads x4 Volume Wave 2 I X2 Wave3 E Printed Waves Wave 4 II x1 2 Measurements Alarms Exit aVR x1 4 Patient Info aVL Auto Trends aVF Other V1 High Contrast On V2 Exit i 1012 iy Arrhythmia Monitoring 54 NOTE The HeartStart MRx uses the ST AR Basic Arrhythmia Algorithm Arrhythmia analysis provides information on your patient s condition including heart rate and arrhythmia alarms The HeartStart MR x uses the ECG lead appearing in Wave Sector 1 for single lead arrhythmia analysis Because the ST AR Basic Arrhythmia Algorithm is the HeartStart MRx s cardiotach source and is needed to generate heart rate and heart rate alarms the algorithm can never be disabled However if desired arrhythmia and heart rate alarms can be turned off During arrhythmia analysis the monitoring function continuously optimizes ECG signal quality to facilitate arrhythmia analysis The ECG signal is continuously filtered to remove baseline wander muscle artifact and signal irregularities Also if the Patient Paced status is set to Yes pace pulses are filtered out to avoid processing them as QRS beats measures signal features such as R wave height width and timing creates beat templates and classifies beats to aid in rhythm analysis and alarm detection examines the ECG signal for ventricular arrhythmias asystole Aberrantly C
2. Pressure Label Alarms Off Measurements PVC min Limit Logged when device is turned on if ECG alarms are on when settings are VTACH Limits HR _ changed or when ECG alarms are turned on value Run value ECG Alarms Off Logged when ECG alarms are turned off Primary ECG abel Logged for initial or change in primary ECG source Gain xY Logged for initial or change in ECG gain Learning Rhythm Logged when ST AR algorithm learns ECG rhythm SpO On Off Logged when device is turned on if measurement is connected and subsequently EtCO On Off when measurement is disconnected connected Pressure Label On Off Temperature Label On Off HR Limits low high Logged with measurement on event if measurement alarms are on when settings SpO Limits low high are changed or when measurement alarms are turned on EtCO Limits low high Pressure Label Limits source low high Temperature Label Limits low high AwRR Limits low high Pulse Limits low high SpO Alarms Off Logged when measurement alarms are turned off EtCO Alarms Off Temperature Label Alarms Off AwRR Alarms Off Apnea Time limit sec Logged when AwRR alarms are turned on and EtCO when settings are changed Pulse Alarms Off Logged when Pulse alarms are turned off Press 1 Press 2 Label Pressure Label Logged when a pressure label is set or changed Pressure Label zeroed Logged when pressure label is zeroed Pressure
3. No Shock Delivered Logged when discharge to patient fails Sync On Logged when Sync function turned on by user Sync Off Logged when Sync function turned off by user AED Mode Pause Resume Logged when the Pause for CPR or Resume Analyzing soft keys are pressed Analyzing Logged when advisory algorithm begins analysis Artifact Detected Logged when advisory algorithm detects noise or motion artifact Cannot Analyze ECG Logged when advisory algorithm cannot complete analysis sequence No Shock Advised Logged when a non shockable rhythm is detected Shock Advised Logged when a shockable rhythm is detected Pacer Pacer Mode Demand Fixed Logged when pacing is started and when mode is changed Pacer Start or Resume Logged when pacing is started and when pacing is resumed xx ppm xx mA Pacer Rate ppm Logged when rate or output is changed and maintained for 2 seconds while Pacer Output xv mA pacing The logged time will be the time the setting took effect If this event is logged out of order a will be appended to the time stamp Pacer Pause Stop Logged when the Therapy Knob is moved off the Pacer position while pacing Pacer Output Low xx in mA Logged when the pacer output is less than the selected setting by 20 percent or 10 mA whichever is greater 12 Lead 12 Lead Acquired Logged when action occurs 12 Lead Printed date time Logge
4. No Central duplicate monitor label Another bedside with the same equipment monitor label as the HeartStart MRx has already been connected to the Information Center Change the HeartStart MRx equipment label to be unique and assign it to the Information Center or turn the other device off Assigned Central is not available The Information Center assigned to monitor the HeartStart MRx is not functional Start the Information Center by powering on the PC No Central check software revision Software revisions on the HeartStart MRx and the Information Center are not compatible Verify that the Information Center revision is at Release J or beyond Central cannot identify this bed The Information Center can not identify this bed because of unexpected errors Verify the Information Center is configured to monitor the HeartStart MRx 317 Audio Tones and Alarm Indications The following table describes the audio tones and alarm indications when they occur and their meaning NOTE Alarm tone volume levels exceed 60 dB See the HeartStart MRx Service Manual for alarm signal pressure ranges Table 100Audio Tones Single beep Message tone Accompanies a new message on the display Informational such as switching to the other battery Continuous tone lower pitch than charged tone Charging tone Generated when the Charge button is pressed and continues until the dev
5. Table 39 Invasive Pressure Settings P1 Alarm Source Selects the type of alarm source Systolic Diastolic Mean Systolic High Limit Selects the systolic high limit value Adult 35 360 160 mmHg Ped 35 360 120 Adjusted in increments of 5 mmHg or 1kPa Systolic Low Limit Selects the systolic low limit value Adult 40 355 90 mmHg Ped 40 355 70 Adjusted in increments of 5 mmHg or 1 kPa Diastolic High Limit value Selects the diastolic high limit Adult 35 360 90 mmHg Ped 35 360 70 Adjusted in increments of 5 mmHg or 1 kPa Diastolic Low Limit Selects the diastolic low limit value Adult 40 355 50 mmHg Ped 40 355 40 Adjusted in increments of 5 mmHg or 1 kPa Mean High Limit Selects the mean high limit value Adult 35 360 110 mmHg Ped 35 360 90 Adjusted in increments of 5 mmHg or 1 kPa Mean Low Limit Selects the mean low limit value Adult 40 355 70 mmHg Ped 40 355 50 Adjusted in increments of 5 mmHg or 1 kPa Selects the default wave form scale Scale Adult 300 240 180 150 120 110 100 90 80 70 60 50 40 30 20 10 5 10 15 20 Pedi 300 240 180 150 120 110 100 90 80 70 60 50 40 30 20 10 5 10 15 20 Artifact Suppression Specifies the duration for suppressing pressure alarms due to non physiological artifacts An INOP is 30 sec 60 sec 90
6. NBP Equip Malfunction INOP NBP hardware failure Call for service of the NBP module Do not use the NBP monitoring capabilities If NBP monitoring is essential to patient care take the device out of use NBP Service Required INOP The NBP module has reached its end of life defined as 50 000 cycles Call for service of the NBP module Do not use the NBP monitoring capabilities If NBP monitoring is essential to patient care take the device out of use Measurement cycle doesn t automatically start NBP is not configured for automatic measurements Check modify the configuration as needed Automatic measurements are not scheduled for the current patient Use the Measurements Alarms menu to define an automatic schedule of measurements for the current patient The Start NBP soft key has not been pressed Press the Start NBP soft key The pump operates but the cuff does not inflate or fails to inflate fully Defective cuff Replace the cuff Poor connection between the cuff and the HeartStart MRx Check connections and replace tubing if needed NBP measurements appear high low The cuff size is too small large for the patient Use the correct cuff size Table 84 SpO Monitoring Problems The SpO waveform is not displayed The sensor is not properly connected or the sensor cable is damaged Check the sensor connection and cable T
7. Therapy cable not attached Pads paddles connection compromised Make sure the therapy cable is connected and the pads paddles are making proper contact with the patient Maximum Energy 50J message Attempted delivery of greater than 50 using internal paddles Only energies up to 50J are available for internal defibrillation Select a lower energy No Shock Delivered Replace Pads Now message Faulty pads or poor pads application to patient Low impedance Make sure pads are applied properly If the problem persists replace the pads No Shock Delivered Press Pads Firmly message Poor pads contact with the patient High impedance Make sure pads are applied properly Firmly press pads on the patient s chest No Shock Delivered Low High Impedance message Poor paddles contact with patient skin Paddles failure Make sure paddles are making adequate contact with the patient s skin If the problem persists replace the paddles Pacer Equip Malfunction INOP Pacing hardware failure Call for service If pacing functionality is essential to patient care take the device out of use Press Charge Before Shock message The device is not charged to the selected energy Make sure the desired energy is selected Then press the Charge button Press Shock Buttons on Paddles message The Shock button on the device is disabled because external paddles or sw
8. LA L placement directly below the clavicle and near the left shoulder LL F placement on the left lower abdomen LL F x Red j Green Figure 34 shows the typical electrode placement for a 5 lead ECG set Figure 34 5 lead Placement RAIR RA R placement directly below the clavicle and near LA L he right shoulder wrigRed a Black ii N lar J NN allow LA L placement directly below the clavicle and near the left shoulder V C i Brown A i RL N placement on the right lower abdomen Whieg LL F placement on the left lower abdomen V C placement on the chest the position depends on LL F our required lead selection See Figure 35 RL N He Reg nt See Figure 35 Gred e ot Re CET i 51 The V C lead may be placed in any of the precordial electrode positions as shown in Figure 35 V1 Cl through V6 C6 Figure 35 V C Electrode Placement V1 C1 placement fourth intercostal space at right sternal margin V2 C2 placement fourth intercostal space at left sternal margin V3 C3 placement midway between V2 and V4 V4 C4 placement fifth intercostal space at left midclavicular line V5 C5 placement same level as V4 on anterior axillary line V6 C6 placement same level as V4 at left mid axillary line For accurate V C lead placement and measurement it is important to locate the fourth intercostal space as follows 1 Locate the second intercostal space by first palpating the Angle of Lew
9. Secondary DNS Typically not needed but may be required by nnn nnn non nnn blank some cell phone service providers http Proxy Address Typically not needed but may be required by 15 characters blank some cell phone service providers http Proxy Port Typically not needed but may be required by 15 characters blank some cell phone service providers 215 Table 56 Data Transmission 12 Lead Settings Hub Server URL Hub server address Available from your ISP 40 characters blank User Name http user name Use your web server 30 characters blank documentation to create user accounts on the hub Password http password Use your web server 40 characters blank documentation to create user accounts on the hub Table 57 Data Transmission 12 Lead Settings Sites Site Name This label appears in the Send To menu when intitiaing a transmission The label should be an easy to recognize name 12 20 characters blank Site Type Indicates the type of device receiving the transmission Fax Printer TraceMaster 12LTS Hub Telemedicine Phone Number Phone number for fax site type otherwise N A Note It is important that the you know the dialing rules from the 12 Lead Transfer Station For example does the 12 Lead Transfer Station need to dial a 1 or an area code in addition to the number If it does the number sent by the MRx must include these digits 20 characters blank URL
10. Select Calibration Factor and press the Menu Select button A OW RR WOW N e Set the calibration factor using the Navigation buttons Values range from 180 0 to 220 0 in 0 2 increments Press the Menu Select button NOTE Calibration only needs to be done on reusable transducers 121 Calibrating Reusable Transducer CPJ840J6 Perform a mercury calibration when you use a new reusable transducer and at regular intervals according to your hospital policy You will need e standard sphygmomanometer e sterile 10cc syringe with heparinized solution e 3 way stopcock e approximately 25cm of tubing WARNING Never perform invasive pressure mercury calibration while the patient is being monitored To perform a mercury calibration on the CPJ840J6 perform the following 1 Zero the transducer see previous section 2 Connect the syringe and manometer See Figure 63 a Attach the tubing to the manometer b Connect the 3 way stopcock to the stopcock that is not connected to the patient catheter c Attach the syringe to one port and the manometer to the other port d Open the port to the manometer Figure 63 Connecting the Syringe and Manometer 122 Raise the manometer pressure to approximately 200 mmHg or 27 0 kPa Press the Menu Select button Using the Navigation buttons select Measurements Alarms and press the Menu Select button Select the pressure channel label you wish to calibrate and press the Menu Select button
11. Select Calibration Pressure and press the Menu Select button o N A Wn A Q Using the Navigation Buttons select the Calibration Pressure you set for the manometer in Step 3 above The default is 200 mmHg 27 0 kPa Values range from 90 to 220 mmHg in increments of 1 12 0 to 30 0 kPa in increments of 0 2 9 Press the Menu Select button The HeartStart MRx will automatically set and display the calibration factor NOTE Upon successful calibration write the calibration factor on the transducer for future reference Calibration Confirmation If the calibration process is successful a brief message appears on the HeartStart MRx display with the date and time the calibration was completed and the new calibration factor If calibration is not successful an Unable to Calibrate message appears with a probable cause See Table 16 for probable cause messages Table 16 Unable to Calibrate Probable Causes Equipment Malfunction Hardware is faulty Contact your service personnel Out of range Make sure you have selected a value for the calibration pressure that you are applying to the transducer Repeat calibration Unstable Signal Make sure there are no disturbances to the transducer Repeat calibration No Transducer Reconfirm that the transducer is connected and try again Perform Zero first A valid zero does not exist Zero the transducer WARNING Fach time you use a reusable transducer you should confirm
12. URL for PC site type i e TraceMaster or another 12 Lead Transfer Station otherwise N A 40 characters blank Use Hub s Routing Indicates whether or not to use hub routing Note This field is not used by the 12 Lead Transfer Station 2 0 Yes No Default Site If yes this will be the highlighted site when the Send to menu is displayed When set to yes this field will automatically be set to no for all other sites Yes No User Name Sets the http user name for the data viewing software server 30 characters blank Password Sets the http password for the data viewing software server 40 characters blank Table 58 Data Transmission Transmit Interval Sets the interval between Periodic Clinical Data Transmissions when connected to the data viewing software server 1 2 3 4 5 minutes 216 Table 59 Reference ID Reference ID Defines a maximum of 20 preconfigured Up to 20 user defined settings Reference IDs Each Reference ID has a maximum of 16 characters limited to uppercase letters numbers spaces and hyphens Table 60 Manual Therapy Settings Remain In Sync Mode Defines whether the device remains in Sync Yes No After Shock Mode after a synchronized shock is delivered Time To Auto Disarm Determines the amount of time the device will 30 60 90 seconds remain charged if a shock has not been delivered Applies to both Manual De
13. You can configure your device to e Auto ACI TIPI Auto ACI TIPI runs the ACI TIPI analysis if there isn t an Acute MI Critical Value statement and the ECG severity is not Normal e ACI TIPI ACI TIPI prints the standard report followed by computer generated diagnostic statements using ACT TIPI criteria e ACI TIPI and TPI ACI TIPI amp TPI uses the ACI TIPI report followed by TPI inputs computer generated diagnostic statements using TPI criteria and the user selected Thrombolytic Therapy Contraindications To configure analysis see Table 53 in the Configuration chapter CAUTION Proper lead placement must be used in order to receive proper predictive instrument algorithm calculations See V C Electrode Placement on page 52 To acquire a 12 lead ECG in Monitor Mode with additional ACI TIPI and or TPI analysis 1 Perform steps 1 5 from Acquiring a 12 Lead ECG on page 138 2 If you had not previously entered information on Chest Pain symptoms you are prompted to do so Use the Menu Select button and Navigation buttons to select the proper value See Table Required ACI TIPI amp TPI data on page 142 3 Keep the patient still while the message Acquiring 12 Lead is displayed 4 Once ECG acquisition is complete ECG analysis begins automatically and is accompanied by the message Analyzing 12 Lead The patient does not need to be still during this time 5 Ifyou are not configured for TPI analysis the
14. e There is no Q CPR voice or text prompt feedback or storage e INOPS regarding ventilation are not displayed Data and Events Recorded With the Data Capture option the HeartStart MRx records CPR data in all clinical modes when data recording is active It will start recording when a CPR meter is detected and stop when the CPR meter is removed from the HeartStart MRx or the HeartStart MRx leaves a clinical mode In addition to the standard HeartStart MRx defibrillation and monitoring events and ECG waveform the following data and events related to Q CPR are captured Q CPR feedback prompts are captured if the Q CPR Feedback configuration option is set to On However these Q CPR related events are not included in the Event Summary report printed by the HeartStart MRx Table 29 Q CPR Captured Data Compression Waveform Waveform showing compression depth versus time Ventilation Waveform Waveform showing change in chest impedance versus time Compression event Compression occurs Ventilation event Ventilation occurs Compression rate Rate of compressions Ventilation rate Rate of ventilation Level 2 feedback Visual feedback on the CPR meter is displayed if some aspect of the CPR performed does not conform to CPR guidelines Level 3 feedback Verbal feedback announced if some aspect of the CPR performed continues to fall outside CPR guidelines after Level 2 feedback is given Research Storage Setting Wh
15. Another server with data review software from Ganel pp ees 2 Way Radio Radio Tower at healthcare facility Or other ECG Management System through the Data Med Format Translator from General Devices by Engineering Solutions Inc 239 Transmitting During a Critical Care Event The HeartStart MRx provides multiple options to transmit data during a critical care event See Table 69 Table 69 Critical Care Transmission Use Cases Clinical data to a destination point periodically during transport using Bluetooth wireless A 12 Lead ECG using Bluetooth wireless technology via a cell phone land line modem or other cellular broadband gateway to the Internet Dial Up Networking DUN and a Bluetooth wireless card to transmit a 12 Lead ECG through a cell phone land line modem or other gateway to a destination point The Periodic Clinical Data Transfer options B18 and 989803153411 Internal Bluetooth Card See Periodic Clinical Data Transmission on page 250 and Transmitting Clinical Values on page 250 The 12 Lead Transmission Bluetooth wireless technology option B06 OR product upgrades M3801 12 Lead BT Transmit and 989803153411 Internal Bluetooth Card See Transmitting During a Critical Care Event on page 240 A 12 Lead ECG using my portable computer to forward to the Internet Bluetooth File Transfer and a Bluetooth wireless card to transmit the 12 Lead
16. Figure 95 Transfer Patient Confirmation Transfer Patient The patient will be discharged to the transfer list in the Central and the MRx will enter transfer mode Transfer Patient No 6 Select Yes to transfer the patient No to cancel transfer When a patient transfer is confirmed the patient is discharged to the transfer list at the Information Center and the HeartStart MRx enters Transfer Mode Prepared for transfer is displayed above the patient name The HeartStart MRx continues to store data that can be accessed through the Data Management feature 187 Transfer Mode Transfer Mode is used to hand off patient data from one monitoring location to another While in Transfer Mode patient information can t be modified The HeartStart MRx continues to send data to the Information Center without an associated patient name The data is not associated with the patient now on the transfer list Patient data can be identified by a unique bed label common to both the HeartStart MRx and the specific data sector being monitored at the Information Center Re admit Patient If you need to re admit a patient the Re admit function restores patient data It moves the patient off the Information Center s transfer list back into the corresponding Information Center sector when connected to the network To select Re admit perform the following steps 1 Press the Menu Select C button 2 Using the Navigation buttons select Pa
17. Preparing for Defibrillation In preparation for defibrillation 1 Connect the appropriate Therapy cable 2 Apply the paddles or pads as described below Using Multifunction Electrode Pads To prepare for defibrillation using multifunction electrode pads 1 If not pre connected connect the pads cable to the HeartStart MRx by aligning the white pointer on the pads cable connector with the white arrow on the green Therapy port Then push until you hear it click into place See Figure 47 Figure 47 Pads Internal Paddles Cable Connection 2 Check the expiration date that appears on the pads package 3 Inspect the packaging for any damage 4 Connect the pads connector to the pads cable See Figure 48 Figure 48 Pads Connectors 5 Apply the pads to the patient as directed on the pads packaging or according to your organization s protocol 74 Using External Paddles To defibrillate using external paddles 1 If not pre connected connect the paddles cable to the HeartStart MRx by aligning the white pointer on the paddles cable connector with the white arrow on the green Therapy port Then push until you hear it click into place See Figure 49 Figure 49 Paddles Cable Connection 2 Remove the Paddle Set from the Paddle Tray by pulling the paddles straight up and out of the paddle tray Verify there is no debris or residue including dried electrode gel on the surfaces of the paddles Clean if necessary 3 Apply condu
18. The top of the HeartStart MRx has a handle and basic operating instructions If optional external paddles are present they reside on the top panel as shown Figure 3 Basic Orientation Top with Optional Paddles 2 ae DDD HF SS 10 Back Panel The back panel of the HeartStart MRx has two compartments for lithium ion batteries Compartment B may also be used to connect an AC power module Between the battery compartments is a DC Power Input port The back panel also has an RS 232 serial port for 12 lead ECG transmission or setting up a wireless connection to the IntelliVue Network The LAN port is for a wired connection to the IntelliVue Network or for Batch LAN Data Transfer Figure 4 Basic Orientation Back Battery AC Compartment B PHILIPS r y RS 232 Serial Port Me lt g AC Power Module DC Power Input Battery WARNING The HeartStart MRx LAN port is intended for connection to the IntelliVue Clinical Network or for Batch LAN Data Transfer It should only be used for connection to devices that comply with IEC 60950 1 and IEC 60601 1 During real time patient monitoring the HeartStart MRx wired LAN connector should only be connected to the IntelliVue Network For post event Batch LAN Data Transfer the HeartStart MRx should only be connected to the facility network The RS 232 Serial Port is intended for connection to the IntelliVue wireless backpack I
19. non latching alarms meaning they are automatically removed when their alarm condition no longer exists Table 19 details Temperature alarms Table 19 Temperature Physiological Alarms Temperature Yellow Yellow alarm message The temperature value exceeds the high label High alarm tone alarm limit Temperature Yellow Yellow alarm message The temperature value has fallen below label Low alarm tone the low alarm limit Alarms are on unless you turn them off during use Once turned off alarms remain off until they are turned back on WARNING Make sure you enable disable and set alarm limits for the correct label These settings are stored for that particular label only Changing the label may change the alarm limits NOTE If temperature alarms are enabled alarm limits appear next to the temperature value If alarms are off the Alarms Off VAN symbol replaces the limits Changing Temperature Alarm Limits To change the temperature alarm limits for the current incident perform the following 1 2 3 Press the Menu Select button Using the Navigation buttons select Measurements Alarms and press the Menu Select button Select the temperature label option currently assigned to your measurement and press the Menu Select button Select Temperature Limits and press the Menu Select button Using the Navigation buttons change the high limit and press the Menu Select button Using the Navig
20. present and inspected Temperature Sensors present and inspected 268 Shift Checklist page 2 HeartStart MRx Weekly Shock Test Do one of the following at least once a week to verify the ability to deliver defibrillation therapy Operational check See Instructions for Use for details Signature Date Deliver a 150J shock into a test load See instructions below Signature Date Note If the HeartStart MRx has Software Release B 05 or greater with the Pacing option you cannot test external paddles through Operational Check Perform the Weekly Shock Test to test the external paddles Additionally test reusable sterilizable paddles internal or external prior to each use See the Sterilizable Defibrillator Paddles Instructions for Use How to Perform the Weekly Shock Test Test each type of patient therapy cable used pads cable or paddles 1 Ifyou are using paddles make sure the paddles and the paddle tray are thoroughly clean and there is no debris or residue including all conductive material on the electrode surfaces of the paddles and tray Secure the paddles in the paddle tray and confirm the Patient Contact Indicator PCI LEDs located on the sternum paddle are not lit If the LEDs are lit adjust the paddles in the tray If the LEDs continue to light clean both the adult and pediatric paddle electrode surfaces 2 Ifyouare using multifunction electrode pads attach a test load to the e
21. s Instructions for Use for information on reducing hazards of burns in the event of a defect in its equipment Do not expose the equipment to x ray or strong magnetic fields MRI 46 Qe CAUTION Be aware of patient cables including ECG monitoring equipment when used with high frequency surgical equipment NOTE This device and its accessories are not intended for home use NOTE The HeartStart MRx can be operated with only AC DC power only 14V M3538A Lithium Ion Battery or AC DC power and M3538A battery simultaneously NOTE For operation in the U S the AC power cord must have the proper NEMA type plug NOTE The HeartStart MRx does not require the practice of any special ElectroStatic Discharge ESD precautionary procedures 347 Defibrillation WARNING Keep hands and feet clear of paddle electrode edges Use your thumbs to depress the shock buttons on the paddle handle WARNING Do not allow multifunction electrode pads to touch each other or to touch other ECG monitoring electrodes lead wires dressings etc Contact with metal objects may cause electrical arcing and patient skin burns during defibrillation and may divert current away from the heart WARNING During defibrillation air pockets between the skin and multifunction electrode pads may cause patient skin burns To help prevent air pockets make sure the pads completely adhere to the skin Do not use dried out pads do not open pads package un
22. CO waveform appears as a flat line and if alarms are on an apnea alarm is annunciated Measuring EtCO The EtCO measurement is automatically turned on when you connect a FilterLine to the CO Inlet port The CO waveform is displayed in the configured Wave Sector if available The measurement values for EtCO and AwRR are displayed in Parameter Block 2 see Figure 62 i 62 EtCO and AwRR Parameter Block 2 mmHg PAP mmHg SpO2 EtCO2mmHg AWRR rpm 118 77 ss 24 10 o 95 a 15 100 38 18 EtCO and AwRR Alarms Alarms are annunciated if measurements fall outside the configured limits for high or low EtCOg high or low Airway Respiration Rate AwRR and Apnea time EtCO alarms except Apnea are all categorized as non latching alarms meaning they are automatically removed when their alarm condition no longer exists Apnea alarms are latching meaning they remain present even if the alarm condition no longer exists Table 13 EtCO Red Yellow Physiological Alarms Apnea Red Red alarm message alarm tone No detectable breaths for the configured number of seconds EtCO High Yellow Yellow alarm message alarm tone The EtCO value exceeds the high alarm limit EtCO Low Yellow Yellow alarm message alarm tone The EtCO value has fallen below the low alarm limit AwRR High Yellow Yellow alarm message alarm tone The AwRR value exceeds the high alarm limit AwRR Low Yellow Yellow alarm message alarm tone The
23. Electrode Placement 51 Lead Selection 53 Lead Choices 53 Selecting the Lead 54 Arrhythmia Monitoring 54 vi Aberrantly Conducted Beats 55 Intermittent Bundle Branch Block 55 Heart Rate and Arrhythmia Alarms 56 Arrhythmia Alarm Latching 56 INOP Messages 58 Setting Alarms 59 Changing Heart Rate or VTACH Alarm Limits 59 Enabling Disabling Heart Rate and Arrhythmia Alarms 59 Responding to HR and Arrhythmia Alarms 59 Displaying an Annotated ECG 60 Arrhythmia Learning Relearning 61 Troubleshooting 61 5 AED Mode 63 Precautions for AED Therapy 63 AED View 64 Preparation 65 Using AED Mode 66 Step 1 Turn the Therapy Knob to AED 67 Step 2 Follow Screen and Voice Prompts 67 Step 3 Press Shock Button if Prompted 69 Using Q CPR in AED Mode 69 Troubleshooting 69 6 Manual Defibrillation and Cardioversion 71 Overview 71 Precautions for Manual Defibrillation Therapy 72 Synchronized Cardioversion Therapy 72 Code View 73 Preparing for Defibrillation 74 Using Multifunction Electrode Pads 74 Using External Paddles 75 Using Pediatric Paddles 76 Using Internal Paddles 76 Defibrillating asynchronously 77 Performing Synchronized Cardioversion 79 Preparing for Synchronized Cardioversion 79 Delivering a Synchronized Shock 80 Delivering Additional Synchronized Shocks 81 Disabling the Sync Function 81 Using Q CPR in Manual Mode 81 Troubleshooting 81 7 Noninvasive Pacing 83 Overview 83 Alarms 84 vii Pacing View 85
24. FilterLine and if necessary airway adapter measures the partial pressure of carbon dioxide in a sample of the patient s exhaled breath aspirated from the breathing circuit The HeartStart MRx may be used to monitor carbon dioxide in both intubated and non intubated patients The partial pressure of carbon dioxide is derived by multiplying the measured carbon dioxide concentration with the ambient pressure From the partial pressure measurement the end tidal carbon dioxide EtCO is derived EtCO is the peak CO value measured during expiration It is used to monitor the patient s respiratory status The EtCO measurement uses a technique based on the absorption of infrared radiation by some gases It indicates the change in e The elimination of COz The delivery of O to the lungs The CO monitoring function of the HeartStart MRx provides an EtCO value a CO waveform and an airway respiration rate AwRR WARNING The EtCO readings do not always correlate closely with blood gas values especially in patients with pulmonary disease pulmonary embolism or inappropriate ventilation Do not measure CO in the presence of pharmaceuticals in aerosols NOTE For more information on capnography and EtCO refer to the Application Note Uses of Capnography and Benefits of the Microstream Method 109 Preparing to Measure EtCO Selecting the Accessories There are some factors to consider when selecting accessories e the ty
25. Primary ECG ABP mmHg PAP mmHg Sp02 EtCO2mmHg AwRR P MAT qs 24110 ma 95 gt 15 100 38 18 2s Displayed Waves Printed Waves Measurements Alarms Patient Info Softkey Softkey 2 3 4 Wave Sector 1 Wave Sector 1 only contains an ECG waveform This is the waveform used by the arrhythmia heart rate derivation and AED analysis algorithms If Pads are configured as the primary ECG source for Wave Sector 1 the ECG patient cable must be connected to the HeartStart MRx and to the monitoring electrodes on the patient in order to change the ECG source to a Leads selection NOTE When monitoring using a 3 lead ECG set the HeartStart MRx displays 1 ECG lead at a time 15 Wave Sectors 2 4 Wave Sectors 2 through 4 are automatically populated when parameter sources cables tubing are connected to the HeartStart MRx If the parameter source is the configured choice of a particular wave sector it is displayed in that wave sector If you connect a parameter source that is not configured to be displayed it is displayed in the first empty wave sector If you subsequently connect the configured parameter source it replaces the current parameter For invasive pressures you should label your waveforms as they are connected to avoid possible confusion Changing Displayed Waveforms Wave Sector 1 has a dedicated Lead Select button to change the displayed lead source Waveforms displayed in other wave sectors may be chang
26. Selecting a Sensor See SpO2 Sensors and Cables on page 293 for a list of the SpO sensors that may be used with the HeartStart MRx CAUTION Do not use disposable sensors in high humidity environments or in the presence of fluids which may contaminate sensor and electrical connections causing unreliable or intermittent measurements e Do not use disposable sensors on patients who have allergic reactions to the adhesive e Do not use the ear transducer on patients with small ear lobes as incorrect measurements may result The most important factor when selecting a sensor is the position of the light emitting diodes in relation to the photodetector When a sensor is applied the diodes and the photodetector must be opposite each other Sensors are designed for patients with a specific weight range and for specific sites Be sure to e Select a sensor appropriate for the patient s weight e Select a sensor site with adequate perfusion Improve perfusion at the site by rubbing or warming the site e Avoid application to sites with edematous tissue Reusable Sensors may be reused on different patients after they have been cleaned and disinfected see the manufacturer s instructions supplied with the sensor Disposable Sensors should be used only once and then discarded They may be relocated to another sensor site on the patient if the first location does not give the desired results Disposable sensors must not be reu
27. changing 101 enabling disabling 101 source 128 changing 129 troubleshooting 314 Pulse Oximetry see SpO monitoring 93 Q Q CPR 157 compression waveform 167 configurable parameters 222 connecting CPR cable 41 contraindications 4 CPR feedback 172 adjusting volume 173 CPR meter 160 adhesive pad 162 after each use 174 back 161 Basic View details 170 compression depth indicator 165 feedback 164 compression depth indicator 165 compression rate indicator 165 166 front 161 icons 166 performing CPR 164 placement 163 preparation 163 status light colors 161 warnings 163 data capture 157 174 data events recorded 175 reviewing data 175 electrode pads 160 feedback Advanced View details 167 on HeartStart MRx display 167 ventilation icons 169 in manual defib mode 171 indications 4 ona mattress 158 overview 157 preparing to use 159 research data storage 175 senor and meter differences 158 troubleshooting 314 using in AED Mode 171 warnings 158 QRS beeper 299 R Ready For Use RFU Indicator 2 22 266 blinking black hourglass 22 blinking red x 22 solid red x 22 Reference ID 241 configurable parameters 217 modifying during an event 241 usage 26 Return to Owner 29 S safety considerations 5 345 separation distances 357 service numbers 319 setting alarms 59 setting date time 200 Shift Checklist 267 copy of 268 SMART Biphasic impedance 66 soft key labels 16 specifications 321 12 Lead ECG
28. equipment marked with the following symbol K At 80 MHz and 800 MHz the higher frequency range applies These guidelines my not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people a The ISM industrial scientific and medical bands between 150 kHz and 80 MHz are 6 765 MHz to 6 795 MHz 13 553 MHz to 13 567 MHz and 26 957 MHz to 27 283 MHz and 40 66 MHz to 40 70 MHz gt The compliance levels in the ISM frequency bands between 150 kHz and 80 MHz and in the frequency range 80 MHz to 2 5 GHz are intended to decrease the likelihood that mobile portable communications equipment could cause interference if it is inadvertently brought into patient areas For this reason an additional factor of 10 3 is used in calculating the recommended separation distance for transmitters in these frequency ranges Field strengths from fixed transmitters such as base stations for radio cellular cordless telephones and land mobile radios amateur radio AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy To assess the electromagnetic environment due to fixed RF transmitters an electromagnetic site survey should be considered If the measured field strength in the location in which the HeartStart MRx is used exceeds the applicable RF compliance level above the HeartStart MRx should be observed to verify normal operation If
29. format of the Event Summary is defined in Configuration WARNING Should an alarm condition occur while an Event Summary is printing an alarm strip is not printed However the corresponding ECG waveform is stored and available in the Event Summary Vital Signs Trending Reports You can print the current Vital Signs Trending Report at any time during a patient event by pressing the Summary button and selecting Trends and then a Trends Interval from the menu or by hitting the soft key under the Print Trends label If an event is not in progress pressing the Summary button and selecting Trends and then a Trends Interval prints the most recent Vital Signs Trending Report 12 Lead ECG Reports You can print individual 12 Lead ECG Reports for the current or most recent patient event through the 12 Lead Report View menu You can print the current 12 Lead ECG report by hitting the Print softkey in 12 Lead View To print a recent 12 Lead ECG Report 1 Press the Menu Select button and highlight Reports 2 Use the Navigation buttons to highlight the report you want to print 3 Press the Menu Select button and highlight Print 4 Press the Menu Select button to print the report 229 Printing Individual Events The HeartStart MRx can be configured to print automatically when certain events occur Table 67 lists these events and the length of the strip printed depending on whether the printer is configured to print real time or with a 1
30. gt 95 dip in Ur for 5 sec for 5 sec Power frequency 3 A m 3 A m Power frequency magnetic fields should be at levels characteristic of a typical location in a typical commercial or hospital environment Uris the AC mains voltage prior to application of the test level 353 354 Table 111Electromagnetic Immunity Life Supporting Functions Portable and mobile RF communications equipment should be used no closer to any part of the HeartStart MRx including cables than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter Conducted RF IEC 61000 4 6 3 Vrms Recommended Separation Distance 150 kHz to 80 MHz 3 Vrms outside ISM bands d 12 P 10 Vrms Recommended Separation Distance 150 kHz to 80 MHz 10 Vrms in ISM bands d 1 2VP Table 111Electromagnetic Immunity Life Supporting Functions Continued Radiated RF 10 V m 10 V m IEC 61000 4 3 80 MHz to 2 5 GHz d 124P 80 MHz to 800 MHz d 2 34 P 800 MHz to 2 5 GHz where P is the maximum output power rating of the transmitter in watts W according to the transmitter s specified output power and d is the recommended separation distance in meters m gt Field strengths from fixed RF transmitters as determined by an electromagnetic site survey should be less than the compliance level in each frequency range Interference may occur in the vicinity of
31. is also contraindicated for patients with conditions whom the administration of thrombolytics is contraindicated Some of these conditions are aortic dissection acute myocardial infarction due to bacterial endocarditis vasculitis intracardiac thrombi and acute nonsuppurative and suppurative pericarditis mimicking acute myocardial infarction These situations as well as Posterior Acute Myocardial Infarction were not considered or covered in the development of the predictive instrument calculations NOTE See note on page 140 for additional details on contraindications for TPI therapy Safety Considerations General warnings and cautions that apply to use of the HeartStart MRx are provided in Specifications and Safety on page 321 Additional warnings and cautions specific to a particular feature are provided in the appropriate section of this guide WARNING Electric shock hazards exist internally Do not attempt to open the device Refer servicing to qualified personnel WARNING Use only supplies and accessories approved for use with your HeartStart MRx Use of non approved supplies and accessories could affect performance and results WARNING Use single use supplies and accessories only once Documentation and Training Available documentation and training for the HeartStart MRx includes e HeartStart MRx Instructions for Use e HeartStart MRx Quick Reference Cards e HeartStart MRx Battery Application No
32. saving configuration to a data card 201 setting date time 200 continued use 27 and pacing 27 controls 18 therapy knob 19 21 CPR feedback 172 CPR meter 160 adhesive pads disposal 290 specifications 333 cleaning 289 disposal 290 specifications 333 Critical Values 143 D data card installing 46 loading configuration 201 troubleshooting 312 viewing and erasing 228 data management 225 copying from internal memory 227 Data Management Mode entering 226 printing 231 Event Summary 225 events recorded 232 external data card 228 Rosetta troubleshooting 308 specifications 334 uses 225 data transmission 239 12 Lead Mode 248 setup 248 Batch LAN Data Transfer 259 erasing the memory card 259 setup 259 transferring a single file 260 transferring all events 260 troubleshooting 308 Bluetooth 242 configurable 214 configurable parameters 215 216 Event Summaries 255 in Data Management Mode 255 options critical care use cases 240 during an event 239 post event 254 post event use cases 254 Periodic Clinical Data Transmission 250 data sent 250 251 icons 250 transmission intervals 252 transmit interval 216 troubleshooting 308 Rosetta connecting devices 246 contents of report 245 set up 245 RS 232 set up 247 scenarios 239 setup 241 to a personal computer 249 to fax number 249 transmission cancelling BLDT transmission 261 cancelling transmission 257 errors 257 finding results 258 queueing multiple transmissions
33. temperature probe adds an additional 0 1 C Settling Time Constant lt 10 seconds Alarm Signal Generation Delay 5 seconds Averaging Time 1 second Minimum measurement time See the probe s Instructions for Use to obtain minimum measurement times for accurate readings The HeartStart MRx does not add any clinically significant time to obtain accurate readings EtCO Range 0 to 99 mmHg at sea level Resolution 1 mmHg 0 1kPa Accuracy For values between 0 and 38 mmHg 2 mmHg For values between 39 and 99 mmHg 5 of reading 0 08 for every 1 mmHg above 38 mmHg Values read at sea level For breath rates above 80 and EtCO values gt 18 mmHg accuracy is 4mmHg or 12 of reading whichever is greater Drift of Measurement Accuracy Over any 24 hour period the accuracy claims listed above are maintained The accuracy specification is maintained to within 4 for the following gas mixtures all values are in Vol 0to1l3 0 to97 5 0 to 100 0to 80 dry to saturated According to EN21647 Rise Time 190 ms maximum 10ml min System Response Time with a standard length FilterLine 2 9 seconds typical includes the delay time and rise time 10 to 90 in response to a step change in the CO concentration Alarm Delay Time 5 2 seconds standard deviation 0 08 seconds includes the 2 9 second FilterLine delay Sample Flow Rate Nominally 50 ml min 7 5 to 15 ml min Microstream CO Humidity Correction
34. the cuff is not compressed crimped or damaged c Check that the edge of the cuff falls within the range identified by the lt gt markings If it does not use a larger or smaller cuff that fits better Place the limb used for taking the measurement at the same level as the patient s heart WARNING Do not perform noninvasive blood pressure measurements on patients with sickle cell disease or any condition where skin damage has occurred or is expected Do not use in a hyperbaric chamber Use clinical judgement to decide whether or not to perform automatic blood pressure measurements on patients with severe blood clotting disorders because of the risk of hematoma in the limb wearing the cuff Do not apply the cuff to a limb that has an intravenous infusion or arterial catheter in place This could cause tissue damage around the catheter when the infusion is slowed or blocked during cuff inflation Use only approved cuffs and tubing in order to prevent inaccurate data injury or damage All specified cuffs are protected against the effects of the discharge of a defibrillator Prolonged series of noninvasive blood pressure measurements in automatic mode may be associated with purpura ischemia and neuropathy in the limb wearing the cuff When monitoring a patient examine the extremities of the limb frequently for normal color warmth and sensitivity If any abnormality is observed stop the blood pressure measurements imm
35. 12 Lead Report including the ACI TIPI predicted probability of Acute Ischemia percentage is displayed printed and stored internally If you are configured for TPI analysis the HeartStart MRx next performs a TPI screening test to see if the ECG is a candidate for TPI analysis Ifthe ECG is not a candidate for TPI analysis the 12 Lead Report is displayed printed and stored internally If the ECG is a candidate for TPI analysis the HeartStart MRx asks you to input more patient information Continue with Step 6 6 When required the HeartStart MRx displays a list of TPI inputs which require data entry See Figure 67 Press the Menu Select button to view possible values for the first highlighted topic You can press the Skip TPI softkey to bypass TPI analysis 7 Use the Navigation buttons to highlight your answer and press the Menu Select button to select 8 Use the Navigation buttons to select the next item and repeat steps 6 and 7 to complete all TPI inputs 9 Once you ve completed all inputs press the Run TPI softkey 10 You are now prompted to consider contraindications for thrombolytics See Contraindications for Thrombolytic Therapy on page 140 139 Figure 67 TPI Inputs Candidate for Thrombolysis Time Since Onset of Ischemic Symptoms Unknown Blood Pressure Unknown History of Hypertension unknown Unknown History of Diabetes Unknown Patient Weight Unknown Contraindications for Thrombolyt
36. 24 0 22 0 20 0 18 0 16 0 14 0 13 0 12 0 11 0 10 0 9 0 8 0 7 0 6 0 5 0 4 0 3 0 2 0 1 0 1 5 2 0 2 5 NOTE A positive scale sets the top gridline to your selected scale and the bottom to zero A negative scale will set the bottom gridline to the selected negative unit and the middle gridline to zero 118 Zeroing the Pressure Transducer To avoid inaccurate pressure readings the HeartStart MRx requires a valid zero be performed on the pressure channel It should be zeroed according to your hospital policy at least once per day Also you should rezero in the following circumstances e Every time you reconnect the transducer cable to the HeartStart MRx e After a patient is moved e During changes in altitude when using the HeartStart MRx aboard an aircraft Re zero when reaching a cruising altitude e When you use a new transducer or tubing e When you think the pressure readings are not correct NOTE The numeric value will be invalid displayed as when the transducer is plugged in until zeroed successfully For each assigned label the pressure channel can be zeroed through the Menu Select button menu or when in Monitor Mode through the use of a soft key You can zero the pressure channels separately or together WARNING Before zeroing a pressure make sure related pressure transducers are vented to atmospheric pressure and the stopcock to the patient is closed Zeroing Using the Menu Select Butt
37. 333 AED Mode 323 batteries 326 Bluetooth 336 CPR meter 333 adhesive pads 333 data management 334 display 326 ECG and arrhythmia monitoring 324 environmental M3535A 334 M3536A 335 EtCO 331 general 321 IntelliVue Networking 333 Invasive Pressures 330 manual defibrillation 323 Noninvasive Blood Pressure NBP 329 Nonivasive Pacing 327 SpO 328 Temperature 331 SpO monitoring 93 accuracy 328 alarms 99 changing 99 enabling disabling 100 applying a sensor 96 care and cleaning 102 configurable parameters 210 connecting the cable 36 desat alarm 100 disabling 101 indications 3 overview 93 parameters 97 pleth wave 98 selecting a sensor 95 setup 36 specifications 328 troubleshooting 303 understanding 94 warnings 93 96 successful resuscitation 72 supplies 291 warning 291 supplies and accessories warnings 350 symbol definitions 337 shipping carton 339 Synchronized Cardioversion 79 disabling 81 preparing 79 shock delivery 80 using an external monitor 79 Temperature 131 alarms 132 changing 133 enabling disabling 133 changing degree units 133 configurable parameters 211 connecting the cable 39 disabling 134 indications 4 monitoring 132 selecting a label 131 self tests 132 specifications 331 troubleshooting 313 therapy cable connecting 41 TPI 135 analysis 139 contraindications 4 configurable parameters 223 default 140 display 141 modify 141 contraindications for thrombolytics 139 indications 4 inp
38. 7 3 7 1 _ 2J 8J 7 4 8 0 8 1 8 2 8 4 8 3 8 1 2J 9J 8 3 9 0 9 1 9 3 19 4 9 4 9 1 2J 10J 9 2 10 10 10 10 10 10 2J 15J 14 15 15 15 16 16 15 15 20J 18 20 20 21 21 21 20 15 30J 28 30 30 31 31 31 30 15 50J 46 50 51 51 52 52 50 15 70J 64 70 71 72 73 73 71 15 100J 92 100 101 103 104 104 101 15 120J 110 120 121 123 125 125 121 15 150J 138 150 152 154 157 156 151 15 170J 156 170 172 175 177 177 172 15 200J 184 200 202 206 209 209 202 15 Charge Time e Less than 5 seconds to 200 Joules with a new fully charged Lithium Ion battery pack at 25 C e Less than 15 seconds when operating without a battery using the M3539A AC power module alone at 90 100 rated mains voltage e Less than 15 seconds with a new fully charged Lithium Ion battery pack at 25 C depleted by up to 15 200 Joule discharges e Less than 25 seconds from initial power on with a new fully charged Lithium Ion battery pack at 25 C depleted by up to 15 200 Joule discharges e Less than 25 seconds from initial power on when operating without a battery using the M3539A AC power module alone at 90 100 rated mains voltage e Less than 30 seconds from initiation of rhythm analysis AED Mode with a new fully charged Lithium Ion battery pack at 25 C
39. Asystole VFIB VTACH VTACH Extreme Tachy Extreme Brady PVC rate Pacer Not Capture Pacer Not Pacing Common Mode Rejection Greater than 90 dB measured per AAMI standard for cardiac monitors EC 13 ECG Size 2 5 5 10 20 40 mm mV autogain Maximum T wave amplitude Meets recommended minimum 1 2mV T wave amplitude rejection 324 Frequency Response e AC Line Filter 60 Hz or 50 Hz e Pads ECG for Display Monitor 15 40 Hz or EMS 1 30 Hz e Pads ECG for Printer Monitor 15 40 Hz or EMS 1 30 Hz e Leads ECG for Display Monitor 15 40 Hz or EMS 1 30 Hz e Leads ECG for Printer Diagnostic 05 150 Hz or Monitor 15 40 Hz or EMS 1 30 Hz Heart rate accuracy and response to irregular rhythm Meets AAMI standard for ventricular bigeminy HR 80 bpm slow alternating ventricular bigeminy HR 60 bpm rapid alternating ventricular bigeminy HR 120 bpm bidirectional systoles HR 90 bpm Heart rate averaging For heart rates gt 50 bpm heart rate is determined by averaging the 12 most recent R R intervals Beats N P and V are included When heart rate drops below 50 bpm the 4 most recent R R intervals are used in the average Note For ventricular tachycardia alarms which have a user definable PVC run length limit the heart rate is based on the user selected PVC length up to 9 PVCs maximum Heart Rate Response Time e 80 to 120 bpm 7 seconds e 80 to 40 bpm 6 seconds Time to Alarm for Tachycardia
40. Cancel soft key WARNING Battery calibration is terminated if external power or the battery being calibrated is removed before the calibration process is completed If calibration is terminated the battery will not be calibrated and its capacity may be very low Calibration Results When a battery is calibrated in the HeartStart MRx a Pass or Fail is reported to indicate whether calibration completed successfully In addition an estimate of battery capacity is provided so you can determine if the battery is fit for use When a battery is calibrated in a Philips approved battery support system the estimated battery capacity is not displayed To view the capacity Insert the calibrated battery into a HeartStart MRx that is not connected to a patient Turn the Therapy Knob to Monitor Press the Menu Select button highlight Other and press the Menu Select button again Highlight Battery Calibration and press the Menu Select button 1 2 3 4 5 Press the Menu Select button to acknowledge leaving normal operating mode 6 Press the Start softkey and wait until any information appears in the first Charging line 7 Press the Cancel softkey 8 The battery capacity is displayed at the top of the screen In either instance if the capacity is e gt 80 continue to use the battery e lt 80 discard the battery NOTE After successfully calibrating your batteries perform an Operational Check You may be prompted to recalibrate dependi
41. Cell phone service is unavailable Check that the connections are secure Check that the cellular signal strength is sufficient Transmission Failed message accompanied by an Error Configuring Transmission Device message The phone configuration settings are invalid incorrect Modify the Serial Phone Profile configuration settings as needed For more information refer to the Transmission Implementation Guide Wrong number Check the number and re send Invalid Password message The Internet Service Provider ISP or Hub user name or password is incorrect Modify the Serial Phone Profile or Hub configuration settings as needed For more information refer to the Transmission Implementation Guide Transmission Failed message accompanied by a Connection Failed message The connection with the ISP cannot be made Modify the Serial Phone Profile configuration settings as needed For more information refer to the Transmission Implementation Guide Transmission Failed message accompanied by a Cannot Reach Server message The network server is unavailable Contact the network administrator Transmission Failed message accompanied by a Server Unknown message Server Name or address is not recognized Modify the Server configuration settings as needed For more information refer to the Transmission Implementation Guide 307 Table 86 12 Lead Transmission Problems
42. Demand Mode Versus Fixed Mode 86 Preparing for Pacing 87 Demand Mode Pacing 88 Fixed Mode Pacing 89 Defibrillating During Pacing 91 Troubleshooting 91 8 Pulse Oximetry 93 Overview 93 Understanding Pulse Oximetry 94 Selecting a Sensor 95 Applying the Sensor 96 Monitoring SpO 97 Pleth Wave 98 SpO Alarms 99 Changing the SpO Alarm Limits 99 SpO Desat Alarm 100 Enabling Disabling the SpO Alarms 100 Pulse Rate Alarms 100 Enabling Disabling the Pulse Rate Alarms 101 Changing the Pulse Rate Alarm Limits 101 Disabling the SpO Monitoring Function 101 Caring for Sensors 102 Troubleshooting 102 9 Noninvasive Blood Pressure 103 Overview 103 Preparing to Measure NBP 104 Measuring NBP 106 Changing the NBP Schedule 106 Alarms 107 Changing NBP Alarms 107 Enabling Disabling NBP Alarms 108 Troubleshooting 108 10 Monitoring Carbon Dioxide 109 Overview 109 Preparing to Measure EtCO 110 Selecting the Accessories 110 Setting Up Microstream EtCO Measurements 111 Using the Nasal FilterLine 111 Using the FilterLine and Airway Adapter 111 Measuring EtCO 112 EtCO and AwRR Alarms 112 Changing the EtCO Alarm Limits 113 viii Enabling Disabling the EtCO Alarms 113 Changing the AwRR Alarm Limits 113 Changing the Apnea Time Alarm Limit 114 Enabling Disabling AwRR Alarms 114 Disabling the EtCO Monitoring Function 114 Troubleshooting 114 11 Invasive Pressures 115 Overview 115 Setting up for a Pressure Measurement 115 Selecting a Pressur
43. ECG severity is not Normal e ACI TIPI prints the standard report followed by computer generated diagnostic statements using ACT TIPI criteria e ACI TIPI amp TPI uses the ACI TIPI report followed by TPI inputs computer generated diagnostic statements using TPI criteria and the user selected Thrombolytic Therapy Contraindications Facility ID Enters the Facility ID in the 12 Lead ECG 5 alpha numeric characters blank Report Department ID Enters the Department ID in the 12 Lead ECG 10 alpha numeric characters blank Report Device ID Enters a device identification number 4 digits Analysis Defines the analysis information included on the None Measurements Only Standard Auto ACI TIPI ACI TIPI ACI TIPI and TPI Critical Values Statements Enables or disables the printing and exporting of Critical Value Statements Yes No analysis Weight is only used for TPI analysis ACI Threshold Set the threshold above which the predicted 0 100 percent 75 probability of Acute Cardiac Ischemia is highlighted on the 12 Lead Report screen Patient Weight Units To set the units of weight measurement for TPI lbs kg ECG Bandwidth for 12 Defines the default ECG bandwidth for the 12 15 40 Hz 05 40 Hz 05 150 Hz Lead Display Lead preview display ECG Bandwidth for 12 Defines the default ECG bandwidth for printed Same as Display 05 150 Hz Lead Report and stored 12 Lead Reports ECG
44. ECG signal and deliver a shock as appropriate CPR Meter The CPR meter is a small lightweight device that provides CPR feedback in a display area in the line of sight of the caregiver performing compressions See Figure 76 Figure 76 CPR Meter FRONT This surface faces up Status Light Display Area Compression Pi Area lt Placement Guide BACK This surface placed on patient Patient Adhesive lt Mount Area The vent membrane allows internal and external pressures to equalize NOTES Remove the protective film from the CPR meter s display screen before first use To prolong the life of the display avoid storing the CPR meter where it is exposed to direct sunlight when not in use Status Light The CPR meter s status light will be off when the meter is attached to a HeartStart MRx that is turned off When the HeartStart MRx is turned on the CPR meter s status light turns green to indicate that it has passed its self test If the status light is orange or does not light during start up see Table 97 to troubleshoot The status light turns off once the CPR meter display turns on The status light turns on and remains on for 10 seconds after the HeartStart MRx is turned off 161 Attaching the CPR Meter Adhesive Pad You need to attach an adhesive pad to the back of the CPR meter before using To attach the CPR meter Adhesive Pad to the CPR meter 1 Open the package of
45. Event Summary report printed by the HeartStart MRx Events and waveforms related to Q CPR can be viewed through Event Review Pro For more Q CPR feedback messages see Table 28 in the Q CPR and Data Q CPR feedback On Logged at the beginning of an event if the Q CPR Feedback configuration setting is On Q CPR feedback Off Logged at the beginning of an event if the Q CPR Feedback configuration setting is Off Cannot Analyze Vent Caused by ventilation events either spontaneous respiration or noise with an impedance change gt 3 ohms Pads Off Pads are off the patient while Q CPR is active ventilation invalid Poor Pads Contact Pads are on the patient but the impedance is gt 140 ohms while Q CPR is active CPR meter CPR meter responds with an error Malfunction CPR meter Unplugged Device cannot communicate with the CPR meter Compression Event A CPR chest compression was detected Ventilation Event A ventilation event was detected Table 68 Event Information Continued INOPs See Troubleshooting chapter for information regarding INOP statements Defibrillation Charging to xx J Logged when device starts charging to selected energy setting Disarm Manual Auto Logged when device disarmed by user or automatically after time out period Shock x Logged when discharge to patient energy delivered impedance and peak current are stored with the waveform
46. Factor BTPS Body Temperature and Pressure Saturated 37 C 750mmHg 100 humidity or 47mmHg is the humidity correction factor for the Microstream CO readings Correction calculation formula Pprps FCO x Pb 47 FCO x 0 94 Where FCO2 fractional concentration of CO in dry gas Foo2 CO 100 Pb ambient pressure Alarm Range e Low Limit 10 to 94 mmHg Adult Pediatric e High Limit 20 to 95 mmHg Adult Pediatric AwRR Range 0 to 150 rpm Resolution 1 rpm Accuracy e 0 to 40 rpm 1 rpm e 41 to 70 rpm 2 rpm e 71 to 100 rpm 3 rpm e 101 to 150 rpm 5 rpm Alarm Range e Low Limit 0 to 95 rpm Adult Pediatric e High Limit 10 to 100 rpm Adult Pediatric Apnea Alarm Delay 10 40 seconds in increments of 5 Calibration Gas for CO Measurement System Ingredients 5 Carbon Dioxide 21 Oxygen 74 Nitrogen Cylinder Size BD Method of Preparation Gravimetric Blend Tolerance 0 03 Accuracy 0 03 absolute Moisture 10 PPM Maximum Expiration Period 2 years Pressure 144 PSIG Volume 10L 332 CPR Meter Dimensions 154mm x 64mm x 28mm with a 91m integrated cable Weight 6 oz 170 g Input voltage 4 0 6 0V at 170mA The CPR meter is electrically and galvanically isolated from the defibrillator power and communication sources Temperature Storage 20 C to 60 C 4 F to 140 F Operating 0 C to 50 C 32 F to 122 F Relative Humidity Storage 0 to 75 Operating 0 to 95 S
47. FilterLine 111 warnings 109 110 111 Event Summary 225 229 button 20 events stored 232 initiating events 226 IntelliVue Networking events logged 195 external paddles 75 patient contact indicator 75 external power indicator 22 H HeartStart MRx I AED Mode set up 65 calling for service 319 identifying your device 26 indications for use 3 intended use 2 on the IntelliVue Network 177 190 symbol definitions 337 warnings 345 icons audio 14 23 controls alarm pause button 20 charge button 21 event summary button 20 lead select button 20 mark event button 20 menu select button 20 navigation buttons 20 print button 20 shock button 21 IntelliVue Networking 177 178 network connectivity 14 Periodic Clinical Data Transmission 14 250 INOP alarm types 24 statements 14 troubleshooting 297 IntelliVue Networking 177 admitting a patient 184 bed equipment label bed equipment label 178 clearing a transfer 189 configurable parameters 219 configuration 181 connecting 179 connection icons 178 date and time 191 device icon 177 discharging a patient 185 messages 186 display 178 frequency 179 handling conflicting info 192 locating a device on the network 182 prerequisites 182 messages at the information center 196 network connection rejection messages 317 network setting parameters 183 patient information 190 viewing 193 printing 193 radio AC power module 180 re admitting a pati
48. Hewlett Packard Str 2 71034 Boblingen Germany Canada EMC ICES 001 U S FCC and Industry Canada Radio Compliance Contains FCC ID PQC WMTS MODULE When using the IntelliVue networking option operation of this equipment requires the prior coordination with a frequency coordinator designated by the FCC for the Wireless Medical Telemetry Service This device complies with Part 15 of the FCC rules and RSS 210 of Industry Canada Operation is subject to the following conditions e This device may not cause harmful interference e This device must accept any interference received including interference that may cause undesired operation Notice Any changes or modifications to this equipment not expressly approved by Philips Medical Systems may cause harmful radio frequency interference and void your authority to operate this equipment China After Sales Service Beijing MEHECO PHILIPS Medical Equipment Service Center After Sales Service Address No 208 2nd District Wang Jing Li Ze Zhong Yuan Chao Yang District Beijing Postal code 100102 Telephone 8008100038 Registration number SFDA I 20083211481 Product Standard number YZB USA 1863 2008 For the Declaration of Conformity Statement please see the Philips Medical web site at http incenter medical philips com PMSPublic Scroll over the Quality and Regulatory Tab located in the upper left corner of the window Click to select Regulatory by Modality The
49. ID information is entered using the Reference ID menu You can pre configure up to 20 Reference IDs and can also manually enter one new Reference ID during a clinical event Each Reference ID can be up to 16 characters long and can include uppercase letters numbers spaces and hyphens See Configuration on page 199 and Periodic Clinical Data Transmission on page 250 The HeartStart MRx maintains Reference IDs until e changed by the user e changed in Configuration Mode e anew HeartStart MRx configuration is imported Institution ID Device ID and Equipment Bed Label indentifications are entered in Configuration Mode See Configuration on page 199 NOTE Institutions should develop clear naming conventions for users to follow in order to assure accurate post event data review 26 Entering Patient Information Patient information may be entered for the following e Name e ID e Patient Category e Age Date of Birth if the IntelliVue Networking option is installed e Sex e Chest Pain if the ACI TIPI and TPI option is installed e Paced internal paced status Information is entered using the Patient Info menu Patient Name is entered using 2 alphabetical lists one to enter the last name followed by another to enter the first name When each name is complete select Done Select Cancel to close the patient name menu without saving NOTE Pediatric patients are defined on the HeartStart MRx as children under 8 ye
50. IEC Yellow Alarm Tone Generated while at least one yellow alarm is occurring Tone repeated every two seconds lower pitch then yellow alarm tone Cyan indicator message Philips INOP Tone Generated while at least one INOP condition is occurring Lower pitched tone is repeated twice followed by a pause Cyan indicator message IEC INOP Tone Generated while at least one INOP condition is occurring Tone occurring synchronously with each heart beat QRS tone 318 Calling for Service For telephone assistance call the Response Center nearest to you or visit our website at www medical philips com cms and click on Support Table 101 Response Center Phone Numbers Canada 800 323 2280 United States of America European International Sales 800 722 9377 41 22 354 6464 Austria 01 25125 333 Belgium 02 778 3531 Finland 010 855 2455 France 0803 35 34 33 Germany 0180 5 47 50 00 Italy 800 825087 Netherlands 040 278 7630 Sweden 08 5064 8830 Switzerland 0800 80 10 23 United Kingdom 0870 532 9741 Australia 1800 251 400 China Beijing 800 810 0038 Hong Kong 852 2876 7578 Macau 0800 923 India New Delhi 011 6295 9734 Mumbai 022 5691 2463 2431 Calcutta 033 485 3718 Chennai 044 823 2461 Bangalore 080 5091 911 Hyderabad 040 5578 7974 Indonesia 021 794 7542 Japan 0120 381 557 Korea 080 372 7777 02 3445 90
51. Insensitive Predictive Instrument ACI TIPI and Thrombolytic Predictive Instrument TPI algorithms You can also transmit 12 Lead reports and Event Summaries via the 12 Lead ECG Transmission and Event Summary Data Transfer options Other transmission options are available See Data Transmission on page 239 Manual Defib Mode offers simple 3 step defibrillation You analyze the patient s ECG and if appropriate 1 select an energy setting 2 charge and 3 deliver the shock Defibrillation may be performed using paddles or multifunction electrode pads Manual Defib Mode also allows you to perform synchronized cardioversion and internal defibrillation If desired use of Manual Defib Mode may be password protected In AED Mode the HeartStart MRx analyzes the patient s ECG and determines whether a shock is advised Voice prompts guide you through the 3 step defibrillation process providing easy to follow instructions and patient information Voice prompts are reinforced by messages on the display The Manual Defib and AED modes incorporate Philips low energy SMART Biphasic waveform for defibrillation Both modes also offer the Q CPR option Q CPR offers real time measurement and corrective feedback on the rate depth complete release of compressions and lack of CPR activity and ventilation rate The HeartStart MRx displays a CPR Timer and compression counter to assist with protocol management The HeartStart MRx also has an opti
52. Invasive Pressures option Cascade otherwise Wave 3 Selects the waveform displayed in Wave Sector 3 Pads I II III aVR aVL aVF V CO Pleth Press 1 Press 2 None Default Press 2 if you have the Invasive Pressures option Pleth if you have SpO none otherwise Wave 4 Selects the waveform displayed in Wave Sector 4 Pads I II III aVR aVL aVF V CO Pleth Press 1 Press 2 Cascade None Default CO if you have the CO option none otherwise Table 52 Alarm Settings Alarm Tone Selects either traditional Philips or IEC Standard Philips IEC alarm tones Alarm Pause Time Selects the interval of time during which alarms 1 2 3 5 10 indefinite are paused after the Alarm Pause button is minutes pressed 211 Table 53 12 Lead Settings Institution Name Enters your organization s name in the 12 Lead ECG Report If you are sending data to the TraceMasterVue database then this field must match a valid entry in the TraceMasterVue database 32 characters blank 12 Lead Report e None prints waveforms Event patient ID date and time e Measurements Only adds HR interval and axis measurements Standard adds severity interpretive statements and reasons e Standard prints waveform ID basic measurements and standard diagnostic statements e Auto ACI TIPI runs the ACI TIPI analysis if there is no Acute MI Critical Value statement and the
