Home

HeartStart MRx Instructor Guide

1. May be printed out on an Event Summary Report e New Event Summaries are initiated each time one of the following activities occurs The arrival of a valid ECG signal The arrival of valid SpO data The arrival of valid CO data The arrival of valid invasive pressure data The arrival of valid temperature data The arrival of a valid CPR meter compression An NBP measurement is requested The Charge button is pressed 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 A complete list of events and related information can be found in the Events Stored in Event Summary section of the MRx Instructions for Use 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 a 12 hour data limit per incident with a maximum capacity of 55 patient incidents regardless of card capacity or size of incidents When deleting oldest records are erased first In contrast trend storage is up to the most recent 12 hours of monitoring e Monitoring and defibrillation functions are disabled while in Data Management Mode e An active patient event is closed upon entering Data Management Mode 174 Additional points notes 175 Copying from Internal Memory Demonstrate how to copy Event Summaries and 12
2. Lesson Introduction 73 Ob jectives s so s w Row ee be Oe eR Be ke O oe O Time bah amp be eee ee Se ke a a a A Accessories Romea E Clinical Resources 73 Lesson Presentation 7 Overview fae eh ae a Sw Bl aOR Gs Ge ae a a a 74 Q CPR Pequation Ly ooo ek Be A Q CPR in Manual Defib Made CA AA AA Q CPR in AED Mode 2 2 2 e 81 Review 2 ee 83 8 Noninvasive Pacing 85 Lesson Introduction ee 85 Objectives 2 2 be Se Be ee a eee Pe ew ES a we GBS Time OO ai Be eee bee be es A ee N Accessories medad Sow bee eee ee ee ee oe 8D Clinical Resources 85 Lesson Presentation 86 Pacer Made 86 Pacing View ee ee O Demand vs Fixed Wiede Si Preparation Soy a ow G Ae A oe a a aod mw 4 ow 82 Demand Mode Pics ee baw AER Fixed Mode Pacing Bou e Wy oop a ee ee ba ta cd a ea oR Defibrillating During Pacing Sm EP eee SOR IA eo e D3 RevieW a mo hh we ewe A A RAE ads A A A he a DA 9 Pulse Oximetry Monitoring 95 Lesson Introduction y a oe be eRe eres Pw ewe 95 ODEs 6 owe RRR RR Rae so DD Time e ss CEA ass OS Accessories Resomcndad CADA AAA Oe oa 9 Clinical Resources 12 253 de sa 2D Lesson Presentation ro o a e sa 9 96 Overviews s sop w oa a S a 2 a Bow e 96 Selecting a Sensor 4 ww Ree ew 96 Applying the Sensor dc ss Monitoring SpO 2 2 aa 98 Pleth Wave se th oR SS eR SHRED SSR BR Se AR 99 Setting SpOy Alarms
3. A therapy port for paddles external or internal therapy cable multifunction electrode pads or pads CPR meter cable A slot for a data card to transfer patient information Top Panel The top panel has a handle and basic operating instructions Optional external adult pedi paddles also reside here if present NOTE Be sure to demonstrate access to the pediatric paddles 10 Back Panel The back panel has e Two compartments for lithium ion batteries Compartment B also used to connect an AC power module NOTE Be sure to demonstrate how to take batteries in and out of the compartments e A DC Power Input port e ALAN port for network connectivity Note the following The LAN port is intended for connection to the IntelliVue Clinical Network or for Batch LAN Data Transfer During real time patient monitoring the LAN port should only be connected to the IntelliVue Network and devices that comply with IEC 60950 1 and IEC 60601 1 For post event Batch LAN Data Transfer or when the patient is not connected to the MRx the MRx should only be connected to the facility network e An RS 232 serial port for 12 Lead ECG transmission and Philips network connectivity Note the following The RS 232 serial port is intended for connection to the IntelliVue wireless backpack It is also for connecting with the Rosetta Lt and cell phones for data transmission Improper system operation may result if any other device is connected to
4. Note Upon returning to a clinical mode from a non clinical mode such as Configuration or Data Management all settings are re set to the device s default values Password Security Access to Manual Defib Mode and Pacer Mode may be password protected if configured If the modes are password protected you are prompted to enter the password when you move the Therapy Knob to either the Pacer position or an energy selection Use the Navigation buttons to select the password numbers select Done and then press Menu Select to complete the entry The Charge button and the Start Pacing soft key remain inactive until the password is entered AED Mode is always available without a password Note the following 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 prevents manual defibrillation delivery or pacing therapy Prior to selecting this Configuration option review this potential risk with your Risk Manager Display Layout The MRx display layout is segmented as follows General Status At the top this area contains Mark Event button label e Date and time e Battery icons Labeled A and B to match battery compartments on back panel Display current available battery power ranging from hollow fully discharged to full fully charged Ifan AC Power Module is in Compartment B the No Battery icon is dis
5. Suggestion Have students complete the above steps during or after your demonstration selecting each option to see the respective discharge message above e If discharge patient is confirmed The current patient incident is closed The MRx sends the discharge command to the Information Center if connected and then automatically shuts down and restarts While shutting down the MRx display will go black You can turn the device off at this point If you do not turn the MRx off a Patient Discharged message will appear on the screen until the MRx restarts Upon restart the patient name is displayed as Not Admitted Patient type paced status and alarm limits all reset to default values Other patient information is cleared 165 Transfer Transfer prepares the current patient s data to be moved to another location on the IntelliVue Network by moving the patient to the transfer list at the Information Center found under Admit To access Transfer on the MRx 1 Confirm that the MRx is on the network not already in Transfer Mode and the patient has been admitted The patients name or is displayed Press the Menu Select button Using the Navigation buttons select Patient Info and press Menu Select 2 3 4 Select Transfer and press Menu Select 5 The Transfer Patient message prompts you with a Transfer Patient question 6 Select Yes to transfer the patient or No to cancel transfer When a p
6. Turning a Networked Device Off e Ifa networked MRx is turned off wave and alarm data may be displayed at the Information Center for 10 more seconds After 10 seconds a No data from bed INOP statement appears on the Information Center display The current patient incident is closed at the MRx but the patient will not be discharged from the Information Center If the MRx is turned back on the ADT state is initially set to Not Admitted and patient type paced status and alarm limits are reset to their default settings If the patient is still admitted at the Information Center the MRx is updated with patient information from the Information Center The ADT state is reset to admitted e In the event the MRx loses its network connection with the Information Center and both devices are still powered on the devices retain the patient s status and other settings when a network connection is restored Note the following Prior to monitoring a new patient with the MRx discharge the old patient to ensure that all old data at the Information Center are removed Leaving a Clinical Mode If a networked MRx is changed to a non clinical mode e g Data Management or Operational Check a No data from bed INOP statement appears on the Information Center display The current patient incident is closed at the MRx The patient will not be discharged from the Information Center If you re enter a clinical mode the ADT state is initially set t
7. Using the Device Location option section in the Networking chapter of the MRx Instructions for Use 161 c Acombination of Wired and Wireless The wired LAN and wireless radio AC power module are physically connected to the MRx at the same time The wired connection takes priority thus only the wired icon appears on the MRx display in all clinical views and indicates data can be exchanged with and viewed at the Information Center d This feature is currently available only in the United States Note the following If you lose the wired connection the MRx automatically attempts to connect to the network via the wireless radio AC module If the radio AC module is not connected to the MRx when you lose your wired connection you will not automatically switch over to wireless operation You must plug the module in and restart the MRx before obtaining a wireless connection Regardless of a wired or wireless connection the MRx provides the same level of network functionality It sends up to four waveforms except Q CPR and a maximum of seven alarms to the Information Center All arrhythmia processing and controls reside at the MRx Using the Device Location Option e 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 It identifies the general location of the MRx by associating it with network access points i
8. e AED Mode may include Q CPR measurement and feedback if so equipped See the Q CPR lesson for details AED View Connect a simulator to the MRx set it to normal sinus rhythm NSR and turn the Therapy Knob to AED Then introduce the unique AED View characteristics Enlarged ECG Wave Sectors 1 and 2 combined Enlarged Event Timer e Shock Counter with total number of shocks delivered in AED Manual Defib Modes e Text message window accompanied by related voice prompts Suggestion Ask students to point out characteristics instead of YOU stating them Additional points notes 42 Preparation Discuss the AED defibrillation preparation 1 Confirm the patient s condition i e unresponsive not breathing and or pulseless 2 Prepare the patient s chest Wipe moisture away and if necessary clip or shave excessive chest hair 3 Apply multifunction electrode pads to the patient as directed on the pads package using the anterior anterior electrode placement Note the following The AED algorithm used by the MRx has not been validated using anterior posterior pads placement 4 Ifnot pre connected insert the pads cable into the green Therapy port DEMONSTRATE 5 Connect the pads to the pads cable DEMONSTRATE Suggestion Have students complete steps 4 and 5 Additional points notes 43 AED Mode Demonstrate the AED defibrillation steps with the simulator set to VF V Fib
9. 1 Turn the Therapy Knob to AED 2 Follow the voice and screen prompts 3 Press the orange Shock button if prompted Mention the following AED Mode characteristics during the demonstration e Device capabilities are limited to those essential to AED e Only the ECG acquired through pads is displayed No other parameters appear e Shockable rhythms are VTACH High and V Fib e Previously set alarms and scheduled measurements are indefinitely paused e Entry of patient information is disabled e Sync Lead Select and Alarm Pause buttons are inactive e The voice prompt volume is easily adjusted Suggestion Ask students to help point out characteristics instead of YOU stating them all Additional points notes 44 Turn the Therapy Knob to AED When the MRx is turned to AED it checks for proper pads cable and pads connection as follows If the you are prompted to pads cable is not properly Connect Pads Cable attached pads are not connected Apply Pads and Plug in Connector to the pads cable pads are not applied to the patient or pads are not making proper contact with the patient s skin Practice Exercise 1 Have students turn the Therapy Knob to AED without a pads cable and or pads connected to see what prompts are generated Additional points notes 45 Follow the Screen and Voice Prompts Next connect the pads and pads cable set the simula
10. Acquiring the 12 Lead ECG Demonstrate how to acquire a 12 Lead ECG 1 Press the 12 Lead soft key 2 Check the signal quality on each lead and if necessary make adjustments 3 Press the Start Acquire soft key The message Acquiring 12 Lead is then displayed while the MRx acquires ten seconds of ECG data e If the patient age and sex were not previously entered you are prompted to enter the information using the Navigation and Menu Select buttons If the MRx is configured to run the ACLTIPI and TPI algorithms enter the patient s chest pain symptoms in the Chest Pain Comp menu primary complaint default secondary complaint or none 4 Keep the patient still while the message Acquiring 12 Lead is displayed 5 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 6 Following analysis the 12 Lead Report is displayed printed and stored internally 7 Press New 12 Lead to acquire another 12 Lead ECG 8 Press Exit 12 Lead to exit the 12 Lead function Note the following e Failure to enter correct patient age and sex can result in an erroneous diagnosis 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 e Wet gel electrodes take less time to settle than hydrogel
11. Clear Transfer Clear Transfer exits the Transfer Mode after losing connection to the network Demographic or 8 g patient data remain in the Information Center s transfer list and are maintained at the MRx To Clear Transfer 1 While in Transfer Mode press the Menu Select button 2 Using the Navigation buttons select Patient Info and press Menu Select 3 Select Clear Transfer and press Menu Select 4 The message Transfer mode will be exited displays when Clear Transfer is selected prompting with a Clear Transfer question Select Yes to clear transfer or No to remain in Transfer Mode Suggestion Have students complete the above steps during or after your demonstration stating what they see during the procedure Automatic Re Admit If a lost network connection between the MRx and Information Center is restored while in Transfer Mode the patient is automatically re admitted from the transfer list The MRx exits Transfer Mode Turning the MRx off When the MRx is turned off or enters a non clinical mode e g Data Management Operational Check Configuration etc while in Transfer Mode the current patient incident is closed and the MRx exits Transfer Mode The patient will remain on the Information Center s transfer list When the 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 Suggestion Have students turn off
12. Latching exceed defined 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 32 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 15 message alarm tone 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 Alarm Chain for Basic Arrhythmia Monitoring RED ALARMS Asystole V Fib V Tach y V Tach Extreme Tachy Extreme Brady YELLOW ALARMS PVC Alarms Beat Detection Alarms Rate Alarms Frequent PVCs PNC PNP High HR Low HR First level timeout period Second level timeout period y PNC Pacer Not Capture PNP Pacer Not Pacing PVCs gt xx Min INOP Messages Review INOP messages Produce only 1 2 messages for reference purposes e Communicate conditions preventing
13. M3535A IM3536A About This Edition Publication number 453564045041 Edition 7 Printed in the USA To determine the product level version to which this guide applies to refer to the version level on the label of the User Documentation CD ROM that accompanied the device This information is subject to change without notice 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 Edition History 1 September 2006 2 February 2007 3 August 2007 4 May 2009 5 October 2009 6 December 2011 7 August 2013 Copyright Copyright 2013 Koninklijke Philips N V All rights are reserved Permission is granted to copy and distribute this document for your organization s internal educational use Reproduction and or distribution outside your organization in whole or in part is prohibited without the prior written consent of the copyright holder SMART Biphasic is a registered trademark of Philips Notice Microstream and FilterLine are registered trademarks of Oridion Medical Ltd Smart CapnoLine is a trademark of Oridion Medical Ltd Q CPR is a trademark of Laerdal Medical The HeartStart MRx contains an Ezurio PC Card with Bluetooth wireless technology The Bluetooth wordmark and logos are owned by the Bluetooth SIG Inc and any use of such marks by Ezurio is un
14. Option 1 am AT lt A AS la Option 2 Suggestion Have students set up the carrying case and accessory pouches during your instruction Additional points notes 25 Review Have students answer the following questions individually or as a group Correct answers are in bold 1 Identify at least three controls or buttons on the MRx involved with defibrillation Therapy Knob Charge button Shock button Sync button 2 What does a solid red X and periodic audio chirp indicate on the RFU a No battery is present blinking red X and chirp b No power is available solid red X and no chirp c A low battery condition blinking red X and chirp d Defibrillation therapy may not be available 3 The arrhythmia algorithm uses the ECG in which Wave Sector for analysis a 1 b 2 c 3 d all of the above 4 True or false You can select the ECG lead for Wave Sector 2 using either the Lead Select button or Displayed Waves menu False You can only use the Displayed Waves menu to select the ECG lead for Wave Sector 2 5 True or false You should respond to alarms primarily by pressing the Alarm Pause button F You should respond to alarms by acknowledging them and changing limits if needed vs pressing the Alarm Pause button Instructor Guide ECG and Arrhythmia Monitoring Lesson Introduction Introduce the lesson including the learning objectives estimated time to comple
15. QRS alarm tone and voice prompt volumes ECG gain Pacing settings Patient record in the Event Summary Report new data is appended to the record e This feature will not function if all power sources battery and external AC DC power modules are removed from the device even briefly Suggestion Have students shut off MRx and turn it back on within 10 seconds Then ask them to state some of the settings that are retained Consider having students complete this task before giving them the above list of retained settings Printing Waveforms Describe waveform printing characteristics and procedures e Obtain a continuous printout of the primary ECG and one additional waveform on a 50mm printer e Obtain a continuous printout of the primary ECG and two additional waveform on a 75mm printer 18 e Certain waveforms including invasive pressures and CO3 include scale indications on the printout e Printouts are generated either real time or with a 10 second delay depending on your configuration To change wave forms for the second wave printed with a 50mm printer 1 Press the Menu Select button 2 Using the Navigation buttons select the Printed Waves option and press Menu Select 3 Using the Navigation buttons select the wave form you want to print in Wave 2 and press Menu Select To change wave forms for the second or third wave printed with a 75mm printer 1 Press the Menu Select button 2 Using the Naviga
16. 12 Lead Report 2 2 Ebo er AAA AR Accessing Stored Reports 2 2 2 2 ee ee ee ee 148 Adjusting Wave Size e a we ee ee ee ee ee BOE a 12 Lead Filters 2 2 2 ee a Review E 15 Vital Signs Trending 153 Lesson Introduction 2 lt lt aaa ws a 113 Objectives 2 s e s e ee See ee w osom oa g r oa pa a Hw oO Time Leh ee Ae A gt Accessories Reena aoe ee ee ES Lesson Presentation a oa he oO eR ee GS ee eo we a a 154 Overview Bom US a a Back Boe 204 405 a 2m e154 Reviewing Heading Dats pa Se ee Se EP ae aw So Ga Sy Oe Trending Report Intervals 8 i he ew me wee Oe A Scrolling inthe Trending Report 2 2 4 4 4 01m 4155 Printing the Trending Report 2 5 2 aa a2 2 eA e a 155 Exiting the eae Report o a e so s a r ee wow woe 2 al99 Review Boe ee ee ee ee a ee we we o 16 IntelliVue Ebert 159 Lesson Introduction 159 Objectives E de rea SG ee Lhe ee eS ee 2 a 159 Time onya sir BAS Bee ER woe Ee hw 2159 Accessories Ramel AA ee a ee AO Technical Resources 2 we a a 159 Lesson Presentation 2 o 160 Overview noe amp db hohe oe 4 aw amp 2 1 alG0 IntelliVue Weoo Diy ib ae amp RA eae i eee eo 6400 Connecting to the Network 2 2 2 2 eee ee 161 Patient Admit Discharge and Transfer 2 2 2 2 164 Sharing Information on the Network 2 2 2 2 2 ee 168 Review Ob mS wee ob ek Re ee Se AR a 17 Wor
17. 5 What happens when you press the Disarm soft key Additional points notes 55 Synchronized Cardioversion Introduce synchronized cardioversion e Synch cardioversion allows synchronized shock delivery with the ECG R wave monitored in Wave Sector 1 It can be performed through either multifunction electrode pads or external paddles e You should monitor ECG through 3 5 or 10 Lead monitoring electrodes when using external paddles Preparation Discuss cardioversion preparation 1 Perform the tasks as described in the previous Manual Defibrillation Preparation topic 2 If monitoring through a 3 5 or 10 Lead ECG cable plug the cable into MRx s ECG port and apply monitoring electrodes to the patient 3 Use the Lead Select button to select pads paddles or a lead from attached monitoring electrodes Suggestion Have students complete steps 2 using a simulator and 3 Additional points notes 56 Synchronized Shock Delivery Demonstrate synchronized cardioversion with a simulator set to AFib 1 Turn the Therapy Knob to Monitor and press the Sync button 2 Confirm that the Sync marker appears with each R wave If the marker does not appear select another lead Turn the Therapy Knob to Manual Defib and select an energy setting 4 Press the Charge button on the MRx or external paddle 5 Make sure no one is touching the patient or anything connected to the patient
18. 55 lbs ina moving environment e g ambulance Additional movement introduced during patient transport may reduce compression and ventilation measurement accuracy If Q CPR must be used in a moving environment do not rely on the Q CPR feedback during such conditions There is no need to remove the CPR meter from the patient with any other CPR compression devices aside from the Q CPR CPR meter Q CPR should not be used to verify placement of airway adjuncts such as endotracheal tubes and laryngeal masks e There is a Q CPR Data Capture option available that allows you to capture data on CPR quality from the HeartStart MRx using the Q CPR option as well as standard MRx defibrillation and monitoring events and ECG waveforms Events related to Q CPR are logged to the patient incident record but not included in the Event Summary report printed by the MRx however these events and related waveforms can be viewed through Event Review Pro for retrospective review and analysis See the Q CPR Data Capture section in the MRx Instructions for Use for more information 62 Additional points notes Q CPR Preparation Discuss cable connection and CPR meter preparation for Q CPR The Q CPR option requires the use of the Pads CPR cable that connects the CPR meter to the MRx The CPR meter provides real time CPR feedback in a display area for the caregiver performing compressions Pads CPR Cable to the MRx
19. AED Mode only the Patient information from the MRx and Central has been merged message appears on the display for 10 seconds d You can silence or reset most MRx alarms and INOPs from the Information Center T 172 Instructor Guide 17 Working with Data Lesson Introduction Introduce the lesson including the learning objectives and estimated time to complete This lesson describes the data management features of the HeartStart MRx Objectives Upon completion of this lesson students should be able to 1 Identify MRx data management features 2 Identify characteristics associated with printing data reports 3 Mark patient events Time 5 15 minutes Accessories Recommended e External data card 173 Lesson Presentation Overview Provide a summary of MRx s data management features e MRx creates Event Summaries that Have a unique event identification number and date time stamp Contain measurements stored for viewing reporting and printing in the Vital Signs Trending Report Include trending and associated 12 Lead Reports Are automatically stored in internal memory one or more of the oldest summaries is overwritten if space is needed for a new summary May be copied to an external data card using the Data Management menu May be transmitted to a remote personal computer via Bluetooth or LAN for viewing in a data management application like Event Review Pro
20. Plus Sodium hypochlorite chlorine bleach 3 solution in water Quaternary ammonium compounds 21 quaternary ammonium content such as Steris Coverage Plus NPD one part Coverage Plus NPD to 255 parts water Isopropyl alcohol 70 solution in water Do not immerse the Compression Sensor 219 Carrying Case Clean the carrying case by hand with mild soap and water Use fabric stain removers to remove stubborn stains Air dry the carrying case Do not wash or dry by machine Additional points notes 220 Review Have students answer the following questions individually or as a group Correct answers are in bold Consider having students correct FALSE statements to ensure comprehension 1 Which RFU status indicates the MRx is unable to acquire an ECG a Blinking red X with a chirp b Blinking red X without a chirp c Solid red X with a chirp d Solid red X without a chirp 2 Which of the following statement s are TRUE related to the Operational Check a It is automatic You can start it leave and come back later when it s done F This test requires user interaction for some of the tests b The Battery Compartment B test checks for BOTH capacity and calibration of battery B T c An ECG cable must be connected to the MRx to complete the Leads ECG test F A user can check the ECG without a cable d A pads cable must be connected to complete the Pads ECG test T 3 W
21. The multifunction pads should be placed in an anterior posterior position to measure ventilation activity F The pads need to be in an anterior anterior position for measurement purposes 3 True or false The CPR meter can indicate whether you are doing good compressions what your compression depth is and what your compression rate is T True or false In Manual Defib Mode good compression depth is indicated by the downward peak of the waveform appearing between the horizontal lines representing the target zone T True or false The ventilation detection icon indicates ventilation has been detected but not the actual filling of both lungs T True or false Only AED Mode Basic CPR View provides voice and text prompts associated with compression and ventilation activity T Instructor Guide 7 Q CPR with Compression Sensor Lesson Introduction Introduce the lesson including the learning objectives estimated time to complete and applicable resources This lesson describes how to set up and use the Q CPRO option with compression sensor available on the HeartStart MRx Objectives Upon completion of this lesson students should be able to 1 2 Time Identify intended use and preparation for use related to Q CPR Identify characteristics related to Q CPR in Manual Defib and AED Modes 15 20 minutes Accessories Recommended Pads CPR cable Compression sensor Compression sensor adhesi
22. capacity e Life is approx 2 years when properly cared for and depending on the frequency and duration of use e Charging a fully or nearly fully discharged battery as soon as possible optimizes performance e Charging should be done in either the HeartStart MRx with AC or DC power or in the Philips approved Battery Support System at temperatures between 0 C 32 F and 45 C 113 F e Charge status is indicated by the fuel gauge on the battery top each LED represents approx 20 charge capacity and the battery power indicators displayed in the General Status area Suggestion Discuss how and when batteries will be charged in students organizations to ensure charged batteries are available when needed Ask who will calibrate the batteries Recommend students check the Maintenance chapter of MRx Instructions For Use for information about battery calibration storage and disposal Also stress caution when handling using and testing the batteries to prevent physical injury Additional points notes 216 Cleaning Instructions Discuss the following recommendations for cleaning the HeartStart MRx and its associated accessories as appropriate e The HeartStart MRx along with its accessories and supplies may not be autoclaved steam cleaned ultrasonically cleaned or immersed unless otherwise indicated in the Instructions for Use that accompany the accessories and supplies e Do not use abrasive clean
23. characteristics instead of YOU stating all characteristics Practice Exercise 2 Have students turn to 150J manual defibrillation setting and practice performing CPR alone and with another student on a manikin to experience 1 and 2 rescue person situations according to AHA guidelines for compression to ventilation ratio Make sure each student has proper hand arm and body position to perform CPR Also press the Sync button to show what happens to Q CPR when you switch to synchronized cardioversion or the Alarm Pause button to show what happens to Q CPR Pose the following questions 1 What voice prompts do you hear when performing CPR What is the most frequently heard prompt Note The prompt will vary depending on the student 2 How long can you perform CPR without getting a voice prompt How long could you perform CPR before getting totally fatigued 3 What range of compression rate do you achieve 4 How often do you get No Flow times and how long are those times 5 What happens to Q CPR when you press the Sync and or Alarm Pause buttons 69 Additional points notes Q CPR in AED Mode Demonstrate Q CPR in AED Mode in Basic and or Advanced CPR View Configure the Advanced View prior to class as needed Turn the Therapy Knob to AED press the Pause for CPR soft key and mention the following AED Q CPR view characteristics while performing CPR Consider enlisting two students to perform compressions
24. 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 149 Additional points notes 150 Review Have students answer the following questions individually or as a group Correct answers are in bold Consider having students correct FALSE statements to ensure comprehension 1 Which of the following statements is FALSE The 12 Lead Preview screen displays a Patient ID age and sex b Waveforms are presented at a rate of 15mm sec for approximately 2 5 seconds F 25mm sec rate c A flat straight line which indicates a lead can t be derived F dashed line d SpO CO and NBP measurements display in Parameter Blocks 1 and 2 if configured 2 True or false Once ECG acquisition is complete you press the Start Analysis soft key to start ECG analysis F Once acquisition is complete ECG analysis begins automatically 3 The MRx acquires how many seconds of ECG data a 5 b 10 c 12 d 15 4 Which one of the following inputs is
25. required Suggestion Ask students to help point out characteristics instead of YOU stating them all 57 Practice Exercise 2 Have students attach a simulator and pads to the MRx set the simulator to a shockable rhythm e g VF and complete synchronized cardioversion Pose the following questions 1 2 3 What do you see when you press the Sync button How do you know if sync is active How long do you need to press the Shock button Once in Sync mode what happens when you turn the Therapy Knob to a position other than Manual Defib What happens when you press the Sync button again Additional points notes 58 Review Have students answer the following questions individually or as a group Correct answers are in bold 1 Identify the Code View elements Event timer heart rate enlarged ECG shock status area 2 What are the three basic steps for manual defibrillation using the MRx a Turn the Therapy Knob to Manual Defib on a desired energy level b Press the Charge button c Press the Shock button 3 Which of the following statement s indicate that the MRx is ready to deliver a shock via pads a The device sounds a continuous high pitched tone Y b The Charged value on the display matches the Therapy Knob setting Y c The disarm soft key is disabled N d The Shock button flashes Y 4 What are the four basic steps for synchronized cardioversion using the MRx a Turn the Therapy K
26. 2 2 eb we bbe eG ee oe eG 2 100 Setting Pulse Rate Alarms oaao oag od oa oe poa a oa 5 TOD Disabling the SpO Monitoring Function e we Be oe ghu oe a A REVIEW e e e ise A Gee e eR a RS He Aa a lO 10 Noninvasive Blood Pressure Monitoring 105 Lesson Introduction e a Oe ee we we 4105 Objectives o Exa Ba Me we RW ae ER Bo Pome e105 Time eG Boe amp eB Sa e ee Oe ew we ae 6 105 Accessories kenana So om a ae w a a e o we a a a a a a05 Clinical Resources a a a a ee 105 Lesson Presentation 106 vil Overview eee Se Ba ced eae a me a a LOG Preparing to Mesue NBP a e See ke PP eae a ee aoa LO Measuring NBP w s w s wo ee 108 ro 2 osos E ee a oe a GTO Review of AAA ee eee E Boece Y e Ree 11 Carbon Dioxide Mei 113 Lesson Introduction 113 Objectives 2 3 y he dez He ee Ree ww GS 13 Time OO a Se ee a os a dS Accessories medad pda aa bee ss AS Clinical Resources 0000 a a a 113 Lesson Presentation 00a a a ee 114 Overview how as aa Be eae a UA Preparing to Neste EXCO LR od Kop eose fo O Measuring EtCO3 Sodo at AA a we ATG Setting Up the EtCO and AwRR Matin Be ee Ae eM ee aG Disabling EtCO Monitoring 2 a 2 2 ee ee ee 118 Review 119 12 Invasive Pressures Monitoring 121 Lesson Introduction 121 Objectives oe eee ee sas ass ass el Time Soe Cee eee ee eee ee ee eT Accessories Renna me eee we ee ee ee e o al
27. 35 Note the following Disabling alarms prevent all alarms associated with HR measurements from being annunciated If an alarm condition occurs no alarm indication will be given Responding to HR and Arrhythmia Alarms Discuss and demonstrate how to respond to alarms e The Audio Pause label appears when an alarm is announced e Menu Select or Navigation buttons silence alarm audio e Two minutes after being paused if an alarm condition still exists the alarm audio re sounds e Respond to an HR or Arrhythmia alarm as follows 1 Acknowledge the alarm condition 2 Adjust the limits using the New Limits menu Practice Exercise 3 Have students change HR or VIACH limits and enable disable and respond to HR and arrhythmia alarms Additional points notes 36 Displaying an Annotated ECG Demonstrate how to display an annotated ECG e Beat labels appear in Wave Sector 2 based on the ST AR Algorithm analysis e Beat labels appear in Wave Sector 1 after a six second delay e Below are the various beat labels with related descriptions N Normal Above QRS V Ventricular Ectopic Above QRS P Paced Above QRS i 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 Ab