53. Label cal factor value Logged when cal factor for pressure label is entered or a mercury calibration is completed Pulse Source source Logged when the pulse source is initially determined and when changed NBP Schedule Logged when schedule is changed Manual q1 NBP On Logged when Start NBP is initially pressed manually or configured schedule NBP Limits source low Logged when Start NBP soft key pressed and when settings are changed high NBP Alarms Off Logged when NBP alarms are turned off 233 234 Table 68 Event Information Continued Temperature Label Temperature Label Logged when a temperature label is set or changed Alarms yellow or red alarm Logged when alarm condition occurs Alarms Paused Logged when action occurs Alarms Resumed Logged when action occurs Alarms Off Logged when action occurs Audio Paused Logged when action occurs Audio Resumed Logged when action occurs Capture chapter Audio Audio Recording Logged when audio recording starts or resumes after being stopped Started Audio Recording Logged when audio recording stops because of MRx mode change Stopped Audio Recording Full Logged when audio recording stops because 90 minutes of audio has been recorded for the current event Q CPR NOTE Q CPR events are logged to the patient incident record but are not included in the
54. Lead e Operational Check e Configuration e Status Log e Device Information Speed 25 or 50 mm s with an accuracy of 5 Amplitude Accuracy 5 or 40 uV whichever is greater Paper Size e 50 mm W x 30 m 100 ft L e 75 mm W x 30 m 100 ft L Noninvasive Pacing Waveform Monophasic Truncated Exponential Current Pulse Amplitude 10 mA to 175 mA 5 mA resolution accuracy 10 or 5 mA whichever is greater Pulse Width 40 ms with 10 accuracy Rate 30 ppm to 180 ppm 10 ppm increments accuracy 1 5 Modes Demand or Fixed Rate Refractory Period 340 msec 30 to 80 ppm 240 msec 90 to 180 ppm 327 SpO Pulse Oximetry SpO Measurement Range 0 100 SpO Resolution 1 SpO Update Period 1 2 sec typical maximum lt 60 sec SpO Accuracy with e M1191A sensor 1 standard deviation 70 to 100 2 0 e M1191AL sensor 1 standard deviation 70 to 100 2 0 e M1191B sensor 1 standard deviation 70 to 100 2 0 e M1191BL sensor 1 standard deviation 70 to 100 2 0 e M1191T sensor 1 standard deviation 70 to 100 3 0 e M1192A sensor 1 standard deviation 70 to 100 2 0 e M1192T sensor 1 standard deviation 70 to 100 3 0 e M1194A sensor 1 standard deviation 70 to 100 3 0 e M1196A sensor 1 standard deviation 70 to 100 3 0 e M1196T sensor 1 standard deviation 70 to 100 3 0 e M1195A sensor 1 standard deviation 70 to 100 3 0 e M1131A sen
55. MRx may degrade performance of the HeartStart MRx Electromagnetic compatibility with surrounding devices should be assessed prior to using the defibrillator Fixed portable and mobile radio frequency communications equipment can affect the performance of medical equipment See Table 113 for the minimum recommended separation distance between RF communications equipment and the HeartStart MRx Reducing Electromagnetic Interference The HeartStart MRx and associated accessories may be susceptible to interference from other RF energy sources and continuous repetitive power line bursts Examples of other sources of RF interference are medical devices cellular products information technology equipment and radio television transmission Should interference be encountered as demonstrated by artifact on the ECG or dramatic variations in parameter measurement values attempt to locate the source Assess e Is the interference intermittent or constant e Does the interference occur only in certain locations e Does the interference occur only when in close proximity to certain medical devices e Do parameter measurement values change dramatically when the AC line cord is unplugged Once the source is located attempt to attenuate the EMC coupling path by distancing the monitor defibrillator from the source as much as possible If assistance is needed call your local service representative Qe 50 Restrictions for Use Artifact on t
56. Mode AED Energy Profile 150 Joules nominal into a 50 ohm test load AED Controls On Off shock Text and Voice Prompts Extensive text audible messages guide user through configured protocol Indicators Monitor display messages and prompts voice prompts battery status Ready For Use external power Armed Indicators Charging charged tones flashing shock button energy level indicated on display ECG Analysis Evaluates patient ECG and signal quality to determine if a shock is appropriate and evaluates connection impedance for proper defibrillation pad contact Shockable Rhythms Ventricular Fibrillation with amplitude gt 100 uV and shockable wide complex tachycardias Shockable tachycardias include wide complex rhythms of ventricular or unknown origin with heart rate greater than 150 bpm and polymorphic ventricular tachycardia at any heart rate Shock Advisory Algorithm Sensitivity and Specificity Meets AAMI DF 39 323 Table 102 AED ECG Analysis Performance Shockable Rhythm 600 Meets AAMI DF39 requirement and AHA Ventricular Fibrillation recommendation sensitivity gt 90 for adult defibrillation Shockable Rhythm 300 Meets AAMI DF39 requirement and AHA Ventricular Tachycardia recommendation sensitivity gt 75 for adult defibrillation Non shockable Rhythm 250 Meets AAMI DF39 nears mnie specificity gt 95 and Normal Sinus Rhythm AHA recommendation specificity gt 99 for adult defibrillation Non
57. Operational Check with a pads cable in order to pass the Pacer test Prior to performing the Operational Check ensure that the paddles if tested and the paddle tray are thoroughly clean and there is no debris or residue including all conductive material on the electrode surfaces of the paddles and tray Make sure the paddles are secure in their pockets and that the PCI LEDs are not lit Should the LEDs light adjust the paddles in their pockets If the LEDs continue to light clean both the adult and pediatric paddle electrode surfaces At completion of the Operational Check the message Operational Check Passed is displayed if all of the tests pass If any test fails the message Operational Check failed is displayed along with one or more of the following messages depending upon the severity of the failed functionality e Service device e Replace battery e Replace CPR meter e Replace Pads cable e Replace Paddles cable e Replace Therapy cable e Replace ECG cable You must fix the problem and successfully run the Operational Check to clear the failure If the HeartStart MRx is equipped with multifunction defib pads only and does not have a paddle tray you cannot test paddles during an Operational Check To test paddles you must have a test load Run the Weekly Shock Test delivering the shock into the test load See Weekly Shock Test on page 267 Performing the Operational Check To perform the Operational Check
58. Personal Computer 249 Periodic Clinical Data Transmission 250 Transmitting Clinical Values 250 PCDT Contents 250 Starting a Periodic Clinical Data Transmission 252 Ending a Periodic Clinical Values Transmission 253 Transmitting Event Summaries Post Event 254 Transmitting in Data Management Mode 255 Tracking Data Transmission 257 Transmission Errors 257 Cancelling a Transmission 257 Queuing Transmissions 258 Finding Transmission Results 258 Batch LAN Data Transfer 259 Setting Up for Batch LAN Data Transfer 259 Transferring Files with BLDT 260 Troubleshooting 261 xii 20 Maintenance 263 Overview 263 Automated Tests 264 Automated Test Summary 265 Ready For Use Indicator 266 Shift Checklist 267 Weekly Shock Test 267 HeartStart MRx Shift Checklist 268 Operational Check 270 Performing the Operational Check 271 Operational Check Report 277 Operational Check Summary 282 Battery Maintenance 283 Battery Life 283 Charging Batteries 284 Battery Calibration 284 Storing Batteries 286 Discarding Batteries 286 Cleaning Instructions 287 Monitor Defibrillator 287 Printer Printhead 287 Paddles Therapy Cable 288 ECG Cable 288 Carrying Case 289 NBP Cuff 289 SpO Sensor and Cable 289 Invasive Pressures Transducer and Cable 289 Temperature Probe and Cable 289 CPR meter 289 HeartStart MRx Disposal 290 Empty Calibration Gas Cylinders Disposal 290 CPR Meter and Adhesive Pads Disposal 290 21 Supplies amp Access
59. Pressure label s Yellow Yellow alarm message The systolic pressure value has fallen below Low alarm tone the low alarm limit Pressure label d Yellow Yellow alarm message The diastolic pressure value has fallen Low alarm tone below the low alarm limit Pressure label m Yellow Yellow alarm message The mean pressure value has fallen below alarm tone the low alarm limit Each pressure label has its own unique set of default alarm limits which are set in Configuration mode See Configuration on page 199 for details If the alarm is from a pulsatile source the source is displayed above the alarm limits If alarms are off the Alarms Off ON symbol replaces the limits If a wave becomes non pulsatile the measurement will become mean only and be compared to the current source which may be systolic or diastolic and alarm limits WARNING Make sure you enable disable and set alarm limits for the correct label These settings apply to that particular label only Changing the label might change the alarm limits 125 Enabling Disabling alarms To enable disable alarms perform the following steps 1 Press the Menu Select button 2 Using the Navigation buttons select Measurements Alarms and press the Menu Select button 3 Select the pressure label channel label you wish to modify alarm status on and press the Menu Select button 4 Select Alarms On or Alarms Off and press the Menu Select button
60. Printer Problems Continued Incompatible Printer message The installed printer does not support the fonts required Asian fonts require the 75 mm printer Install the 75 mm printer Check Printer message The printer is out of paper or the door is open Load reload the printer paper Make sure the printer door is closed Printer Malfunction message The printer is faulty or there is a problem communicating with the printer Turn the HeartStart MRx off for 15 seconds and then turn it on again If the problem persists call for service If printing is essential to patient care take the device out of use Printer Temperature High message The temperature of the print head exceeds the recommended operating temperature Wait until the printer cools down and restart printing Table 93 Data Card Problems Incompatible Data Card message Data card is not compatible with the HeartStart MRx Use only compatible Data Cards For a listing of compatible Data Cards see Maintenance chapter Data Card Full message The data card has reached capacity Insert new data card or erase data from card No Data Card Present message A data card is not inserted in the device Insert data card Once inserted wait 5 seconds before trying to access the data card Sufficient time not allowed for data card recognition Re insert data card and wait 5 seconds before trying t
61. Rosetta Lt for two way radio transmission to a healthcare facility running CAREpoint or Rosetta Rx See Figure 104 Available in the United States only Figure 104 Rosetta Lt Transmissions Ny HeartStart MRx Rosetta Lt 2 Way Radio Radio Tower Receiving device at a healthcare facility WARNING Do not connect the HeartStart MRx to the Rosetta Lt when the Rosetta Lt is connected to a telephone line This combination is prohibited Before connecting the Rosetta Lt to a telephone line disconnect it from the HeartStart MRx The 12 Lead Report sent to the Rosetta Lt includes e Patient identification information e Device identification information e Event ID number e Waveform data Optional information in the 12 Lead Report includes e Measurements The 12 Lead Report can also contain numerics for vital signs SpO EtCO AwRR Pulse Temp Invasive Pressure NBP if available The vitals sent with the report are the values recorded at the beginning of the 12 Lead acquisition If a vital numeric is unavailable or its source is off then the vital numeric is not included in the report NBP numerics are valid for 60 minutes If no measurement has been taken in the last 60 minutes NBP numerics are considered unavailable NBP numerics include the measurement time e Interpretive Statements e Acute MI Critical Values Statements e Rhythm strips NOTE The HeartStart MRx sends the above data to the Rosetta Lt Information displayed on
62. Selection Selecting the 1 10 1 9 energy setting displays the Select Energy menu with a default setting of 6J The low energy setting can be changed using the Navigation buttons to increase or decrease the desired setting Complete your selection by pressing the Menu Select button Your current energy selection is shown in the Shock Status area of the display as shown in Figure 46 WARNING Clinicians must select an appropriate energy level for defibrillation of pediatric patients WARNING The HeartStart MRx has a built in limitation of 50 Joules when using internal paddles WARNING Do not leave patients unattended when the HeartStart MRx is in manual defibrillation mode with pads applied to the patient 7 N 2 Charge Press the Charge 2 button on the front panel If using external paddles the charge button on the paddles may be used instead As the defibrillator charges the energy selection shown in the Shock Status area changes to show the current charge energy A continuous low pitch charging tone sounds until the desired energy level is reached at which point you will hear a continuous high pitch charge done tone You may increase or decrease the selected energy at any time during charging or after charging is complete Simply move the Therapy Knob to the desired energy level as explained above The defibrillator charges to the selected energy level automatically To disarm the defibrillator press D
63. The message Pacing Stopped Pads Off Pads Cable Off is displayed in the top line of the pacing status bar Once the condition is corrected resume pacing by pressing the Resume Pacing soft key While pacing if the pacer output drops below the selected setting sometimes caused by poor pads contact as a result of gas bubbles underneath the pads by 20 percent or 10 mA whichever is greater a Pacer Output Low yellow alarm is displayed on the top line of the Pacer Status block The alarm remains on the display until pacing is stopped the condition clears or the therapy knob is moved off the Pacer position A Pacer Output Low entry is logged in the Event Summary While pacing in demand mode should the ECG source for Wave Sector 1 become invalid e g a Leads Off condition or the ECG cable is disconnected a latching red alarm is generated and pacing is stopped The message Pacing Stopped Leads Off is displayed in the top line of the pacing status bar Once the condition is corrected resume pacing by pressing the Resume Pacing soft key When pacing in demand mode using a 3 lead ECG set if the lead in Wave Sector 1 is changed a latching red alarm is generated The message Pacing Stopped Leads Off is displayed in the top line of the pacing status bar Resume pacing by pressing the Resume Pacing soft key NOTE The Pacing Stopped red alarm cannot be disabled WARNING Heart rate displays and alarms function during pacing but the
64. The server connection has timed out Re send the 12 lead report TCP IP Failure Re send the 12 lead report If still unsuccessful check the MRx configuration settings The web server has rejected the data Check the MRx and the12 Lead Transfer Station to ensure that the correct product versions are installed Table 86 12 Lead Transmission Problems RS 232 First attempt to solve the problem by disconnecting the serial cable from the cell phone reconnecting it and resending the 12 Lead Report Transmission Settings Have Not Been Configured message Hub information has not been entered or is entered incorrectly in Configuration Modify the Hub configuration settings as needed No Transmission Devices Detected message The cell phone is not an approved model for 12 Lead Transmission Use an approved cell phone model See the requirements listed in the Transmission Implementation Guide The cell phone s RS 232 port has not been configured Check the cell phone configuration settings The cell phone is not connected properly Check that the cell phone is turned on and the connection is secure Disconnect and reconnect the serial cable The serial cable is defective or incompatible Work with your cell phone provider to obtain a serial cable that connects to your phone with a 9 pin D serial cable connection No Dial Tone message There is no dial tone
65. This can only occur when pulse is determined from a pressure wave The pulse rate is less than 25 bpm or the amplitude of the pressure wave is less than 3 mmHg Check the catheter and connections to the patient Invasive Pressure Label Overrange INOP The pressure wave is outside the measurement range Make sure the measurement has been properly prepared and zeroed and that the transducer is level with the heart If the INOP message persists try another transducer Make sure the transducer is on the supported accessories list Invasive Pressure Label Unplugged INOP The pressure transducer has been disconnected from the device or is faulty Try unplugging and then replugging the transducer If the symptom does not go away use a different transducer Invasive Pressure Label Zero Check Cal INOP Occurs when a new transducer is attached to the monitor Zero the transducer Check the calibration factor if applicable Check Scale displayed with pressure waveform The wave is clipped in the displayed wave area Change the scale Unable to Zero message The cause is displayed with the message Depends on the cause Unable to Calibrate message The cause is displayed with the message Depends on the cause Invasive Pressure Label one of the labels which can be applied to an Invasive Pressure pressure channel Table 95 Temperature Monitoring Problem
66. VTACH limits 1 Press the Menu Select 9 button 2 Using the Navigation buttons select Measurements Alarms from the menu and press the Menu Select button Select HR Arrhythmia and press the Menu Select button 4 Select HR or VTACH Limits and press the Menu Select button 5 Using the Navigation buttons select the new values and press the Menu Select button Enabling Disabling Heart Rate and Arrhythmia Alarms To enable disable the HR and Arrhythmia alarms 1 Press the Menu Select 9 button 2 Select Measurements Alarms from the menu and press the Menu Select button 3 Select HR Arrhythmia and press the Menu Select button 4 Select Alarms On Off and press the Menu Select button Responding to HR and Arrhythmia Alarms When an alarm is announced the audio pause label is presented above the Navigation and Menu Select buttons Pressing any of these buttons temporarily silences the alarm audio while you are attending to the patient See Figure 39 Alarms will reannunciate if conditions exist for two minutes or another alarm condition is generated Figure 39 Audio Pause Label EN Audio Pause Then respond to the alarm condition on the HeartStart MRx There are two ways to respond to an HR or Arrhythmia alarm 1 Acknowledge the alarm condition 2 Adjust the limits using the New Limits menu 59 Displaying an Annotated ECG You may choose to display an annotated ECG with arrhythmia beat labels in Wave Sector 2 The same ECG source
67. a system message is displayed to alert you that a lead is disconnected or that the pads have a poor connection Fixed Mode Pacing To pace in fixed mode 1 Turn the Therapy Knob to the Pacer position The message Pacing Paused appears and indicates that the pacing function is enabled however pace pulses are not being delivered Pacing is enabled in demand mode with the configured lead displayed in Wave Sector 1 If the configured lead is set to Pads Lead II or the first available monitoring lead is displayed 2 Change the pacer mode to fixed mode using the menu selections shown below in Figure 55 Figure 55 Changing Pacer Modes Main Menu Pacer Mode Demand Start Data Transmit ou Volume Displayed Wave Printed Waves Measurements Alarms Patient Info Trends Other High Contrast On Exit 8 Ne 3 Use the Lead Select button to select the desired lead for viewing NOTE Ifyou want to see the ECG waveform and related parameters while pacing you must have electrodes on the patient with pads Using pads only will give you an incorrect heart rate and inappropriate alarms 4 Press Pacer Rate and use the Navigation and Menu Select buttons to select the desired number of paced pulses per minute The initial rate is configurable 5 If needed adjust the initial pacer output To do this press Pacer Output and use the Navigation and Menu Select buttons to select the desired output The initia
68. a yellow arrow pointing up to the compression release target zone You should allow the chest to completely recoil between compressions 165 Compression Rate 166 The CPR meter also provides feedback on your rate of compressions and uses a speedometer to tell you to speed up or slow down your compression rate See Figure 83 Figure 83 Compression Rate Indicator If the CPR meter detects the rate of compression is within the target area the speedometer needle on the compression rate indicator points to the green target zone which lights up A If the CPR meter detects your compression rate is faster than the target rate 120 compressions per minute the needle on the compression rate eg a indicator points to the right of the green target zone If the compression rate is not corrected the HeartStart MRx provides corrective voice prompts if configured If the CPR meter detects your compression rate is slower than the target rate 90 cpm the needle on D the compression rate indicator points to the left of the green target zone If the compression rate is not corrected the HeartStart MRx provides corrective voice prompts if configured Table 27 Other Icons Appearing on the CPR Meter Display The CPR meter displays the Do Not Touch The Patient Icon when the HeartStart MRx provides prompts to stop CPR for analyze of the patient s heart rhythm the HeartStart MRx is charging or advises a shock is require
69. activities occurs e The arrival of a valid ECG signal e The arrival of valid SpO data e The arrival of valid CO data e The arrival of valid invasive pressure data e The arrival of valid temperature data e The arrival of a valid CPR meter compression e An NBP measurement is requested e The Charge oe button is pressed e The Mark Event button is pressed Patient data collected includes two ECG waveforms two invasive pressure waveforms and one CO waveform and other clinical events The number of incidents stored in memory at any given time is determined by the length of each incident and the amount of data collected There is 12 hour data limit per incident with a maximum capacity of 55 patient incidents regardless of card capacity or size of incidents When deleting records are erased oldest first NOTE Monitoring and defibrillation functions are disabled while using the data management features of the HeartStart MRx An active patient event is closed upon entering Data Management Entering Data Management Mode To enter Data Management Mode Turn the Therapy Knob to either Monitor Pacer or Manual Defib Press the Menu Select K button Using the Navigation buttons select the Other menu and press the Menu Select button 1 2 3 4 Select Data Management and press the Menu Select button 5 Press the Menu Select button to acknowledge the message Leaving Normal Operational Mode 6 Press the Menu Select button
70. and reconnect the cable tubing The HeartStart MRx will detect the connection and remove the message Soft Key Labels 16 The four soft key labels correspond to the soft key buttons located immediately below These labels change as appropriate according to the current display view and function Soft key labels appearing as gray text indicate that the soft key is inactive Menus Menus with controls and options specific to each function of the HeartStart MRx are easily accessible using the Menu Select and Navigation buttons located on the front panel Menus are used to adjust volume select waveforms for display select waves for printed strips set alarms schedule measurements enter patient information perform the Operational Check generate reports and a variety of other tasks Menus and submenus are organized to allow you to conveniently make selections and enter information To display a menu press the Menu Select button Then use the up A or down V Navigation buttons to scroll through the available choices until the desired selection is highlighted The menus have a wrap around scrolling feature Holding the Navigation button down accelerates scrolling through the menu choices Once you hit the bottom of a menu it automatically wraps around to the top of the menu and continues scrolling To activate a selection press the Menu Select button Select Exit to close the menu without activating a selection Arrows at the bottom of the
71. and tighten Then snap the handle cover in place by pushing down on either side of the handle cover 7 Ifyour handle cover has screw holes replace the handle cover and then insert the 2 T 15 screws and tighten Smooth down the label corners to cover the screw holes 8 Secure the front and rear cinch straps using the metal rings provided 9 Perform an Operational Check as described in Operational Check on page 270 1 Attach the side pouches using the hook and loop fastener with the flaps and slots Figure 16 Accessory Pouch Assembly 32 Storing Accessories Suggested parameter cabling and accessories storage is shown below Figure 17 Storing Accessories 1 Attach the Therapy cable and route it through cable fastener loop securing the cable just below the strain relief 2 Attach the rear pouch using the buckles provided NOTE Depressions are provided on the inside of the rear pouch should you wish to make a cut out to accommodate external power Some devices may come with the cut outs already made Figure 18 Connecting Cables WARNING When using the carry bag to transport the HeartStart MRx it is important to position it with the display facing away from the body If not the Therapy Knob may be bumped and inadvertently moved from its current position NOTE When packing cables into the carry bag keep them untangled to ensure quick and easy deployment when needed Connecting the ECG Cabl
72. anterior position If is not valid for ventilation necessary prepare the patient s skin and apply new detection pads Pads Off INOP Pads are not making proper contact Make sure the Pads CPR cable is connected and pads with the patient are properly applied in an anterior anterior position If necessary prepare the patient s skin and apply new pads Cannot Analyze Vent INOP Excessive noise on the impedance Make sure the Pads CPR cable is connected and pads signal are properly applied If necessary prepare the patient s skin and apply new pads Table 98 IntelliVue Networking Problems Data from the HeartStart MRx are not on the Information Center display and you have no INOPs on your HeartStart MRx display The HeartStart MRx may not have the IntelliVue option installed Print Device Info to see if the IntelliVue Networking option is installed on the device If not the device can not be used on the network The HeartStart MRx may have the No Central Monitoring INOP configured to optional If your institution s policy allows configure the INOP to mandatory and troubleshoot No Central Monitoring INOP The Information Center may have a different monitor assigned to the sector you are reviewing Confirm that the equipment label assigned to the sector you are reviewing matches the device 315 Table 98 IntelliVue Networking Problems Continued No Central Monitoring INOP on H
73. appearing in the Wave Sector 1 is displayed with a six second delay along with white arrhythmia beat labels See Table 8 below for additional information on beat classification Table 8 Arrhythmia Beat Labels N Normal Above QRS V Ventricular Ectopic Above QRS P Paced Above QRS Pacer spike Above the waveform where the pacer spike is detected If the patient is both atrially and ventricularly paced the display will show two marks above the waveform aligned with the atrial and ventricular pacing L Learning Patients ECG Above QRS A Artifact noisy episode Above the waveform where the noise is detected Insufficient information to classify beats Above QRS I Inoperative condition e g LEAD OFF Above the waveform at start of INOR every second of INOP and at end of INOP M Pause Missed Beat No QRS Above the waveform where the condition is detected To display an annotated ECG Press the Menu Select 9 button Using the Navigation buttons select Displayed Waves and press the Menu Select button Select Wave 2 and press the Menu Select button BR Z O N e Select Annotated ECG and press the Menu Select button Arrhythmia Learning Relearning When arrhythmia monitoring starts a learning process is initiated The goal is to learn the patient s normal complexes and or paced complexes if the patient with an internal transvenous pacemaker is in paced rhythm The learning proce
74. as illustrated on the front of the CPR meter and in Figure 78 It is acceptable if the CPR meter overlaps the defibrillator pad Figure 78 CPR Meter Placement If difficulty is encountered in applying the CPR meter do not delay CPR Remove the CPR meter and begin compressions If the CPR meter moves during use reposition it correctly in the center of the chest WARNING Do not apply the CPR meter to an open wound or recent incision site Do not use the CPR meter in conjunction with any mechanical or automated compression device If the CPR meter stops working isn t working as expected or you are uncertain about the patient s age or the device fitting properly on the patient remove the CPR meter from the patient and continue CPR according to your organization s protocol 163 Starting CPR with the CPR Meter Using standard CPR technique place the heel of one hand directly over the compression area of the attached CPR meter Place your other hand on top of the first interlocking your fingers You should be able to see the display area of the CPR meter to look for feedback see Figure 79 Provide chest compressions according to your organization s CPR protocol Figure 79 CPR and Positioning When the CPR meter first detects compressions the display changes to enlarged compression indicators See Figure 80 For a list of all feedback displays see Feedback Prompts on page 172 Figure 80 Beginning Compression
75. be prompted to select a profile when adding a Bluetooth device as part of the Event Summary Bluetooth option 242 5 Once the Bluetooth device is paired with the HeartStart MRx and the profile selected the HeartStart MRx performs a transmission test After successfully connecting the message Transmission Test Passed is displayed Press the Menu Select button to acknowledge the message Should the transmission test fail the message Transmission Test Failed is displayed along with additional information about where the failure occurred See Transmission Problems Bluetooth on page 304 for troubleshooting information NOTES The profile contains specific information about the Bluetooth device that enables it to communicate with the 12 Lead Transfer Station personal computers and devices running data viewing software Your administrator sets up the profiles and can tell you which one to choose There may be exceptions to the pairing process particularly for devices that do not have a user interface Please refer to the documentation for your Bluetooth device Additionally pairing may sometimes be referred to by other names such as bonding Pairing information is not retained when importing a configuration file from the data card The devices must be paired again using the process above CAUTION The HeartStart MRx is capable of communicating via Bluetooth with nearby devices such as computers laptops tablets and mobile devic
76. below the configured SpO Desat Limit SpO alarms except Desat are all categorized as non latching alarms meaning they are automatically removed when their alarm condition no longer exists Desat alarms are latching meaning they remain present even if the alarm condition no longer exists Table 9 lists SpO alarms Table 9 SpO Red Yellow Physiological Alarms Desat Red Red alarm message The SpO value has fallen below the alarm tone desat low limit SpO High Yellow Yellow alarm message The SpO value exceeds the high alarm alarm tone limit SpO Low Yellow Yellow alarm message The SpO has dropped below the low alarm tone alarm limit SpO alarms are on unless you turn SpO alarms off or alarms for the entire device are off Once disabled alarms remain off until they are turned on WARNING Turning off alarms prevents all alarms associated with the SpO measurement from being annunciated If an alarm condition occurs NO alarm indication will be given Changing the SpO Alarm Limits To change the SpO high and low alarm limits perform the following steps 1 Press the Menu Select 9 button 2 Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button A NW BR O Select SpO and press the Menu Select button Select SpO Limits and press the Menu Select button Select the new low limit value and press the Menu Select button Using the N
77. cable as shown in Figure 42 Figure 42 Pads Connections 65 WARNING Do not use anterior posterior pads placement multifunction electrode pads placed on the patient s chest and back The AED algorithm used by the HeartStart MRx has not been validated using this placement WARNING Do not let the multifunction electrode pads touch each other or other monitoring electrodes lead wires dressings transdermal patches etc Such contact can cause electrical arcing and patient skin burns during defibrillation and may divert defibrillation current away from the heart WARNING During defibrillation air pockets between the skin and multifunction electrode pads can cause patient skin burns To help prevent air pockets make sure defibrillation pads completely adhere to the skin Do not use dried out multifunction electrode pads CAUTION Aggressive handling of multifunction electrode pads in storage or prior to use can damage the pads Discard the pads if they become damaged NOTE Impedance is the resistance between the defibrillator s pads or paddles that the defibrillator must overcome to deliver an effective discharge of energy The degree of impedance differs from patient to patient and is affected by several factors including the presence of chest hair moisture and lotions or powders on the skin The low energy SMART Biphasic waveform is an impedance compensating waveform that is designed to be effective across a
78. change are not updated on your display However both are updated in the Event Summary All timestamps of non clinical events events that occur outside of a patient incident such as NBP and CO calibration Operational Check and Automated Tests indicate the HeartStart MRx s time when the event occurred Apnea time is based on elapsed time and is not affected by a time change 191 Conflict Handling Conflicting patient information between the Information Center and the HeartStart MRx is automatically resolved using the Information Center s Same Patient Conflict Resolution when the HeartStart MRx associates with the Information Center If patient information on the HeartStart MRx has changed as a result of the resolution the message Patient information from the MRx and Central has been merged and a menu to confirm or edit patient info appear in all modes except AED see Figure 98 When in AED Mode only the Patient information from the MRx and Central has been merged message appears on the display for 10 seconds Figure 98 Patient Information Patient information from the MRx and the Central has been merged Last Name Jones First Name Samuel ID 1234567890123456 Patient Category Adult DOB 25Jan 1977 Sex Male Paced No Edit Patient I nfo Press the Menu Select 9 button to confirm the information If you wish to edit the information use the Navigation buttons to highlight Ed
79. confirm the exit After all cases are successfully transferred and the internal data card is erased the HeartStart MRx adjusts its system time based on the time provided by the Data Messenger computer s response Batch Data Transfer is not available on devices with the IntelliVue Networking Option Event Summaries and 12 Lead Reports could contain information which could be considered Patient Healthcare Information PHI or patient identifiable data This information can be printed or transferred from the HeartStart MRx Please handle in accordance with HIPAA or your local patient privacy requirements 258 Batch LAN Data Transfer 19 Data Transmission Batch LAN Data Transfer By using Batch LAN Data Transfer BLDT you can download either a single Event Summary or all Event Summaries on the Internal Data Card to an external personal computer running Data Messenger software for further review and archiving Data Messenger software 4 0 formerly Review Express Connect is software that communicates with the HeartStart MRx to download Event Summaries It monitors an inbox and forwards files as Event Review Pro files to a remote Event Review Pro computer The Event Review Pro software 4 1 can then automatically import the cases into the Event Review Pro database Data Management Part Numbers Data Messenger 861453 Event Review Pro single license 861431 Option A01 Event Review Pro sitewide license 861431 Option A03 S
80. energy delivery or device performance AED View Once the Therapy Knob is moved to AED AED View is displayed Figure 40 AED View Display Mark Event 10 Feb 2006 11 20 A_ hE X Alarms Off HR 154 02 42 Analyzing Do Not Touch Patient Pause for CPR Wave Sectors 1 and 2 are combined so that a large ECG may be shown The Event Timer is also large for easier viewing A Shock Counter is displayed just below the ECG and shows the total number of shocks delivered to the patient in AED and Manual Defib Mode Also below the ECG is a prominent text message window which accompanies the voice prompts annunciated in AED Mode NOTE Only the ECG acquired through multifunction electrode pads is displayed in AED Mode 64 Preparation Confirm that the patient is unresponsive e not breathing e pulseless Then 1 Remove clothing from the patient s chest Wipe moisture from the patient s chest and if necessary clip or shave excessive chest hair 2 Make sure the multifunction electrode pads packaging is intact and within the expiration date shown 3 Apply multifunction electrode pads to the patient as directed on the pads package Use the anterior anterior electrode placement 4 Ifnot pre connected insert the pads cable into the green Therapy port located on the right side of the device Push until you hear it click into place See Figure 41 Figure 41 Pads Cable Connection 5 Connect the pads to the pads
81. for Sealed Lead Acid and Lithium Ion Batteries 989803148551 M4761A Compression Sensor M4762A Compression Sensor Adhesive Pads Package of 10 M4763A Pads CPR Cable for use with Compression Sensor 989803158661 Pads CPR Cable for use with CPR meter 989803162401 CPR meter for Q CPR option with HeartStart MRx software Rev F or higher 989803163291 CPR meter Adhesive Pads 10 Instrument Telemetry 1 4 GHz radio and A C module M4842 61300 1 4 GHz replacement antenna 40457C 50 mm Chemical Thermal Paper Gray Grid 10 rolls 40457D 50 mm Chemical Thermal Paper Gray Grid 80 rolls 989803138171 75 mm Chemical Thermal Paper Red Grid 10 rolls 989803138181 75 mm Chemical Thermal Paper Red Grid 80 rolls Color Handie o Oe M5521A Green M5522A Blue M5523A Yellow M5524A Rose M5525A Gray M1781A Test Load for use with M3507A Pad Cable M3725A Test Load for use with M3508A Pad Cable M3541A Carrying Case 989803146981 Data Card and Tray M3544A Data Card Tray M3853A Data Card Tray also used with HeartStart FR2 M3854A Data Card and Tray also used with HeartStart FR2 M4737A Display Cover M3549A Wide bedrail hook 989803153411 Internal Bluetooth Card 22 Troubleshooting If the HeartStart MRx detects an error or potential problem during use it displays an INOP statement or a message window with text to guide you INOP statement
82. from the Information Center The ADT state is reset to admitted In the event the HeartStart MRx loses its network connection with the Information Center and both devices are still powered on the devices retain the patient s status and other settings when a network connection is restored Prior to monitoring a new patient with the HeartStart MRx you should discharge the old patient to ensure that all old data at the Information Center are removed 193 Leaving a Clinical Mode Ifa networked HeartStart MRx is changed to a non clinical mode i e Data Management Operational Check Battery Calibration Configuration or Service modes a No data from bed INOP statement appears on the Information Center display The current patient incident is closed at the HeartStart MRx The patient will not be discharged from the Information Center If you re enter a clinical mode the ADT state is initially set to Not Admitted and patient type category paced status and alarm limits are reset to their default settings If the patient is still admitted at the Information Center the HeartStart MRx is updated with patient information from the Information Center The ADT state is reset to admitted 194 Events Logged The HeartStart MRx automatically creates an Event Summary for each patient incident Each Event Summary is assigned a unique event identification number and is date time stamped Table 34 lists IntelliVue Networking relate
83. gt 0 10 mV IN III gt II Inferior infarct acute LCX ST gt 0 10 mV II III aVF STD V1 V3 Inferoposterior infarct acute ST gt 1 INE lt 1 V1 3 OR gt 05 V7 9 Inferoposterior infarct acute RCA ST gt 1 INE lt 1 ANT Inferoposterior infarct acute LCX ST gt 1 INE lt 1 V1 3 OR gt 05 V7 9 Inferolateral infarct acute ST gt 10 mV INF LAT LEADS Inferolateral infarct acute LCX ST gt 10 mV INF LAT LEADS Inferolateral infarct acute RCA ST gt 10 mV INF LAT LEADS Probable lateral infarct acute Q gt 28 mS ST gt 0 10 mV V5 V6 I aVL Lateral infarct possibly acute Q gt 28 mS ST gt 0 10 mV V5 V6 I aVL Lateral infarct acute ST gt 10 mV V5 V6 I aVL 143 Table 21 Acute MI Statements Continued Lateral infarct acute LAD ST gt 10 mV V5 V6 I aVL Posterior infarct acute ST lt 01 V1 V3 or ST gt 05 V7 V9 Probable posterior infarct acute ST lt 05 V1 V3 or gt 05 V7 V9 Posterior infarct acute LCX ST lt 01 V1 V3 or ST gt 05 V7 V9 Acute Ischemia If the interpretive statement listed in Table 22 result from measurements generated by an ECG the Critical Value statement Acute Ischemia appears on the 12 Lead Report Table 22 Acute Ischemia Statements Repol abnrm severe global ischemia LM MVD STe aVR STd amp Tneg ant lat inf Extreme Tachycardia If the interpretive statemen
84. is copying data 227 Viewing and Erasing the External Data Card The contents and status of your data card are conveniently available for viewing To display data card information 1 Enter Data Management Mode See Entering Data Management Mode on page 226 2 Press the Menu Select button to display the Data Management menu 3 Select View Data Card and press the Menu Select button Prev Page and Next Page soft keys appear to navigate to additional display pages Use the Erase Card menu entry to delete the contents of the data card CAUTION Ifyou format a Philips data card in a PC card reader you must use a FAT 16 file system to format the data card Using a FAT32 format makes the card incompatible with the HeartStart MRx Do not use the data card as a long term storage device Follow your organization s protocol for backing up electronic data 228 Printing During a Patient Event The HeartStart MRx allows you to print data reports during a patient event The device also allows you to go back and print data reports after the fact from Data Management Mode see Printing from Data Management Mode on page 231 Event Summaries You can print the current Event Summary at any time during a patient event by pressing the Summary button and selecting Event Summary from the menu If an event is not in progress pressing the Summary button and selecting Event Summary prints the most recent Event Summary The printed
85. list indicate additional list options are available An indication of which page you are on in the menu is located between the arrows Scrolling down or up reveals the remaining options Depending upon the situation there are times when some options on various menus are unavailable for use These options will appear in menus as grayed out and can t be highlighted or selected See Figure 9 Figure9 Sample Menus Measurements Alarms HR Arrhythmia Patient Info Press1 ABP i i L Press2 PAP 4 9 PAP q Highlighted selection J CPP Disabled selection ID NBP Patient Category EtC02 Date of Birth AwRR Sex e Paced ulse i More men Chest Pain Lay 2 T MlM options available Exit Value Adjustment By using the HeartStart MRx s Navigation buttons you can set numeric values for several parameters by displaying a values box in the Menu area See Figure 10 Some values are adjustable in increments other than 1 Hold the Navigation button down to accelerate scrolling through the numeric values Release the Navigation button to stop the scrolling The value initially displayed is the default value Figure 10 Setting Values Pacer Rate 60 ppm NOTE Accelerated scrolling is not available when setting Pacer Rate and Pacer Output 17 Message Windows Periodically message windows appear on the display to provide additional status information alert you to an error or a potential pr
86. meet your monitoring and resuscitation needs by providing advanced multi parameter monitoring functions a full range of defibrillation therapies industry leading algorithms and a suite of data transmission options This guide provides instructions for the safe and proper operation of the device as well as set up configuration and maintenance information Be sure to familiarize yourself with the features and operation of your HeartStart MRx prior to its use Overview The HeartStart MRx is a lightweight portable monitor defibrillator It provides four modes of operation Monitor Manual Defib AED and Pacer optional In Monitor Mode you can monitor up to four ECG waveforms acquired through a 3 5 or 10 lead ECG set Optional monitoring of pulse oximetry SpO noninvasive blood pressure NBP carbon dioxide EtCO temperature and invasive pressures are also available Measurements from these parameters are presented on the display Alarms are available to alert you to changes in the patient s condition You can also display a Vital Signs Trending Report to view all key parameters and their measurements at a glance Monitor Mode also provides an optional 12 Lead ECG function enabling you to preview acquire store and print 12 lead ECG reports with or without analysis interpretation In addition there are several STEMI decision support tools including STEMI Culprit Artery Critical Values and the Acute Cardiac Ischemia Time
87. only J Mw Contains number of CPR meter patient adhesive pads shown after equals sign Manufacturer Not for use on children under 8 years old RoHS exempt Environmentally friendly for a use period of 50 years Je Device meets Directive 95 54 EC This device can be run off a battery 5 This device can be run off AC power DC current AC current 338 Table 104 lists the meaning of the symbols that may appear on the shipping carton Table 104 HeartStart MRx Shipping Carton Symbols Atmospheric pressure range Recyclable paper product Temperature range Fragile mE E Relative humidity range Do not get wet A A Refer to operating instructions Right side up B gt 339 Units and Abbreviations Table 105 lists units and abbreviations used with the HeartStart MRx Table 105 Abbreviations bpm beats per minute cpm compressions per minute C degrees Celsius sec seconds F degrees Fahrenheit min minutes mmHg millimeters of mercury mm mV millimeter per millivolt kPa kilo Pascal Hz Hertz percent ppm pulses per minute rpm respirations per minute mA milliAmpere mm millimeter J Joule 340 Clinical Performance Summary Defibrillation Methods An international multicenter prospective randomized clinical study was conducted to assess the effectiveness of the SMART Biphasi
88. printer installed two additional waveforms if you have the 75mm printer installed Certain waveforms including invasive pressures and CO will include scale indications on the printout The printouts are generated either real time or with a 10 second delay depending on your configuration For devices with a 50mm printer to change wave forms for the second wave printed perform the steps below 1 Press the Menu Select 9 button 2 Using the Navigation buttons select the Printed Waves option and press the Menu Select button 3 Using the Navigation buttons select the wave form you want to print in Wave 2 and press the Menu Select button For devices with a 75mm printer to change wave forms for the second or third waves printed perform the steps below 1 Press the Menu Select button 2 Using the Navigation buttons select the Printed Waves option and press the Menu Select button 3 Using the Navigation buttons select Wave 2 or Wave 3 and press the Menu Select button 4 Using the Navigation buttons select the wave form you want printed and press the Menu Select button 5 Repeat Steps 2 through 4 for the other printed wave 28 Return to Owner The Return to Owner feature allows the owner of the HeartStart MRx to enable a specified loan period When the time period is up the borrower of the HeartStart MRx will be reminded to return the device to its owner as identified on the display The feature is password protected in Co
89. pull up on the roll to remove it 3 Examine a new roll of printer paper and remove any remaining adhesive residue from the outer layer of paper 4 Place the new roll of printer paper into the paper well positioning the roll so that the end of the roll is on the bottom and the grid faces up as indicated by the symbol meL inside the printer door 5 Pull the end of the paper out past the paper roller 6 Close the printer door 42 75mm Printer optional To install printer paper 1 Open the printer door by pushing on the latch as shown in Figure 27 2 If there is an empty or low paper roll in the printer pull up on the tab holding the paper roll to remove it 3 Examine a new roll of printer paper and remove any remaining adhesive residue from the outer layer of paper 4 Place a new roll of printer paper into the paper well positioning the roll so that the end of the roll is on the bottom and the grid faces up as indicated by the symbol ep7 door aU way inside the printer a 5 Pull the end of the paper out past the paper roller 6 Close the printer door Figure 27 Installing Paper 75mm aah 2 43 Installing Batteries To install the batteries 1 Align the M3538A Lithium Ion battery in a battery compartment 2 Insert the battery and press until you hear it click into place Ensure that the latches located on both sides of the battery are engaged fully
90. sec Off displayed Filter Selects the filter setting 12 Hz 40 Hz Color Selects the P1 color Red Yellow Blue Green Cyan Magenta White Note The High Contrast feature does not display the colors red or blue therefore be sure your device is configured correctly with appropriate parameter color settings Table 40 Invasive Pressure Settings P2 All setting options are exactly the same as P1 in Table 39 except for Color Selects the P2 color Red Yellow Blue Green Cyan Magenta White Table 41 Invasive Pressure Settings ABP ART Ao All setting options are exactly the same as P1 in Table 39 Table 42 Invasive Pressure Settings CVP RAP LAP Alarm Source Source is always Mean and not configurable High Limit Selects the high limit value Adult 39 360 10 mmHg Ped 39 360 4 Adjusted in increments of 1 mmHg or 0 1 kPa Low Limit Selects the low limit value Adult 40 359 0 mmHg Ped 40 359 0 Adjusted in increments of 1 mmHg or 0 1 kPa Scale Selects the default waveform scale Adult 300 240 180 150 120 110 100 90 80 70 60 50 40 30 20 10 5 10 15 20 Ped 300 240 180 150 120 110 100 90 80 70 60 50 40 30 20 10 5 10 15 20 Artifact Suppression Selects the default artifact suppression timeframe 30 sec 60 sec 90 sec Off Filter Selects the filter setting 12 Hz 40 Hz Co
91. should take if any As each test is run the name of the test appears on the display with the message In Progress as shown in Figure 120 Once you have answered the last prompt Audio test you can leave the HeartStart MRx unattended and the Operational Check will complete If you cancel the Operational Check before it completes there is no record of it in the Operational Check Summary 271 272 Figure 119 Operational Check Setup Screen 02 Mar 2006 10 52 a_ BL Operational Check Model Number M3535A Serial Number US00108360 Last Operational Check 01 Mar 2006 9 35 Pass Setup 1 Connect pads CPR cable CPR meter and test load Or Connect pads cable and test load 2 Turn knob to 150J Required 3 Connect ECG cable Exit Op Check Figure 120 Operational Check Screen 02 Mar 2006 10 53 A_ EM Operational Check Model Number M3535A Serial Number US00108360 Last Operational Check 04 May 2005 9 35 Pass General System Test Pass Therapy Knob Pass Charge Button Pass Shock Button Pass Audio Test Pass Defib Test Pass Pads Pacer Test Pass CPR Meter Test Pass Leads ECG Test Pass ECG Cable Pads Paddles ECG Test Pass Battery Compartment A Test Pass Cal Recommended Battery Compartment B Test Pass SpO2 Test In Progress NBP Test CO2 Test Invasive Pressure Test Temperature Test Bluetooth Test Printer Test Exit Op Check 273 Table 76 Operational Checks Tes
92. the 12 Lead Report produced by the Rosetta Lt is determined by Rosetta Lt software 245 CAUTION A 12 Lead Report sent to the Rosetta Lt will overwrite any 12 Lead Report which currently exists on the Rosetta Lt It is your responsibility to forward the 12 Lead Report from the Rosetta Lt to its destination See the Rosetta Lt User s Guide for more information NOTEs If your HeartStart MRx is transmitting a 12 Lead Report via means other than the Rosetta Lt the Rosetta Lt option is disabled in the Send to menu until the transmission is complete Rosetta LT is available in the United States only Connecting Rosetta Lt To connect the Rosetta Lt to the HeartStart MRx insert the Rosetta Lt cable into the HeartStart MRx s RS 232 Serial port and tighten the screws See Figure 105 Figure 105 Attaching the Rosetta Lt to the HeartStart MRx NOTE For questions about the Rosetta Lt and connector cable or to purchase a connector cable additional items contact General Devices See the Rosetta Lt Data Translator User s Manual for more information Transmitting Using Rosetta Lt For instructions on transmitting with Rosetta Lt from12 Lead Mode see Post Event Transmission Use Cases on page 254 To transmit from Data Management Mode see on page 254 246 Setting Up for RS 232 Transmissions 12 Lead ECG Transmission using RS 232 requires a 9 pin serial cable connected to the RS 232 Serial Port located on the back pan
93. the Mark Event function button See Marking Events on page 237 for more information Monitoring alarms are available in Manual Defib Mode however they are turned off once an energy is selected for defibrillation unless Sync is active Alarms may be turned on in Manual Defib Mode by pressing the Alarm Pause button Alarms are also reactivated once the Therapy Knob is moved to Monitor or Pacer or Sync is selected When an energy is selected automatic NBP measurements are discontinued Ifa manual NBP measurement is requested by pressing the Start NBP soft key the NBP information including the current schedule is displayed in its normal position and scheduled NBP measurements resume The use of Manual Defib Mode may be password protected as defined in Configuration See Password Security on page 13 71 Precautions for Manual Defibrillation Therapy Defibrillating asystole can inhibit the recovery of natural pacemakers in the heart and completely eliminate any chance of recovery Asystole should not be routinely shocked Synchronized Cardioversion Therapy 72 NOTES The HeartStart MRx provides synchronized cardioversion therapy by delivering a brief biphasic pulse of electricity to the cardiac muscle immediately following an R wave detected in the ECG measurement The SMART Biphasic waveform utilized in the HeartStart MRx has undergone clinical testing demonstrating its effectiveness for cardioversion of atrial fibri
94. the changes you are prompted with the message Configuration Not Saved Exit Anyway Select No and press the Menu Select button Then press the Save Changes soft key NOTE This chapter lists configuration parameters for all HeartStart MRx options Your specific device may not have all options installed or data specific to an option programed in therefore all related configuration parameters are not available for modification 200 Saving Configuration Settings to a Data Card To save configuration settings to a data card 1 Make sure a data card is in the HeartStart MRx 2 Press the Export soft key The HeartStart MRx copies the configuration settings to the data card Loading Configuration Settings from a Data Card To load configuration settings from a data card 1 2 3 4 5 Insert the data card with the saved configuration in the HeartStart MRx Press the Change Config soft key and enter the configuration password Press the Import soft key Make any device specific configuration changes such as 12 Lead location code Press the Save Changes soft key Restoring the Default Settings To return to using the configuration settings initially entered during manufacture 1 2 3 4 Press the Change Config soft key Enter the Configuration password Press the Factory Defaults soft key Press the Save Changes soft key Printing Configuration Settings To print the configuration settings se
95. the current cuff pressure is displayed in Parameter Block 1 Once the measurement is complete the values for systolic diastolic and mean pressure are displayed along with the measurement schedule manual or automatic intervals and a time stamp see Figure 60 If NBP alarms are enabled alarm limits appear next to the NBP value and the alarm source systolic diastolic or mean is displayed above the NBP alarm limits If alarms are off the alarms off symbol UN replaces the limits Figure 60 NBP Parameter Block 1 B x Temp C Pulse bpm Yaya g q120 bpm 120 39 0 160 10 40 36 930 80x 95 9 For more information on monitoring NBP refer to the Application Note About Noninvasive Blood Pressure WARNING Do not perform NBP monitoring on patients whose upper arm circumference is less than 13 cm Doing so may result in inaccurate measurements 103 The first time an NBP measurement is taken the cuffs initial inflation pressure is 160 mmHg adult or 120 mmHg pediatric If the measurement is successful the next inflation pressure is 35 40 mmHg above the systolic measurement with a minimum inflation pressure of 120 mmHg If the patient s systolic pressure measurement is higher than the inflation pressure the cuff inflation pressure is automatically increased by 35 40 mmHg and another measurement is attempted The maximum cuff inflation pressure is 280 mmHg while the maximum systolic value is 260 mmHg WARNING Initial cuff infl
96. turn it off for 10 seconds before obtaining a wireless connection Figure 91 Simultaneous Wired and Wireless Physical Network Connections On the display When both wired and wireless connections are available the wired connection takes priority Only the wired icon appears on your display in all clinical views The icon indicates data can be exchanged with and viewed at the Information Center WARNING The HeartStart MRx LAN port is intended for connection to the IntelliVue Clinical Network or for Batch LAN Data Transfer It should only be used for connection to devices that comply with IEC 60950 1 and IEC 60601 1 During real time patient monitoring the HeartStart MRx wired LAN connector should only be connected to the IntelliVue Network For post event Batch LAN Data Transfer the HeartStart MRx should only be connected to the facility network The RS 232 Serial Port is intended for connection to the IntelliVue wireless backpack It is also for connecting with the Rosetta Lt and cellphones for data transmission Improper system operation may result if any other device is connected to this port NOTE Regardless of a wired or wireless connection the HeartStart MRx provides the same level of network functionality The device sends up to four waveforms except Q CPR and a maximum of seven alarms to the Information Center All arrhythmia processing and controls reside with the HeartStart MRx Configuring to Work on the Networ
97. use Bluetooth e Pass A Bluetooth card is detected and If the test fails call for service communicating e Fail A Bluetooth card is not installed or is not functioning Printer e Pass The printer passed its self test If the test fails call for service e Fail The printer needs repair 281 Operational Check Summary The Operational Check Summary lists the results from the last 60 Operational Checks Test results are reported as described in Table 77 To view the Operational Check Summary Turn the Therapy Knob to Monitor Press the Menu Select 9 button Using the Navigation buttons select Other and press the Menu Select button 1 2 3 4 Select Operational Check and press the Menu Select button 5 Using the Navigation buttons select Op Check Summary and press the Menu Select button 6 Press the Menu Select button to acknowledge the message Leaving Normal Operational Mode The Operational Check Summary screen is displayed 7 Pressthe Print soft key to print the report Table 78 Operational Check Summary Results Pass Hourglass All tests passed None Fail DX Solid red X chirp A problem has been detected Turn the Therapy Knob to Monitor An that may prevent the delivery inop indicating the problem is displayed of a shock pacing or ECG See Chapter 22 Troubleshooting for the acquisition corrective action Fail CX Solid red X chirp A problem has been detect
98. use and begin troubleshooting NOTE Detach the test load from the patient Therapy cable after performing the Shift Check So your device is ready for use when needed do not leave the test load attached after performing an Operational Check 267 20 Maintenance Shift Checklist HeartStart MRx Shift Checklist Inspect the MRx accessories and supplies at the change of every shift per AHA guidelines Place a check mark in the box as you check each item in the list below or place a dash or N A if not applicable Then initial the list to indicate the check was performed for that shift Device Name or Serial Number Unit or Department RFU Indicator Hourglass If blinking red X Plug into AC DC power or insert charged battery If solid red X Insert charged battery or AC DC power If condition persists call for service Cables connectors present and inspected Paddles Therapy cable present and inspected Pads Present sufficient supply CPR meter and Adhesive Pads Monitoring Electrodes present sufficient supply Charged Batteries one in device spares AC DC Power Cord plugged in green light on Printer Paper present sufficient supply Data Card present sufficient supply SpO Sensors present sufficient supply NBP cuffs tubing present sufficient supply CO FilterLine present sufficient supply Invasive Pressure Tranducers
99. wait for the printing to finish or cancel the printing before proceeding 256 Tracking Data Transmission After initiating a data transmission from the HeartStart MRx you can track transmission progress on the device display For events the Event ID along with the date and time of the event data being sent are displayed while for 12 Lead reports the date and time of the report are displayed The phase Connecting to Device and Sending are also shown If the HeartStart MRx is in the process of sending data a percentage complete is also displayed See Figure 114 Figure 114 Transmission Status Bar 11 Aug 2004 10 52 Sending 40 complete Once transmission is complete a brief Confirming Stand by message appears on the display followed by a Disconnecting message Then the transmission progress message is removed NOTE Ifa 12 Lead transmission occurs during a patient event an event indicating the time of transmission is logged into the current Event Summary using the format 12 Lead hh mm ss Transmitted to site L name If you exit the Data Management screen or leave a clinical mode causing a reboot of the device during transmission the transmission is aborted Changing between clinical views AED Monitoring Pacing Manual Defibrillation does not terminate a transmission The status bar is displayed in all clinical modes Transmission Errors If there is an error in transmission a message is displayed on the HeartStart M
100. with the CPR meter on a person The CPR meter can be used with a training manikin or on acompliant surface for practice CAUTION The CPR meter and its Pads CPR cable can only be used on HeartStart MRx devices with Software Version F 01 installed Earlier versions of the Compression Sensor and Pads CPR cable can t be used on a HeartStart MRx with Version F 01 installed See Figure 72 Institutions with mixed fleets should develop a way for end users to identify which CPR devices go with which HeartStart MRx units The Q CPR option is not intended for use with any other CPR compression devices This Pads Compression a Pa idet De toed Figure 72 CPR meter and Sensor Differences This Pads CPR meter must be used with iy on ean str MRx connection this CPR meter LP devices with software version F01 Pal installed on HeartStart MRx devices with with this software version Sensor connection A A Compression m Sensor 9 xx or lower installed al Preparing to Use Q CPR A Pads CPR cable connects the CPR meter to the HeartStart MRx To set up the Q CPR option on the HeartStart MRx and prepare the patient for use follow the steps described on the following pages Connecting the Pads CPR Cable To connect the Pads CPR cable 1 Align the white pointer on the cable with the white arrow on the green Therapy port as shown in Figure 73 Insert the cable into the green Therapy port Push until you hear it click into plac
101. 0 second delay Table 67 Printed Strip Lengths HeartStart MRx charges to Continuous 10 seconds just prior to charging plus deliver a shock continuous printing through the charge duration Shock delivered 12 seconds 10 seconds just prior to shock plus 12 seconds after shock Shock failed 12 seconds 10 seconds just prior to the message No Shock Delivered plus 12 seconds after the message Alarm condition 15 seconds 10 seconds of pre alarm data and 5 seconds of post alarm data when specified alarm type occurs Same as real time strip Mark Event gt button pressed For more information on this feature see Marking Events on page 237 6 seconds from the start of the annotation text or from the time the Events menu is removed from the display 10 seconds prior to the Mark Event plus 6 seconds from the start of the annotation text or from the time the Events menu is removed from the display 230 Printing from Data Management Mode To print a historical Event Summary Vital Sign Trends Report or 12 Lead Report 1 Enter Data Management Mode See Entering Data Management Mode on page 226 2 Use the soft keys labeled Prev Item and Next Item to select the Event Summary you want to print 3 Press the Menu Select button to display the Data Management menu 4 Highlight Print and press the Menu Select button 5 Select the data option listed that you want to print see
102. 10 Transducer Load Resistance 195 to 2200 Ohms Transducer Output Resistance 0 to 3000 Ohms Frequency Response 0 12Hz or 0 40Hz Zero Adjustment Range 200mmHg 26 7kPa Zero Adjustment Accuracy 1 0mmHg 0 1kPa Zero Setting Drift lt 0 1mmHg C 0 013kPa C Gain accuracy excluding transducers 1 of reading or lmmHg 0 1kPa whichever is greater Gain Drift less than 0 05 C Overall Accuracy included listed transducers 4 of reading or 4mmHg 0 5kPa whichever is greater Measurement Range 40 to 361mmHg 5 3 to 48 1kPa Measurement Resolution 1mmHg 0 1kPa Noise lt 1mmHg 0 1kPa Alarm Response Time 60 bpm transition from 120 0 to 25 0 11 1 seconds standard deviation 0 001 seconds Alarm Signal Generation Delay lt 14 seconds after an INOP condition for that pressure channel clears or 8 seconds in the absence of an INOP for that pressure channel Transducer Dome Volume Displacement Refer to the specific device s specifications Additional Noise from EMI if operating under conditions according to EMC standard EN60601 1 2 Radiated Immunity 3 V m or Conducted Immunity 3 VRMS lt 3mmHg Pulse Rate Range 25 350 bpm Pulse Rate Accuracy 1 of full range 330 Pulse Rate Resolution 1 bpm Temperature Measurement Range 0 45 C 32 113 F Measurement Resolution 0 1 C 0 2 F Measurement Accuracy excluding any adapter cable 0 1 C from 25 C to 45 C 0 3 C from 0 C to 24 9 C
103. 10 Malaysia 1800 886 188 New Zealand 0800 251 400 Philippines 02 845 7875 Singapore 1800 PHILIPS Thailand 02 614 3569 Taiwan 0800 005 616 319 23 Specifications and Safety This chapter describes the specifications and safety features of the HeartStart MRx monitor defibrillator Specifications General Dimensions with pads 31 5 cm W x 21 0 cm D x 29 5 cm H 12 4 in x 8 3 in x 11 7 in Dimensions with paddles 34 0 cm W x 21 0 cm D x 34 5 cm H 13 4 in x 8 3 in x 13 6 in Weight Less than 13 2 lbs including pads pads cable battery and full roll of paper Incremental weight of external standard paddles and paddle tray is less than 2 5 lbs Additional battery weighs less than 1 8 lbs Standard Operator Position Within one meter of device Defibrillator Waveform Biphasic Truncated Exponential Waveform parameters adjusted as a function of patient impedance Shock Delivery Via multifunction electrode pads or paddles 321 Delivered Energy Accuracy Selected Nominal Delivered Energy vs Patient Impedance Accuracy Energy Load Impedance ohms 25 50 75 100 125 150 175 1J 1 2 1 3 1 2 1 1 1 0 0 9 0 8 2J 2J 1 8 2 0 2 0 1 9 1 7 1 6 1 5 2J 3J 2 8 13 0 3 0 3 1 3 0 2 9 2 7 2 4J 3 7 14 0 4 0 4 1 4 2 4 2 4 0 2J 5J 4 6 5 0 5 1 5 1 5 2 5 2 5 0 2J 6J 5 5 6 0 6 1 16 2 6 3 6 3 6 1 2J 7J 6 4 7 0 7 1 7 2 7 3