28. CPR soft key Additional points notes 48 e Review Have students answer the following questions individually or as a group Correct answers are in bold 1 Identify the AED View elements Event timer enlarged ECG shock counter message window 2 Apply multifunction electrode pads using anterior posterior placement for AED F anterior anterior 3 What are the three basic steps for AED using the MRx a Turn the Therapy Knob to AED b Follow the voice and screen prompts c Press the orange Shock button if prompted 4 Which of the following statement s about AED Mode are TRUE a The MRx automatically checks for proper pads cable and pads connection T b Ifartifact interferes with ECG analysis and persists analysis will suspend but resume automatically after 60 seconds F Analysis resumes automatically after 30 seconds c The MRx automatically disarms ifa shock becomes unnecessary T d The MRx automatically analyzes the patients heart rhythm after a shock is delivered T 49 Instructor Guide Manual Defibrillation and Cardioversion Lesson Introduction Introduce the lesson including the learning objectives estimated time to complete and applicable resources This lesson explains how to prepare for and perform manual asynchronous and synchronous cardioversion defibrillation using multifunction electrode pads and external internal paddles Objectives Upon completion of this l
29. ECG monitoring or analysis e Displayed just above the HR Arrhythmia alarm status area e Multiple messages alternate every 2 seconds 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 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 dashed line Pads Paddles Off The multifunction electrode pads used INOP message INOP tone 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 Practice Exercise 2 Have students set the simulator and MRx to produce a variety of latching non latching and INOP conditions as appropriate Pose the following questions 1 What do you see and hear when a red alarm goes off A yellow alarm An INOP message 2 Ifyou acknowledge the Alarm Pause mes
30. If no shock was delivered during the Shock test the voice prompt No Shock Delivered is annunciated Defib Tests defibrillation circuitry None None and 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 None None and delivers a paced pulse into a 50 ohm test load CPR meter or Checks the basic None None Compression Sensor communication circuity of the meter or sensor Leads ECG Tests leads ECG acquisition None if the test passes If the test If the ECG test fails with the and the ECG cable fails the following prompt is cable and passes without the displayed at the end of all cable the ECG cable is bad remaining tests Leads ECG Replace the ECG cable and Test failed with cable rerun Operational Check Disconnect pran rene If the ECG test fails with and rerun test without cable without the cable refer to the MRx Instructions For Use Troubleshooting chapter for the action to take 213 Operational Check Tests Continued Discuss the Op Check tests in the order they are performed corresponding prompts and actions to take if any Pads Paddles ECG Checks ECG acquisition None if test passe
31. Knob to Monitor 2 Press the Menu Select button 3 4 214 Select Operational Check and press Menu Select 5 Using the Navigation buttons select Op Check Summary and press Menu Select 6 Press Menu Select to acknowledge the message Leaving Normal Operational Mode The Operational Check Summary screen is displayed 7 Press the Print soft key to print the report Suggestion Have students complete the steps to access the Op Check Summary with you or after you have demonstrated the procedure Discuss the Op Check Summary Results and actions to take see below 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 MRx Instructions For Use acquisition Troubleshooting chapter for the action to take Fail CX Solid red X chirp A problem has been detected 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 MRx Instructions For Use Troubleshooting chapter for the action to take Fail S Hourg
32. Menu Select button 1 Place the transducer at the appropriate level for the measurement site 2 Close the transducer stopcock to the patient and vent the transducer to atmospheric pressure 3 Press the Menu Select button 4 Using the Navigation buttons select Measurements Alarms and press Menu Select 5 Select the pressure label you wish to zero 6 Press Zero and press Menu Select Zeroing begins Suggestion Have students complete the above steps during or after your demonstration Ask what message they see if the process is successful Pressure label zero done at date time for example ABP zero done at 25Jan2006 9 26 Zeroing in Monitor Mode Demonstrate zeroing using the soft key in Monitor Mode 1 Place the transducer at the appropriate level for the measurement site 2 Close the transducer stopcock to the patient and vent the transducer to atmospheric pressure 3 Press the soft key under the Zero Pressure label 4 Using the Navigation buttons select the pressure s you wish to zero from the Zero menu and press Menu Select Zeroing begins Note the following 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 Suggestion Have students complete the above steps during or after your demonstration Ask what message they see if the process is successful
33. To connect the Pads CPR cable 1 Align the white pointer on the cable with the white arrow on the green Therapy port and insert the cable into the port Push until you hear it click into place DEMONSTRATE Suggestion Have students complete this step Note the following as appropriate e Pre connect the Pads CPR cable to the MRx prior to a resuscitation event or rescue to save on set up time e The Q CPR option requires the Pads CPR cable to be connected to the HeartStart MRx CPR feedback is not available if the standard pads or paddles cable is connected 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 Push until you feel it snap into place There should be no gap between the two connectors DEMONSTRATE Suggestion Have students complete this step Note the following Pre connect the CPR meter cable to the Pads CPR cable to save time on set up Multifunction Electrode Pads 1 Check the expiration date on the pads package and inspect the packaging for any damage 2 Prepare the patient s chest 63 3 Connect the pads connector to the Pads CPR cable DEMONSTRATE 4 Apply the pads to the patient as directed on the pads package using the anterior anterior placement DEMONSTRATE if manikin available Suggestion Have students complete steps 3 and 4 if a manikin is available Note the following e Anterior posterior pad placement
34. and ventilations so that you can focus on discussion of Q CPR characteristics AED Mode has a Basic CPR View and can be configured to Advanced View Basic View displays only the ECG waveform a configurable CPR Timer status bar and CPR prompts There is no compression waveform displayed e AED Mode issues voice prompts like Manual Defib Mode however it also displays the same prompts as momentary text messages For details on all Manual Defib and AED Mode feedback prompts refer to the Feedback Prompts section in the Q CPR and Data Capture chapter of the MRx Instructions for Use e Ifyour 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 e Compression and ventilation measurement values are printed in the annotation area of the ECG printed strip Suggestion Ask students to help point out characteristics instead of YOU stating them all Practice Exercise 3 Have students turn to AED Mode and practice performing CPR alone and with a another student on a manikin to experience a 1 and 2 rescue person situation according to AHA guidelines for compression to ventilation ratio Make sure each student has proper hand arm and body position to perform CPR Pose the following questions 1 What voice and text prompts do you get when performing CPR What is the most frequent voice or text prompt produced Note The prompt will
35. automatically attempts to connect to the network via the wireless radio AC module T d The MRx provides the same level of network functionality for both wired or wireless connections T 3 Which of the following statement s are FALSE regarding patient admittance discharge and transfer a The MRx admits patients via patient name patient ID patient type category date of birth or sex F You can t admit a patient by changing patient type b Discharging a patient resets patient type category paced status and other MRx settings to default values T c When a patient transfer is confirmed the patient is discharged to the transfer list at the Information Center T d When the MRx enters a non clinical mode e g Data Management while in Transfer Mode the patient remains on the Information Center s transfer list T 4 Which of the following statement s are TRUE regarding the type of information shared between the MRx and Information Center a A patients weight and height entered on the Information Center are automatically updated on the MRx F Patient weight and height are not available on the MRx b Ifthe Information Center sends a neonatal patient type to the MRx the MRx modifies the setting to pediatric T c If patient information changes on the MRx due to a conflict resolution you will see a patient information merged message and a menu to confirm or edit patient info in all modes F In
36. communicate with the 12 Lead Transfer Station Progress messages are displayed during the test If the test is successful the message Transmission Test Passed displays Press Menu Select to acknowledge the message If the transmission test fails the message Transmission Test Failed displays along with additional information about where the failure occurred See Transmission Problems Bluetooth in the Troubleshooting chapter of the MRx Instructions for Use for support Additional Bluetooth Device Information Mention the following points regarding Bluetooth devices as appropriate e Many Bluetooth devices are not discoverable by default Check the device s documentation to see if you need to enable discovery e Asa general security practice don t leave the Bluetooth device in discovery mode e Some devices require that you turn on the Bluetooth functionality 186 e Some devices may prompt you to authenticate each time Check the device s documentation to see if you can configure it to always communicate with the MRx e Give your Bluetooth device an easily recognizable name as this is the name that appears on the MRx menus Limit the name to up to 15 characters 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 Practice Exercise 1 Have students complete a Bluetooth transmission setup After completin
37. d Gently lift the cap plate up 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 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 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 on the MRx 10 Attach the side pouches using the snaps located inside the pouch pockets The following illustrations show carrying case and accessory pouch assembly 21 22 Storing Accessories 1 Store parameter cabling and accessories as shown below 2 Attach the Therapy cable and route it through the cable fastener loop securing the cable just below the strain relief See below left 3 Attach the rear pouch using the buckles provided See below right Note Depressions are provided on the inside of the rear pouch should you wish to make a cut out to accommodate external power 23 Here are recommended carry bag storage instructions for Q CPR accessories for easy access
38. devices within the specified range are discovered detected by the HeartStart MRx assuming they are in discoverable mode and displayed on the Add Device menu even if you have already paired with the device Pairing a Bluetooth Device with the MRx e Once a Bluetooth device is selected from the Add Device menu perform a passkey procedure to communicate or pair the wireless device with the HeartStart MRx The passkey is like a PIN number or password you create for a personal account Some Bluetooth devices only allow pairing for approximately 30 seconds so be ready to enter the passkey 1 Use the Navigation buttons to define a passkey on the MRx and select Done The Bluetooth device prompts you for a passkey 185 2 Enter the same passkey on your Bluetooth device See the documentation that came with your Bluetooth device for instructions 3 Select a Bluetooth Service Highlight File Transfer or Dial Up Networking and press the Menu Select button 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 DUN select the designated profile from the Phone Modem Profiles menu If you selected FT proceed to the next step You will not be prompted to select a profile when adding a Bluetooth device as part of the Event Summary Bluetooth option 5 Once the B
39. e g changing waveform for a sector the patient s age alarm limits etc If you access the Patient Info menu point out that a patient s full name is entered using 2 alphabetical lists one to enter last name followed by another to enter first name When each name is complete select Done When entering names follow your organization s or HIPPA regulations Message Windows e Provide status information e Alert you to an error or a potential problem e Direct you to take action e Use the Navigation and Menu Select buttons to respond to messages High Contrast Display e Provides a High Contrast view to optimize visibility of the MRx display when used in bright sunlight 15 e Display appears with a yellow background and all other screen elements appearing in black or shades of gray e Select High Contrast On from the Main Menu to enable the feature Note the following The High Contrast view does not display the colors red or blue therefore be sure the MRx is configured correctly with the appropriate parameter color settings Suggestion Have students set their devices to the High Contrast view any time during your discussion Additional points notes Responding to Alarms Create an alarm condition and cover the following steps to respond to the condition 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
40. exceeds 1 minute it is assumed that CPR compression activity has stopped intentionally and the value is cleared e If monitoring CO the EtCO numeric value is displayed in Parameter Block 2 along with its alarms off indicator Note the following e SpO monitoring functionality is not available during Q CPR use e Compression ventilation and No Flow measurement values are printed in the annotation area of the ECG printed strip Suggestion Print a strip to exhibit the values Soft Keys Toggle between the soft keys in manual defibrillation mode and discuss the following characteristics e The Q CPR sub view is manually displayed by pressing the Start CPR soft key from any energy setting excluding 150J This soft key is then labeled Stop CPR and may be used to switch between the Q CPR sub view and the standard Code View The Q CPR sub view and Stop CPR soft key display automatically upon the first CPR compression from any energy setting excluding 150 e If the Sync button is pressed to initiate synchronized cardioversion Q CPR is deactivated Reactivate Q CPR by pressing the Start CPR soft key or performing chest compressions e Ifthe Alarm Pause button is used to turn alarms on Q CPR is deactivated e The Intubate soft key displays in the Q CPR view in both Manual Defib Mode and AED Mode When intubation is indicated by pressing the Intubate soft key the soft key then becomes inactive and its label changes to Intuba
41. gender sex and paced status It does not display height or weight from the Information Center Admit e The MRx displays physiological data and stores it in an event summary and trends report as soon as a patient is connected so you can monitor a patient who is not yet admitted You need to admit patients to correctly identify them on recordings reports and network devices Data must be entered to save it at discharge The 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 MRx 1 Press the Menu Select button 2 Using the Navigation buttons select Patient Info and press Menu Select 3 Select Name ID Date Of Birth or Sex and press Menu Select 4 Enter the appropriate information and press Menu Select A Patient Admitted momentary message displays on the MRx when a patient is admitted Note the following e When admitting a patient from the MRx if you enter a patient ID but not a last name the last name is set to if you enter a first name date of birth or sex but not a last name or patient ID the last name is set to and the patient ID is set to the MRx Event ID and sent to 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 las
42. how to disable enable temperature alarms 1 Press the Menu Select button 2 Using the Navigation buttons select the Measurements Alarms menu and press Menu Select 3 Select the temperature label option currently assigned to your measurement and press Menu Select 4 Select Alarms Off Alarms On and press Menu Select 138 Disabling the Temperature Function Demonstrate how to disable the Temperature function e Disconnect the temperature cable from the MRx Temperature port The message Temp or the label currently activated Unplugged Turn Off Temp or the label currently activated appears Select Yes and press the Menu Select button e Should the temperature cable get disconnected accidentally or if the probe and cable separate and you want to continue monitoring temperature select No and press Menu Select Reconnect the temperature cable to restart the temperature monitoring function Practice Exercise 1 Have students change temperature alarm limits and disable enable and respond to related alarms Pose the following questions 1 What happens when you change a limit Disable an alarm Respond to an alarm Additional points notes 139 Review Have students answer the following questions individually or as a group Correct answers are in bold Consider having students correct FALSE statements to ensure comprehension 1 True or false When you change a temperature label you need to activate its related alarm
43. label on the display changes to Select Event and the Mark Events menu displays Use the Navigation buttons to select the desired event and press Menu Select e The ECG strip is annotated with the mark event 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 appears on the ECG strip e The marked event is stored in the Event Summary e Entries on the Mark Events menu are as configured Changes are made using the Configuration menu e Ifyou have a MRx M3536A with software version R 03 and later you have a choice of 10 configurable events and a generic Other event to select from and can add numeric data to an event after it is marked Suggestion Have students mark and print an event during or after your discussion 179 Review Have students answer the following questions individually or as a group Correct answers are in bold Consider having students correct FALSE statements to ensure comprehension 1 Which of the following statement s are TRUE related to MRx s data management a Data management includes Event Summaries that have a unique event identification number and are automatically stored in internal memory b New Event Summaries are initiated by the arrival of valid SpO CO or invasive pressure data along with other activities c The number of incidents stored in memory is determined by the a
44. label displays above the Navigation and Menu Select buttons Pressing any of these buttons silences 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 the two minute audio pause for all active alarms When an INOP is announced without a concurrent physiological alarm the Audio Off label displays above the Navigation and Menu Select buttons Pressing any of these buttons silences the audio for all active alarms while you are attending to the patient INOPs do not reannunciate after pressing audio off 4 Address the alarm condition with one of the following options Acknowledge For latching alarms acknowledge clears the alarm condition when the condition no longer exists New Limits Adjust the parameter limits accordingly 16 Alarms Off Turns the monitoring parameter s alarms off and prevents real time print strips The alarm message is no longer displayed and the Alarm Off icon appears next to the parameter value Note the following Turning off alarms turns them off indefinitely 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 a
45. limits F All settings including alarm limits associated with a label become active as soon as you change the label 2 Which of the following statement s are TRUE regarding temperature alarms a All temperature alarms cease when their alarm condition no longer exists T b The Tesoph Low message means the esophageal temperature has fallen below the low alarm limit T c Temperature alarms default to off F Temperature alarms default to on d Changing the label may change the alarm limits T 140 Instructor Guide 14 12 Lead ECG Monitoring Lesson Introduction Introduce the lesson including the learning objectives estimated time to complete and applicable resources The ACI TIPI TPI topic in this lesson is optional so advise students accordingly on objectives and how long the lesson will take to complete This lesson describes how to use the diagnostic 12 Lead ECG function of the HeartStart MRx Objectives Upon completion of this lesson students should be able to 1 Identify pertinent information in the 12 Lead preview screen 2 Perform 12 Lead ECG acquisition 3 Identify characteristics of the ACI TIPI and TPI algorithms Optional objective 4 Identify important characteristics of the 12 Lead Report Time 10 25 minutes Accessories Recommended e Simulator e 10 Lead monitoring electrodes cable Clinical Resources e DXL ECG Algorithm Application Note e ACI TIPI Application Note e
46. manufacturer of a new transducer plugged into the pressure line Please refer students to the Calibration topic of the Invasive Pressures chapter in the HeartStart MRx Instructions for Use for details on setting a known calibration factor on the MRx perform a mercury calibration on the reusable CPJ840J6 transducer calibration confirmation viewing a mercury calibration date and time suppressing alarms associated with non physiological artifact Suggestion Have the Instructions for Use available in case you need to demonstrate any related procedures Additional points notes 127 Alarms Mention the following invasive pressure alarm characteristics and details in the following table as appropriate e Invasive pressure alarms except ABP ART Ao PAP P1 or P2 disconnect alarms are all categorized as non latching alarms being automatically removed when their alarm condition no longer exists e The disconnect alarms are latching meaning they remain present even if the alarm condition no longer exists e Ifalarms are enabled alarm limits appear next to the pressure value The following table details red yellow physiological alarms Enabling Disabling Alarms 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
47. or Delete and press Menu Select Note the following A report can be transmitted from the selected 12 Lead Report menu This procedure will be covered in the Data Transmission lesson 6 Press Exit to close the menu Suggestion Have students try printing an additional copy of a report Adjusting Wave Size Demonstrate how to adjust the ECG wave size to improve signal viewability if necessary 1 While in 12 Lead press the Menu Select button 2 Using the Navigation buttons select ECG Size and press Menu Select 3 Using the Navigation buttons select the desired size value and press Menu Select Note the following e The lead size is retained when you exit and then return to 12 Lead functionality without turning off power for more than 10 seconds e Selecting an ECG wave size of either 10mm mV Y V or 20 mm mV V displays V C leads at half of the selection i e 5 mm mV and 10 mm mV respectively Suggestion Have students try adjusting a few wave sizes to see related changes 12 Lead Filters Discuss the characteristics of 12 Lead filters e ECG bandwidth filters of 0 15 40 Hz 0 05 40 Hz or 0 05 150 Hz can be configured to apply to 12 lead ECG waveforms shown on the display e The 12 Lead Report can be configured to apply either the same filter choice used for the display or a 0 05 150 Hz filter The filter setting is applied to both printed and stored 12 Lead Reports Note the following Although the 0 05 150 Hz
48. pulse rate alarm characteristics e Alarms sound if measurements fall outside the configured high and low pulse rate limits e Pulse rate alarms are all categorized as non latching alarms meaning they are automatically removed when their alarm condition no longer exists e Alarms are disabled unless enabled during use e Limits can be changed during use Changing Pulse Rate Alarm Limits Demonstrate how to change pulse rate alarm limits 1 Press the Menu Select button Using the Navigation buttons select the Measurements Alarms menu and press Menu Select Select Pulse and press Menu Select 2 3 4 Select Pulse Limits and press Menu Select 5 Using the Navigation buttons select the new high limit value and press Menu Select 6 Select the new low limit value and press Menu Select Enabling Disabling Pulse Rate Alarms Demonstrate how to enable pulse rate alarms 1 Press the Menu Select button 2 Using the Navigation buttons select the Measurements Alarms menu and press Menu Select 3 Select Pulse and press Menu Select 4 Select Alarms On Off and press Menu Select Practice Exercise 2 Have students change pulse rate limits and enable disable and respond to related alarms Pose the following questions 1 What happens when you change a limit Disable an alarm Respond to an alarm Disabling the SpO Monitoring Function Demonstrate how to disable the SpO monitoring function Disconnect the sensor cab
49. s skin apply new multifunction electrode pads as necessary Reposition new pads in a slightly different location to help prevent skin burns Refer to the manufacturer s documentation for replacement recommendations Suggestion Have students complete steps 2 4 using a simulator Additional points notes 89 Demand Mode Pacing Demonstrate how to pace in demand mode 1 Turn the Therapy Knob to the Pacer position Note the following a The message Pacing Paused appears in the status block indicating that the pacing function is enabled though pace pulses are not being delivered b 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 in place of Pads 2 Press the Lead Select button to select the best lead with an easily detectable R wave 3 Verify white R wave markers appear above or on the ECG waveform with a single marker for each R wave If no R wave markers appear coinciding with the R wave select another lead 4 Press the Pacer Rate soft key and use the Navigation and Menu Select buttons to select the desired number of pace pulses per minute The initial rate is configurable 5 If needed adjust the initial pacer output before you start pacing Press the Pacer Output soft key and use the Navigation and Menu Select buttons to select the desired output The initial ou
50. should not be used with the Q CPR option e Philips multifunction pads are required to measure ventilation activity as well as acquire an ECG signal and deliver a shock as appropriate Pads need to be applied securely and maintain good contact to ensure a good signal for ventilation measurement CPR meter Adhesive Pad 1 Peel a CPR meter adhesive pad from the liner strip DEMONSTRATE 2 Align the bottom of the pad with the yellow patient adhesive mount area on the back of the CPR meter Make sure the channel on the adhesive is directly over the visible groove in the plastic and press the pad into place DEMONSTRATE Suggestion Have students complete steps 1 and 2 Note the following e The CPR meter adhesive pad is intended for single patient use only e Pre attach the adhesive pad to the CPR meter to save time on set up and protect the vent membrane from getting dirty or damaged 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 DEMONSTRATE 3 Position the CPR meter s compression area on the lower half of the sternum and the centerline of the bare chest as illustrated on the front of the CPR meter The CPR meter can be placed on top of a defibrillator pad if the two overlap DEMONSTRATE on a manikin Suggestion Have students complete steps 2 and 3 Note
51. 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 resuscitation guidelines e 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 e The ventilation volume icon depicts an approximate level of ventilation volume A set of lungs graphically shows four states of the ventilation s magnitude empty one third full two thirds full SE and full After a brief display the icon returns to the empty state Lungs marked with a indicate when ventilation cannot be measured Note the following The graphical lungs do not signify the actual filling or presence of both lungs in the patient The actual ventilation volume associated with filling of the lung icon varies from patient to patient Actual lung expansion is based upon chest rise and checking bilateral breath sounds e The No Flow Time value represents time without a detectable chest compression beginning at 2 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
52. the following e Ifyou have difficulty 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 e Ifthe 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 meter from the patient and continue CPR according to your organization s protocol e 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 64 Starting CPR with the CPR meter 1 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 Provide chest compressions according to your organization s CPR protocol DEMONSTRATE on a manikin or compliant surface Suggestion Have students complete this step Note the following e Do not practice with the CPR meter on a person Use only a training manikin or a compliant surface for practice e 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 patien
53. this port M3538A Lithium lon Battery e Has a fuel gauge with 5 LED indicators each representing a charge of approximately 20 of capacity Press the fuel gauge button to illuminate the fuel gauge e Should be used as the primary power source with AC DC as a secondary source if desired If an AC DC power module is used as the only power source the 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 Anew fully charged M3538A battery operating at room temperature 25 C 77 F provides at least 5 hours of monitoring with ECG SpO CO 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 e Battery life depends on the frequency and duration of use When properly cared for useful life is approximately 2 years To optimize performance a fully or nearly fully discharged battery should be charged as soon as possible 11 Additional points notes Display View Introduce the display view characteristics of th
54. to do so results in overwriting the first transmission to the Rosetta Lt with the second transmission e To queue another transmission while a transmission is in progress follow the same steps 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 e When you queue a transmission items listed in the Send Menu that are incompatible with the current connection are unavailable and grayed out e To transmit using different transmission devices you must complete the first transmission before initiating the next one e When a transmission fails or you cancel a transmission any queued transmissions are cancelled and no events are logged Finding Transmission Results Describe where transmission results are placed on a receiving device e Data transmitted from the MRx via Bluetooth File Transfer to a receiving device is placed in the default folder typically located at My Documents Bluetooth Exchange Folder set up during Bluetooth configuration of the receiving device The 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 e Event Summaries and 12 Lead Reports could contain information considered Patie
55. vary depending on the student 2 How long can you perform CPR without getting a voice or text prompt How long could you perform CPR before getting totally fatigued 70 Additional points notes CPR Feedback Volume Adjustment Turn the MRx Therapy Knob to a Manual Defib setting e g 150J and demonstrate the volume adjustment Press the Start CPR soft key and mute the voice prompts To mute the CPR feedback voice prompts once you start CPR 1 Press Menu Select 2 Select Mute CPR Voice and press Menu Select Note the following When muted a CPR Voice Muted text message displays in the middle of the compression waveform and CPR inactivity time is indicated by an audible tone To resume voice prompts set at the previously selected volume 1 Press Menu Select 2 Select Resume CPR V oice and press Menu Select To adjust the volume of CPR feedback voice prompts 1 Press the Menu Select button 2 Select Volume and press Menu Select 3 Select Voice and press Menu Select 4 Select the desired volume level and press Menu Select A sample voice prompt is annunciated to confirm your selection Suggestion Have students complete the above volume adjustment steps during or after your demonstration 71 Review Have students answer the following questions individually or as a group Correct answers are in bold 1 True or false Q CPR can be used on patients 8 years and older T 2 True or false
56. would you assign a specific label to pressure channel 1 if it is already assigned to channel 2 Answer You could unplug the channel 2 pressure cable or depending on the circumstance you might want to change the channel 2 pressure first If you unplug the cable you ll have to re zero which is covered next Additional points notes Zeroing the Pressure Transducer Introduce zeroing the pressure transducer and demonstrate the steps to zero a pressure on the MRx e The MRx requires a valid zero on a pressure channel to avoid inaccurate pressure readings Zero a pressure according to your hospital policy at least once per day Also re zero Every time you reconnect the transducer cable to the MRx After a patient is moved During changes in altitude when using the MRx aboard an aircraft Re zero when reaching a cruising altitude When you use a new transducer or tubing When you think the pressure readings are not correct Note the following The numeric value is invalid displayed as when the transducer is plugged in until zeroed successfully e Zero an assigned pressure channel through the Menu Select button or a soft key when in Monitor Mode Zero pressure channels separately or together Note the following Before zeroing a pressure vent pressure transducers to atmospheric pressure and close the stopcock to the patient 125 Zeroing Using the Menu Select Button Demonstrate zeroing using the
57. 5 6 Time Identify characteristics of the MRx data transmission Set up for Bluetooth transmission Optional objective Transmit a 12 Lead Report Identify characteristics of a Periodic Clinical Data Transmission Optional objective Identify characteristics of MRx s Data Management Mode Identify characteristics of a Batch LAN Data Transfer Optional objective 20 40 minutes Accessories Suggested Bluetooth enabled MRx and wireless device e g cell phone or modem with Dialup Networking DUN profile A server running Philips Telemedicine software and printer a fax machine and or Philips TraceMasterVue ECG Management System A transmission device and any related transmission mechanism e g Bluetooth or Wireless Link A LAN cable A wireless access point and PC running Data Messenger and set up for BLDT all for Wireless Link 181 Technical Resources Data Transmission Implementation Guide for detailed information on transmission devices e g Wireless Link and HeartStart MRx setup configuration and troubleshooting Telemedicine Server Instructions for Use for detailed telemedicine server information for MRx version F xx and later e MRx Instructions for Use including Wireless Link addendum HeartStart Data Management Solutions Implementation Guide Lesson Presentation Overview Introduce data transmission on the MRx using the following figures and table to explain the data transmission flo
58. CG to oversight receiving station the PC Data Messenger software will forward to the Telemedicine System 183 Preparing for Transmission Discuss transmission preparation e Before transmitting data the MRx needs to be configured for the type of transmission you want to perform See the MRx Instructions for Use and work with your IT team to determine how to set up MRx and related transmission devices Ifusing Bluetooth wireless technology wireless devices need to be set up as well Ifusing the Wireless Link option the Wireless Link device needs to be set up as well Ifusing the Batch LAN Data Transfer option Data Messenger software needs to be set up and configured on a receiving computer See the instructions which came with the HeartStart Data Messenger software for more information Also the IP address should be configured appropriately on a MRx using T 00 software e Regardless of the solution selected test the transmission before using in a clinical situation Create sample data and send it to a live destination e g Telemedicine System or Data Messenger Then be sure to delete the data after the test is complete to prevent confusion with real patient data e Philips data transmission has been extremely reliable however there are some places where cellular data service is spotty and may result in either limited or insufficient bandwidth Philips data transmission is designed to allow a retry of tra
59. Check the test load is you are prompted to Verify attached and press the Test Load is Attached Charge button and Press the Charge Button e Make sure the paddles are e Ifexternal paddles are seated in their pockets and attached you are prompted to press the Charge button Verify Paddles are in Holders and Press the Charge Button e If no cable is attached the test If the Charge button is not is marked Not Tested working press Charge from the If the MRx does not detect a press No Button Resp OPS The ops Charge button test is marked of the Charge button within 10 Fail and the Op Check fail seconds the message If the a DEET aS Charge button does not work select Charge from the menu below is displayed Shock Button Tests the Shock button 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 e Select Shock from the menu to continue the Operational Check or press Exit Op Check The Shock button test is marked Fail Operational Check Tests Continued Discuss the Op Check tests in the order they are performed corresponding prompts and actions to take if any Audio If a shock was delivered Did you hear No Shock Use the navigation buttons to during the Shock test the Delivered respond Yes or No Then press voice prompt Shock the Menu Select button Delivered is annunciated
60. Clinical Resources 2 o 12 Lesson Presentation 2 1 1 we ee 122 Oven 122 Pressure Measurement Setup ee e o o 122 Selecting a Pressure to Monitor ou sz Ree a Boe 4 128 Pressure Waves Zoso 8 eae e poa omoa poa a ey 2 124 Zeroing the Pressure Tarsa eae EA ea a ADS Calibration o a a a so a a ana uoa woa H oa p pop a a a aos 127 Alatms os aoa BOS e a RY eA Aw a a e 128 Wedge caeee a sd a gle Pale 3 c e BOs eG bw ee eee SES Ee o a A 180 Review 2 1 133 13 Temperature Monitoring 135 Lesson Introduction amp dese o e 1 Objectives 6 2 a y GS a Alar a SID Time RARA a A a 2 sn Accessories ad be we eA A ER we Re a Se Ae 15 Lesson Presentation 2 2 o 136 Overview zoa a ee Y aw BO a 286 Selecting a Topera bd Coe ee Re ee eR ad A ee a aG Monitoring Temperature 2 a ew a we SR o 1D Alarms ES FEA ae eo lag Disabling the Topas Fueron TEE Review yaa AAA AAN 14 12 Lead ECG Mentoring 141 Lesson Introduction 141 Objectives E s a mom ad ie a a A A A Time ee Cee e a a a eh Se Row ee ee el Accessories ee ee Clinical Resources eee ee a Lesson Presentation 2 1 o 142 Overviews lt lt w x amp 2 8 sa 2 oe oe 41 Preview Screen e s sor rone 142 Preparation ok Ow boop d et bk we fo s os we we w 9 148 Acquiring the 12 ied ECG a wee ee 144 Acquiring a 12 lead ECG with ACI TIPI o or ACL TIPI TPI M oa a ane LAS
61. DT from the MRx e Periodic Clinical Data Transmission PCDT enables you to transmit data from the point of care to the receiving hospital to facilitate the next level of care This option uses Bluetooth or Wireless Link to automatically transmit live periodic vitals and transmit 12 leads and waveform data upon a set of trigger events from a clinical mode to a remote data viewing server providing advance status and decision making assistance IT help is likely required to assist with Wireless Link setup and configuration e When PCDT is turned on the MRx displays an icon indicating connectivity status for Bluetooth and Wireless Link as follows Bluetooth PCDT Icons No symbol No connection association with the data viewing server is established PCDT Values is not activated A PCDT session has been established and is working properly Blue icon with white Bluetooth symbol A PCDT session is currently transmitting data Blue icon with green Bluetooth symbol oo WM A PCDT session has been started but the connection to the data gt lt viewing server has failed most likely due to a weak cellular signal Blue icon with white Bluetooth symbol crossed out Wireless Link PCDT Icons No symbol A transmission has not been initiated A Wireless Link connection for PCDT has been made a White symbol Wireless Link is currently transmitting PCDT data ee Green symbol pea Wirele
62. Dalel4 multiparameter simulator p n 2249138 from Dale Technology e Temperature cable connecting the simulator to the MRx e Skin surface temperature probe connecting directly to the MRx Example 21078A as an alternative to the simulator and related temperature cable 135 Lesson Presentation Overview Introduce the Temperature option associated with the MRx The MRx offers one channel of real time continuous temperature monitoring while in Monitor Pacer or Manual Defib Modes e It can monitor nasopharyngeal esophageal rectal skin arterial venous core and urinary bladder vesic temperatures e It can display temperature in either Fahrenheit or Celsius The default is Celsius which can only be changed through Configuration Mode Selecting a Temperature Label Discuss the following temperature label characteristics and then demonstrate label selection e The MRx monitors the temperature of the area where the sensor is located e Assign the proper temperature label to the measurement to assure specific temperature settings are matched with the temperature reading e When modifying a temperature label all settings including alarm limits associated with that label become active e Below are the available labels Temp is the default label Tesoph esophageal temperature Tnaso nasopharyngeal temperature Trect rectal temperature Tvesic urinary bladder Tskin skin temperature Tart arterial temperature Te
63. Follow the manufacturer s directions for applying and using the sensor making sure to observe any warnings or cautions For the best results Make sure the sensor is dry e If the 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 e 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 are formed If the sensor does not appear to be operating properly remove it immediately from the patient Additional points notes 97 Monitoring SpO Attach an SpO senso
64. G waves 1 CO and 2 invasive pressure waves events and trending per patient incident When the time interval 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 To adjust the interval 1 2 3 With Vital Signs Trending active on your display press the Menu Select button Using the Navigation buttons select Trend Interval and press Menu Select Using the Navigation buttons select the trend interval you want and press Menu Select Scrolling in the Trending Report Use the lt lt or gt gt softkeys to scroll left and right backward and forward in the report The softkey is 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 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 Printing the Trending Report Print the Trending Report two ways 1 Press the soft key under the Print Trends label A report for the displayed period and interval is printed Press the Summary button select Trends and then Trends Interval A report for the entire incident period is printed If your MRx has a 50mm printer the report will have 11 lines of text If you have
65. Ge Ia Time See fee ee A ee ee eee a a A Accessories Kannada LAI ss ee Pe a A Clinical Resources 4 Lesson Presentation 42 Ouen a oo sos os oros os oaoa ana AED View w 2 mess amp Ba oE 4 24 4 4a 4 4 e a a Preparation s s s w a feo ee OR Oe FY Ao ee oe aw BB AED Mode 44 Revia 49 5 Manual Defibrillation and Cardioversion 51 Lesson Introduction 2 2 1 1 ee ee ee ee 51 Objectives s o soe sos Bee 4 ee eae ee ew eR eS a Go Sl Time oo Ske Bem 2 om Boe aoe ow eae we ell Accessories Recommended eee es ee a ee ee ee ae SO Clinical Resources 2 2 1 we a 1 Lesson Presentation 5D Manual Mode o 52 Code View eoa oe Boe eee bow oe a ee GO Manual Debibillai n Preven CH hee ae eS ee eee ee ee a Manual Defibrillation 2 2 2 54 Synchronized Cardioversion 2 2 1 ee ee ee 5G Synchronized Shock Delivery 2 2 1 0 0 0 57 Review E OD 6 Q CPR with CPR meter 61 Lesson Introduction 2 30 a a a aaa 4 OI Opes 2 s ea 2S SoS a A ee Be we ee eo o a Gl Time lt a Soe we eee See a oe A Accessories same Stee eee Se e ae ee a AO ee Al Clinical Resources G1 Lesson Presentation 2 1 ee ee 62 Overview Moh ok om ohh a oe a a be 44 a 4 Ad He 1762 Q CPR enon a bo Ae a a a Oe Oe ewe eee we 6 GB Q CPR in Manual Defib Mode ce oma ee oa aoa a o Q CPR in AED Mode a a a aa 70 Review A 4M ED Ee 7 Q CPR with son Seto 73
66. Lead ECG Reports stored in internal memory to a data card 1 Insert a data card into MRx 2 Turn the Therapy Knob to Monitor 3 Press the Menu Select button 4 Using the Navigation buttons select Other and press Menu Select Note Using T 00 software on the MRx M3536A you can access Data Management Mode by pressing the Summary i button thus eliminating steps 3 and 4 above 5 Select Data Management and press Menu Select 6 Press Menu Select to acknowledge the message Leaving Normal Operational Mode 7 Use the Prev Item and Next Item soft keys to select an Event Summary 8 Press Menu Select to display the Data Management menu 9 Select Copy and press Menu Select 10 Select the data option that you want to copy and press Menu Select You can copy all event data or individual 12 Lead Reports if you have software Version 9 xx and greater includes Version Fxx Note the following If you print an event summary 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 Suggestion Have students complete the copy procedure during or after your demonstration Remind students not to remove the external data card from the MRx during the proced
67. Navigation buttons select the Measurements Alarms menu and press Menu Select 3 Select NBP and press Menu Select 4 Select NBP Schedule and press Menu Select 5 Using the Navigation buttons select the desired interval and press Menu Select Note the following e Ifthe 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 9 e Interval choices are presented in the format qx indicating measurements are taken every x minutes from the time you first press Start NBP e If no subsequent measurements are taken NBP values will be removed from the display after 60 minutes but can still be obtained through Vital Signs Trending 108 Practice Exercise 1 Have students complete manual and automatic NBP measurements including changing the NBP schedule Pose the following questions 1 What displays when you start a measurement Stop a measurement 2 How does the display differ between a manual and automatic measurement Additional points notes 109 Alarms Mention the following NBP alarm characteristics e An alarm sounds when a measurement 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 remo
68. Pressure label zero done at date time Mention the Unable to zero message that displays if the process is unsuccessful some of the probable cause messages and related corrective actions as needed Equipment Malfunction Hardware is faulty Contact your service personnel q y P Excessive Offset Make sure the transducer is vented to the air and try again If this doesn t Ty ag 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 y ag work replace the transducer Pulsatile Pressure Make sure that the transducer is vented to air and not the patient Try again Note the following Upon successful completion of the process close the stopcock to atmospheric pressure which opens the stopcock to the patient 126 Last Zero Demonstrate viewing dates and times for a channel s last zero 1 Press the Menu Select button 2 Using the Navigation buttons select Measurements Alarms and press Menu Select 3 Select the pressure label channel label you want and press Menu Select 4 The last zero dates and times are displayed Calibration Briefly introduce MRx s calibration functionality The MRx allows you to input the calibration factor see documentation supplied by the transducer s
69. R meter Examine the CPR meter vent membrane in the center of the rear cover after each use If needed use a soft cloth or toothbrush to gently clean the vent membrane If soiled after cleaning or damaged 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 l Compression 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 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 Wipe the exterior with a clean soft cloth dipped in distilled water Allow to dry completely 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 Sensor Clean with a soft cloth moistened with mild soap and water Gluteraldehyde solution 3 4 gluteraldehyde content such as Johnson amp Johnson Cidex
70. Rx Service Manual See this addendum for MRx IntelliVue Networking configuration settings and detailed symptoms INOP messages possible causes and troubleshooting solutions associated with the option Lesson Presentation Overview Introduce the IntelliVue Networking option associated with the MRx e Allows the M3535A HeartStart MRx to connect and communicate with the Philips IntelliVue M3185 Clinical Network Requires System L and later e MRx devices with the Networking Option have an identifying icon placed on the device s handle e When on the network MRx has similar behavior to a bedside monitor sending waveforms e g ECG Pleth NBP invasive pressure Temp and CO3 and patient parameters along with alarm and INOP messages to IntelliVue Information Center for monitoring The IntelliVue Option for PIIC iX allows you to identify your HeartStart MRx as either a bedside or transport device depending on a given use model in your facility e Connection to the Information Center allows you to silence most alarms and send patient demographic data to the MRx from a remote location Monitoring data can also be sent from the MRx to the patient s electronic medical record through the IntelliVue HL7 connection e Refer to the IntelliVue M3150 Information Center Instructions for Use for details on the Information Center Note the following The IntelliVue Networking option is available in most countries wireless functionality is o
71. Rx with software version F 02 R 02 or later the 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 user fails to correct the problem based on the arrow the MRx then provides corrective voice prompts if configured e Ifthe compression exceeds the compression depth target 50mm 2 for a meter connected to a MRx with software version F 01 R 01 or reaches 70mm 2 75 for a meter connected to a MRx with software version F 02 R 02 or later the area below the compression depth target area lights up e Ifyou do not fully release pressure between four consecutive compressions the display shows a yellow arrow pointing up to the compression release target zone Compression Rate e If the compression rate is within the target area the speedometer needle on the compression rate indicator points to the green target zone which lights up 65 e Ifthe CPR meter detects the compression rate is faster than the target rate 120 compressions per minute the needle on the compression rate indicator points to the right of the green target zone If the compression rate is not corrected the MRx provides corrective voice prompts if configured e Ifthe CPR meter detects the compression rate is slower than the target rate 100 cpm the needle points to the left of the green target zone If the compression rate is not corrected t
72. SpO and press Menu Select 2 3 4 Select SpO Limits and press Menu Select 5 Using the Navigation buttons select the new high limit value and press Menu Select 6 Select the new low limit value and press Menu Select Desat Alarm Discuss the following Desat alarm characteristics e This alarm provides an additional limit setting below the low limit setting to notify you of potentially life threatening decreases in oxygen saturation e It isa latching alarm remaining present even if the alarm condition no longer exists e Ifthe SpO low limit is set below the preset Desat limit the Desat limit automatically adjusts to the low limit value if the SpO reading falls below the low limit the Desat limit alarm sounds Enabling Disabling Alarms Demonstrate how to enable the SpO alarms 1 Press the Menu Select button 2 Using the Navigation buttons select the Measurements Alarms menu and press Menu Select 3 Select SpO and press Menu Select 4 Select Alarms On Off and press Menu Select Note the following SpO INOP messages are suppressed for up to 60 seconds while an NBP measurement is in progress 100 Practice Exercise 1 Have students change SpO limits and enable disable and respond to related alarms Pose the following questions 1 What happens when you change a limit Disable an alarm Respond to an alarm Additional points notes 101 Setting Pulse Rate Alarms Mention the following
73. TPI Application Note 141 Lesson Presentation Overview Introduce the 12 Lead ECG function e It previews acquires analyzes prints copies and stores 12 Lead ECGs e It provides computerized ECG analysis and a report using the Philips DXL ECG Algorithm on MRxs using software version Exx and later The algorithm provides an analysis of the amplitudes durations and morphologies of the ECG waveforms and the associated rhythm Patient age and gender 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 and culprit artery detection 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 algorithm also identifies paced patients automatically The DXL Algorithm includes the optional Acute Cardiac Ischemia Time Insensitive Predictive Instrument ACI TIPD and Thrombolytic Predictive Instrument TPI algorithms ACI TIPI generates a 0 100 predicted probability score of acute cardiac ischemia TPI predicts patient outcomes with and without thrombolytic therapy for an acute myocardial infarction See the DXL ECG Algorithm ACI TIPI and TPI application notes for detailed explanation on each of these three algorithms e The 12 Lead Report contain measurements interpretive sta
74. Using the Navigation buttons highlight the pulse source desired and press Menu Select Setting Pulse Alarms Mention the following pulse alarm characteristics 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 If pulse alarms are enabled alarm limits appear next to the pulse value If alarms are off the Alarms Off symbol replaces the limits Enabling Disabling the Pulse Alarm Demonstrate how to enable disable the pulse alarm l 2 3 4 Press the Menu Select button Using the Navigation buttons select Measurements Alarms and press Menu Select Select Pulse and press Menu Select Select Alarms On Off and press Menu Select Changing Pulse Alarm Limits Demonstrate how to change pulse alarm limits 1 2 3 4 5 6 Press the Menu Select button Using the Navigation buttons select Measurements Alarms and press Menu Select Select Pulse and press Menu Select Select Pulse Limits and press Menu Select Using the Navigation buttons select the new high limit value and press Menu Select Select the new low limit and press Menu Select 131 Changing Default Pulse Source and Alarm Limits Mention that you can change the default pulse source in the pulse section of Configuration Mode and default pulse alarm limits in the ECG section of Configur
75. Wave Sector 1 or 2 F Automatic relearning takes places when there is a lead change for Wave Sector 1 only 39 Instructor Guide Semi Automated External Defibrillation Lesson Introduction Introduce the lesson including the learning objectives estimated time to complete and applicable resources This lesson describes how to use AED Mode It highlights the AED display view and explains the steps and associated prompts that guide users through the defibrillation process Objectives Upon completion of this lesson students should be able to 1 Locate pertinent information in AED View 2 Prepare a patient for AED defibrillation 3 Defibrillate in AED Mode Time 10 15 minutes Accessories Recommended e Simulator e Hands free cable e Multifunction electrode pads Clinical Resources e AED Algorithm Application Note e SMART Biphasic Application Note 41 Lesson Presentation Overview Introduce the Semi Automated External Defibrillation AED Mode AED Mode guides users through standard treatment algorithms for cardiac arrest e It includes voice and screen prompts for defibrillation preparation ECG analysis and shock delivery e You can customize AED Mode configuration to meet your organization s needs 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
76. Weak Signal Logged when event occurs INOP detected All ECG Alarms Off Logged when event occurs INOP detected 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 Refer to the HeartStart MRx Instructions for Use Addendum IntelliVue Networking Option for a table that lists alarms INOPs and messages that appear differently at the Information Center Additional points notes 171 Review Have students answer the following questions individually or as a group Correct answers are in bold Consider having students correct FALSE statements to ensure comprehension 1 The IntelliVue Information Center replaces equipment label on the MRx display with a bed label when the MRx connects to the network T 2 Which of the following statement s are FALSE regarding MRx connectivity to the IntelliVue Network a Ifyou connect the radio AC power module to MRx after you turn it on it takes 10 seconds for the MRx to detect the module F The radio AC power module must be fully connected before turning on the MRx otherwise the MRx will not detect the module You need to turn the power off for 10 seconds and then turn the device back on to ensure a detection b Ifa MRx leaves the healthcare facility disconnect the radio module from the device T c Ifyou lose the wired connection the MRx
77. a 75mm printer the report contains 16 lines Exiting the Trending Report To exit the Trending Report and return to a waveform display simply press the Close Trends soft key You will be returned to Monitor Mode Practice Exercise 1 Have students change report time intervals scroll through data and print out sample reports Pose the following questions 1 Does the layout of a report change in any way when you increase or decrease the time interval 2 Does the information on a printout differ from what you see on the display 155 Additional points notes 156 Review Have students answer the following questions individually or as a group Correct answers are in bold Consider having students correct FALSE statements to ensure comprehension 1 Which of the following statement s are TRUE regarding data displayed on the Trending Report a Ifyou scroll left to view older data the screen will not update to new data when available T b Questionable data is indicated by F Questionable data is indicated by a question mark just before the numeric value c Unavailable data is indicated by an empty space T d A after the timestamp indicates multiple measurements taken during the interval T 2 For the one minute time interval data from continuous measurements is the average reading for that one minute period T 157 Instructor Guide 16 IntelliVue Networking Lesson Introduction I
78. a become available as long as the latest data are displayed on screen If you scroll left to view older data the screen will not update to new data when available The latest data will be displayed when scrolling back to the most recent data e Parameters are listed 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 e Ifa parameter has not been measured during the display period it is not listed in the display e Ifa parameter has invalid information it is indicated by Questionable data is indicated by a question mark just before the numeric value while unavailable data is 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 taken during the interval The most recent measurement within the interval displays e Ifan inactive parameter becomes active when viewing the Trending Report the added parameter automatically appears in the report when the interval is updated and the latest data is available 154 Trending Report Intervals 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 The internal Event Summary stores up to 12 hours of 2 continuous EC
79. able between the MRx and a router or personal computer b Data Messenger software serves as communication software between the MRx and PC c You can queue a second BLDT while the first transfer is in progress F You must wait for the first BLD transfer to complete before sending the next set of information 202 d After successfully sending all Event Summaries at once via BLDT MRx s internal memory card is erased 203 204 Instructor Guide 19 Maintenance Lesson Introduction Introduce the lesson including the learning objectives estimated time to complete and applicable resources This lesson describes how to care for the HeartStart MRx including a brief look at battery maintenance and cleaning Objectives Upon completion of this lesson students should be able to 1 Identify the meaning of each Ready For Use status 2 Identify the appropriate steps to complete a shift check 3 Perform the necessary steps to complete an operational check on the MRx 4 Identify the appropriate steps related to battery maintenance 5 Identify the appropriate steps to clean the MRx and its associated accessories Time 10 20 minutes Accessories Recommended e Simulator or test load e Hands free cable or Pads CPR cable when appropriate e Multifunction electrode pads or external paddles e 3 5 or 10 Lead monitoring electrodes cable Maintenance Resources M3538A Lithium Ion Battery Characteristics a
80. 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 Briefly mention transmission errors e A message is displayed on the MRx screen for any transmission error accompanied by an audio beep Press the Menu Select button to acknowledge the error e The error is logged into the Device Status Log Cancelling a Transmission Demonstrate how to cancel a transmission in progress 1 From either 12 Lead Mode or Data Management Mode press the Menu Select button 2 Highlight Cancel Transmission and press Menu Select 3 Select Yes and press Menu Select to cancel or No and press Menu Select to continue the transmission After confirming a transmission cancellation a Disconnecting message displays until the process is completed Some disconnections may occur so quickly that the Disconnecting message may not be visible 197 Queuing Transmissions Discuss options associated with queuing transmissions e You can queue more than one 12 Lead Report or Event Summary for a non BLDT transmission using the same transmission device except the Rosetta Lt e 12 Lead Reports can be queued to the same or different locations e Ifusing the Rosetta Lt you must complete the transmission from the MRx to the Rosetta Lt AND from the Rosetta Lt to its communication device before beginning another transmission Failure
81. ad Datamed FT GE MUSE The following table outlines MRx s various use cases for transmitting data during a critical care event Table 6 Critical Care Transmission Use Cases Periodic clinical data to a Periodic Clinical Data hospital or remote medical Dial Up Networking DUN Transmission oversight center during patient and a Bluetooth wireless card to transport using Bluetooth transmit a 12 Lead ECC wireless technology through a cell phone land line ____________ A 12 Lead ECG using modem or other gateway to a Transmitting in 12 Lead Bluetooth wireless technology destination point Mode via a cell phone land line i P Bluetooth device being used modem or other cellular a for transmission must support h broadband gateway to the Bluetooth DUN prokio hospital or medical oversight receiving station A 12 Lead ECG or periodic Connect the Wireless Link Setting up Wireless Link clinical data using WiFi or device to the HeartStart MRx Transmissions cellular broadband to a hospital to transmit 12 Leads or a EN A Transmitting in 12 Lead or remote medical oversight periodic clinical data to the a ee Mode center Philips Telemedicine System Periodic Clinical Data Transmission A 12 Lead ECG using my Bluetooth File Transfer anda Transmitting to a Personal portable computer to forward Bluetooth wireless card to Computer to the hospital or medical transmit the 12 Lead E
82. 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 cleared two dashes e If monitoring CO the Et CO numeric value is displayed in Parameter Block 2 along with its alarms off indicator 68 Note the following e SpO monitoring functionality is not available during Q CPR use e Compression and ventilation measurement values are printed in the annotation area of the ECG printed strip Suggestion Print a strip to exhibit the values Soft Keys Toggle between the soft keys in manual defibrillation mode and discuss the following characteristics e To stop CPR while in Advanced View press the soft key labeled Stop CPR To return to the Advanced View press the Start CPR soft key e If the Sync button is pressed to initiate synchronized cardioversion Q CPR is deactivated Reactivate Q CPR by pressing the Start CPR soft key or performing chest compressions e Ifthe Alarm Pause button is used to turn alarms on Q CPR is deactivated e The Start CPR soft key is disabled if patient category is Pedi or patient age is less than 8 years old NOTE Suggestion Ask students to help point out compression waveform parameter block and soft key
83. al Check with the Pads CPR cable and the CPR meter or Compression Sensor keeping the CPR meter or Compression Sensor still during the test Performing the Operational Check Note the following e Be sure the MRx is not connected to the patient when performing an Operational Check Demonstrate how to perform the Op Check 1 Insert a charged battery with a capacity of 20 or greater Turn the Therapy Knob to Monitor Press the Menu Select button Using the Navigation buttons select Other and press Menu Select Select Operational Check and press Menu Select Select Run Op Check and press Menu Select NADA oe De US The message window Leaving Normal Operating Mode indicates exiting clinical functionality and entering device test mode Press Menu Select to acknowledge the message 8 Carefully read the setup instructions on the screen Attach a pads or paddles therapy cable and test load or Pads CPR cable CPR meter or Compression Sensor and test load If the MRx has Pacing you must run the Operational Check with a Pads cable Attach an ECG cable Turn the Therapy Knob to 150J If you choose to proceed without correctly setting up the device the Operational Check may fail 209 9 Read and respond to applicable test prompts Once you have answered the last prompt Audio test you can leave the MRx unattended and the Op Check will complete As each test is run the message In Progress appears followed by Pass or Fai