104. 151 Reviewing Trending Data 151 About The Data Displayed 152 Vital Signs Trending Report Parameter List Order 153 Scrolling in the Vital Signs Trending Report 153 Vital Signs Trending Report Intervals 153 Adjusting Vital Signs Trending Report Interval 153 Printing the Vital Signs Trending Report 154 Exiting Vital Signs Trending Report 155 Troubleshooting 155 15 Q CPR and Data Capture 157 Overview 157 Preparing to Use Q CPR 159 Connecting the Pads CPR Cable 159 Connecting the CPR Meter to the Pads CPR Cable 160 Applying Multifunction Electrode Pads 160 CPR Meter 161 Attaching the CPR Meter Adhesive Pad 162 Placing the CPR Meter on the Patient 163 Starting CPR with the CPR Meter 164 CPR Meter Display 165 Q CPR Feedback on the HeartStart MRx 167 Advanced View 167 Basic View 170 Using Q CPR in Manual Defib Mode 171 Using Q CPR in AED Mode 171 Feedback Prompts 172 Adjusting CPR Feedback Volume 173 After Each Use 174 Q CPR Data Capture 174 Q CPR Feedback Setting 174 Data and Events Recorded 175 Research Storage Setting 175 Reviewing Q CPR Data 175 Troubleshooting 175 16 Networking 177 IntelliVue Networking Display 178 Connecting to the Network 179 Physical Connections 179 Wired Connection 180 Wireless Connection 180 Combined Connection 181 Configuring to Work on the Network 181 Using the Device Location Option 182 Network Settings 183 Admit Discharge Transfer of Patients 184 Admit 184 Discharge 185 Transfer 187 Transfer Mod
105. 2 Lead report transmission and a new 12 Lead report is acquired only the newest 12 Lead Report is sent e Ifthere is a pending event message that s greater than a minute old it is not sent NOTE The most recent 500 transmission events are logged in the Periodic Clinical Data Transmission log available in Service Mode See the HeartStart MRx Service Manual for more information Ending a Periodic Clinical Values Transmission To end an on going periodic clinical data transmission 1 Press the Menu Select button 2 Using the Navigation buttons select End Data Transmit and press the Menu Select button 3 Confirm you want to end the transmission by highlighting Yes and press the Menu Select button Selecting No continues the transmission 4 The transmission stops and all pending transmissions are deleted NOTE Exiting a clinical mode cancels a data transmission session and all transmissions in queue 253 Transmitting Event Summaries Post Event The HeartStart MRx provides options see Figure 110 and Table 72 to transmit data after an event for quality review billing and archiving You can e Save data to the data card for personal transport to another device See Copying from Internal Memory on page 227 e Send data via Bluetooth to a receiving device See Setting up Bluetooth Transmissions on page 242 e Send data via Batch LAN Data Transfer See Batch LAN Data Transfer on page 259 Figure 110 Post Ev
106. 2 Using the Navigation buttons select Measurements Alarms and press the Menu Select button 3 Select Press 1 or Press 2 and press the Menu Select button 4 Select Label and press the Menu Select button 5 Select the appropriate label from the list provided see Table 14 for list and press the Menu Select button 6 Select the size of your scale See Pressure Waves on page 118 7 Select Alarm Source type See Alarms on page 125 8 Set the high and low alarm limits Repeat the steps to label the other pressure channel NOTE Changing the pressure site label activates scales and alarm settings associated with the new label You will be presented with the controls for scale and alarm settings after selecting a label from the menu to either confirm or adjust the value Table 14 lists pressure labels Table 14 Pressure Labels ABP Arterial Blood Pressure LAP Left Atrial Pressure ART Arterial Blood Pressure PAP Pulmonary Artery Pressure Ao Aortic Pressure RAP Right Atrial Pressure CVP Central Venous Pressure P1 Non specific pressure label Channel 1 ICP Intracranial Pressure P2 Non specific pressure label Channel 2 Cerebral Perfusion Pressure CPP is automatically displayed with ICP when one pressure is already set to ABP ART or Ao and the other pressure is set to ICP CPP will be displayed in the same color as ICP Only one of the ICP or CPP alarms can be enabled at the same time See Ala
107. 2 g Hz from 5 to 350 Hz 6 dB octave slope from 350 to 500 Hz e Non operating Random vibration 2 41 Grms 5 500 Hz for gt 10 minutes axis PSD 0 02 g Hz from 5 to 100 Hz 6 dB octave slope from 100 to 137 Hz 0 dB octave slope from 137 to 350 Hz 6 dB octave slope from 350 to 500 Hz Swept sine vibration 0 75 g 0 to peak 5 to 500 Hz resonant search 1 octave minute sweep rate 5 minute resonant dwell at 4 resonances per axis Water Solids Resistance IP24 if used with water resistant paddles M3543A or pads only IP20 if used with other paddles EMC Complies with the requirements of standard EN 60601 1 2 2001 Safety Meets UL 2601 1 CSA C22 2 No 601 1 EN 60601 1 and 60601 2 4 standards 334 Other Considerations e The HeartStart MRx is not suitable for use in the presence of concentrated oxygen or a flammable anesthetic mixture with air oxygen or nitrous oxide e Hazards arising from software errors were minimized by the product s compliance with the software requirements contained in EN 60601 1 4 1996 Mode of Operation Continuous AC Line Powered 100 240 VAC 50 60 Hz 1 0 46 A Class 1 Battery Powered Minimum 14 4 V Rechargeable Lithium Ion DC Powered Input 11 32 VDC 11 A e Output 18 V 5 A 90 W Environmental M3536A Temperature 0 C to 45 C operating 20 to 70 C storage e Charging the battery at temperatures above 45 C may degrade battery life Storing the battery for e
108. 258 tracking 257 tracking BLDT 260 troubleshooting 304 data storing 2 Defibrillating 91 defibrillation charge button 21 charge time 322 clinical performance summary 341 delivered energy accuracy 322 manual 71 asynchronous 77 code view 73 external paddles 75 Manual Defib Mode 73 overview 71 precautions 72 preparation 74 select energy 77 multifunction electrode pads 74 Q CPR 171 shock button 21 shock counter 73 Sync button 21 Therapy knob 21 troubleshooting 310 using internal paddles 76 using pediatric paddles 76 warnings 348 delivered energy accuracy 322 Device ID usage 26 display high contrast 18 displayed waves 49 E ECG and arrhythmia monitoring 47 61 59 bundle branch 55 configurable parameters 203 ECG wave size 54 electrode placement 51 12 lead 52 3 lead 51 5 lead 51 VIC 52 INOP messages 58 lead choices 53 lead selection 53 monitoring view 48 overview 47 preparation 49 specifications 324 troubleshooting 299 via electrodes 49 via multifunction electrode pads 50 ECG cable 35 connecting 35 electrode pads 160 electrode placement 51 electromagnetic compatibility 350 emissions and immunity 351 EtCO alarms 112 changing 113 enabling disabling 113 configurable parameters 209 disabling 114 indications 3 specifications 331 troubleshooting 309 EtCO monitoring 109 connecting filter line 40 measured levels 109 measuring EtCO 112 overview 109 selecting accessories 110 setting up 111 using Nasal
109. 30 300 bpm Pulse Rate Resolution 1bpm Pulse Rate Accuracy 2 or 1 bpm whichever is greater over the measurement range Pulse Alarm Range Low Limit 30 to 195 Adult 30 to 235 Pediatric High Limit 35 to 200 Adult 35 240 Pediatric Pulse Response Time 90 to 120 bpm average 18 0 seconds standard deviation 0 86 seconds NBP Pressure Range e Systolic 40 260 mmHg e Diastolic 20 200 mmHg Pulse Rate Range 30 to 220 bpm Initial Pressure 160 mmHg Adult 120 mmHg Pediatric Maximum Pressure 280 mmHg Overpressure Safety Limits Maximum of 300 mmHg Cuff Inflation Time 75 second maximum pediatric or adult Pressure Transducer Accuracy 3mmHg Alarm Range e Systolic high limit 35 270 Adult 35 180 Pediatric e Systolic low limit 30 265 Adult 30 175 Pediatric e Diastolic high limit 15 245 Adult 15 150 Pediatric e Diastolic low limit 10 240 Adult 10 145 Pediatric e Mean high limit 25 255 Adult 25 160 Pediatric e Mean low limit 20 250 Adult 20 155 Pediatric Rated Life 50 000 measurement cycles 36 day for 2 3 years Auto Mode Repetition Time 1 2 5 5 10 15 30 60 or 120 minutes 329 Maximum Measurement Time 120 sec Interconnect Tube Length e M1598B Connect tubing 1 5 m e M1599B Connect tubing 3 0 m Recommended frequency of pressure transducer calibration yearly Invasive Pressures Transducer Sensitivity 5uV V mmHg 37 5uV V kPa Sensitivity Adjustment Range
110. 3802 12 Lead BT RS 232 Transmit and 989803153411 Internal Bluetooth Card See Setting Up for RS 232 Transmissions on page 247 1 Patient Care Report PCR software must be able to deliver the file to the healthcare facility The destination site set at the HeartStart MRx is contained in the file information transmitted If you use a Philips product to deliver the file to the healthcare facility it reads the destination site from the file sent For more information on the set up of your ePCR software see the software s Instructions for Use 2 Available in the U S only 3 Cable provided by General Devices 4 There are a limited number of carriers and cellphones which support this feature Consult your cellular handset sales representative for more information Preparing for Transmission Before transmitting data the HeartStart MRx needs to be set up properly based on the type of transmission option selected If you are using Bluetooth wireless technology your wireless devices need to be set up as well If you are using Batch LAN Data transfer set up your HeartStart Data Messenger Server ahead of time and configure both devices See the instructions which came with the Data Messenger Server for more information Regardless of the solution selected test the transmission before using in a clinical situation If you are using a cell phone data transmission can sometimes be unreliable A strong signa
111. 3m 10 4m 7m 100 12m 23 m reflection from structures objects and people For transmitters rated at a maximum output power not listed above the recommended separation distance d in meters m can be determined using the equation applicable to the frequency of the transmitter where P is the maximum output power rating of the transmitter in watts W according to the transmitters manufacturer At 80 MHz and 800 MHz the higher frequency range applies These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and 357 12 Lead ECG 135 ACI TIPI 135 139 acquiring 138 adjusting wave sizes 149 algorithm 135 136 configurable parameters 212 Critical Values 143 Acute ischemia statements 144 Acute MI statements 143 Complete Heart Block statements 144 Extreme Tachycardia statements 144 Culprit Artery 145 acronyms 145 entering patient info 138 filters 150 indications 3 Leads off 137 preparation 137 preview screen 137 report 146 accessing stored reports 148 contents 146 copy to data card 148 display 147 printing 229 setup 136 signal problems 149 specifications 333 TPI 135 139 warnings 146 A abbreviations units 340 AC Line Filter 22 AC power module installing 45 accessories 291 connecting pouches 31 ACI TIPI 135 analysis 139 display 147 indications 4 patient info required 142 predicted probability 139 ST and T changes 142 AED Mode 63 and childre
112. 79 Table 77 Operational Check Test Results Continued Pads Paddles ECG Pass cable type ECG acquisition and the cable are both If the test fails with a cable connected remove functioning the cable and repeat the test If the test passes Pass No cable ECG acquisition is functioning a cable without the cable replace the cable If the test Sasa unreal continues to fail take the device out of use and call for service Fail cable type ECG acquisition and or the cable specified are not functioning Battery A e None There is no battery in the slot Charge the battery Battery B e Pass The battery has 20 or greater capacity Calibrate the battery e Fail The battery has 20 or less capacity e Cal Recommended The battery requires calibration SpO e Pass SpO passed its self test If the test fails call for service to repair the e Fail SbO is not functionin SpO module If SpO monitoring is essential p z E to patient care take the device out of use NBP e Pass NBP passed its self test If the test fails call for service to repair the e Fail NBP is not functionin NBP module If NBP monitoring is essential i to patient care take the device out of use Pass Cal Due NBP passed its self test and is due to o be calibiated If calibration is due or overdue arrange for a qualified service provider to perform the e Fail Cal Overdue NBP passed its self test but is calibration due for calibrati
113. 8 automatic 106 configurable parameters 208 connecting tubing 37 indications 3 initial inflation 104 manual 106 measuring 104 changing schedule 106 overview 103 pressure displayed 103 specifications 329 troubleshooting 302 warnings 105 Noninvasive Pacing 83 alarms 84 changing modes 89 continued use 27 defibrillating 91 Demand Mode 86 demand mode 88 Fixed Mode 86 fixed mode 89 indications 3 overview 83 pacer output 84 pacing view 85 pads off 84 power interruption 84 preparation 87 R wave markers 88 shielded leadsets 83 soft keys 85 specifications 327 troubleshooting 310 operating modes 12 Operational Check 270 performing 271 report 277 summary 282 results 282 362 test results 279 tests 274 User Checks 278 P Pacing see Noninvasive Pacing 83 paddles using internal 76 using pediatric 76 parameter blocks 16 parameters turning on and off 16 password security 13 patient category 14 entering data 27 name 14 pediatric patients age 27 Periodic Clinical Data Transmission 250 pleth wave 98 printing 12 Lead ECG Reports 229 cleaning printhead 287 configurable parameters 220 configuration settings 201 Event Summary 229 from Data Management Mode 231 from the IntelliVue Network 193 installing paper 50mm 42 75mm 43 printer specifications 327 strip lengths 230 troubleshooting 311 Vital Signs Trending Report 154 229 waveforms 28 pulse configurable parameters 210 pulse rate alarms 100
114. Alarm Limits You can change the default pulse source in the pulse section of Configuration Mode See Pulse Settings on page 210 Because pulse and heart rate share the same default alarm limits default pulse alarm limits can be changed in the ECG section of Configuration Mode Caring For Your Transducers and Probes Refer to the manufacturer s instructions for care and cleaning of your invasive pressure transducers and cables Inappropriate treatment of the cables will reduce their lifetime Troubleshooting If your HeartStart MRx does not operate as expected during invasive pressure monitoring see Troubleshooting on page 297 130 12 Temperature This chapter describes how to monitor temperature using the HeartStart MRx Overview The HeartStart MRx offers one channel of real time continuous temperature monitoring The device can monitor nasopharyngeal esophageal rectal skin arterial venous core and urinary bladder temperatures Measurements which can be displayed in either Fahrenheit or Celsius may be taken while in Monitor Pacer or Manual Defib modes Selecting a Temperature Label The HeartStart MRx monitors the temperature of the area where the sensor is located To assure specific temperature settings are matched with the temperature reading assign the proper temperature label to the measurement When modifying a temperature label all settings including alarm limits associated with that label bec
115. AwRR value has fallen below the low alarm limit EtCO and AwRR alarms are on unless you turn them off or alarms for the entire device are off Once disabled alarms remain off until they are turned back on WARNING Turning off alarms prevents all alarms associated with EtCO or AwRR measurements from annunciating If an alarm condition occurs NO alarm indication will be given Changing the EtCO Alarm Limits To change the EtCO alarm limits 1 Press the Menu Select 9 button 2 Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button Select EtCO and press the Menu Select button 4 Select EtCO Limits and press the Menu Select button 5 Using the Navigation buttons increase or decrease the high limit value and press the Menu Select button 6 Set the new low limit value and press the Menu Select button Enabling Disabling the EtCO Alarms To enable or disable the EtCO alarms 1 Press the Menu Select 9 button 2 Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button Select EtCO and press the Menu Select button 4 Select Alarms On Off and press the Menu Select button Changing the AWRR Alarm Limits To change the AwRR alarm limits 1 Press the Menu Select 9 button 2 Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button 3 Select AWRR and press the Menu Select bu
116. CG in Wave Sector 1 to a lead derived from monitoring electrodes There is a dashed line on the display instead of an ECG ECG data is not being acquired Check the pads paddles or ECG cable is connected Check the pads paddles or monitoring electrodes are properly applied Check that the desired lead is selected Lead wire Off message displayed in wave sector The specified monitoring electrode is off or not making proper contact with the patient Check that monitoring electrodes are properly applied If necessary prepare the patient s skin and apply new electrodes Check Limb Leads message displayed in wave sector 2 or more limb lead electrodes are off or not making proper contact with the patient Check that the limb lead electrodes are properly applied Pads Off message displayed in a wave sector Pads are not making proper contact with the patient Make sure the pads therapy cable is connected and pads are properly applied If necessary prepare the patient s skin and apply new pads Cannot Analyze ECG INOP The arrhythmia or 12 Lead algorithm cannot reliably analyze the ECG data Check ECG signal quality If necessary improve lead position or reduce patient motion Table 82 ECG Monitoring Problems Continued Pads ECG Cable Failure INOP A short was detected between a lead wire and ground Replace the pads cable and perform an O
117. CPR meter Adhesive Pads and peel one from the liner strip to expose the adhesive surface on the underside 2 Align the bottom of the patient adhesive with the yellow patient adhesive mount area on the back of the CPR meter Make sure the channel on the adhesive indicated by a dotted line on the front of the pad is directly over the visible groove in the plastic Press into place See Figure 77 Do not peel off the green liner from the front of the pad until you are ready to apply the CPR meter to a patient WARNING Check the label on the outside packing to confirm the adhesive pads are within their expiration date Do not use pads beyond their expiration date Figure 77 CPR Meter Adhesive Pad ery p s af We WARNING The CPR meter Adhesive Pad is intended for single patient use only It should be replaced after each use CAUTION The CPR meter should always be stored with the CPR meter Adhesive Pad in place as described above Use of the adhesive pad assists in protecting the vent membrane from getting dirty or damaged 162 Placing the CPR Meter on the Patient To place the CPR meter on the patient 1 Ensure the patient s skin is clean and dry If necessary clip or shave the hair from the sternum area 2 Peel off the green liner from the CPR meter Adhesive Pad to expose the adhesive surface 3 Position the CPR meter so the compression area is centered between the nipples and on the centerline of the bare chest
118. Cable 38 Connecting the Temperature Cable To connect the temperature cable 1 Insert the temperature cable into the temperature port as shown in Figure 23 2 If needed attach the cable to your probe Figure 23 Connecting the Temperature Cable 39 Connecting the CO FilterLine To connect the CO FilterLine 1 Using the end of the FilterLine fitting slide the CO compartment door down 2 Insert the fitting into the CO Inlet port as shown in Figure 24 3 Turn the fitting clockwise into place Figure 24 Connecting the CO FilterLine 40 Connecting the Therapy or Pads CPR cables To connect the Therapy or Pads CPR cable 1 Align the white pointer on the cable with the white arrow on the green Therapy port as shown in Figure 25 2 Insert the cable into the green Therapy port Push until you hear it click into place 3 Ifyou are using the carry case thread the cable through the fabric fastener at the bottom of the side pouch to secure the cable into position Figure 25 Connecting the Therapy or Pads CPR Cable To detach the Therapy or Pads CPR cable A 1 Rotate the green knob in a clock wise direction as indicated by the lock unlock symbol next to the Therapy door 2 Pull the cable away from the device 41 Installing Paper 50 mm paper To install printer paper 1 Open the printer door by pushing on the latch as shown in Figure 26 2 If there is an empty or low paper roll in the printer
119. Care Reusable NBP Cuff Adult M4557B Easy Care Reusable NBP Cuff Large Adult M4559B Easy Care Reusable NBP Cuff Thigh M1572A Multi Patient Comfort Cuffs Pediatric M1573A Multi Patient Comfort Cuffs Small Adult M1574A Multi Patient Comfort Cuffs Adult M1575A Multi Patient Comfort Cuffs Large Adult Disposable Blood Pressure Cuffs M4572B Soft Single Patient Disposable Cuff Infant M4573B Soft Single Patient Disposable Cuff Pediatric M4574B Soft Single Patient Disposable Cuff Small Adult M4575B Soft Single Patient Disposable Cuff Adult M4576B Soft Single Patient Disposable Cuff Adult X Long M4577B Soft Single Patient Disposable Cuff Large Adult M4578B Soft Single Patient Disposable Cuff Large Adult X Long M4579B Soft Single Patient Disposable Cuff Thigh Table 80 Supplies and Accessories Continued Intubated Circuits M1920A FilterLine Set Adult Pediatric 25 sets case M1921A Filter H Set Adult Pediatric 25 sets case M1923A Filter H Set Infant Neonatal yellow 25 sets case Non Intubated Dual Purpose Circuits CO O3 M2520A Smart CapnoLine Pediatric M2522A Smart CapnoLine Adult Non Intubated Single Purpose Circuits CO3 M2524A Smart CapnoLine Pediatric M2526A Smart CapnoLine Adult CPJ840J6 Reusable pressure transducer CPJ84022 Sterile disposable pressure dome for use with CPJ840J6 CPJ84046 Transducer holder for CPJ840J6 M1567A Single chan
120. ECG to the PC Data Messenger software will forward to the 12 Lead Transfer Station The 12 Lead Transmission Bluetooth wireless technology option B06 and either Event Summary Bluetooth option B10 or Periodic Clinical Data Transmission options B18 HeartStart Data Messenger software 861453 See Transmitting to a Personal Computer on page 249 A 12 Lead ECG using electronic PCR software in my portable computer Bluetooth File Transfer and a Bluetooth wireless card to transmit the 12 Lead ECG to the PC The Event Summary Bluetooth option B10 AND one of the 12 Lead Transmission options Serial Bluetooth or Rosetta Lt installed See Transmitting to a Personal Computer on page 249 A 12 Lead ECG using a 2 way radio and the Rosetta Lt toa CAREpoint or Rosetta Rx device at a healthcare facility An RS 232 cable to connect the HeartStart MRx to the Rosetta Lt which then transmits to a destination point The 12 Lead Transmission Rosetta Lt interface option B11 OR product upgrade 861326 12 Lead transmission Rosetta Lt Interface See Setting up Rosetta Transmissions on page 245 A 12 Lead ECG using the RS 232 port a cell phone and the Internet to a destination point 4 The RS 232 port to transmit data through a cell phone to a selected destination The 12 Lead Transmission RS 232 and Bluetooth option B07 OR product upgrades M
121. ECG cable 1 30 Hz EMS This setting does not affect 12 Lead Reports If Diagnostic is selected pads ECG is set to Monitor ECG Electrode Labels Selects electrode label format AAMI RA LA AAMI IEC LL RL V IEC R L F N C HR Pulse High Limit Selects the default High Alarm Limit for the Adult 35 200 120 bpm HR derived from the ECG and the pulse Pediatric 35 240 160 derived from SpO or Invasive Pressures adjusted in increments of 5 HR Pulse Low Limit Selects default Low Alarm Limit for the HR Adult 30 195 50 bpm derived from the ECG and the pulse derived Pediatric 30 235 80 from SpO or Invasive Pressures adjusted in increments of 5 VTACH Detection of ventricular tachycardia based on Heart Rate Limit heart rate limit and PVC run limit Adult 95 150 100 bpm Pediatric 95 150 120 adjusted in increments of 5 PVC run limit Adult 3 20 5 Pediatric 3 20 5 adjusted in increments of 1 Color Selects the HR ECG color Red Yellow Blue Green Cyan Magenta White Note Red and blue text and numerics are not visible in high contrast mode 203 Table 38 Invasive Pressure Settings Default Labels Unit and Default Selects measurement units for all invasive mmHg kPa Labels pressures Press 1 Label Selects default label for pressure channel 1 P1 ABP ART Ao CVR ICP LAB PAP RAP Press 2 Label Selects default label for pressure channel 2 P2 ABP ART Ao CVP ICP LAB PAP RAP
122. English HeartStart MRx M3535A IM3536A PHILIPS About This Edition Publication number 989803160421 Edition 1 Printed in the USA To determine the product level version to which these Instructions for Use are applicable refer to the version level appearing on the back cover of this book or on the label of the User Documentation CD ROM that accompanied this device This information is subject to change without notice Edition 1 April 2009 Print Date NOTE To obtain Instructions for Use for previous versions of the HeartStart MRx visit the Philips Documentation and Downloads web site at http www philips com ProductDocs and search for resuscitation Philips shall not be liable for errors contained herein or for incidental or consequential damages in connection with the furnishing performance or use of this material Copyright Copyright 2009 Koninklijke Philips Electronics N V All rights are reserved Permission is granted to copy and distribute this document for your organization s internal educational use Reproduction and or distribution outside your organization in whole or in part is prohibited without the prior written consent of the copyright holder SMART Biphasic is a registered trademark of Philips Rosetta Lt Rosetta Rx and CAREpoint are trademarks of General Devices Microstream and FilterLine are registered trademarks of Oridion Medical Ltd Smart CapnoLine i
123. Figure 101 and press the Menu Select button to print Figure 101 Printing in Data Management Mode Print a Highlight Event Summary to print the selected Event Summary All Events Data Highlight Trends to bring up the Trends Interval screen and print the Trends current Trends Report according to the configured format 1 25 Apr 2007 11 15 ao Highlight the specific 12 Lead Report you want to print 2 25 Apr 2007 11 30 Exit a Highlight Exit to exit the Print menu NOTE To print an Event Summary stored on the removable data card the information must first be downloaded to the HeartStart Event Review Pro data management system Refer to the HeartStart Event Review Pro Instructions for Use for download instructions Events Stored in Event Summary 232 Table 68 lists events and related information stored in an Event Summary if they occur Not all are possible based on your device options Italicized text is replaced by an appropriate value Table 68 Event Information Power On Off Device On Logged when device first turns on Device Off Logged when Therapy Knob is turned to Off position Continued Use Logged when device is turned on after being turned off for less than 10 seconds Mode AED Mode Monitor Mode Pacer Mode Selected Energy xx J Logged at start of incident and when mode or selected energy changes Return To Owner Display Logged when Return To Own
124. Figure 28 Installing Batteries Charging Batteries Charge batteries fully upon receipt and prior to use Be sure to familiarize yourself with the battery maintenance procedures discussed in Battery Maintenance on page 283 Battery Safety Review the Application Note M3538A Lithium Ion Battery Characteristics and Care provided with your HeartStart MRx Additionally read the battery related warnings in Specifications and Safety on page 321 prior to using the M3538A Lithium Ion Battery 44 Installing the AC Power Module If not presently installed in your device insert the M3539A AC power module as follows 1 Align the M3539A AC power module in Compartment B 2 Insert the AC power module and press until you hear it click into place Ensure that the latched located on both sides of the AC power module are engaged fully 3 Insert the power cord into the AC power receptacle 4 Plug into an AC power outlet 5 Check that the External Power indicator on the front panel is illuminated Figure 29 Installing the AC Power Module 45 Installing the Data Card If not presently installed in your device install the data card as follows 1 Insert the data card in the data card tray sliding it under the tray clip Confirm that the connector is facing away from the pull tab 2 With the front of the tray facing forward press the data card and tray firmly into the data card slot located on the right side of the HeartStart MR
125. INOP tone has been detected between a lead wire and ground Leads Off An electrode used for Wave Sector 1 INOP message INOP tone may be off or not attached securely Pads Paddles Off The multifunction electrode pads or INOP message INOP tone paddles used as the source for the Wave Sector 1 may be off or not attached securely ECG Unplugged The primary ECG is derived from leads INOP message INOP tone and the ECG cable is not connected ECG Equip Malfunction A malfunction has occurred in the INOP message INOP tone ECG hardware Pads Paddles Cable During the Operational Check a INOP message INOP tone Failure failure was detected in the pads or paddles cable during the pads paddles ECG test Pads ECG Equip A device hardware failure was detected INOP message INOP tone Malfunction Setting Alarms Alarms are automatically enabled in Monitor and Pacer modes In Manual Defib Mode alarms are automatically enabled if the Sync function is enabled If the Sync function is not enabled alarms are enabled in Manual Defib mode using the Alarm Pause button Alarm settings for Heart Rate HR and VTACH are as configured but may be changed via the Menu Select button during operation for the current patient incident The setting for PVC Rate Limit may only be changed in response to a PVC Rate alarm condition Settings for other HR and arrhythmia alarms may not be changed Changing Heart Rate or VTACH Alarm Limits To change the HR or
126. Insert a charged battery capacity of 20 or greater Turn the Therapy Knob to Monitor Press the Menu Select button Using the Navigation buttons select Other and press the Menu Select button Select Operational Check and press the Menu Select button A Wn O N e Select Run Operational Check and press the Menu Select button The message window Leaving Normal Operating Mode appears to let you know that you are exiting from clinical functionality and entering a test mode of the monitor defibrillator 7 Press the Menu Select button to acknowledge the message Operational Check Setup Carefully read the setup instructions on the screen Once the HeartStart MRx is set up properly you can proceed with the Operational Check If the device has the Q CPR option you should run the Operational Check with the Pads CPR cable and the CPR meter keeping the CPR meter still during the test If the HeartStart MRx has the Pacing option you must run the Operational Check with a Pads cable WARNING Be sure to safely discharge internal and external paddles tested during the Operational Check NOTE Ifyou choose to proceed without setting up properly the Operational Check may fail When a response is required use the Navigation buttons to select your answer and the Menu Select button to confirm your choice Table 76 shows the tests in the order in which they are performed explains the prompts that may appear and describes the actions you
127. LTIPI 4 TPI 4 Safety Considerations 5 Documentation and Training 5 2 Getting Acquainted 7 Basic Orientation 8 Front Panel Side Panels 9 Top Panel 10 Back Panel 11 M3538A Lithium Ion Battery 12 Battery Capacity 12 Battery Life 12 Operating Modes 12 Password Security 13 Display Views 13 General Status 14 Wave Sectors 15 Parameter Blocks 16 Turning Parameters On Off 16 Soft Key Labels 16 Menus 17 Message Windows 18 High Contrast Display 18 Controls 19 Therapy Knob 19 General Function Buttons 20 Defibrillation Controls 21 Soft Keys 21 Indicators 22 Audio Recording 23 Reviewing Recorded Audio 23 Alarms 24 Responding to Alarms 24 Printing on Alarms 26 Identifying Your Device 26 Entering Patient Information 27 Continued Use 27 Printing Waveforms 28 Return to Owner 29 3 Setting Up 31 Attaching the Carrying Case and Accessory Pouches 31 Storing Accessories 33 Connecting the ECG Cable 35 Connecting the SpO Cable 36 Connecting the NBP Interconnect Tubing 37 Connecting the Invasive Pressures Cable 38 Connecting the Temperature Cable 39 Connecting the CO FilterLine 40 Connecting the Therapy or Pads CPR cables l Installing Paper 42 50 mm paper 42 75mm Printer optional 43 Installing Batteries 44 Charging Batteries 44 Battery Safety 44 Installing the AC Power Module 45 Installing the Data Card 46 46 4 ECG and Arrhythmia Monitoring 47 Overview 47 Monitoring View 48 Preparing to Monitor ECG 49
128. NING Danger explosion hazard sidestream measurement should not be used in the presence of flammable anesthetics such as flammable anesthetic mixture with air flammable anesthetic mixture with oxygen or nitrous oxide e CO should not be measured in the presence of aerosolized pharmaceuticals e When using the nasal FilterLine if one or both nostrils are partially or completely blocked or the patient is breathing through the mouth the displayed EtCO values may be significantly low e Reflux of gastric contents mucus pulmonary edema fluid or endotracheal epinephrine introduced into the detector can increase airway resistance and affect ventilation Discard accessory if this occurs e The presence of carbonated beverage or antacids in the stomach may cause incorrect readings and unreliable capnography in identifying esophageal intubation Using the Nasal FilterLine To set up EtCO measurements using the nasal FilterLine perform the following steps 1 Attach the FilterLine tubing to the CO Inlet port as described in Connecting the CO2 FilterLine on page 40 2 Check that both nostrils are clear and position the nasal FilterLine on the face by inserting the FilterLine tips into the nostrils 3 Pass the FilterLine tubing over the ears then slide the sleeve up the tubing towards the neck to a comfortable fit under the chin If using dual purpose FilterLine tubing connect the green tubing to the oxygen source Chec
129. No 601 1 EN 60601 1 and 60601 2 4 standards Other Considerations e The HeartStart MRx is not suitable for use in the presence of concentrated oxygen or a flammable anesthetic mixture with air oxygen or nitrous oxide e Hazards arising from software errors were minimized by the products compliance with the software requirements contained in EN 60601 1 4 1996 Mode of Operation Continuous AC Line Powered 100 240 VAC 50 60 Hz 1 0 46 A Class 1 Battery Powered Minimum 14 4 V Rechargeable Lithium Ion DC Powered e Input 11 32 VDC 11 A e Output 18 V 5 A 90 W Bluetooth The HeartStart MRx supports File Transfer Profile Server 1 1 and was tested with the following Bluetooth stacks Toshiba 4 20 01 IVT 2 1 2 0 Product 05 04 11 20060301 stack and Widcomm 4 0 1 2400 For other Bluetooth stacks review your user documentation to see if File Transfer Profile Server 1 1 is supported If not it is recommended that you install drivers that support File Transfer Profile Server 1 1 336 Symbol Definitions Table 103 lists the meaning of each symbol shown on the HeartStart MRx and the M3538A battery Table 103 Monitor Defibrillator Battery and CPR Meter Symbols Dangerous voltage Dispose of in accordance to your X country s requirements Attention See operating instructions in f IP24 Protected against ingress of solid foreign Instructions for Use objects gt 12 5mm in diameter Protected agai
130. O sensor is not connected There is too much interference The sensor is damaged Check the SpO connection SpO Unplugged Turn off SpO message appears when the device is turned on and the SpO sensor is not connected The SpO sensor is not connected Check that the sensor connection is secure Try another sensor The software was not upgraded after an SpO repair or upgrade was performed Call for service 303 Table 84 SpO Monitoring Problems Continued Sp0 Sensor Malfunction INOP The SpO numeric value is replaced with a The SpO sensor or cable is faulty Try another sensor If the problem persists call for service of the SpO module If SPO monitoring is essential to patient care take the device out of use SpO Equip Malfunction message Faulty SpO hardware Call for service of the SpO module If SpO monitoring is essential to patient care take the device out of use SpO Extended Update INOP The SpO numeric value is replaced with a An NBP measurement or an excessively noisy signal is delaying display update of the SpO measurement for more than 60 Wait until the NBP measurement is complete Try another sensor site Move sensor to a different limb from the NBP cuff seconds SpO Low Perfusion INOP The SpO numeric value is replaced with a an accurate reading The SpO signal is too low t
131. Options are 30 60 and 90 seconds or off The default is 60 seconds During suppression the HeartStart MRx shows an INOP message and next to the pressure label Pressure alarms and Pressure Label Non Pulsatile INOPs are inactive during the suppressed period The CPP high alarm is not suppressed 124 Alarms Alarms are provided to alert you to a change in the patient s condition If alarms are enabled alarm limits appear next to the pressure value Invasive pressure alarms except ABP ART Ao PAP P1 or P2 disconnect alarms are all categorized as non latching alarms meaning they are automatically removed when their alarm condition no longer exists The above listed disconnect alarms are latching meaning they remain present even if the alarm condition no longer exists Table 17 details invasive pressure alarms Table 17 Invasive Pressure Red Yellow Physiological Alarms Low ABP ART Ao Red Red alarm message The mean pressure has fallen below 10 PAP P1 P2 alarm tone mmHg 1 3 kPa and the pressure is non Disconnect pulsatile Pressure label s Yellow Yellow alarm message The systolic pressure value exceeds the High alarm tone high alarm limit Pressure label d Yellow Yellow alarm message The diastolic pressure value exceeds the High alarm tone high alarm limit Pressure label m Yellow Yellow alarm message The mean pressure value exceeds the High alarm tone high alarm limit
132. PD 5 oz per gallon water one part Coverage Plus NPD to 255 parts water Before cleaning remove all adherent soil tissue fluids etc and wipe thoroughly with a cloth dampened with water before applying the cleaning solution When cleaning do not immerse Wring any excess moisture from the cloth before cleaning Be sure to avoid pouring fluids on the device and do not allow fluids to penetrate the exterior surfaces of the device To prevent scratching the display the use of a soft cloth is recommended CAUTION Do not use quaternary ammonium compounds like Steris Coverage Plus NPD to clean the CPR meter Printer Printhead If the printout has light or varying print density clean the printhead to remove any buildup of paper residue To clean the printhead 1 2 3 4 Push the printer door latch to open the door Remove the roll of paper Clean the printhead surface above the brush with a cotton swab dipped in isopropyl alcohol Replace the roll of paper 287 Paddles Therapy Cable If external non sterilizable paddles were used during defibrillation make sure you thoroughly clean the paddles and paddle tray after each patient event and before performing an Operational Check or Weekly Shock Test Verify that there is no debris or residue including all conductive material on the electrode surfaces of the paddles and paddle tray External non sterilizable paddles and the Therapy cables may be cleaned wi
133. Q CPR option is contraindicated as follows e The Q CPR option is contraindicated for use on neonatal and pediatric patients under 8 years of age or weighing less that 25 kg e The Q CPR option is not for use when CPR is contraindicated Invasive Pressures The Invasive Pressures option is indicated for measuring arterial venous intracranial and other P physiological pressures on patients Temperature The Temperature option is indicated for measuring temperature in patients ACI TIPI This device is intended to be an aid to clinicians by focusing their attention on indicators of Acute Cardiac Ischemia TPI Indications for Use Physiological purpose To aid the clinician deciding whether to administer thrombolytic therapy or to provide another avenue of treatment Condition Patient is a potential candidate for thrombolytic therapy Patient Population adult 35 to 75 years patients diagnosed as having symptoms of Acute Myocardial Infarction Body or type of tissue interacted with No body or tissue contact Prescription versus over the counter TPI is a prescription device Contraindications NOTE The Thrombolytic Predictive Instrument TPI is contraindicated for patients with conditions which mimic acute myocardial infarction Some of these conditions are Prinzmetal variant angina acute pericarditis acute myocarditis cardiomyopathy and primary and secondary cardiac neoplasms The Thrombolytic Predictive Instrument TPI
134. RS 232 Continued First attempt to solve the problem by disconnecting the serial cable from the cell phone reconnecting it and resending the 12 Lead Report Transmission Failed message accompanied by a The connection with the network server has Choose the destination site again and re connect message accompanied by a Settings Configured Incorrectly message configuration settings are incorrect Connection Interrupted terminated message Transmission Failed The URL or Proxy Modify the Serial Phone Profile Hub or Site configuration settings as needed For more information refer to the Transmission Implementation Guide Transmission Failed The 12 Lead Report did not transmit correctly Choose the destination site again and re connect Check the cell phone connection to the HeartStart MRx message The network is down Check with your internet provider to see if your service is unavailable Table 87 Transmission Problems Rosetta No transmission device detected The HeartStart MRx failed to connect to the selected transmission device Transmission Failed The 12 Lead Report was not transmitted to the Rosetta Lt Check cables and connections Replace Rosetta Lt battery Transmission Failed Timeout The transfer did not complete within the 1 minute timeout period Table 88 Transmission Problems Periodic Clinical Data Transmission My vital
135. Report Specifies how the 12 lead ECG segments are displayed for the 12 Lead Report The segments are displayed in three rows four columns for each row e Sequential reports Each column represents a sequential 2 5 second period of time for a total of 10 seconds e Simultaneous reports Each column represents the same 2 5 seconds of time Sequential Simultaneous Number of Automatic Printouts Selects the number of 12 Lead ECG Reports printed at the completion of analysis 0 1 2 Printer Format Selects the number of rhythm strips to be printed with the 12 Lead Report 0 1 or 3 3x4 3x4 1R 3x4 3R Rhythm Strip 1 Selects the first rhythm strip printed in the 3x4 I II II aVR aVL aVE V1 V2 V3 V4 V5 IR or 3x4 3R format V6 Rhythm Strip 2 Selects the second rhythm strip printed for I II II aVR aVL aVF V1 V2 V3 V4 V5 reports in the 3x4 3R format V6 Rhythm Strip 3 Selects the third rhythm strip printed for reports I II III aVR aVL aVF V1 V2 V3 V4 V5 in the 3x4 3R format V6 12 Lead Export Format Indicates which version of the 12 Lead XML schema the 12 Lead Reports are to conform to 1 03 1 04 NOTE number to each device If the same configuration file is used to configure multiple devices be sure to assign a unique device ID NOTE The 3x4 3R Printer Format Setting is not for use with the 12 Lead Transmission option 213 Table 54 D
136. Rx screen accompanied by an audio beep Press the Menu Select button to acknowledge the error See Figure 115 The error is logged into the Device Status Log Figure 115 Transmission Failure Transmission Failed Connection Failed Cancelling a Transmission To cancel a transmission in progress perform the following 1 From either 12 Lead Mode or Data Management Mode press the Menu Select button 2 Highlight Cancel Transmission and press the Menu Select button 3 Confirm the Cancel Transmission action Highlight Yes and press the Menu Select button to cancel highlight No and press the Menu Select button to continue the transmission After confirming a transmission cancellation the HeartStart MRx displays a Disconnecting message until the cancel process is completed Some disconnections may occur so quickly that the Disconnecting message may not be visible 257 Queuing Transmissions You can queue more than one HeartStart MRx 12 Lead Report or Event Summary for a non BLDT transmission using the same transmission device except the Rosetta Lt 12 Lead Reports can be queued to the same or different locations If you are using the Rosetta Lt you must complete the transmission from the HeartStart MRx to the Rosetta Lt AND from the Rosetta Lt to its communication device before beginning another transmission Failure to do so results in overwriting the first transmission to the Rosetta Lt with the second transmission To queue another trans
137. Summary Report Begin a new patient case Power Supply Failure INOP There is a problem with the internal power supply Remove the device from use and call for service Replace Clock Battery message The battery on the internal clock needs to be replaced Call for service Shock Equip Malfunction INOP A shock can not be delivered due to a hardware failure Remove the device from use and call for service Shutting Down in 1 Minute message Very low battery and the device is not connected to AC DC power Insert a charged battery and or connect to AC DC power Shutting Down Now message Battery charge is depleted and the device is not connected to AC DC power Insert a charged battery and or connect to AC DC power Settings for the current patient may need to be reset Arching or sparking during paddles in pocket test therapy discharge Weekly Shock Test Debris or residue such as electrolytic gel on the surfaces of the paddles and or paddles tray Clean paddles and paddles tray Table 82 ECG Monitoring Problems QRS beeper inaudible or beeps do not occur with each QRS complex The QRS volume is configured to Off or the setting is too low Configure the QRS beeper volume The QRS volume was turned Off or set too low through the Volume menu Adjust the volume through the Volume menu The amplitude of the QRS complex is too small to de
138. TIPI algorithm Preparation Proper skin preparation and electrode placement are the most important elements in producing a high quality 12 lead ECG The patient should be supine and relaxed when an ECG is acquired In preparation for acquiring the ECG 1 Connect the 10 lead cable to the HeartStart MRx as described in Connecting the ECG Cable on page 35 Prepare the skin and apply electrodes as described in Electrode Placement on page 51 Turn the Therapy Knob to Monitor Enter patient information as described in Entering Patient Information on page 27 A Re BW N Confirm the patient s pacing status is correct 136 Preview Screen The 12 lead function s Preview Screen allows you to see real time 12 lead ECG data and verify signal quality before acquiring the ECG As shown in Figure 66 it displays patient information and approximately 2 5 seconds of each of the 12 leads acquired Waveforms are presented at a rate of 25mm sec and the configured wave size A dashed line is displayed if a lead cannot be derived The message Lead Wire Lead Off is displayed if an electrode is not making adequate contact with the patient The Preview Screen s patient information includes ID age and sex The Event ID is displayed until you enter the patient s ID Age and sex are displayed once entered see Entering Patient Information on page 27 Although waveforms for monitored parameters such as ECG SpO Invasi
139. The device must have software Version 9 xx or Version E xx installed The device s radio module must have Instrument Telemetry HeartStart MRx Subsystem firmware revision A 00 17 or greater The device s radio module must have Instrument Telemetry Subsystem radio firmware revision A 00 52 or greater The Information Center needs to be configured for the Device IntelliVue Network Locator functionality Access Point firmware must be A 00 54 or greater NOTE The HeartStart MRx does not verify the above mentioned firmwares are at the correct levels To confirm firmware versions on the HeartStart MRx enter Service Mode and highlight Instrument Telemetry Press the Menu Select button and wait for the version numbers to appear 182 Network Settings You can view your current network settings in Monitor Pacer and Manual Defib modes To view current network settings perform the following 1 Press the Menu Select button 2 Using the Navigation buttons A and V select Other and press the Menu Select button 3 Select Network Settings and press the Menu Select button See Figure 92 and Table 32 Figure 92 Network Settings Display Network Settings Connection Wireless MAC Address 0009F B03 A015 MAC Instr Tele 0009 FB16 0035 RF Access Code 45 IP Address 172 31 6 40 Server IP 172 31 3 0 Subnet Mask 255 255 240 0 RSSI 50 Table 32 Network Settings Parameters Connection Displays curren
140. Viewing Changing Setting Source for Alarms Alarm sources and limits can be viewed or modified for a given pressure label To view or modify alarm settings perform the following steps 1 Press the Menu Select 9 button 2 Using the Navigation buttons select Measurements Alarms and press the Menu Select button 3 Select the pressure label channel label you wish to view modify alarms on and press the Menu Select button 4 Select pressure label Limits and press the Menu Select button 5 If the pressure label is pulsatile select the desired source of the alarm Systolic Diastolic or Mean and press the Menu Select button 6 Using the Navigation buttons increase or decrease the high limit and press the Menu Select button 7 Set the new low limit and press the Menu Select button 126 CPP Alarms Wedge With CPP and ICP only one of the two parameters can have alarms enabled at one time If CPP alarms are turned on then ICP alarms are turned off Both alarms can be turned off at the same time The parameter with alarms off will be displayed at the bottom of the ICP CPP parameter area with the Alarms Off J symbol ICP alarms default to on CPP to off Perform a pulmonary artery wedge procedure according to your hospital protocol The wedge numeric will not be stored in the Vital Signs Trending WARNING For Pulmonary Artery Wedge Pressure PAWP readings due to a measurement delay do not use Microstream sidestream CO as a
141. abnormal performance is observed additional measures may be necessary such as re orienting or relocating the HeartStart MRx d Over the frequency range 150 kHz to 80 MHz field strengths should be less than 3 V m 355 Table 112Electromagnetic Immunity Nonlife Supporting Functions Portable and mobile RF communications equipment should be used no closer to any part of the HeartStart MRx including cables than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter Recommended Separation Distance Conducted RF 3 Vrms 3 Vrms IEC 61000 4 6 150 kHz to 80 MHz d 2 P Radiated RF 3 Vim 3 V m IEC 61000 4 3 80 MHz to 2 5 GHz d l 2 P 80 MHz to 800 MH d IWP 800 MHz to 2 5 GHz where P is the maximum output power rating of the transmitter in watts W according to the transmitter s specified output power and d is the recommended separation distance in meters m Field strengths from fixed RF transmitters as determined by an electromagnetic site survey should be less than the compliance level in each frequency range Interference may occur in the vicinity of equipment marked with the following symbol gt At 80 MHz and 800 MHz the higher frequency range applies These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people F
142. according to the manufacturer s instructions CAUTION Do not ultrasonically clean immerse autoclave or steam sterilize the ECG cable Do not clean electrical contacts or connectors with chlorine bleach 288 Carrying Case The carrying case may be cleaned by hand with mild soap and water Fabric stain removers may be used to remove stubborn stains Air dry the carrying case Do not wash or dry by machine NBP Cuff The cuff can be disinfected by immersion in a decontamination solution of 70 85 isopropyl alcohol but remember to remove the rubber bag if you use this method The cuff should not be dry cleaned The cuff can also be machine washed or hand washed as recommended by the manufacturer the latter method will prolong the service life of the cuff Before washing remove the latex rubber bag and for machine washing close the hook and loop fastening Allow the cuff to dry thoroughly after washing then reinsert the rubber bag SpO Sensor and Cable To clean the SpO sensor and cable follow the instructions provided with the accessory Invasive Pressures Transducer and Cable To clean the invasive pressure cable follow the instructions provided with the accessory Temperature Probe and Cable To clean the temperature probe and cable follow the instructions provided with the accessory CPR meter You should examine the CPR meter vent membrane in the center of the rear cover after each use If needed use a soft c
143. acturers of patient coupled equipment must specify immunity levels for their systems See Tables 109 through 112 for this detailed immunity information See Table 113 for recommended minimum separation distances between portable and mobile communications equipment and the HeartStart MRx Immunity is defined in the standard as the ability of a system to perform without degradation in the presence of an electromagnetic disturbance Degradation in ECG quality is a qualitative assessment which can be subjective Caution should therefore be taken in comparing immunity levels of different devices The criteria used for degradation is not specified by the standard and may vary with the manufacturer Guidance and Manufacturer s Declaration The HeartStart MRx is intended for use in the electromagnetic environment specified in the tables below The customer or the user of the HeartStart MRx should assure that it is used in such an environment Table 109 Electromagnetic Emissions RF emissions Group 1 The HeartStart MRx uses RF energy only for its CISPR 11 internal function Therefore its RF emissions are very low and not likely to cause interference in nearby electronic equipment RF emissions Class B CISPR 11 Harmonic Class A The HeartStart MRx is suitable for use in all emissions establishments including domestic establishments or IEC 61000 3 2 those directly connected to the public low voltage power supply network that supplie
144. ad Report View is in a format similar to Monitor View so that you may monitor the patient while viewing the report In this view the 12 Lead Report replaces Monitoring View s Wave Sectors 3 and 4 as shown in Figure 69 and includes the following information if configured Measurements The measurements component of the algorithm generates standard interval and duration measurements in milliseconds limb lead axis measurements in degrees and heart rate in beats per minute Interpretive statements Measurements and patient information are used by the Philips 12 Lead DXL Algorithm to generate statements describing the patient s cardiac rhythm and waveform morphology There is also culprit artery detection which locates the probable anatomical site of a coronary artery occlusion responsible for ischemia Statements regarding signal quality problems encountered during ECG acquisition are also included in this section Critical Values Statements The HeartStart MRx displays Critical Value statements to aid in quickly identifying an interpretation that may mean your patient needs immediate attention Statements identify any of four life threatening conditions acute myocardial infarction acute ischemia complete heart block and extreme tachycardia The values appear as white text on a red background For more information on Critical Values Statements see Critical Values on page 143 ECG severity Each interpretive statement on the repor
145. ady For Use St IV EX RFU Indicator Label Recess 7 Mark Event herapy Knob button Charge Lead Select button Shock button Display Printer Door Latch Speaker Alarm Pause button Summary Soft keys Navigation Microphone button 4 total buttons Menu Select button Additional controls and indicators are on the paddles if used and batteries NOTE A palette of colored decals is included with your HeartStart MRx These colored decals may be applied to the label recesses located on the device handle to aid in identification Use an indelible marker to print identification information on the decal Side Panels The left side of the HeartStart MRx has ports for monitoring cables including ECG pulse oximetry SpO gt noninvasive blood pressure NBP invasive pressure 2 temperature and carbon dioxide CO The ECG port may be used to connect a 3 5 or 10 lead patient cable The ECG Out jack may be used to connect to an external monitor The right side of the HeartStart MRx has a therapy port for paddles external or internal or therapy cable and multifunction electrode pads It also has a slot for a data card to transfer patient information Figure 2 Basic Orientation Right Left Sides gt T Therapy ee Connector Data Card slot B N Invasive Pressure A N OD s ports D NEP Port ee m e ECG Port a PONN OC O gt SpO Port q LA Top Panel
146. al Check for further information If the condition persists take the device out of use and call for service Solid red X without a periodic chirp No power or device failure cannot turn on Insert a charged battery or connect to AC DC power If the condition persists take the device out of use and call for service NOTE The RFU indicator may briefly display a solid red X when initially turning on the device switching between clinical and non clinical operating modes and at the start of any Automated test This does not indicate a failure of the device Shift Checklist 20 Maintenance Shift Checklist In order to ensure defibrillators are ready when needed the American Heart Association AHA recommends that users complete a checklist often referred to as a shift check at the beginning of each change in personnel The activities on this check list include verifying that the appropriate supplies and accessories are present the device is plugged in and has sufficient battery power and the device is ready for use Philips Healthcare supports the AHA checklist recommendations and has provided a Shift Checklist document with the device and published a copy in this book See the HeartStart MRx Shift Checklist on page 268 Weekly Shock Test In addition to the shift check you must verify the ability to deliver defibrillation therapy once a week by performing one of the following e Operation
147. al Check e Weekly Shock Test See following instructions NOTE Test reusable sterilizable paddles internal or external prior to each use See the Sterilizable Defibrillator Paddles Instructions for Use for more information To perform the Weekly Shock test 1 Ifyou are using paddles make sure the paddles and the paddle tray are thoroughly clean and there is no debris or residue including all conductive material on the electrode surfaces of the paddles and tray Secure the paddles in the paddle tray and confirm the Patient Contact Indicator PCI LEDs located on the sternum paddle are not lit If the LEDs light adjust the paddles in their pockets If the LEDs continue to light clean both the adult and pediatric paddle electrode surfaces or If you are using multifunction electrode pads attach a test load to the end of the patient Therapy cable 2 Turn the Therapy knob to 150J 3 Press the Charge button NOTE Ifit becomes necessary to disarm the defibrillator press Disarm 4 The strip prints if configured to do so If the strip does not print immediately press the Print button 5 If using Pads press the Shock button on the MRx to deliver a shock into the test load External paddles simultaneously press the shock buttons located on the paddles to deliver a shock into the pockets 6 Confirm on the printed strip that the energy delivered to the test load is 150J 23J 127J to 173J If not take the device out of
148. al shock hazard To avoid contaminating or infecting personnel the environment or other equipment make sure you disinfect and decontaminate the monitor defibrillator and any appropriate device accessories appropriately prior to disposal NOTE This product consists of devices that may contain mercury which must be recycled or disposed of in accordance with local state or federal laws Within this system the backlight lamps in the monitor display contain mercury Empty Calibration Gas Cylinders Disposal To dispose of empty calibration gas cylinders 1 Empty the cylinder completely by pushing the pin of the regulator valve or by pulling out the pin of the fill valve using a tire valve stem wrench or a pair of needle nose pliers 2 Write Empty on the cylinder and dispose of it appropriately for scrap metal CPR Meter and Adhesive Pads Disposal The CPR meter contains electronic components Dispose of it at an appropriate recycling facility in accordance with local regulations A used patient adhesive pad may be contaminated with body tissue fluid or blood Dispose of it as infectious waste 21 Supplies amp Accessories This chapter lists the various supplies and accessories for the HeartStart MRx Overview Approved supplies and accessories for your HeartStart MRx are listed in the following tables To order In the USA call 1 800 225 0230 pads electrodes cables paper etc Outside the USA contact your loca
149. alue Adult 40 355 50 mmHg Ped 40 355 40 Adjusted in increments of 5 mmHg or 1 kPa 207 Table 46 Noninvasive Blood Pressure Settings systolic is the selected alarm source NBP Schedule Selects the schedule for NBP measurements Manual q1 q2 5 q5 q10 q15 q30 q60 manual or automatic at the selected frequency q120 NBP Alarm Source Selects the alarm source Systolic Diastolic Mean Unit Selects the measurement units mmHg kPa Systolic High Limit Selects the high limit alarm value used when Adult 35 270 160 mmHg Pediatric 35 180 120 adjusted in increments of 5 mmHg or 1 kPa Systolic Low Limit Selects the low limit alarm value when systolic is the selected alarm source Adult 30 265 90 mmHg Pediatric 30 175 70 adjusted in increments of 5 mmHg or 1 kPa Diastolic High Limit Selects the high limit alarm value when diastolic is the selected alarm source Adult 15 245 90 mmHg Pediatric 15 150 70 adjusted in increments of 5 mmHg or 1 kPa Diastolic Low Limit Selects the low limit alarm value when diastolic is the selected alarm source Adult 10 240 50 mmHg Pediatric 10 145 40 adjusted in increments of 5 mmHg or 1 kPa Mean High Limit Selects the high limit alarm value when mean is the selected alarm source Adult 25 255 110 mmHg Pediatric 25 160 90 adjusted in increments of 5 mmHg or kPa Mean Low Limit Selects t
150. ameter values are displayed with On Off or without corresponding measurement units Patient Category Selects the default patient category Adult Pedi Device Owner Identification for Return to Owner feature 20 characters Return to Owner Password required in order to deactivate the 4 characters Password loan period setting Audio Recording Turns audio recording on or off On Off NOTE The Return to Owner Password should be documented in a secure manner Should it need to be reset all configuration settings must be reset to factory default values and the device must then be re configured NOTE Do not set alarm volumes so low that you can t hear them in loud environments Table 37 Heart Rate and ECG Settings Auto Gain Determines whether ECG size is automatically On Off adjusted to the standard maximum wave size without clipping the wave sector If auto gain is off the gain is set to 1 1Omm mV AC Line Filter Selects the setting used to filter out AC line 60 Hz 50 Hz noise Adjust this setting to the power frequency of your country ECG Bandwidth for Selects the display filter frequency for the 15 40 Hz Monitor 1 30 Hz EMS Display attached therapy cable or 3 5 lead ECG cable This setting does not affect 12 Lead View ECG Bandwidth for Selects the printer filter frequency for the 0 05 150 Hz Diagnostic 15 40 Hz Monitor Printer attached therapy cable or 3 5 lead
151. an be generated for the conditions shown in Tables 5 and 6 Once generated they appear as alarm messages in the alarm status area of the display located just above the HR numeric The notification of an alarm is indicated by both an audible and visual alert signal Arrhythmia Alarm Latching 56 Arrhythmia alarms are categorized as latching or non latching alarms Latching alarms are announced and remain present regardless of whether the alarm condition still exists until they are either acknowledged or a higher priority alarm condition occurs Indications for non latching alarms are automatically removed when their alarm condition no longer exists Latching and non latching alarms are categorized in Tables 5 and 6 Table 5 HR Arrhythmia Red Alarms Asystole No detectable beats for four Red alarm message Latching seconds in the absence of alarm tone Vfib VFIB VTACH A fibrillatory wave detected Red alarm message Latching for four seconds alarm tone VTACH Consecutive PVCs and HR Red alarm message Latching exceed configured limits alarm tone Extreme Brady 10 bpm below HR Low Red alarm message Latching limit capped at 30 bpm _ alarm tone Extreme Tachy 20 bpm above HR High _ Red alarm message Latching limit capped at 200 bpm alarm tone adult or 240 bpm pedi Figure 38 Alarm Chain for Basic Arrhythmia Monitoring Red Alarms Asystole aN tac J Extreme Tach
152. are formed If the sensor does not appear to be operating properly remove it immediately from the patient CAUTION Do not use more than one extension cable M19414A Position the sensor cable and connector away from power cables to avoid electrical interference Monitoring SpO To monitor SpO 1 Connect the appropriate sensor cable to the to the HeartStart MRx as described in Connecting the SpO2 Cable on page 36 2 Apply the sensor to the patient 3 If the HeartStart MRx is not turned on turn the Therapy Knob to Monitor 4 Check that the patient category is appropriate for the patient If necessary use the Patient Info menu to access Patient Category and select the correct patient category setting adult pediatric This is used to optimize the calculation of the SpO and pulse values A is displayed in Parameter Block 2 while the oxygen saturation is initially measured and a value is calculated In a few seconds a value appears replacing the As the patient s oxygen saturation changes the SpO value is updated continuously See Figure 58 If SpO alarms are turned on alarm limits are displayed to the right of the SpO value If alarms are turned off the UN symbol is displayed instead of the alarm limits SpO alarms are on by default See SpO2 Alarms on page 99 The patient s pulse rate as derived from pulse oximetry is displayed in Parameter Block 1 see Figure 60 If pulse rate alarms are t
153. area 14 message window 18 side panels 9 top panel 10 value adjustment 17 batteries calibration 284 calibration recommended 284 calibration results 285 capacity 12 326 charge level indicators 14 charge status 284 charge time 326 charging 284 discarding 286 installing 44 359 life expectancy 12 283 low battery warning 326 M3538A Lithium Ion Battery 12 maintenance 283 process 283 specifications 326 storage 286 326 warnings 349 beat labels 60 Bluetooth adding a device 242 changing a profile 244 general security practice 244 pairing a device 242 setup 242 specifications 336 troubleshooting 304 working with 244 C Calibrating invasive pressures confirmation 123 calibrating invasive pressures 121 calibration gas disposal 290 calling for service 319 cardioversion 71 therapy 72 carry case 31 pouches 32 setting up 31 storing accessories 33 cautions 345 charge time 322 cleaning 287 carrying case 289 CPR meter 289 ECG cable 288 invasive pressure transducer 289 monitor defibrillator 287 NBP cuff 289 paddles 288 printer printhead 287 SpO sensor 289 temperature probe cable 289 therapy cable 288 clinical performance summary cardioversion 342 defibrillation 341 internal defibrillation 344 configuration 199 accessing menu 199 201 configurable parameters 202 loading configuration from a data card 201 modifying settings 200 360 printing configuration settings 201 restoring default settings 201
154. arrhythmia relearning takes place during a ventricular rhythm or during a period of poor ECG signal quality ectopic beats may be incorrectly learned as the normal QRS complex This may result in missed detection of subsequent events of V tach and high PVC rates For this reason you should e take care to initiate arrhythmia relearning only when the ECG signal is noise free e be aware that arrhythmia relearning can happen automatically e respond to any INOP messages for example if you are prompted to reconnect electrodes e display an annotated wave to ensure beat labels are correct Troubleshooting If your HeartStart MRx does not operate as expected during ECG and Arrhythmia monitoring see Troubleshooting on page 297 61 5 AED Mode Defibrillation therapy is the definitive method for termination of a variety of potentially fatal arrhythmias The HeartStart MRx s Semi Automated External Defibrillation AED Mode is designed to guide you through standard treatment algorithms for cardiac arrest The HeartStart MRx provides therapy through the application of a brief biphasic pulse of electricity to the cardiac muscle This electrical energy is transferred through disposable multifunction electrode pads applied to the patient s bare chest Configuration choices allow you to customize AED Mode to better meet the unique needs of your organization or resuscitation team This chapter describes how to use AED Mode It exp
155. ars old or less than 25kg Adult patients are defined as 8 years old and over or 25 kg 55 lbs and heavier Continued Use Once a patient event begins the Continued Use feature is activated This feature facilitates continued treatment of the same patient by retaining the current settings and the patient record when the HeartStart MRx is turned off for less than 10 seconds for instance when switching between AED and Manual Defib Modes or when the Therapy Knob is inadvertently moved to Off When turned on within the 10 second time period the HeartStart MRx retains the most recent settings including e Alarm settings e Wave Sector settings e Event Timer e QRS alarm tone and voice prompt volumes e ECG gain e Vital Signs Trending data e Pacing settings The device DOES NOT automatically resume pacing e Patient record in the Event Summary Report new data is appended to the record The Sync feature remains active if the HeartStart MRx is turned off for less than 10 seconds However Sync is disabled when AED Mode is activated and must be turned on upon returning to Manual Defib Mode NOTE The Continued Use feature will not function if all sources of power battery and external AC DC power modules are removed from the device even briefly 27 Printing Waveforms By using the Print Button on the front of the HeartStart MRx you can obtain a continuous printout of the primary ECG and one additional waveform if you have the 50mm
156. artStart MRx charge Batteries are charged one at a time With the HeartStart MRx turned off and at a temperature of 25 C 77 F a fully discharged battery typically charges to 80 of its capacity in 2 hours and to 100 of its capacity in 3 hours Batteries charge at a slower rate with the device turned on Batteries should be charged at temperatures between 0 C 32 F and 45 C 113 F Charge Status You can check the battery s state of charge by e periodically pushing the fuel gauge button on the battery to illuminate the fuel gauge Each LED represents a charge of approximately 20 of capacity e turning the Therapy Knob to any mode of operation and observing the battery power indicators displayed in the General Status area see General Status on page 14 Battery Calibration Battery capacity diminishes with use and age Battery calibration checks to see if the battery is nearing the end of its useful life and should be discarded Battery calibration also ensures that the fuel gauge provides accurate estimates of the battery s state of charge based on the total available capacity Calibrate a battery when the Cal Recommended message appears during an Operational Check or every 6 months whichever comes first Battery calibration may be performed in the HeartStart MRx or in a Philips approved battery support system To calibrate a battery in the HeartStart MRx Connect the HeartStart MRx to AC or DC power Insert the ba
157. ary The internal Event Summary stores up to 12 hours of 2 continuous ECG waves 1 CO and 2 invasive pressure waves events and trending per Event Summary There is a maximum capacity of 55 Event Summaries or 240 megabytes 62 megabytes for those devices with a 64 megabyte card of patient data whichever comes first Data Card Event Summary The Data Card has a maximum capacity of 60 Event Summaries or 240 megabytes 62 megabytes for those devices with a 64 megabyte card of patient data whichever comes first Environmental M3535A Temperature 0 C to 45 C operating 20 to 70 C storage e Charging the battery at temperatures above 45 C may degrade battery life e Storing the battery for extended periods at temperatures above 40 C will reduce battery capacity and degrade battery life Humidity Up to 95 Relative Humidity e Printer paper may jam if paper is wet Thermal Printer may be damaged if wet paper is allowed to dry while in contact with printer elements Atmospheric Pressure Range e Operating 1014 hPa to 572 hPa 0 to 15 000 ft 0 to 4 500 m e Storage 1014 hPa to 572 hPa 0 to 15 000 ft 0 to 4 500 m Shock e Operating Half sine waveform duration lt 3 ms acceleration gt 145 g 1 time on all six faces e Non operating Trapezoidal waveform acceleration gt 30 g velocity change 742 cm s 10 on all six faces Vibration e Operating Random vibration 0 30 Grms 5 500 Hz for gt 10 minutes axis PSD 0 000
158. ata Transmission Serial Phone Profile Settings Profile Name Name of the profile This field is fixed Serial Phone Profile Configuration String Available from your cell phone service provider 45 characters blank Dial String Available from your cell phone service provider 40 characters blank Wait for Dial Tone Available from your cell phone service provider Yes No PPP User Name Typically not needed but may be required by some 30 characters blank cell phone service providers PPP Password Typically not needed but may be required by some 40 characters blank cell phone service providers Static IP Address Typically not needed but may be required by some 15 characters nnn nnn nnn nnn blank cell phone service providers Primary DNS Typically not needed but may be required by some nnn nnn nnn nnn blank cell phone service providers Secondary DNS Typically not needed but may be required by some nnn nnn nnn nnn blank cell phone service providers http Proxy Address Typically not needed but may be required by some 15 characters blank cell phone service providers http Proxy Port Typically not needed but may be required by some 15 characters blank cell phone service providers Baud Rate Available from your cell phone documentation If 9600 19200 38400 57600 115200 your phone transmits high speed data set to 115200 Flow Control Available from your cell phone docu
159. atient is automatically re admitted from the transfer list The HeartStart MRx exits Transfer Mode Turning the HeartStart MRx Off When the HeartStart MRx is turned off or enters a non clinical mode i e Data Management Operational Check Battery Calibration Configuration or Service modes while in Transfer Mode the current patient incident is closed and the HeartStart MRx exits Transfer Mode The patient remains on the Information Center s transfer list When the HeartStart MRx is turned back on or you re enter a clinical mode patient information is reset to device defaults and the patient state is Not Admitted 189 Sharing Information on the Network Once connected to the IntelliVue Network the HeartStart MRx shares information and data with the Information Center You can also silence and reset most alarms remotely from the Information Center Patient Information Updates After the HeartStart MRx makes a network connection with the Information Center all patient information except height weight screen notes and care group which are not available on the HeartStart MRx entered at one location is automatically reflected at the other Date Of Birth The HeartStart MRx with IntelliVue Networking Option allows you to enter a patient s date of birth Without the IntelliVue Option you enter the patient s age The valid range for date of birth is the current date to 150 years ago The patient s date of birth is unpopulated
160. ation buttons change the low limit and press the Menu Select button Enabling Disabling Temperature Alarms Temperature alarms default to on To disable temperature alarms perform the following 1 2 4 Press the Menu Select C button Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button Select the temperature label option currently assigned to your measurement and press the Menu Select button Select Alarms Off and press the Menu Select button To turn alarms back on repeat the steps above except select Alarms On in Step 4 Changing Degree Units The HeartStart MRx can display temperature in either Fahrenheit or Celsius The default is Celsius and can only be changed through Configuration Mode See Configuration on page 199 for more information 133 Disabling the Temperature Function To turn off the Temperature function disconnect the temperature cable from the HeartStart MRx port The message Temp or the label currently activated unplugged Turn off Temp appears Select Yes and press the Menu Select button Should the temperature cable get disconnected accidentally or if the probe and cable separate the message Temp unplugged Turn off Temp appears to notify you of the disconnection To continue monitoring temperature select No and press the Menu Select button Reconnect the temperature cable to restart the temperature monitoring function See Turning Paramet
161. ation buttons to select the patient s sex and press the Menu Select button c If your device is configured to run the ACI TIPI and TPI algorithms you re asked to enter the patient s chest pain symptoms in the menu 6 Keep the patient still while the message Acquiring 12 Lead is displayed Once ECG acquisition is complete ECG analysis begins automatically and is accompanied by the message Analyzing 12 Lead The patient does not need to be still during this time Following analysis the 12 Lead Report is displayed printed and stored internally To acquire another 12 Lead ECG press New 12 Lead To exit the 12 lead function press Exit 12 Lead WARNING Failure to enter correct patient age and sex can result in erroneous diagnosis NOTES A minimum of one chest lead and all limb leads are required to get a partial interpretation from the 12 Lead algorithm You must have all six chest leads to get a full interpretation Also wet gel electrodes take less time to settle than hydrogel electrodes thereby varying the amount of time you might have to wait before acquiring a 12 Lead ECG Pressing the Acquire softkey a little too soon may result in a dashed line The Lead Select button is disabled when the 12 lead function is active Acquiring a 12 lead ECG with ACI TIPI and or TPI Analysis If configured to do so the HeartStart MRx runs the ACI TIPI and TPI predictive instrument algorithms after a 12 lead ECG has been acquired
162. ation pressure is based on the configured patient type adult or pediatric If necessary select the correct patient type during use by changing the Patient Category selection through the Patient Info menu Preparing to Measure NBP To prepare for NBP measurement 1 Select the appropriately sized cuff for the patient The cuff width should be either 40 of the limb circumference or 2 3 of the upper arm length The inflatable part of the cuff should be long enough to encircle 50 80 of the limb The wrong cuff size may give false and misleading results If you do not have the correct cuff size use a larger one to minimize error 2 Attach the cuff to the NBP tubing making sure that air can pass through the tubing and that the tubing is not squeezed or kinked see Figure 61 Figure 61 Connecting the NBP Cuff Tubing 3 Insert the NBP tubing into the NBP port as described in Connecting the NBP Interconnect Tubing on page 37 104 4 Apply the blood pressure cuff to the patient s arm or leg as follows a Ensure that the cuff is completely deflated b The cuff should not be placed on the same extremity as an SpO sensor Wrap the cuff around the arm making sure that the artery marker is aligned over the brachial artery Ensure that the cuff is not wrapped too tightly around the limb Excessive tightness may cause discoloration and eventual ischemia of the extremities Also ensure that the NBP tubing from the defibrillator to
163. ator charges automatically Shock Button Delivers a shock through multifunction electrode pads or switchless internal paddles In AED mode a 150J shock is delivered In Manual Defib Mode the shock is delivered at the selected Manual Defib energy setting NOTE When external paddles or switched internal paddles are used once the HeartStart MRx is fully charged the shock is delivered by pressing the Shock button s on the paddles Sync Button Toggles between synchronized energy delivery used during cardioversion and asynchronous energy delivery used during defibrillation Figure 12 Defibrillation Controls amp Sync N Button gt R Adult Ae 120 150 SF 70 oe 170 Ry 200 S aa 1 Therapy nergy Charge 2 Charge Button C se Soft Keys The soft keys perform the function displayed as a label appearing immediately above on the display The labels and therefore the function change appropriately for the various modes of operation and are described in the following chapters 21 Indicators The HeartStart MRx indicators provide a visual display of device status Ready For Use Indicator The Ready For Use RFU indicator is located on the upper right corner of the device It indicates the status of the therapy delivery functions of the monitor defibrillator using the following definitions e A blinking black hourglass symbol x indicates the shock pacing and ECG functions of the device are ready for u
164. ault artifact suppression 30 sec 60 sec 90 sec Off timeframe Filter Selects the filter setting 12 Hz 40 Hz Color Selects the parameter color Red Yellow Blue Green Cyan Magenta White Table 44 Invasive Pressure Settings ICP Alarm Source Source is always Mean and not configurable High Limit Selects the high limit value Adult 39 360 10 mmHg Ped 39 360 4 Adjusted in increments of 1 mmHg or 0 1 kPa Low Limit Selects the low limit value Adult 40 359 0 mmHg Ped 40 359 0 Adjusted in increments of 1 mmHg or 0 1 kPa Scale Selects the default waveform scale Adult 300 240 180 150 120 110 100 90 80 70 60 50 40 30 20 10 5 10 15 20 Ped 300 240 180 150 120 110 100 90 80 70 60 50 40 30 20 10 5 10 15 20 Artifact Suppression Selects the default artifact suppression timeframe 30 sec 60 sec 90 sec Off Filter Selects the filter setting 12 Hz 40 Hz Color Selects the parameter color Also applies to CPP Red Yellow Blue Green Cyan Magenta White Table 45 Invasive Pressure Settings CPP Alarm Source Source is always Mean and not configurable High Limit Selects the high limit value Adult 35 360 130 mmHg Ped 35 360 100 Adjusted in increments of 5 mmHg or 1 kPa Low Limit Selects the low limit v
165. avigation buttons select the new high limit value and press the Menu Select button 99 SpO Desat Alarm NOTE The HeartStart MRx also provides an alarm for SpO Desat Limit The SpO Desat alarm provides an additional limit setting below the low limit setting to notify you of potentially life threatening decreases in oxygen saturation This additional limit setting is preset through the Configuration menu If the SpO Low Limit alarm value is set below the configured SpO Desat Limit the SpO Desat Limit value is automatically adjusted to the SpO Low Limit alarm value Should the SpO reading fall below this limit the SpO Desat Limit alarm is announced Enabling Disabling the SpO Alarms NOTE To enable the SpO Alarms perform the following steps 1 Press the Menu Select 9 button 2 Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button 3 Select SpO and press the Menu Select button 4 Select Alarms On Off and press the Menu Select button While an NBP measurement is in progress SpO INOP messages are suppressed for up to 60 seconds Pulse Rate Alarms 100 Pulse Rate alarms are off unless you enable them during use The configured alarm limits may be changed during use Alarms are annunciated if measurements fall outside the configured limits for high and low pulse rate Pulse Rate alarms are all categorized as non latching alarms meaning they are automatically remove
166. avigation buttons to select the password numbers and then selecting Done to complete the entry The Charge C52 button and the Start Pacing soft key remain inactive until the password is entered AED mode is always available without a password WARNING Use of the Manual Therapy security password requires the clinician to know and remember the password as defined in Configuration Failure to enter the correct password will prevent the delivery of manual defibrillation or pacing therapy Prior to selecting this Configuration option review this potential risk with your Risk Manager Display Views The HeartStart MRx display layout is segmented as shown in Figure 5 Figure 5 Display Layout General Mark Event 10 Feb 2006 11 20 A_ EL Status Area 5 patentan LLNS Fom alarms Adult Non Paced 5 Parameter Temp C Pulse bpm Ya T q120 bom 80 39 0 em 0 1040 amp mechs 36 930 80 Wave Sector 1 gt Wave Sector 2 gt Primary ECG Parameter Ss Block 2 see p02 EtCO2 mmHg AwRR P Toone 18 Main Menu Wave Volume Sector 3 D oo Displayed Waves Printed Waves Measurements Alarms te Wave Patient I nfo Menu Area Sector 4 gt q e Soft Keys EEE DEE NOTE Pictures of the HeartStart MRx display appearing in this manual are for illustration purposes only The content of these areas varies with the display view the options on your device and the function being performed 13 General Status T
167. c waveform in out of hospital sudden cardiac arrests SCAs as compared to monophasic waveforms The primary objective of the study was to compare the percent of patients with ventricular fibrillation VF as the initial monitored rhythm that were defibrillated in the first series of three shocks or less This section summarizes the methods and results of this study Victims of out of hospital SCA were prospectively enrolled in four emergency medical service EMS systems Responders used either 150J SMART Biphasic AEDs or 200 360 monophasic waveform AEDs A sequence of up to three defibrillation shocks were delivered For the biphasic AEDs there was a single energy output of 150J for all shocks For monophasic AEDs the shock sequence was 200 200 360J Defibrillation was defined as termination of VF for at least five seconds without regard to hemodynamic factors Results Randomization to the use of monophasic or SMART Biphasic automatic external defibrillators AEDs was done in 338 SCAs from four emergency medical service systems VF was observed as the first monitored rhythm in 115 patients The biphasic and monophasic groups for these 115 patients were similar in terms of age sex weight primary structural heart disease cause or location of arrest and bystanders witnessing the arrest or performing CPR The 150J SMART Biphasic waveform defibrillated 98 of VF patients in the first series of three shocks
168. cel a BLDT currently being sent press the Menu Select button use the Navigation buttons to highlight Cancel Transmission and press the Menu Select button The transfer stops and the HeartStart MR x is placed back in the Data Management screen Troubleshooting If your HeartStart MRx does not operate as expected during transmission see Troubleshooting on page 297 261 20 Maintenance This chapter describes how to care for your HeartStart MRx and its accessories Overview Proper maintenance of the HeartStart MRx is a very simple yet important factor in dependability It involves Providing power so automated tests can be run Observing the Ready For Use RFU indicator Performing the Operational Check Caring for batteries Cleaning the device and accessories Ordering replacement supplies and accessories WARNING _ Electric shock hazards exist internally Do not remove assembly screws HeartStart MRx service should only be performed by qualified service personnel in accordance with the HeartStart MRx Service Manual NOTE Calibration of the optional end tidal CO and noninvasive blood pressure modules of the HeartStart MRx needs to be performed yearly by a qualified service provider as described in the HeartStart MRx Service Manual 263 Automated Tests The HeartStart MRx independently performs many maintenance activities including three tests that run automatically at regularly scheduled intervals whi
169. computer running Event Review Pro software For more information about Event Review Pro go to www medical philips com and search for data management For more information on HeartStart MRx transmission options see Data Transmission on page 239 23 Alarms The HeartStart MRx provides various alarm types indicating changes in patient condition or device cable conditions which may require attention Table 3 details different alarm types Table 3 HeartStart MRx Alarm Types Red High priority Life threatening alarm condition is present Immediate operator response is required Red alarm message alarm tone Yellow Medium priority Non life threatening alarm condition is present Prompt operator response is required Yellow alarm message alarm tone INOP Low priority Most technical alarms are grouped together as INOPs and are handled as low priority alarms indicating a problematic condition exists related to the ability of part or all of the device to perform its intended monitoring function Operator awareness is required Exception conditions which stop or may stop the delivery of pacing therapy and invasive pressure disconnect These are classified as high priority technical alerts They are potentially life threatening conditions Latching Alarm is announced and remains present regardless of whether the alarm condition continues to exist A latching alarm is not removed until it is either acknowledged or a higher priority a
170. ctive matter to the paddle electrodes Do not distribute conductive matter by rubbing the paddle electrodes together 4 Apply paddles to the patient s bare chest using the anterior anterior placement or in accordance with your organization s protocol The sternum paddle contains a patient contact indicator PCI See Figure 50 If necessary as indicated by the appearance of either a red or orange LED on the PCI adjust paddle pressure and placement to optimize patient contact Once proper contact is made the PCI shows a green LED Figure 50 Patient Contact Indicator T NOTE Reasonable effort should be made to obtain a reading of at least one green LED Due to impedance this may not be possible for some patients and orange LEDs may be the best that can be achieved Patient Contact Indicator PCI 75 Using Pediatric Paddles The HeartStart MRx s external paddle set comes with pediatric paddles included The American Heart Association recommends using pediatric paddles on children weighing lt 10 Kg larger paddles may be used as long as contact between the paddles is avoided To use the pediatric paddles set 1 Depress the latch at the front of the external paddle set while pulling forward on the adult paddle electrode 2 Store the adult paddle electrodes in the paddle tray pockets 3 To defibrillate see Using External Paddles on page 75 NOTE Impedance is the resistance between the defibrillator s pads o
171. d Radio Weak Signal Logged when event occurs INOP detected All ECG Alarms Off Logged when event occurs INOP detected See Table 99 for causes and possible solutions to these logged events 236 Marking Events The Mark Event button allows you to annotate the Event Summary and the ECG strip at the point in time the button is pressed If configured pressing the Mark Event button prints a 6 second ECG strip Depending on configuration the ECG strip is either printed real time or prepended with the previous 10 seconds of data leading up to the marked event Once pressed the Mark Event label in the upper left corner of the display changes to Select Event and the Mark Events menu is displayed see Figure 102 Figure 102 Mark Events Menu Mark Events ET Access IV Access Lidocaine Atropine Morphine Nitroglycerin Aspirin Other Use the Navigation buttons to select the desired event and press the Menu Select 9 button The ECG strip is annotated with the mark event J gt symbol and the selected annotation If an annotation item is not selected within five seconds after the Mark Event button is pressed only the generic mark event symbol will appear on the ECG strip The marked event is stored in the Event Summary NOTE Entries on the Mark Events menu are as configured Changes are made using the Configuration menu 237 19 Data Transmission This chapter p
172. d Stay clear of the patient when the icon is displayed NOTE Do not remove the CPR meter during rhythm analysis or shock delivery Leave the CPR meter on the patient s chest If compressions are stopped for 10 seconds the CPR meter display changes to a flashing white image to indicate that CPR should be resumed If compressions are not resumed the HeartStart MRx provides voice prompts if configured that no compressions are detected The customer service indicator appears only at shutdown when the number of compressions performed on the CPR meter reaches the device s service limit Take the CPR meter out of service and contact your local response center for more information Q CPR Feedback on the HeartStart MRx 5 QC PR and Data Capture Q CPR Feedback on the HeartStart MRx Depending upon how you configure your HeartStart MRx you can receive a variety of information on the HeartStart MRx display Feedback is also displayed on the CPR meter On the HeartStart MRx display Advanced View can be displayed in both Manual Defibrillation Mode and in AED Mode while Basic View is available in AED Mode only You can only configure which view is displayed in Configuration Mode not during a patient event See Configuration on page 199 for more information Advanced View When configured for Advanced View the HeartStart MRx can display the following parameters depending upon your configuration See Figure 84 A
173. d at cable and passes without the the end of all remaining tests cable the ECG cable is bad Leads ECG Test failed with cable Replace the ECG cable and Disconnect ECG cable to rerun rerun Operational Check test without cable If the ECG test fails with and without the cable see Troubleshooting on page 297 275 Table 76 Operational Checks Test Continued Pads Paddles ECG Checks ECG acquisition None if test passes If test fails the If the Pads Paddles test fails with through pad paddles following prompt is displayed at the cable and passes without the the end of all remaining tests cable the cable is bad Replace Pads Paddles ECG Test failed the Therapy cable and rerun with cable Disconnect therapy Operational Check cable to rerun test without cable If the Pads Paddles test fails with and without the cable see Troubleshooting on page 297 Battery A Checks the total battery None None Battery B capacity combination of both batteries and calibration status of the batteries in Compartments A and B SpO Checks the internal SpO PCA None None The SpO cable is not tested NBP Checks to see if the NBP None None module is functioning determines if it is due for calibration CO Checks to see if the CO None None module is functioning determines if it is due for calibration Invasive Pressures Checks to see if the invasive None None pressure
174. d battery support system Fail D Hourglass A problem has been detected Turn the Therapy Knob to Monitor An with a component that does not inop indicating the failed component is affect therapy delivery displayed Refer to Chapter 22 Troubleshooting for the action to take 265 Ready For Use Indicator 266 The results from Automated Tests are reported through the Ready For Use RFU indicator Be sure to observe the RFU indicator periodically and take the appropriate action as described in Table 75 Table 75 RFU Indicator Status Blinking black hourglass Shock pacing and ECG functions are ready for use and sufficient battery power is available None Blinking red X with or without a periodic chirp Low battery The device can be used but run time is limited Chirping indicates the battery is not being charged No chirping indicates the battery is being charged Charge the battery as soon as possible and or replace the battery with a charged battery Charging may be done in the HeartStart MRx by connecting to AC DC power or in a Philips approved battery support system Solid red X and a periodic chirp A failure has been detected that may prevent the delivery of a shock pacing or ECG acquisition Turn the Therapy Knob to Monitor An inop message describing the failure is displayed See Chapter 22 Troubleshooting for the corrective action If needed run an Operation
175. d by the Information Center Bed Equipment Label The HeartStart MRx equipment label is displayed when the device is not connected to the network The equipment label will be replaced by a bed label when connected to the network Figure 88 HeartStart MRx With IntelliVue Networking Option Status Area Network Connectivity Icon Bed Equipment Label Mark Event Bed5678901 ECG Unplugged Extreme Tachy NOTE Fora description of other information in the status area refer to Getting Acquainted on page 7 178 Connecting to the Network There are two aspects to getting your HeartStart MRx up and active on the IntelliVue Network Both need to be in working order before your HeartStart MRx can be used on the IntelliVue Network 1 Configure the device and the IntelliVue Network to talk with each other See Configuring to Work on the Network on page 181 2 Physically connect your device to the IntelliVue network See Physical Connections below Physical Connections You can physically connect your HeartStart MRx to the network in three different configurations 1 Wired An IntelliVue Network LAN cable is plugged into the RJ 45 connector labeled LAN on the back of the HeartStart MRx See Wired Connection on page 180 2 Wireless Philips Instrument Telemetry 1 4 GHz radio and A C module radio AC power module backpack is mounted on the HeartStart MRx and plugged into the RS 232 conn
176. d culprit artery detection DXL Algorithm adult criteria apply if the patient age is 16 years old or older Pediatric criteria apply if the patient age is less than 16 The DXL Algorithm also identifies paced patients automatically The DXL Algorithm also includes the optional Acute Cardiac Ischemia Time Insensitive Predictive Instrument ACI TIPI and Thrombolytic Predictive Instrument TPI algorithms ACI TIPI generates a 0 100 predicted probability score of Acute Cardiac Ischemia ACI TPI predicts patient outcomes with and without thrombolytic therapy for an acute myocardial infarction WARNING Computerized ECG interpretation is not intended to be a substitute for interpretation by a qualified physician NOTE Refer to the DXL Physician s Guide for more information on the algorithm s functionality 135 NOTES The Philips DXL Algorithm is capable of interpreting up to 16 leads however the HeartStart MRx uses the 12 lead functionality only ACI TIPI and TPI are to be used as part of a suite of diagnostic tools and used in an advisory basis Clinical symptoms 12 Lead ECG information and or patient history may contradict the results of the predictive algorithms Institutions should establish protocols before instituting the use of the predictive instrument algorithms You can configure the ACI TIPI algorithm on your 12 lead without running the TPI algorithm However to use the TPI algorithm you must first run the data through ACI
177. d events and information stored in the Event Summary Refer to the Working with Data chapter of the HeartStart MRx Instructions for Use for a complete listing of all events stored Table 34 IntelliVue Networking Events Logged Audio Paused by Central Logged when alerts are silenced reset from the Information Center Time changed from with Logged when the HeartStart MRx time and date are synchronized to original device time the Information Center time Date of Birth day month Logged when the Date of Birth is set or changed year Central Monitoring Active Logged when the HeartStart MRx associates with the Information Center Patient Discharged Logged when the patient is discharged No Central Monitoring Logged when event occurs depending upon configuration Central Monitoring Mandatory Radio Malfunction Logged when event occurs INOP detected Radio Unplugged Logged when event occurs INOP detected Radio Weak Signal Logged when event occurs INOP detected All ECG Alarms Off Logged when event occurs INOP detected See Table 99for causes and possible solutions to these logged events INOPs Alarms and Messages at the Information Center Most HeartStart MRx alarms INOPs and messages display at the Information Center in their entirety or in an abbreviated form Table 35 lists alarms INOPs and messages that appear differently at the Information Center Refer to Tro
178. d when action occurs 12 Lead Deleted date time Logged when action occurs 12 Lead Transmitted date time Logged when 12 Lead Report is successfully transmitted from the MRx Mark Event Mark Event Logged when Mark Event button is pressed Mark event drug Logged when user selects an entry from the Mark Event menu 235 Table 68 Event Information Continued Print Print Strip Logged when Print button is pressed Periodic Clinical Data Transfer Start Data Transmit to Logged when the HeartStart MRx begins a periodic clinical data transfer session site End Data Transmit Logged when the HeartStart MRx ends a periodic clinical data transfer session Network Audio Paused by Logged when alerts are silenced reset from the Information Center Central Time changed from Logged when the HeartStart MRx time and date are synchronized to the with original device Information Center time time Date of Birth day Logged when the Date of Birth is set or changed month year Central Monitoring Logged when the HeartStart MRx associates with the Information Center Active Patient Discharged Logged when the patient is discharged No Central Logged when event occurs depending upon configuration Central Monitoring Monitoring Mandatory Radio Malfunction Logged when event occurs INOP detected Radio Unplugged Logged when event occurs INOP detecte
179. d when their alarm condition no longer exists Table 10 details Pulse Rate alarms Table 10 Pulse Rate Physiological Alarms Pulse High Yellow Yellow alarm message Pulse value exceeds the high alarm limit alarm tone Pulse Low Yellow Yellow alarm message Pulse value has fallen below the low alarm tone alarm limit Enabling Disabling the Pulse Rate Alarms To enable disable the Pulse Rate Alarms perform the following steps 1 Press the Menu Select K button 2 Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button Select Pulse and press the Menu Select button 4 Select Alarms On Off and press the Menu Select button Changing the Pulse Rate Alarm Limits To change the Pulse Rate Alarm Limits perform the following steps 1 Press the Menu Select 9 button 2 Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button Select Pulse and press the Menu Select button Select Pulse Limits and press the Menu Select button Using the Navigation buttons select the new high limit value and press the Menu Select button A NN oA O Select the new low limit value and press the Menu Select button Disabling the SpO Monitoring Function To disable the SpO monitoring function disconnect the sensor cable from the SpO port The message SpO Unplugged Turn off SpO appears Select Yes and press the Menu Select button Should
180. depleted by up to 15 200 Joule discharges e Less than 30 seconds from initiation of rhythm analysis AED Mode when operating without a battery using the M3539A AC power module alone at 90 100 rated mains voltage 322 e Less than 40 seconds from initial power on AED Mode with a new fully charged Lithium Ion battery pack at 25 C depleted by up to 15 200 Joule discharges e Less than 40 seconds from initial power on AED Mode when operating without a battery using the 3539A AC power module alone at 90 100 rated mains voltage Patient Impedance Range Minimum 25 Ohm external defibrillation 15 Ohm internal defibrillation Maximum 180 Ohm Note Actual functional range may exceed the above values Manual Defib Mode Manual Output Energy Selected 1 10 15 20 30 50 70 100 120 150 170 200 Joules maximum energy limited to 50J with internal paddles Controls On Off Therapy Knob Charge Shock Sync ECG Lead Select Disarm Print Mark Event Alarm Pause Event Review Energy Selection Front panel Therapy Knob Charge Control Front panel button button on external paddles Shock Control Front panel button buttons on external or switched internal paddles Synchronized Control Front panel SYNC button Indicators Text Prompts Audio Alerts QRS Beeper Battery Status Ready For Use External Power Sync Mode Armed Indicators Charging charged tones flashing shock button energy level indicated on display AED
181. direct reference for determining the end expiratory point in the pressure curve If the pulmonary artery flotation catheter drifts into the wedge position without inflation of the balloon the pulmonary artery pressure waveform will assume a wedged appearance To correct the situation take appropriate action in accordance with standard procedures 127 Pulse The HeartStart MRx can provide pulse readings from either the SpO or Invasive Pressures options To understand how pulse works with SpO only read Chapter 8 Pulse Oximetry If your device has both options read the following section Pulse Sources When both SpO and Invasive Pressures options are present on the HeartStart MRx pulse can be derived from an SpO pleth wave or one of the two invasive pressure waves in Monitor Pacing and Manual Defib modes The pulse reading will be displayed in the color of its source e g if your pleth wave is cyan and pulse is being derived from the pleth wave then the pulse reading will appear in cyan Pulse is on and displayed if one of the possible sources is activated SpO is the factory default but can be modified in Configuration Mode If the default pulse source is not active during an event but a secondary source is the pulse value will appear on screen but it will be invalid and display a where the value should be A Pulse Check Source INOP will also appear on the screen To obtain a pulse rate you must modify the pulse source t
182. done tone To disarm the defibrillator press Disarm If Shock has not been pressed within the time period specified in the Time to Auto Disarm Configuration Choice the defibrillator disarms automatically If desired you may increase or decrease the selected energy level after pressing the Charge button by moving the Therapy Knob to the desired setting The defibrillator charges to the modified energy level automatically Wait until the current charge reaches the selected energy level before proceeding 5 Make sure no one is touching the patient or anything connected to the patient Call out clearly and loudly Stay Clear 6 Press and hold the Shock OS button on the HeartStart MRx or if you are using external paddles press and hold the orange buttons on both paddles The shock will be delivered when the next R wave is detected NOTE Itis important to continue to hold the Shock GS button or the paddle shock buttons until the shock is delivered The defibrillator shocks with the next detected R wave NOTE Should an ECG or pads INOP such as Leads Off occur while performing synchronized cardioversion the HeartStart MRx will not charge or if charged will disarm automatically WARNING Defibrillation current can cause operator or bystander injury Do not touch the patient or equipment connected to the patient during defibrillation Delivering Additional Synchronized Shocks If additional synchronized shocks are indica
183. dvanced Q CPR View on page 168 e Compression rate e No flow time e EtCO numeric if available e Ventilation Rate e Ventilation detected icon e CPR Timer e Compression Counter e Compression Wave if an IBP arterial or pulmonary arterial pressure wave is available it replaces the Compression Wave e CO wave if available Compression Waveform If you do not have an invasive pressure waveform ABP ART Ao or PAP displayed the compression waveform appears in Wave Sector 3 and is labeled Comp The waveform is drawn at a speed of 12 5 mm second As the chest is compressed the compression is shown as a downward stroke of the wave rebounding up to a baseline as compression pressure is released The wave sector contains lines drawn at minus 38 mm and minus 51 mm minus 1 5 inches and minus 2 inches that define a target zone to help you achieve good compression depth Good compression depth is achieved when the peak or minimum value of the waveform appears between the lines When pressure is not released between compressions an asterisk will annotate the baseline segment between compressions This is also referred to as leaning If the signal from the CPR meter becomes invalid e g the meter is disconnected the waveform appears as a dashed line In Manual Defib Mode if you do have an arterial or pulmonary arterial invasive pressure waveform displayed it displays in Wave Sector 3 The compression waveform remains i
184. e Battery life depends on the frequency and duration of use When properly cared for the M3538A Lithium Ion battery has a useful life of approximately 2 years To optimize performance a fully or nearly fully discharged battery should be charged as soon as possible Operating Modes The HeartStart MRx has four clinical modes of operation each with a customized display view The modes are as follows Table 1 Operating Modes and Views Monitor Mode Monitoring View or Used to monitor ECG take an optional 12 lead ECG and monitor 12 Lead View optional parameters such as SpO3 EtCO3 NBP Invasive Pressures Temperature and for viewing Vital Signs Trending data AED Mode AED View Used to analyze ECG and if necessary perform semi automatic external defibrillation Q CPR available Manual Defib Mode Code View Used to perform asynchronous and synchronous defibrillation cardioversion Q CPR available Pacer Mode Pacing View Used to perform demand or fixed mode pacing NOTE Upon returning to a clinical mode from a non clinical mode such as Configuration or Data Management all settings reset to the default settings Password Security Access to Manual Defib Mode and Pacer Mode may be configured to be password protected If the modes are password protected you are prompted to enter the password upon moving the Therapy Knob to either the Pacer position or an energy selection The password is entered by using the N
185. e To connect a 3 5 or 10 lead cable 1 Align the ECG cable with the white ECG port as shown in Figure 19 The white key marker on the ECG cable faces the top of the device Push the ECG cable firmly into the ECG port until the white portion of the cable connector is no longer visible Figure 19 Connecting the ECG Patient Cable 35 3 Setting Up Connecting the SpO3 Cable Connecting the SpO Cable To connect the SpO cable 1 Hold the cable connector with the flat side facing front as shown in Figure 20 2 Insert the cable into the blue SpO port on the HeartStart MRx and push until the blue portion of the cable connector is no longer visible Figure 20 Connecting the SpO Cable 36 Connecting the NBP Interconnect Tubing Setting Up Connecting the NBP Interconnect Tubing To connect the NBP Interconnect Tubing 1 Insert the NBP Interconnect Tubing into the red NBP port as shown in Figure 21 2 Attach the NBP Interconnect Tubing fitting to the NBP cuff Figure 21 Connecting NBP Interconnect Tubing NBP Cuff 37 Connecting the Invasive Pressures Cable To connect the invasive pressure cable 1 Insert the invasive pressure cable into either of the invasive pressure ports as shown in Figure 22 2 Attach the invasive pressure cable to your transducer tubing 3 Assign a label to the connection on the HeartStart MRx See Selecting a Pressure to Monitor on page 117 Figure 22 Connecting Invasive Pressure
186. e Some modes of operation allow for the entry of patient information via a menu choice If no information is entered the patient category is defaulted to Adult unless configured otherwise and the pacing status is set to Non Paced unless the Paced status has been previously set to paced for an internally paced patient In Pacer Mode Paced status is not displayed Patient Name If entered the patient s name will appear above the patient type and paced status e Bed Equipment Label The HeartStart MRx equipment label is displayed when the device is not connected to the IntelliVue Network The Equipment label is replaced by the bed label when connected to the IntelliVue Network Event Timer An Event Timer communicates the elapsed time for the current patient event 14 Wave Sectors The HeartStart MRx is configured to populate each wave sector with a predetermined waveform when powered on in Monitor Manual Defib or Pacer Mode Figure 7 shows the default Waves configuration choices for a device containing all monitor options See Configuration on page 199 for more information A dashed line in a wave sector or an empty wave sector indicates that the waveform source is invalid Wave sectors may contain a variety of information as appropriate to the parameter view and task Figure 7 Default Waves Configuration Mark Event 10 Feb 2006 11 20 E e m Patentname LLL MIM SS ECG HR alarms Adult Non Paced m B02 36 933 80
187. e As a time saving measure you may choose to always keep your Pads CPR cable pre connected to the MRx Figure 73 Connecting the Pads CPR Cable NOTE The Q CPR option is operational only when the Pads CPR cable is connected to the HeartStart MRx CPR feedback is not available if the standard pads or paddles cable is connected 159 Connecting the CPR Meter to the Pads CPR Cable To connect the CPR meter to the Pads CPR cable 1 Align the arrow on the CPR meter cable with the arrow on the receptacle end of the Pads CPR cable as shown in Figure 74 As a time saving measure you may choose to always keep your CPR meter cable pre connected to the Pads CPR cable 2 Push until you feel it snap into place There should be no gap between the two connectors Figure 74 Attaching the CPR meter to the Pads CPR Cable CPR meter cable Pads CPR cable N P a Applying Multifunction Electrode Pads To apply pads to the patient 1 Check the expiration date that appears on the pads package 2 Inspect the packaging for any damage then open 3 Connect the pads connector to the Pads CPR cable See Figure 75 Figure 75 Pads Connections 4 Apply the pads to the patient in the anterior anterior position as shown on the pads package WARNING Anterior posterior pad placement should not be used with the Q CPR option CAUTION Philips multifunction defib electrode pads are required to measure ventilation activity as well as acquire an
188. e human impedance data encountered in direct heart defibrillation The efficacy results of the HeartStart MRx are shown in Table 108 along with historical efficacy results of a standard monophasic damped sine MDS waveform Table 108 Clinical Performance Summary Internal Defibrillation 2J 5J 10J 20J 30 HeartStart MRx biphasic Mean Success 4 47 77 86 88 Sample Size 48 53 53 51 41 Control Biphasic Mean Success 10 60 93 92 92 Sample Size 49 48 54 49 40 p value Fisher s Exact p lt 0 050 0 436 0 232 0 032 0 526 0 712 Historical MDS Mean Success 3 25 34 57 76 Conclusion Overall the intra thoracic defibrillation success rate for the HeartStart MRx Biphasic versus a control biphasic waveform had no significant difference p lt 0 05 except at 10J 1 Zhang Y Davies R Coddington W Jones J Kerber RE Open Chest Defibrillation Biphasic versus Monophasic Waveform Shocks JACC 2001 37 320A 344 Safety Considerations The following general warnings and cautions apply to use of the HeartStart MRx Additional warning and cautions specific to a particular feature are provided in the appropriate section General WARNING The HeartStart MRx is not intended to be deployed in settings or situations that promote use by untrained personnel Operation by untrained personnel can result in injury or death WARNING HeartStart MRx service should only be performed by qualified service personnel in accordance with t
189. e 188 Sharing Information on the Network 190 Patient Information 190 Conflict Handling 192 Viewing Patient Incident Data 193 Alarms 193 Printing 193 Turning a Networked Device Off 193 Leaving a Clinical Mode 194 Events Logged 195 INOPs Alarms and Messages at the Information Center 195 Troubleshooting 197 17 Configuration 199 Overview 199 Accessing the Configuration Menu 199 Setting the Date and Time 200 Modifying Settings 200 Saving Configuration Settings to a Data Card 201 Loading Configuration Settings from a Data Card 201 Restoring the Default Settings 201 Printing Configuration Settings 201 xi Configurable Parameters 202 18 Working with Data 225 Overview 225 Initiating an Event Summary 226 Entering Data Management Mode 226 Copying from Internal Memory 227 Viewing and Erasing the External Data Card 228 Printing During a Patient Event 229 Event Summaries 229 Vital Signs Trending Reports 229 12 Lead ECG Reports 229 Printing Individual Events 230 Printing from Data Management Mode 231 Events Stored in Event Summary 232 Marking Events 237 19 Data Transmission 239 Overview 239 Transmitting During a Critical Care Event 240 Preparing for Transmission 241 Modifying Reference IDs 241 Setting up Bluetooth Transmissions 242 Setting up Rosetta Transmissions 245 Connecting Rosetta Lt 246 Setting Up for RS 232 Transmissions 247 Transmitting in 12 Lead Mode 248 Transmitting to a Manually Entered Fax Number 249 Transmitting to a
190. e 206 bpm 1 mV 3 seconds e 206 bpm halved amplitude 3 seconds 206 bpm doubled amplitude 3 seconds e 195 bpm 2 mV 3 seconds 195 bpm halved amplitude 3 seconds 195 bpm doubled amplitude 3 seconds Patient Isolation defibrillation proof e ECG Type CF e SpO Type CF e EtCO Type CF e NBP Type CF e Invasive Pressures Type CF e Temperature Type CF e External Defib Type BF e Internal Defib Type CF e CPR meter Type BF Other Considerations The HeartStart MRx is suitable for use in the presence of electrosurgery Burn hazard protection is provided via a 1K current limiting resistor contained in each ECG lead wire 325 Display Size 128 mm x 171 mm Type TFT Color LCD Resolution 640 x 480 pixels VGA Sweep Speed 25mm s nominal stationary trace sweeping erase bar for ECG Invasive Pressure and SpO 6 25 mm sec for CO Wave Viewing Time 5 seconds ECG Battery Type Rechargeable Lithium Ion See battery label for capacity information Dimensions 165 mm H x 95 mm W x 42 mm D 6 5 in x 3 8 in x 1 6 in Weight Less than 1 8 Ib 0 82 kg Charge Time with instrument off Approximately 3 hours to 100 Approximately 2 hours to 80 indicated by indicator Charging the battery at temperatures above 45 C may degrade battery life Capacity At least 5 hours of monitoring with ECG SpO CO3 temperature and two invasive pressures monitored continuously NBP measured every 15 min
191. e CPR pause is determined by the CPR Timer Setting A new Shock Series begins when a shock is delivered e after the device is turned on e after the automatic CPR pause e after the Pause for CPR soft key has been pressed or e if the time since the previous shock exceeds the Protocol Timeout setting 1 2 3 4 Protocol Timeout Sets the time interval used to determine if a delivered shock should be counted as part of the shock series see Shock Series above 30 60 90 120 150 180 210 Off seconds No Shock Advised NSA Action Defines how the device behaves following a No Shock Advised NSA decision e Monitor directs the device to monitor the patients ECG following an NSA decision and prompts the user to periodically perform CPR The CPR prompt interval is defined by the Monitor Prompt interval e Time Setting directs the device to provide a CPR Pause interval following a NSA decision If a shock has been delivered in the current Shock Series the length of the CPR Pause interval is defined by the CPR Timer setting Otherwise the length of the CPR Pause interval is defined by the NSA Action time setting Monitor 30 60 90 120 150 180 seconds CPR Prompt Defines the level of detail provided in the CPR reminder voice prompts provided at the completion of a Shock Series e Long provides detailed instruction to check airway breathing and pulse circulation before beginning CPR
192. e Short provides instruction to begin CPR if needed only Long Short Monitor Prompt Interval Sets the interval for patient care prompts provided during AED monitoring of the patient s ECG following an NSA decision Off means there are no prompts during AED monitoring 30 60 90 120 150 180 Off seconds CPR Display If Q CPR is installed and configured on sets the look of Q CPR data in the AED display Basic display shows the CPR Progress Indicator and any prompt text The Advanced view shows Compression Rate No Flow Time EtCO numeric if available Ventilation Rate if configured ventilation detected icon if configured CPR Timer Compression Counter Compression Wave CO wave if available Basic Advanced Table 62 Network Settings Equipment Label A user entered name that uniquely identifies the device used to associate the HeartStart MRx with an Information Center monitoring sector up to 16 Unicode characters blank Central Monitoring Controls whether the No Central Monitoring INOP appears at startup Mandatory means when the HeartStart MRx is not connected to the Information Center and is turned on or a connection is lost during monitoring the No Central Monitoring INOP message appears Optional means the INOP message only appears when a connection is lost during monitoring not at startup Mandatory Optional Remote Controls Sets or defines
193. e in demand mode 1 Turn the Therapy Knob to the Pacer position The message Pacing Paused appears in the status block and indicates that the pacing function is enabled however pace pulses are not being delivered Pacing is enabled in demand mode with the configured lead displayed in Wave Sector 1 If the configured lead is set to Pads Lead II or the first available monitoring lead that lead is displayed 2 Press the Lead Select button to select the best lead with an easily detectable R wave See Lead Selection on page 53 NOTE Ifyou are using anterior anterior pads placement while pacing and are experiencing difficulty with Lead II select another lead 3 Verify that white R wave markers appear above or on the ECG waveform A single marker should be associated with each R wave If the R wave markers do not appear or do not coincide with the R wave select another lead 4 Press Pacer Rate and use the Navigation and Menu Select buttons to select the desired number of pace pulses per minute The initial rate is configurable 5 If needed adjust the initial pacer output To do this press Pacer Output and use the Navigation and Menu Select buttons to select the desired output The initial output is configurable 6 Press Start Pacing The message Pacing appears WARNING Use care when handling the multifunction electrode pads on the patient to avoid shock hazard during pacing 7 Verify that white pacing marke
194. e to Monitor 117 Pressure Waves 118 Zeroing the Pressure Transducer 119 Zeroing Using the Menu Select Button 119 Zeroing Using a Soft Key in Monitor Mode 119 Calibration 121 Known Calibration Factor 121 Calibrating Reusable Transducer CPJ840J6 122 Calibration Confirmation 123 Last Zero Calibration 124 Non Physiological Artifact Suppression 124 Alarms 125 Enabling Disabling alarms 126 Viewing Changing Setting Source for Alarms 126 CPP Alarms 127 Wedge 127 Pulse 128 Pulse Sources 128 Changing Pulse Source 129 Setting Pulse Alarms 129 Enabling Disabling Pulse Alarms 129 Pulse Alarm Limits 130 Changing Default Pulse Source and Alarm Limits 130 Caring For Your Transducers and Probes 130 Troubleshooting 130 12 Temperature 131 Overview 131 Selecting a Temperature Label 131 Monitoring Temperature 132 Alarms 132 Setting Temperature Alarms 132 Changing Temperature Alarm Limits 133 Enabling Disabling Temperature Alarms 133 Changing Degree Units 133 Disabling the Temperature Function 134 Caring For Your Temperature Cables and Probes 134 Troubleshooting 134 13 12 Lead ECG 135 Overview 135 Preparation 136 Preview Screen 137 Acquiring a 12 Lead ECG 138 Acquiring a 12 lead ECG with ACI TIPI and or TPI Analysis 139 Critical Values 143 Culprit Artery 145 12 Lead Report 146 Accessing Stored Reports 148 Improving Signal Quality 149 Adjusting Wave Size 149 12 Lead Filters 150 Troubleshooting 150 14 Vital Signs Trending 151 Overview
195. ead ECG Trunk Cable IEC M1605A 3 lead ECG Lead Set with Snaps AAMI MI1615A 3 lead ECG Lead Set with Snaps IEC M1669A 3 Lead Trunk Cable M1671A 3 Lead ICU Grabber AAMI M1672A 3 Lead ICU Grabber IEC M1673A 3 Lead ICU Snaps AAMI M1674A 3 Lead ICU Snaps IEC M1675A 3 Lead OR Grabber AAMI M1678A 3 Lead OR Grabber IEC BEES aa M1520A 5 lead ECG Trunk Cable AAMI M1530A 5 lead ECG Trunk Cable IEC M1602A 5 Lead Chest ICU Snaps AAMI M1604A 5 Lead Chest ICU Snaps IEC M1625A 5 lead ECG Lead Set with Snaps AAMI M1635A 5 lead ECG Lead Set with Snaps IEC M1644A 5 Lead ICU Snaps AAMI M1645A 5 Lead ICU Snaps IEC M1668A 5 Lead Trunk Cable M1968A 5 Lead ICU Grabber AAMI M1971A 5 Lead ICU Grabber IEC M1973A 5 Lead OR Grabber AAMI M1974A 5 Lead OR Grabber IEC M1976A 5 Lead Chest ICU Grabber AAMI M1978A 5 Lead Chest ICU Grabber IEC M1979A 5 Lead Chest OR Grabber AAMI M1984A 5 Lead Chest OR Grabber IEC 989803158061 5 Lead ECG Lead Set Limb Leads Snaps Shielded Electrode AAMI 989803158071 5 Lead ECG Lead Set Chest Leads Snaps Shielded Electrode AAMI 989803158081 5 Lead ECG Lead Set Limb Leads Snaps Shielded Electrode IEC 989803158091 5 Lead ECG Lead Set Chest Leads Snaps Shielded Electrode IEC Sync Cable 8 ft M5526A Sync Cable 25 ft M1191A Reusable SpO Sensor Adult Finger 2 meters M1191AL Reusable SpO Sensor Adult Finger 3 meters M1191B Re
196. eartStart MRx appears within 30 seconds of the interruption The device may not have a compatible therapy board Print Device Info report and verify therapy hardware revision is at least 14 If not call for service to upgrade therapy board No network connection At the HeartStart MRx verify the equipment label is correct At the Information Center verify that the equipment label is assigned to the correct sector Attend to any momentary connection rejection message See Table 99 Verify that the IntelliVue Network is correctly configured to see the HeartStart MRx Verify wired connection Verify wireless radio module is connected prior to turning device on and within range of an access point Check signal strength by reviewing the RSSI number If the RSSI number is any value other than 128 The radio is communicating with the device and the device is communicating with the network Check to see if the Information Center is configured correctly check to see if the equipment label and RF Code are correct remains steady at 128 The radio is talking to the device but not to the network Move the device closer to an access point and confirm the proper RF code is entered is blank Call for service See Network Connection Rejection Messages on page 317 for other possible causes Radio Unplugged INOP on HeartStart MRx The wireless radio module is unplugged from the device Con
197. ector See Wireless Connection on page 180 3 A combination of wired and wireless The wired LAN and wireless radio AC power module are physically connected to the device at the same time See Combined Connection on page 181 CAUTION The radio module operating in the Wireless Medical Telemetry Service 1 4 GHz frequency is limited by US FCC 47 CFR Part 95 to operation and use in healthcare facilities only Use in ambulances or other vehicles is prohibited If a HeartStart MRx M3535A leaves the healthcare facility disconnect the radio module from the device Do not place the radio module on the HeartStart MRx M3536A NOTE The IntelliVue Networking option is not available with the Batch LAN Data Transfer option 179 Wired Connection To connect your HeartStart MRx to the network using a wired connection plug an active IntelliVue Network cable into the LAN port on the back of the device See Figure 89 Figure 89 Wired Connection Physical Setup On the display The wired icon appears on your display in all clinical views indicating a wired connection to the network Data can be exchanged with and viewed at the Information Center Wireless Connection The radio AC power module snaps into the back of the HeartStart MRx and connects to the device using an RS 232 DB 9 connection See Figure 90 Your institution must have a 1 4 GHz frequency wireless network to use this function To connect your HeartStart MRx to the netwo
198. ed Turn the Therapy Knob to Monitor An with a cable inop indicating the failed cable is displayed Replace the failed cable Fail BF N A A battery failure was detected Replace the battery Fail D Hourglass A problem has been detected Turn the Therapy Knob to Monitor An with a component that does inop indicating the failed component is not affect therapy delivery displayed See Chapter 22 Troubleshooting for the corrective action Fail S Hourglass CPR meter failure Check the CPR meter and cable connections If necessary replace the CPR meter I The Automated Tests continually check for a low battery condition and set the RFU Indicator appropriately 282 Battery Maintenance Battery maintenance is essential to ensure that the battery s state of charge is accurately reported there is sufficient charge and capacity to operate your HeartStart MRx and battery life is optimized Remove faulty batteries from service immediately Battery maintenance begins upon receipt of a new battery and continues throughout the life of the battery Detailed information on battery care is available in the Application Note M3538A Lithium Ion Battery Characteristics and Care which was provided with your HeartStart MRx Table 79 lists battery maintenance activities and when they should be performed Table 79 Battery Maintenance Procedures Perform a visual inspection As part of the Operational Check C
199. ed for the current patient through the menu See Menus on page 17 Parameter Blocks Measurements for monitored parameters are provided in the parameter blocks Parameter Block 1 always contains the heart rate and HR alarm settings Other parameters are in fixed locations depending upon the options which were included in your HeartStart MRx Each measurement is labeled and displays the current value and the high and low alarm limit settings or the rN alarms off icon A is displayed until a valid measurement can be obtained Your parameter text colors always match their corresponding wave Parameter Alarm Messages are displayed in the space above each numeric value replacing the parameter label except HR Turning Parameters On Off SpO Invasive Pressures EtCO and Temperature parameters are activated when the associated parameter cable tubing is connected To turn the parameter off disconnect the cable tubing from the HeartStart MRx A prompt message see Figure 8 alerts you that the parameter has been disconnected and requests confirmation to turn the parameter off Turn off Sp02 Yes Figure 8 Parameter Message Press the Menu Select 9 button to select Yes confirm your action and turn off the parameter If you do not wish to turn the parameter off use the Navigation Buttons to highlight No Press the Menu Select button to keep the parameter on and reconnect the cable tubing You can also ignore the message
200. ed in this chapter disregard these features and related information Before using the HeartStart MRx review the configuration settings of your device Confirm and update the settings as appropriate Attaching the Carrying Case and Accessory Pouches The HeartStart MRx accessory pouches are designed to hold your essential monitoring and defibrillation accessories Follow the procedures below for assembly and recommended accessory placement 1 Disconnect all external power and remove all batteries 2 Lower the device into the sleeve of the carry case The rear base of the device fits in the sleeve socket Paddle Tray a If paddles are connected disconnect them from the Therapy port and remove them from the paddle tray b Remove the 4 T 15 screws from the tray plates c Gently lift the paddle tray up leaving all wires connected Handle Only a Remove the handle cover by pushing in on either side of the handle cover and lifting up or by lifting the corners of the label to expose the two T 15 screws b Remove the 2 T 15 screws c Remove the handle d Gently lift the cap plate up 31 3 Fold the two sleeve flaps over the top of the device positioning them so that the screw holes are exposed 4 Replace the paddle tray and 4 T 15 screws or cap plate as appropriate so that the molded openings fit over the sleeve flaps 5 Replace the handle 6 Ifyour handle cover does not have screw holes insert the 2 T 15 screws
201. ed to insure patient confidentiality Please handle in accordance with HIPAA or your local patient privacy requirements To de identify patient data you must delete the event summary 251 Configuring a receiving site Before sending a Periodic Clinical Data Transmission you need to have a receiving site destination configured unless you are sending to an electronic Patient Care Record ePCR application See Modifying Settings on page 200 in the Configuration chapter to modify the Site options in the Data Transmission configuration section Starting a Periodic Clinical Data Transmission You can configure your HeartStart MRx to automatically transmit clinical values every 1 2 3 4 or 5 minutes See Configuration on page 199 for details on how to configure this setting To begin PCD Transmission 1 Confirm the HeartStart MRx is in a clinical mode and that your device has a properly configured data viewing software destination and Bluetooth FTP or DUN device If it is not properly configured see Adding a Bluetooth Device on page 242 2 Press the Menu Select button 3 Using the Navigation buttons select Start Data Transmit and press the Menu Select button 4 From the Send To menu use the Navigation buttons to select a pre configured data viewing server location to send the data to and press the Menu Select button to select 5 From the Transmission Devices menu use the Navigation buttons to select the tra
202. ediately Blood pressure readings may be affected by the position of the subject his her physiologic condition the presence of arrhythmia and other factors To obtain accurate blood pressure readings the cuff must be the correct size and also be correctly fitted to the patient Incorrect size or incorrect fitting may result in incorrect readings CAUTION Do not compress or restrict pressure tubes during an NBP measurement If a spill occurs and liquid appears to be inside the tubing contact your service personnel NOTE When using the HeartStart MRx aboard aircraft NBP measurements should only be taken while on the ground or once cruising altitude is reached Measurements taken during ascent or descent may not be accurate 105 9 Noninvasive Blood Pressure Measuring NBP Measuring NBP To measure NBP press the Start NBP soft key The cuff pressure is displayed as the cuff inflates and deflates When the measurement is complete the NBP values are displayed Additional measurements are taken according to the configured NBP schedule If the schedule is configured to Manual There is no schedule for additional measurements One measurement is taken each time you press Start NBP Take additional measurements by pressing Start NBP Automatic The measurement is repeated at the configured interval of 1 2 5 5 10 15 30 60 or 120 minutes from the time you press the Start NBP soft key Additional manual measurem
203. ee Figure 108 You can e Transfer 12 Lead Periodic Clinical Data or Event Summary data to a personal computer e Transfer data to be used by an ePCR or Event Review Pro on the receiving personal computer or forwarded on to a remote destination using Data Messenger software Figure 108 Transmitting to a PC HeartStart MRx Personal Computer 249 Periodic Clinical Data Transmission Periodic Clinical Data Transmission PCDT provides the ability to transmit clinical data from the point of care for a critical care patient to the receiving hospital to facilitate the next level of care The PCDT option uses Bluetooth technology to automatically transmit periodic vitals and transmit 12 leads and waveform data upon a set of trigger events from a clinical mode to remote data viewing software See Table 71 for details on the type of data sent Transmitting Clinical Values With the Periodic Clinical Data Transmission PCDT option the HeartStart MRx uses Bluetooth technology to transmit live clinical patient information from a HeartStart MRx in a clinical mode to a remote data viewing server for consultation and decision making assistance When the option is turned on the HeartStart MRx displays an icon indicating connectivity status See Figure 109 and Table 70 Figure 109 PCDT icon location TE aa Meee PEDT icon ECG Unplugged Extreme Tachy Table 70 PCDT Icons No symbol No connection association with the data view
204. efines menu choice 4 on the Mark Events 20 characters Lidocaine menu Mark Event 5 Defines menu choice 5 on the Mark Events 20 characters Atropine menu Mark Event 6 Defines menu choice 6 on the Mark Events 20 characters Morphine menu Mark Event 7 Defines menu choice 7 on the Mark Events 20 characters Nitroglycerin menu Mark Event 8 Defines menu choice 8 on the Mark Events 20 characters Aspirin menu 221 Table 65 CPR Settings Q CPR In devices with the Q CPR option this On Off setting defines whether Q CPR is configured off or on CPR Timer Sets the length of the pause interval that 30 60 90 120 150 180 240 300 automatically starts when e a Shock series is completed e The Pause for CPR Timer softkey is pressed e A No Shock Advised NSA decision is made the NSA CPR pause is enabled and the conditions for using the CPR Timer setting for NSA CPR pause period are met see NSA entry in Table 61 e The Shock Button is not pressed for the configured Time to Auto Disarm setting after the device is armed in AED Mode e Continuous artifact is detected during rhythm analysis Q CPR Voice Sets default setting for Q CPR voice Audible Muted prompts Compression only CPR Enables disables ventilation feedback and On Off measurements Comp Color Selects the color of the compression Red Yellow Blue Green Cyan waveform and values for compression rate Magenta White and n
205. el of the HeartStart MRx Attach the cable to the device and secure the screws into place Then connect the cell phone to the other end of the cable See Figure 106 Figure 106 RS 232 Cable Connections NOTE For further information concerning the setup and configuration of transmission devices and the HeartStart MRx refer to the Transmission Implementation Guide For further information concerning the 12 Lead Transfer Station refer to the 12 Lead Transfer Station Instructions for Use Transmitting using RS 232 For instructions on transmitting with RS 232 in 12 Lead Mode see Post Event Transmission Use Cases on page 254 247 Transmitting in 12 Lead Mode You can transmit a 12 Lead Report while monitoring a patient in 12 Lead Mode Reports can be transmitted to printers fax machines PDAs Philips TraceMaster ECG Management System or other servers running Philips data viewing server software Reports are sent from the HeartStart MRx to the hub a web server running Philips 12 Lead Transfer Station software Using Bluetooth transmission they are transmitted to the hub using configured wireless devices such as cell phones handheld devices and other external devices like computers laptops and other mobile devices Using the Rosetta Lt available in the U S only 12 Lead Reports are transmitted via two way radio transmission to a healthcare facility running CAREpoint or Rosetta Rx Using RS 232 Transmission the reports are