84. alarms Time 10 15 minutes Accessories Recommended NBP cuff Clinical Resources e Noninvasive Blood Pressure Monitoring Application Note 105 Lesson Presentation Overview Review NBP characteristics respective to its use with the MRx MRx measures blood pressure for adults pediatrics using the oscillometric method NBP may be measured in Monitor Pacer or Manual Defib Modes e NBP measurements can be taken automatically on a schedule or manually on demand e Alarms signal changes in the patient s condition e Systolic diastolic and mean pressure measurement schedule manual or automatic intervals and a time stamp are displayed in Parameter Block 1 e Ifenabled NBP alarm limits appear next to the NBP value and the alarm source systolic diastolic or mean is displayed above the limits e Ifalarms are disabled the Alarms Off symbol replaces the limits e Initial cuff inflation pressure 160 mmHg adult or 120 mmHg pediatric for first time measurement next pressure 35 40 mmHg above systolic measurement with a minimum inflation pressure of 120 mmHg e Ifthe systolic pressure is higher than the inflation pressure the inflation pressure is automatically increased by 35 40 mmHg and another measurement is attempted e The maximum inflation pressure 280 mmHg maximum systolic value 260 mmHg Additional points notes 106 Preparing to Measure NBP Demonstrate NBP measurement prep
85. and proper printing Data Card If applicable insert a data card with 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 Transducer Inspect the transducer for visible signs of damage Temperature Sensor Inspect the sensor for visible signs of damage CPR meter or Compression Sensor for MRxs running software version 9 xx or lower Inspect the meter or Sensor 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 or Compression Sensor Adhesive Pads for MRxs running software version 9 xx or lower Make sure there is an Adhesive Pad applied to the meter or Sensor and there is an adequate supply available Suggestion Ask students complete a shift check using a Shift Checklist versus you telling them what they should do 207 Additional points notes Weekly Shock Test In addition to the shift check verify the ability to deliver defibrillation therapy once a week by performing either a weekly shock test or an Operational Check Op Check Demonstrate how to perform a weekly shock test on the MRx 1 Ifusing External paddles Make sure the padd
86. aration 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 Demonstrate how to prepare for ECG acquisition 1 Connect the 10 Lead cable to the HeartStart MRx 2 Prepare the patient s skin at appropriate electrode sites If necessary clip hair at the electrode sites or shave sites if needed Wash sites thoroughly with soap and water if possible Dry the electrode sites briskly to increase capillary blood flow in the tissues and to remove oil and skin cells Attach the snaps to the electrodes 4 Apply the electrodes to the patient At least one chest lead and all limb leads are required to get an interpretation from the 12 Lead algorithm Note Attach electrodes to the simulator 5 Turn the Therapy Knob to Monitor 6 Enter the patient s ID name age and sex through the Patient ID menu using the Menu Select and Navigation buttons Also enter chest pain symptoms if the MRx is configured to run the ACI TIPI and TPI algorithms 7 Confirm the patient s pacing status is correct Note With software version Exx the paced status is determined by the DXL ECG Algorithm Suggestion Have students attach a 10 Lead set to the MRx and a simulator set the simulator to NSR and complete the appropriate preparation steps during or after your demonstration 143 Additional points notes
87. aration using the NBP cuff 1 Select the appropriately sized cuff for the patient 2 Attach the cuff to the NBP tubing 3 Insert the NBP tubing into the NBP port on the MRx 4 Apply the blood pressure cuff to the patient s arm 5 Place the limb used for taking the measurement at the same level as the patient s heart Note the following Do not perform NBP monitoring on patients whose upper arm circumference is less than 13 cm Doing so may result in inaccurate measurements When using the MRx aboard aircraft NBP measurements should only be taken while on the ground or once cruising altitude is reached to ensure accuracy Suggestion Have students complete the above steps during or after your demonstration Additional points notes 107 Measuring NBP Demonstrate the steps to measure NBP 1 Press the Start NBP soft key Note the following e NBP values display when the measurement is complete e You need to press Start NBP for every manual measurement e Automatic measurement is repeated at configured intervals after pressing Start NBP e Additional manual measurements may be taken without affecting the automatic measurement schedule Press the Stop NBP soft key to stop an NBP reading S Changing the NBP Schedule Demonstrate how to change the NBP schedule and or the interval of automatic measurements for the current patient 1 Press the Menu Select button 2 Using the
88. aries Print the current Event Summary at any time by pressing the Summary button and selecting Event Summary from the menu e Ifan event is not in progress pressing the Summary button and selecting Event Summary prints most recent Event Summary e Ifan alarm condition occurs 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 e Print the current Vital Signs Trending Report at any time 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 e Ifan event is not in progress press the Summary button select Trends and then select a Trends Interval to print the most recent Vital Signs Trending Report 12 Lead ECG Reports e Print a current individual 12 Lead ECG Report by hitting the Print softkey in 12 Lead View e To print a recent 12 Lead ECG Report 1 Press the Menu Select button and highlight Reports m Use the Navigation buttons to highlight the report you want to print 3 Press Menu Select and highlight Print 177 4 Press Menu Select to print the report Suggestion Have students print any of the above data reports during or after your discussion Printing Individual Events As appropriate review the following list of events and related strip lengths that are printed automatically real t
89. atient identifiable data is encrypted to insure patient confidentiality Handle this data in accordance with HIPAA or local patient privacy requirements Delete the event summary to de identify patient data e Before sending a PCDT configure a receiving site destination unless you are sending to an electronic Patient Care Record ePCR application See Modifying Settings in the Data Transmission section in the Configuration chapter of the MRx Instructions for Use to modify the site options Starting a Periodic Clinical Data Transmission Demonstrate how to begin a PCDT if utilizing Bluetooth 1 Confirm the MRx is in a clinical mode and press the Menu Select button 2 Using the Navigation buttons select Start Data Transmit and press Menu Select 3 From the Send To menu select a pre configured data viewing server location to send the data to and press Menu Select 4 From the Transmission Devices menu select the transmission device option you want to use and press Menu Select The PCDT icon appears on the display and transmission begins If your device does not have a transmission device the MRx prompts you to add a device Demonstrate how to begin a PCDT if utilizing Wireless Link 1 Confirm the MRx is in a clinical mode and press the Menu Select button 2 Using the Navigation buttons select Start Data Transmit and press Menu Select 3 Using the Navigation buttons highlight the pre configured Telemedicine destination for the da
90. atient transfer is confirmed the patient is discharged to the transfer list at the Information Center No new additional data is added to the patient information in the transfer list The MRx enters Transfer Mode and Prepared for transfer is displayed above the patient name The MRx continues to store data that can be accessed through the MRx Data Management feature The data now residing in the transfer list can be restored to the MRx however newly collected data i e waveforms cannot be merged with the transfer list data Note the following Be sure the MRx is not connected to a patient while in Data Management or other non clinical mode Ifthe MRx is connected to the PIIC ix all patient transfers need to be initiated at the PIIC iX Ifthe MRx is configured for the transport use model and the PIIC X requests the device travel with the patient the bed assignment updates on the MRx to the new location Ifthe MRx is configured for the transport use model and the PIIC iX requests the device not travel with the patient you need to discharge the patient from that MRx to keep the device in its current physical location on the PHC ix Ifthe MRx is configured for the bedside use model you are about to transfer the patient and leave the device in its current location you should turn the MRx off assuming there is no patient safety risk before initiating the transfer at the PHC X If you do not turn it off before star
91. ation Mode the latter because pulse and heart rate share the same default alarm limits Practice Exercise 3 Have students change pulse alarm limits and enable disable and respond to related alarms Pose the following questions 1 What happens when you change a limit Disable an alarm Respond to an alarm Additional points notes 132 Review Have students answer the following questions individually or as a group Correct answers are in bold Consider having students correct FALSE statements to ensure comprehension 1 You must flush the tubing system to remove air bubbles to prevent potential incorrect readings T 2 Which of the following statement s are TRUE regarding pressure selection and related wave scale adjustment a When selecting a label you need to specify its color alarm source and limits and scale F The MR x uses that label s stored configured information b Controls for scale and alarm settings automatically appear after selecting a new label T c You can not select the same label for both pressure channels T d The available pressure wave scale spans from 300 to 20 in mmHg and from 38 to 2 5 in kPa T 3 Which of the following statement s are TRUE regarding zeroing a pressure a You must zero a pressure every time you reconnect the transducer cable to the MRx T b Before zeroing a pressure you must vent pressure transducers to atmospheric pressure and clos
92. ation 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 delivers a Weekly between high energy internal discharge to further exercise the 11PM Sunday and defibrillation circuitry 1 AM Monday e Test results are reported through the Automated Test Summary report the RFU indicator inop statements when MRx is turned on e 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 Discuss the possible automated test summary results visual indications what they mean and what action to take based on the result Pass Hourglass All tests passed None Fail DX Solid red X chirp A problem has been detected that may Turn the Therapy Knob to Monitor An prevent the delivery of a shock pacing or inop indicating a problem has occurred is ECG acquisition displayed Refer to the MRx Instructions For Use Troubleshooting chapter for the action to take If the condition persists take the device out of use and call for service 205 19 Maintenance Lesson Presentation Fail BF Blinking red X The total battery capacity combination Charge the battery as soon as possible and of both batteries is less than 20 or replace the battery with a charged battery Charging may b
93. ause length is defined by the configured CPR timer period Q CPR may be activated if the MRx is equipped with this option Practice Exercise 2 Have students attach a simulator to the MRx set it to a shockable rhythm e g VF and complete defibrillation with one shock Pose the following questions 1 What screen prompts do you see and voice prompts do you hear initially 2 How do you know the device is ready to deliver a charge 3 What do you see and hear after delivering a shock 4 What happens when you press the Resume Analyzing soft key 47 Additional points notes No Shock Advised NSA Finally set the simulator to a normal sinus rhythm NSR Tell users how their MRx is configured for NSA Monitor or a pause time setting Mention that if a shockable rhythm is not detected MRx Informs that No shock advised If the NSA is set to MRx Monitor e monitors the ECG and periodically prompts If needed press Pause and begin CPR Pause Time e suspends analysis during which time you can administer CPR and attend to the patient e displays a Pause status bar and resumes analysis at the completion of the pause period Practice Exercise 3 Have students set the simulator to NSR Consider both Monitor and Pause Time configuration choices Pose the following questions 1 What screen prompts do you see and voice prompts do you hear 2 What happens when you press the Pause for
94. before delivering a shock call out loudly and clearly Stay Clear 6 Press and hold the Shock button on the MRx or orange buttons on both paddles The shock will be delivered when the next R wave is detected Mention the following cardioversion characteristics during the demonstration e The selected energy can be changed at any time during charging or after charging is complete the MRx charges to the selected energy level automatically e Press Disarm to disarm the defibrillator if the Shock button is not pressed within the time period specified in the Time to Auto Disarm configuration setting the MRx disarms automatically e This point is important to emphasize Continue to hold the Shock button or the paddle shock buttons until the shock is delivered so the defibrillator shocks the next detected R wave e Confirm sync markers on the R wave are appropriate and repeat above steps 4 6 to deliver additional synchronized shocks assuming Sync is enabled If Sync is off complete steps 1 6 The Sync function can be configured to either be enabled or disabled after each shock is delivered If enabled and the Therapy Knob is moved to either Monitor or Pacer the Sync function is still active If the Therapy Knob is moved to either Off or AED the Sync function is disabled e Press the Sync button again to turn off the Sync function e This point is important to emphasize REMEMBER to turn Sync off if manual defibrillation is
95. ble tubing is disconnected a prompt message requests approval to turn off the measurement e Alarm messages appear in the space above each numeric value replacing a parameter label Suggestion Have students disconnect and reconnect parameter accessories to see how parameter blocks are affected Ask students what they see when detaching and attaching an accessory cable or tubing Soft Key Labels e Correspond to soft key buttons e Change according to the current display view and function e Grey text labels indicate inactive soft keys e g Disarm in Manual Mode Suggestion Switch between modes to show different labels with students following along Menus e Provide controls and options specific to each function e Accessible through Menu Select and Navigation buttons e Used to adjust volume select waveforms for display set alarms schedule measurements enter patient information perform an Operational Check generate reports etc e Press Menu Select button to activate selections select Exit to close menus without activating selections e Arrows at the bottom of a list indicate additional options available than the space allowed 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 options unavailable for use are grayed out Suggestion Access different menu options to illustrate various menu functionality
96. button 2 Select End Data Transmit and press Menu Select 3 Confirm you want to end the transmission by highlighting Yes and press Menu Select Selecting No continues the transmission The transmission stops and all pending transmissions are deleted Note the following Exiting a clinical mode cancels a data transmission session and all transmissions in queue Practice Exercise 3 Have students complete a PCDT and ask them to point out what display changes they see during the procedure Additional points notes 194 Transmitting Post Events Describe the methods that MRx transmits data after an event for quality review billing and archiving Figure 4 illustrates a couple methods The following table provides you a couple of use cases to cover with students as needed e Save data to the data card for personal transport to another device e Send data via Bluetooth to a receiving device e Send data via Batch LAN Data Transfer wired and wireless via Wireless Link Figure 4 Post Event Transmission HeartStart MRx Data Messenger PC locally D Table 8 Post Event Transmission Use Cases ePCR ePCR database Event Review Pro PC at central location An Event Summary to an external computer wirelessly A single Event Summary or group of Event Summaries to my computer together after an event or shift is finished Bluetooth wireless technology to transmit data to a Blueto
97. cates with the Data Messenger personal computer and prompts you to send data For wireless transmission once the MRx is in Data Management mode the MRx automatically displays the Send menu once it has successfully communicated with the Data Messenger This can take between 30 60 secs During this time you will observe a connecting message on the MRx To transfer a single event To transfer all events 3 Usethe Prev Item and Next item 3 Select Send All and press Menu Select softkeys to highlight the correct Event Summary to download 4 Select Send Selected and press Menu Select 5 Select the type of data you wish to download and press Menu Select e Once the transfer begins the MRx tracks progress indicating the number of files sent and the percent complete e When the transfer is complete the Transmission Complete message displays Press Menu Select to acknowledge the message The transmitted file appears in the destination folder which was set up on the Data Messenger Server Note the following You must wait for a BLD transfer to complete before sending the next set of information After successfully sending all Event Summaries at once via BLDT the 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 before doing a BDLT or transfer each of the Event Summari
98. cation number of devices available for training optional device parameters purchased and student knowledge and needs Guide Structure This guide is divided into eighteen 18 lessons as follows Getting Acquainted ECG and Arrhythmia Monitoring Semi Automated External Defibrillation Manual Defibrillation and Cardioversion Q CPR with CPR meter Q CPR with Compression Sensor Noninvasive Pacing Pulse Oximetry Monitoring Noninvasive Blood Pressure Monitoring Carbon Dioxide Monitoring Invasive Pressures Monitoring Temperature Monitoring 12 Lead ECG Monitoring Vital Signs Trending IntelliVue Networking Working with Data Data Transmission Maintenance This is an optional parameter with the MRx so ensure you teach only the lessons that match the organization s device configuration Preparation Prior to each class e Contact the organization s training coordinator to schedule training if applicable Suggest train the trainer sessions Make sure students understand that they must be free from other responsibilities at the scheduled time for the duration of the course A maximum of 10 students is recommended for each class e Talk to the training coordinator if applicable about which device functions students will be using on the job AED Mode Manual Mode Pacing SpO etc Use this information to select the appropriate lessons and determine your lesson presentation e Recommend to the tra
99. ch a connection To use the MRx on the IntelliVue Network 1 Confirm the MRx and the Information Center are configured to talk with each other Note For HeartStart MRx configuration instructions see the HeartStart MRx Service Manual To access configuration options on the HeartStart MRx see the IntelliVue Networking Problems table in the Troubleshooting chapter of the MRx Instructions for Use For instructions on how to set up the IntelliVue Information Center see the IntelliVue Information Center System Installation and Service Manual 2 Physically connect the MRx to the network Physical Connections Physically connect the MRx to the network in three different configurations wired wireless or a combination of wired and wireless a Wired An IntelliVue Network LAN cable is plugged into the RJ 45 connector labeled LAN on the back of the HeartStart MRx Wired icon appears on the MRx display in all clinical views indicating a wired connection to the network Data can be exchanged with and viewed at the Information Center Note the following The LAN port is intended for connection to the IntelliVue Clinical Network or for Batch LAN Data Transfer During real time patient monitoring the LAN port should only be connected to the IntelliVue Network and devices that comply with IEC 60950 1 and IEC 60601 1 For post event Batch LAN Data Transfer or when the patient is not connected to the MRx the MRx shoul
100. complete a lesson and point out what related resources e g application notes are available to students for further education Present the lesson content Annotate and or highlight material in your copy of the guide to ensure you stress information that you feel is important to your students needs Note that instructor directions are in bold Look for suggestions that raise the level of student interaction There is also space for additional points or notes to be made at a topical level depending on students needs Review the content presented by completing the review questions at the end of each lesson Note that answers to the questions are in bold e Periodically ask for questions to ensure comprehension e Periodically ask questions to engage students and increase learning effectiveness e Take breaks over the course of the training if time allows to ensure learning effectiveness e At the completion of a class use the Skills Checklist to test students on various functions and features of the MRx Safety Considerations Some warnings and cautions specific to a particular feature of the HeartStart MRx are provided in this guide however you and students should reference the Instructions For Use for a complete description of all safety warnings and cautions Nonetheless reinforce the fact that the MRx is a live device that can deliver high energy therapy and should not be used by untrained personnel Operation by untraine
101. cturer s recommended minimum compression depth for performing 67 CPR on a surface that yields such as a mattress when a backboard is in place For a patient on a soft surface the compression waves should at a minimum drop below the dashed line For a MRx using software version E 02 R 02 or later and configured for ERC 2010 CPR guidelines three lines are drawn on the screen 50 mm 2 A solid line indicates the minimum depth recommended by ERC when the patient is on a firm surface Your compression waves should at a minimum drop below this line 60 mm 2 4 A solid line indicates the maximum depth recommended by ERC when the patient is on a firm surface Your compression waves should stay on or above this line 70 mm 2 75 A dashed line indicates the manufacturer s recommended minimum compression depth for performing CPR on a surface that yields such as a mattress when a backboard is in place For a patient on a soft surface your compression waves should at a minimum drop below this line e An asterisk annotates when pressure is not released between compressions also referred to as leaning e If the CPR meter signal becomes invalid e g the meter is disconnected the waveform appears as a dashed baseline Suggestion Disconnect the meter to display the dashed baseline Parameter Block 2 e Parameter Block 2 displays numeric values for compression and ventilation rates Both rates are a movi
102. d personnel can result in injury or death Additional Documentation and Training Available documentation and training for the HeartStart MRx includes e HeartStart MRx Instructions for Use provides the most comprehensive review of MRx functionality and operation for students It is available on the User Documentation CD ROM or may be purchased in hardcopy form e HeartStart MRx Quick Reference Cards provide visual step by step summaries of key functions parameters and related operation Controls Connections and Indicators Ready For Use Indicator Alarms Monitoring ECG Monitoring SpO Monitoring NBP Monitoring CO Monitoring Invasive Pressures Monitoring Temperature Vital Signs Trending Noninvasive Pacing Q CPR 12 Lead ECG IntelliVue Networking Connection and Data Sharing IntelliVue Networking Admit Discharge Transfer Weekly Shock Test Operational Check e HeartStart MRx Web based User Training provides a comprehensive self paced training on the same content found in the instructor guide It is located on Philips Medical Systems web site at www medical philips com goto mrxtraining Students need to enter the training access password meetMRx to get started e HeartStart MRx User Training Video provides a 58 minute overview of MRx functions features and operation The video serves as valuable preparation for the classroom or as a refresher after th
103. d only be connected to the facility network b Wireless Philips Instrument Telemetry 1 4 GHz radio and A C module radio AC power module backpack is mounted into Compartment B of the MRx and the RS 232 connector is plugged into the RS 232 port and screwlocks are tightened Do not wiggle the connections A wireless icon appears on the MRx display in all clinical views indicating a wireless connection to the network Data can be exchanged with and viewed at the Information Center Note the following The radio AC power module must be fully connected before turning on the MRx otherwise the MRx will not detect the module If you connect the module to the MRx after you turn it on turn the power off for 10 seconds When you restart the MRx it will find the wireless module and start a new patient incident 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 If a MRx leaves the healthcare facility disconnect the radio module from the device Use in ambulances or other vehicles is prohibited Do not place the radio AC module on the HeartStart MRx M3536A A MRx that is powered on and has an active wireless connection to the IntelliVue Network can be located by using the Information Centers Device Location option For further details on this option including device prerequisites for it to work see the
104. d press Menu Select 4 Select the desired volume level and press Menu Select A sample voice prompt is annunciated to confirm your selection Suggestion Have students complete the above volume adjustment steps during or after your demonstration 82 Review Have students answer the following questions individually or as a group Correct answers are in bold 1 True or false Q CPR can be used on patients 8 years and older T 2 True or false The multifunction pads should be placed in an anterior posterior position to ensure the ventilation algorithm interprets ventilations properly F The pads need to be in an anterior anterior position for interpretation 3 True or false The compression sensor should be positioned on the upper half of the patient s sternum to perform compressions F The sensor should be placed on the lower half of the sternum at the normal CPR hand location 4 True or false In Manual Defib Mode good compression depth is indicated by the downward peak of the waveform appearing between the horizontal lines representing the target zone T 5 True or false The ventilation volume icon indicates ventilation has been detected but not the actual filling of both lungs T 6 True or false Only AED Mode provides voice and text prompts associated with compression and ventilation activity T 83 Instructor Guide 8 Noninvasive Pacing Lesson Introduction Introduce the lesson inc
105. der license Coverage Plus and Coverage Plus NPD are registered trademarks of Steris Corp CidexPlus is a registered trademark of Advanced Sterilization Products Other trademarks and trade names are those of their respective owners Use of supplies or accessories other than those recommended by Philips may compromise product performance THIS PRODUCT IS NOT INTENDED FOR HOME USE IN THE U S FEDERAL LAW RESTRICTS THIS DEVICE TO SALE ON OR BY THE ORDER OF A PHYSICIAN Medical Device Directive The HeartStart MRx complies with the requirements of the Medical Device Directive 93 42 EEC and carries the CE 0123 mark accordingly Manufacturer Philips Healthcare 3000 Minuteman Road Andover MA 01810 Authorized EU representative Philips Medizin Systeme B blingen GmbH Hewlett Packard Str 2 71034 B blingen 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 Any chang
106. device is in this state to isolate the failure e A solid red X without periodic audio chirps indicates Either no power is available or a catastrophic failure has occurred 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 following 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 External Power lights green if power is being provided by an external AC or DC power source momentarily goes out when charging for defibrillation with a charged battery installed as the device switches power source to the battery for a faster charge time The front panel also includes the printer door and latch speaker for audible alarms and AED voice prompts microphone for audio recording and the display covered in detail later Side Panels The left panel has Ports for monitoring cables if ordered including ECG for 3 5 or 10 Lead patient cable pulse oximetry SpO2 noninvasive blood pressure NBP two invasive pressures temperature and carbon dioxide CO For CO there is an Inlet port for monitoring tubing and an Outlet port when administering anesthetic gases An ECG Out jack to connect to an external monitor The right panel has
107. displayed in the 12 Lead screen and printed on and stored with 12 Lead reports The MRx supports only adult and pediatric patient categories If the Information Center sends a neonatal patient type category to the MRx this possibility exists only ifa 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 MRx the MRx modifies the setting to pediatric and sends it back to the Information Center 168 Date and Time Whenever the MRx s date and time are not in agreement with the Information Center the MRx automatically synchronizes its date and time to match the Information Center s The date and time displayed in the MRx status area reflect the new time See the Date and Time section in the Networking chapter of the MRx Instructions for Use for date and time details Conflict Handling e Conflicts can occur if MRx patient information or MRx defaults don t match what is on the Information Center Conflicting information is automatically resolved using the Information Center s Same Patient Conflict Resolution when the MRx associates with the Information Center e If patient information on the MRx has changed as a result of a 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 In AED Mode only the Patient informati
108. e it replaces the compression wave e Ventilation detected icon e CO wave if available e 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 The EtCO waveform will appear in Wave Sector 4 if present AwRR numeric values are not displayed Compression Waveform e The compression waveform appears in Wave Sector 3 is labeled Comp and is drawn at a speed of 12 5 mm second e As the chest is compressed the chest compression is shown as a downward stroke of the wave rebounding up to a baseline as compression pressure is released e For a MRx with software version F 01 R 01 the wave sector contains solid horizontal lines drawn at 40 mm 1 5 and 50 mm 2 that define a target zone for appropriate chest compression depth For a MRx using software version F 02 R 02 or later and configured for AHA 2010 CPR guidelines the wave sector contains a solid horizontal line drawn at 50 mm 2 that indicates the minimum depth recommended by AHA when the patient is on a firm surface and a dashed line at 70 mm 2 75 that indicates the manufa
109. e the stopcock to the patient T c Invasive pressure alarms are active while the transducer is zeroing F Invasive pressure alarms are temporarily turned off while the transducer is zeroing d The message Unable to zero message displays if the zeroing process fails T 4 Which of the following statement s are TRUE regarding pressure alarms a All invasive pressure alarms cease when their alarm condition no longer exists T b The PAPd High message means the pulmonary artery diastolic pressure has exceeded the high alarm limit T c Ifthe pressure label is non pulsatile you select either Systolic Diastolic or Mean as the desired alarm source F The measurement is Mean only if the pressure label is non pulsatile d When CPP and ICP are displayed together only one of them can have related alarms enabled T 5 IfSpO2 as the default pulse source is not active but the ABP source is the pulse value displays but it is invalid T 133 Instructor Guide 13 Temperature Monitoring Lesson Introduction Introduce the lesson including the learning objectives estimated time to complete and applicable resources This lesson describes how to monitor temperature using the HeartStart MRx Objectives Upon completion of this lesson students should be able to 1 Select a temperature to monitor 2 Set temperature alarms and related limits Time 5 minutes Accessories Recommended e Simulator e g
110. e training e Application Notes Arrhythmia Monitoring Algorithm AED Algorithm SMART Biphasic Noninvasive Pacing Philips Pulse Oximetry Noninvasive Blood Pressure Monitoring Uses of Capnography The Microstream Method Q CPRO Measurement and Feedback Q CPRO Measurement and Feedback with CPR meter M3538A Battery Characteristics and Care DXL ECG Algorithm Philips ACI TIPI Philips TPI Vital Signs Trending Improving ECG Quality ECG Out Cable Philips 12 Lead Algorithm Physicians Guide available from IntelliVue Information Center User Materials under Patient Monitoring at http www3 medical philips com en us doc_downloads docdownload asp Instructor Guide 2 Getting Acquainted Lesson Introduction Introduce the lesson including the learning objectives estimated time to complete and applicable resources This lesson provides an overview of the HeartStart MRx controls indicators operational modes and display views It also provides general information on use of the device Objectives Upon completion of this lesson students should be able to 1 2 3 4 Time Identify the physical features controls and indicators of the MRx Identify the purpose of various controls and indicators Identify the display view characteristics associated with MRx s operating modes Identify the correct procedure for responding to an alarm 15 25 mi