206. en you enable Research Storage in addition to the data and events listed in Table 29 the following data is captured e CPR meter acceleration data e CPR meter force data e Patient Contact Impedance PCI from multifunction electrode pads Reviewing Q CPR Data To review Q CPR data e Copy the event data from the HeartStart MRx internal memory to an external data card See the Data Management chapter for information e Import the data into the Event Review Pro application Troubleshooting If your HeartStart MRx does not operate as expected during Q CPR see Chapter 22 Troubleshooting 175 16 Networking The IntelliVue Networking Option allows the HeartStart MRx monitor defibrillator to connect and communicate with the Philips IntelliVue M3185 Clinical Network System J or later via a wired network connection or wirelessly When on the network the HeartStart MRx performs in a fashion similar to a bedside monitor sending waveforms ECG Pleth invasive pressure and CO and patient parameters along with alarm and INOP messages to the Philips IntelliVue Information Center for monitoring Connection to the Information Center allows you to silence certain alarms and send patient demographic data to the HeartStart MRx from a remote location Monitoring data can also be sent from the HeartStart MRx to the patient s electronic medical record through the IntelliVue HL 7 connection Defibrillation and pacing capabiliti
207. ent No 186 If a patient discharge is confirmed 1 The current patient incident is closed 2 The HeartStart MRx sends the discharge command to the Information Center if connected then automatically shuts down and restarts While shutting down the display will go black You can turn the device off at this point If you do not turn the device off a Patient Discharged message will appear on the screen until the HeartStart MRx restarts Upon restart the patient name is displayed as Not Admitted Patient type paced status and alarm limits are all reset to default values Other patient information is cleared NOTE Data related to previous patient incidents must be accessed through Data Management Refer to the HeartStart MRx Instructions for Use Transfer The Transfer option is used to transfer the current patient s data to another location on the IntelliVue Network by moving the patient to the transfer list at the Information Center To access Transfer perform the following steps 1 Confirm that the HeartStart MRx is on the network not already in Transfer Mode and the patient has been admitted The patient s name or is displayed Press the Menu Select button Using the Navigation buttons select Patient Info and press the Menu Select button Select Transfer and press the Menu Select button WA Re O N The Transfer Patient message see Figure 95 prompts you with a Transfer Patient question
208. ent 188 specifications 333 transfer patient confirmation 187 transferring a patient 187 troubleshooting 315 turning device off 193 wired and wireless connections 181 wired connection 180 wireless connection 180 Invasive Pressures 115 air bubbles 115 alarms 125 changing 126 enabling disabling 126 cable connecting 38 calibration 121 confirmation 123 Cerebral Perfusion Pressure 117 changing altitude 119 configurable parameters 204 205 206 207 CPP alarms 127 ICP warning 116 indications 4 last zero 124 non physiological artifact suppression 124 overview 115 pressure labels 117 pressure waves 118 available scales 118 reusable transducers 122 selecting a pressure 117 setting up 115 specifications 330 troubleshooting 312 unable to calibrate 123 warnings 122 127 wedge 127 zeroing 119 Maintenance 263 automated tests 264 batteries 283 procedure 283 calibration gas disposal 290 cleaning instructions 287 disposing the HeartStart MRx 290 Operational Check 270 Performing an Operational Check 271 Ready For Use RFU Indicator 266 Shift Checklist 267 User Checks 278 weekly shock test performing 267 manual defibrillation 361 configurable parameters 217 indications 3 specifications 323 Mark Event 237 configurable parameters 221 menu patient info 27 monitoring view 48 multifunction electrode pads 74 Noninvasive Blood Pressure NBP 103 alarms 107 changing 107 enabling disabling 10
209. ent Transmission oy x ePCR ePCR database Event Review Pro HeartStart MRx Data Messenger Event Review Pro PC locally PC central lt gt ocation Table 72 Post Event Transmission Use Cases An Event Summary to an Bluetooth wireless The Event Summary Bluetooth option See Transmitting external computer wirelessly technology to B10 OR product upgrades 861325 Event Event Summaries transmit data to a Summary Bluetooth and 989803153411 Post Event on Bluetooth enabled Internal Bluetooth Card page 254 computer A single Event Summary or A LAN cable The Batch LAN Data Transfer BLDT See Transmitting group of Event Summaries to a connecting the device option B12 or product upgrades 861447 Event Summaries local computer after an event to your computer Batch LAN Data transfer 989803153411 Post Event on or shift is finished Internal Bluetooth Card HeartStart Data page 254 Messenger software 861453 1 Windows based personal computer laptop tablet mobile device with a Bluetooth stack installed that supports File Transfer Profile Server See Specifications on page 321 for more information 254 Transmitting in Data Management Mode The HeartStart MRx Event Summary Bluetooth option uses Bluetooth wireless technology to send an Event Summary complete or partial or a 12 Lead Report to a receiving Bluetooth device from Data Management Mode The Rosetta Lt tran
210. ent listed in Table 21 result from measurements generated by an ECG the Critical Value statement Acute MI appears on the 12 Lead Report Table 21 Acute MI Statements Probable anterolateral infarct acute ST gt 0 15 mV V2 V6 aVL Anterolateral infarct possibly acute Q gt 35 mS ST gt 0 15 mV V2 V6 I aVL Anterolateral infarct acute ST gt 0 20 mV V2 V6 I aVL Anterolateral infarct acute LAD ST gt 0 20 mV V2 V6 I aVL Probable anteroseptal infarct acute ST gt 0 15 mV T UPRIGHT V1 V2 Anteroseptal infarct possibly acute Q gt 35 mS ST gt 0 15mV V1 V2 Anteroseptal infarct acute ST gt 0 20 mV V1 V2 Anteroseptal infarct acute LAD ST gt 0 25 mV V1 V2 Probable anterior infarct acute ST gt 0 15 mV UPRIGHT T V2 V5 Anterior infarct acute ST gt 0 25 mV V2 V5 Anterior infarct acute LAD ST gt 0 25 mV V2 V5 Anterior infarct possibly acute ST gt 0 15 mV UPRIGHT T V2 V5 Extensive anterior infarct acute ST gt 0 20 mV V1 V6 Extensive anterior infarct acute LAD ST gt 0 20 mV V1 V6 Extensive anterior infarct possibly acute Q gt 35 mS ST 0 15 mV V1 V6 Probable inferior infarct acute ST gt 0 10 mV II III aVF Inferior infarct possibly acute Q gt 30 mS ST gt 0 10 mV II III aVF Inferior infarct acute ST gt 0 10 mV T UPRIGHT II III aVF Inferior infarct acute RCA ST
211. ent may be accessed while a report is displayed or from either the 12 Lead Acquire Screen or the 12 Lead Preview Screen To do this 1 While in 12 Lead press the Menu Select 9 button 2 Using the Navigation buttons select Reports Reports for the current patient event are listed by date time and sequence number Use the Navigation buttons to select a report and press the Menu Select button 4 Select Print Copy or Delete and press the Menu Select button 5 To select another report repeat steps 1 through 3 or press Exit to close the menu 148 Improving Signal Quality Signal quality can impact ECG analysis Refer to Table 26 for possible solutions to common ECG quality problems Table 26 ECG Signal Problems Tremor or muscle artifact L T Poor electrode placement A cold patient Tense uncomfortable patient Patient tremors e Clean the site and reapply electrodes Be sure the electrodes are placed on flat non muscular areas of the body Warm the patient e Reassure and relax the patient e Attach electrodes high on the extremities near the trunk Baseline wander mE Patient movement Electrode movement Poor electrode contact and skin preparation Respiratory interference e Reassure and relax the patient Be sure lead wires are not pulling on the electrodes e Move electrodes away from areas with the greatest respiratory motion if possible Power line AC Interf
212. ents may be taken without affecting the automatic measurement schedule by pressing Start NBP The configured NBP schedule may be changed during use through the Measurements Alarms menu If the automatic measurement schedule is changed the new time interval is applied to the start time of the last measurement If the new time interval is less than or the same as the time since the last measurement a measurement begins immediately NOTE You may perform a manual NBP measurement at any time even when an automatic schedule is set Simply press the Start NBP soft key To stop an NBP reading in progress press the Stop NBP soft key Changing the NBP Schedule To change the NBP schedule and or the interval of automatic measurements for the current patient 1 Press the Menu Select 9 button 2 Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button 3 Select NBP and press the Menu Select button 4 Select NBP Schedule and press the Menu Select button 5 Using the Navigation buttons select the desired interval and press the Menu Select button 9 NOTE Interval choices are presented in the format qx indicating measurements will be taken every x minutes from the time you first press Start NBP NOTE If no subsequent measurements are taken NBP values will removed from the display after 60 minutes but can still be obtained through Vital Signs Trending 106 Alarms An NBP alarm i
213. enu Select button Should the FilterLine be disconnected accidentally the message CO Unplugged Turn off EtCO appears to notify you of the disconnection Select No and press the Menu Select button Secure the connection The CO monitoring function is once again enabled Troubleshooting If your HeartStart MRx does not operate as expected during CO Monitoring see Chapter 22 Troubleshooting on page 297 11 Invasive Pressures This chapter describes how to monitor invasive pressures using the HeartStart MRx Overview The Invasive Pressures option on your HeartStart MRx offers two channels of real time continuous invasive pressure measurements and waveforms in Monitor Manual Defib and Pacer modes If the pressure signal is pulsatile numeric values are displayed for systolic diastolic and mean pressure If the pressure signal is non pulsatile then only the mean is displayed Alarms are provided to alert you to a change in the patient s condition If alarms are enabled alarm limits appear next to the pressure value and the alarm source is displayed above the alarm limits If alarms are off the Alarms Off symbol replaces the limits Setting up for a Pressure Measurement 1 Turn the HeartStart MRx on 2 Connect the pressure cable to the HeartStart MRx NOTE The HeartStart MRx will perform a check of invasive pressure functionality when the option is turned on 3 Connect the cable to the transducer 4 Prepare the flush
214. er screen is displayed Patient Info Adult Patient Pediatric Patient Logged at start of incident and when changed Paced Patient Non Paced Patient Logged at start of incident and when changed Age xx unit Logged when set Male Female Logged when set Patient ID Logged when set Battery Status Battery Low Logged when batteries are low and external power is not available Batteries Low Logged when batteries are low and device is pacing Shutting Down in 1 Minute Logged when warning issued Shutting Down Now Pads Paddles Leads Pads On Logged when pads are applied to patient Pads Off Logged after a Pads On event if adult pediatric multifunction electrode pads are removed from the patient or the pads cable is disconnected External Paddles On Logged when external paddles make contact with the patient External Paddles Off Logged after an External Paddles On event if paddles lose contact with patient Internal Paddles On Logged when internal paddles make contact with the patient Internal Paddles Off Logged after an Internal Paddles On event if paddles lose contact with patient Leads On Logged when monitoring electrodes for primary ECG are attached to the patient Leads Off Logged after a Leads On event if a monitoring electrode for the primary wave loses contact with the patient Table 68 Event Information Continued
215. erence ea irae ren ta Poor electrode contact Dry or dirty electrodes Interference from poorly grounded instrument near patient Reapply electrodes e Route electrode wires along the limbs and away from other electrical equipment Intermittent or jittery waveform Poor electrode contact Dry electrodes Faulty lead wires e Clean the site and reapply electrodes e Apply new electrodes e Repair or replace faulty leads Adjusting Wave Size Adjusting ECG wave size may improve signal viewability To do this While in 12 Lead press the Menu Select 9 button 1 2 3 Using the Navigation buttons select ECG Size and press the Menu Select button Using the Navigation buttons select the desired size value and press the Menu Select button The lead size is retained when you exit and then return to 12 lead functionality without turning off power for more than 10 seconds NOTE Selecting ECG wave size of either 10mm mV V or 20 mm mV V displays V leads at half of the selection 5 mm mV and 10 mm mV respectively 149 13 12 Lead ECG 12 Lead Filters 12 Lead Filters ECG bandwidth filters of 0 15 40 Hz 0 05 40 Hz or 0 05 150 Hz may be selected in Configuration to apply to 12 lead ECG waveforms shown on the display Additionally the 12 Lead Report may be configured to apply either the same filter choice used for the display or a 0 05 150 Hz filter The filter setting
216. erent alarm limits are used for the same or similar equipment in any single area Confirm the alarm limits are appropriate for the patient each time there is a new patient incident Do not set alarm limits to such extreme values that render the alarm system useless NOTE Heart Rate and Arrhythmia Alarms function a bit differently than other alarms For information about responding to these alarms see Responding to HR and Arrhythmia Alarms on page 59 25 Printing on Alarms You can configure your HeartStart MRx to automatically print on certain alarms and not on others See Printing Settings on page 220 for more information Identifying Your Device There are multiple ways to identify your HeartStart MRx and the data transmitted from it In Configuration Mode you can set up an Institution Name and or Device ID These two names are not configurable during a patient event You can also set up multiple Reference IDs which are selectable during a patient event For example a HeartStart MRx could have the Institution Name City Hospital and a Reference ID of Emergency Department 1 or City Fire amp EMS and Truck 32 The Institution Name and Reference ID are part of the data transmitted to a receiving device institution For devices with the IntelliVue Network installed Reference IDs are replaced with an Equipment Label if the device is not on an active network and a Bed Label if it is on an active network Reference
217. ering Sync Mode 157 WARNING The Q CPR option is not intended for use in a moving environment such as an ambulance Additional movement introduced during patient transport may reduce the accuracy of the compression and ventilation measurements If Q CPR must be used in a moving environment do not rely on the Q CPR feedback during such conditions It is not necessary to remove the CPR meter from the patient Q CPR is not to be used on patients under 8 years of age or less than 25 kg 55 lbs The Q CPR option should not be used to verify placement of airway adjuncts such as endotracheal tubes and laryngeal masks Ventilation feedback accuracy may be decreased when the patient is handled or moved or when the Q CPR option is used on patients with certain conditions such as trauma seizures reduced lung volume or high cardiac ejections CPR is best performed when the patient is lying on a firm surface If the patient is on a surface that yields such as a mattress compression depth feedback from the CPR meter is inaccurate Either move the patient to a rigid surface or slide a backboard under the patient and compensate for mattress compliance by ensuring that each compression exceeds the minimum depth target shown on the CPR meter or exceeds the lower line of the depth target zone on the MRx display Do not reply on CPR meter feedback during aircraft ascent and descent as its accuracy is reduced in such conditions Do not practice
218. erly so you can correctly identify your patient on recordings reports and network devices The HeartStart MRx admits patients by entering one or more of the following patient name patient ID date of birth or sex You can t admit a patient by changing patient type category or paced status To admit a patient from the HeartStart MRx perform the following steps 1 Press the Menu Select Y button 2 Using the Navigation buttons select Patient Info and press the Menu Select button See Figure 93 3 Select Name ID Date Of Birth or Sex and press the Menu Select button 4 Enter the appropriate information and press the Menu Select button 5 A Patient Admitted momentary message displays on the device when a patient is admitted Figure 93 Admitting a Patient Main Menu Patient Info Last Name Volume Discharge Patient Jones _ Displayed Waves eee Printed Waves ID Measurements Alarms Patient Category Done Paa une Date of Birth Trends Sex B Other Paced C High Contrast On Exit D Exit E F G A Page 1 0f4 wy NOTE When admitting a patient from the HeartStart MRx if you enter a Patient ID but do not enter a last 184 name the last name is set to If you enter a first name date of birth or sex and not a last name or ID the last name is set to the Patient ID is set to the HeartStart MRx Event ID and the Patient ID is sent to
219. erms of age sex weight current medical history cause of heart disease and estimated ejection fraction The 150J SMART Biphasic waveform successfully converted far more patients with an initial 100J shock 60 compared with 22 for the monophasic waveform and successfully converted patients at least as well with a maximum energy of 200J as the monophasic did with its maximum energy of 360J 91 compared to 85 for the monophasic waveform Overall the biphasic waveform required fewer shocks 1 7 compared to 2 8 for the monophasic waveform and lower delivered energy 217 J compared to 548 for the monophasic waveform Outcomes are summarized in Table 107 Table 107 Clinical Summary Cardioversion Cumulative Cardioversion Efficacy Single shock only 58 96 60 24 107 22 lt 0 0001 lt 2 shocks 74196 77 471107 44 lt 0 0001 lt 3 shocks 86 96 90 56 107 53 lt 0 0001 lt 4 shocks 87 96 91 91 107 85 0 29 Skin burn None 25 90 28 15 105 14 0 0001 Mild 50 90 56 471105 45 Moderate 15 90 17 41 105 39 Severe 0 90 0 2 105 2 Number of shocks 1 7 1 0 2 84 1 2 lt 0 0001 Cumulative delivered energy 217 176J 548 331J lt 0 0001 Mild erythema no tenderness Moderate erythema tenderness Severe blistering or necrosis tenderness Skin reaction definitions evaluated 24 48 hours after procedure Conclusion The SMART Biphasic waveform ca
220. ers On Off on page 16 Caring For Your Temperature Cables and Probes Refer to the manufacturer s instructions for care and cleaning of your cables Inappropriate treatment of the cables will reduce their lifetime Troubleshooting If your HeartStart MRx does not operate as expected during temperature monitoring see Chapter 22 Troubleshooting 134 13 12 Lead ECG This chapter describes how to use the diagnostic 12 lead ECG function of the HeartStart MRx Overview The optional 12 lead ECG function using Philips DXL Algorithm is available in Monitor Mode and allows you to preview acquire print copy and store a 12 lead ECG In addition the 12 lead function provides computerized ECG analysis using the DXL Algorithm A report with measurements and interpretive statements from the analysis is displayed stored and printed as configured Certain interpretive results generate Critical Value statements which alert you to an interpretation which may mean your patient needs immediate attention The Philips DXL Algorithm provides an analysis of the amplitudes durations and morphologies of the ECG waveforms and the associated rhythm Patient age and gender are used to define normal limits for heart rate axis deviation time intervals and voltage values for interpretation accuracy in tachycardia bradycardia prolongation or shortening of PR and QT intervals hypertrophy early repolarization myocardial infarction an
221. es Each of these devices has a unique set of features and configuration options In order to ensure reliable transmissions familiarize yourself with the Bluetooth configuration choices of each Some choices either default or chosen by the user could prevent receipt of data from the HeartStart MRx For example it is recommended that you disable features such as Start discovery every 10 minutes Enabling this option could interfere with transmissions from the HeartStart MRx 243 Changing Bluetooth Profiles Once you have added and paired a Bluetooth device you can change its profile using the following steps 1 In 12 Lead Mode press the Menu Select 0 button 2 From the 12 Lead Main Menu select Bluetooth Devices and press the Menu Select button A list of paired Bluetooth devices is displayed Using the Navigation buttons select a device and press the Menu Select button 4 To change a profile select Change Profile and press the Menu Select button A menu of configured profiles for that device is displayed with the currently associated profile highlighted 5 Select the profile you want to associate with the device The MR x tests the profile to determine if the Bluetooth device can communicate with the 12 Lead Transfer Station Progress messages are displayed during the test If the test is successful the message Transmission Test Passed is displayed Press the Menu Select button to acknowledge the message Should the tra
222. es all visual and audible physiological alarms and audible inops for the configured time interval At the end of the pause interval each alarm returns to its previous setting On or Off Pressing the Alarm Pause button during the pause interval also returns alarms to their previous settings Print button The Print button initiates a continuous print out of the primary ECG and other selected wavetorm s either real time or with a 10 second delay depending on your configuration Pressing the Print button while printing is in progress stops the printing Summary button The Summary button displays a menu from which you can print the current or most recent Event Summary report or Vital Signs Trending Report Menu Select button 0 Pressing the Menu Select button either brings up the current menu or confirms a menu selection Navigation buttons V The Navigation buttons display the current menu just as the Menu Select button does Additionally within any menu or list these buttons move to the next or previous item in the list They also increase or decrease numbers or values in a sequence 20 Defibrillation Controls The defibrillation controls are shown in Figure 12 They include Therapy Knob Enables AED or selects an energy for Manual Defib Mode defibrillation or cardioversion Charge Button Charges the defibrillator to the selected Manual Defib energy setting Used only in Manual Defib Mode In AED Mode the defibrill
223. es can only be initiated at the HeartStart MRx The IntelliVue Networking Option is available in most countries wireless functionality is available in the U S only HeartStart MRx devices that have the IntelliVue Networking Option have an identifying icon placed on the device s handle See Figure 87 Figure 87 HeartStart MRx with IntelliVue Networking Option WARNING Before using the HeartStart MRx with IntelliVue Networking Option you should familiarize yourself with the operation of the IntelliVue Information Center Refer to the IntelliVue M3150 Information Center Instructions for Use 177 IntelliVue Networking Display When in a clinical mode the status area of the HeartStart MRx with IntelliVue Networking Option provides network related data see Figure 88 including Network Connectivity Icon An icon indicating a wired or wireless Local Area Network LAN connection is displayed It is located on the display s top line to the left of the bed equipment label See Table 30 Table 30 Icon Definitions No symbol No connection association with the Information Center is established Connected A wired connection is established The HeartStart MRx is assigned to a sector and is being monitored by the Information Center Z Connected A wireless connection is established The HeartStart MRx p is assigned to a sector and is being monitore
224. esat Limit Selects extreme low limit alarm value Adult 50 low limit 80 Pediatric 30 low limit 80 adjusted in increments of 1 Color Selects the SpO color Red Yellow Blue Green Cyan Magenta White Table 49 Pulse Settings Pulse Source Sets default pulse source SpO3 Press 1 label Press 2 label Default SpO if device has SpO4 option otherwise Press 1 NOTE Pulse is only included in the Configuration menu if your device has the Invasive Pressures option 210 Table 50 Temperature Settings Unit Selects measurement units C F Label Selects the default temperature label Temp Tskin Trect Tnaso Tesoph Tart Tven Tvesic Tcore High Limit Selects the high limit value Adult 0 1 to 45 0 39 0 C 32 2 to 113 F Ped 0 1 to 45 0 39 0 C Adjusted in increments of 0 1 C or 0 2 ok Low Limit Selects the low limit value Adult 0 0 to 44 9 36 0 C 32 0 to 112 8 F Ped 0 0 to 44 9 36 0 C Adjusted in increments of 0 1 C or 0 2 F Color Selects the temperature color Red Yellow Blue Green Cyan Magenta White Table 51 Wave Sector Settings Wave Selects the waveform displayed in Wave Sector 1 Pads I II II aVR aVL aVE V Wave 2 Selects the waveform displayed in Wave Sector 2 Pads I II II aVR aVL aVF V CO Pleth Press 1 Press 2 Cascade Annotated ECG None Default Press 1 if you have the
225. essed to continue pacing 85 A white pacing marker appears on the ECG waveform in Wave Sector 1 each time a pacer pulse is delivered to the patient If pacing in demand mode white R wave markers also appear on the ECG until capture occurs NOTE R wave markers do not appear on paced beats Demand Mode Versus Fixed Mode The HeartStart MRx can deliver paced pulses in either demand or fixed mode e In demand mode the pacer only delivers paced pulses when the patient s heart rate is lower than the selected pacing rate e In fixed mode the pacer delivers paced pulses at the selected rate WARNING Use demand mode pacing whenever possible Use fixed mode pacing when motion artifact or other ECG noise makes R wave detection unreliable or when monitoring electrodes are not available The HeartStart MRx requires a 3 5 or 10 lead ECG cable and monitoring electrodes as the source of the ECG during demand pacing Pace pulses are delivered through the multifunction electrode pads However the pads cannot be used to monitor the ECG and deliver pace pulses simultaneously NOTE The ECG derived from pads does not need to be displayed in a wave sector in order to deliver pacing therapy NOTE When using demand mode pads are not an available choice for display in Wave Sector 1 through either the Lead Select button or the Displayed Waves menu Preparing for Pacing To prepare for pacing 1 If not pre connected connect the pad
226. esumed pacing settings selected prior to defibrillation mode rate and output are retained Be sure to confirm that cardiac capture has been maintained CAUTION Pacing must be turned off before defibrillating with a second defibrillator Failure to do so could damage the HeartStart MRx Troubleshooting If your HeartStart MRx does not operate as expected during pacing see Chapter 22 Troubleshooting on page 297 8 Pulse Oximetry Pulse Oximetry SpO monitoring is one of the tools available to assist in assessing a patient s cardiac and respiratory systems This chapter explains how pulse oximetry works and describes how to use the HeartStart MRx to monitor SpO Overview Pulse oximetry is a noninvasive method of continuously measuring functional oxygen saturation SpO3 in arterial blood The resultant SpO reading indicates the percentage of hemoglobin molecules in the arterial blood which are saturated with oxygen WARNING Do not rely solely on SpO readings assess the patient at all times Inaccurate measurements can be caused by e Incorrect sensor application or use e Significant levels of dysfunctional hemoglobins such as carboxyhemoglobin or methemoglobin e Injected dyes such as methylene blue or intravascular dyshemoglobins such as methemoglobin or carboxyhemoglobin e Exposure to excessive illumination such as surgical lamps especially those with a xenon light source bilirubin lamps flu
227. etting Up for Batch LAN Data Transfer Batch LAN Data Transfer requires the LAN cable to be plugged into the LAN port on the back of the HeartStart MRx See Figure 116 The LAN cable connects to either a router or Network Interface Card NIC on a local personal computer Figure 116 Batch LAN Data Transfer Connections CAUTION After successfully sending all Event Summaries at once via Batch LAN Data Transfer the HeartStart MRx adjusts its system time based on the time provided by the Data Messenger personal computer and the internal memory card is erased If you want to keep other copies of the data copy the files to an external data card see Entering Data Management Mode on page 226 before doing a BLDT or transfer each of the Event Summaries independently 259 Transferring Files with BLDT To transfer data using the BLDT option 1 Confirm the HeartStart MRx is in Data Management Mode Data Messenger is running on the receiving personal computer and the LAN cable is securely connected See Setting Up for Batch LAN Data Transfer on page 259 2 Once the LAN cable is connected the HeartStart MRx automatically communicates with the Data Messenger personal computer and prompts you to send data See Figure 117 If you are not prompted to send data within a short period of time see Transmission Problems Batch LAN Data Transfer on page 308 If you want to transfer a single event If you want to transfer all events 3 U
228. everal methods to your destination point The HeartStart MRx is highly configurable to better meet the needs of diverse users Be sure to familiarize yourself with your device s configuration before using the HeartStart MRx See Chapter 17 Configuration for more details Intended Use The HeartStart MRx is intended for use in hospital and pre hospital settings by qualified medical personnel trained in the operation of the device and qualified by training in basic life support advanced cardiac life support or defibrillation When operating as a semi automatic external defibrillator in AED Mode the HeartStart MRx is suitable for use by medical personnel trained in basic life support that includes the use of an AED When operating in Monitor Manual Defib or Pacer Mode the HeartStart MRx is suitable for use by healthcare professionals trained in advanced cardiac life support The SMART Biphasic waveform utilized in the HeartStart MRx has previously undergone clinical testing in adults These trials support the waveform s effectiveness for defibrillation of ventricular tachyarrhythmias at 150J Indications for Use The HeartStart MRx is for use for the termination of ventricular tachycardia and ventricular fibrillation The device is for use by qualified medical personnel trained in the operation of the device and qualified by training in basic life support advanced cardiac support or defibrillation It must be used by or on the o
229. evice displays a No Shock Delivered message but you see a physiological response from the patient Poor skin contact pads are not properly connected to the patient Minimal patient movement is possible in this situation as the defibrillator may deliver a small amount of energy The shock counter will remain at zero Make sure the pads are applied properly Replace pads in necessary Table 92 Printer Problems Paper won t move Paper improperly loaded or jammed or paper is wet Reload paper or clear jam If paper is wet replace with fresh dry roll Paper moves then stops Door improperly latched Check door latch Paper improperly loaded or jammed Reload paper or clear jam Paper moves but printing is faint or absent Paper roll improperly installed Incorrect paper type Printhead temperature approaching maximum recommended operating temperature Check that the paper is installed correctly Incorrect paper type Use only recommended paper type Printhead temperature approaching maximum recommended operating Wait until the printer cools down and restart printing paper temperature Paper moves but print quality Dirty printhead Clean the printhead poor or some dots missing Loud buzzing or grinding Door improperly latched Check door latch noise White line running along Dirt on printhead Clean the printhead 311 Table 92
230. external defibrillation e Monitor to enable Monitor Mode for 3 or 5 lead ECG monitoring 12 lead ECG acquisition optional Vital Signs Trending or monitoring of optional parameters e Pacer to enable Pacer Mode optional for demand or fixed mode pacing e Manual Defib to enable Manual Defib Mode for asynchronous or synchronous defibrillation cardioversion at the selected energy setting In Manual Defib Mode without Pacing the defibrillation energy settings are labeled as 1 9 10 15 20 30 50 70 100 120 150 170 and 200 Joules If your unit is equipped with Pacing the energy settings are labeled as 1 10 15 20 30 50 70 100 120 150 170 and 200 Joules 19 General Function Buttons The general function buttons control monitoring or non critical resuscitation activities They include Mark Event button allows you to insert a time stamped annotation in the Event Summary Report to note events as they occur including the administration of certain drugs A Mark Event button label appears at the top left corner of the display Lead Select button changes the ECG lead in Wave Sector 1 Pressing this button cycles through the available ECG waves changing the displayed wave and label The list of available ECG waves is based on the current lead set and device configuration and includes pads or paddles if the corresponding cable is connected to the device Alarm Pause button The Alarm Pause button paus
231. f Hard INOP Replace Clock Battery Hard INOP Check Device Hard INOP Printer INOPs Incompatible Printer Hard INOP Check Device Hard INOP Check Printer Hard INOP Check Device Hard INOP Printer Temperature High Hard INOP Check Device Hard INOP Printer Malfunction Hard INOP Check Device Hard INOP Printer Not Ready Soft INOP None NA Other HeartStart MRx Messages Pacing on Batteries Message only Pace on Batteries Soft INOP Shutting Down 1 Min Message only 1 Defib Shutdown Red INOP Shutting Down Now Message only 1 Defib Shutdown Red INOP Power Interrupted All settings have Message only Check Settings Hard INOP been reset to default values Device Restarted All settings have Message only Check Settings Hard INOP been reset to default values 196 Troubleshooting If your HeartStart MRx does not operate as expected while trying to communicate with the IntelliVue Network see on page 314 and Network Connection Rejection Messages on page 317 197 17 Configuration This chapter describes the configurable parameters of the HeartStart MRx and the procedures for modifying configuration Overview Configuration settings allow you to customize the HeartStart MRx to best meet your needs Configuration is performed through the Configuration menu of the device and may be saved to a data card for replication on multiple devices At any time configuration settings may be viewed and exported to a data card and the date and
232. fib and AED Modes Pacing Rate Upon entering the selected Pacer Mode 30 180 70 ppm Demand or Fixed defines the default rate of delivery of paced pulses Pacing Output Upon entering the selected Pacer Mode 10 160 30 mA Demand or Fixed defines the default current setting at which paced pulses are delivered Manual Therapy Security Defines whether Manual Defib and Pacer Modes Off On See Warning below are password protected adjusted in increments of 10 adjusted in increments of 5 A password entry screen is displayed when the setting is changed to On Using the Menu enter a 4 character password Selecting Cancel during password entry resets the setting to Off Once the password is set changing the setting to Off clears the password from the device memory CPR Timer Defines whether the CPR Timer is displayed in Off On Manual Defib mode This does not affect the display of the timer in AED Mode WARNING Use of the Manual Therapy Security password requires the clinician to know and remember the password as defined in Configuration Failure to enter the correct password will prevent the delivery of manual defibrillation or pacing therapy Prior to selecting this Configuration option review this potential risk with your Risk Manager 217 Table 61 AED Settings Shock Series Sets the number of shocks that must be delivered to activate an automatic CPR Pause The length of th
233. firm wireless radio module is solidly plugged into the device then turn the device on Wireless radio module malfunction Replace wireless radio module Radio Malfunction INOP on Wireless radio module Replace wireless radio module are turned off HeartStart MRx malfunction Radio Weak Signal INOP on Radio signal strength is below Attempt to improve signal strength by moving device closer HeartStart MRx an acceptable level to access point All ECG Alarms Off HR and arrhythmia alarms Turn HR and arrhythmia alarms on If you have the wireless radio module connected only power is on no connection to the Information Center and no INOP messages No Central Monitoring INOP is configured to optional If your institution s policy allows configure INOP to mandatory and troubleshoot No Central Monitoring INOP Table 99 Network Connection Rejection Messages When the Information Center rejects a connection attempt from the HeartStart MRx a momentary message accompanied by an audio beep is displayed in the middle of the HeartStart MRx display Messages possible causes and possible solutions No Central assigned to this bed No Information Center is configured to monitor the HeartStart MRx with the assigned equipment monitor label Confirm the HeartStart MRx equipment label is correct Assign the HeartStart MRx equipment label to the appropriate sector in the Information Center
234. for the 12 Lead Report is applied to both printed and stored 12 Lead Reports Regardless of filter settings for display or printing the DXL Algorithm uses the full 0 05 150 Hz bandwidth for its analysis The full bandwidth is also transmitted NOTE Although the 0 05 150 Hz or Diagnostic bandwidth filter may be selected for the display filter LCD display limitations prevent the ECG from appearing in true diagnostic quality A filter soft key is available to switch between filter settings during use When changing the filter during use the filter setting is applied to both the display and the 12 Lead Report The display and 12 Lead Report filter settings are returned to their configured settings whenever the New 12 Lead soft key is pressed or when the Therapy Knob is moved from the Monitor position Troubleshooting If your HeartStart MRx does not operate as expected during 12 Lead ECG operation see Chapter 22 Troubleshooting on page 297 150 14 Vital Signs Trending This chapter describes how to review patient data using HeartStart MRx Vital Signs Trending Overview In Monitor Mode your HeartStart MRx provides the ability to view and print numeric vital sign trending for the current incident Trending data are automatically acquired if parameters are on When viewing trending the Vital Sign Trending Report is displayed in the HeartStart MRx s lower two wave sectors and takes over the soft key functions Trendi
235. g Vital Signs Trending see Chapter 22 Troubleshooting 155 15 Q CPR and Data Capture Overview The Q CPR option offers real time measurement and corrective feedback on the rate depth and complete release of compressions ventilation rate and lack of CPR activity in accordance with current CPR guidelines The feedback can appear on the HeartStart MRx display and on the CPR meter display compression feedback only Compressions are measured by the CPR meter connected to the HeartStart MRx using a Pads CPR meter cable Ventilation data is acquired through Philips multifunction defib electrode pads applied to the patient and connected to the HeartStart MRx using the same Pads CPR cable Q CPR is available in both Manual Defib Mode and AED Mode In both modes easy to follow visual indicators and audio prompts provide feedback to the rescuer when CPR performance deviates outside of target ranges Feedback from the HeartStart MRx is configurable Manual Defib Mode provides advanced feedback while AED Mode can be configured to provide either advanced or basic feedback See the Q CPR Application Note for more information on Q CPR The Q CPR Data Capture option enables you to capture data on CPR quality from the HeartStart MRx using the Q CPR option The option enables the storage of CPR related data for retrospective review and analysis in Event Review Pro NOTE Q CPR is not available in 12 Lead Mode and is deactivated when ent
236. g is supported by TraceMasterVue version A 02 01 or higher 248 NOTES For further information concerning the setup and configuration of transmission devices and the HeartStart MRx refer to the Transmission Implementation Guide For further information concerning the data viewing server refer to the software s instructions for use Subsequent 12 Lead Reports can be placed in queue for transmittal while transmission is in progress or the originally selected 12 Lead Report can be chosen for transmission to multiple sites Transmitting to a Manually Entered Fax Number Upon acquisition of the 12 Lead ECG the 12 Lead Report is displayed To manually enter a fax number destination 1 Press the Menu Select 9 button 2 Using the Navigation buttons select Send from the 12 Lead Main Menu and press the Menu Select button Using the Navigation buttons select Fax Number from the Send To Menu 4 Enter the fax number from the numeric list using the Navigation buttons Include any extra digits necessary such as 9 for an outside line or 1 plus the area code for long distance 5 Select Done and press the Menu Select button NOTE Ifyou are transmitting to a manually entered fax number using a Bluetooth device the device and landline prefix if applicable must be entered Transmitting to a Personal Computer By using Bluetooth FTP either during an event transport or post event the HeartStart MRx can send its data to your personal computer S
237. g on the HeartStart MRx display A configurable CPR Timer status bar is also displayed The time period of the CPR Timer is determined by the Configuration setting for CPR Pause Time See Figure 86 NOTES Basic CPR View in AED Mode displays the ECG waveform only Q CPR prompts appear as text on the display and the compression waveform is not displayed while performing CPR in AED Mode If the Pads CPR cable is not connected when you turn the Therapy Knob to AED Mode the message Connect Pads Cable is displayed Compression and ventilation measurement values are printed in the annotation area of the ECG printed strip 171 Feedback Prompts Table 28 lists the feedback prompts that may be issued during the use of Q CPR Table 28 CPR Feedback Prompts Compression Depth Too shallow Compress deeper Compress deeper Compression Rate Too slow Compress faster Compress faster Too fast Compress slower Compress slower Residual Pressure on the Patient s Chest Incomplete release of compression Leaning Release pressure between compressions Release pressure between compressions Ventilation Rate Too high Ventilate less often Ventilate less often No Compression Activity 15 seconds without sign of compressions Fifteen seconds without sign of compressions 15 seconds without sign of compressions 30 seconds without sign of compressions Thirty seconds without sign of comp
238. hardware is working properly Temperature Checks to see if the temperature None None hardware is working properly Bluetooth Checks for the presence of the None None Bluetooth card and database integrity Printer Runs a printer self test None None Operational Check Report The Operational Check takes only a short time to complete When it is done a report is printed as shown in Figure 121 The first part of the report lists test results The second part lists checks to be performed by the user Figure 121 Operational Check Report Operational Check Report Current Test Results Model Number M3535A General System Test Pass Battery Compartment A Test Pass Serial Number USD0123456 Therapy Knob Pass Battery Compartment B Test Pass Ver F 00 00 Charge Button Pass SpO2 Test Pass Shock Button Pass NBP Test Pass Current Operational Check Audio Test Pass CO2 Test Pass DD Mon YYYY HH MM SS Pass Defib Test Pass Pads Invasive Pressure Test Pass Pacer Test Pass Temperature Test Pass Last Operational Check CPR Meter Test Pass Bluetooth Test Pass DD Mon YYYY HH MM SS Pass Leads ECG Test Pass ECG Cable Printer Test Pass Pads Paddles ECG Test Pass Pads Qty Check List ___ Defibrillator Inspection ____ p02 Sensor Comments ___Cables Connectors NBP Cuffs amp Tubing ____ Paddles Pads ___CO2 FilterLine ___ CPR meter Inspection ____Invasive Pressure Cables ___ CPR meter Pads ___ Temperature Probes ____ Monito
239. harge the battery Upon receipt after use or if the message Batteries Low is displayed Perform a calibration When the Operational Check test results state Calibration Recommended or every 6 months whichever comes first Store batteries in a state of charge in the When not in use for an extended period of time range of 20 40 Discard the battery When there are visual signs of damage or calibration reports less than 80 capacity Battery Life Battery life depends on the frequency and duration of use When properly cared for the M3538A Lithium Ion battery has a useful life of approximately 2 years To optimize performance a fully or nearly fully discharged battery should be charged as soon as possible 283 Charging Batteries The M3538A Lithium Ion Battery should be charged in either the HeartStart MRx or in a Philips approved battery support system The two methods of charging in the HeartStart MRx are as follows Using AC power Insert the battery to be charged into Battery Compartment A Insert the AC Power Module into Battery Compartment B and connect to an AC power source Using DC power Insert a battery to be charged into Battery Compartment A If a second battery is in need of charging insert it in Battery Compartment B Connect the DC Power Module to the HeartStart MRx and the DC power source Once AC or DC power is applied the External Power Indicator turns green and batteries in the He
240. he ECG and parameter waveforms caused by electromagnetic interference should be evaluated by a physician or physician authorized personnel to determine if it will negatively impact patient diagnosis or treatment Emissions and Immunity The HeartStart MRx is designed and tested to comply with the radiated and conducted emissions requirement of international and national standards IEC 60601 1 2 2001 and EN 60601 1 2 2002 See Tables 109 through 113 for detailed information regarding declaration and guidance WARNING The use of accessories transducers and cables other than those specified may result in increased emissions or decreased immunity of the HeartStart MRx The list of cables transducers and other accessories with which Philips claims compliance with the emissions and immunity requirements of IEC standard 60601 1 2 are listed in Supplies amp Accessories on page 291 The local area network LAN connector of the HeartStart MRx is marked with the Ated label The pins of connectors marked with this warning symbol should not be touched or connections made to until the following precaution is taken Discharge yourself to a conductive metal surface which is connected to earth ground before making connections or touching the marked connector All staff using the HeartStart MRx should be instructed on these precautionary measures in order to avoid damage to this sensitive medical equipment The EMC standards state that manuf
241. he HeartStart MRx Service Manual WARNING Use of the HeartStart MRx is restricted to a single patient at a time WARNING When transporting the HeartStart MRx it is important to position it with the display facing away from the body If not the Therapy Knob may be bumped and inadvertently moved from its current position WARNING Remain attentive to the patient during the delivery of therapy Delay in delivering a shock may result in a rhythm that was analyzed as shockable converting spontaneously to non shockable and could result in inappropriate delivery of a shock WARNING Use only 3 wire AC power cords with 3 pronged grounded plugs WARNING Never operate the HeartStart MRx in standing water Do not immerse or pour fluids on any portion of the HeartStart MRx If the device does get wet dry the device with a towel WARNING Do not use the HeartStart MRx in the presence of a flammable anesthetic mixture or oxygen concentrations greater than 25 or partial pressures greater than 27 5 kPa 206 27 mmHg This can cause an explosion hazard WARNING Avoid connecting the patient to several devices at once Leakage current limits may be exceeded Do not use a second defibrillator on the patient while pacing with the HeartStart MRx 34 a WARNING Electric shock hazards exist internally Do not remove assembly screws except as described in the carry bag assembly procedure Refer servicing to q
242. he general status area of the display contains e Mark Event button label e Date and time e Audio recording icon If the option is enabled one of the audio recording icons is displayed to the left of the battery icons in all clinical modes to indicate the status of audio recording e Network Connectivity icon If the option is enabled a network connectivity icon will appear to the right of the Mark Event Statements See Networking on page 177 for more information e Periodic Clinical Data Transmission PCDT icon If the option is enabled the PCDT icon will appear to the right of the Mark Event Statement See PCDT Icons on page 250 for more information e Battery power indicators Battery icons labeled A and B correspond with the battery compartments located at the back of the HeartStart MRx Each battery icon displays the current available battery power ranging from hollow fully discharged to full fully charged as shown in Figure 6 If the AC Power Module is inserted in Compartment B the no battery icon is displayed Figure 6 Battery Charge Level Indicators eae ae ae I No Battery Empty Battery 25 Capacity 50 Capacity 75 Capacity 100 Capacity e INOP statements INOP statements appear in the top left of the display if equipment problems are detected e ECG HR alarm status Alarm messages communicate arrhythmia alarms as well as overall alarm status alarms off alarms paused Patient Typ
243. he low limit alarm value when mean is the selected alarm source Adult 20 250 60 mmHg Pediatric 20 155 50 adjusted in increments of 5 mmHg or 1 kPa Color Selects the NBP color Red Yellow Blue Green Cyan Magenta White Table 47 End Tidal Carbon Dioxide Settings Unit Selects the unit of measure mmHg kPa EtCO High Limit Selects the high limit alarm value Adult 20 95 50 mmHg Pediatric 20 95 50 adjusted in increments of ImmHg or 0 1 kPa EtCO Low Limit Selects the low limit alarm value Adult 10 94 30 mmHg Pediatric 10 94 30 adjusted in increments of lmmHg or 0 1 kPa AwRR High Limit Selects the high limit alarm value Adult 10 100 30 rpm Pediatric 10 100 60 adjusted in increments of 1 AwRR Low Limit Selects the low limit alarm value Adult 0 99 8 rpm Pediatric 0 99 12 adjusted in increments of 1 Apnea Time Length of time without respiration required to Adult 10 40 20 seconds trigger an apnea alarm Pediatric 10 40 20 adjusted in increments of 5 Color Selects the EtCO and AwRR color Red Yellow Blue Green Cyan Magenta White 209 Table 48 SpO Settings SpO High Limit Selects high limit alarm value Adult 51 100 100 Pediatric 51 100 100 adjusted in increments of 1 SpO Low Limit Selects low limit alarm value Adult 50 99 90 Pediatric 50 99 90 adjusted in increments of 1 SpO D
244. ic Therapy After entering TPI inputs the HeartStart MRx prompts you to indicate the presence of thrombolytic therapy contraindications from a pre configured list Speak with and observe the patient to answer the contraindications The HeartStart MRx allows you to pre configure up to 20 thrombolytic therapy contraindications If you have configured 9 or less contraindications they appear on the HeartStart MRx on a single screen If you have more than 9 configured contraindications they appear on multiple screens Press the Next Page softkey to advance to the next page of contraindications If you do not enter any thrombolytic indications the resulting printed 12 Lead Report prompts you to consider other Thrombolytic contraindications There are 10 default contraindications e Right vs left arm systolic blood pressure difference gt 15 mmHg e History of structural central nervous system disease e Significant closed head facial trauma within previous 3 months e Major trauma surgery GI GU bleed within 6 weeks e Bleeding or clotting problem or on blood thinners e CPR for longer than 10 minutes e Pregnant female e Serious systemic disease e Pulmonary edema e Signs of shock The default value for each contraindication is Unknown You have the ability to change each contraindication to Yes or No or leave it as Unknown Once entered the contraindications are retained for the current patient Pressing the No Other Contra softke
245. ice is fully charged Continuous tone Charged tone Generated when the selected defibrillation energy is reached and continues until the Shock button is pressed the Disarm soft key is pressed or the device disarmed automatically after the configured time had elapsed since pressing the Charge button Periodic chirp Low battery or RFU failure Repeated periodically while the condition exists Continuous tone alternating pitch Device will shut down in one minute Tone repeated once a second Red alarm indicator message for applicable HR arrhythmia apnea extreme desat and pressure disconnect alarms Philips Red Alarm Tone Generated while at least one red alarm is occurring High pitched tone repeated five times followed by a pause Red alarm indicator message for applicable HR arrhythmia apnea extreme desat and pressure disconnect alarms IEC Red Alarm Tone Generated while at least one red alarm is occurring Tone repeated every two seconds lower pitch than red alarm tone Yellow alarm indicator message for applicable HR arrhythmia SpO NBP Invasive Pressures Temperature Pulse and EtCO alarms Philips Yellow Alarm Tone Generated while at least one yellow alarm is occurring Lower pitched tone is repeated three times followed by a pause Yellow alarm indicator message for applicable HR arrhythmia SpO NBP Invasive Pressures Temp Pulse and EtCO alarms
246. ield strengths from fixed transmitters such as base stations for radio cellular cordless telephones and land mobile radios amateur radio AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy To assess the electromagnetic environment due to fixed RF transmitters an electromagnetic site survey should be considered If the measured field strength in the location in which the HeartStart MRx is used exceeds the applicable RF compliance level above the HeartStart MRx should be observed to verify normal operation If abnormal performance is observed additional measures may be necessary such as re orienting or relocating the HeartStart MRx gt Over the frequency range 150 kHz to 80 MHz field strengths should be less than 3 V m Recommended Separation Distances The HeartStart MRx is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled The customer or the user of the HeartStart MRx can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment transmitters and the HeartStart MRx as recommended below according to the maximum output power of the communications equipment Table 113Recommended Separation Distances Rated Maximum Output 150 kHZ to 800 MHz 800 MHz to 2 5 GHz Power of Transmitter W d 1 2VP d 2 3VP 0 01 0 1m 0 2 m 0 1 0 4m 0 7 m 1 1 2m 2
247. indications to thrombolysis Page 1 of 2 Right vs left arm sys BP difference gt 15 mmHg Unknown History of structural central nervous system disease Unknown Significant closed head facial trauma within prev 3 mos Unknown Major trauma surgery GI GU bleed within six wks Unknown Bleeding or clotting problem or on blood thinners Unknown CPR for longer than 10 min Unknown Pregnant female Unknown Serious systemic disease Unknown Pulmonary edema Start NoOther Next Done MENU NBP Contra Page 141 Table 20 Required ACI TIPI amp TPI data Chest pain symptoms Is chest pain YES NO e Primary complaint Primary pressure or left arm pain the patient s Secondary complaint Complaint most important presenting e None symptom Time since ischemic symptoms onset NO YES e Hour settings ranging unknown from 0 to 7 hours e 8 hours Unknown Blood Pressure NO YES The HeartStart MRx auto populates the NBP value if there is a valid one If not the initial value is unknown and the starting values for entering an NBP are 120 80 Patient history of diabetes NO YES e Yes unknown e No e Unknown Patient history of hypertension NO YES e Yes unknown e No e Unknown Patient weight NO YES 50 450 Lbs Initial value 25 225 kg is unknown Starting menu value is 160 Lbs If 0 7 hours is selected a second menu appears asking you to select the number of minutes in 15 minute inc
248. indicator will momentarily go out when charging for defibrillation with a charged battery installed This is normal operation as the device is switching its power source to the battery for a faster charge time NOTE The AC Line Filter default setting of all HeartStart MRx devices is 60 Hz You should adjust the AC Line Filter default to the electric power frequency of your country See Configurable Parameters on page 202 22 Audio Recording If your device has the Audio Recording option it is configured to On by default and cannot be turned off during use but can be turned off in Configuration Mode If configured audio will be recorded in Manual Pacing 12 Lead Monitor and AED modes independent of whether Sync is on or off You can record up to 90 minutes of audio during an event The audio is synchronized with clinical event data One of the following icons is displayed to the left of the battery icon in all clinical modes Table 2 Audio Recording Icon Audio recording on Audio recording off Audio is not recorded if the Audio Recording configuration setting is set to Off or 90 minutes of audio has been recorded for the current event NOTE You need to be within five feet of the HeartStart MRx three feet if the printer and CO are running for a quality voice recording Reviewing Recorded Audio To review recorded audio transmit your Event Summary from the HeartStart MRx to a receiving personal
249. ing Check the tubing for knots kinks or pinches CO Purging INOP A blockage in the FilterLine or airway adapter has been detected If it is not successful a CO Occlusion condition will occur The HeartStart MRx automatically attempts to purge the blockage CO Occlusion INOP Attempts to purge the FilterLine and exhaust tube were unsuccessful A sample cannot be taken because of the blockage Make sure the FilterLine and exhaust tubing if connected are not kinked and are free of blockages Then disconnect and reconnect the FilterLine to retry If necessary replace the FilterLine and or exhaust tubing CO Overrange INOP The CO value is higher than the measurement range If you suspect a false high value do not use the CO monitoring capabilities and call for service of the CO module If CO monitoring is essential to patient care take the device out of use CO Auto Zero INOP The automatic zero process is running It takes from 10 to 30 seconds and CO values are invalid at this time No action required The module automatically resets itself CO Calibration Overdue INOP The CO module should be calibrated once a year or after 4 000 operating hours Do not use the CO monitoring capabilities and call for service to calibrate the CO module If CO3 monitoring is essential to patient care take the device out of use CO Check Exhaust INOP When CO is turned o
250. ing using and testing the batteries Do not short circuit crush drop mutilate puncture apply reverse polarity expose to high temperatures or disassemble Misuse or abuse could cause physical injury NOTE Wash skin with large amounts of water in the event of electrolyte leakage to prevent skin irritation and inflammation 286 Cleaning Instructions Listed below are recommendations for cleaning the HeartStart MRx and its associated accessories CAUTION The HeartStart MRx along with its accessories and supplies may not be autoclaved steam sterilized ultrasonically cleaned or immersed unless otherwise indicated in the Instructions for Use that accompany the accessories and supplies Do not use abrasive cleaners or strong solvents such as acetone or acetone based cleaners Do not mix disinfecting solutions such as bleach and ammonia as hazardous gases may result Do not clean electrical contacts or connectors with bleach Disinfect the device as determined by your institution s policy to avoid long term damage to the device Monitor Defibrillator The following cleaning products may be used to clean the exterior surfaces of the monitor defibrillator as well as the batteries and data card Isopropyl alcohol 70 solution in water Mild soap and water Sodium hypochlorite chlorine bleach 3 solution in water Quaternary ammonium compounds 21 quaternary ammonium content such as Steris Coverage Plus N
251. ing server is established PCDT is not activated A PCDT session has been established and is working properly Blue icon with white Bluetooth symbol A PCDT session is currently transmitting data Blue icon with green Bluetooth symbol A PCDT session has been started but the connection to the data viewing server has failed Blue icon with white Bluetooth symbol crossed out PCDT Contents When a PCDT is initiated the HeartStart MRx transmits patient vital signs trending data automatically at pre configured intervals You can configure your HeartStart MRx to automatically transmit clinical values every 1 2 3 4 or 5 minutes See Configuration on page 199 for details on how to configure this setting The type of information sent in a PCDT depends on the event which triggers the transmission See Table 71 250 Table 71 Data Transmitted During PCDT Vital signs updated every 1 to 5 minutes based on configuration e Patient vital data for pulse heart and AwRR rates NBP EtCO SpO Invasive Pressures and temperature for the parameters that are turned on timestamp of vitals e HeartStart MRx device ID e HeartStart MRx incident ID 12 lead acquired When obtained 12 lead ECG may include ACI TIPI and TPI information Marking an event When Mark Event button is pressed e All data with Vital signs update Event label and time e Mark event description NOTE Ifa labe
252. ion Detection Icons WARNING The graphical display of a set of lungs does not signify the actual filling ventilation or presence of both lungs in the patient The actual ventilation volume associated with filling of the lung icon will vary from patient to patient Actual tidal volumes should be determined based on chest rise The HeartStart MRx does not provide feedback on hyperventilation if the transthorasic impedance signal is too noisy Proceed doing ventilations according to your organization s protocol Soft Keys NOTE NOTE Parameter Block 2 also contains a numeric value for No Flow Time If no compressions are detected the No Flow Timer starts The No Flow Time value is displayed beginning at 3 seconds and incremented with each additional second A voice prompt is given every 15 seconds that compression activity is not detected The No Flow Time value is reset when a compression occurs or when the Shock button on the HeartStart MRx is pressed If the No Flow Time value exceeds 1 minute it is assumed that CPR compression activity has stopped intentionally and the value is reset to two dashes t If monitoring CO the EtCO numeric value is displayed in Parameter Block 2 along with its alarm limits Annunciation of alarms is suspended in AED Mode In Advanced View to stop CPR press the soft key labeled Stop CPR Ifyou want to return to the Advanced View press the Start CPR soft key Pressing the Start CPR
253. ips for technical support If there is no other responder present to help provide CPR using the meter even though it does not adhere to the patient Be sure to keep the meter properly Adhesive pad not sticking to the positioned chest If there is another responder present to perform CPR remove the CPR meter and replace the patient adhesive pad and restart CPR with the CPR meter in place CPR meter does not adhere to the patient s chest If there is another responder present to perform CPR remove the CPR meter dry the patient s chest off Patient has a wet chest with minimal interruption to CPR reapply a new patient adhesive pad and restart CPR with the CPR meter in place CPR meter Malfunction INOP The CPR meter power on self test Check the CPR meter and cable connections If has failed necessary replace the CPR meter Table 97 Q CPR Problems Continued The CPR meter is unplugged Check the CPR meter and cable connections The device cannot communicate Confirm your HeartStart MRx is running with the CPR meter Version F 01 software and you are using the CPR CPR meter Unpliigjan NICE meter not the CPR sensor See See CPR meter and Sensor Differences on page 158 Replace the CPR meter Poor Pads Contact INOP Thoracic impedance measured at Make sure the Pads CPR cable is connected and pads 25 200 Ohms therefore the signal are properly applied in an anterior
254. is the small bony protuberance where the body of the sternum joins the manubrium This rise in the sternum is where the second rib is attached and the space just below this is the second intercostal space 2 Palpate and count down the chest until you locate the fourth intercostal space Figure 36 shows electrode placement for a 12 lead ECG set Figure 36 12 Lead Placement rs 12 Lead ECG Ina 12 Lead ECG using 10 electrodes an S electrode is placed on the right arm left arm right leg and l a left leg Six V C electrodes are placed on the chest as shown SS n p in Figure 36 The right leg electrode is the reference electrode y y Jej fel Y A NOTE When you do a 12 lead ECG you should attach the limb leads to the patient s extremities 52 Lead Selection It is important to select a suitable lead for monitoring so that a QRS complex can be accurately detected The guidelines for lead selection are as follows For non paced patients e QRS complex should be tall and narrow recommended amplitude gt 0 5mV e R wave should be above or below the baseline but not biphasic e P wave should be smaller than 1 5 R wave height e T wave should be smaller than 1 3 R wave height NOTE To prevent detection of P wave or baseline noises as QRS complexes the minimum detection level for QRS complexes is set at 0 15 mV according to AAMI EC 13 specifications If the ECG signal is too weak you may get false alarms for asys
255. is printing an alarm strip is not printed however the corresponding ECG waveform is stored and available in the Event Summary A 12 Lead report must finish printing before you can acquire a new 12 lead If you can t wait cancel the printing and acquire the new 12 lead Figure 69 Displayed 12 Lead Report SEE De 12345 11 Apr 2009 11 19 00 55 years Male HR 60 Sinus rhythm PR 168 Consider right atrial abnormality lneararadve QRSD 74 Inferior injury probable early acute infarct A ae QT 360 Ant sept injurt probable early acute infarct ACEmEnES QTc 360 Lateral leads are also involved ECE aa i Severity QRS 45 ABNORMAL ECG Unconfirmed diagnosis T 41 Philips Predicted Probability of O AE E emn Predicted gt gt gt Acute MI lt lt lt Probability of Acute Start Exit New Print Ischemia NBP 12 Lead 12 Lead percentage Measurements Critical Value Statement NOTES TPI results and contraindications appear on the HeartStart MRx 12 Lead Report s printed results and in transmitted 12 Leads and Event Summaries They do not appear on the 12 Lead Report displayed on the HeartStart MRx Full interpretive statements appear on the printed strip but may be shortened on the HeartStart MRx display 147 Accessing Stored Reports You may access stored reports to print additional copies or delete the report from internal storage You may also copy the report to a data card The list of stored reports for the current patient ev
256. isarm If the Shock button has not been pressed within the time period specified in the Time to Auto Disarm Configuration setting the defibrillator disarms automatically 3 Shock Confirm that a shock is still indicated and that the defibrillator has charged to the selected energy level Make sure no one is touching the patient or anything connected to the patient Call out loudly and clearly Stay Clear If using pads or switchless internal paddles press the flashing Shock O button to deliver a shock to the patient external paddles simultaneously press the shock buttons located on the paddles to deliver a shock to the patient switched internal paddles press the Shock button located on the paddles to deliver a shock to the patient The number of shocks delivered is displayed in the Shock Status area of the display This number includes any shocks administered while in AED Mode WARNING Defibrillation current can cause operator or bystander injury Do not touch the patient or equipment connected to the patient during defibrillation CAUTION Alarms are turned off when an energy is selected for asynchronous defibrillation and the Alarms Off message is displayed Alarms remain paused until toggled on using the Alarm Pause button the Sync function is enabled or the Therapy Knob is moved to Monitor or Pacer Performing Synchronized Cardioversion Synchronized Cardioversion allows you to synchro
257. isplay the ATS and print its results 1 Turn the Therapy knob to Monitor Press the Menu Select 9 button Using the Navigation buttons select Other and press the Menu Select button 2 3 4 Select Operational Check and press the Menu Select button 5 Using the Navigation buttons select Automated Test Summary and press the Menu Select button The Automated Test Summary is displayed The message Leaving Normal Operating Mode appears to let you know that you are exiting from clinical functionality of the monitor defibrillator 6 Press the Print soft key to print the report The report shows the results of the most recent Hourly Test the Daily Tests that have run since the last Weekly Test and the last 53 Weekly Tests Test results are reported as described in Table 74 Table 74 Automated Test Summary Results Pass Hourglass All tests passed None Fail Solid red X chirp A problem has been detected Turn the Therapy Knob to Monitor An DX that may prevent the delivery of inop indicating a problem has occurred is a shock pacing or ECG displayed Refer to Chapter 22 acquisition Troubleshooting for the action to take Fail BF Blinking X The total battery capacity Charge the battery as soon as possible and combination of both batteries or replace the battery with a charged is less than 20 battery Charging may be done in the HeartStart MRx or by connecting to AC DC power or in a Philips approve
258. it Patient Info and press the Menu Select button The Edit Patient Info menu is displayed See Figure 99 Figure 99 Edit Patient Info Edit Patient Info ID Patient Category Date of Birth Sex Paced Any selection from the Edit Patient Info menu brings up a screen for modifying the selection After modifying the information and closing the screen the Patient Information merged menu will reappear with the new patient information included The Information Center is also updated with the modified information NOTE The Patient Merged and Edit Patient Info menus are removed from the screen when you change displayed views 192 Viewing Patient Incident Data Alarms NOTE Printing While at the Information Center you can view patient incident data sent from the HeartStart MRx Refer to the IntelliVue Clinical Information Center Instructions for Use for details Up to 30 single valued and or tripled valued parameters up to four waveforms except for Q CPR and seven alarms are viewable at the Information Center The waveforms that appear at the Information Center are determined by the Information Center s wave wishlist If configured you can silence reset HeartStart MRx alarms and INOPs from the Information Center Refer to the IntelliVue Information Center Instructions for Use for details As they do on the HeartStart MRx alarms will re sound after two minutes if the condition is not cleared Pacing Stopped Ba
259. itched internal paddles are connected Press the Shock button s on the paddles to deliver a shock R Wave Not Detected message During synchronized cardioversion the r wave was not detectable Choose a lead with a clearly define QRS complex Pacing Stopped Leads Off message Pacing has stopped because the ECG source for Wave Sector 1 has become invalid because of a Leads Off condition or an ECG cable disconnection Check that the monitoring electrodes are applied properly to the patient Check cable connections Press the Resume Pacing soft key to continue pacing Pacing Stopped Pads Off Pads Cable Off message Pacing has stopped because of poor pads patient contact or a pads cable disconnection Check that the pads are applied correctly to the patient Check cable connections Press the Resume Pacing soft key to continue pacing Table 91 Defibrillation and Pacing Problems Continued Shock Button Failure INOP During an Operational Check when the Shock button was pressed there was no response Remove the device from use and call for service Therapy Knob Failure INOP During an Operational Check the Therapy Knob test failed Remove the device from use and call for service Time to charge to selected energy is slow The device is being operated with only AC DC power no battery or the battery power is low Install a fully charged battery D
260. k Before you can use the HeartStart MRx on the IntelliVue Network it needs to be correctly configured AND the IntelliVue Information Center needs to be properly set up to accept the HeartStart MRx For HeartStart MRx configuration instructions see the HeartStart MRx Service Manual To access configuration options on the HeartStart MRx see Troubleshooting on page 197 For instructions on how to set up the IntelliVue Information Center see the IntelliVue Information Center System Installation and Service Manual 181 Using the Device Location Option A HeartStart MRx that is powered on and has an active wireless connection to the IntelliVue Clinical Network can be located by using the Information Center s Device Location option The Device Location option allows you to identify the general location of your HeartStart MRx by associating the device with network access points installed in the healthcare facility These access points provide communication pathways between the HeartStart MRx and the Information Center WARNING Because the coverage range of access points can sometimes overlap including floor levels the Device Location feature is not intended for use when attempting to locate a patient There are device prerequisites for the Device Location function to work See Table 31 For further Device Location information see the IntelliVue M3150 Information Center Instructions for Use Table 31 Device Location prerequisites
261. k the positioning of the FilterLine regularly to ensure proper monitoring function 4 Change the nasal FilterLine every 24 hours if the CO Occlusion INOP message appears or if measurement readings become erratic Using the FilterLine and Airway Adapter To set up EtCO measurements using the FilterLine and airway adapter 1 Attach the FilterLine tubing to the CO Inlet port as described in Connecting the CO2 FilterLine on page 40 2 Connect the wide end of the airway adapter to the endotracheal tube and connect the narrow end of the airway adapter to the ventilator tubing or manual resuscitator Disconnect the FilterLine during suctioning and nebulizing therapies For best results for non humidified use change the FilterLine after 24 hours of continuous use For humidified use change the FilterLine H after 72 hours of continuous use 111 WARNING When using the Microstream EtCO measurement on patients who are receiving or have recently received anesthetics connect exhaust tubing from the CO Outlet port to a scavenging system or to the anesthesia machine ventilator to prevent exposing medical staff to anesthetics Use an exhaust tube to remove the sample gas to a scavenging system Attach scavenging tube to the CO outlet port NOTE Should the FilterLine or exhaust tubing be blocked when the HeartStart MRx is turned on the CO Check Exhaust INOP message is displayed Should the blockage occur during CO monitoring the
262. l Philips Healthcare Sales Office your authorized Philips Healthcare Dealer or Distributor or visit our website at http philips com healthcarestore and follow the Medical Supplies link WARNING Use only supplies and accessories approved for use with your HeartStart MRx Use of non approved supplies and accessories could affect performance and results WARNING Use single use supplies and accessories only once Table 80 Supplies and Accessories M3542A Standard External Paddles M3543A Water Resistant External Paddles M4745A Sterilizable External Paddles Ce MI1741A 7 5 cm Switchless M1742A 6 0 cm Switchless M1743A 4 5 cm Switchless M1744A 2 8 cm Switchless M4741A 7 5 cm Switched M4742A 6 0 cm Switched 292 Table 80 Supplies and Accessories Continued M4743A 4 5 cm Switched M4744A 2 8 cm Switched M4740A Internal Paddles Adapter Cable igure sea M3713A Adult Plus M3716A Adult Radiolucent M3717A Pediatric Plus M3718A Adult Radiotransparent Reduced Skin M3719A Pediatric Radiotransparent Reduced Skin M3501A Defib Adult AAMI M3502A Defib Adult IEC M3503A Defib Pediatric IEC M3504A Defib Pediatric AAMI M3507A Defib Hands free Pads Cable barrel style 2 2m 7 ft M3508A Hands free Pads Cable plug style 2 2m 7 ft 05 10200 Pads Adapter use with M3507A 989803158661 Defibrillator Pads Hands Free Cable CPR
263. l and stationary transmission will improve the transmittal success rate Follow instructions provided with your cell phone CAUTION Many institutions prohibit the use of cell phones on their premises Please abide by local rules and regulations NOTES If transmitting in a clinical mode waveforms for all monitored parameters can be viewed during the transmission process However the waveform appearing in Wave Sector 4 is partially obscured when the transmission status bar is displayed Related alarms measurements and INOP messages remain active and are reported in Parameter Blocks 1 and 2 and the general status area The HeartStart MRx transmits data from internal memory only Data contained on the external data card only is not transmittable Modifying Reference IDs You can change the Reference ID of your HeartStart MRx during an event by performing the following for more information on Reference IDs see Identifying Your Device on page 26 1 Press the Menu Select 0 button 2 Use the Navigation buttons to highlight Other and press the Menu Select button to select 3 Highlight Reference IDs and press the Menu Select button to select 4 Select the Reference ID you want to use or Other to add an additional Reference ID If you selected a reference ID from the list in Step 4 it becomes the Reference ID for the current event and subsequent events If you selected Other the HeartStart MRx prompts you to create a new Refere
264. l is not selected within five seconds of pressing the Mark Event button the event is labeled as generic and sent e A segment consisting of the 10 seconds prior to and the five seconds following the Mark Event inclusive for each of the waveforms configured to be printed Delivering a shock After shock is delivered or aborted due to impedance or other issues e All data with Vital signs update Event label and time Shock number e Number of Joules e Data on impedance and peak current e A segment consisting of the 10 seconds prior to and the five seconds following the shock inclusive for each of the waveforms configured to be printed _ not sent with an aborted shock PCDT Physiological alarm including Asystol VFIB VTACH VTACH Extreme Tachy Extreme Brady Apnea Extreme Desat Invasive Pressure Disconnect PVC min high Pacer Not Captured Pacer Not Pacing Pacer Output Low and alarm limits for HR NBE EtCO3 SpOg Pulse rate AwRR Invasive Pressure CPP and Temperature Print button is pressed Start End PCDT When trigger event occurs e All data with Vital signs update Event label and time e A segment consisting of the 10 seconds prior to and the five seconds following the event trigger inclusive for each of the waveforms configured to be printed End PCDT does not send vitals or waveform data NOTE All transmitted personal patient identifiable data is encrypt
265. l output is configurable 6 Press Start Pacing The message Pacing appears WARNING Use care when handling the multifunction electrode pads on the patient to avoid shock hazard during pacing 7 Verify that white pacing markers appear on the ECG waveform if ECG electrodes are in place 8 Press Pacer Output Then use the Navigation and Menu Select buttons to a increase the output until cardiac capture occurs Capture is indicated by the appearance of a QRS complex after each pace pulse marker b decrease the output to the lowest level that still maintains capture 9 Verify the presence of a peripheral pulse 10 To pause or stop pacing Press Pause Pacing A prompt message will ask you to confirm your action Figure 56 Pause Pacing Message Pause Pacing Yes Confirm your action Use the Navigation buttons to highlight Yes and press the Menu Select button OR Move the Therapy Knob off the Pacer position Defibrillating During Pacing Should it be necessary to defibrillate the patient during pacing refer to the procedure for defibrillating in Manual Defib Mode in Chapter 6 or AED Mode in Chapter 5 Once the Therapy Knob is moved from the Pacer position to a Manual Defib Mode energy setting or AED pacing is stopped To resume pacing after defibrillation repeat the pacing procedure as described in Demand Mode Pacing on page 88 or Fixed Mode Pacing on page 89 When pacing is r
266. lains the prompts that guide you through the defibrillation process and describes how prompts vary depending upon the condition of the patient and the configuration of your device For information on annotating storing and printing event information acquired in AED Mode see Working with Data on page 225 For information on setting configuration choices see Configuration on page 199 Precautions for AED Therapy WARNING The AED algorithm is not designed to handle erratic spiking problems caused by a properly or improperly functioning pacemaker In patients with cardiac pacemakers the HeartStart MRx may have reduced sensitivity and not detect all shockable rhythms NOTES The Philips HeartStart MRx AED mode is not intended for children under 8 years of age For children 8 years of age and older the American Heart Association recommends that standard operating procedures for AEDs be followed See the American Heart Association Guidelines 2005 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Dallas Texas AHA 2005 Successful resuscitation is dependent on many variables specific to the patient s physiological state and the circumstances surrounding the patient incident Failure to have a successful patient outcome is not a reliable indicator of monitor defibrillator performance The presence or absence of a muscular response to the transfer of energy during electrical therapy is not a reliable indicator of
267. larm condition occurs Non latching Alarm is automatically removed when the alarm condition no longer exists NOTE The presence of multiple alarm conditions is quite possible Announcing all of the detected alarms would cause confusion and a less serious condition might hide a more serious condition For this reason alarms are prioritized and categorized so that the most serious or highest priority alarm condition is the one announced If multiple same parameter same priority alarms occur all alarms will be displayed NOTE Audio is suppressed for INOP alarms for the first 60 seconds after the HeartStart MRx is turned on INOP messages do appear on the display Responding to Alarms Alarm limits are displayed with each parameter if alarms for the parameter are on When an alarm condition occurs and an alarm is indicated visually and audibly there are several ways to respond Initially 1 Attend to the patient 2 Identify the alarm s indicated 3 Silence the alarm s When a physiological alarm is announced the audio pause label see Figure 14 is displayed above the Navigation and Menu Select buttons Pressing any of these buttons will silence the audio for all active alarms while you are attending to the patient If the alarming condition continues to exist it will re alarm in two minutes Silencing a specific alarm does not prevent another alarm condition from sounding If you also silence the second alarm it resets
268. le the device is off to assess operational performance and alert you if a problem exists Results of tests associated with critical functionality of the device are reported through the Ready For Use indicator and the Automated Test Summary report Results are also reported through INOP statements on the display when the HeartStart MRx is turned on Table 73 provides a brief explanation of the tests and lists the frequency with which each is performed Table 73 Automated Tests Hourly Tests batteries internal power supplies and internal Hourly memory Daily Tests batteries internal power supplies internal memory Daily between 11 pm internal clock battery defibrillation pacing ECG SpO and 1 am EtCO NBP Invasive Pressure Temperature Bluetooth and printer The defibrillation test includes low energy internal discharges If a 3 5 or 10 lead ECG cable is attached the cable is tested as well Weekly Performs the Daily Test described above plus deliversa Weekly between high energy internal discharge to further exercise the 11PM Sunday and defibrillation circuitry 1 AM Monday NOTE Automated tests do not test therapy cables paddles buttons audio or the display An ECG cable is tested if connected at the time of the test 264 Automated Test Summary An Automated Test Summary ATS showing the results of recent tests may be printed as evidence that the HeartStart MRx is tested regularly To d
269. lect Print Configuration from the Configuration Main menu and press the Menu Select button The configuration report is printed on the printer NOTE Upon exiting Configuration and returning to a clinical mode Monitor Pacer Manual Defib or AED all settings will be reset to the device s configured values 201 Configurable Parameters The following tables list configurable parameters for each of the sub menus on the Configuration Main menu A description of each parameter is provided along with the possible choices for settings Default settings are in bold type Table 36 General Settings Institution Name Enters your organization s name in the 12 Lead 32 characters blank ECG Report If you are sending data to the TraceMasterVue database then this field must match a valid entry in the TraceMasterVue database Voice Volume Voice prompt volume level Very Soft Soft Medium Loud Very Loud Alarm Volume Audible alarm volume level Very Soft Soft Medium Loud Very Loud Minimum Alarm Volume Minimum audible alarm level available during Very Soft Soft Medium Loud Very Loud use QRS Volume Volume of audible beep with each QRS Off Very Soft Soft Medium Loud Very Loud complex detected Time Format Selects time format to display 12 hour 24 hour Pacing on Batteries Displays the warning message Pacing on Yes No Warning Batteries if pacing using only battery power Unit Display Defines if par
270. llation Successful resuscitation is dependent on many variables specific to the patient s physiological state and the circumstances surrounding the patient event Failure to have a successful patient outcome is not a reliable indicator of monitor defibrillator performance The presence or absence of a muscular response to the transfer of energy during electrical therapy is not a reliable indicator of energy delivery or device performance Use only approved lead sets with the HeartStart MRx Failure to do so may introduce noise and result in intermittent leads off messages Code View In Manual Defib Mode an energy is selected and the Code View is displayed Code View is optimized to clearly communicate data associated with a resuscitation event Notice the increased prominence of the Event Timer as well as the enlarged ECG in Wave Sectors 1 and 2 as shown in Figure 46 Figure 46 Code View Display Mark Event 10 Feb 2006 11 20 A_ EM Heart Alarms Off Adult Non Paced ea Temp oC Pulse bpm Event Timer Rate 8 Ox 120 39 0 0 3 4 lt 4 enlarged 36 9 360 80 2 n 2 ECG enlarged gt Shock Status Area Selected Energy 150Joules Shocks 0 SpO2 EtCO2 mmHg AWRR rpm 60 8 348 18 Start Disarm NBP For details related to using Q CPR in Manual Mode see Preparing to Use Q CPR on page 159 NOTE The Shock Counter displays the number of shocks delivered while in AED and Manual Defib modes 73
271. lor Selects the parameter color Red Yellow Blue Green Cyan Magenta White 205 Table 43 Invasive Pressure Settings PAP Alarm Source Selects the type of alarm source Systolic Diastolic Mean Systolic High Limit Selects the systolic high limit value Adult 39 360 35 mmHg Ped 39 360 60 Adjusted in increments of 1 mmHg or 0 1 kPa Systolic Low Limit Selects the systolic low limit value Adult 40 359 10 mmHg Ped 40 359 24 Adjusted in increments of 1 mmHg or 0 1 kPa Diastolic High Limit Selects the diastolic high limit value Adult 39 360 16 mmHg Ped 39 360 4 Adjusted in increments of 1 mmHg or 0 1 kPa Diastolic Low Limit Selects the diastolic low limit value Adult 40 359 0 mmHg Ped 40 359 4 Adjusted in increments of 1 mmHg or 0 1 kPa Mean High Limit Selects the mean high limit value Adult 39 360 20 mmHg Ped 39 360 26 Adjusted in increments of 1 mmHg or 0 1 kPa Mean Low Limit Selects the mean low limit value Adult 40 359 0 mmHg Ped 40 359 12 Adjusted in increments of 1 mmHg or 0 1 kPa Scale Default waveform scale Adult 300 240 180 150 120 110 100 90 80 70 60 50 40 30 20 10 5 10 15 20 Ped 300 240 180 150 120 110 100 90 80 70 60 50 40 30 20 10 5 10 15 20 Artifact Suppression Selects the def
272. loth or toothbrush to gently clean the vent membrane If damaged or still soiled after cleaning replace the rear cover Keep sharp objects away from the vent membrane See the HeartStart MRx Service Manual Addendum for instructions If the CPR meter has been used in a training situation it can be cleaned using an alcohol wipe 70 ethanol solution If the CPR meter has been used in a clinical situation clean it as follows 1 Clean and scrub the exterior using a mild detergent and either a soft cloth or toothbrush until the surfaces are visually clean Wipe the exterior with a soft cloth dampened with lukewarm tap water 2 Clean the exterior using a 3 solution of RelyOn or Virkon Spray the solution on all exterior surfaces and wait at least five minutes Alternative cleaning agents include isopropyl alcohol 70 solution in water 3 Wipe the exterior with a clean soft cloth dipped in distilled water Allow to dry completely CAUTION Do not immerse the CPR meter in water hold it under running water or allow moisture to penetrate in Do not sterilize Do not use quaternary ammonium compounds like Steris Coverage Plus NPD to clean the CPR meter 289 HeartStart MRx Disposal Prior to disposal remove the batteries Then dispose of the device and accessories in accordance with your country s regulations for equipment containing electronic parts WARNING Disposal of the device with the battery inserted presents a potenti
273. me or six 200J shocks Battery A Low Switching to The specified battery needs Charge the low battery Device Error Service Required message Failure detected during start up Take the device out of use and call for service External Power Interrupted message AC DC power was removed now operating from battery power Connect to AC DC power if appropriate Fan Failure message The internal fan should be running but it is not Call for service Internal Memory Failure message INOP message appears every time the device is turned on The internal memory card has been reformatted after failing an automated test Although all previous data stored on the card has been erased it is now ready once again to record data Patient data cannot be stored in internal memory because the internal memory card is not recognized Call for service An attempt to print an Event Summary or trending report was requested during power up Data Card was not available Cycle the power Wait at least 16 seconds after power up before attempting to print an Event Summary or trending report Table 81 General Problems Continued Event Storage Full message Event Summary data for the current patient case exceeds the storage capacity of internal memory or you ve reached the 12 hour limit Copy or print Event Summary to retain data and then begin a new patient case Print the Event
274. memory are functioning module present remove the module and s Fail The clock battery power supplies and or repeat the test If the test continues to fail call internal memory are not functioning A failure may for service If the test passes replace the power abort the remaining tests module Therapy Knob e Pass The Therapy Knob is set to 150J If the test fails confirm that the Therapy s Bal The Theap Koob knot erto 150 Knob is set to 150J and repeat the test If the test continues to fail call for service e Fail The Therapy Knob is not functioning Charge Button e Pass The Charge Button passed its self test Repeat the test If the test continues to fail e Fail Proceed was selected from the No Button becange there is no response Mom tie Changa Response Menu Button call for service e Fail The Charge Button is not functioning Shock Button e Pass The Shock Button passed its self test Repeat the test being sure to press the Shock e Fail Proceed was selected from the No Button Button before reaching the Auto Disarm time Respodee Nenu If the test continues to fail call for service e Fail The Shock Button was not pressed before the configured Auto Disarm time period ended Audio e Pass You responded Yes that you were able to hear Take the device out of use and call for service the test voice prompt e Fail You responded No to hearing the voice prompt Defib e Pass cable type The defib test passed with the If the te
275. mentation None Hardware Table 55 Data Transmission Phone Modem Settings Profile Name Name of the profile Serial Phone Profile Configuration String Available from your cell phone service provider 45 characters blank Landline Set to Yes if you are using a modem Yes No Dial Prefix Only configurable if Landline is set to Yes The dial prefix is the number or numbers you dial before the phone number For example you may need to dial 9 for an outside line or an area code in addition to a number 10 charaters blank Dial String Available from your cell phone service provider 40 characters blank User Name Password Sets how the user name password pairs are configured Per profile means a single user name password is configurable for this profile per device means a different user name password is configurable for each device which uses this Per Profile Per Device profile PPP User Name Typically not needed but may be required by 30 characters blank some cell phone service providers PPP Password Typically not needed but may be required by 40 characters blank some cell phone service providers Static IP Address Typically not needed but may be required by 15 characters nnn nnn nnn nnn blank some cell phone service providers Primary DNS Typically not needed but may be required by nnn nnn nnn nnn blank some cell phone service providers
276. meter cable and connector M2202A High Tack Foam ECG Electrodes 5 electrodes pack 60 packs case M4612A Solid Gel ECG Electrodes 5 electrodes pack 60 packs case M4613A Solid Gel ECG Electrodes 30 electrodes pack 10 packs case M1500A M3525A 2 7 meter 10 lead ECG Trunk Cable 12 pin Connector for 3 Lead 5 Lead and 12 Lead use 989803147691 1 3 meter 10 lead ECG Trunk Cable 12 pin Connector for 3 Lead 5 Lead and 12 Lead use M3526A 3 wire Lead Set with Snap AAMI M3527A Add 7 wire Lead Set for 12 Lead use AAMI M3528A 3 wire Lead Set with Snap IEC M3529A Add 7 wire Lead Set for 12 Lead use IEC M5530A Combiner Plug for 3 wire Lead Set for use with M3526A M3528A M1663A 10 lead ECG Patient Trunk Cable 12 pin ECG Input Connector for 5 Lead and 12 Lead use AAMI M1949A 10 lead ECG Patient Trunk Cable 12 pin ECG Input Connector for 5 Lead and 12 Lead use IEC M1968A 10 electrode Cable Set Extremities Grabber use with M1976A AAMI M1976A 10 electrode Cable Set Chest Grabber use with M1968A AAMI M1971A 10 electrode Cable Set Extremities Grabber use with M1978A IEC M1978A 10 electrode Cable Set Chest Grabber use with M1971A IEC 3 lead ECG Trunk Cable AAMI Table 80 Supplies and Accessories Continued M1783A M1510A 3 l
277. mission while a transmission is in progress follow the same steps you used to send the first transmission except you are not asked to select a transmission device Your data is sent following completion of the transmission in progress When you attempt to queue a transmission items listed in the Send Menu which are incompatible with the current connection are unavailable and grayed out To transmit using different transmission devices you must complete the first transmission before initiating the next one NOTE When a transmission fails or you cancel a transmission any queued transmissions are cancelled and no events are logged Finding Transmission Results When data is transmitted from the HeartStart MRx via Bluetooth File Transfer to a receiving device it is placed in the default folder typically located at My Documents Bluetooth Exchange Folder set up during Bluetooth configuration of the receiving device The HeartStart MRx creates a philipsMRx folder and depending on the data sent a sub folder 12 Leads or events The events folder contains all event data sent including any 12 Leads sent as part of the event Independently sent 12 Leads are contained in the 12 Leads folder NOTES Ifyou pressthe Exit Data Mgt softkey to exit Data Management Mode while a batch download is processing the HeartStart MRx displays an Exiting Data Management will cancel the current transfer message and asks you to
278. mpts Once an ECG is detected through the multifunction electrode pads the HeartStart MRx automatically analyzes the patient s heart rhythm and warns you not to touch the patient Figure 43 Figure 43 ECG Analysis Message in AED Mode ANALYZING DO NOT TOUCH PATIENT WARNING Handling or transporting the patient during ECG rhythm analysis can cause an incorrect or delayed diagnosis Under these circumstances if the HeartStart MRx issues a Shock Advised prompt keep the patient as still as possible for at least 10 seconds so the HeartStart MRx can reconfirm the rhythm analysis before you deliver a shock If artifact interferes with analysis the message Analyzing Interrupted Do Not Touch the Patient is annunciated while the HeartStart MRx attempts to continue analyzing If the artifact persists the message Cannot Analyze is annunciated and the message Paused Attend To Patient is displayed While paused analysis is suspended Check that the pads are making proper contact with the patient s skin and minimize movement Analysis resumes automatically after 30 seconds or when you press Resume Analyzing Always use the analyze function to determine if a rhythm is shockable Adjusting Voice Prompt Volume NOTE You may adjust the volume of the voice prompts at any time by accessing the Voice Volume menu Press the Menu Select 9 button Select the desired volume level and press the Menu Select button In loud en
279. n CO and SpOz modules temperature Bluetooth invasive pressures printer and CPR meter are checked periodically The best way to do this is through an Operational Check It is recommended that you establish a schedule for conducting periodic Operational Checks 269 Operational Check Operational Checks should be performed at regular intervals to supplement the hourly daily and weekly Automated Tests executed by the HeartStart MRx Automated Tests provide adequate assurance that the device is in a functional state of readiness Operational Checks supplement the Automated Tests by verifying therapy cables the ECG cable paddles audio the Charge and Shock buttons Therapy Knob and CPR meter along with replicating the Weekly test Operational Checks also notify you if the battery NBP module or CO module need calibration WARNING Be sure the HeartStart MRx is not connected to the patient when performing an Operational Check NOTE NOTE NOTE It is important to establish a schedule for conducting Operational Checks as well as for checking supplies and accessories associated with the HeartStart MRx This will ensure that the device is ready to monitor and deliver therapy The Operational Check is run with a battery installed to reflect optimal operating conditions for defibrillation The device automatically disconnects AC DC power If you have the Pacing option test external paddles using the Weekly Shock test You must run
280. n the exhaust tube is blocked to the extent that a measurement sample cannot be taken Make sure the exhaust tubing is not kinked and is free of blockages If necessary replace the tubing CO Equip Malfunction INOP CO hardware failure Do not use the CO monitoring capabilities and call for service of the CO module If CO monitoring is essential to patient care take the device out of use CO Service Required INOP The CO module has reached its end of life defined as 15 000 operating hours Do not use the CO monitoring capabilities and call for service of the CO module If CO monitoring is essential to patient care take the device out of use 309 Table 91 Defibrillation and Pacing Problems Analyzing Stopped or Cannot Analyze ECG message in AED Mode Excessive patient movement Minimize patient movement If the patient is being transported stop if necessary Radio or electrical sources are interfering with ECG analysis Remove possible sources of interference from the area Charge Button Failure INOP During an Operational Check when the Charge button was pressed there was no response Remove the device from use and call for service Defib Disarmed message The Shock button was not pressed within the time period specified in the Time to Auto Disarm Configuration setting No action required If desired charge the device and press the Shock button
281. n 63 artifact 67 configurable parameters 218 ECG analysis 324 impedance 66 indications 3 no shock advised 68 patient status 65 prepping the patient 65 setup 65 specifications 323 therapy precautions 63 using 66 using Q CPR 171 view 64 voice volume 67 alarms 24 apnea time limit 114 AwRR changing 113 enabling disabling 114 chain for basic arrhythmia 57 configurable parameters 211 CPP 127 EtCO changing 113 enabling disabling 113 EtCO and AwRR 112 heart rate and arrhythmia 56 changing 59 enabling disabling 59 latching 56 HR and arrhythmia yellow 57 IntelliVue Networking 193 invasive pressures 125 changing 126 enabling disabling 126 Noninvasive Blood Pressure NBP 107 changing 107 enabling disabling 108 noninvasive pacing 84 pulse 129 enabling disabling 129 setting limits 130 pulse rate from SpO 100 responding 59 responding to 24 SpO monitoring 99 changing 99 desat 100 enabling disabling 100 temperature 132 Index changing limits 133 enabling disabling 133 types 24 annotated ECG 60 Apnea Time Alarm 114 arrhythmia alarms chain 57 learning relearning 61 monitoring 54 artifact AED Mode 67 TENS unit 49 audio 27 pause label 25 recording 23 reviewing recorded 23 tones 318 automated tests 264 summary results 265 AwRR Alarms 112 changing 113 alarms enabling disabling 114 warnings 114 B basic orientation 8 back panel 11 display menus 17 views 13 front panel 8 general status
282. n AED Mode 167 Figure 84 Advanced Q CPR View 11 Feb 2006 22 32 A __ Eh R Alarms Off Adult_Non Paced 145 14 02 Selected Energy 150 Joules Shocks 0 CPR Timer CPR 02 30 i ompression gt Poz Compressions KIE Counter Compression MATAVAYATAVATAVAVA 1 5 inches A a V 7 a V y V V V 2 0 inches pe E E E E Compression Target Zone Parameter Block 2 In Advanced View Parameter Block 2 contains the numeric values for compression rate as well as ventilation rate Both rates are a moving average rate measured per minute Based on the Q CPR algorithm the target compression rate is 100 compressions per minute within an acceptable range of 90 120 compressions per minute The acceptable range for ventilation rate while CPR is being administered is 4 16 ventilations per minute to reflect 2005 AHA ERC resuscitation guidelines The acceptable range for ventilation rate following 60 seconds without compressions such as while rescue breathing is being administered is 9 16 ventilations per minute 168 If your device does not have invasive pressure active the ventilation detection icon is displayed in Parameter Block 2 and depicts the level of ventilation volume A set of lungs graphically shows the three states of volume full empty and questionable if ventilation cannot be measured lungs marked with a appear A filled ventilation icon indicates a ventilation was detected Figure 85 Ventilat
283. n Transfer Mode Discharge Patient is not available in Pacer Manual Defib 12 Lead or AED modes At the Information Center Discharge Patient except for the Discharge for Transport function is not available when the HeartStart MRx is in Pacer Manual Defib or AED modes NOTE You should always perform a discharge even if your previous patient was not admitted to clear out patient data and reset all settings at the HeartStart MRx and Information Center To access Discharge Patient perform the following steps 1 Press the Menu Select button 2 Using the Navigation buttons select Patient Info and press the Menu Select button 3 Select Discharge Patient and press the Menu Select button 4 Your screen will display one of two Discharge Patient messages see Table 33 and prompt you with a Discharge Patient question 18 a Table 33 Discharge Patient Messages Connected to network The patient demographics and all patient data will be closed in the MRx and erased in Central and settings reset to defaults Not connected to network All trends events and patient identification of the current patient will be closed and settings reset to defaults 5 Select Yes to discharge the patient No to cancel discharge See Figure 94 Figure 94 Discharge Patient Confirmation Discharge Patient The patient demographics and all patient data will be closed in the MRx and erased in Central and settings reset to defaults Discharge Pati
284. n click to select Defibrillators and select the entry for Declaration of Conformity DoC Warning Radio frequency RF interference coming from devices other than the HeartStart MRx may degrade the perfor mance of the MRx Electromagnetic compatibility with surrounding devices should be assessed prior to using the monitor defibrillator These Instructions for Use contain the following conventions WARNING Warning statements describe conditions or actions that can result in personal injury or loss of life CAUTION Caution statements describe conditions or actions that can result in damage to the equipment or loss of data NOTE Notes contain additional information on usage Voice represents voice prompt messages Text represents messages that appear on the display Soft key represents soft key labels that appear on the display above the button to which they correspond Images of the HeartStart MRx display and menus appearing in this document are for illustration purposes only Menu choices on your device are driven by the options you have purchased and selections you make in Configuration Mode e ii Table of Contents 1 Introduction ja Overview 1 Intended Use p Indications for Use 3 AED Therapy 3 Manual Defibrillation 3 Noninvasive External Pacing Therapy 3 Pulse Oximetry 3 Noninvasive Blood Pressure Monitoring 3 End tidal CO 3 12 Lead ECG 3 Q CPR 4 Invasive Pressures 4 Temperature 4 AC
285. nce ID Use the Menu Select button and the Navigation buttons to create the new entry Selecting Done saves your edits as the current Reference ID Selecting Cancel closes the menu and does not change the Reference ID 241 Setting up Bluetooth Transmissions To use Bluetooth technology to wirelessly transfer data from the HeartStart MRx including Clinical Values Data Transmission you must configure both the monitor defibrillator and the receiving Bluetooth device Adding a Bluetooth Device The HeartStart MRx can have up to 20 Bluetooth devices configured at one time Adding a 21st device replaces the device used least recently NOTE Bluetooth devices may not be added or modified during transmission and transmission is not allowed during Bluetooth device configuration To add a Bluetooth device to the list of Transmission Devices 1 Once in 12 Lead mode press the Menu Select 9 button 2 Using the Navigation buttons select Bluetooth Devices and press the Menu Select button A list of previously discovered Bluetooth devices is displayed 3 Select Add Device and press the Menu Select button The message Searching for Bluetooth Devices is displayed The search lasts for 30 seconds 4 From the Add Device menu select the desired device and press the Menu Select button The selected device must now go through the Pairing process described below NOTE All Bluetooth devices within the specified range are discovered by the HeartStar
286. nd of the patient Therapy cable If your pads are preconnected you need to detach them first before attaching the test load Turn the Therapy Knob to 150J 4 Press the Charge button NOTE If it becomes necessary to disarm the defibrillator press Disarm 5 The strip prints if configured to do so If the strip does not print immediately press the Print button 6 fusing Pads Cable press the Shock button on the HeartStart MRx to deliver a shock into the test load External paddles simultaneously press the shock buttons located on the paddles to deliver a shock into the test load 7 Confirm on the printed strip that the energy delivered to the test load is 150J 23J 127J to 173J If not take the device out of use and call for service 8 Detach the test load from the Therapy cable after performing the Shift Check and reattach your preconnected pads if you use them What Gets Tested in an Operational Check Operational Checks supplement the Automated Tests by verifying therapy cables the ECG cable paddles audio charge and shock buttons and the ability to deliver defibrillation and pacing therapy Operational Checks also notify you if the battery NBP module or CO module needs calibration and checks the SpO module printer and CPR meter If you choose to perform the weekly shock test in lieu of the Operational Check you need to ensure the ECG cable pacing functions audio battery calibration NBP and CO calibratio
287. nect a therapy cable and rerun Operational Check Table 83 NBP Monitoring Problems NBP Cuff Not Deflated INOR The NBP numeric value is replaced with a The NBP cuff pressure has been greater than SmmHg 0 67kPa for more than 3 minutes Remove cuff from patient Release pressure in the cuff disconnect cuff from tubing Replace the cuff If the problem persists call for service replaced with a for inflation deflation or the total measurement NBP Cuff Overpressure INOP The NBP cuff pressure has No action is required the cuff should deflate The NBP numeric value is exceeded the overpressure safety automatically If not remove cuff from patient and repkicad wih at limit of 300 mmHg deflate NBP Interrupted INOP The measurement needed longer Check that the cuff size is appropriate The NBP numeric value is tkan tie ainun tine proideg Check cuff placement NBP Measurement Failed INOR The NBP numeric value is replaced with a A measurement value could not be obtained Check cuff size and placement NBP Calibration Overdue INOR NBP module needs calibration Calibration should be performed once a year or every 10 000 cycles whichever comes first Call for service of the NBP module Do not use the NBP monitoring capabilities until the calibration has been performed If NBP monitoring is essential to patient care take the device out of use
288. nel disposable blood pressure kit available in Europe and Asia only M1568A Dual Line blood pressure kit for measuring CVP ABP and other pressure measurements available in Europe and Asia only M1634A Reusable adapter cable available in Europe and Asia only TransPac IV Disposable transducer TruWave PX212 Disposable transducer DTX Plus DT 4812 Disposable transducer Contact the individual manufacturers for purchasing and service information Disposable Temperature Probes 21090A Esophageal rectal 21091A Skin surface 21093A Esophageal stethoscope 21094A Esophageal stethoscope 21095A Esophageal stethoscope 21096A Foley catheter 21097A Foley catheter M1837A Esophageal rectal M2255A Foley catheter Reusable Temperature Probes 21075A Esophageal rectal adult 21076A Esophageal rectal pediatric 21078A Skin surface Reusable Temperature Probe Extension Cables 21082A 3 0m 2 pin plug extension cable for mini phone plug 21082B 1 5m 2 pin plug extension cable for mini phone plug 295 296 Table 80 Supplies and Accessories Continued M3538A Lithium Ion Battery M3539A AC Power Module M5529A DC Power Module M5528A DC Power Module Mounting Bracket 989803135301 2 Bay Battery Support System for Lithium Ion Batteries 989803135331 4 Bay Battery Support System for Lithium Ion Batteries 989803135341 4 Bay Battery Support System
289. nfiguration and enabled through the Other Menu where the owner can activate deactivate and specify the length of the loan period NOTE Monitoring and defibrillation functions are suspended while the Return to Owner set up screen is displayed Alarms Off is indicated on the display Monitoring and defibrillation functions will return when exiting the Return to Owner screen NOTE The appearance of the loan expiration message does not disable monitoring and defibrillation functionality To enable the Return to Owner feature 1 Press the Menu Select 9 button 2 Select Other from the menu and press the Menu Select button 3 Select Return To Owner and press the Menu Select button 4 Pressthe Activate soft key 5 Enter the number of days in the loan period and press the Menu Select button 6 Pressthe Exit Return To soft key To disable the Return to Owner feature Press the Menu Select 9 button Select Other from the menu and press the Menu Select button Select Return To Owner and press the Menu Select button 1 2 3 4 Pressthe Deactivate soft key 5 Enter the password and press the Menu Select button 6 Press the Exit Return To soft key 29 3 Setting Up This chapter provides the basic set up information you need to prepare your HeartStart MRx for operation and to connect the optional monitoring accessories NOTE Ifyour HeartStart MRx does not have some of the optional functionality or accessory pouches list
290. ng data are presented at the selected interval for up to the most recent 12 hours of monitoring The newest data appear when trending is initially displayed The oldest measurements are deleted as needed to store the newest measurements Reviewing Trending Data To review trending data 1 Place the HeartStart MRx into Monitor Mode 2 Press the Menu Select button 3 Using the Navigation buttons select Trends and press the Menu Select button The Vital Signs Trending Report takes over the bottom two wave sectors See Figure 70 151 Figure 70 Vital Signs Trending Report Time intervals Vital Sign trends are displayed at the selected time interval See Date of report The earliest time displayed Vital Signs Trending Report Intervals on in the table determines the date of the report page 153 indicates multiple measurements were taken Print Trends Parameters A list of vital signs Trending data In the body of the monitored by the MRx during the report vital sign units of measure are displayed time period not displayed in the table About The Data Displayed e When trending is initially displayed the latest most recent trending data will appear in the far right column The display will auto update as new vital sign data become available as long as the latest data are displayed on screen If you have scrolled left to view older data the screen will not update to new data when available The la
291. ng upon the condition of your battery 285 Storing Batteries Batteries should be rotated regularly to ensure even usage When storing batteries make sure that the battery terminals do not come in contact with metallic objects If batteries are stored for an extended period of time they should be stored in a cool place with a partial charge of 20 1 LED illuminated to 40 2 LED s illuminated capacity Storing batteries in a cool place slows the aging process The ideal storage temperature is 15 C 60 F Batteries should not be stored at temperatures outside the range of 20 C 4 F to 60 C 140 F CAUTION Do not store batteries in the HeartStart MRx if it is out of service for an extended period of time Storing batteries at temperatures above 38 C 100 F for extended periods of time significantly reduces a battery s life expectancy Stored batteries should be charged every 2 months to 20 40 of their full capacity They should be charged to full capacity prior to use Discarding Batteries Batteries should be discarded if there are visual signs of damage or if they fail calibration Batteries should be discarded in an environmentally safe manner Properly dispose of batteries according to local regulations WARNING Do not disassemble puncture or incinerate batteries Be careful not to short the battery terminals because this could result in a fire hazard CAUTION Use caution when handl
292. nize delivery of the shock with the R wave of the ECG being monitored in Wave Sector 1 You may choose to perform synchronized cardioversion through either e multifunction electrode pads or e external paddles When using paddles you should monitor the ECG through monitoring electrodes connected to a 3 5 or 10 lead ECG cable or a Philips bedside monitor You may choose to monitor through an alternate source when using pads as well Cardioversion is still delivered through either pads or paddles Preparing for Synchronized Cardioversion NOTE In preparation for synchronized cardioversion 1 Perform the tasks as described in Preparing for Defibrillation on page 74 2 If monitoring through a 3 5 or 10 lead ECG cable plug the ECG cable into the ECG port on the HeartStart MRx and apply monitoring electrodes to the patient See ECG and Arrhythmia Monitoring on page 47 3 Use the Lead Select button to select pads paddles or a lead from attached monitoring electrodes The selected ECG source should have a clear signal and a large QRS complex See Lead Selection on page 53 When the patient is already connected to Philips bedside monitoring equipment an external Syne cable plugs into the ECG Output jack of the bedside monitor and connects to the ECG port of the HeartStart MRx This connects the ECG signal from the monitor into the HeartStart MRx where it is displayed and synchronization occurs If you are
293. nk editable for you to list more contraindications 223 18 Working with Data This chapter describes the data management features of the HeartStart MRx See Data Transmission on page 239 for instructions on how to send data from the HeartStart MRx Overview The two most common uses of data coming from the HeartStart MRx are e Transmission of vital signs and related data e Post event data management The HeartStart MRx automatically creates a complete Event Summary for each patient event Each Event Summary is assigned a unique event identification number and is date time stamped Measurements are stored for viewing reporting and printing in the Vital Signs Trending Report Event Summaries including any trending and associated 12 Lead reports are automatically stored in internal memory When internal memory reaches capacity each addition of an Event Summary to internal memory causes one or more of the oldest Event Summaries to be overwritten The current or most recent Event Summary or Vital Signs Trending report may be printed by pressing the button Event Summaries stored in internal memory may be individually selected and e Printed e Copied to a data card using the Data Management menu e Transmitted to a remote computer via Bluetooth or LAN for viewing in a data management application like Event Review Pro 225 Initiating an Event Summary New Event Summaries are initiated each time one of the following
294. nsmission device option you want to use and press the Menu Select button to select The PCDT icon appears on the display and transmission begins If your device does not have a a transmission device the HeartStart MRx prompts you to add a device See Adding a Bluetooth Device on page 242 NOTES Ifthe connection between the HeartStart MRx and the destination server fails the HeartStart MRx automatically tries to reconnect and sends the transmission when a connection is established If you start a PCDT within 10 seconds of turning the HeartStart MRx on the first transmission contains no wave data Periodic Clinical Data Transmission is not available when the HeartStart MRx is connected to the IntelliVue network 252 Priorities For Sending Data In low bandwidth or poor signal quality areas the HeartStart MRx has the ability to queue periodic data transmissions See Periodic Clinical Data Transmission on page 250 for details on data transmitted When you have more than one transmission in queue the HeartStart MRx sends data according to a preset priority e Ifthere are multiple transmissions all patient vital signs transmissions are sent first event transmissions second and 12 Lead Report transmissions third e If there are multiple transmissions of the same type they will be sent in chronological order e Ifa pending vital signs transmission is greater than 15 minutes old the message is not sent e Ifthere is a pending 1
295. nsmission test fail the message Transmission Test Failed is displayed along with additional information about where the failure occurred See Transmission Problems Bluetooth on page 304 Additional Bluetooth Device Information Keep the following points in mind when working with Bluetooth devices e Many Bluetooth devices are not discoverable by default Check your device s documentation to see if you need to enable discovery e Asa general security practice you should not leave your Bluetooth device in discoverable mode e Some devices require that you turn on the Bluetooth functionality e Some devices may prompt you to authenticate each time Check your device s documentation to see if you can configure it to always communicate with the HeartStart MRx e Give your Bluetooth device an easily recognizable name as this is the name that appears on the MRx menus The name should be no more than 15 characters in order for it to display properly on the HeartStart MRx e Bluetooth modems and fax machines use analog lines to transmit data If you are transmitting using a Bluetooth modem plug it into the analog line used by the fax machine Transmitting Using Bluetooth For instructions on transmitting with Bluetooth from 12 Lead Mode see Post Event Transmission Use Cases on page 254 244 Setting up Rosetta Transmissions Using an easy cable connection the HeartStart MRx enables you to transmit a 12 Lead Report to a
296. nst access to hazardous parts with a finger Protected against splashing water Input IP2X Protected against ingress of solid foreign objects gt 12 5mm in diameter Protected against access to hazardous parts with a finger Output Data In Out Gas Sample Input Electrostic sensitive device Gas Exhaust Output Invasive Pressure Port Number indicates Port 1 or Port 2 IN Meets IEC type BF leakage current NBP port requirements and is defibrillator Q protected Patient Applied Part is isolated and defib proof suitable for direct patient contact except the heart or major arteries Meets IEC type CF leakage current SpO port Y requirements and is defibrillator protected Patient Applied Part is lO isolated and defib proof suitable for aml direct patient contact including the heart or major arteries Alarm Pause button Temperature port 337 Table 103 Monitor Defibrillator Battery and CPR Meter Symbols Continued Device is Network enabled AO m TI Reference order number Non lonizing Radiation Device contains a radio frequency transmitter The CPR meter meets IEC 60529 class IP55 Device complies with the requirements of Medical Device Directive 93 42 EEC Expiration date This product has passed relevant safety tests by the CSA a nationally recognized test lab Does not contain natural rubber latex Single patient use
297. o access the data card Table 94 Invasive Pressure Monitoring Problems Invasive Pressure wave not displayed The sensor is not properly connected or the sensor cable is damaged Check the sensor connection and cable Try another sensor The pressure waveform is not configured to be displayed and there is not an unused wave sector Use the Displayed Waves menu to select a wave sector for display of the pressure waveform CPP Check Sources INOP The ICP and or arterial pressure used to derive CPP is invalid Make sure ICP and arterial pressure cables are connected to the device and zeroed Invasive Pressure Label Artifact INOP The device has detected a pressure change A resulting alarm most likely a high limit alarm will be suppressed In the event you do not think you created a non physiological event check cable and tubing Rezero and try again Invasive Pressure Label Equip Malfunction INOP There has been a malfunction in the Invasive Pressure hardware Contact Service 312 Table 94 Invasive Pressure Monitoring Problems Continued Invasive Pressure Label Noisy Signal INOP This can only occur when pulse is determined from a pressure wave The pulse rate is higher than 350 bpm May be caused by movement artifact or electrical interference Stop movement Minimize possible electrical interference Invasive Pressure Label Non pulsatile INOP
298. o an active source for this incident If the pulse source you are using to obtain a pulse rate is disconnected during active measuring and a secondary pulse source is available the pulse rate does not automatically switch to the secondary source The pulse value and the value of your source measurement remains on screen but becomes invalid and displays a where the value should be An INOP message also appears on screen To reactivate a pulse reading reconnect the original pulse source or change the pulse source to the secondary option 128 Changing Pulse Source To change pulse source for the current incident perform the following steps 1 Press the Menu Select button 2 Using the Navigation buttons select Measurements Alarms and press the Menu Select button 3 Select Pulse and press the Menu Select button 4 Select Pulse Source and press the Menu Select button Pick a source with an arterial or pulmonary waveform 5 Using the Navigation buttons highlight the pulse source desired and press the Menu Select button Figure 65 Pulse Source Main Menu Measurements Alarms Pulse Pulse Source Start Data Transmit HR Arrhythmia Pulse Source Sp02 Volume Press1 ABP Alarms On Press 1 ABP Displayed Waves Press2 PAP Pulse Limits Press 2 PAP Printed Waves CPP Exit NBP Patient Info EtCO2 Trends AwRR Other p02 High Contrast On Puse Exit 1of2 Setting Pulse Alarm
299. o flow time Q CPR Feedback Enables or suppresses Q CPR feedback On Off Suppressing Q CPR feedback will prevent Q CPR View in Manual Mode voice prompt feedback and storage of prompts in Manual and AED modes and Q CPR text prompt feedback in AED Mode This configuration item is only displayed and printed if the Q CPR Data Storage option is enabled Research Storage If on enables the storage of specific research On Off data including acceleration and force data from the CPR Meter and PCI data from pads Table 66 Thrombolytic Therapy Contraindications Settings Prompt for Enables disables the prompt for Yes No Contraindications Thrombolytic Therapy Contraindications Contraindication 1 Right vs left arm sys BP difference gt 15 mmHg Contraindication 2 History of structural central nervous system disease Contraindication 3 Significant closed head facial trauma within prev 3 mos Contraindication 4 Major trauma surgery GI GU bleed within 6 wks Contraindication 5 Bleeding or clotting problem or on blood thinners Listing of contraindications to Contraindication 6 Thrombolytic Therapy for you to CPR for longer than 10 min consider before treatment Contraindication 7 Pregnant female Contraindication 8 Serious systemic disease Contraindication 9 Pulmonary edema Contraindication 10 Signs of shock Contraindications 11 20 Bla
300. o give Check the sensor is applied properly Try another sensor type Table 85 Transmission Problems Bluetooth The MRx does not have a Bluetooth card Bluetooth Malfunction INOP The Bluetooth card is incompatible The Bluetooth card is corrupt Call for service The MRx could not discover the Bluetooth device Try searching again for Bluetooth devices The Bluetooth device is not turned on Make sure the Bluetooth device is turned on No Bluetooth Devices Detected message The Bluetooth device is not authorized to pair with the MRx See the Bluetooth device s documentation to set authorization The Bluetooth device is not within range Move the Bluetooth device closer to the MRx within the transmitting range See the Transmission Implementation Guide for information on transmission ranges The Bluetooth card is corrupt Call for service No Bluetooth Profiles Configured message There are no profiles configured for the Bluetooth device Create a profile for the Bluetooth device See the Transmission Implementation Guide for more information Transmission Settings Have Not Been Configured message The Hub information settings are not correct Modify the Hub Configuration settings on the MRx as needed Table 85 Transmission Problems Bluetooth Continued Bluetooth Connection Lost message The Bluetooth device is no
301. o not pull on the electrodes WARNING Be sure that the electrodes do not come in contact with other conductive materials especially when connecting or disconnecting the electrodes to from the patient NOTES Use only approved lead sets with the HeartStart MRx Failure to do so may introduce noise and result in intermittent leads off messages A signal from a TENS unit can cause ECG artifact 4 Ifnot preconnected connect the ECG patient cable Align the keyed patient cable connector with the ECG port on the Measurement module as shown in Figure 32 Push the patient cable firmly into the ECG port until the white portion is no longer visible Figure 32 ECG Cable Connection If monitoring via multifunction electrode pads 1 If not preconnected connect the pads cable to the HeartStart MRx See Figure 41 on page 65 2 Connect the pads to the pads cable See Figure 42 on page 65 3 Apply the pads as directed on the package NOTE If monitoring for extended periods of time monitoring electrodes and multifunction electrode pads may need to be changed periodically Refer to the manufacturer s documentation for how often to replace the monitoring electrodes or pads 50 Electrode Placement Figure 33 shows the typical electrode placement for a 3 lead ECG set Figure 33 3 lead Placement RA R a LA L RA R placement directly below the clavicle and White Red d I Black near the right shoulder e5 Xalow
302. oblem or direct you to take action Remain alert to these messages If a response is required use the Navigation buttons and Menu Select buttons to highlight and select the appropriate action Figure 11 Sample Message Window Connect Pads Cable High Contrast Display To optimize visibility of the HeartStart MRx display when used in bright sunlight the device provides a High Contrast feature which may be enabled In this view the MRx display appears using a yellow background with all other screen elements appearing in black or shades of gray High Contrast is enabled in Manual Defib Pacer and Monitor Modes by pressing the Menu Select button and selecting High Contrast On from the Main Menu NOTE The High Contrast feature does not display colors configured as red or blue therefore be sure your device is configured correctly with the appropriate parameter color settings Refer to Configuration on page 199 for more information 18 Controls The Therapy Knob is used to turn the HeartStart MRx on in the desired mode of operation Operating controls are organized by function with general function buttons located along the left and bottom sides of the display defibrillation controls to the right of the display and soft keys immediately below the display See Figure 1 Therapy Knob The Therapy Knob serves as the power switch for the HeartStart MRx It can be set to Off e AED to enable AED Mode for semi automated
303. of ECG acquired in Wave Sector 1 For example if your HeartStart MRx has Lead II configured to display in Wave Sector 1 but pads are attached to the patient and connected to the defibrillator before a valid ECG can be obtained from the monitoring electrodes then Pads will be displayed in Wave Sector 1 However Lead II will take its place as soon as it is acquired NOTE The ECG lead source appearing in Wave Sector 1 is used to determine heart rate and monitor arrhythmia Preparing to Monitor ECG To prepare for monitoring ECG perform the following steps If monitoring via electrodes 1 Prepare the patient s skin prior to applying monitoring electrodes Skin is a poor conductor of electricity so skin preparation is important in achieving good electrode to skin contact Identify the appropriate electrode sites See Figures 33 and 34 If necessary clip hair at the electrode sites or shave sites if needed Clean and abrade the skin at the electrode site Dry the electrode sites briskly to increase capillary blood flow in the tissues and to remove oil and skin cells 2 Attach the snaps to the electrodes before placing them on the patient 3 Apply the electrodes by peeling them one at a time from the protective backing and sticking them firmly to the patient s skin Refer to Figures 33 and 34 for proper electrode placement Press around the entire edge of each electrode to ensure they are secure Make sure the lead wires d
304. oice To resume voice prompts set at the previously selected volume 1 Press the Menu Select 0 button 2 Press the Menu Select button again to select Resume CPR Voice NOTE Mute is only available when Q CPR is active 173 After Each Use The CPR meter vent membrane and horizontal groove on the rear of the meter should be inspected after each use and cleaned if necessary Remove the CPR meter Adhesive Pad from the CPR meter and follow the cleaning directions listed in the Maintenance chapter section entitled CPR meter on page 289 Q CPR Data Capture This section describes how to configure Q CPR Data Capture settings lists the data and events recorded and provides information on reviewing Q CPR data Q CPR Feedback Setting 174 You can enable or suppress Q CPR feedback while still capturing CPR data When Q CPR feedback is enabled the MRx displays the CPR view with accompanying voice and or text prompts When Q CPR feedback is suppressed the HeartStart MRx behaves in the following way Manual Defib Mode e The CPR sub view chest compression waves compression rate and ventilation rate numerics and no flow time is not displayed e There is no Q CPR voice or text prompt feedback or storage e INOPS regarding ventilation are not displayed AED Mode e For Advanced View chest compression waves compression rate and ventilation rate numerics and no flow time are not displayed They are never shown in Basic View
305. olids Water Resistance IP55 Meets ISO IEC 60529 EMC Meets IEC 60601 1 2 and RTCA DO 160E Patient Adhesive Pads Dimensions 39mm x 90 mm Temperature Storage 20 C to 60 C 4 F to 140 F Operating 0 C to 50 C 32 F to 122 F Relative Humidity Storage 0 to 75 Operating 0 to 95 Material Foam pad with biocompatible adhesive on both sides Shelf life 2 years when applied to the CPR meter or 4 years in an unopened package 12 Lead ECG Inputs With a 10 lead cable leads I II III aVR aVL aVF V C1 V C6 can be obtained All 12 Lead ECG waves can be viewed on the display simultaneously All 12 leads can be printed on the strip chart printer in 3x4 format Networking Delay time from alarm signal generation at the HeartStart MRx to presence of alarm representation at the device s network output port lt 4 seconds Time of alarm representation at HeartStart MRx network output port to appearance at Information Center Dependent on inherent network delay Check with your network administrator for further details Telemetry channels The maximum number of telemetry channels may be limited in some geographies The spacing between channel 4a and channels 5 and 6 is less than 1 6 MHz therefore transmission on channel 4a may not be used simultaneously with transmissions on channels 5 or 6 The device meets the U S FCC 47 CFR Part 15 and Part 95 for WMTS transmission 333 Patient Data Storage Internal Event Summ
306. ome active The default label is Temp Table 18 Temperature Labels Tesoph esophageal temperature Tnaso nasopharyngeal temperature Trect rectal temperature Tvesic urinary bladder Tskin skin temperature Tart arterial temperature Temp non specific temp label Tven venous temperature Tcore core temperature To select a temperature label perform the following 1 Press the Menu Select button 2 Using the Navigation buttons select Measurements Alarms and press the Menu Select button 3 Select the temperature label option currently assigned to your measurement default is Temp and press the Menu Select button 4 Select Label and press the Menu Select button 5 Select the appropriate label from the list provided and press the Menu Select button 131 Monitoring Temperature NOTE To monitor temperature perform the following 1 Connect the temperature cable to the HeartStart MRx 2 Select the correct temperature label for your measurement 3 Check that the current device settings including alarm settings are appropriate for the patient 4 Apply the temperature probe to the patient The temperature function performs a self test when initially turned on and also performs hourly system tests when active Alarms Setting Temperature Alarms Temperature alarms are annunciated if measurements fall outside the configured limits for high and low temperatures Temperature alarms are all categorized as
307. oms The following tables list symptoms INOP statements and messages that you may encounter along with possible causes of the problem and potential solutions Symptoms are characterized by functionality Table 81 General Problems The HeartStart MRx does not turn on There is no power Insert a fully charged battery Connect to AC DC power Audio is too low or absent The QRS Voice or Alarm volume is configured to a Very Soft or Off setting Use the Volume menu to adjust the volume of the QRS beeper voice prompts and or alarms inaccurate Low battery life appears to The battery may be nearing its end Replace the battery deplete quickly of life Battery charge indicators The battery may need calibration Calibrate the battery All Settings Have Been Reset To Default Values message A power failure or critical software error has occurred Reset alarms waveforms volumes and other settings previously defined for the current patient All Settings Have Been Set To Factory Default Values message accompanied by a Power Interrupted or Device Restarted message Corrupt or incomplete configuration file Reload device configuration file Batteries Low message The batteries may not have enough remaining charge to provide 10 Insert a fully charged battery Battery B or vice versa message charging ae sae Connect to AC DC power minutes of monitoring ti
308. on M t b UTE S E wn ng ee If replacement is recommended call for service e Fail Replacement Recommended NBP passed its self test but has exceeded 50 000 cycles CO e Pass CO passed its self test If the test fails call for service to repair the e Fail CO is not functionin CO module If CO monitoring is essential i E to patient care take the device out of use e Pass Cal Due CO is passed its self test and is due o fr dibatin If calibration is due or overdue arrange for a qualified service provider to perform the e Fail Cal Overdue CO passed its self test and is calibration due for calibration M b ee i a e a If replacement is recommended call for service e Fail Replacement Recommended CO passed its self test but has exceeded 15 000 operating hours Table 77 Operational Check Test Results Continued Invasive Pressures Pass Invasive Pressures passed its self test If the test fails call for service to replace the i a Invasive Pressures Temperature board If e Fail Invasive Pressures is not functioning i E invasive pressure monitoring is essential to patient care take the device out of use Temperature e Pass Temperature passed its self test If the test fails call for service to replace the ree Invasive Pressure Temperature board If e Fail Temperature failed its self test ae temperature monitoring is essential to patient care take the device out of