111. e MRx starting with a brief look at the various operating modes Attach a simulator set to a normal sinus rhythm 3 5 or 10 Lead ECG set and all available parameter accessories to the MRx Feel free to switch between modes to illustrate display view characteristics however consider spending most of your time in Monitor Mode as it provides the most comprehensive view You will cover details of the AED Code and Pacing views in related lessons later in this guide Suggestion Have students set up their devices with accessories they will use and turn them on to the operating mode s you cover to follow your display view introduction Ask students what they see in each display view you cover versus just telling them what they see Operating Modes 12 The MRx has four clinical modes of operation each with a customized display view function being performed Monitor Mode Monitoring View or Monitors ECG takes an optional 12 lead 12 Lead View ECG and monitors optional parameters such as SpO EtCO NBR Invasive Pressures and Temperature and for viewing Vitals Signs Trending data AED Mode AED View Analyzes ECG and if necessary performs semi automated external defibrillation and optional Q CPR Manual Defib Mode Code View Performs asynchronous and synchronous defibrillation cardioversion and optional Q CPR and monitors ECG Pacer Mode Pacing View Performs demand or fixed mode pacing and monitors ECG
112. e disable and respond to related alarms Pose the following questions 1 What happens when you change a limit Disable an alarm Respond to an alarm 2 Ifthe CO waveform is not displayed how do you display it in the desired wave sector Additional points notes 117 Disabling EtCO Monitoring Demonstrate how to disable EtCO monitoring e Disconnect the FilterLine from the CO inlet port The message CO2 Unplugged Turn off EtCO2 appears Select Yes and press Menu Select e Should the FilterLine be disconnected accidentally select No in response to the message and press Menu Select Then secure the connection to re enable the function Additional points notes 118 Review Have students answer the following questions individually or as a group Correct answers are in bold 1 True or false EtCO values may be significantly low if a patient is breathing through their mouth when using a nasal FilterLine T 2 True or false The CO waveform only displays in Wave Sector 3 F It displays where it is configured to display it fills the first available empty wave sector if the configured wave sector is full True or false FilterLine or exhaust tubing blockage can generate an apnea alarm T True or false AwRR alarms are disabled unless enabled during use F They are on unless turned off during use 119 Instructor Guide 12 Invasive Pressures Monitoring Lesson I
113. e done in the HeartStart MRx or by connecting to AC DC power or in a Philips approved battery support system Fail D Hourglass A problem has been detected with a Turn the Therapy Knob to Monitor An component that does not affect therapy inop indicating the failed component is delivery displayed Refer to the MRx Instructions For Use Troubleshooting chapter for the action to take If the condition persists take the device out of use and call for service Ready For Use Indicator Cover what action to take based on automated test results that are communicated through the RFU status as described below Blinking black hourglass Shock pacing and ECG None functions are ready for use and sufficient battery power is available Blinking red X with or Low battery or no battery The Charge the battery as soon as possible without a periodic chirp device has limited runtime and or replace with a charged one Chirping indicates the battery Charge in the MRx using AC DC power is not being charged No or in a Philips approved battery support chirping indicates the battery is system being charged Solid red X and a A failure has been detected that Turn the Therapy Knob to Monitor A periodic chirp may prevent delivery of a message indicates a critical device error shock pacing or ECG and an inop message describes the acquisition failure Refer to the MRx Instructions For Use Troublesho
114. e is drawn at an approximate speed of 25 mm second e The wave is auto scaled to grid lines when signal quality is good e Wave size is proportionately decreased when signal quality is poor e The wave continues to display when the Therapy Knob is moved to Manual Defib as long as it is not located in Wave Sector 2 or you re in Q CPR View The SpO value is also retained in manual Defib Mode but not in Q CPR View e The pacing status bar replaces the wave in Wave Sector 4 when the Therapy Knob is moved to Pacer however SpO and Pulse values and alarm settings are retained e SpO and pulse information is no longer monitored when the Therapy Knob is moved to AED Additional points notes 99 Setting SpO Alarms Mention the following SpO alarm characteristics e Alarms sound if measurements fall outside the configured high or low SpO limits or below the configured SpO Desat limit e SpO alarms except Desat are all categorized as non latching alarms meaning they are automatically removed when their alarm condition no longer exists e Alarms are enabled unless turned off during use they remain disabled until re enabled e Ifan alarm condition occurs when alarms are disabled no alarm indication is given Changing Alarm Limits Demonstrate how to change the SpO alarm limits 1 Press the Menu Select button Using the Navigation buttons select the Measurements Alarms menu and press Menu Select Select
115. e pulse should be not wider than the normal QRS complex large enough to be detected half the height the height of the QRS complex with minimal re polarization e Adjusting the ECG wave size on the display does not affect the ECG signal which is used for arrhythmia analysis The ECG lead for Wave Sector 1 is selected through the Lead Select button or through the Displayed Waves menu Demonstrate ECG lead selection for Wave Sectors 2 4 which is accomplished through the Displayed Waves menu 1 Press the Menu Select button 2 Select Displayed Waves and press Menu Select 3 Select the appropriate Wave Sector and press Menu Select 4 Select the desired lead and press Menu Select Practice Exercise 1 Have students attach a simulator and 3 5 and 10 Lead ECG set to the MRx 5 or 10 Lead set preferred set the simulator to a normal sinus rhythm and complete a variety of lead selections for Wave Sectors 2 3 and 4 as appropriate Try adding a parameter to see how a wave sector is affected Pose the following questions 1 How do Wave 2 3 and or 4 menus differ from each other in terms of available leads From Wave 1 menu 2 What wave size s provide the clearest wave form 3 What happens when you add a parameter Additional points notes 31 Heart Rate and Arrhythmia Alarms Introduction Set the simulator and the MRx to produce a variety of alarm conditions and discuss MRx alarm cha
116. ector 1 The switch is made to a new source with a good signal also called Target ECG when the current signal becomes unavailable Code View Connect a simulator to the MRx set it to a normal sinus rhythm NSR and turn the Therapy Knob to Manual Defib on the MRx Introduce the unique Code View characteristics Enlarged Event Timer e Heart rate e Enlarged ECG Wave Sectors 1 and 2 combined e Shock counter with total number of shocks delivered in AED Manual Defib Modes e Text message window Suggestion Ask students to point out characteristics instead of YOU stating them 52 Additional points notes Manual Defibrillation Preparation Discuss defibrillation preparation using multifunction electrode pads external paddles and or internal paddles Multifunction electrode pads 1 2 4 5 Confirm the patient s condition i e unresponsive not breathing and or pulseless Prepare the patient s chest i e remove clothing remove moisture from chest and remove excessive hair Apply multifunction electrode pads to the patient according to pads package directions or organization s protocol If not pre connected insert the pads cable into the green Therapy port DEMONSTRATE Connect the pads to the pads cable DEMONSTRATE Suggestion Have students complete steps 4 and 5 External paddles 1 2 3 Confirm the patient s condition i e unresponsive not breathing and or
117. electrodes thereby varying the amount of time you might have to wait before acquiring a 12 Lead ECG Pressing the Start 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 Suggestion Ask students to point out characteristics instead of YOU stating them 144 Practice Exercise 1 Have students complete a 12 Lead acquisition Ask them to point out what display changes they see when completing each step Additional points notes Acquiring a 12 lead ECG with ACI TIPI or ACI TIPI TPI Analysis Optional topic This topic is for students who have and use the ACI TIPI and TPI option Before covering this topic check the MRx configuration for the ACI TIPI and TPI option If configured to do so the MRx runs the ACI TIPI and TPI algorithms after a 12 Lead ECG has been acquired and shows signs of ECG changes Configurations choices are e Auto ACI TIPI runs the ACI TIPI analysis if there is no gt gt gt Acute MI lt lt lt Critical Value statement and the 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 and TPI prints the ACI TIPI report followed by TPI inputs computer generated diagnostic statements using TPI criteria and user selected Thrombolytic Therapy Contraindications Note the following Proper lead plac
118. ement is required to receive proper predictive instrument algorithm calculations Demonstrate how to acquire a 12 lead ECG with ACI TIPI or ACI TIPI and TPI analysis Set the simulator to AMI 1 Perform steps 1 5 from the previous Acquiring the 12 Lead ECG procedure 2 Ifyou are not configured for TPI analysis the 12 Lead Report including the ACI TIPI predicted probability of Acute Ischemia percentage is displayed printed and stored internally If you are configured for TPI analysis the MRx performs a TPI screening test to see if the ECG is a candidate for TPI analysis You can press the Skip TPI softkey to bypass TPI analysis If the ECG is not a candidate the 12 Lead Report is displayed printed and stored internally 145 Ifthe ECG is a candidate you re prompted to input more patient information Continue with Step 3 3 When required the MRx displays a list of TPI data and related values that must be entered The following table provides the required TPI data Table 1 Required TPI data Time since ischemic symptoms onset Hour min settings unknown ranging from 0 to 7 hours e 8 hours Unknown Blood Pressure The 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 e Yes unknown No e Unknown Patient history of hypertension e Yes unknown No e Unkn
119. ent 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 according to the manufacturers instructions e Do not ultrasonically clean immerse autoclave or steam sterilize the ECG cable Do not clean the ECG cable with alcohol or clean electrical contacts and connectors with chlorine bleach NBP Cuff e Disinfect the cuff by immersion in a decontamination solution of 70 85 isopropyl alcohol but remove the rubber bag if you use this method e Machine or hand wash the cuff 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 Velcro fastening Allow the cuff to dry thoroughly after washing then reinsert the rubber bag e Do not dry clean the cuff 218 SpO Sensor and Cable Clean the SpO sensor and cable by following the instructions provided with the accessory Invasive Pressure 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 CP
120. entilation rate and lack of CPR activity in accordance with current CPR guidelines Feedback can appear on the MRx display and on the CPR meter display e Compressions are measured by the CPR meter connected to the MRx using a Pads CPR cable Ventilation data is acquired through Philips multifunction defib electrode pads applied to the patient and connected to the MRx using the same Pads CPR cable Note the following The CPR meter and its Pads CPR cable can only be used on MRxs with software version F 01 R 01 or F 02 R 02 or later installed Earlier versions of the CPR compression sensor and Pads CPR cable can t be used on a MRx with an F or R software version and higher installed Institutions with mixed fleets should develop a way for end users to identify which CPR devices go with which HeartStart MRx units e MRx software versions E02 R 02 and later have a Q CPR configuration option to select 2010 AHA or ERC compliant guidelines for the device use e Q CPR measurement and feedback is available in Manual Defib Mode and AED Mode Both modes provide audio prompts and visual indicators when CPR performance deviates outside of target ranges Manual Defib Mode provides advanced feedback while AED Mode can be configured to provide either advanced or basic feedback e Q CPR is not available in 12 Lead Mode and is deactivated when entering Sync Mode e Q CPR is not intended for use on patients under 8 years of age or weighing less than 25 kg
121. eports can be sent to a wireless modem connected to an analog line for areas where cell transmission is unavailable Demonstrate how to transmit a displayed 12 Lead Report First acquire a 12 Lead ECG display the 12 Lead Report and then complete the following procedure 1 From the 12 Lead Report screen press the Menu Select button 2 Select Send and press Menu Select 3 Select the report destination from the Send To menu and press Menu Select If MRx is configured with just one option to transmit the report or Rosetta Lt is selected transmission begins when you press Menu Select 4 If MRx has more than one configured transmission device highlight the device you want to use and press Menu Select Transmission begins Note the following Enter Patient Name and ID prior to 12 Lead acquisition to ensure it appears on the report e The MRx transmits data from internal memory only thus nothing on the external data card is transmittable e TraceMasterVue version A 02 01 or higher supports the 05 40 Hz 12 Lead filter setting e The first 12 Lead Report can be transmitted to multiple sites while subsequent reports can be placed in queue for transmittal while the first transmission is in progress e With the Wireless Link option if a 12 lead transmission fails the device will automatically retry the transmission for 30 seconds You will have the option to cancel this automatic retry operation and attempt to resend Transmi
122. erence ID is 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 e Reference ID information is entered using the Reference ID menu e Institution ID Device ID and Equipment Bed Label identifications are entered in Configuration Mode Additional points notes 17 Entering Patient Information Discuss the various patient information that can be entered on the MRx 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 Use the Patient Info menu to enter data Patient Name is entered using 2 alphabetical lists one for last name followed by another for first name Note the following Pediatric patients are defined on the MRx as children under 8 years old or less than 25kg Adult patients are defined as 8 years old and over or 25 kg or heavier Continued Use Cover the characteristics associated with MRx s continued use feature e Activated once a patient event is started e Facilitates continued treatment of the same patient by retaining current settings and the patient record when the MRx is turned off for less than 10 seconds or switching between modes e g Monitor AED and Manual Defib e MRx retains the most recent settings including Alarm settings Wave Sector settings Event Timer
123. ers or strong solvents such as acetone or acetone based cleaners e Do not mix disinfecting solutions such as bleach and ammonia as hazardous gases may result Do not clean electrical contacts or connectors with bleach e Disinfect the device as determined by your organization s policy to avoid long term damage to the device Monitor Defibrillator e Use these cleaning products on the exterior surfaces of the MRx 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 NPD 5 ounces gallon one part Coverage Plus NPD to 255 parts water e Remove all adherent soil tissue fluids etc and wipe the MRx thoroughly with a cloth dampened with water before applying the cleaning solution e When cleaning do not immerse the MRx in fluid Wring any excess moisture from the cloth before cleaning Avoid pouring fluids on the device and do not allow fluids to penetrate the exterior surfaces of the device e Use a soft cloth on the display to prevent scratching 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 Push the printer door latch to open the door 2 Remove the roll of paper 3 Clean the printhead
124. es are used once the MRx is fully charged the shock is delivered by pressing the Shock button s on the paddles NOTE Internal paddles should only be discussed with clinicians dealing with open chest defibrillation e Sync toggles between asynchronous and synchronous cardioversion defibrillation Soft Keys Perform functions presented as labels appearing immediately above the keys on the display Labels and related functions change based on the mode of operation Indicators Provide a visual display of device status Ready For Use RFU e A blinking black hourglass symbol indicates Shock pacing and ECG functions are ready for use Sufficient battery power is available for device operation An installed battery is being charged assuming the presence of external power AC or DC A blinking red X and a periodic audio chirp indicate No battery is present or a low battery condition The device can be used in a low battery condition but its operation time is limited If the device is running only on external power it takes longer to charge 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 that may prevent delivery of defibrillation therapy pacing or ECG acquisition When turned on the device displays an error message for the first critical failure detected Consider doing an Operational Check if the
125. es independently Cancelling a BLDT Demonstrate how to cancel a BLDT 1 Press the Menu Select button select Cancel Transmission and press Menu Select The transfer stops and the MRx is placed back in the Data Management screen Note the following If you exit Data Management Mode while a batch download is processing the MRx displays an Exiting Data Management will cancel the current transfer message and asks you to confirm the exit Practice Exercise 5 Have students complete a BLDT and ask them to point out what display changes they see when completing the transfer 200 Additional points notes 201 Review Have students answer the following questions individually or as a group Correct answers are in bold Consider having students correct FALSE statements to ensure comprehension 1 True or false Excluding Wireless Link transmissions MRx requires Bluetooth wireless technology to transmit a 12 Lead ECG to a personal PC T 2 Optional question Which of the following statements is TRUE To establish communication between a Bluetooth device and the MRx a pass key is needed for a only the Bluetooth device b only the MRx c both the Bluetooth device and MRx 3 Which of the following statements is FALSE regarding 12 Lead Report transmission a You can transmit reports to printers fax machines PDAs and cell phones b The MRx transmits reports from internal memory only c If you are transmitting to a
126. es 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 Then click to select Defibrillators and select the entry for Declaration of Conformity DoC Warning Radio frequency RF interference from nearby transmitting devices may degrade the performance of the HeartStart MRx Electromagnetic compatibility with surrounding devices should be assessed prior to using the monitor defibrillator This Instructor Guide contain the following conventions Voice represents voice prompt messages Text represents messages that appear on the display Text represents bolded directions to the instructor that appear in the guide and options that appear on MRx menus Soft key represents soft key labels that appear on the display abo
127. es outside of target ranges and in accordance with AHA ERC guidelines e Q CPR is contraindicated for use on neonatal and pediatric patients under 8 years of age or weighing less than 25 kg when CPR is contraindicated ina moving environment e g ambulance Additional movement introduced during patient transport may reduce compression and ventilation measurement accuracy If Q CPR must be used in a moving environment do not rely on the Q CPR feedback during such conditions There is no need to remove the Compression Sensor from the patient with any other CPR compression devices aside from the Q CPR Compression Sensor e Events related to Q CPR are not stored in the HeartStart MRx Event Summary e There is a Q CPR Data Capture option available that allows you to capture data on CPR quality from the HeartStart MRx using the Q CPR option The Q CPR Data Capture option stores CPR related data for retrospective review and analysis using Q CPR Review software available from Laerdal Medical Corporation See the Q CPR Review Directions for Use for more information on Q CPR Review software Additional points notes 74 Q CPR Preparation Discuss cable connections and preparation for Q CPR Pads CPR Cable to the MRx The Q CPR option requires the use of the Pads CPR cable M4763A To connect the Pads CPR cable 1 Align the white pointer on the cable with the white arrow on the green Therapy port and in
128. ess Menu Select 3 Select HR Arrhythmia and press Menu Select 4 Select Relearn Rhythm and press Menu Select The messages Learning ECG and Learning Rhythm appear in the rhythm status area of the display Practice Exercise 5 Have students complete the steps to initiate manual relearning as appropriate Additional points notes 38 Review Have students answer the following questions individually or as a group Correct answers are in bold Consider having students correct FALSE statements to ensure comprehension 1 Identify the Monitoring View elements 4 wave sectors INOP area ECG HR alarms HR values alarm settings 2 True or false You can select the ECG lead for Wave Sectors 1 4 using the Lead Select button F The Lead Select button can only be used with Sector 1 3 Which of the following alarms can ONLY be changed while IN RESPONSE TO AN ALARM CONDITION a HR b PVC c VTACH 4 Which of the following statement s are TRUE a All arrhythmia alarms are classified as latching alarms F Some are non latching b Yellow alarms can communicate equipment failures F INOP messages do this c Alarms are enabled as soon as you enter Manual Defib Mode if the Sync function is enabled T d Menu Select AND Navigation buttons can acknowledge alarms T 5 True or false The MRx automatically performs arrhythmia learning relearning when there is a lead selection change for
129. esson students should be able to 1 Locate pertinent information in Code View 2 Prepare a patient for asynchronous and synchronous defibrillation 3 Perform asynchronous and synchronous defibrillation Time 10 20 minutes Accessories Recommended Simulator Hands free cable Multifunction electrode pads External paddles Internal paddles include M4740A Paddle Adapter Cable for switchless paddles 3 5 or 10 Lead monitoring electrodes Clinical Resources SMART Biphasic Application Note 51 Lesson Presentation Manual Mode Introduce the Manual Defib Mode e The entire defibrillation process is under your control i e you assess the ECG decide if defibrillation or cardioversion is indicated select the appropriate energy setting charge the device and deliver the shock e Text messages are present voice prompts are not present e Defibrillation is always performed through paddles or pads e You can monitor the ECG using an alternate ECG source 3 5 or 10 Lead monitoring electrodes e You should be ACLS certified to use this mode e This mode may be password protected as defined in Configuration e This mode may include Q CPR measurement and feedback if equipped on the MRx Note the following if you are using the MRx M3536A with R 02 software and later which features automatic lead switching behavior In Manual Defib Mode you can configure the MRx to switch sources for the waveform in Wave S
130. eth wave is cyan and pulse is being derived from the pleth wave then the pulse reading will appear in cyan e Pulse is on and displayed if one of these possible sources is activated SpO is the factory default but can be modified in Configuration Mode e If the default pulse source is not active during an event but a secondary source is the pulse value will display but 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 to an active source for this incident 130 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 Changing Pulse Source Demonstrate how to change pulse source for the current incident 1 2 3 4 5 Press the Menu Select button Using the Navigation buttons select Measurements Alarms and press Menu Select Select Pulse and press Menu Select Select Pulse Source and press Menu Select Pick a source with an arterial or pulmonary waveform
131. f scales for the pressure wave To select a pressure wave and the associated scale for the display or printed strip 1 Press the Menu Select button 2 Using the Navigation buttons highlight Displayed Waves and press Menu Select 3 Select Wave Position Wave 1 Wave 2 Wave 3 or Wave 4 and press Menu Select 4 Select the appropriate wave and press Menu Select 5 Select the appropriate scale and press Menu Select 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 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 Suggestion Have students complete the above steps during or after your demonstration Note the following A positive scale sets the top gridline to your selected scale and the bottom to zero A negative scale sets the bottom gridline to the selected negative unit and the middle gridline to zero Practice Exercise 1 Have students attach a simulator and pressure cable s to the MRx select different pressure waves and associated scales and display and print out the results as appropriate Pose the following questions 1 How does the display or printout differ from one pressure wave to another From Wave 1 menu 2 What wave scale s provide the clearest wave form NOTE The answer may depend on what the simulator is set to 3 How
132. fax number you may need to include a 9 for an outside line or 1 before the area code d You must wait for one transmission to complete before initiating another one F You can p 8 put additional reports in queue for transmittal while transmission is in progress 4 Optional question Which of the following statements is FALSE regarding Periodic Clinical Data Transmission a A blue icon with a green Bluetooth symbol indicates a PCDT session is currently transmitting data b All transmitted personal patient identifiable data is encrypted to insure patient confidentiality c For multiple transmissions event summary transmissions are sent first patient vital signs transmissions second and 12 Lead Report transmissions third F Vital signs transmissions are sent first followed by event summaries and then 12 Lead Reports d If you start a PCDT within 10 seconds of turning the MRx on the first transmission contains no wave data 5 Optional question True or false The Send menu option transmits periodic clinical data if you are in clinical mode F Start Data Transmit sends periodic clinical data from clinical mode Send is used to transmit 12 Leads 6 True or false You can transmit all event data a specific 12 Lead Report audio data and Q CPR data from Data Management Mode T 7 Optional question Which of the following statements is FALSE regarding BLDT a Batch LAN Data Transfer is simply a LAN c
133. ference ID Use the Menu Select button and the Navigation arrows 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 184 Additional points notes Setting Up Bluetooth Transmissions Optional Optional topic This topic is for students who use Bluetooth technology to transmit MRx data Discuss and demonstrate how to set up to use Bluetooth technology to wirelessly transfer data from the MRx It is recommended that you have at least one wireless device set up and tested with the MRx prior to teaching this lesson Adding a Bluetooth Device e Configure up to 20 Bluetooth devices for use Adding a twenty first device replaces the device used least recently e Bluetooth devices may not be added or modified during transmission Conversely transmission is not allowed during Bluetooth device configuration To add a Bluetooth device to the list of transmission devices 1 Access 12 Lead Mode and press the Menu Select button 2 From the 12 Lead Main Menu select Bluetooth Devices and press Menu Select 3 Select Add Device and press Menu Select The message Searching for Bluetooth Devices displays The search lasts for 30 seconds 4 From the Add Device menu select the desired Bluetooth device and press Menu Select The selected Bluetooth device must now go through the pairing process described below All Bluetooth
134. g a successful setup try failing the transmission test e g add a cell phone that not Bluetooth enabled or fail the pairing process by letting it time out and pose a few related questions 1 For example what does it mean if you cant find a Bluetooth device when trying to add it to the transmission device list Answer It may not be turned on there may be too many Bluetooth enabled devices more than 10 in the area or it may not be discoverable For the latter condition you ll have to enable it following the device s documentation Keep in mind that during discovery the MRx will pick up to 10 Bluetooth devices within the maximum communication distance based ona device s class If the device is not found search again and complete the procedure for adding a Bluetooth device 2 What other resources would you use to troubleshoot a problem Answer Data Transmission Implementation Guide and or IT administrator Additional points notes 187 Setting up Wireless Link Transmissions Optional Optional topic This topic is for students who use the Wireless Link device to transmit MRx data Briefly mention Wireless Link transmission setup e An appropriate IT professional must set up and configure your HeartStart MRx and the Wireless Link device before you can send data For further information on setup and configuration including Data Messenger setup for wireless Batch LAN Data Transfer refer to the Data Transmissi
135. ge to No unless they were previously set to Yes Demonstrate how to change a contraindication The list may be comprised of more than one page 1 When the list of contraindications appears on the MRx display use the navigation arrows to highlight one of the contraindications and press the Menu Select button 2 Use the Navigation arrows to select a new value for the contraindication and press Menu Select Use the Navigation arrows to select the next contraindication 4 Complete steps 1 3 for the remaining contraindications in your list Navigate to additional page s as needed 5 Press the Done softkey to exit contraindications to thrombolytic therapy The 12 Lead analysis is complete 6 To acquire another 12 Lead ECG press New 12 Lead To exit the 12 lead function press Exit 12 Lead Note the following Each institution can configure the TPI software to reflect the processes it uses to determine if thrombolytic therapy should be administered Practice Exercise 2 Have students complete a 12 Lead acquisition with ACI TIPI or ACI TIPI and TPI analysis Make sure their simulators are set to AMI Ask them to point out what display changes they see when completing each step Additional points notes 147 12 Lead Report Discuss the characteristics of the 12 Lead Report View and printout e The 12 Lead Report View lets you monitor a patient and see report data simultaneously e The report replaces Wave Sect
136. hange the pads and or the pads cable Suggestion Reference and read through the SMART Biphasic Application Note M3535 91040 for further details on the SMART Biphasic waveform as appropriate Shock Advised Mention that if a shockable rhythm is detected the MRx e Automatically charges to 150 e Generates voice and screen prompts and a steady high pitched tone e Displays a flashing Orange Shock button when fully charged e Analyzes heart rhythm while charging e Disarms if a rhythm change is detected before a shock is delivered and no longer appropriate Note the following You can disarm a fully charged device by turning the Therapy Knob to Off or by pressing the Pause for CPR soft key Resume monitoring by turning the Therapy Knob back to AED 46 Additional points notes Press the Orange Shock Button if Prompted Now complete the Shock step Note the following e MRx prompts Deliver Shock Now Press the Orange Button Now once charging is complete e No one should be touching patient or anything connected to patient Call out clearly and loudly Stay Clear Then press the orange Shock button e The Shock Delivered message confirms shock delivery e The shock counter gets updated e An annotated strip is automatically printed MRx prompts Paused If Needed Begin CPR and commences analysis at the completion of the pause period or when you press the Resume Analyzing soft key The CPR p
137. he Information Center To save event data at the Information Center use the Information Center to discharge the patient e Discharge Patient is an option whether a patient is admitted or not whether the MRx is connected to the Information Center or not or if the MRx is in Transfer Mode It is not available in Pacer Manual Defib 12 Lead or AED Modes At the Information Center Discharge Patient excluding the Discharge for Transport function is not available when the MRx is in Pacer Manual Defib or AED Modes e When monitoring a new patient if the MRx is not turned on as a new use always perform a discharge to clear out patient data and reset all MRx and Information Center settings even if your previous patient was not admitted To discharge a patient 1 Press the Menu Select button 2 Using the Navigation buttons select Patient Info and press Menu Select 3 Select Discharge Patient and press Menu Select 4 The MRx displays one of two Discharge Patient messages and prompts you with a Discharge Patient question See Table 2 Table 4 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 or No to cancel the discharge