309. on To Zero using the Menu Select button perform the following Place the transducer at the appropriate level for the measurement site Close the transducer stopcock to the patient and vent the transducer to atmospheric pressure On the HeartStart MRx press the Menu Select Vv button 1 2 3 4 Using the Navigation buttons select Measurements Alarms and press the Menu Select button 5 Select the pressure label you wish to perform the zero procedure on 6 Press Zero and press the Menu Select button Zeroing begins Zeroing Using a Soft Key in Monitor Mode To Zero using the soft key in Monitor Mode perform the following 1 Place the transducer at the appropriate level for the measurement site 2 Close the transducer stopcock to the patient and vent the transducer to atmospheric pressure 3 Press the button under Zero Pressure on the display 4 Using the Navigation buttons select the pressure s you wish to zero from the Zero menu and press the Menu Select button Zeroing begins 119 WARNING Invasive pressure alarms and pulse alarms if they are derived from invasive pressure readings are temporarily turned off while the transducer is zeroing The alarms will turn back on 30 seconds after zeroing is complete During the zeroing process a message will appear on the HeartStart MRx display If the process was successful the message on the screen changes to Pressure label zero done at date time for example ABP zero done a
310. onal Audio function which allows you to record audio during a patient event Optional Pacer Mode offers noninvasive transcutaneous pacing therapy Pace pulses are delivered through multifunction electrode pads using a monophasic waveform If desired use of Pacer Mode may be password protected The HeartStart MRx is powered by rechargeable lithium ion batteries Available battery power is easily determined by viewing the convenient battery power indicators located on the device display or by checking the gauge on the battery itself Additionally an external AC or DC Power Module may be applied as a secondary power source and for continual battery charging The HeartStart MRx performs Automated Tests on a regular basis The results of these tests are reported to the Ready For Use RFU indicator The prominently displayed RFU indicator communicates the status of your device letting you know it is operating correctly needs attention or is unable to deliver therapy In addition performing the specified Operational Check ensures that the HeartStart MRx is functioning properly The HeartStart MRx automatically stores critical event data such as Event Summaries 12 Lead Reports and Vital Signs Trending in its internal memory The HeartStart MRx also enables you to store data and event information on an optional data card for downloading to Philips data management solution HeartStart Event Review Pro or you can send the data electronically via s
311. onducted Beats As P waves are not analyzed it is difficult and sometimes impossible for the algorithm to distinguish between an aberrantly conducted supraventricular beat and a ventricular beat If the aberrant beat resembles a ventricular beat it is classified as a ventricular beat You should always select a lead where the aberrantly conducted beats have an R wave that is as narrow as possible to minimize incorrect classifications Intermittent Bundle Branch Block Bundle branch and other fascicular blocks create a challenge for the arrhythmia algorithm If the QRS complex changes considerably from the learned normal due to a bundle branch block the blocked beat may be incorrectly identified as ventricular and may cause false PVC alarms You should always select a lead where the bundle branch block beats have an R wave that is as narrow as possible to minimize incorrect classifications NOTE For more information on arrhythmia analysis refer to the Application Note Arrhythmia Monitoring Algorithm available on the web at www medical philips com goto productdocumentation 55 Heart Rate and Arrhythmia Alarms The HeartStart MRx detects arrhythmia alarm conditions by comparing ECG data to a set of pre defined criteria An alarm can be triggered by a rate exceeding a threshold for example HR gt XX an abnormal rhythm for example Ventricular Tachycardia or an ectopic event for example PVC gt limit HR Arrhythmia Alarms c
312. onments WARNING Do not crush dent or allow any deformation of the batteries WARNING Do not disassemble or open batteries Do no attempt to alter or bypass the safety circuit WARNING Avoid extreme shock and vibration to the battery WARNING Do not use or connect the battery to batteries of other chemistries 34 o Supplies and Accessories WARNING Use only the multifunction electrode pads battery and accessories as listed in this guide Substitutions may cause the HeartStart MRx to function improperly WARNING Use multifunction electrode pads prior to their expiration date Discard pads after use Do not reuse pads Do not use for more than 8 hours of continuous pacing Electromagnetic Compatibility When using the HeartStart MRx electromagnetic compatibility with surrounding devices should be assessed A medical device can either generate or receive electromagnetic interference Testing for electromagnetic compatibility EMC with and without the appropriate accessories has been performed according to the international standard for EMC for medical devices IEC 60601 1 2 This IEC standard has been adopted in Europe as the European Norm EN 60601 1 2 The EMC standards describe tests for both emitted and received interference Emission tests deal with interference generated by the device being tested WARNING Radio frequency RF interference from devices other than the HeartStart
313. or there has been a failure in the DNS Work with your ISP to ensure the Bluetooth Profile and Hub settings are correct Transmission Failed Settings Configured Incorrectly message There is a problem with the Server URL Proxy user name Proxy password Work with your ISP to ensure the Bluetooth Profile and Hub settings are correct Transmission Failed Connection Failed message A Bluetooth Card malfunction occurred Retry Transmission The wrong Bluetooth Profile was selected Check the profile to ensure it is the correct one for that Bluetooth device The Dial String under the Phone Profile settings is incorrect Work with your cell phone provider to ensure that the Dial string is correct Data transfer service is unavailable on the phone Work with your cell phone provider to ensure that your cell phone plan has data transfer capability Wrong number Check the number and re send Invalid Password message The wrong Bluetooth Profile was selected Check the profile to ensure it is the correct one for that Bluetooth device The PPP User Name or PPP Password under the Profile Phone settings is incorrect Modify the Bluetooth Profile setting as needed The server User Name or Password is incorrect Modify the Hub settings as needed Transmission Failed message The network is down Check with your ISP to see if your service is down
314. or less compared with 69 of patients treated with monophasic waveform shocks Outcomes are summarized in Table 106 Table 106 Clinical Summary Defibrillation Defibrillation Efficacy Single shock only 52 54 96 36 61 59 lt 0 0001 lt 2 shocks 52 54 96 39 61 64 lt 0 0001 lt 3 shocks 53 54 98 42 61 69 lt 0 0001 Patients Defibrillated 54 54 100 49 58 84 0 003 Return of Spontaneous Circulation 41 54 76 33 61 54 0 01 Survival to Hospital Admission 33 54 61 31 61 51 0 27 Survival to Hospital Discharge 15 54 28 19 61 31 0 69 CPC 1 Good 13 15 87 10 19 53 0 04 Conclusion The 150J SMART Biphasic waveform defibrillated at higher rates than 200 360 monophasic waveforms resulting in more patients achieving return of spontaneous circulation ROSC p 0 01 EMS system outcomes of survival discharge were not significantly different statistically However patients resuscitated with the lower energy SMART Biphasic waveform were more likely to have good cerebral performance CPC cerebral performance category p 0 04 341 Clinical Performance Summary Cardioversion Methods Results 342 An international multicenter prospective double blinded randomized clinical trial was conducted to assess the effectiveness of the SMART Biphasic waveform in treatment of atrial fibrillation AF as compared to monophasic waveforms The primary objective of the study was to determine the re
315. or on the front panel is lit Printer Paper Make sure the printer has sufficient paper and is printing properly Data Card If applicable make sure a data card is inserted and has sufficient space available SpO Sensor Inspect the sensor and cable for visible signs of damage NBP Cuffs and Tubing Inspect the pressure cuffs and tubing for visible signs of damage CO FilterLine Confirm that at least one un opened sterile package is available Invasive Pressure Cables Inspect the cable for visible signs of damage Temperature Probes Inspect the probe and cable for visible signs of damage NOTES Upon completing the Operational Check and returning to a clinical mode Monitor Pacer Manual Defib or AED all settings will be reset to the device s configured values If your institution s protocol requires periodic alarm verification and you wish to perform an alarm verification test in a non clinical environment outside of the Operational Check testing you can connect the HeartStart MRx up to a simulator manually change the alarm limits to a setting which should cause an alarm to annunciate Look at the display and listen for the alarm Be sure to reset the alarm limits to the appropriate settings before returning the device to a clinical environment 278 Table 77 Operational Check Test Results General System Pass The clock battery power supplies and internal If the test fails with the AC DC power
316. orescent lights infrared heating lamps or direct sunlight The HeartStart MRx allows you to monitor SpO while in Monitor Manual Defib and Pacer modes When using the Q CPR option SpO monitoring functionality is not available NOTE For more information on SpO refer to the Application Note Philips Pulse Oximetry 93 Understanding Pulse Oximetry 94 A pulse oximetry sensor sends light through patient tissue to a receiver on the other side of the sensor As Figure 57 shows light emitting diodes transmit red and infrared light through peripheral areas of the body such as a finger Figure 57 Pulse Oximetry Sensor Light a Emitting Diodes m Photodetector A photodetector positioned opposite the light emitting diodes compares light absorption before and after pulsation The amount of light getting through reflects the blood flow in the arterioles This measurement of light absorption during pulsation is translated into an oxygen saturation percentage and an SpO value is displayed For accurate SpO measurements the following conditions must apply e The patient must have perfusion in that extremity The light emitter and the photodetector must be directly opposite each other e All of the light from the emitter must pass through the patient s tissue e The sensor site should be free of vibration and excessive motion e Power cables should be kept away from the sensor cable and connector
317. ories 291 Overview 291 22 Troubleshooting 297 Symptoms 298 Audio Tones and Alarm Indications 318 Calling for Service 319 23 Specifications and Safety 321 Specifications 321 General 321 Defibrillator 321 ECG and Arrhythmia Monitoring 324 Display 326 Battery 326 Thermal Array Printer 327 Noninvasive Pacing 327 SpO2 Pulse Oximetry 328 NBP 329 Invasive Pressures 330 Temperature 331 EtCO2 331 AwRR 332 Calibration Gas for CO Measurement System 332 CPR Meter 333 Patient Adhesive Pads 333 12 Lead ECG 333 Networking 333 Patient Data Storage 334 Environmental M3535A 334 Environmental M3536A 335 Bluetooth 336 Symbol Definitions 337 Units and Abbreviations 340 Clinical Performance Summary Defibrillation 341 Methods 341 Results 341 Conclusion 341 Clinical Performance Summary Cardioversion 342 Methods 342 Results 342 Conclusion 343 Clinical Performance Summary Internal Defibrillation 344 Overview 344 Methods 344 Results 344 Conclusion 344 Safety Considerations 345 General 345 Defibrillation 348 Battery 349 Supplies and Accessories 350 Electromagnetic Compatibility 350 Reducing Electromagnetic Interference 350 Restrictions for Use 351 Emissions and Immunity 351 Guidance and Manufacturer s Declaration 351 xiv Index 359 Introduction Thank you for choosing the HeartStart MRx monitor defibrillator Philips Healthcare welcomes you to its family of resuscitation devices The HeartStart MRx is designed to
318. otated with event information using the Mark Event function button See Marking Events on page 237 for more information Use only approved lead sets when pacing with the HeartStart MRx Failure to do so may introduce noise and result in intermittent leads off messages For treatment of patients with implantable devices such as permanent pacemakers or cardioverter defibrillators consult a physician and the instructions for use provided by the device s manufacturer Waveforms ECG monitoring measurements and most alarms remain active and retain their settings when you transition from Monitor or Manual Defib Mode to Pacer Mode However the waveform displayed in Wave Sector 4 is replaced by the pacing status bar The use of Pacer Mode may be password protected as defined in Configuration See Password Security on page 13 83 Alarms Arrhythmia alarms for Pacer Not Pacing and Pacer Not Capture are associated with non transcutaneous pacing such as internal transvenous or epicardial pacing therefore these alarms are off when the HeartStart MRx is in Pacer Mode All other red and yellow alarms are active if enabled and their limits may be changed while in Pacer Mode Refer to the specific chapter for each measurement for information on red and yellow alarms and changing alarm limits While pacing should a Pads Off condition occur or the pads cable get disconnected a latching red alarm is generated and pacing is stopped
319. pads external paddles and internal paddles Defibrillation is always performed through paddles or pads However during defibrillation you may choose to monitor the ECG using an alternate ECG source 3 5 or 10 lead monitoring electrodes If an alternate ECG source is connected any available lead may be displayed For information on monitoring optional measurements while in Manual Defib Mode see the corresponding chapters in these Instructions for Use Overview NOTE Defibrillation therapy is the definitive method for termination of a variety of potentially fatal arrhythmias The HeartStart MRx provides this therapy through the application of a brief biphasic pulse of electricity to the cardiac muscle This electrical energy is transferred through attached paddles or disposable multifunction electrode pads applied to the patient s bare chest Internal paddles for open chest intrathorasic defibrillation can also be used In Manual Defib Mode you must assess the ECG decide if defibrillation or cardioversion is indicated select the appropriate energy setting charge the monitor defibrillator and deliver the shock The entire defibrillation process is under your control Voice prompts are not present However text messages on the display provide relevant information throughout the process It is important to be attentive to these messages when displayed The ECG strip and Event Summary are easily annotated with event information using
320. pe of patient adult pediatric or neonate e airway status of the patient ventilated or not ventilated e if a ventilated patient whether humidified or non humidified ventilation is used WARNING Do not re use clean or sterilize Microstream CO accessories as they are intended for single patient one time use Table 12 shows CO accessories with their corresponding application areas Table 12 Microstream CO Accessories M1920A Intubated FilterLine Set Adult Pediatric 25 sets case M1921A Intubated FilterLine H Set Adult Pediatric 25 sets case M1923A Intubated FilterLine H Set Infant Neonatal yellow 25 sets case M2520A Non Intubated Smart CapnoLine Pediatric Dual Purpose M2522A Non Intubated Smart CapnoLine Adult Dual Purpose M2524A Non Intubated Smart CapnoLine Pediatric Single Purpose M2526A Non Intubated Smart CapnoLine Adult Single Purpose WARNING Use only Microstream accessories as listed above to ensure correct functioning of the CO sidestream measurement WARNING Dueto a measurement delay do not use Microstream sidestream CO as a direct reference for determining the end expiratory point in the pressure curve NOTE The HeartStart MRx is equipped with automatic barometric pressure compensation _ 10 Setting Up Microstream EtCO Measurements 10 Monitoring Carbon Dioxide Setting Up Microstream EtCO Measurements WAR
321. perational Check ECG Cable Failure INOP A short has been detected between a lead wire and ground Replace the ECG cable Pads ECG Equip Malfunction INOP A device hardware failure was detected Perform an Operational Check If the Pads Paddles ECG Test fails with Therapy cable disconnect the Therapy cable from the device when prompted in order for the Pads Paddles ECG Test to run without the cabled connected If the Pads Paddles ECG test passes without the cable connected replace the Therapy cable ECG Equip Malfunction INOP A device hardware failure was detected Disconnect the ECG cable and perform an Operational Check If the Leads ECG Test fails remove the device from use and call for service If the Leads ECG Test passes replace the ECG cable and perform an Operational Check Lead Select button does not respond The 12 lead function is active Exit the 12 lead function Device is in AED Mode None Lead Select button does not display a pads choice The pads therapy cable is not connected Connect the pads therapy cable Demand mode pacing is active Exit pacing or choose fixed mode pacing One or more controls do not respond e g select lead or soft keys Faulty control or connection Remove the device from use and call for service Therapy Cable Failure INOP Performing an Operational Check without a therapy cable attached Con
322. pressed Print on Shock Prints a 12 second strip when a shock is delivered Yes No or when a shock is attempted but unable to be delivered Print on Mark Prints a strip when the Mark Event button is Yes No pressed The strip includes the printer delay if configured and extends 6 seconds from the start of the annotation text or from the time the Events menu is removed from the display Printer Delay Defines whether printed strips including those No Delay 10 sec requested manually and those generated by an event mark charge or shock include an additional 10 seconds of information the 10 seconds occurring just prior to printing being initiated Event Summary Report Selects the Event Summary Report format Short Short Medium Long includes a log of events and vitals Medium adds waveforms Long adds 12 Lead Reports Strip Print Speed Selects the ECG strip print speed 25 50 mm sec 12 Lead Print Speed Selects the 12 Lead ECG Report print speed 25 50 mm sec NOTE Red arrhythmia alarms can t be turned off Table 64 Mark Event Settings Mark Event 1 Defines menu choice 1 on the Mark Events 20 characters ET Access menu Mark Event 2 Defines menu choice 2 on the Mark Events 20 characters IV Access menu Mark Event 3 Defines menu choice 3 on the Mark Events 20 characters Adrenaline for Europe menu Epinephrine for the rest of the world Mark Event 4 D
323. quired energy for cardioversion of AF using the SMART Biphasic waveform as compared with a monophasic damped sine waveform This section summarizes the methods and results of this study Patients enrolled for this study were adults scheduled for elective cardioversion of AF at one of 11 clinical sites Clinicians used both a defibrillator delivering the SMART Biphasic waveform and one delivering a monophasic waveform A sequence of up to five shocks was administered four with the initial defibrillator and a fifth cross over shock was delivered with the other defibrillator if necessary The sequence of energy settings was 100J 150J 200J through the first three shocks on either type of defibrillator A fourth shock if necessary was delivered at 200J if the initial defibrillator was biphasic and at 360J if the initial defibrillator was monophasic The cross over shock was 360J monophasic if the initial defibrillator was biphasic and 200J biphasic if the initial defibrillator was monophasic Successful cardioversion was defined as the occurrence of two P waves uninterrupted by atrial fibrillation within 30 seconds of the shock Randomization to the use of monophasic or SMART Biphasic defibrillators was done in 212 elective cardioversions involving 210 patients at eleven clinical sites in the United States and Europe Of these 203 results met the protocol criteria for inclusion in this analysis The biphasic and monophasic groups were similar in t
324. r paddles that the defibrillator must overcome to deliver an effective discharge of energy The degree of impedance differs from patient to patient and is affected by several factors including the presence of chest hair moisture and lotions or powders on the skin The low energy SMART Biphasic waveform is an impedance compensating waveform that is designed to be effective across a wide range of patients However if you receive a No Shock Delivered message check that the patient s skin has been washed and dried and that any chest hair has been clipped If the message persists change the pads and or the pads cable Using Internal Paddles To defibrillate using internal paddles 1 Select the appropriate paddle electrode size 2 Ifusing switchless internal paddles connect the paddles to the M4740A Paddle Adapter Cable 3 Connect the paddles cable or the paddle adapter cable to the HeartStart MRx by aligning the pointer on the paddles cable or paddle adapter cable with the white arrow on the green Therapy port Then push until you hear it click into place See Figure 47 76 Defibrillating asynchronously Once you have performed the necessary preparation for defibrillation perform the following steps 1 Select Energy To select the energy setting rotate the Therapy Knob to the desired energy level as shown in Figure 51 Energy choices range from 1 to 200 with 150 the recommended level for adult patients Figure 51 Energy
325. rce and or limits for the current patient incident 1 Press the Menu Select 9 button 2 Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button Select NBP and press the Menu Select button 4 Select NBP Limits and press the Menu Select button 5 Select the desired source for the alarm Systolic Diastolic or Mean and press the Menu Select button 6 Using the Navigation buttons increase or decrease the high limit value and press the Menu Select button 7 Set the new low limit value and press the Menu Select button 107 Enabling Disabling NBP Alarms To enable disable NBP Alarms 1 Press the Menu Select button 2 Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button Select NBP and press the Menu Select button 4 Select Alarms On Off and press the Menu Select button Troubleshooting If your HeartStart MRx does not operate as expected during NBP Monitoring see Chapter 22 Troubleshooting on page 297 108 10 Monitoring Carbon Dioxide This chapter describes how to monitor carbon dioxide CO3 and measure end tidal carbon dioxide EtCO and Airway Respiration Rate AwRR with the HeartStart MRx using the Microstream sidestream method CO Monitoring is available in Monitor Pacer and Manual Defib modes Overview The carbon dioxide monitoring function of the HeartStart MRx together with the appropriate
326. rder of a physician AED Therapy To be used in the presence of a suspected cardiac arrest on patients of at least 8 years of age that are unresponsive not breathing and pulseless Manual Defibrillation Asynchronous defibrillation is the initial treatment for ventricular fibrillation and ventricular tachycardia in patients that are pulseless and unresponsive Synchronous defibrillation is indicated for termination of atrial fibrillation Noninvasive External Pacing Therapy The pacing option is intended for treating patients with symptomatic bradycardia It can also be helpful in patients with asystole if performed early Pulse Oximetry The SpO option is intended for use when it is beneficial to assess a patient s oxygen saturation level Noninvasive Blood Pressure Monitoring The NBP option is intended for noninvasive measurement of a patient s arterial blood pressure End tidal CO The EtCO option is intended for noninvasive monitoring of a patient s exhaled carbon dioxide and to provide a respiration rate 12 Lead ECG The 12 Lead ECG function is to provide a conventional diagnostic 12 Lead ECG report which may include measurements and interpretative statements Q CPR The Q CPR option provides feedback designed to encourage rescuers to perform resuscitation in accordance with AHA ERC guidelines for chest compression rate depth and duty cycle and ventilation rate volume and flow rate inflation time The
327. rdioverted at higher rates than the monophasic damped sine waveform at each step of the protocol although the cumulative biphasic rate after 4 shocks was not significantly different from the monophasic rate Tissue damage was more pronounced in the monophasic population 343 Clinical Performance Summary Internal Defibrillation Overview A study was conducted during the first half of 2002 to assess the effectiveness of the HeartStart MRx biphasic for use in intra thoracic application as compared to a control biphasic waveform This appendix summarizes the methods and results of the study Methods Twelve swine each weighing approximately 30 kg were anesthetized and intubated A sternotomy was performed to expose the heart VF was induced electrically by 60 Hz current via a pacemaker catheter in the right ventricle After 15 seconds of VF a defibrillating shock was applied using hand held 2 inch diameter surgical electrode paddles applied directly to the epicardium Shock energies of 2 5 10 20 and 30 J were used in random order At least 4 shocks at each energy level were administered for 4 separate VF episodes to derive a success data point at that energy Success was defined as conversion of fibrillating rhythm to non fibrillating rhythm five seconds after the shock Results The results showed that the average impedance was about 40 ohms in this study which is similar to th
328. rements ST and T Changes 142 The ACL TIPI s probability value substantially depends on the primary values for ST and T changes However ventricular conduction abnormalities and ventricular hypertrophy cause secondary ST and T wave changes that if misinterpreted as primary could cause erroneously high ACI TIPI scores Philips algorithm attempts to sort out the primary from the secondary ST and T changes when conduction abnormalities are present The algorithm issues a warning message if the distinction can t be made The algorithm excludes the ST and or T factors as appropriate from its calculations when it detects e Left ventricular hypertrophy can alter T waves and the ST segment e Right bundle branch block produces conduction delay Left bundle branch block produces conduction delay e Secondary repolarization ST and T abnormalities e The presence of an artificial pacemaker When such data is excluded from calculations the HeartStart MRx prints a message indicating the reason for a lower ACI TIPI score Critical Values Certain interpretive results generate Critical Value statements which alert you to a condition which may need immediate attention The Critical Value statements appear on the bottom of the HeartStart MRx 12 Lead display in white text on a red background with directional arrows gt gt gt lt lt lt on each side of the statement text Acute Myocardial Infarct If the interpretive statem
329. ress the Menu Select button If the device is configured to use a 12 hour clock format am or pm is displayed next to the hour For a 24 hour format only the hour is shown with choices from 0 to 23 7 Pressthe Exit Config soft key if finished with configuration Date and time should be changed to correspond with local clock changes for Daylight Savings Time and Summer Time Modifying Settings When modifying configuration settings the device should be connected to external power and have a battery with at least 20 capacity installed To modify configuration settings from the Configuration Main menu 1 Pressthe Change Config soft key 2 When prompted enter the configuration password 3 Press the Menu Select button Use the Navigation buttons to select the sub menu for the category of parameters to be changed Then press the Menu Select button 4 Usethe Prev Item and Next Item soft keys to select a parameter 5 Use the Navigation buttons to highlight the desired choices Press the Menu Select button to select the highlighted choice 6 Repeat steps 3 4 and 5 to select another sub menu and modify additional settings 7 Once the desired setting changes have been made from the Configuration Main screen press the Save Changes soft key You may press the Cancel Changes soft key to return to the previous settings 8 Pressthe Exit Config soft key to return to normal operating mode If you press Exit Config before saving
330. ressions 30 seconds without sign of compressions 45 seconds without sign of compressions Forty five seconds without sign of compressions 45 seconds without sign of compressions 60 seconds without sign of compressions Sixty seconds without sign of compressions 60 seconds without sign of compressions Poor pad patient contact Pads are on the patient but impedance is greater than 200 ohms or less than 25 ohms Press pads firmly to patient s bare chest Press pads firmly to patient s bare chest 172 Adjusting CPR Feedback Volume To adjust the volume of CPR feedback voice prompts 1 Press the Menu Select button 2 Using the Navigation buttons select Volume from the menu and press the Menu Select button 3 Select Voice and press the Menu Select button 4 Select the desired volume level and press the Menu Select button A sample voice prompt is annunciated to confirm your selection NOTE In AED Mode steps 2 and 3 are not applicable unless Q CPR is active If desired CPR feedback voice prompts may also be muted When muted a CPR Voice Muted text message displays in the middle of the wave sector containing the compression waveform during Manual Defib Mode or below the text prompt in AED Mode CPR inactivity time is indicated by an audible tone To mute the CPR feedback voice prompts 1 Press the Menu Select 4 button 2 Press the Menu Select button again to select Mute CPR V
331. ring Electrodes ___ Charged Batteries _ AC DC Power amp Cord ___ Printer Paper _ Data Card Inspected by Press the Print soft key when the Operational Check is complete to print an additional copy of the report 277 User Checks The guidelines for completing user checks are as follows Defibrillator Inspection Make sure the HeartStart MRx is clean including the surfaces of the paddles and paddle tray clear of objects and has no visible signs of damage Cables Connectors Paddles Pads Monitoring Electrodes Make sure there are no cracks broken wires or other visible signs of damage Make sure the connections are secure Check expiration date and quantity of pads and monitoring electrodes CPR meter Inspect the CPR meter and cable for visible signs of damage If damaged remove from use Check the meter s status light to confirm it is green CPR meter Adhesive Pads Make sure there is a CPR meter Adhesive Pad applied to the CPR meter and there is an adequate supply available Replace the pads at least every 2 years if it has not been used Batteries Make sure a charged battery is in the HeartStart MRx Another charged battery should be available or should be charging Ensure the batteries have no visible signs of damage AC DC Power Check the AC DC power source and power cord available 1 Connect the AC DC power module to the HeartStart MRx and plug it into a power outlet 2 Verify that the external power indicat
332. rk using a wireless connection make sure the device is off then insert the radio AC power module into Compartment B and press in until you hear it click Then plug the RS 232 connector into the RS 232 port on the HeartStart MRx and tighten the screwlocks Do not wiggle the connections Turn the device on Figure 90 Wireless Connection Physical Setup On the display The wireless icon o appears on your display in all clinical views indicating a wireless connection to the network Data can be exchanged with and viewed at the Information Center NOTE Be sure to fully connect the wireless radio AC module to the HeartStart MRx before turning the device on Failure to do so will prevent the HeartStart MRx from detecting the module If you connect the wireless radio AC module to the device after it has been turned on turn the power off for 10 seconds When you restart the HeartStart MRx it finds the wireless module and starts a new patient incident 180 Combined Connection NOTE In instances when you have both wired and wireless connections available See Figure 91 the wired connection takes priority If you lose the wired connection the device automatically attempts to connect to the network via the wireless radio AC module If the radio AC module is not connected to the device when you lose your wired connection you will not automatically switch over to wireless operation You must plug the module in and restart the device
333. rms page 125 NOTE When selecting a pressure label for a pressure channel the label assigned to the other pressure channel appears in your options list only if the other channel is not connected to a transducer If you select the same label as the other channel the label for the other channel changes to a non specific label P1 or P2 If you decide to re label the first channel the other channel s label remains non specific P1 or P2 NOTE To monitor a pressure from an arterial waveform when using an intra aortic balloon pump connect your invasive pressure device directly to the balloon pump 117 Pressure Waves Each pressure label has a set of scales for the pressure wave You can adapt the displayed wave to the offset and amplitude of the signal The scale can be modified through the Displayed Waves menu To select a pressure wave and the associated scale for the display or printed strip perform the following steps Press the Menu Select 9 button Using the Navigation buttons highlight Displayed Waves and press the Menu Select button Select Wave Position Wave 1 Wave 2 Wave 3 or Wave 4 and press the Menu Select button Select the appropriate label and press the Menu Select button naO O N e Select the appropriate scale and press the Menu Select button Available scales in mmHg 300 240 180 150 120 110 100 90 80 70 60 50 40 30 20 10 5 10 15 and 20 Available scales in kPa 38 0 32 0 26 0
334. rovides instructions on how to transmit data from the HeartStart MRx to various external devices using the suite of data transmission options available in the monitor defibrillator Overview There are two applicable scenarios for transmitting HeartStart MRx data e During a critical care event Transmission of vital signs and related data 12 lead waveforms and vital signs ahead of a critical care patient cardiac stroke trauma respiratory pediatric etc to alert a healthcare facility of an incoming critical care patient so the facility can prepare for the next level of care before the patient arrives See Transmitting During a Critical Care Event on page 240 e Post event Transmission of complete event data after an event has occurred for quality review billing and eventual archiving Transmitting Event Summaries Post Event on page 254 Depending upon what you are trying to do the HeartStart MRx can send 12 Lead Reports Event Summaries and or Periodic Clinical Data to a remote location See Figure 103 Figure 103 MRx Data Transmission Options During An Event KN Email an B Personal Computer Fax aptop Tablet Mobile TA Device a i T LAN Printer HeartStart MRx 1 x E SU Server running TraceMasterVue Cell Radio Tower data review ECG Management System 4 software onBoard Mobile Gateway from InMotion Technology Q Z r QD Rosetta LT CAR EPoint station GE MUSE
335. rs appear on the ECG waveform 8 Press Pacer Output Then use the Navigation and Menu Select buttons to a increase the output until cardiac capture occurs Capture is indicated by the appearance of a QRS complex after each pacing marker b decrease the output to the lowest level that still maintains capture 9 Verify the presence of a peripheral pulse NOTE Spontaneous beats may be present which are not associated with the delivery of pace pulses Additionally if the patient s heart rate is above the pacer rate pace pulses are not delivered and therefore pacing markers do not appear To stop delivery of pace pulses press Pause Pacing Once paused press Resume Pacing to resume delivery of pace pulses You may also stop delivery of pace pulses by moving the Therapy Knob off the Pacer position WARNING When Pacing in demand mode the ECG cable must be directly connected from the patient to the HeartStart MRx WARNING Ifyou are using the pacing function with battery power and the Low Battery Alarm is annunciated connect the device to external power or insert a fully charged battery NOTE Routinely assess the patient s cardiac output by assessing peripheral pulses NOTE Pacing will not start if there is a problem with the multifunction electrode pads connection or patient contact Pace pulses will not be delivered if there is a problem with the ECG monitoring electrodes connections If either situation occurs
336. ry another sensor The SpO waveform is not configured to be displayed and there is not an unused wave sector Use the Displayed Waves menu to select a wave sector for display of the SpO waveform SpO Non Pulsatile INOP The patient s pulse is absent or too weak to be detected The sensor has come off Check perfusion at the measurement site Check that the sensor is applied properly Make sure the sensor site has a pulse Relocate the sensor to another site with improved circulation If the message occurs due to NBP measurement on the same limb wait until the NBP measurement is finished Try another sensor SpO Erratic INOP The SpO numeric value is replaced with a SpO measurement readings are erratic Check that the sensor is applied properly Make sure the sensor site has a pulse Relocate the sensor to another site with improved circulation Try another sensor SpO Noisy Signal INOP Excessive patient movement or electrical interference Minimize patient movement Make sure the sensor cable is not positioned too close to power cables SpO Interference INOP The SpO numeric value is replaced with a Ambient light is too high Cover the sensor with an opaque material to minimize ambient light Make sure the sensor cable is not positioned too close to power cables Make sure that the sensor cable is not damaged SpO Unplugged INOR The Sp
337. s Temperature Label Equip Malfunction INOP There has been a malfunction in the temperature hardware Contact Service Temperature Label Qverrange INOP The temperature value is outside the measurement range of the device lt 0 C or gt 45 C Check that the temperature probe is on the list of supported accessories Try changing the application site Temperature Label Unplugged INOP The temperature transducer is faulty or has been disconnected from the device Try unplugging and then replugging the temperature transducer If the symptom does not go away use a different transducer Temperature Label one of the labels which can be applied to a temperature measurement 313 Table 96 Pulse Problems Pulse Check Source INOP The currently selected pulse source Switch to the secondary pulse source is not available but another possible pulse source is on See SpO2 Monitoring Problems on page 303 and Invasive Pressure Monitoring Problems on page 312 for further troubleshooting information Table 97 Q CPR Problems The CPR meter display is dark The CPR meter is not connected to Confirm all CPR meter and cable connections are in and the status light is not on the HeartStart MRx place and the HeartStart MRx is turned on CPR meter status light is Malfunction in the meter Remove the CPR meter from service and contact orange and the display is dark Phil
338. s When on pulse alarms annunciate if measurements fall outside of the limits for high or low pulse Alarms are turned off unless you turn them on during use Once turned on alarms remain on until they are turned back off NOTE X symbol replaces the limits Enabling Disabling Pulse Alarms Pulse alarms are turned off by default To turn the pulse alarms on for the current incident perform the following steps 1 Press the Menu Select button w 2 Using the Navigation buttons select Measurements Alarms and press the Menu Select button 3 Select Pulse and press the Menu Select button 4 Select Alarms On and press the Menu Select button The alarms will now be on To turn alarms off repeat the steps above except select Alarms Off in Step 4 If pulse alarms are enabled alarm limits appear next to the pulse value If alarms are off the Alarms Off Pulse Alarm Limits Pulse alarm limits can be changed for the current incident To change alarm limits perform the following steps Press the Menu Select button Using the Navigation buttons select Measurements Alarms and press the Menu Select button Select Pulse and press the Menu Select button 1 2 3 4 Select Pulse Limits and press the Menu Select button 5 Using the Navigation buttons select the new high limit value and press the Menu Select button 6 Select the new low limit and press the Menu Select button Changing Default Pulse Source and
339. s Resume Analyzing If you press Pause for CPR after a shock is delivered in the current Shock Series the length of the CPR Pause is defined by the CPR Timer Configuration Choice NOTE You may return to analyzing the patient s heart rhythm at any time by pressing the Resume Analyzing soft key NOTE Once prompted to Deliver Shock Now Press the Orange Button Now if you do not do so within the configured Auto Disarm time interval the HeartStart MRx disarms itself and provides a pause for CPR The device resumes analyzing at the end of the configurable pause period or when the Resume Analyzing soft key is pressed NOTE Rhythm Monitoring is intended to provide a backup or secondary measure of potentially shockable rhythms in various environments but is not a substitute for being attentive to the state of the patient Using Q CPR in AED Mode If your HeartStart MRx is equipped with the Q CPR option your default view is Basic View For more information see Basic View on page 170 You can configure the device for Advanced View See AED Settings on page 218 for more information Troubleshooting If your HeartStart MRx does not operate as expected during defibrillation see Troubleshooting on page 297 6 Ke 6 NOTE Manual Defibrillation and Cardioversion This chapter explains how to prepare for and perform asynchronous and synchronous cardioversion defibrillation using multifunction electrode
340. s a trademark of Oridion Medical Ltd Q CPR is a registered trademark of Laerdal Medical AS The HeartStart MRx contains an Ezurio PC Card with Bluetooth wireless technology The Bluetooth wordmark and logos are owned by the Bluetooth SIG Inc and any use of such marks by Ezurio is under license Coverage Plus and Coverage Plus NPD are registered trademarks of Steris Corp CidexPlus is a registered trademark of Advanced Sterilization Products Nellcor is a registered trademark of Nellcor Puritan Bennett Inc TransPac IV is a registered trademark of ICU Medical Inc TruWave is a registered trademark of Edwards Lifescience Corp DTX Plus is a trademark of Becton Dickinson amp Co Notice RelyOn and Virkon are registered trademarks or trademarks of E I du Pont de Nemours and Company or its affiliates Other trademarks and trade names are those of their respective owners Use of supplies or accessories other than those recommended by Philips may compromise product performance THIS PRODUCT IS NOT INTENDED FOR HOME USE U S FEDERAL LAW RESTRICTS THIS DEVICE TO SALE ON OR BY THE ORDER OF A PHYSICIAN Medical Device Directive The HeartStart MRx complies with the requirements of the Medical Device Directive 93 42 EEC and carries the C 0123 mark accordingly Manufacturer Philips Medical Systems 3000 Minuteman Road Andover MA 01810 USA Authorized EU representative Philips Medizin Systeme B blingen GmbH
341. s and messages are often accompanied by a voice prompt or an audible beeping tone This chapter describes the INOP statements and messages that you may see along with other symptoms and provides suggestions for what to do In addition this chapter provides an explanation of audible tones and information on contacting your service representative If you are unable to resolve a problem using the suggestions in this chapter e Run an Operational Check to determine if there is a malfunction requiring service e Ifa malfunction is identified call for service e Take the HeartStart MRx out of use if there is a malfunction affecting ECG monitoring defibrillation or pacing For malfunctions related to SpO NBP Invasive Pressures Temperature CO monitoring or 12 Lead functionality take the device out of service if the function is essential to patient care in your organization Results of Automated Tests associated with critical functionality of the device are reported through the Ready For Use indicator and the Automated Test Summary report For information on responding to these results see Ready For Use Indicator on page 266 To respond to errors reported through Operational Check see Operational Check Test Results on page 279 For further technical and repair information refer to the HeartStart MRx Service Manual WARNING Product servicing and repair should only be performed by qualified service personnel 297 Sympt
342. s annunciated when a measurement for the configured source systolic diastolic or mean falls outside the configured high or low limits NBP alarms are all categorized as non latching alarms meaning they are automatically removed when their alarm condition no longer exists Both the source of the alarm and the limits may be changed during use for the current patient incident NBP alarms are on unless you disable them Once disabled alarms remain off until enabled Table 11 lists NBP alarms Table 11 NBP Red Yellow Physiological Alarms NBPs High Yellow Yellow alarm message The NBP systolic value exceeds the high alarm tone alarm limit NBPd High Yellow Yellow alarm message The NBP diastolic value exceeds the alarm tone high alarm limit NBPm High Yellow Yellow alarm message The NBP mean value exceeds the high alarm tone alarm limit NBPs Low Yellow Yellow alarm message The NBP systolic value has fallen below alarm tone the low alarm limit NBPd Low Yellow Yellow alarm message The NBP diastolic value has fallen below alarm tone the low alarm limit NBPm Low Yellow Yellow alarm message The NBP mean value has fallen below the alarm tone low alarm limit WARNING Turning off alarms prevents all alarms associated with the NBP measurement from being annunciated If an alarm condition occurs NO alarm indication will be given Changing NBP Alarms To change the NBP alarm sou
343. s aren t being transferred as often as I want The device is configured to a longer transmission interval In Configuration Mode change the Transmit Interval to a shorter period of time Connection lost icon The connection has timed out Connection will automatically be re established with next PCDT Connection lost see Transmission Problems Bluetooth on page 304 Table 89 Transmission Problems Batch LAN Data Transfer Device does not automatically display BLDT menu LAN cable is not properly connected to HeartStart MRx and external server Connection lost message Successful connection to the Data Messenger server was lost Unplug and re plug in the LAN cable from both devices assuring a solid connection Confirm that HeartStart MRx is in Data Management Mode and Data Messenger is active on the receiving server Contact your IT professional for assistance 308 Table 90 CO Monitoring Problems The CO waveform does not appear on the display The FilterLine is not properly connected Check the FilterLine connection Check tubing for knots kinks or pinches The CO waveform is not configured to be displayed and there is not an unused wave sector Use the Displayed Waves menu to select a wave sector for display of the CO waveform CO Unplugged INOR The FilterLine is disconnected Check the FilterLine connection and tub
344. s buildings used for domestic purposes Voltage Complies fluctuations flicker emissions IEC 61000 3 3 352 Table 110 Electromagnetic Immunity General Electrostatic discharge ESD IEC 61000 4 2 6 kV contact 8kV air 6 kV contact 8kV air Floors should be wood concrete or ceramic tile If floors are covered with synthetic material the relative humidity should be at least 30 Electrical fast transient burst IEC 61000 4 4 2 kV for power supply lines 1 kV for input output lines 2 kV for power supply lines 1 kV for input output lines Mains power quality should be that of a typical commercial or hospital environment Surge IEC 61000 4 5 1 kV differential mode 2kV common 1 kV differential mode 2 kV common Mains power quality should be that of a typical commercial or hospital environment 50 60 Hz magnetic field IEC 61000 4 8 mode mode Voltage dips short lt 5 Ur lt 5 Ur Mains power quality should be that interruptions and gt 95 dip in Ur gt 95 dip in Uy of a typical commercial or hospital voltage variations on for 0 5 cycle for 0 5 cycle environment power supply input 40 Ur 40 Uz ne 60 dip in Uy 60 dip in Uy IEC 61000 4 11 for 5 cycles for 5 cycles 70 Ur 70 Ur 30 dip in Uy 30 dip in Uy for 25 cycles for 25 cycles lt 5 Ur lt 5 Ur gt 95 dip in Ur
345. s cable to the HeartStart MRx by aligning the white pointer on the pads cable with the white arrow on the green Therapy port Then push until you hear it click into place See Figure 53 Figure 53 Pads Cable Connection 2 Make sure the multifunction electrode pads packaging is intact and within the expiration date shown 3 Connect the pads connector to the pads cable See Figure 54 Figure 54 Pads Connectors 4 Apply the pads to the patient as directed on the pads packaging or according to your organization s protocol Prepare the patient s skin prior to applying the pads Skin is a poor conductor of electricity so skin preparation is important in achieving good contact If necessary clip hair at the electrode sites or shave sites if needed Clean and abrade the skin at the electrode site Dry the electrode sites briskly to increase capillary blood flow in the tissues and to remove oil and skin cells 87 5 Ifpacing in demand mode apply monitoring electrodes see Electrode Placement on page 51 and connect the ECG cable to the HeartStart MRx see Connecting the ECG Cable on page 35 NOTE If pacing for long periods of time new monitoring electrodes and multifunction electrode pads should be applied periodically Refer to the manufacturer s documentation for replacement recommendations NOTE The signal from a TENS unit can cause ECG artifact which may impact pacing Demand Mode Pacing To pac
346. s on CPR Meter 164 CPR Meter Display The CPR meter provides real time graphical feedback as a coaching tool once CPR compressions begin See Figure 81 Figure 81 CPR Meter Indicators Compression Release Target a Compression Depth Indicator a Compression Depth Target Compression Rate Target Compression Rate Indicator u Compression Depth As you perform CPR on the patient the CPR meter display tells you what your compression depth is and if you are not completely releasing pressure after a compression See Figure 82 Figure 82 Compression Depth Indicator Each compression performed is represented on the CPR meter display by a moving white compression depth indicator bar When the correct compression depth is achieved the bottom target lights up When D the pressure is completely released the top target lights up If your compression fails to meet the target depth 40mm 1 5 inches the compression depth target zone does not light up If four consecutive compressions fail to meet the depth target a yellow arrow appears on the display pointing to the depth target zone If the compression depth is not corrected the HeartStart MRx provides corrective voice prompts if configured If your compression exceeds the compression depth target 50mm 2 inches the CPR meter will show the depth indicator bar below the target area If you do not fully release pressure between four shows
347. se Sufficient battery power is available for device operation Additionally a blinking black hourglass together with the presence of external power AC or DC indicates that installed battery s are being charged A blinking red X and a periodic audio chirp indicate no battery is present or a low battery condition The device can be used but its operation time is limited If a battery is inserted and charging the audio chirp is not present e A solid red X and a periodic audio chirp indicate a failure has been detected that may prevent the delivery of defibrillation therapy pacing or ECG acquisition When turned on the device displays INOP messages for the failures detected e A solid red X without periodic audio chirps indicates either there is no power available or the device cannot power on If after power is supplied the indicator reverts to the blinking black hourglass symbol the device is once again ready for use NOTE The RFU indicator may briefly display a solid red X when initially turning the device on when switching between clinical and non clinical operating modes and at the start of any automated test This does not indicate a failure of the device External Power Indicator The external power indicator is located above the display It is green if power is being provided by an external AC or DC power source See Figure 13 Figure 13 External Power Indicator a Lan NOTE The external power
348. sed on different patients NOTE A 2 meter SpO extension cable M1941A is available for use with the HeartStart MRx 8 Pulse Oximetry plying the Sensor Applying the Sensor Follow the manufacturer s directions for applying and using the sensor making sure to observe any warnings or cautions For the best results e Make sure the sensor is dry e Ifthe patient is moving secure the sensor cable loosely to the patient e Make sure the transducer is not too tight Too much pressure can cause venous pulsation or can impede the blood flow resulting in low readings e Keep power cables away from the sensor cable and connection e Avoid placing the sensor in an environment with bright lights If necessary cover the sensor with opaque material e Avoid placing the sensor on an extremity with an arterial catheter blood pressure cuff or intravenous infusion line WARNING Failure to apply the sensor properly may reduce the accuracy of the SpO measurement e Inspect the sensor application site at least every two hours for changes in skin quality correct optical alignment and proper sensor application If skin quality is compromised change the sensor site Change the application site at least every four hours More frequent checking may be required due to an individual patient s condition e Using an SpO sensor during MR imaging can cause severe burns Minimize this risk by positioning the cable so that no inductive loops
349. sethe Prev Item and Next item 3 Use the Navigation buttons to highlight softkeys to highlight the correct Event Send All and press the Menu Select button Summary to download to select and send your data 4 Use the Navigation buttons to highlight Send Selected and press the Menu Select button 5 Use the Navigation buttons to highlight the type of data you wish to download See Figure 111 Press the Menu Select button to select and send your data Figure 117 Transferring files with BLDT computer network name lt Name of the host received when IP address is obtained Send Selected Send All Exit Downloads the single Event Summary highlighted in Data Management Mode Downloads all Event Summaries from Data Management Mode lt Select Exit to exit the menu Tracking Transfer Once the transfer begins the HeartStart MRx tracks transmission progress indicating the number of files sent and the percent complete See Figure 118 Figure 118 BLDT Transmission Message Processing 1 of 1 Sending 32 Complete When the transmission is complete the HeartStart MRx displays a Transmission Complete message Press the Menu Select button to acknowledge the message The transmitted file appears in the destination folder which was set up on the Data Messenger Server NOTES You must wait for a BLDT to complete before starting to send the next set of information 260 Cancelling BLDT To can
350. shockable Rhythm 500 Meets AAMI DF39 requirements and AHA Asystole recommendation specificity gt 95 for adult defibrillation Non shockable Rhythm 600 Meets AAMI DF39 requirements and AHA All other non shockable recommendation specificity gt 95 for adult defibrillation rhythms a From Philips Medical Systems ECG rhythm databases b American Heart Association AHA AED Task Force Subcommittee on AED Safety amp Efficacy Automatic External Defibrillators for Public Access Use Recommendations for Specifying and Reporting Arrhythmia Analysis Algorithm Performance Incorporation of New Waveforms and Enhancing Safety American Heart Association AHA AED Task Force Subcommittee on AED Safety amp Efficacy Circulation 1997 95 1677 1682 ECG and Arrhythmia Monitoring Inputs Up to four 4 ECG waves may be viewed on display and up to two 2 waves printed simultaneously Lead I II or III is obtained through the 3 wire ECG cable and separate monitoring electrodes With a 5 lead ECG cable leads aVR aVL aVF and V can also be obtained Pads ECG is obtained through 2 multifunction electrode pads Lead Fault LEAD OFF message and dashed line appear on the display ifan electrode or lead becomes disconnected Pad Fault Dashed line appears on the display if a pad becomes disconnected Heart Rate Display Digital readout on display from 15 to 300 bpm with an accuracy of 10 Heart Rate Arrhythmia Alarms HR
351. smission device uses two way radio to transmit 12 Lead Reports from Data Management Mode The Batch Data Transfer option uses a LAN cable to download a single Event Summary or all Event Summaries on your internal data card Transmitted Event Summaries include all stored waves trending data 12 Lead Reports and event files including vital signs such as heart rate pulse SpO EtCO AwRR NBP invasive pressure and temperature numerics If your HeartStart MRx has the Audio and or Q CPR Data options you can include these parts of the Event Summary NOTE Event Summaries can only be transferred via Bluetooth to devices that support the Bluetooth File Transfer Profile Server To transmit an Event Summary or 12 Lead Report from the HeartStart MRx s internal memory to a receiving device perform the following 1 After you have finished monitoring the patient and removed them from the HeartStart MRx place the device into Data Management Mode The display reads Data Management Internal Memory across the top 2 Using the Prev Item and Next Item softkeys highlight the Event Summary you want to transmit or the Event Summary which contains the 12 Lead Report you want to transmit and press the Menu Select button 3 Highlight Send and press the Menu Select button 4 Highlight the type of data you want to transmit see Figure 111 and press the Menu Select button Figure 111 Send Functions Highlight All Event Data to send an entire event incl
352. soft key turns off the Sync function Conversely pressing the Sync button turns off Q CPR The Start CPR soft key is disabled if patient category is Pedi or patient age is less than 8 years old 169 Basic View When selecting Basic View the HeartStart MRx displays the following parameters depending upon your configuration See Figure 86 e CPR Timer e AED and Q CPR prompt commands See Feedback Prompts on page 172 Figure 86 Basic Q CPR View 11 Feb 2006 22 25 C Ex R Alarms Off 180 02 09 Pads Shocks 0 a CR Time Status Bar COMPRESS FASTER l AED and Q CPR prompt area 170 Using Q CPR in Manual Defb Mode 1 Q CPR and Data Capture Using Q CPR in Manual Defib Mode When the Therapy Knob is moved to the 150J Manual Defib setting the Advanced CPR View is automatically displayed only if the Sync function is disabled patient category is Adult and patient age is equal to or greater than 8 years old Advanced View is automatically displayed after the Manual Therapy Security password is entered only if Manual Defib Mode is password protected When the Therapy Knob is located on any other Manual Defib setting a compression on the CPR meter turns on Advanced CPR View Advanced View may also be manually displayed by pressing the Start CPR soft key Also the patient category must be Adult and the patient age must be equal to or greater than 8 years old to display the view for either ac
353. solution 5 Flush the system to expel air from the tubing Make sure the stopcocks and transducer are also free of air bubbles WARNING If air bubbles appear in the tubing system flush the system with infusion solution again Air bubbles may lead to an incorrect reading 6 Connect the pressure line to the patient catheter 115 7 Ifyou are using an infusion pressure cuff with the pressure line attach the pressure cuff to the fluid to be infused Inflate it according to your hospital s standard procedure then begin the infusion Position the transducer so that it is level with the heart approximately at the level of the midaxillary line WARNING If measuring intracranial pressure ICP with a sitting patient level the transducer with the top of the patient s ear Incorrect leveling may lead to an incorrect reading Selecting a Pressure to Monitor You need to assign a label to each pressure channel as it is connected Channels are identified as Press 1 and Press 2 You can apply labels to each pressure channel by selecting the appropriate pressure label using the Menu Select button Once you select a label the HeartStart MRx will use that label s stored information color alarm source and limits scale as the default You should check each pressure channel label as the cable is connected and make changes as appropriate To select a pressure label perform the following steps 1 Press the Menu Select button
354. sor 1 standard deviation 70 to 100 3 0 NOTE Accuracy outside the range indicated for each sensor is not specified The above referenced sensors were validated for use with the HeartStart MRx using the Philips picoSAT II SpO module with Fourier Artifact Suppression Technology FAST This module is not available as a stand alone device NOTE Pulse oximeter equipment measurements are statistically distributed therefore only two thirds of pulse oximeter equipment measurements can be expected to fall within Arms of the value measured by a CO oximeter The HeartStart MRx is calibrated to display functional oxygen saturation Ambient Light Sensitivity Interference from fluorescent light is lt 2 SpO perfusion between 0 3 and 1 typical transmission 50nA mA 10 to 1000 1x light intensity 50Hz 0 5Hz as well as 60Hz 0 5Hz line frequency SpO Alarm Range Low Limit 50 to 99 Adult Pediatric High Limit 51 to 100 Adult Pediatric SpO and Pulse High Low Alarm Signal Generation Delay 10 seconds SpO Response Time 90 to 80 average 18 9 seconds standard deviation 0 88 seconds SpO Averaging Time 20 seconds Maximum Power Output lt 15mW 328 Wavelength Range 500 1000nm Information about wavelength range can be useful to clinicians especially those performing photodynamic therapy average 18 9 seconds standard deviation 0 88 seconds Desat Alarm Signal Generation Delay 20 seconds Pulse Rate Measurement Range
355. splayed tai Shock Button Tests the Shock button e Once charged the Shock e Press the Shock button e Ifthe Shock button is not working press Shock from the No Button Response menu The Shock button test is marked Fail Select Shock from the menu to continue the Operational Check or press Exit Op Check The Shock button test is marked Fail Table 76 Operational Checks Test Continued Audio If a shock was delivered during Did you hear Shock No Shock Use the navigation buttons to the Shock test the voice Delivered respond Yes or No Then press prompt Shock Delivered is the Menu Select button annunciated If no shock was delivered during the Shock test the voice prompt No Shock Delivered is annunciated Defib Tests defibrillation circuitry and None None delivers a shock through e pads into a test load and or e external paddles into the MRx Note The Defib test has two components a high energy internal discharge and a low energy 5J external discharge The results of the device s ability to charge and shock are reported in the Defib test Pacer Tests pacing functionality and None None delivers a paced pulse into a 50 ohm test load CPR meter Checks the basic None None communication circuity of the meter Leads ECG Tests leads ECG acquisition None if test passes If test fails the If the ECG test fails with the and the ECG cable following prompt is displaye
356. ss involves the first 15 valid non noisy beats encountered during the learning phase The family selected to represent the normal complex includes the beat that is the most frequently seen narrowest on time beat For this reason learning should not be initiated when the patient s rhythm is primarily ventricular Arrhythmia learning relearning automatically occurs when the Therapy Knob is turned on to Monitor Pacer or Manual Defib any time there is a change in the lead selection for Wave Sector 1 and after the correction of a Leads or Pads Off INOP condition that has been active longer than 60 seconds Manual relearning should be initiated if the beat detection is not occurring or if beat classification is incorrect and results in a false alarm Remember however that if the same signal condition which caused the algorithm to perform poorly still persists relearning will not be able to correct the problem The problem can only be corrected by improving the quality of the signal e g by selecting a different lead To initiate relearning manually 1 Press the Menu Select 9 button 2 Using the Navigation buttons select Measurements Alarms from the menu and press the Menu Select button 3 Select HR Arrhythmia and press the Menu Select button 4 Select Relearn Rhythm and press the Menu Select button The messages Learning ECG and Learning Rhythm appear in the rhythm status area of the display WARNING If
357. ssion begins See Figure 112 Figure 112 Sending 12 Leads from Data Management Send To Send Transmission Devices Rosetta All Events Data i Medic Phone 1 Exclude Audio amp Q CPR ETE Pead OMG Gateway m 5 St Joseph s Cath Lab 1 25 Apr 2007 11 15 P 3 Data Mess PC 2 25 Apr 2007 11 30 eS gurediDevt p 20th Configured Device Exit Dr Jones Exit EMS Station Fax Number Exit If you selected an Event Summary If your device is configured with just one transmission device transmission begins If your device has more than one configured transmission device highlight the option you want to use and press the Menu Select button Transmission begins See Figure 113 Figure 113 Event Summary Transmission Transmission Devices Medic Phone 1 OMG Gateway Data Mess PC 20th Configured Device Exit NOTES Ifyou press the Exit Data Management softkey while a transmission is ongoing you need to confirm your selection Selecting Yes exits Data Management cancels your current transmission and any queued transmissions Selecting No continues the current transmission If you print an event in Clinical Mode and switch to Data Management Mode the printing must be complete before the event can be copied or sent Failure to do so results in either a Cannot copy this event while printing or a Cannot send this event while printing message If you get either message
358. st fails repeat it using a different specified cable type pads external paddles attached therapy cable A passing result with a different lt Fail cable type The test failed with the specified cable indicates the previous cable is defective able type connected and should be replaced If the test continues to fail take the device out of use and call for service Pacer e Pass Pacing is functioning If the pacer fails attach a different pads cable Pal Gig enor Doctori and test load and repeat the test If the pacer fails again take the device out of use and call for service CPR meter e Pass The CPR meter passed its self test If the test fails call for service If Q CPR is e Fail The CPR meter failed its self test essential to patient care take the device out of use Leads ECG Pass ECG Cable leads ECG acquisition and the If the test fails without an ECG cable ECG cable connected are both functioning connected take the device out of use and call Pass No Cables leads HCG acquisition is for service If the test fails with a cable repeat functioning the test without an ECG cable attached A passing result without a cable attached e Fail ECG Cable leads ECG acquisition and or the indicates the cable is defective and should be ECG cable connected are not functioning replaced If the test continues to fail take the Fail No Cable leads ECG acquisition is not device out of use and call for service functioning 2
359. t button lights and you are prompted to Press Shock or Press Shock buttons on paddles e Ifthe MRx does not detect a press of the Shock button within 10 seconds the message If the Shock button does not work select Shock from the menu below is displayed Note The device automatically disarms after the time specified in the configuration is reached The message Defib Disarmed is displayed General System Tests internal clock battery None None power supply and internal memory card Therapy Knob Tests if the Therapy Knob is set None None to 150J Charge Button Tests the Charge button Depending on the cable Respond to the prompt as connected as follows follows e Ifthe Pads cable is attached Check the test load is you are prompted to Verify attached and press the Test Load is Attached and Charge button Press the Charge Button e Ifexternal paddles are e Make sure the paddles are attached you are prompted to seated in their pockets and Verify Paddles are in Holders press the Charge button and Press the Charge Button e If no cable is attached the test is marked Not Tested If the MRx does not detect a press If the Charge button is not ee working press Charge from the of the Charge button within 10 No Button Response menu The seconds the message If the Charge button does not work select Charge button test is marked Charge from the menu below is Fail and the Operational Check di