138. he MRx provides corrective voice prompts if configured Other icons e The Do Not Touch The Patient icon displays when the MRx provides prompts to stop CPR to analyze the patient s heart rhythm is charging or advises a shock is required Stay clear of the patient when the icon is displayed Do not remove the CPR meter during rhythm analysis or shock delivery e Ifcompressions are stopped for 10 seconds a flashing white image indicates that CPR should be resumed If compressions are not resumed voice prompts if configured indicate that no compressions are detected e 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 Practice Exercise 1 Have students make all cable attachments and then detach a cable e g Pads CPR meter cable to see what inop is produced For example the message Connect Pads CPR Cable displays if not pre connected Loosen a multifunction pad to see what inop is produced e g Poor Pads Contact or Pads Off Make sure students attach the CPR meter adhesive pad properly and position the CPR meter correctly on the patient or manikin Have students practice using the CPR meter on the manikin or compliant surface attempting to achieve appropriate compression depth and rate Additional points note
139. hey troubleshoot it Additional points notes Selecting a Pressure to Monitor Demonstrate how to select a pressure to monitor on the MRx e You need to assign a label to each pressure channel as it is connected Channels are identified as Press 1 and Press 2 e Once you select a label the MRx uses that label s stored information color alarm source and limits scale as the default Check each pressure channel label as the cable is connected and make changes as appropriate To select a pressure label 1 Press the Menu Select button 2 Using the Navigation buttons select Measurements Alarms and press Menu Select 3 Select Press 1 or Press 2 and press Menu Select 4 Select Label and press Menu Select 5 Select the appropriate label from the list provided see pressure label list below and press Menu Select 6 Verify and change the size of your scale as appropriate Reference the Pressure Waves topic as needed 7 Verify and change the alarm source type as appropriate Reference the Alarms topic as needed 8 Set the high and low alarm limits Repeat the above steps to label the other pressure channel Suggestion Have students complete the above steps during or after your demonstration Note the following Changing a pressure label activates scales and alarm settings associated with the new label Controls for scale and alarm settings appear after selecting a label to either confirm
140. hich of the following statement s are TRUE related to battery maintenance a Batteries should be inspected as part of the Operational Check T b Discard the battery when calibration reports less than 80 capacity T c Batteries charge automatically if they are in an MRx connected to AC or DC power T d Frequency and duration of use have a direct correlation on battery life T 4 Which of the following statement s are TRUE related to MRx and accessory cleaning a You can clean the exterior of the MRx and the batteries with chlorine bleach T b You can clean the printer printhead surface with isopropyl alcohol T c Youcan ETO sterilize the external paddles F You should not ETO sterilize paddles d You can clean the carrying case by hand or machine with mild soap and water F You should not machine wash the carrying case 221 222 PHILIPS 453564045041 Edition 7 Koninklijke Philips N V Printed in the U S A Aug 2013 E
141. ics related to EtCO measurement e The measurement is automatically turned on when the FilterLine is connected to the CO Inlet port e The CO waveform displays in the configured Wave Sector if available otherwise the wave fills the first available empty Wave Sector e EtCO and AwRR values display in Parameter Block 2 Suggestion Ask students to point out characteristics instead of YOU stating them Setting Up the EtCO and AwRR Alarms Mention the following EtCO and AwRR alarm characteristics e Alarms sound if measurements fall outside the configured high and low limits for EtCO and AwRR and for Apnea time A red alarm occurs for Apnea time measurement outside the configured limits e EtCO and AwRR alarms are all categorized as non latching alarms meaning they are automatically removed when their alarm condition no longer exists e Alarms are enabled unless turned off during use they remain disabled until re enabled e Ifan alarm condition occurs when alarms are disabled no alarm indication is given Changing EtCO Alarm Limits Demonstrate how to change the EtCO alarm limits 1 Press the Menu Select button Using the Navigation buttons select the Measurements Alarms menu and press Menu Select Select EtCO and press Menu Select 2 3 4 Select EtCO Limits and press Menu Select 5 Using the Navigation buttons increase or decrease the high limit value and press Menu Select 6 Set the new low limit
142. ime or with a 10 second delay HeartStart MRx Continuous 10 seconds just prior to charging plus charges to deliver a continuous printing through the charge shock 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 Same as real time strip alarm data and 5 seconds of post alarm data when specified alarm type occurs Mark Event button 6 seconds from the start of the 10 seconds prior to the Mark Event plus 6 pressed annotation text or from the time seconds from the start of the annotation text or the Events menu is removed from from the time the Events menu is removed the display from the display Printing from Data Management Mode Demonstrate how to print an Event Summary Vital Sign Trends Report or 12 Lead Report 1 Turn the Therapy Knob to Monitor 2 Press the Menu Select button 3 Using the Navigation buttons select the Other menu and press Menu Select Note Using T 00 software on the MRx M3536A you can access Data Management Mode by pressing the Summary 1 button thus eliminating steps 2 and 3 above 4 Select Data Management and press Menu Select 5 Press Menu Select to acknowledge the message Leaving Normal Operational Mode 6 Press Menu Select to display the Data Management
143. ining coordinator that students watch the latest version of the HeartStart MRx User Training Video or DVD prior to the instructor based training if available Also suggest taking the HeartStart MRx Web based User Training prior to or after the instructor based training e Determine the number of devices needed for training and make arrangements to have them set up at the scheduled time if possible Try not to exceed grouping 2 3 students per device e Determine who in the organization makes decisions about configuration Arrange a time to discuss the organization s desired configuration and set up the devices used in training to that configuration Use the configuration worksheet available on the User Documentation CD ROM to help you complete the configuration procedure e Perform an Operational Check on each device to be used in training prior to training Refer to the latest version of the HeartStart MRx Instructions For Use to complete the Op Check if necessary e Try to have fully charged batteries and external power available if needed e Try to have one simulator for each device to be used in training as well as extra batteries for the simulators e Try to have appropriate sets of parameter accessories cables etc for each device e Try to have one copy of the latest HeartStart MRx User Training Workbook available for each student if possible The workbook contains a similar lesson flow to the guide but only a summary of the con
144. king with Data 173 Lesson Introduction ou a ke ek a ee ee ew ww a173 OpjectiyesS w s ou ABR BS eR ER eS oe BG A AI Time e 3 E De wee k a a y 6178 Accessories sti PACA A rd oe aO Lesson Presentation y 2 4 4 4 e 1 4 Overview Sob be eh A be ad a 4 a a we 4 274 Copying from taal emit A car o 4176 Viewing and Erasing the External Data Cad Ye eo ee ae we a ow we 2070 Printing During a Patient Event 2 2 2 2 2 0 0 TT Printing from Data Management Mode 178 Marking Events 2 ba e ARA Se eK amp uw 2 TD Review 2 amp b Ge eR HERES Ree ee ae So 4180 18 Data Transmission 181 Lesson Introduction i f G4 dadas ou Gm a E Objectives be Be Soe Geek ee eR RR BR eS Ge VDT Time 4 ce ee reaga ean as amp a ag Accessories subes E Technical Resources ys amp we Be ss oe ee Ke oy BZ Lesson Presentation 2 2 ee e182 Overview e 182 Preparing for Transmission 2 2 1 2 ee ee 183 Setting Up Bluetooth Transmissions 2 2 a ee ee 185 Setting up Rosetta Transmissions 2 be ew we 188 Setting up RS 232 Transmissions 2 1 1 1 ee ee ee ee 188 Transmitting in 12 Lead Mode 2 2 sw eb ee ee 4 60 0 189 Periodic Clinical Data Transmission 2 4a sac es e woo 19l Transmitting Post Events Cae et oa Les ae ass Transmitting in Data Management Moda oo ee See ss a ae Tracki
145. l At completion of the Op Check the message Operational Check Passed is displayed if all tests have passed 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 Service device Replace battery Replace CPR meter or Compression Sensor Replace Pads cable Replace Paddles cable Replace Therapy cable Replace ECG cable You must fix the problem and successfully run Op Check to clear the failure e A report prints out automatically listing test results and items the user should check manually The user can press the Print soft key to print an additional copy of the report e Ifyou cancel the Op Check before it completes there is no record of it in the Operational Check Summary e Upon completing the Op Check and returning to a clinical mode Monitor Pacer Manual Defib or AED all settings are reset to the device s configured values So the MRx is ready for use when needed do not leave the test load attached after performing an Operational Check Suggestion Have students complete the Op Check steps with you or after you have demonstrated the procedure Advise students to safely discharge paddles if they are being tested Consider discussing the Op Check details outlined on the next few pages depending on your audience s interests and needs Point out that Op Check
146. l Defib Modes It provides EtCO and AwRR values and a CO waveform EtCO and AwRR alarm limits appear next to related values Additional points notes 114 Preparing to Measure EtCO Demonstrate the following preparation to measure EtCO 1 Select the appropriate Microstream accessories based on the type and airway status of the patient 2 Set up the Microstream accessories 3 Attach the FilterLine tubing to the CO Inlet port Note the following 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 Should the FilterLine or exhaust tubing be blocked when the MRx is turned on the CO Check Exhaust INOP message displays Should the blockage occur during CO monitoring the CO waveform appears as a flat line and if alarms are on an apnea alarm sounds e Use only Microstream accessories to ensure correct functioning of the CO sidestream measurement e Dueto a measurement delay do not use Microstream sidestream CO as a direct reference for determining the end expiratory point in the pressure curve e The Outlet port is used for removing anesthetic gases from MRx Suggestion Have students complete the appropriate above steps during or after your demonstration Additional points notes 115 Measuring EtCO Cover the following display characterist
147. lass CPR meter or Compression Check the CPR meter or Compression Sensor failure Sensor and cable connections If necessary replace the CPR meter or Compression Sensor I The Automated Tests continually check for a low battery condition and set the RFU Indicator appropriately Additional points notes 215 Battery Maintenance Discuss battery maintenance related activities and characteristics e Proper maintenance ensures the battery s charge state is accurately reported ensures there is sufficient charge and capacity to operate the MRx ensures battery life is optimized begins upon receipt of a new battery and continues throughout the battery life Detailed information on battery care is available in the M 3538A Lithium Ion Battery Characteristics and Care application note provided with each MRx Here are the battery maintenance activities and when they should be performed Perform a visual inspection As part of the Operational Check Charge the battery Upon receipt after use or if the message Batteries Low is displayed Perform a calibration When the Operational Check test results state Calibration Recommended or every 6 months whichever comes first Store batteries in a state of charge in the When not in use for an extended period of time range of 20 40 Discard the battery When there are visual signs of damage or calibration reports less than 80
148. le from the SpO port The message SpO Unplugged Turn off SpO appears Select Yes and press the Menu Select button Should the sensor cable be disconnected accidentally the message SpO Unplugged Turn off SpO appears Select No and press Menu Select Then secure the connection to re enable the function 102 Additional points notes 103 Review Have students answer the following questions individually or as a group Correct answers are in bold 1 True or false You can monitor SpO in all MRx modes Monitor Manual Defib AED or Pacer F Not AED 2 True or false The pleth wave is auto scaled to grid lines when the signal quality is poor F The wave is auto scaled with a good signal 3 True or false SpO alarms are off unless turned on during use while pulse rate alarms are on unless turned off during use F SpO alarms are on unless turned off during use while pulse rate alarms are off unless turned on 4 How many seconds are SpO INOP messages suppressed during an NBP measurement a 15 b 30 c 45 d 60 104 Instructor Guide Noninvasive Blood Pressure Monitoring Lesson Introduction Introduce the lesson including the learning objectives estimated time to complete and applicable resources This lesson describes how to monitor noninvasive blood pressure NBP with the HeartStart MRx Objectives Upon completion of this lesson students should be able to 1 Monitor NBP 2 Set NBP
149. les and the paddle tray are thoroughly clean there is no debris or residue including all conductive material on the electrode surfaces of the paddles and tray the paddles are secure in their trays and the Patient Contact Indicator PCI LEDs located on the sternum paddle are not lit If the LEDs light adjust the paddles in their pockets If the LEDs continue to light clean both the adult and pediatric paddle electrode surfaces Also if the MRx has the Pacing option test external paddles using the Weekly Shock test You must run Operational Check with a pads cable in order to pass the Pacer test Multifunction electrode pads Attach a test load to the end of the patient Therapy cable Note the following See the Sterilizable Defibrillator Paddles Instructions for Use for instructions to test reusable sterilizable paddles internal or external prior to each use 2 Turn the Therapy knob to 150J 3 Press the Charge button If it is necessary to disarm the defibrillator press the Disarm soft key 4 The strip prints if configured to do so If the strip does not print immediately press the Print button 5 Ifusing External paddles Simultaneously press the shock buttons located on the paddles to deliver a shock into the paddle tray Pads Press the Shock button on the MRx to deliver a shock into the test load 6 Confirm on the strip print that the energy delivered to the test load is 150J 23 127 to 173 If n
150. luding the learning objectives estimated time to complete and applicable resources This lesson describes the noninvasive transcutaneous pacing option available with the HeartStart MRx and how to perform pacing Objectives Upon completion of this lesson students should be able to 1 Identify pertinent information in Pacing View 2 Prepare a patient for pacing 3 Perform demand or fixed mode pacing Time 10 20 minutes Accessories Recommended e Simulator e Hands free cable e Multifunction electrode pads e 3 5 or 10 Lead monitoring electrodes Clinical Resources Noninvasive Pacing Application Note 85 Lesson Presentation Pacer Mode Introduce the Pacer Mode e Pacer Mode delivers pace pulses to the heart through multifunction electrode pads e The ECG strip and Event Summary are easily annotated using the Mark Event button in Pacer Mode e Waveforms ECG monitoring measurements and most alarms from Monitor or Manual Defib Mode remain active and retain their settings while in Pacer Mode however the waveform in Wave Sector 4 is replaced by the pacing status bar e Alarms Arrhythmia alarms for Pacer Not Pacing and Pacer Not Capture associated with non transcutaneous pacing are off in Pacer Mode All other red and yellow alarms are active if enabled and their limits may be changed while in Pacer Mode ECG INOPs are also annunciated While pacing if the pacer output drops below the selected set
151. luetooth device is paired with the MRx and the profile selected the MRx performs a transmission test After successfully connecting the message Transmission Test Passed displays Press Menu Select to acknowledge the message If the transmission test fails the message Transmission Test Failed displays along with additional information about where the failure occurred See Transmission Problems Bluetooth in the Troubleshooting chapter of the MRx Instructions for Use for support on failures Emphasize this point The MRx can communicate via Bluetooth with nearby devices such as computers laptops tablets and mobile devices 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 MRx Changing a Bluetooth Profile Once you have added and paired a Bluetooth device you can change its profile 1 In 12 Lead Mode press Menu Select 2 From the 12 Lead Main Menu select Bluetooth Devices and press Menu Select A list of configured Bluetooth devices displays Use the Navigation buttons to select a device and press Menu Select Select Change Profile and press Menu Select A menu of configured profiles for that device displays with the current associated profile highlighted 5 Select the profile you want to associate with the device The MRx tests the profile to determine if the Bluetooth device can
152. maining steps are similar to demand mode pacing 4 Press Pacer Rate and use the Navigation and Menu Select buttons to select the desired number of pace pulses per minute The initial rate is configurable If needed adjust the initial pacer output by pressing Pacer Output and using the Navigation and Menu Select buttons to select the desired output The initial output is configurable Press Start Pacing Verify the presence of a peripheral pulse Press Pacer Output and use the Navigation and Menu Select buttons to adjust the output as needed To pause or stop pacing Press Pause Pacing or Move the Therapy Knob off the Pacer position Practice Exercise 2 Have students attach pads and electrodes to the MRx and a simulator set the simulator to bradycardia and complete fixed mode pacing Pose the following questions 1 2 What display changes do you see when completing each step i e turn on pacing set pacing status adjust pacer rate and output and stop pacing How do you know when pace pulses are being delivered Additional points notes 92 Defibrillating During Pacing Discuss how switching to Manual or AED Mode affects pacing Once the Therapy Knob is moved from Pacer to Manual Defib or AED pacing is stopped e To resume pacing after defibrillation repeat the pacing procedure When pacing is resumed pacing settings selected prior to defibrillation mode rate and outpu
153. menu 7 Use the soft keys labeled Prev Item and Next Item to select the Event Summary you want to print 8 Press Menu Select to display the Data Management menu 9 Highlight Print and press Menu Select 10 Select the data option listed that you want to print Event Summary Trends or specific 12 Lead Report and press Menu Select to print 178 Note the following To print an Event Summary stored on the external data card the information must be downloaded to the HeartStart Event Review Pro data management system Refer to the HeartStart Event Review Pro Instructions for Use for download instructions Also if you are using a HeartStart MRx M3536A with software version R 03 and later e you can print four different Event Summary report lengths short medium long or full e If there is a CO waveform it is part of the printed Event Summary e The presenting waveform is part of the Event Summary Suggestion Have students print a data report during or after your demonstration Additional points notes Marking Events Discuss the characteristics associated with marking events e Use the Mark Event button to annotate the Event Summary and the ECG strip at the point in time the button is pressed The Mark Event button prints a 6 second ECG strip if so configured the strip is printed real time or prepended with the previous 10 seconds of data leading up to the marked event e Once pressed the Mark Event
154. mmunicates elapsed time for the current patient incident Wave Sectors e MRx displays up to 4 wave sectors with a predetermined waveform when powered on in Monitor Manual or Pacer Mode e A dashed line in a wave sector or empty wave sector indicates waveform source not connected to MRx e Sectors may contain a variety of information as appropriate to the parameter view and task ECG wave sectors contain a calibration bar Wave Sector 1 e Will only contain an ECG waveform used by the arrhythmia heart rate derivation and AED analysis algorithms the waveform may be acquired through the therapy port for pads paddles or the monitoring port for 3 5 or 10 Lead electrodes Ifthe configured source is not connected to the device when turned on the first valid ECG source is displayed in Wave Sector 1 Once the source is available it automatically populates Wave Sector 1 The displayed lead source is controlled primarily by the Lead Select button although the Displayed Waves menu can be used e This sector includes R wave detection e When monitoring using a 3 lead ECG set the MRx displays only one ECG lead at a time e IfPads are configured as the primary ECG source for Wave Sector 1 the ECG patient cable must be connected to the MRx and to the monitoring electrodes in order to change the ECG source to a Leads selection Wave Sectors 2 4 e Automatically populate when parameter sources cables tubing are connected t
155. mount of data card space available F The number is determined by the length of each incident and the amount of data collected d When in Data Management Mode monitoring and defibrillation modes are disabled 2 True or false If an alarm condition occurs while an Event Summary is printing any associated ECG waveform is not stored nor is an alarm strip printed F The corresponding ECG waveform is stored and available in the Event Summary 3 True or false For a Shock delivered or Shock failed event the MRx will print a 12 second strip if so configured T 4 True or false The Mark Event button can be configured to print a 6 second ECG strip real time or prepended with the previous 10 seconds of data leading up to the marked event T 180 Instructor Guide 18 Data Transmission Lesson Introduction Introduce the lesson including the learning objectives estimated time to complete and applicable resources Most topics in this lesson involve optional features so review what material you ll cover and advise students accordingly on objectives and how long the lesson will take to complete This lesson describes how to transmit data from the HeartStart MRx to various external devices using a suite of available data transmission options For Rosetta and RS 232 transmissions please see the MRx Instructions for Use Objectives Upon completion of this lesson students should be able to l 2 3 4
156. mp non specific temp label Tven venous temperature Tcore core temperature To select a temperature label 1 Press the Menu Select button 2 Using the Navigation buttons select Measurements Alarms and press Menu Select 3 Select the temperature label option currently assigned to your measurement and press Menu Select 4 Select Label and press Menu Select 5 Select the appropriate label from the list provided and press Menu Select Suggestion Have students complete the above steps during or after your demonstration 136 Monitoring Temperature Demonstrate how to monitor temperature 1 Connect the temperature cable to the 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 Suggestion Have students complete the above steps during or after your demonstration Note the following The temperature function performs a self test when initially turned on and also performs hourly system tests when active Additional points notes 137 Alarms Setting Temperature Alarms Mention the following temperature alarm characteristics and details in the following table as appropriate e Temperature alarms are all categorized as non latching alarms meaning they are automatically removed when their alarm condition no longer exists e They annu
157. nciate if measurements fall outside the configured limits for high and low temperatures The table below details 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 e Alarms are on unless turned off during use Once turned off alarms remain off until they are turned back on e Iftemperature alarms are enabled alarm limits appear next to the temperature value If alarms are off the Alarms Off symbol replaces the limits Changing Temperature Alarm Limits Demonstrate how to change the temperature alarm limits for the current incident 1 Press the Menu Select button Using the Navigation buttons select Measurements Alarms and press Menu Select Select the temperature label option currently assigned to your measurement and press Menu Select Select Temperature Limits and press Menu Select Using the Navigation buttons change the high limit and press Menu Select oN MY ps iS Using the Navigation buttons change the low limit and press Menu Select Note the following 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 Disabling Enabling Temperature Alarms Demonstrate
158. nd Care Application Note e MRx Shift Checklist 203 Lesson Presentation Overview Describe the critical aspects associated with maintaining the MRx e Providing power so automated tests can be run e Observing the Ready For Use RFU indicator e Performing a shift check weekly shock test and an operational check e Caring for batteries e Cleaning the device and accessories e Ordering replacement supplies and accessories Note the following For information on cleaning the MRx and accessories device disposal and a listing of replacement supplies and accessories check out the Maintenance chapter of the HeartStart MRx Instructions For Use Also MRx service including calibration of optional EtCO2 and NBP modules should only be performed by qualified service personnel in accordance with the HeartStart MRx Service Manual Additional points notes 204 Automated Tests If appropriate to your audience describe the three automated tests MRx runs to assess operational performance and alert users if a problem exists Point out that they occur at regularly scheduled intervals while the device is off 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 defibrill
159. ng Data Transmission 2 2 1 7 eee ee ee 197 Transmission Errors gt acao a ee a Hw os es oo IZ Cancelling a Transmission o 2 2 ee ee 197 Queuing Transmissions 2224226 SS Ha wm a ow 2197 Finding Transmission Results a su 2 ko 4 o amp w 198 Batch LAN Data Transfer lt a es 3 4 4 ed oe as 2 a 199 Review Gb ae ee RE EEE eee eee Re aS e S20 19 Maintenance 203 Lesson Introduction e 2 ow 4B 4 EB aA ew AA eK Ow a 08 Ob jectiv s 2 o e moe Roe bee eee wR eR Ew a 8 Time o 203 Accessories Recommended 2 1 1 eee 203 Maintenance Resources s s o sao s ee ee 203 Lesson Presentation 204 OVERVIEW a so s w so woa a w e a se A Automated Tests 205 Ready For Use Indicator 2 2 a ee ee ee 206 Shift Check a so wo 207 Weekly Shock Test aaa a a 208 Operational Check y 2 ea a a O Battery Maintenance a a aa 2166 Cleaning Instructions 2 2 aa 4217 R vieWs y 2 Sb 2G BLS ESE EES eSB ED Ee Ew 2 Instructor Guide Introduction This instructor guide is designed to assist you in the delivery of end user training on the HeartStart MRx It provides directions and suggestions for teaching the safe and proper operation of the device and is intended only for ACLS personnel thoroughly trained in the use of the device Instruction Time It is estimated that this course will require 2 5 hours to complete depending on class size lo
160. ng 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 for advanced airway is 8 10 ventilations per minute to reflect 2010 resuscitation guidelines e The ventilation detected icon depicts an approximate level of ventilation volume A set of lungs graphically shows three states of volume empty full and questionable A filled icon indicates a ventilation was detected Lungs marked with a indicate ventilation cannot be measured Note the following The graphical lungs do not signify the actual filling or presence of both lungs in the patient The actual ventilation volume associated with filling of the lung icon varies from patient to patient Actual lung expansion is based upon chest rise and checking bilateral breath sounds Also the MRx does not provide feedback on hyperventilation if the transthorasic impedance signal is too noisy Proceed doing ventilations according to your organization s protocol e The accuracy of ventilation feedback 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 The No Flow Time value represents time without a detectable chest compression beginning at 3 seconds and incremented with each
161. nly in the U S at this time The option is not available with the Batch LAN Data Transfer option nor is it supported on a MRx using T software IntelliVue Networking Display Describe the IntelliVue Networking data displayed in the MRx status area e Network Connectivity Icon indicates a wired or wireless Local Area Network LAN connection between the MRx and Information Center appears on the displays top line to the left of the bed equipment label once there is communication with the Information Center Bed Equipment Label equipment label displays when MRx not connected to the network bed label may replace equipment label once there is connection to the network or bed equipment label may be the same e Date Time date and time are synchronized with the Information Center See the Sharing Information on the Network section in the Networking chapter of the MRx Instructions for Use for more details The patient name and type category Adult or Pedi and paced status are also displayed If a patient is not admitted Not Admitted will be displayed until the patient is admitted Suggestion Prior to your description ask students to describe any data they see that may pertain to network connectivity 160 Connecting to the Network This topic is optional to discuss how to connect the MRx to the IntelliVue Network and view related network settings pending interest and or responsibility of end users with for making su
162. nob to Monitor and press the Sync button b Turn the Therapy Knob to Manual Defib on a desired energy level c Press the Charge button d Press and hold the Shock button 59 Instructor Guide 6 Q CPR with CPR meter Lesson Introduction Introduce the lesson including the learning objectives estimated time to complete and applicable resources This lesson describes how to set up and use the Q CPR option with CPR meter available on the HeartStart MRx Objectives Upon completion of this lesson students should be able to 1 Identify intended use and preparation for use related to Q CPR 2 Identify characteristics related to the CPR meter 3 Identify characteristics related to Q CPR in Manual Defib and AED Modes Time 15 20 minutes Accessories Recommended Pads CPR meter cable CPR meter CPR meter adhesive pads e Philips multifunction electrode pads Ambu bag Resusci Anne manikin to perform compressions only Note To perform and measure both compressions and ventilations the Resusci Anne SkillReporter manikin and Q CPR Trainer are required Clinical Resources Q CPRO Measurement and Feedback with CPR meter Application Note Note Q CPR is a registered trademark of Laerdal Medical 61 Lesson Presentation Overview Introduce the Q CPR option and its intended use e Q CPR offers real time measurement and corrective feedback on the rate depth and complete release of compressions v
163. ns alarms to their previous settings e Print initiates a continuous print out of the primary ECG and the waveform displayed in Wave Sector 2 on the 50mm printer either real time or with a 10 second delay depending on device configuration If the ECG waveform cascades into Wave Sector 2 the waveform in Wave Sector 3 prints out as the second wave A third waveform is printed if the 75mm printer is installed Pressing this button while printing is in progress stops the printing e Summary displays a menu from which you can print the current or most recent Event Summary report or Vital Signs Trending Report e Menu Select brings up the current menu or confirms a menu selection e Navigation display the current menu just like Menu Select button does move to the next or previous item in a list increase or decrease numbers or values in a sequence may be held down to accelerate through the available choices Defibrillation Controls Therapy Knob enables AED or selects an energy for Manual Mode defibrillation or cardioversion e Charge charges the defibrillator to the selected Manual Defib energy setting Used only in Manual Mode Defibrillator charges automatically in AED Mode e Shock delivers a shock through multifunction electrode pads or switchless internal paddles In AED Mode a 150J shock is delivered In Manual Mode the shock is delivered at the selected energy setting When external paddles or switched internal paddl
164. ns when you change a limit Disable an alarm Respond to an alarm Additional points notes 129 Wedge Briefly mention the pulmonary artery wedge procedure as appropriate Perform a pulmonary artery wedge procedure according to your hospital protocol e The wedge numeric will not be stored in the Vital Signs Trending Note the following e For Pulmonary Artery Wedge Pressure PAWP readings due to a measurement delay do not use Microstream sidestream CO as a direct reference for determining the end expiratory point in the pressure curve e Ifthe 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 Additional points notes Pulse Discuss MRx s ability to provide pulse readings in relation to the Invasive Pressures option To discuss how pulse works with SpO only refer to the Pulse Oximetry lesson If the MRx you are instructing on has SpO and Invasive Pressures options discuss the following Pulse Sources topic Pulse Sources e When both SpO and Invasive Pressures options are present on the MRx pulse is derived from an SpO pleth wave or one of the two invasive pressure waves in Monitor Pacing and Manual Defib modes The pulse reading is displayed in the color of its source e g if your pl
165. nsmission with a single button press for when the cellular signal is stronger Follow instructions provided with your cell phone as appropriate Emphasize this point Many institutions prohibit the use of cell phones on their premises Please abide by local rules and regulations e When transmitting periodic clinical data 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 e The MRx transmits data from internal memory only Data contained on the external data card only is not transmittable Modifying Reference IDs Demonstrate how to change the Reference ID of an MRx during an event 1 Press the Menu Select button 2 Use the Navigation buttons to highlight Other and press Menu Select 3 Highlight Reference IDs and press Menu Select 4 Select the Reference ID you want to use or Other to add an additional Reference ID If you select a reference ID it becomes the Reference ID for the current event becomes part of the event summary and appears in the upper left corner of the MRx display This setting remains persistent even if you turn off the MRx and will remain until you change it to a different ID If you select Other the MRx prompts you to create a new Re
166. nstalled in the healthcare facility e 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 Below are device prerequisites for the option to work For further information see the IntelliVue M3150 Information Center Instructions for Use Table 2 Device Location prerequisites The device must have software Version 9 xx or Version Exx 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 Network Settings This topic is optional to discuss pending interest and or responsibility of end users to monitor the network settings To view current network settings in Monitor Pacer and Manual Defib modes 1 Press the Menu Select button 2 Using the Navigation buttons select Other and press Menu Select 3 Select Network Settings and press Menu Select Suggestion Have students complete the above steps and review the network setting parameters in the following table as appropriate 162 Table 3 Network Settings Parameters Connection Displays cu
167. nt Healthcare Information PHI or patient identifiable data This information can be printed or transferred from the HeartStart MRx and should be handled in accordance with HIPAA or local patient privacy requirements Practice Exercise 4 Have students complete a transmission in Data Management Mode for a single Event Summary all summaries or a single 12 Lead Report as appropriate Ask them to point out what display changes they see when completing each transmission procedure 198 Additional points notes Batch LAN Data Transfer Optional Optional topic This topic is for students who use Batch LAN Data Transfer technology to transmit MRx data Define Batch LAN Data Transfer Batch LAN Data Transfer BLDT enables you to download either a single Event Summary or all Event Summaries being deleted from the MRx on the Internal Data Card to an external personal computer running Data Messenger software for further review and archiving Data Messenger software communicates with the MRx to download Event Summaries monitoring an inbox and either storing files locally for an ePCR or forwarding them as Event Review Pro files to a remote computer The Event Review Pro software can then automatically import the cases into the Event Review Pro database Note the following You can perform wireless BLDT via Wireless Link BLDT is not available on MRxs with the IntelliVue Networking Option Setting Up for Batch LAN Data Tran
168. ntroduce the lesson including the learning objectives estimated time to complete and applicable resources This lesson describes the HeartStart MRx s IntelliVue Networking Option Objectives Upon completion of this lesson students should be able to 1 Identify IntelliVue Networking display data 2 Identify how to connect the MRx to the IntelliVue Network 3 Admit discharge and transfer patients to or from the Philips IntelliVue Information Center 4 Share information and data with the Information Center Time 10 20 minutes Accessories Required e Access to the Philips IntelliVue Information Center or IntelliVue Information Center iX System PIIC iX A 01 and later e Connectivity to the Philips IntelliVue M3185 Clinical Network System L and later e IntelliVue Network LAN cable and or Philips Instrument Telemetry 1 4 GHz radio and A C module Note Given the above requirements it may not be easy to teach this option Consider teaching on a nursing unit when the MRx can be tuned into an available wave sector on the Information Center Technical Resources e IntelliVue M3150 Information Center Instructions for Use e HeartStart MRx Instructions for Use See the IntelliVue Networking Problems table in the Troubleshooting chapter for problems and solutions associated with the IntelliVue Networking option e HeartStart MRx and Intellivue iX addendum to the HeartStart MRx Instructions for Use 159 e HeartStart M
169. ntroduction Introduce the lesson including the learning objectives estimated time to complete and applicable resources This lesson describes how to monitor invasive pressures using the HeartStart MRx Objectives Upon completion of this lesson students should be able to 1 Set up a pressure measurement 2 Select a pressure to monitor 3 Zero the pressure transducer 4 Set pressure alarms and view related settings 5 Identify how pulse works with the Invasive Pressures option Time 10 20 minutes Accessories Recommended e Simulator e g Dalel4 multiparameter simulator p n 2249138 from Dale Technology e Invasive pressure cables connecting the simulator to the MRx Clinical Resources e Cardiovascular Hemodynamics course found on Philips Online Learning Center 121 Lesson Presentation Overview Pressure 122 Introduce the Invasive Pressures option associated with the MRx Briefly illustrate the points below or wait until the appropriate topic presentation e Two channels of real time continuous invasive pressure measurements and waveforms are available in Monitor Manual Defib and Pacer Modes e Systolic diastolic and mean pressure values display for pulsatile pressure signals Only the mean value displays for non pulsatile pressure signals e Alarms alert you to a change in the patient s condition Measurement Set up Explain or if possible and applicable demonstrate how to set up approp
170. nutes Accessories Recommended Simulator Hands free cable Multifunction electrode pads 3 5 or 10 Lead monitoring ECG Optional Pacing SpO CO NBB invasive pressure temperature and or Q CPR parameter accessories Lesson Presentation Overview Describe the high level features of the MRx e It is designed for a variety of needs e It has controls indicators and menus organized to facilitate ease of use e It displays information specific to the current task Basic Orientation Introduce the physical features controls and indicators on the front left right top and back panels of the MRx Also discuss the lithium ion battery Suggestion Have students identify the features controls and indicators on their devices and the battery while following your orientation NOTE Consider not turning on the MRx during your initial orientation so students focus on each panel and NOT the display Then turn on the device to illustrate display output of features and controls Front Panel Controls and indicators on the front panel are organized by function with the most 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 Therapy Knob Serves as the MRx power switch and can be set to e AED to enable AED Mode for semi automated external defibrillation and optional Q CPR parameter Off e Moni
171. o Not Admitted and patient type category paced status and alarm limits are reset to their default settings If the patient is still admitted at the Information Center the MRx is updated with patient information from the Information Center The ADT state is reset to admitted Note the following Be sure the MRx is not connected to a patient while in a non clinical mode Events Logged The 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 3 lists IntelliVue Networking related events and information stored in the Event Summary 170 Table 5 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
172. o the MRx Q CPR compression waveform automatically populates Wave Sector 3 on 150J Manual Defib Mode setting e If parameter source is the configured choice of a particular wave sector it is displayed in that sector e Ifyou connect a parameter source that is not configured to be displayed it displays 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 e Displayed lead source is controlled by the Displayed Waves menu e Wave Sectors 2 and 4 may contain a cascaded ECG Parameter Blocks e Provide measurements for displayed waveforms and monitored parameters The position of most parameters are in fixed locations depending upon the options which were included in your HeartStart MRx e Block 1 always contains heart rate and HR alarm settings may display Pulse Temp and NBP schedule measurements and alarm settings 14 e Block 2 may contain Invasive Pressures SpO EtCO and Airway Respiration Rate AwRR measurements and related high low alarm limit settings is displayed until a valid measurement is obtained settings may contain the Alarms Off icon Block 2 may also contain Q CPR compression and ventilation values e Invasive Pressures Temp SpO and EtCO measurements are activated when associated cable tubing is connected if a ca
173. ode Pads 1 Check the expiration date on the pads package and inspect the packaging for any damage 2 Prepare the patient s chest 3 Apply the pads to the patient as directed on the pads package using the anterior anterior placement DEMONSTRATE if manikin available 4 Connect the pads to the Pads CPR cable DEMONSTRATE Suggestion Have students complete steps 3 if a manikin is available and 4 Note the following e The ventilation algorithm used by Q CPR requires an anterior anterior pads placement Anterior posterior pad placement should not be used e Pads need to be applied securely and maintain good contact to ensure a good signal for ventilation detection The inop message Poor Pads Contact or Pads Off displays if there is a contact problem Compression Sensor 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 the green liner away from the Compression Sensor Adhesive Pad using the yellow pull tab on the top liner DEMONSTRATE 3 Position the Compression Sensor on the patient as shown in the graphic displayed on the green liner The proper location is on the lower half of the sternum which is at the normal CPR hand location DEMONSTRATE Note If you use a manikin for demonstration purposes place the compression sensor on the manikin so that the side of the sensor with the cable connection is facing toward the manikin s chin 4 When the C
174. ompression Sensor is on the patient s chest the flat grey surface should be facing up Place the heel of your hand on the flat grey surface in the same way that you would position your hand on the patient s chest if performing CPR without the Compression Sensor Perform compressions according to AHA ERC guidelines DEMONSTRATE with shallow simulated compressions if on a person and full compressions if on a manikin Suggestion Have students complete steps 2 4 Note the following e Do not apply the Compression Sensor to an open wound or recent incision site e CPR is best performed when the patient is lying on a firm surface If the patient is on a compliant surface such as a mattress the patient should be placed on a backboard e The accuracy of ventilation feedback 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 e Unless you have a special simulator for a manikin ventilation feedback is not available 76 Practice Exercise 1 Have students make all cable attachments and then detach a cable e g Pads CPR or Compression Sensor cable to see what inop is produced For example the message Connect Pads CPR Cable displays if not pre connected Loosen a multifunction pad to see what inop is produced e g Poor Pads Contact or Pads Off Make sure students attach the Compression Sensor pad pr
175. on from the MRx and Central has been merged message appears on the display for 10 seconds To confirm the information press Menu Select To edit patient info highlight Edit Patient Info and press Menu Select to display the Edit Patient Info menu Any selection from this menu brings up a screen for modifying the selection After modifying the information and closing the selection the Patient Information merged menu reappears with the new patient information included The Information Center is also updated with the modified information Note the following The Patient Merged and Edit Patient Info menus are removed from the screen when you change displayed views e Ifthe HeartStart MRx is connected to the PIIC iX and the PIIC iX can determine the likely outcome of the conflict you receive a Smart Question where your answers help resolve the conflict If the PIIC iX cannot determine the likely resolution or if you answer No to the Smart Question the Conflict Resolution screen is presented You have as many as four options to resolve the conflict Once you make a conflict resolution selection you confirm it and make appropriate patient demographic changes Viewing Patient Incident Data e While at the Information Center you can view patient incident data sent from the MRx Refer to the IntelliVue M3150 Information Center Instructions for Use for details e Up to 30 single valued and or tripled valued parameters up to four waveform
176. on Implementation Guide and HeartStart Data Management Solutions Implementation Guide e Data transmission using Wireless Link is easy by connecting the Wireless Link device to MRx s RS 232 serial and LAN ports respectively e Check the various indicator lights located on the side of the Wireless Link device especially when the device boots up if you need to troubleshoot any data transmission Figure 3 Wireless Link Indicators Cell Signal Indicator ____ Sq WiFi Signal Indicator OL lt Power Indicator Run Indicator pe Ethernet Indicator Indicator On Solid Light Off No Light Flashing Fast Flashing Slow Cellular Network Connected Ready for Cellular option is Searching for No cellular or data transfer powered off subscribed cellular subscribed network network to connect WiFi Network Connected strong signal WiFi option Connected fair Connected weak powered off or no signal signal connection Ethernet Connected to the Not connected to Data transfer in Wireless Link HeartStart MRx the HeartStart progress signalling MRx or in Sleep HeartStart MRx Mode Run Wireless Link in Bridge In Sleep Mode Wireless Link is in Access Point Mode or Router Mode Power Wireless Link powered on Wireless Link off Note the following Depending on your particular configuration some of these lights may or may not be applicable to your transmission Talk with your IT
177. ons must apply The patient must have perfusion in that extremity The light emitter and the photodetector must be directly opposite each other All of the light from the emitter must pass through the patients tissue The sensor site should be free of vibration and excessive motion Power cables should be kept away from the sensor cable and connector e You can monitor SpO in Monitor Manual Defib or Pacer Modes on the MRx When using the Q CPR option SpO monitoring functionality is not available Selecting a Sensor Discuss the criteria for selecting a sensor e 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 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 96 e Reusable sensors may be reused on different patients after they have been cleaned and disinfected See the manufacturer s instructions supplied with the sensor e 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 These sensors must not be reused on different patients Applying the Sensor
178. operly and the Compression Sensor is placed properly on the patient or manikin Additional points notes 77 Q CPR in Manual Defib Mode Demonstrate Q CPR in manual defibrillation mode with a simulator set to VF VFib 1 Turn the Therapy Knob to Manual Defib and select the 150J energy setting to automatically display the Q CPR sub view Note the following The Sync function must be disabled the patient category must be Adult and patient age must be equal to or greater than 8 years old to automatically display the Q CPR sub view e If Manual Therapy Security is enabled the CPR sub view is not automatically displayed The CPR sub view is automatically displayed after the Manual Therapy Security password is entered e When the Therapy Knob is set on any other Manual Defib setting patient category is Adult and patient age is equal to or greater than 8 years old the first CPR compression displays the Q CPR sub view Mention the following Manual Defib Q CPR view characteristics while performing CPR preferably on a manikin Consider enlisting two students to perform compressions and ventilations so that you can focus on discussion of the characteristics e 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 Parame
179. or adjust the value Mention all the available pressure labels listed in the following table 123 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 Important notice to students 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 Note the following as appropriate 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 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 Pressure Waves Demonstrate how to adjust a pressure wave scale Each pressure label has a set o
180. ord and press Menu Select 6 Press the Exit Return To soft key Additional points notes Audio Recording Discuss characteristics of the Audio Recording option e Configured to On by default can only be turned off in Configuration Mode e Up to 90 minutes of audio can be recorded in all clinical modes Manual Defib Pacing 12 Lead Monitor and AED e Need to be within five feet of the MRx three feet if the printer and CO are running for a quality voice recording e To review recorded audio transmit your Event Summary from the MRx to a receiving personal computer running Event Review Pro software 20 Carrying Case and Accessory Pouch Assembly This topic should be covered for only customers who have carrying cases and accessory pouches as appropriate Discuss the following procedures for carrying case 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 four 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 b Remove the two T 15 screws c Remove the handle
181. ors 3 and 4 and includes the following information if configured Measurements standard interval and duration measurements in milliseconds limb lead axis measurements in degrees and heart rate in beats per minute Interpretive statements describe the patient s cardiac rhythm and waveform morphology as well as signal quality problems encountered during ECG acquisition See the Critical Values section in the 12 Lead ECG chapter of the MRx Instruction for Use for lists of all interpretive statements Critical Value statements identify an interpretation that may prompt immediate patient care i e for any of four life threatening conditions acute myocardial infarction acute ischemia complete heart block and extreme tachycardia Acute MI Acute Ischemia Complete Heart Block or Very High Heart Rate appear as white text on a red background ECG severity Associated with each interpretive statement categories of severity are No Severity Normal ECG Otherwise Normal ECG Borderline ECG Abnormal ECG and Defective ECG Probability of acute ischemia a predicted probability score of acute cardiac ischemia if the ACI TIPI and TPI option is configured for use 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 Th
182. ose times DM Py D What happens to Q CPR when you press the Sync and or Alarm Pause buttons Additional points notes 80 A A Q CPR in AED Mode Demonstrate Q CPR in AED mode Turn the Therapy Knob to AED press the Pause for CPR soft key and mention the following AED Q CPR view characteristics while performing CPR Consider enlisting two students to perform compressions and ventilations so that you can focus on discussion of Q CPR characteristics In AED Mode Q CPR provides CPR feedback automatically during the CPR Pause period of the AED protocol or manually when the Pause for CPR soft key is pressed e Ifyour 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 Compression Sensor AED Mode issues voice prompts like Manual Defib Mode however it also displays the same prompts as momentary text messages For details on all Manual Defib and AED Mode feedback prompts refer to the CPR Feedback Prompts section of the Q CPR Instructions for Use Addendum e 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 e The Q CPR view in AED Mode displays only the ECG waveform There is no compression waveform Suggestion Ask students to help point out characteristics instead of YOU stating them all Practice Exercise 3 Ha
183. ot take the device out of use and call for service Note the following Detach the test load from the patient Therapy cable after performing the shock test and reattach the preconnected pads if they are used 208 Operational Check Discuss Op Check characteristics e The Op Check should be performed at regular intervals to supplement Automated Tests e The Op Check checks for electrical shorts on therapy and ECG cables and verifies paddles audio the Charge and Shock buttons Therapy Knob and CPR meter or Compression Sensor along with replicating the Weekly test e The Op Check notifies you if the battery NBP module or CO2 module needs calibration e The Op Check should be run with a battery installed to reflect optimal operating conditions for defibrillation e The user should test each type of patient therapy cable used multifunction electrode pads or paddles e If the MRx is equipped with multifunction defib pads only and does not have a paddle tray you cannot test paddles during an Op Check To test the paddles you must have a test load Run the Weekly Shock Test delivering the shock into the test load Ensure paddles if tested are secure in their pockets prior to performing the check e Ifthe MRx has the Pacing option test external paddles using the Weekly Shock test You must run Operational Check with a pads cable in order to pass the Pacer test e Ifthe device has the Q CPR option you should run the Operation
184. oth enabled computer or Wireless Link and Data Messenger running on the PC set up for BLDT to transmit data A LAN cable connecting the device to your computer or Wireless Link PC will need Data Messenger with BLDT setup and be on the same network 1 Windows based personal computer laptop tablet mobile device with a Bluetooth stack installed that supports File Transfer Profile Server 195 Transmitting in Data Management Mode Discuss the methods data can be transmitted from MRx s Data Management Mode e From Data Management Mode you can send an Event Summary complete or partial or a 12 Lead Report to a receiving Bluetooth device send an Event Summary or a 12 Lead Report via Wireless Link to a receiving PC running Data Messenger transmit 12 Lead Reports via the Rosetta Lt transmission device download a single Event Summary or all Event Summaries on the internal data card via the Batch LAN Data Transfer option e Transmitted Event Summaries include all stored waves trending data 12 Lead Reports and event files and can include audio and or Q CPR data if the MRx has these options and you choose to send it Demonstrate how to transmit an Event Summary or 12 Lead Report from internal memory to a receiving device via Bluetooth FTP 1 Press the Menu Select button 2 Using the Navigation buttons select Other and press Menu Select Note Using T 00 software on the MRx M3536A you can acce
185. oting chapter for the action to take If needed run an Operational Check for further information If the condition persists take the device out of use and call for service Solid red X without a No power or device failure Insert a charged battery or connect to periodic chirp cannot turn on AC DC power If the condition persists take the device out of use and call for service Additional points notes Shift Check Introduce the shift check e The American Heart Association AHA recommends completion of a checklist shift check at the beginning of each change in personnel to ensure that defibrillators are ready when needed Philips supports the AHA checklist recommendations and has shipped a Shift Checklist document with the MRx e Checklist activities include Defibrillator Inspection Ensure the MRx is clean clear of objects and has no visible signs of damage Check RFU Indicator status Cables Connectors Paddles Pads Monitoring Electrodes Check for cracks broken wires or other visible signs of damage as well as secure connections Check expiration date and quantity of pads and monitoring electrodes Batteries Keep a charged battery in the MRx and another on hand or charging Check for visible signs of damage AC DC Power Check the AC DC power source verify that the external power indicator on the front panel is lit Printer Paper Check for sufficient paper
186. ove 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 INOR and at end of INOP M Pause Missed Beat No QRS at beginning of Above the waveform where the condition is asystole detected To display an annotated ECG 1 Press Menu Select Select Displayed Waves and press Menu Select Select Wave 2 and press Menu Select Select Annotated ECG and press Menu Select a YN Practice Exercise 4 Have students display an annotated ECG Pose the following question 1 Where does the annotation first appear Additional points notes Arrhythmia Learning Relearning Discuss and demonstrate how the MRx learns and relearns automatically and manually e To ensure the ST AR Algorithm can properly analyze the patient s normal and or paced complexes MRx automatically performs arrhythmia learning relearning when the Therapy Knob is turned to Monitor Pacer or Manual Defib when there is a change in the lead selection for Wave Sector 1 after the correction of a Leads or Pads Off INOP condition that has been active longer than 60 seconds e Initiate manual relearning if beat detection is not occurring or if beat classification is incorrect and results in a false alarm To initiate relearning manually 1 Press Menu Select 2 Select Measurements Alarms and pr
187. own Patient weight 50 450 Lbs unknown 25 225 kg If 0 7 hours is selected a second menu appears asking you to select the number of minutes in 15 minute increments Press Menu Select to view possible values for the first highlighted topic 4 Select and complete all inputs and press the Run TPI softkey 5 Select any thrombolytic therapy contraindications from a pre configured list based on speaking with and observing the patient Note the following You can pre configure up to 20 thrombolytic therapy 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 146 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 softkey sets all contraindications on that pa
188. played e Audio recording icon If the option is enabled an audio recording icon displays to the left of the battery icons in all clinical modes to indicate the audio recording status e Network Connectivity icon If the option is enabled a network connectivity icon displays to the right of the INOP statements e Patient type All modes except AED permit patient information entry via a menu choice The patient category is either Adult or Pedi If no information is entered the category defaults to Adult unless configured otherwise The category is important because it influences alarms limits and algorithm calculations The paced status is either Non Paced or Paced Non Paced is the default unless the status has been previously set to Paced for an internally paced patient or the MRx is pacing the patient Pacemaker beats optimize ST AR algorithm calculations In Pacer Mode Paced status is not displayed e Patient name If entered the patients name will appear above the patient type and paced status e Bed Equipment label The 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 e Inop statements appear in top left of display if equipment problems occur e ECG HR alarm status alarm messages communicate arrhythmia alarms as well as overall alarm status alarms off alarms paused 13 Event Timer co
189. primary lead with the Lead Select button Change leads through the Displayed Waves menu The first valid ECG source acquired displays in Wave Sector 1 it is replaced by the configured primary lead as soon as it is acquired The ECG lead source in Wave Sector 1 determines heart rate and monitor arrhythmia Suggestion Ask students to point out characteristics instead of YOU stating them Note the following for the HeartStart MRx M3536A using R 02 software and later which features automatic lead switching behavior In Monitor mode you can configure the MRx to switch sources for the waveform in Wave Sector 1 The switch is made to a new source with a good signal also called Target ECG when the current signal becomes unavailable Additional points notes 28 Preparation Discuss monitoring preparation using multifunction electrode pads or electrodes Multifunction electrode pads 1 Prepare the patient s chest i e remove clothing remove moisture from chest and remove excessive hair 2 Apply multifunction electrode pads to the patient according to the pads package directions or your organization s protocol 3 If not pre connected insert the pads cable into the green Therapy port DEMONSTRATE 4 Connect the pads to the pads cable DEMONSTRATE Suggestion Have students complete steps 4 and 5 Electrodes 1 Prepare the patient s skin at the appropriate electrode sites If necessary clip hai
190. professional to find out which lights you should be concerned about and if you experience problems transmitting data See the Planning your solution section in the Data Management Solutions Implementation Guide for more information on use models 188 Transmitting in 12 Lead Mode Discuss the methods 12 Lead Reports can be transmitted from the MRx e Transmit 12 Lead Reports while monitoring a patient in 12 Lead Mode to printers fax machines PDAs Philips TraceMaster ECG Management System or other servers running Philips data viewing server software e Using Bluetooth transmission reports are transmitted to the hub a web server running Philips 12 Lead Transfer Station or Telemedicine Server software using configured wireless devices such as cell phones handheld devices and other external devices like computers laptops and other mobile devices e Using the Wireless Link option reports are wirelessly transmitted to Philips Telemedicine System via a cellular broadband connection or via a wireless access point using WiFi e Using the Rosetta Lt available in the U S only reports are transmitted via two way radio transmission to a healthcare facility running CAREpoint or Rosetta Rx e Using RS 232 transmission reports are 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 r
191. pulseless If not pre connected insert the paddles cable into the green Therapy port DEMONSTRATE Remove the paddles from the paddle tray Verify there is no debris or residue including dried electrode gel on the paddle surfaces Clean if necessary DEMONSTRATE Apply the paddles to the patient s bare chest using the anterior anterior placement or your organization s protocol Suggestion In your demonstration mention the patient contact indicator PCI on the sternum paddle and how once proper contact is made the PCI shows a green LED Also include access to the pediatric paddles Have students complete steps 2 and 3 Consider discussing impedance related to patient preparation and pads and paddles placement and its impact on delivering an effective shock 53 e 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 e 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 pad
192. r at the electrode sites or shave sites if needed Clean and abrade the skin at each electrode site Dry the electrode sites briskly to increase capillary blood flow in the tissues and to remove oil and skin cells 2 Attach the snaps to the electrodes 3 Apply the electrodes Note Review typical electrode placement for a 3 5 and 10 Lead ECG set and lead selection for an accurate QRS complex detection as appropriate Also point out the use of lead sets approved for use with the MRx 4 Ifnot pre connected connect the ECG patient cable DEMONSTRATE Suggestion Have students complete step 4 Additional points notes 29 Lead Choices Review the choice of leads available for 3 5 and 10 Lead ECG sets if connected to the MRx a 3 Lead ECG set I I II One a 5 Lead ECG set I II III aVR aVL aVF V Four a 10 Lead ECG set I II III aVR aVL aVF V1 V6 Four Lead Selection Discuss the guidelines for lead selection e Select a suitable lead for monitoring so that a QRS complex can be accurately detected e For non paced patients the QRS complex should be tall and narrow recommended amplitude gt 0 5mV R wave should be above or below the baseline but not biphasic P wave should be smaller than 1 5 R wave height T wave should be smaller than 1 3 R wave height e For paced patients with internal transvenous pacemakers in addition to the above the pac