360. t within range Move the Bluetooth device closer to the MRx within the transmitting range See the Transmission Implementation Guide for information on transmission ranges Bluetooth device pairing failed message The wrong pass code was entered on the Bluetooth device Check the pass code Select the device from the MRx Add Devices list and pair again The pairing process timed Try pairing again out The Bluetooth card is Call for service corrupt No Bluetooth Devices Configured message The Bluetooth device has not been paired with the MRx Pair the Bluetooth device with the MRx No transmission devices detected message The Bluetooth device is not turned on Make sure the Bluetooth device is turned on The Bluetooth device is not within range Move the Bluetooth device closer to the MRx within the transmitting range See the Transmission Implementation Guide for more information The Bluetooth pairing Pair the Bluetooth device with the MRx information has been lost The Bluetooth card is Replace the Bluetooth card corrupt Transmission Failed No Dial Tone message Cell phone service is unavailable The Bluetooth modem connection is not secure The connection you are using does not provide dial tones Check that the cellular signal strength is sufficient Check that the connection between the Bluetooth modem and the analog line is secure Set
361. t 25Jan2006 9 26 If the process is unsuccessful you get an Unable to zero message with a probable cause message displayed Table 15 lists probable cause messages Table 15 Unable toZero Probable Causes Equipment Malfunction Hardware is faulty Contact your service personnel Excessive Offset Make sure the transducer is vented to the air and try again If this doesn t Unstable Signal work replace the transducer cable and try again If it still doesn t zero replace the transducer and try again If it still will not zero contact your service personnel No Transducer Reconfirm that the transducer is connected and try again If this doesn t work replace the transducer Pulsatile Pressure Make sure that the transducer is vented to air and not the patient Try again NOTE Upon successful completion of the process close the stopcock to atmospheric pressure which opens the stopcock to the patient Calibration The HeartStart MRx allows you to input the calibration factor see documentation supplied by the transducer s manufacturer of a new transducer plugged into the pressure line Known Calibration Factor To set a known calibration factor perform the following Zero the transducer see previous section Press the Menu Select button Using the Navigation buttons select Measurements Alarms and press the Menu Select button Select the correct pressure channel label and press the Menu Select button
362. t MRx and are displayed on the Add Device menu even if you have already paired with the device You can also add a Bluetooth device in Data Management Mode during Periodic Clinical Data Transmission and from the Other option from the Main menu The process is the same beginning with Step 2 above Pairing a Bluetooth Device with the HeartStart MRx Once a Bluetooth device is selected from the Add Devices menu a passkey sequence must be performed in order to communicate or pair the wireless device with the HeartStart MRx The passkey is a user defined character sequence such as 000 or 1234 etc Some Bluetooth devices only allow pairing for 30 seconds so be ready to enter the passkey 1 Use the Navigation buttons to enter the passkey on the MRx and select Done The Bluetooth device prompts you for a passkey 2 Enter the same passkey on your Bluetooth device See the documentation that came with your Bluetooth device for instructions 3 You are prompted to select a Bluetooth Service Highlight File Transfer or Dial Up Networking and press the Menu Select button Generally phones and gateways are Dial Up Networking and personal computers are File Transfer If you are unsure of which service to select contact your Philips installation manager for more information 4 Ifyou selected dial up networking select the designated profile from the Phone Modem Profiles menu If you selected file transfer proceed to the next step You will not
363. t connection status Wired Wireless or Inactive MAC Address HeartStart MRx MAC address wired MAC Instr Tele Instrument Telemetry Radio Module MAC address RF Access Code Used to identify which RF radio frequency channel the HeartStart MRx Information Center wireless communications use Set in Configuration Mode IP Address Current IP address HeartStart MRx wired or Radio Module wireless Server IP Information Center IP address Subnet Mask Subnet mask of wired or wireless network RSSI Instrument Telemetry Radio s Received Signal Strength Indicator Value updates while window is open 183 Admit Discharge Transfer of Patients Admit A HeartStart MRx with the IntelliVue Networking Option synchronizes and maintains common patient demographic data with the Information Center The HeartStart MRx can admit discharge and transfer ADT patients to or from the Information Center and update or modify patient information The HeartStart MRx will also accept certain patient admission data entered at the Information Center including name medical record number patient ID patient type category date of birth gender sex and paced status It does not display height or weight from the Information Center The HeartStart MRx displays physiological data and stores it as soon as a patient is connected This allows you to monitor a patient who is not yet admitted You need to admit patients prop
364. t has an associated severity The severities of all selected interpretive statements are assessed to determine an overall severity for the ECG The categories of severity are Normal ECG Otherwise Normal ECG Borderline ECG Abnormal ECG and Defective ECG Probability of Acute Ischemia If your HeartStart MRx has the ACI TIPI and TPI option configured for use your 12 Lead Report contains a predicted probability score of Acute Cardiac Ischemia The ACI TIPI score does not appear if you are configured for Auto ACI TIPI and you get an Acute MI statement or an ECG severity of normal If the predicted probability is greater than or equal to the pre configured ACI Threshold then results are displayed in white text on a red background Stored and printed 12 Lead Reports can be configured to include all 12 leads measurements interpretive analysis statements ACI TIPI analysis results TPI analysis results and TPI contraindications One or two copies of the 12 Lead Report are printed at the completion of acquisition and or analysis as configured Press the Print soft key to print another copy In addition to the information on the displayed 12 Lead Report the printed report includes a rhythm strip with up to three ECG leads WARNING Do not pull on the paper while a report is being printed This can cause distortion of the waveform and lead to potential misdiagnosis NOTES Should an alarm condition occur while a 12 Lead Report
365. t is also for connecting with the Rosetta Lt and cellphones for data transmission Improper system operation may result if any other device is connected to this port 11 2 Getting Acquainted 538A Lithium lon Battery M3538A Lithium lon Battery The HeartStart MRx uses the M3538A Lithium Ion Battery The battery has a fuel gauge with 5 LED indicators each representing a charge of at least 20 of capacity Press the fuel gauge button to illuminate the fuel gauge CAUTION A battery should be used as the primary power source AC DC should be used as a secondary source if desired Ifan AC DC power module is used as the only power source the HeartStart MRx takes longer to charge to the desired energy level and in the event of power loss all settings reset to the default settings and a new incident is created when power is returned All stored data remains intact and can be found by retrieving the previous incident Keep your unit charged Battery Capacity A new fully charged M3538A battery operating at room temperature 25 C 77 F provides at least 5 hours of monitoring with ECG SpO CO3 temperature two invasive pressures monitored continuously NBP measured every 15 minutes and 20 200J discharges A fully charged new battery provides approximately 3 5 hours of monitoring with ECG SpO CO temperature two invasive pressures monitored continuously NBP measured every 15 minutes and pacing at 180ppm at 160mA Battery Lif
366. t listed in the display Scrolling in the Vital Signs Trending Report Use the lt lt or gt gt softkeys to scroll left and right backward and forward in the Vital Signs Trending Report The softkey will be displayed as inactive if there is no more data to be viewed in a particular direction If there are more vital signs than can be shown on the screen use the Navigation buttons next to the Menu Select button to scroll up and down with the vertical scroll bar on the display Make sure there is not a menu active at the same time Vital Signs Trending Report Intervals Vital Signs Trending data can be shown at selected intervals for up to 12 hours of monitoring You can adjust the display s time interval for the current incident to 1 5 10 15 30 or 60 minutes The default is 5 minutes Adjusting Vital Signs Trending Report Interval To adjust the intervals in the Vital Signs Trending report perform the following steps 1 With Vital Signs Trending active on your display press the Menu Select Y button 2 Using the Navigation buttons select Trend Interval and press the Menu Select button 3 Using the Navigation buttons select the trend interval you want and press the Menu Select button 153 Printing the Vital Signs Trending Report You can print the Vital Signs Trending Report two ways 1 Press the soft key under the Print Trends label A report for the displayed period and interval is printed 2 Press the Summary bu
367. tStart MRx does not revert to the initial source of ECG but you can select a lead by pressing the Lead Select button WARNING Do not use the HeartStart MRx to monitor neonatal ECGs Doing so could result in inaccurate measurements and alarms Monitoring View Monitoring View appears on the display when the Therapy Knob is in the Monitor position Figure 31 shows the information displayed in Monitoring View Figure 31 Monitoring View Mark Event 10Feb 2006 11 20 A_ hE Patient Name 02 42 Li alarms Adult Non Paced Temp C Pulse bpm AF a m OOs 36 988 Bom W e mmHg PAP mmHg Sp02 EtCO2mmHg AwRR Pm 118 77 sis 24 10 IA 5 15 100 383 18 Start 12 Lead NBP Monitoring View can display up to four ECG waves Numeric values for heart rate and all other available parameters are displayed as well as any active alarm settings 48 There are two separate sources of ECG the ECG leads connection and the Pads Paddles connection Leads pads are displayed according to your device s configuration Lead II is configured as the primary ECG lead source and is displayed in Wave Sector 1 You may change this during use with the Lead Select button You can also configure the HeartStart MRx to display up to 3 additional leads or pads paddles when turned on see Configuration on page 199 The leads displayed may be changed during use through the Displayed Waves menu item Monitoring View displays the first valid source
368. te e HeartStart MRx Improving ECG Quality Application Note e HeartStart MRx Web based User Training Located at www medical philips com goto mrxtraining Enter training access password meetMRx e HeartStart MRx User Training Videotape and DVD e To purchase additional copies of the Instructions for Use or Quick Cards visit the Philips Healthcare eStore at www philips com healthcarestore e Other Application Notes can be found on the Philips website at www medical philips com goto productdocumentation a 2 Getting Acquainted The HeartStart MRx is designed with your needs in mind Controls indicators and menus are carefully organized to facilitate easy use Display information is tailored to the current task This chapter acquaints you with the HeartStart MRx operational modes display views controls and indicators It also provides general information on device use NOTE If your HeartStart MRx does not have some of the optional functionality listed in this chapter disregard these controls and the related information described throughout this manual Basic Orientation HeartStart MRx controls indicators and connections are carefully organized Front Panel The front panel contains operational controls and indicators as shown below Figure 1 Basic Orientation Front External Power Indicator Synchronized Cardioversion Sync Location of Networking icon if device is network enabled eee a Re
369. tect Select a different lead Poor ECG signal quality noisy trace wandering baseline etc from signal acquired through monitoring electrodes The monitoring electrodes are not making proper contact with the patient Check that the monitoring electrodes are properly applied If necessary prepare the patient s skin and apply new electrodes Check the date code on the electrodes Do not open the electrode package until immediately prior to use The monitoring electrodes are outdated or dried out Check the date code on the electrodes Do not open the electrode package until immediately prior to use Radio frequency interference RFI is causing artifact Relocate or turn off equipment that may be causing RFI Try repositioning cables leads The ECG cable may be faulty Run the Operational Check with the ECG cable If the test fails run it without the ECG cable If the test passes replace the cable If not remove the device from use and call for service 299 Table 82 ECG Monitoring Problems Continued Poor ECG signal quality noisy trace wandering baseline etc from signal acquired through paddles pads The paddles pads are not making proper contact with the patient Ensure proper skin preparation and correction application If necessary apply new pads The pads are outdated or dried out Check the date code on the pads Do not open the pads package un
370. ted perform the following steps 1 Make sure the Sync function is still enabled as indicated by the presence of the Sync message in the upper right corner of the Wave Sector 1 2 Repeat Steps 4 6 under Delivering a Synchronized Shock The Sync function of the HeartStart MRx can be configured to either be enabled or disabled after each shock is delivered If configured to remain enabled and the Therapy Knob is moved to either Monitor or Pacer the Sync function is still enabled However should the Therapy Knob be moved to either the Off or AED positions the Sync function is disabled Disabling the Sync Function To turn off the Sync function of the HeartStart MRx press the Sync gt button Using Q CPR in Manual Mode If your HeartStart MRx has the Q CPR option refer to Q CPR Feedback on the HeartStart MRx on page 167 Troubleshooting If your HeartStart MRx monitor defibrillator does not operate as expected during defibrillation see Troubleshooting on page 297 81 7 Noninvasive Pacing This chapter explains the noninvasive transcutaneous pacing option available with the HeartStart MRx and describes how to perform pacing Overview NOTES Noninvasive transcutaneous pacing therapy is used to deliver pace pulses to the heart Pace pulses are delivered through multifunction electrode pads that are applied to the patient s bare chest While in Pacer Mode the ECG strip and Event Summary are easily ann
371. test data will be displayed when scrolling back to the most recent data e Ifa parameter has not been measured during the display period it is not listed in the display e Ifa parameter in the display has invalid information it is indicated by Questionable data are indicated by a question mark just before the numeric value and unavailable data are indicated by an empty space e Aperiodic measurements e g NBP are displayed with a measurement timestamp below the readings A after the timestamp indicates multiple measurements were taken during the interval The most recent measurement within the interval is displayed e Ifan inactive parameter becomes active when viewing a Vital Signs Trending Report the added parameter will automatically appear in the report when the interval is updated and the latest data is available 152 NOTE When the time interval in the Vital Signs Trending Report is one minute data from continuous measurements represents the average reading for that one minute period For all other time intervals the measurement shown is the one minute average from the most recent minute in the time interval Vital Signs Trending Report Parameter List Order Vital Signs Trending Reports list parameters in the following order beginning at the top of the table HR P1 P2 ABP Ao ART PAP RAP CVP LAP ICP CPP NBP EtCO AwRR SpO Pulse Temp Ifa parameter has not been measured during the display period it is no
372. th a soft cloth moistened with e Mild soap and water e 3 4 gluteraldehyde content such as CidexPlus e Sodium hypochlorite chlorine bleach 3 solution in water e Quaternary ammonium compounds 21 quaternary ammonium content such as Steris Coverage Plus NPD 5 oz per gallon water one part Coverage Plus NPD to 255 parts water e Isopropyl alcohol 70 solution in water CAUTION The paddles and Therapy cables may not be ultrasonically cleaned or immersed Nor may they be autoclaved or ETO sterilized NOTE For information about cleaning and sterilizing internal and external sterilizable paddles see the Sterilizable Defibrillator Paddles Instructions for Use Philips disposable sterile internal defibrillation paddles multifunction electrode pads and monitoring electrodes are single use items and do not require cleaning ECG Cable For M3525A M3526A M3527A M3528A M3529A and 989803147691 ECG cables e Wipe clean with any of the following Isopropyl alcohol 70 solution in water Mild soap and water Gluteraldehyde solution 3 4 gluteraldehyde content such as CidexPlus Quaternary ammonium compounds 21 quaternary ammonium content such as Steris Coverage Plus NPD Dilution 5 oz per gallon water one part Coverage Plus NPD to 255 parts water Chlorine bleach 6 sodium hypochlorite 3 solution in water This solution may discolor the cable For any other approved ECG cable e Clean
373. the Wait for Dial Tone configuration parameter to No See the Transmission Implementation Guide for more information Transmission Failed Error configuring transmission device message The wrong Bluetooth Profile was selected Check the profile to ensure it is the correct one for that Bluetooth device The Configuration String under the Bluetooth Profile settings is not correct Work with your cell phone provider to ensure that the Configuration String is correct Transmission Failed Cannot reach server message No server or the connection has been lost Resend the 12 Lead Report 305 Table 85 Transmission Problems Bluetooth Continued Transmission Failed Connection Interrupted An error occurred during transmission of one of the files Check that the cellular signal strength is sufficient Move the Bluetooth device closer to the MRx within the transmitting range See the Transmission Implementation Guide for more information Check permissions on FTP device configurations permissions must allow for reading and writing Reset receiving device and re transmit Receiving device is full Check available space on receiving device User settings in the Bluetooth device do not allow transmission Set Bluetooth device to allow all operations for the HeartStart MR x and re transmit Transmission Failed Server Unknown message The DNS has timed out
374. the two minute audio pause for all active alarms When an INOP is announced without a concurrent physiological alarm the audio off label is displayed above the Navigation and Menu Select buttons Pressing any of these buttons will silence the audio for all active alarms while you are attending to the patient INOPs do not reannunciate after pressing audio off Figure 14 Audio Pause Label EN Audio Pause 4 Address the alarm condition on the HeartStart MRx The menu shown in Figure 15 appears Then Figure 15 Sample Alarm Response Menu p02 Alarm Alarms Off Acknowledge New Limits Alarms Off Turns the monitoring parameter s alarms off and prevents future parameter alarms from alarming The alarm message is no longer displayed and the UN icon appears next to the parameter value Acknowledge For latching alarms acknowledge clears the alarm condition when the condition no longer exists New Limits Adjust the parameter alarm limits accordingly NOTE Alarm history can be accessed in the patients Event Summary This information is maintained after powering the device down and in the unlikely event of power loss WARNING Although the Alarm Pause button can be used when responding to alarms the response procedures described above are recommended Alarm Pause removes audio and visual indications of active alarm conditions as well as inhibiting indications of new alarm conditions A potential hazard exists if diff
375. the Information Center If you enter only a last name no other patient information fields are affected Patient ID is left blank Once admitted the last name field can not be cleared If the field is cleared in the field is acceptable and not considered cleared the device will retain the previous last name and display a momentary message Last name must not be blank WARNING Patient Type and Paced status will always have a value regardless if the patient is admitted or not If you do not specify settings for these two fields the HeartStart MRx uses the default settings which may not be correct for your patient Changing a patient s type may change algorithms and alarm limits For internally paced patients you must set Paced to Yes If incorrectly set to No the device may identify a pace pulse as a QRS and not alarm during asystole Discharge Discharge Patient is used to e Clear patient information e Close a patient data record e Reset patient type paced status alarm settings and all other MRx settings to default values e Discharge a patient from the Information Center if connected CAUTION Discharging from the HeartStart MRx clears all data from the Information Center To save event data at the Information Center use the Information Center to discharge the patient Discharge Patient is an option whether a patient is admitted or not whether the device is connected to the Information Center or not or if i
376. the ability of the Information Center to remotely control the HeartStart MRx Silence reset alarms can be controlled from the Information Center Set controls to Disabled if you do not want operators to control this function from the Information Center Enabled Disabled RF Access Code Identifies which RF channel the HeartStart MRx Information Center wireless communications are on 0 255 0 Change the default RF Access Code The default 0 is not valid for clinical use NOTE Network settings are not copied to a data card when exporting configurations and must be set individually on each device 219 Table 63 Printing Settings Print on Alarm Prints a 15 second strip 10 seconds of pre alarm Red Yellow Red Red Arrhythmia data and 5 seconds of post alarm data when selected alarm type occurs Red Arrhythmia An alarm recording strip is printed for Asystole VFIB VTACH VTACH Extreme Tachy Extreme Brady Red An alarm recording strip is printed for the Red Arrhythmia alarms plus IBP Disconnect Apnea SpO Desat Red Yellow An alarm recording strip is printed for the Red alarms plus High and Low alarms for HR NBP SpO Pulse Rate EtCO AwRR IBP CPP and Temp Also Pacer Not Captured Pacer Not Pacing PVC Pacer Output Low Print on Charge Prints a continuous strip during charging Yes No Printing continues until a shock is delivered the device is disarmed or the Print button is
377. the calibration factor written on the transducer is the same as the calibration factor displayed on your HeartStart MRx Different calibration factors may lead to an inaccurate measurement 123 Last Zero Calibration You can view dates and times for a channel s last zero or mercury calibration through the HeartStart MRx menu To view a channel s last zero and mercury calibration dates perform the following steps 1 Press the Menu Select 9 button 2 Using the Navigation buttons select Measurements Alarms and press the Menu Select button 3 Select the pressure label channel label you want and press the Menu Select button 4 The last zero and Mercury calibration dates and times are displayed NOTE The information listed for the last mercury calibration is the date and time of either calibrating at a known pressure or entering the calibration factor manually Figure 64 Last Zero and Mercury Calibration Dates Press 1 ABP Last Zero 28Nov 2005 09 05 Last Mercury Cal 28 Nov 2005 9 06 Label Zero ABP Calibration Pressure Calibration Factor Measurements Alarms Alarms Off ABP Limits Exit Non Physiological Artifact Suppression Various clinical procedures i e taking a blood sample may affect invasive pressure readings Your HeartStart MRx can be configured to suppress alarms when artifact is detected for a specific length of time You can configure suppression lengths in Configuration Mode
378. the sensor cable be disconnected accidentally the message SpO Unplugged Turn off SpO appears to notify you of the disconnection Select No and press the Menu Select button Secure the connection The SpO monitoring function is once again enabled 101 Caring for Sensors Refer to the manufacturer s instructions for care and cleaning of sensors To get the best results from 8 g your reusable SpO sensors always handle the sensor and cable with care and protect them from sharp objects The sensor sleeve houses a sensitive electronic device that can be damaged Harsh treatment of sensors will drastically reduce their lifetime WARNING Do not use a damaged sensor or one with exposed electrical circuits Troubleshooting If your HeartStart MRx does not operate as expected during SpO Monitoring see Chapter 22 Troubleshooting on page 297 9 Noninvasive Blood Pressure This chapter describes how to monitor noninvasive blood pressure NBP with the HeartStart MRx Overview Your HeartStart MRx measures blood pressure for both adult and pediatric patients using the oscillometric method Systolic diastolic and mean measurements are provided and alarms are available to alert you to changes in the patient s condition NBP measurements may be taken while in Monitor Pacer or Manual Defib modes NBP measurements can be taken automatically on a schedule or manually on demand While an NBP measurement is in progress
379. tient Info and press the Menu Select button 3 Select Re admit and press the Menu Select button When Re admit is selected your screen displays the Re admit Patient message see Figure 96 and prompts you with a Re admit Patient question Select Yes to re admit the patient No to cancel re admission Figure 96 Re admit Patient Confirmation Re admit Patient This patient will be re admitted to the MRx and transfer mode will be exited Re admit Patient No 188 Clear Transfer Clear Transfer exits the HeartStart MRx s Transfer Mode after losing connection to the network Demographic or patient data remain in the Information Center s transfer list and are maintained at the HeartStart MRx To select Clear Transfer perform the following steps 1 While in Transfer Mode press the Menu Select button 2 Using the Navigation buttons select Patient Info and press the Menu Select button 3 Select Clear Transfer and press the Menu Select button When Clear Transfer is selected the message Transfer mode will be exited is displayed see Figure 97 The display prompts you with a Clear Transfer question Select Yes to clear transfer No to remain in transfer mode Figure 97 Clear Transfer Confirmation Clear Transfer Transfer mode will be exited Clear Transfer No Automatic Re Admit Ifa lost network connection between the HeartStart MRx and Information Center is restored while in Transfer Mode the p
380. til immediately prior to use Radio frequency interference RFI is causing artifact Relocate or turn off equipment that may be causing RFI Try repositioning the pads cable The paddles pads cable may be faulty Run the Operational Check with the pads cable If the test fails run it without the pads cable If the test passes replace the cable If not remove the device from use and call for service ECG Unplugged INOP No ECG cable is connected and the configured selected ECG in Wave Sector 1 is from leads Check that the ECG cable is firmly connected Connect an ECG cable or a pads therapy cable Leads Off INOP Electrode s for the configured selected ECG in Wave Sector 1 may be off or insecurely attached Apply electrodes pads to the patient Electrode s are not making proper contact with the patient Check that monitoring electrodes are properly applied If necessary prepare the patient s skin and apply new electrodes Solid flat line no waveform no Leads Off INOP Short in patient cable or leads Run the Operational Check with the ECG cable If the test fails run it without the ECG cable If the test passes replace the cable If not remove the device from use and call for service Pads Paddles Off INOP Pads Paddles for Wave Sector 1 are off or insecurely attached Check that pads paddles are properly applied If necessary replace the pads Change the E
381. til just prior to use WARNING Never touch the patient or any equipment connected to the patient including the bed or gurney during defibrillation WARNING Avoid contact between the patient and conductive fluids and or metal objects such as the gurney Contact with metal objects could cause unintentional current pathways WARNING Medical electrical equipment which does not incorporate defibrillator protection should be disconnected during defibrillation WARNING In AED Mode the multifunction electrode pads must be in the anterior anterior position as shown on the packaging The HeartStart MRx was not designed to assess data acquired from pads in an anterior posterior position 48 Qe Battery WARNING Properly dispose of or recycle depleted batteries according to local regulations Do not puncture disassemble or incinerate batteries WARNING Built in safety circuits can not protect against handling abuse Adhere to all warnings and cautions in handing and using lithium ion batteries WARNING Do not expose batteries to temperatures greater than 60 C 140 F Excess temperatures may result in battery damage WARNING Keep batteries away from flame and other heat sources WARNING Do not short circuit the battery Avoid placing batteries around metal objects that may short circuit the battery WARNING Avoid getting batteries wet or using batteries in high humidity envir
382. time may be changed However a password is required to change the configuration of the device Accessing the Configuration Menu To access the Configuration Main menu 1 Turn the Therapy Knob to Monitor 2 Press the Menu Select G button 3 Using the Navigation buttons select Other and press the Menu Select button 4 Using the Navigation buttons select Configuration and press the Menu Select button To return to normal operating mode press the Exit Config softkey The Configuration Main menu is displayed listing sub menus for each category of configurable parameters You may use this menu to view or print your device s configuration as well as to modify the date and time settings To modify any other settings you must enter the configuration password printed on the front of the HeartStart MRx User Documentation CD ROM WARNING The HeartStart MRx should never be connected to a patient while performing configuration activities 199 Setting the Date and Time To modify the date and time setting from the Configuration menu Press the Menu Select 9 button Using the Navigation buttons select Date and Time Then press the Menu Select button Using the Navigation buttons adjust the value for the year Then press the Menu Select button Select the appropriate month Then press the Menu Select button Adjust the value for the day Then press the Menu Select button A nA oA O N e Adjust the value for the hour Then p
383. tion Wave forms for ECG invasive pressure ABP ART Ao or PAP and CO parameters can be viewed during the use of Q CPR Ifan ABP ART Ao or PAP pressure measurement is active the waveform always appears in Wave Sector 3 and the pressure value displays in Parameter Block 2 If two pressures labeled ABP ART Ao or PAP are available the label assigned to Pressure 1 is displayed If no pressure is active then the compression waveform appears in Wave Sector 3 Parameter Block 2 displays compression and ventilation measurement information The EtCO waveform will appear in Wave Sector 4 if present AWRR numeric values are not displayed NOTES Ifthe Pads CPR cable is not connected when you turn the Therapy Knob to Manual Defib Mode the message Connect Pads CPR Cable displays When using Q CPR SpO monitoring functionality is not available Compression and ventilation measurement values are printed in the annotation area of the ECG printed strip Using Q CPR in AED Mode In AED Mode CPR feedback is provided automatically during the CPR Pause period of the AED protocol or manually when the Pause for CPR soft key is pressed If your No Shock Advised NSA Action configuration item is set to provide a CPR Pause interval Q CPR can be activated by delivering a compression with the CPR meter As in Manual Defib Mode voice prompts are issued to guide you if necessary however in AED Mode they are accompanied by a momentary text message appearin
384. to display the Data Management menu 226 Copying from Internal Memory You can copy Event Summaries and 12 Lead ECG Reports stored in internal memory to a data card from Data Management Mode Insert a data card see Installing the Data Card on page 46 Enter Data Management Mode See Entering Data Management Mode on page 226 Use the Prev Item and Next Item soft keys to select an Event Summary 1 2 3 4 Press the Menu Select button to display the Data Management menu 5 Highlight Copy and press the Menu Select button 6 Select the data option listed that you want to copy see Figure 100 and press the Menu Select button to copy to the external data card Figure 100 Copying in Data Management Mode Copy All Events Data lt q Highlight All Event Data to copy the selected Event Summary 1 25 Apr 2007 11 15 Highlight the specific 12 Lead Report listed to copy the selected 2 25 Apr 2007 11 30 12 Lead Report Exit 4 Highlight Exit to exit the Copy menu NOTES Ifyou print an event in Clinical Mode and switch to Data Management Mode the printing must be complete before the event can be copied or sent Failure to do so results in either a Cannot copy this event while printing or a Cannot send this event while printing message If you get either message wait for the printing to finish or cancel the printing before proceeding Do not remove the external data card from the HeartStart MRx while the device
385. tole For paced patients with internal transvenous pacemakers in addition to the above the pace pulse should be e not wider than the normal QRS complex e large enough to be detected half the height of the QRS complex with no re polarization artifact NOTE Adjusting the ECG wave size on the display does not affect the ECG signal which is used for arrhythmia analysis Lead Choices Available monitoring leads vary depending upon what type of ECG cable is connected to your HeartStart MRx and its configuration Table 4 shows the choice of leads available for 3 5 and 10 lead ECG sets Table 4 Lead Choices a 3 electrode ECG set I II III a 5 electrode ECG set I II II aVR aVL aVF V a 10 electrode ECG set I II III aVR aVL aVF V1 V6 53 Selecting the Lead The ECG lead for Wave Sector 1 is selected through the Lead Select button or through the Displayed Waves menu The ECG lead for Wave Sectors 2 4 is selected through the Displayed Waves menu as follows 1 2 Press the Menu Select button Using the Navigation buttons select the Displayed Waves menu and press the Menu Select button Select the Wave Sector and press the Menu Select button Select the desired lead and press the Menu Select button If needed use the Navigation buttons to adjust the ECG wave size gain and press the Menu Select button Figure 37 Displayed Waves Menu
386. transmitted via a cell phone with internet capability connected to the MRx s RS 232 Serial Port The 12 Lead Transfer Station then forwards the report to the selected destination site Additionally reports can be sent to a wireless modem connected to an analog line for areas where cell transmission is unavailable To send the current 12 Lead Report 1 From the 12 Lead Report screen press the Menu Select button 2 Select Send and press the Menu Select button 3 Select the destination of the 12 Lead from the Send To menu and press the Menu Select button 4 If your device is configured with just one option to transmit the 12 Lead Report or you selected the Rosetta Lt transmission begins when you press the Menu Select button If your device has more than one configured transmission device highlight the device you want to use and press the Menu Select button Transmission begins See Figure 107 Figure 107 Steps to Sending 12 Leads Send To Transmission Devices pa St Mary s ED 2nd Configured Device nth Configured Device Dr Smith 20th Configured Device Dr Jones Exit EMS Station Fax Number Exit NOTES Patient Name and ID must be entered prior to 12 Lead acquisition in order for it to appear on the 12 Lead Report The HeartStart MRx transmits data from internal memory only Data contained on the external data card only is not transmittable The 05 40 Hz 12 Lead filter settin
387. ts listed in Table 23 result from measurements generated by an ECG the Critical Value statement Very High Heart Rate appears on the 12 Lead Report Table 23 Extreme Tachycardia Statements Extreme tachycardia v rate gt 220 age Wide QRS tachycardia vs rate gt QRSD gt Extreme tachycardia with wide complex no further rhythm analysis attempted Complete Heart Block If the interpretive statements listed in Table 24 result from measurements generated by an ECG the Critical Value statement Complete Heart Block appears on the 12 Lead Report Table 24 Complete Heart Block Statements AV block complete third degree v rate lt AV dissociation Complete AV block with wide QRS complex v rate lt QRSD gt AV dissoc Atrial flutter fibrillation with complete AV block Culprit Artery If your 12 Lead interpretive statement contains an acronym in parenthesis see Table 25 it is an indication the analysis is identifying the probable anatomical site of a coronary artery occlusion responsible for ischemia Table 25 Culprit Arteries RCA Right Coronary Artery LAD Left Anterior Descending LCx Left Circumflex LMMVD Left Main Multi Vessel Disease NOTE More information on the specificity and sensitivity of these statements can be found in the Physician s Reference Guide for the DXL algorithm 145 13 12 Lead ECG Tolead Report 12 Lead Report The 12 Le
388. tteries Low and Defib Shutdown alarms result in Red INOPs that can t be silenced at the Information Center Pacer Output Low alarm results in a Yellow INOP that can t be silenced at the Information Center All four alarms must be silenced at the HeartStart MRx When the HeartStart MRx prints data and information it prints to the 50 mm or 75 mm printer installed in the device not a printer located on the institution s network Alarm recordings are configured at the HeartStart MRx and sent to the Information Center central recorder if present Once alarm recordings are configured at the HeartStart MRx they can be controlled at the Information Center from the Record Store tab under All Controls Vital Signs Trending Reports generated by the HeartStart MRx can only be printed at the device Turning a Networked Device Off NOTE If a networked HeartStart MRx is turned off wave and alarm data may be displayed at the Information Center for 10 more seconds After 10 seconds a No data from bed INOP statement appears on the Information Center display The current patient incident is closed at the HeartStart MRx The patient is not discharged from the Information Center If the HeartStart MRx is turned back on the ADT state is initially set to Not Admitted Patient type paced status and alarm limits are reset to their default settings If the patient is still admitted at the Information Center the HeartStart MRx is updated with patient information
389. ttery to be calibrated into Battery Compartment A or B Turn the Therapy Knob to Monitor Press the Menu Select 7 button Using the Navigation buttons select Other and press the Menu Select button Select Battery Calibration and press the Menu Select button N A WW Re WOW NH Press the Menu Select button to acknowledge the message Leaving Normal Operational Mode The Calibration view is displayed If external power is not detected you are prompted to Apply External Power If there is no battery in either battery compartment you are prompted to Insert Battery If there are batteries in both battery compartments you must select which battery to calibrate 284 8 Pressthe Start soft key to begin calibrating The calibration procedure charges the battery to full capacity drains the battery in preparation for calibration calibrates the battery and then charges it again following calibration Once you see the message Calibration Complete The battery charges faster when the device is turned off you may turn the Therapy Knob to Off to allow the battery to charge more quickly Calibration takes approximately 11 hours to complete in the HeartStart MRx Progress is shown on the display It takes significantly less time to calibrate in a Philips approved battery support system Monitoring therapy functions are not available during battery calibration in the MRx If it is necessary to terminate calibration to resume clinical use press the
390. tton 4 Select AWRR Limits and press the Menu Select button 5 Using the Navigation Buttons increase or decrease the high limit value and press the Menu Select button 6 Set the new low limit value and press the Menu Select button 113 Changing the Apnea Time Alarm Limit To change the apnea time alarm limit 1 Press the Menu Select 9 button 2 Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button 3 Select AwRR and press the Menu Select button 4 Select Apnea Time and press the Menu Select button 5 Using the Navigation buttons increase or decrease the limit and press the Menu Select button Enabling Disabling AwRR Alarms To enable the AwRR alarms 1 Press the Menu Select button 2 Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button 3 Select AwRR and press the Menu Select button 4 Select Alarms On Off and press the Menu Select button WARNING The safety and effectiveness of the respiration measurement method in the detection of apnea particularly the apnea of infancy has not been established The selected apnea alarm may be delayed by up to 17 seconds if apnea occurs during the automatic zero process Disabling the EtCO Monitoring Function To disable the EtCO monitoring function disconnect the FilterLine from the CO inlet port The message CO Unplugged Turn off EtCO appears Select Yes and press the M
391. tton and select Trends and then Trends Interval A report for the entire incident period is printed Figure 71 Sample Vital Signs Trending Report Printout Trend Report 26 Apr 10 55 10 50 10 45 10 40 10 35 10 30 10 25 DD Mon YYYY HH MM HR bpm 100 100 100 100 100 100 100 P2s mmHg 25 25 25 25 25 25 25 Event ID 0302 P2s mmHg 10 10 10 10 10 10 10 LastName First Name P2s mmHg 16 16 16 16 16 16 16 Patient ID 12345 ABPs mmHg 118 118 118 118 118 118 118 ABPd mmHg 72 72 72 72 72 72 72 ABPm mmHg 95 95 95 95 95 95 95 M3535A S N US00112345 SW Rev 7 00 00 American English page 26 Apr 10 55 10 50 10 45 10 40 10 35 10 30 10 25 NBPs mmHg 120 120 117 NBPd mmHg 70 60 64 NBPm mmHg 82 80 81 10 47 10 30 10 23 EtCO2 mmHg 39 39 38 36 35 39 39 AwRR rpm 12 12 12 12 12 12 12 Spo2 100 100 100 100 100 100 100 Pulse bpm 95 935 95 95 95 95 95 Temp F 99 0 99 0 99 0 99 0 99 0 99 0 99 0 28 page See Vital Signs Trending Reports on page 229 for more information NOTE Ifyour device has a 50mm printer its report will have 11 lines of text If the device has a 75mm printer the report contains 16 lines 154 Exiting Vital Signs Trending Report To exit the Vital Signs Trending Report and return to a waveform display press the soft key under the Close Trends label in the Vital Signs Trending Report display You will be returned to Monitor Mode Troubleshooting If your HeartStart MRx does not operate as expected durin
392. ualified personnel WARNING Operating the HeartStart MRx or its accessories in conditions outside the environmental specifications can result in device or accessory malfunction The HeartStart MRx should be allowed to stabilize within the operating temperature range for 30 minutes prior to operation WARNING The HeartStart MRx should not be used adjacent to or stacked with other equipment If adjacent or stacked use is necessary the HeartStart MRx should be observed to verify normal operation in the configuration used WARNING Avoid touching monitoring electrodes and other measuring devices when they are applied to the patient Doing so can degrade safety and may affect results WARNING Do not touch communication ports and a patient simultaneously CAUTION Do not discharge the defibrillator with the paddles shorted together CAUTION Conductive parts of electrodes and associated connectors for applied parts including the neutral electrode should not contact other conductive parts including earth CAUTION This device is suitable for use in the presence of high frequency surgical equipment Following electrosurgery interference the equipment returns to the previous operating mode within 10 seconds without loss of stored data Measurement accuracy may be temporarily decreased while performing electrosurgery or defibrillation This does not affect patient or equipment safety See the electrosurgery device
393. ubleshooting on page 297 for a full list of alarms INOPs and messages 195 Table 35 HeartStart MRx Messages at the Information Center Defibrillation Pacing Alarm INOP Type Alarm INOP Type Charge Button Failure Hard INOP Defib Malf Hard INOP Shock Button Failure Hard INOP Defib Malf Hard INOP Shock Equip Malfunction Hard INOP Defib Malf Hard INOP Pacer Equip Malfunction Hard INOP Defib Malf Hard INOP Therapy Knob Failure Hard INOP Defib Malf Hard INOP Therapy Cable Failure Hard INOP Defib Malf Hard INOP Pacing Stopped Pads Off Red Alarm Pacing Stopped Red INOP Pacing Stopped Device Error Red Alarm Pacing Stopped Red INOP Pacing Stopped Pads Cable Off Red Alarm Pacing Stopped Red INOP Pacing Stopped Leads Off Red Alarm Pacing Stopped Red INOP Pacing Stopped Power Interrupted Red Alarm Pacing Stopped Red INOP Other INOPs Batteries Low Hard INOP Batteries Low Hard INOP Batteries Low while Pacing on batteries Red Alarm 1 Batteries Low Red INOP Bluetooth Malfunction Hard INOP Check Device Hard INOP Event Storage Full Soft INOP Check Device Soft INOP Fan Failure Hard INOP Check Device Hard INOP Internal Memory Failure Hard INOP Check Device Hard INOP Radio Malfunction Hard INOP Check Device Hard INOP Radio Unplugged Hard INOP Check Device Hard INOP Power Supply Failure Hard INOP Defib Mal
394. uding 12 Lead Reports Text in this menu line varies depending upon the HeartStart MRx options installed Send Exclude Audio amp Q CPR is displayed if your device has the Audio Recording Q All Events Data CPR Data and Event Summary Bluetooth options Exclude Audio amp Q CPR Exclude Audio is displayed if your device has the Audio Recording and Event Summary Bluetooth options and does not have the Q CPR Data option Exclude 0 CPR is displayed if your device has the Q CPR Data and Event Summary Bluetooth options and does not have the Audio Recording option 1 25 Apr 2007 11 15 2 25 Apr 2007 11 30 Exit Highlight the specific data to exclude it from the Event Summary transmission If you only want to transmit a specific 12 Lead Report highlight it to transmit Not available with Batch LAN Data Transfer Highlight Exit to exit the Send menu without transmitting any data 255 5 Depending upon which option you selected in Step 4 you are presented with different menus If you selected a 12 Lead Report 1 Select a destination for the 12 Lead Report from the Send To menu Highlight the destination and press the Menu Select button If your device is configured with just one transmission device or you selected the Rosetta Lt transmission begins 2 If your device has more than one configured transmission device highlight the transmission device you want to use and press the Menu Select button Transmi
395. until entered To enter the date of birth for a patient perform the following 1 Press the Menu Select button 2 Using the Navigation buttons select Patient Info and press the Menu Select button 3 Select Date Of Birth and press the Menu Select button Ifthe patient type is adult the default menu option will be the current month and day 50 years ago Ifthe patient type is pediatric the default menu option will be the current month and day 7 years ago 4 Using the Navigation buttons enter the date of birth and press the Menu Select button The date of birth will automatically be converted to an age for 12 Lead reports Only the age will be displayed in the 12 Lead screen printed on and stored with 12 Lead reports NOTE The HeartStart MRx supports adult and pediatric patient categories only If the Information Center sends a neonatal patient type to the HeartStart MRx this possibility exists only if a neonatal patient is admitted by a networked patient monitor which allows a neonatal status and then the monitor is replaced on the network by the HeartStart MRx the HeartStart MRx modifies the setting to pediatric and sends it back to the Information Center 190 Date and Time In instances where the HeartStart MRx s date and time are not in agreement with the Information Center the HeartStart MRx automatically synchronizes its date and time to match the Information Center s The date and time displayed in the HeartStart MR
396. uration Choice Pause Time Analysis is suspended for the specified period and you may administer CPR and attend to the patient A Pause status bar is displayed as shown in Figure 45 The pause period is defined by the NSA Action Configuration Choice At the completion of the pause period the HeartStart MRx resumes analyzing Figure 45 Paused Display PAUSED ATTEND TO PATIENT Step 3 Press Shock Button if Prompted Once charging is complete the HeartStart MRx prompts you to Deliver Shock Now Press the Orange Button Now Make sure no one is touching the patient or anything connected to the patient Call out clearly and loudly Stay Clear Then press the orange Shock button to deliver a shock to the patient WARNING Defibrillation can cause operator or bystander injury Do not touch the patient or equipment connected to the patient during defibrillation WARNING The Shock button must be pressed to deliver a shock The HeartStart MRx will not automatically deliver a shock Delivery of the shock is confirmed by the message Shock Delivered and the shock counter on the display is updated to reflect the number of shocks given The defibrillator will announce Paused If needed begin CPR The HeartStart MRx pauses for the configured CPR Timer period Prompts may be brief or detailed as defined by the CPR Prompt Configuration Choice Analysis begins again at the completion of the pause period or when you pres
397. urned on alarm limits are displayed to the right of the pulse rate value If alarms are turned off the JX symbol is displayed instead of the alarm limits Pulse alarms are off by default See Pulse Rate Alarms on page 100 Figure 58 SpO Parameter Block 2 mmHg PAP mmHg SpO2 EtCO2mmHg AWRR rpm 118 77 1S 24 10 95 8 15 3100 383 18 97 Pleth Wave 98 When the sensor is connected to the HeartStart MRx the pleth wave is displayed in the configured Wave Sector or the first available empty Wave Sector It is drawn at an approximate speed of 25 mm second Grid lines are displayed to indicate signal quality When signal quality is good the pleth wave is auto scaled to the grid lines When signal quality is poor the size of the pleth wave is proportionately decreased Figure 59 Pleth Wave Size When the Therapy Knob is moved to an energy setting the SpO values and pleth wave continue to be displayed as long as they are not located in Wave Sector 2 or you re in Q CPR View When the Therapy Knob is moved to Pacer the pacing status bar appears in Wave Sector 4 replacing the waveform in that sector If the pleth wave was removed the SpO and Pulse values and alarm settings are retained If the Therapy Knob is moved to AED SpO and pulse related information is no longer monitored SpO Alarms Alarms are annunciated if measurements fall outside the configured limits for high or low SpO or if the measurement falls
398. usable SpO Sensor Adult Finger 2 meters M1191BL Reusable SpO Sensor Adult Finger 3 meters M1191T Reusable Adult Finger Sensor Nellcor 9 pin D sub connector 293 Table 80 Supplies and Accessories Continued M1192A Reusable SpO Sensor Pediatric Small Adult Finger M1192T Reusable Pediatric Sensor Nellcor 9 pin D sub connector M1194A Reusable SpO Sensor Adult Pediatric Ear Clip M1195A Reusable SpO Sensor Infant M1196A Reusable Clip Adult Sensor M1196T Reusable Clip Adult Sensor Nellcor 9 pin D sub connector M1941A SpO Extension Cable 2 m M1943A 1m Nellcor adapter M1131A Disposable SpO Sensor Pediatric Adult Finger Interconnect Tubing M1598B Adult Pressure Interconnect Cable 1 5 m M1599B Adult Pressure Interconnect Cable 3 m Reusable Blood Pressure Cuffs 40400A Reusable NBP Cuff Kit 3 sizes pediatric adult large adult 40400B Reusable NBP Cuff Kit 5 sizes infant pediatric adult large adult thigh 40401A Traditional Reusable NBP Cuff Infant 40401B Traditional Reusable NBP Cuff Pediatric 40401C Traditional Reusable NBP Cuff Adult 40401D Traditional Reusable NBP Cuff Large Adult 40401E Traditional Reusable NBP Cuff Thigh M4552B Easy Care NBP Cuff Infant M4553B Easy Care Reusable NBP Cuff Pediatric M4554B Easy Care Reusable NBP Cuff Small Adult M4555B Easy
399. using a SureSigns monitor and connect it to the HeartStart MRx you will see a square waveform in place of the QRS The signal from the bedside monitor is displayed as Lead II on the HeartStart MRx even though it is not necessarily Lead II coming from the bedside monitor WARNING If you use an external monitor as the ECG source a biomedical technician MUST verify that the external monitor and the HeartStart MRx combination will deliver a synchronized shock within 60 ms of the peak of the R wave Use a 1 mV QRS complex with a QRS width of 40 ms This performance cannot be guaranteed with all commercially available monitors WARNING When monitoring through paddles only artifact introduced by paddle movement may resemble an R wave and trigger a defibrillation shock 79 Delivering a Synchronized Shock To perform synchronized cardioversion 1 With the Therapy Knob in the Monitor position press the Sync G button located beside the Therapy Knob see Figure 51 to activate the Sync function A Sync message appears in the upper right corner of Wave Sector 1 2 Confirm that the Sync marker appears with each R wave 3 Turn the Therapy Knob to the desired energy level setting Charge 4 Press the Charge 2 button on the HeartStart MRx or if using paddles the yellow charge button located on the handle of the paddle with the symbol Wait until the charge has reached the energy level selected and you hear a continuous charge
400. utes and 20 200 discharges with a new fully charged battery operating at room temperature 25 C At least 3 5 hours of monitoring with ECG SpO CO temperature and two invasive pressures monitored continuously NBP measured every 15 minutes and pacing at 180ppm at 160mA Battery Indicators Battery gauge on battery capacity indicator on display flashing RFU indicator chirp and LOW BATTERY message appears on display for low battery condition When LOW BATTERY message first appears there is still enough energy remaining for at least 10 minutes of monitoring time and six maximum energy discharges with a new battery at room temperature 25 C Battery Storage Storing the battery for extended periods at temperatures above 40 C will reduce battery capacity and degrade battery life 326 Thermal Array Printer Continuous ECG Strip The Print key starts and stops the strip The printer can be configured to run real time or with a 10 second delay The strip prints the primary ECG lead and a second or third wave 75mm printer only with event annotations and measurements Auto Printing The printer can be configured to automatically print on Mark Events Charge Shock and Alarm When an alarm condition occurs the unit prints the Primary ECG wave the alarming wave if configured and a third wave 75mm printer only Reports The following can be printed e Event Summary short medium and long e Vital Sign Trends e 12
401. uts 139 140 patient info required 142 skipping 139 training 5 troubleshooting 297 Batch LAN Data Transfer 308 Bluetooth 304 CO 309 data card 312 data transmission 304 defibrillation 310 ECG problems 299 general problems 298 IntelliVue Networking 315 Invasive Pressures 312 NBP problems 302 Noninvasive Pacing 310 Periodic Clinical Data Transfer 308 printing 311 pulse 314 Q CPR 314 Rosetta 308 RS 232 307 service numbers 319 SpO problems 303 Temperature 313 User Checks 278 V Vital Signs Trending 151 adjusting interval 153 data 152 exiting report 155 printing report 154 229 report format 152 reviewing data 151 scrolling 153 wW warnings 345 batteries 349 defibrillation 348 general 345 supplies 291 supplies and accessories 350 wave sectors 15 changing 16 waveforms acquiring 47 printing 28 Waves configurable parameters 211 weekly shock test performing 267 Z Zeroing invasive pressures 119 last zero 124 unable to zero causes 120 363 PHILIPS 989803160421 Edition 1 Philips Medical Systems Printed in the U S A April 2009 IN A T T UL amp F
402. ve Pressures and CO are not visible on the Preview Screen related alarms measurements and INOP messages remain active and are reported in Parameter Blocks 1 and 2 and the general status area Figure 66 12 Lead ECG Preview Screen Mark Event 10 Feb 2006 11 20 A_ e W Jones Samuel F Adult Non Paced 02 42 mm G Ox Temp C Pulse bpm BF oat q120 120 39 0 160 10 40 36 9 36 0 80 4 Sp02 EtCO2 a ee rpm 100 38 18 ID 12345 55 Years Male Display 05 150 Hz Report 05 150 Hz Start Exit Start 05 40 Hz NBP 12 Lead Acquire Filter MENU 137 13 12 Lead ECG Acquiring a 12 Lead ECG Acquiring a 12 Lead ECG Once preparation is complete to acquire a 12 lead ECG in Monitor Mode 1 Press the 12 Lead soft key The Preview Screen is displayed as shown in Figure 66 2 Check the signal quality on each lead and if necessary make adjustments as described in Improving Signal Quality on page 149 3 Check filter settings 4 Pressthe Start Acquire soft key The message Acquiring 12 Lead is then displayed while the HeartStart MRx acquires ten seconds of ECG data 5 If patient age and sex were not previously entered you are prompted to enter the information a For age use the Navigation buttons to increase or decrease the displayed value of the patient s age Then press the Menu Select button OJ If connected to the IntelliVue Network you enter the patient s date of birth b For sex use the Navig
403. vironments you can use the display prompts in lieu of voice prompts Shock Advised If a shockable rhythm is detected the HeartStart MRx automatically charges to 150J Charging is accompanied by voice and screen prompts as shown in Figure 44 A steady high pitched tone is sounded and the orange Shock button flashes when the device is fully charged Heart rhythm analysis continues while the HeartStart MRx charges If a rhythm change is detected before the shock is delivered and a shock is no longer appropriate the defibrillator disarms Figure 44 Shock Advised Charging Display SHOCK ADVISED CHARGING STAND CLEAR NOTE When the HeartStart MRx is fully charged you can disarm it any time by turning the Therapy Knob to the Off position or by pressing the Pause for CPR soft key Resume monitoring the patient by turning the Therapy Knob back to AED No Shock Advised NSA 68 If a shockable rhythm is not detected the HeartStart MRx tells you No shock advised If the NSA Action Configuration Choice is set to Monitor The HeartStart MRx monitors the ECG and automatically resumes analysis if a potentially shockable rhythm is detected You are periodically prompted to If needed press Pause and begin CPR The frequency of these prompts is defined in the Monitor Prompt Interval Configuration Choice You may press Pause for CPR to suspend monitoring and administer CPR The pause period is defined by the CPR Timer Config
404. wide range of patients However if you receive a No Shock Delivered message check that the patient s skin has been washed and dried and that any chest hair has been clipped If the message persists change the pads and or the pads cable Using AED Mode To operate the HeartStart MRx in AED Mode follow these three basic steps 1 Turn the Therapy Knob to AED 2 Follow the voice and screen prompts 3 Press the orange Shock button if prompted These steps are described more fully in the sections that follow While operating in AED Mode the capabilities of the device are limited to those essential to the performance of semi automated external defibrillation Only the ECG acquired through pads is displayed Previously set alarms and scheduled measurements are indefinitely paused and entry of patient information is disabled Additionally the Sync Lead Select and Alarm Pause buttons are inactive Nn nN Step 1 Turn the Therapy Knob to AED When the HeartStart MRx is turned on in AED Mode it checks to see if the pads cable and multifunction electrode pads are properly connected If the e pads cable is not properly attached you are prompted to Connect Pads Cable e multifunction electrode pads are not connected to the pads cable pads are not applied to the patient or pads are not making proper contact with the patient s skin you are prompted to Apply Pads and Plug in Connector Step 2 Follow Screen and Voice Pro
405. x s status area reflect the new time When a time change occurs e Event Summary Report start times are adjusted and a is placed in front to indicate the time change e The date and time printed in the waveform header prior to the time change are updated based on the new time and a placed in front Timestamps related to events prior to the time change are updated based on the new time and a placed in front e When a time change occurs while you are printing a Trends Report the printing stops because the printed time frame no longer matches the displayed timeframe e In the Trends Display and printed Trends reports the interval times prior to and including a time change event and NBP timestamps will be updated based on the new time and a placed in front e While a strip is printing the change is reflected in the next header e For 12 Lead reports Ifyou do not have any 12 Lead reports saved for the current incident the next 12 Lead report is updated with the new date and time Ifyou have one or more 12 Lead reports saved for the current incident the date and time for new 12 Lead reports during the same incident are not updated to reflect the time change The new reports retains the same time sequence as the saved 12 Lead reports to preserve the report order e Timestamps for the last invasive pressure zero and calibration along with a displayed NBP measurement occurring prior to a date time
406. x and marked by the data card symbol eS Figure 30 Installing the Data Card Tray CAUTION Even if a data card is not used the data card tray should always be installed to protect the device from the ingress of liquids or solids 46 4 ECG and Arrhythmia Monitoring This chapter describes the basic ECG and arrhythmia monitoring functions of the HeartStart MRx monitor defibrillator For specific information related to taking a 12 Lead ECG refer to Chapter 13 12 Lead ECG on page 135 Overview The HeartStart MRx can be used for ECG and arrhythmia monitoring allowing you to monitor through e multifunction electrode pads or e 3 5 or 10 lead monitoring electrode ECG sets If both pads and monitoring electrodes are connected monitoring allows you to select a lead from the 3 5 or 10 lead monitoring electrode ECG source or to monitor through pads Configurable heart rate and arrhythmia alarms clearly communicate patient status both audibly and visually Waveforms may be acquired through the therapy port for pads paddles or the monitoring port for 3 5 or 10 lead monitoring electrodes If the configured source is not connected to the HeartStart MRx when turned on the first valid ECG source is displayed in Wave Sector 1 Once the configured source is available it automatically populates Wave Sector 1 Should the configured source then become invalid a Leads Off condition is displayed The Hear
407. xtended periods at temperatures above 40 C will reduce battery capacity and degrade battery life Humidity Up to 95 Relative Humidity e Printer paper may jam if paper is wet e Thermal Printer may be damaged if wet paper is allowed to dry while in contact with printer elements Atmospheric Pressure Range e Operating 1014 hPa to 572 hPa 0 to 15 000 ft 0 to 4 500 m e Storage 1014 hPa to 572 hPa 0 to 15 000 ft 0 to 4 500 m Shock e Operating Half sine waveform duration lt 3 ms acceleration gt 145 g 1 time on all six faces e Non operating Trapezoidal waveform acceleration gt 30 g velocity change 742 cm s 10 on all six faces e Bump EN60068 2 29 Bump Half sine 40 g peak 6 msec duration 1 000 bumps x 3 axes e Free Fall IEC 68 2 32 Free Fall Drops on all faces onto a steel surface excluding bed rail hook 30 in 76 2 cm with carrying case 16 in 40 6 cm without carrying case Vibration e Operating MIL STD 810E 514 4 Category 6 Helicopter General Storage UH60 335 e Non Operating IEC 68 2 6 Vibration sinusoidal 10 57 Hz 0 15mm 58 150 Hz 2g 20 sweeps x 3 axes IEC 68 2 64 Vibration broad band random 10 20 Hz 0 05 g Hz 20 150 Hz 3 dB octave 150 Hz 0 0065 g Hz 1 5 hours x 3 axes Solids Water Resistance IP24 Water testing performed with cables connected to the device EMC Complies with the requirements of standard EN 60601 1 2 2001 Safety Meets UL 2601 1 CSA C22 2
408. y Extreme Brady Yellow Alarms PVC Alarms Beat Detection Alarms Rate Alarms Frequent PVCs PNC PNP High HR oy HR First level timeout period Second level timeout period PVCs gt xx Min PNC Pacer Not Capture PNP Pacer Not Pacing Table 6 HR Arrhythmia Yellow Alarms HR High The HR exceeds the configured Yellow alarm Non Latching HR high limit message alarm tone HR Low The HR is below the configured Yellow alarm Non Latching HR low limit message alarm tone PVC min High The number of detected PVCs in Yellow alarm Non Latching value gt limit a minute exceeds the limit of message alarm tone 15 adult pedi Pacer Not Capture No QRS following a pacer pulse Yellow alarm Latching message alarm tone Pacer Not Pacing No QRS or pacer pulse detected Yellow alarm Latching message alarm tone NOTE Pacer Alarm Messages are associated with internal transvenous pacemakers only 57 INOP Messages INOP messages communicate conditions that prevent the device from monitoring or analyzing the ECG INOP messages are displayed just above the HR Arrhythmia alarm status area If multiple INOP conditions exist the associated INOP messages will cycle through alternating every 2 seconds Table 7 ECG INOPs Cannot Analyze ECG Cannot reliably monitor the ECG in INOP message INOP tone Wave Sector 1 ECG Cable Failure During the Operational Check a short INOP message
409. y can be unreliable Observe the patient closely while pacing Do not rely on the indicated heart rate or heart rate alarms as a measure of the patient s perfusion status NOTE When pacing is stopped due to a power interruption a red Pacing Stopped Power Interrupted alert will appear on the HeartStart MRx display when power is eventually restored Pacing View Pacing View appears when the Therapy Knob is set to the Pacer position Figure 52 shows information displayed in Pacing View Figure 52 Pacing View Mark Event 10 Feb 2006 11 20 A_ bE Samuel 9 an 02 02 42 HR 10 Temp C Pulse bpm 150 80 3s q120 120 sys 5 30 9 30 Om 95 9 Pacing Markers p02 EtCO2 mmHg AWRR rpm 100 38 18 PACI NG ON BATTERIES Pacing Status Demand Mode 70ppm 5O0mA Area Start Pause Pacer Pacer NBP Pacing Rate Output f Pacing Soft Keys Pacing View includes a status block which appears in Wave Sector 4 of the display The first line of the status block communicates whether pacing is active or paused If pacing is powered by batteries this is indicated here as well if configured The second line of the status block identifies the Pacer Mode demand or fixed pacing rate ppm and pacing output mA Soft keys are available for setting pacing status Start Pacing Pause Pacing Resume Pacing and adjusting Pacer Rate Pacer Output NOTE If pacing is interrupted for any reason the Resume Pacing softkey must be pr
410. y sets all contraindications on that page to No unless they were previously set to Yes NOTE The Intended Use statement for the Thrombolytic Predictive Instrument provides a list of some contraindications that were associated with thrombolytic therapy when the U S Food and Drug Administration FDA reviewed the software in 1997 It is important to understand that the second set of contraindications are associated with the therapy and not the TPI software Each institution can configure the TPI software to reflect the processes it uses to determine if thrombolytic therapy should be administered 140 To change a contraindication 1 When the list of contraindications appears on the HeartStart MRx display see Figure 68 use the Navigation buttons to highlight one of the contraindications and press the Menu Select button 2 Use the Navigation buttons to select a new value for the contraindication and press the Menu Select button 3 Use the Navigation buttons to select the next contraindication 4 Complete steps 2 3 for the remaining contraindications in your list 5 Pressthe Done softkey to exit contraindications to thrombolytic therapy After analysis is complete all settings are logged in the Event Summary and the 12 Lead analysis is complete 6 To acquire another 12 Lead ECG press New 12 Lead To exit the 12 lead function press Exit 12 Lead Figure 68 TPI Contraindications 25 Jan 2009 12 03 37 50 years Male Consider contra

HeartStart MRx EMS Monitor / Defibrillator Manual

Contents

Download Pdf Manuals

Related Search

Related Contents