193. r cable to the MRx the sensor to yourself and demonstrate preparation for monitor SpO gt 1 Connect the appropriate sensor cable to the MRx 2 Apply the sensor to the patient If a finger sensor is used the cable should come down the back of the hand 3 Turn the Therapy Knob to Monitor Suggestion Have students complete the above steps during or after your demonstration Discuss SpO display characteristics e A 2 displays in Parameter Block 2 while oxygen saturation is initially measured and an SpO value is calculated a value replaces and is updated continuously as the patient s oxygen saturation changes e Alarm limits display to the right of the value if SpO alarms are turned on alarms are on by default e The Alarms Off symbol displays if SpO alarms are turned off e The patients pulse rate derived from pulse oximetry is displayed in Parameter Block 1 e Alarm limits display to the right of the pulse rate value if pulse rate alarms are turned on alarms are off by default e The Alarms Off symbol displays if pulse rate alarms are turned off Suggestion Ask students to point out characteristics instead of YOU stating them Additional points notes 98 Pleth Wave Mention the following characteristics associated with the pleth wave e The wave displays in the configured Wave Sector if available otherwise the wave fills the first available empty Wave Sector e The wav
194. r than the selected pacing rate Use this mode whenever possible e MRx requires a 3 5 or 10 Lead ECG cable and monitoring electrodes as the ECG source while pace pulses are delivered through pads Use only shielded lead sets when pacing with the MRx to prevent or minimize noise that may result in intermittent leads off messages e Pads is not displayed in Wave Sector 1 The monitored lead is displayed in Wave Sector 1 Fixed mode e Pace pulses are delivered at the selected rate Use when motion artifact or other ECG noise makes R wave detection unreliable or when monitoring electrodes are not available Note the following The ECG derived from pads need not be displayed in a wave sector to deliver pacing therapy Additional points notes 88 Preparation Demonstrate preparation for pacing 1 Prepare the patient s chest Wipe moisture away and if necessary clip or shave excessive chest hair 2 Apply multifunction electrode pads to the patient as directed on the pads packaging or according to your organization s protocol 3 If not pre connected connect the pads cable to the green Therapy port on the MRx DEMONSTRATE 4 Connect the pads connector to the pads cable DEMONSTRATE 5 Ifpacing in demand mode apply monitoring electrodes and connect the ECG cable to the ECG port on the MRx DEMONSTRATE the ECG cable connection Note the following If pacing for long periods of time check the patient
195. racteristics latching and INOP messages as follows e Alarm conditions are detected by comparing ECG data to a set of pre defined criteria e Alarms are triggered by rate exceeding threshold abnormal rhythm or ectopic event e Alarm messages appear in the alarm status area located just above the HR numeric accompanied by both audible and visual alert signals e Multiple alarm conditions are possible the most serious or highest priority alarm condition takes priority i e is announced first and overrides lower priority alarms e g extreme BRADY over low HR e 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 Arrhythmia Alarm Latching Review the arrhythmia alarm categories e Latching alarms are announced and remain present regardless of whether the alarm condition still exists until either acknowledged or a higher priority condition occurs e Non latching alarms are automatically removed when a condition no longer exists 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
196. required by the ACI TIPI algorithm a blood pressure b history of hypertension c history of diabetes d chest pain symptoms 5 Which of the following statement s are TRUE regarding the 12 Lead Report a It displays standard interval and duration measurements as well as interpretive statements on waveform morphology b It can be configured to include ALL 12 leads and related measurements c Its printout can include on screen data and up to two rhythm strips F It can include up to three rhythm strips d An alarm strip is printed when an alarm condition occurs during printing F An alarm strip is not printed though the ECG waveform in question is available in the Event Summary 151 152 Instructor Guide 15 Vital Signs Trending Lesson Introduction Introduce the lesson including the learning objective and estimated time to complete This lesson describes the HeartStart MRx Vital Signs Trending and related report data Objectives Upon completion of this lesson students should be able to 1 Identify data and functionality of the Vital Signs Trending Report Time 5 10 minutes Accessories Recommended e Simulator e Option monitoring cables to produce trending data e g for invasive pressures EtCO SpO etc NOTE It is recommended that you have the monitor on for at least 10 15 minutes to create enough trending data for instructional purposes 153 Lesson Presentation Overview Int
197. reshold results appear as white text on a red background e Stored and printed reports can be configured to include all 12 leads waveforms measurements and interpretive analysis statements ACI TIPI analysis results TPI analysis results and TPI contraindication e One or two copies of the report are printed at the completion of acquisition and or analysis as configured use the Print soft key to print another copy e The printed report includes on screen data and up to three rhythm strips with the configured leads e Ifan alarm condition occurs during printing an alarm strip is not printed however the corresponding ECG waveform is stored and available in the Event Summary e Do not pull on the paper while a report is printing waveform distortion may occur leading to potential misdiagnosis Accessing Stored Reports Demonstrate how to access stored reports to print additional copies or delete them from internal storage and or copy a report to a data card The list of stored reports for the current patient event 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 Mode press the Menu Select button 2 Use the Navigation buttons to select Reports 3 Reports for the current patient event are listed by date time and sequence number 4 Use the Navigation buttons to select a report and press Menu Select 5 Select Print Copy
198. riate medical equipment i e pressure cable transducer flush solution and catheter to display a pressure measurement on the MRx Alternatively have a simulator and appropriate invasive pressure cable s set up 1 Turn the HeartStart MRx to Monitor 2 Connect the pressure cable to the MRx The MRx performs a check of invasive pressure functionality when the MRx is turned on 3 Connect the pressure cable to the transducer 4 Prepare the flush solution 5 Flush the system to expel air from the tubing Make sure the stopcocks and transducer are also free of air bubbles Note the following If air bubbles appear in the tubing system flush the system with infusion solution again otherwise air bubbles may lead to an incorrect reading 6 Connect the pressure line to the patient catheter 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 and then begin the infusion Position the transducer so that it is level with the heart approximately at the level of the midaxillary line Note the following If measuring intracranial pressure ICP with a sitting patient level the transducer with the top of the patient s ear otherwise incorrect leveling may lead to an incorrect reading Suggestion Ask students to describe any issues they have with setting up equipment to measure invasive pressures and how t
199. ring Lesson Introduction Introduce the lesson including the learning objectives estimated time to complete and applicable resources This lesson describes how to use the HeartStart MRx to monitor Pulse Oximetry SpO Objectives Upon completion of this lesson students should be able to 1 Monitor SpO 2 Set SpO and pulse rate alarms Time 10 15 minutes Accessories Recommended e SpO sensor Clinical Resources e Philips Pulse Oximetry Application Note 95 Lesson Presentation Overview Discuss pulse oximetry respective to its use with the MRx e Pulse oximetry is a noninvasive method of continuously measuring oxygen saturation SpO in arterial blood SpO reading indicates percentage of hemoglobin molecules in the arterial blood saturated with oxygen e A pulse oximetry sensor sends light through patient tissue to a receiver on the other side of the sensor Light emitting diodes transmit red and infrared light through peripheral areas of the body such as a finger Light Emmitting Diodes 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 e For accurate SpO measurements the following conditi
200. roduce the MRx s Vital Signs Trending e The MRx lets you view and print numeric vital sign trending for the current incident in Monitor Mode Trending data are automatically acquired if parameters are on Trending data are presented at the selected interval The newest data appear in the far right column when trending is initially displayed The oldest measurements are deleted as needed to store the newest measurements Reviewing Trending Data Demonstrate how to review trending data and discuss Vital Signs Trending Report data and related functionality Set the trend interval to 1 minute to display a more populated report Suggestion Have students complete the steps below and follow your discussion while viewing the Trending Report 1 Turn the Therapy Knob to Monitor 2 Press the Menu Select button 3 Using the Navigation buttons select Trends and press Menu Select The Vital Signs Trending Report displays covering the bottom two wave sectors and the existing soft key functions The report includes Report date which is determined by the earliest time displayed in the table Parameter vital signs monitored by the MRx during the displayed time period Time intervals for vital signs Trending data without related units of measure e The latest most recent trending data appears in the far right column when the Trending Report first displays The display automatically updates as new vital sign dat
201. rrent connection status Wired Wireless or Inactive MAC Address HeartStart MRx MAC address MAC Instr Tele Instrument Telemetry Radio Module MAC address RF Access Code Used to identify which RF channel the HeartStart MRx Information Center communications use Set in Configuration Mode IP Address Current IP address HeartStart MRx wired or Radio Module wireless Server IP Information Center IP address Subnet Mask Subnet mask of wired or wireless network RSSI Instrument Telemetry Radio s Received Signal Strength Indicator Value updates while window is open Note the following as appropriate When the Information Center rejects a connection attempt from the MRx a momentary message displays on the MRx accompanied by an audio beep For a list of the messages possible causes and possible solutions see the Network Connection Rejection Messages section in the Troubleshooting chapter of the MRx Instructions for Use Additional points notes 163 Patient Admit Discharge and Transfer Introduce the admit discharge and transfer functions and then describe them in detail The MRx can admit discharge and transfer ADT patients to or from the Information Center and update or modify patient information It also accepts certain patient admission data entered at the Information Center including name medical record number patient ID patient type category date of birth
202. s 66 Q CPR in Manual Defib Mode Demonstrate Q CPR in manual defibrillation mode with a simulator set to VF VFib 1 Turn the Therapy Knob to Manual Defib and select the 150J energy setting to automatically display the Advanced CPR View Note the following e The Sync function must be disabled the patient category must be Adult and patient age must be equal to or greater than 8 years old to automatically display the Advanced CPR View If Manual Therapy Security is enabled the Advanced View is automatically displayed after the security password is entered e When the Therapy Knob is located on any other Manual Defib setting a compression on the CPR meter turns on the Advanced View This view is 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 action Mention the following Advanced View characteristics while performing CPR preferably on a manikin Consider enlisting two students to perform compressions and ventilations so that you can focus on discussion of the characteristics Advanced View can display the following parameters depending upon device configuration e Compression rate e CPR timer e No flow time e Compression counter EtCO numeric if available e Compression wave if an IBP arterial or Ventilation rate pulmonary arterial pressure wave is availabl
203. s If test fails the Ifthe 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 the Therapy cable and rerun failed with cable Operational Check Disconnect ther apy cable If the Pads Paddles test fails with to rerun test without a bl and without the cable refer to eure the MRx Instructions For Use Troubleshooting chapter for the action to take Battery A Checks the capacity and None None Battery B calibration status of the batteries in Compartments Aand B SpO Checks the internal SpO None None PCA The SpO cable is not tested NBP Checks to see ifthe 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 hardware is working properly Temperature Checks to see if the None None temperature hardware is working properly Bluetooth Checks for the presence of None None the Bluetooth card and database integrity Printer Runs a printer self test None None Operational Check Summary Demonstrate how to view the Operational Check Summary which lists the results from the last 60 Using the Navigation buttons select Other and press Menu Select Op Checks 1 Turn the Therapy
204. s except for Q CPR and up to seven alarms are viewable at the Information Center The waveforms that appear at the Information Center are determined by the Information Center s wave wish list Alarms e If configured you can silence reset most MRx alarms and INOPs from the Information Center Refer to the IntelliVue M3150 Information Center Instructions for Use for details As they do on the MRx alarms re sound after two minutes if the condition is not cleared The HeartStart MRx Instructions for Use has a complete list of MRx alarms to refer to 169 e Pacing Stopped Batteries Low and Defib Shutdown alarms result in Red INOPs that cannot be silenced at the Information Center The Pacer Output Low alarm results in a Yellow INOP that cannot be silenced at the Information Center All four alarms must be silenced at the MRx Suggestion Have students create a Pacing Stopped alarm by pulling a lead off the simulator to see what is displayed at the Information Center Printing e When the MRx prints data and information it prints to the installed 50mm or 75mm printer not to a printer located on the institution s network e Alarm recordings are configured at the MRx and sent to the Information Center central recorder if present You can then control what is recorded on the Information Center recorder from the Record Store tab under All Controls e Vital Signs Trending Reports generated by the MRx can only be printed at the MRx
205. s Alarms and press Menu Select 3 Select the pressure label channel label you wish to modify alarm status on and press Menu Select 4 Select Alarms On or Alarms Off and press Menu Select Viewing Changing Setting Source for Alarms Demonstrate how to view or change alarm settings for a given pressure label 1 2 3 CPP Alarms Press the Menu Select button Using the Navigation buttons select Measurements Alarms and press Menu Select Select the pressure label channel label you wish to view modify alarms on and press Menu Select Select pressure label Limits and press Menu Select If the pressure label is pulsatile select the desired source of the alarm Systolic Diastolic or Mean and press Menu Select Using the Navigation buttons increase or decrease the high limit and press Menu Select Set the new low limit and press Menu Select Mention the following unique CPP and ICP alarm characteristics 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 ICP alarms default to On CPP to Off The parameter with alarms off is displayed at the bottom of the ICP CPP parameter area with the Alarms Off symbol Both alarms can be turned off at the same time Practice Exercise 2 Have students change invasive pressure alarm limits and enable disable and respond to related alarms Pose the following questions 1 What happe
206. s as a measure of the patient s perfusion status When pacing is stopped due to a power interruption a red Pacing Stopped Power Interrupted alert will appear on the MRx display when power is eventually restored e For treatment of patients with implantable devices permanent pacemakers or cardioverter defibrillators consult a physician and the instructions for use provided by the device s manufacturer The use of Pacer Mode may be password protected as defined in Configuration 86 Pacing View Turn the Therapy Knob to Pacer on the MRx and introduce the unique Pacing View characteristics e A status block appears in Wave Sector 4 The first line communicates status active or paused or pacing by batteries if configured and the second line identifies the pacing mode demand or fixed pacing rate ppm and pacing output mA e Soft keys set the pacing status Start Pause Resume and adjust the pacer rate and output e White R wave markers appear on the ECG waveform until capture occurs if pacing in demand mode R wave markers do not appear on pace beats e White pacing markers appears on the Wave Sector 1 ECG waveform with each pacer pulse delivery Suggestion Ask students to point out characteristics instead of YOU stating them Additional points notes 87 Demand vs Fixed Mode Introduce demand and fixed mode pacing Demand mode e Pace pulses are delivered when the patients heart rate is lowe
207. s at the end of the charge e Monitoring alarms are indefinitely paused once energy is selected for defibrillation alarms are active once the Therapy Knob is moved to Monitor or Pacer or if the Alarm Pause button is pressed e Automatic NBP measurements are discontinued once energy is selected manual NBP measurement can be requested and displayed in its normal position on the display e Selected energy can be increased or decreased at any time during charging or after charging is complete the defibrillator charges to the selected energy level automatically Press Disarm to disarm the device if the Shock button is not pressed within the time period specified in the Time to Auto Disarm configuration setting the MRx disarms automatically e Do not leave patients unattended when the MRx is in Manual Defib Mode with pads applied to the patient Suggestion Ask students to help point out characteristics instead of YOU stating them all Practice Exercise 1 Have students attach a simulator and parameter accessories if appropriate to the MRx set the simulator to a shockable rhythm e g VF and complete manual defibrillation with 1 shock Try changing the energy level during and or after a charge Pose the following questions 1 What do you see and hear during a charge How do you know the device is ready to deliver a charge 2 3 What do you see and hear after delivering a shock 4 How do you know if alarms are active
208. s cable Internal Paddles 1 Select the appropriate switched or switchless paddle electrode size 2 Ifusing switchless paddles connect the paddles to the M4740A Paddle Adapter Cable DEMONSTRATE 3 Connect the paddles cable or the paddle adapter cable to the MRx DEMONSTRATE Additional points notes Manual Defibrillation Start with a brief demonstration of the manual defibrillation steps with a simulator set to VF VFib 1 Turn the Therapy Knob to Manual Defib and select an energy setting 2 Press the Charge button on the MRx or external paddle 3 Make sure no one is touching patient or anything connected to patient before shock call out loudly and clearly Stay Clear 4 Press the orange Shock button on the MRx or the buttons on both external paddles Mention the following Manual Mode characteristics during the demonstration e The energy range is 1 to 200J with 150J the recommended level for adult patients 50J is maximum energy for internal paddles e 1 10 or 1 9 energy setting displays the Select Energy menu with a default setting of 6J use the Navigation buttons to increase or decrease the desired setting and the Menu Select button to complete your selection 54 e The energy selection in the Shock Status area changes and a continuous low pitch charging tone sounds as the defibrillator charges e The current energy displays and a continuous high pitch charge done tone sound
209. s inhibiting indications of new alarm conditions A potential hazard exists if different 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 the following if you are using the HeartStart MRx M3536A using R 03 software and later You can configure the MRx to e Have HR Arrhythmia NBP EtCO AwRR SpO IBP P1 and P2 the currently selected Pulse source and Temp alarms to be on or off when the device first powers on e Power on with all alarms paused or active Suggestion Note that you will also cover alarm limits in detail in the ECG and Arrhythmia Monitoring lesson later in the training and students will be able to practice with alarm conditions at that time Device Identification Describe the ways to identify an MRx and the data transmitted from it e Set up an Institution Name and or Device ID in Configuration Mode Set up multiple Reference IDs which are selectable during a patient event Example A 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 e Fora MRx with the IntelliVue Network installed the Ref
210. sage in response to an alarm will you be alerted if the patient s condition persists or recurs Additional points notes Setting Alarms Introduce setting alarms e Alarms are automatically enabled in Monitor and Pacer Modes e In Manual Defib Mode alarms are automatically enabled if the Sync function is enabled If the Sync function is not enabled alarms are enabled using the Alarm Pause button e Alarms alert you when values exceed or fall below defined limits e Heart rate HR and VTACH alarm settings are as configured but may be changed during operation for the current patient e The PVC rate limit setting may only be changed in response to a PVC rate alarm condition e Other HR and arrhythmia alarms may not be changed Changing Heart Rate or VTACH Alarm Limits Demonstrate the steps to change HR or VIACH limits 1 Press the Menu Select button Select Measurements Alarms and press Menu Select Select HR Arrhythmia and press Menu Select Select HR Limits and press Menu Select Select new values and press Menu Select Select VTACH Limits and press Menu Select NAM SA Select new values and press Menu Select Enabling Disabling Heart Rate and Arrhythmia Alarms Demonstrate the steps to enable or disable HR and arrhythmia alarms 1 Press Menu Select 2 Select Measurements Alarms and press Menu Select 3 Select HR Arrhythmia and press Menu Select 4 Select Alarms On Off and press Menu Select
211. sert the cable into the port Push until you hear it click into place DEMONSTRATE Suggestion Have students complete this step Note the following as appropriate e Pre connect the Pads CPR cable to the MRx prior to a resuscitation event or rescue to save on set up time e The Q CPR option requires the Pads CPR cable to be connected to the HeartStart MRx CPR feedback is not available if the standard pads or paddles cable is connected Compression Sensor to the Pads CPR Cable 1 Align the key marker on the Compression Sensor cable with the key marker on the receptacle end of the Pads CPR cable Push until you hear it click into place DEMONSTRATE Suggestion Have students complete this step Note the following Pre connect the Compression Sensor cable to the Pads CPR cable to save time on set up Compression Sensor Adhesive Pad 1 Peel the white rear liner from the bottom of the Compression Sensor Adhesive Pad The rear liner is blank DEMONSTRATE 2 Align the Compression Sensor Adhesive Pad with the yellow area of the Sensor and press into place DEMONSTRATE Suggestion Have students complete steps 1 and 2 Note the following e The Compression Sensor Adhesive Pad is intended for single patient use only e Pre attach the Compression Sensor Adhesive Pad to the Compression Sensor to save time on set up For pre connection storage refer to the Setting Up section of the MRx Instructions for Use 75 Multifunction Electr
212. sfer Demonstrate how to set up for BLDT Batch LAN Data Transfer requires the LAN cable to be plugged into the LAN port on the back of the MRx The LAN cable connects to either a router or Network Interface Card NIC on a local personal computer Your IT support will need to let you know how your setup has been configured Alternatively BLDT can be accomplished wireless via the optional Wireless Link device Make sure that a PC running Data Messenger is connected to the same WiFi network as the MRx You will need to confirm with your IT support which wireless network you ve been configured for Transferring Files with BLDT Demonstrate how to transfer data using the BLDT option 1 Confirm the MRx is in Data Management Mode Data Messenger is running on the receiving personal computer as indicated by the Data Messenger icon in the task bar and the LAN cable or Wireless Link device is securely connected to the MRx For wireless transmission the PC is on the same WiFi network as the MRx Note the following When Wireless Link is used in access point mode which is the standard configuration for customers sending cases to ePCRs it will only broadcast its SSID when in Data Management mode So you need to ensure that they are connected to the same network as MRx when in Data Management mode 199 2 Once the LAN cable is connected or the HeartStart MRx and PC are on the same subnet on the same wireless network the MRx automatically communi
213. ss Data Management Mode by pressing the Summary i button thus eliminating steps 1 and 2 above Select Data Management and press Menu Select 4 Press Menu Select to acknowledge the message Leaving Normal Operational Mode 5 Using the Prev Item and Next Item softkeys highlight the Event Summary you want to transmit or the Event Summary which contains the 12 Lead Report you want to transmit and press Menu Select 6 Highlight Send and press Menu Select 7 Highlight the type of data you want to transmit on the Send menu and press Menu Select You can send all event data include 12 Lead Reports exclude audio and or Q CPR and transmit a specific 12 Lead Report 8 Depending upon which option you selected in Step 7 you are presented with different menus Ifyou selected a 12 Lead Report a Select a destination for the 12 Lead Report from the Send To menu and press Menu Select If your device is configured with just one transmission device or you selected the Rosetta Lt transmission begins b If your device has more than one configured transmission device highlight the transmission device you want to use and press Menu Select Transmission begins Ifyou selected an Event Summary If your device is configured with just one transmission device transmission begins If your device has more than one configured transmission device highlight the option you want to use and press Menu Select Transmission begins 196 No
214. ss Link started a PCDT transmission but the connection failed e When a PCDT is initiated the MRx transmits vital signs data automatically every 1 2 3 4 or 5 minutes as configured The type of information sent in a PCDT depends on the event that triggers the transmission as outlined in the following table 191 Table 7 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 e 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 label 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 Pacing change When pacing is started or stopped or a pacing control is changed mode rate or output Event label and time e Pacer mode Fixed or Demand rate and output e A segment consisting of the 10 seconds prior to and the five seconds following
215. surface above the brush with a cotton swab dipped in isopropyl alcohol 4 Replace the roll of paper 217 Paddles and Therapy Cable e External non sterilizable paddles and Therapy cables including Pads CPR cable may be cleaned with a soft cloth moistened with Mild soap and water Gluteraldehyde solution such as Cidex Plus 2 solution in water Sodium hypochlorite chlorine bleach 3 solution in water Quaternary ammonium compounds 21 quaternary ammonium content such as Steris Coverage Plus NPD 5 ounces gallon one part Coverage Plus NPD to 255 parts water Isopropyl alcohol 70 solution in water Verify that there is no debris or residue including all conductive material on the electrode surfaces of the paddles and paddle tray e The paddles and Therapy cables may not be ultrasonically cleaned or immersed autoclaved or ETO sterilized e See the Sterilizable Defibrillator Paddles Instructions for Use for cleaning and sterilizing internal and external sterilizable paddles e 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 cont
216. 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 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 Low alarm tone the low alarm limit e Each pressure label has its own unique set of default alarm limits as set in Configuration mode e Ifthe alarm is from a pulsatile source the source is displayed above the alarm limits If alarms are off the Alarms Off symbol replaces the limits e Ifa wave becomes non pulsatile the measurement becomes mean only and is compared to the current source which may be systolic or diastolic and alarm limits Note the following 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 Demonstrate how to enable disable alarms 1 Press the Menu Select button 2 Using the Navigation buttons select Measurement
217. t are retained Be sure to confirm that cardiac capture has been maintained e Turn off pacing before defibrillating with a second defibrillator to prevent damage to the MRx Additional points notes 93 Review Have students answer the following questions individually or as a group Correct answers are in bold Consider having students correct FALSE statements to ensure comprehension 1 Which of the following statement s are TRUE related to pacing with the MRx a The device requires a 3 5 or 10 Lead ECG cable and monitoring electrodes during demand mode pacing T b The device always delivers pace pulses in demand mode F In demand mode pace pulses are delivered when the patient s heart rate is lower than the selected pacing rate c The Pacing status area indicates pacing mode status rate and output T d Ifyou exit Pacer Mode to defibrillate and then return to Pacer Mode the settings from the previous pacing session must be re entered F The settings remain in effect 2 Which ONE of the following steps should be performed before pacing is initiated in demand mode a Verify that a white pacing marker appears in front of each QRS complex b Verify that white R wave markers appear above or on the ECG waveform c Increase pacer output until capture occurs d Decrease pacer output to the lowest level that still maintains capture 94 Instructor Guide 9 Pulse Oximetry Monito
218. t 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 e Patient Type category 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 MRx uses default settings which may not be correct for your patient Changing a patients type category may change algorithms and alarm limits For internally paced patients you must set Paced to Yes Ifincorrectly set to No the device may identify a pace pulse as a QRS and not alarm during asystole Practice Exercise 1 Have students try admitting a patient on the MRx to the Information Center Try admitting limited patient information as outlined in the first bullet above Pose the following questions 1 What is displayed on the MRx and Information Center once you complete the patient admittance Is there any difference in the format of the information displayed between the MRx and Information Center 164 Discharge e Discharge Patient Clears patient information Closes a patient data record Resets patient type category paced status alarm settings and all other MRx settings to default values and Discharges a patient from the Information Center if connected e Discharging from the MRx clears all data from t
219. t 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 e Do not rely on CPR meter feedback during aircraft ascent and descent as its accuracy is reduced in such conditions e Store the CPR meter away from direct sunlight when not in use to prolong the display s life CPR meter Display As you perform CPR on the patient the CPR meter display indicates whether you are compressing at the proper rate and depth and releasing each compression completely A status light in the display area is off when the meter is attached to a MRx that is turned off The light is green when the MRx is on and the meter has passed its self test If the light is orange or does not light follow instructions in the Troubleshooting chapter of the MRx Instructions for Use The light remains on for 10 seconds after the MRx is turned off Compression Depth e Each compression performed is represented on the display by a moving white compression depth indicator bar A target zone lights up when a compression meets the targets for depth of release e Ifthe compression fails to meet the minimum compression depth required for a patient on a hard surface 40mm 1 5 for a meter connected to a MRx with software version F 01 R 01 or 50mm 2 for a meter connected to a M
220. ta and press Menu Select Transmission begins Note the following e Start Data Transmit is used to send periodic clinical data from clinical mode whereas Send is used to transmit 12 Leads e Ifthe connection between the MRx and the destination server fails the MRx automatically tries to reconnect and sends the transmission when a connection is established 193 e Ifyou start a PCDT within 10 seconds of turning the MRx on the first transmission contains no wave data e PCDT is not available when the MRx is connected to the IntelliVue network Discuss the following priorities for sending data In low bandwidth or poor signal quality areas the MRx can queue periodic data transmissions For more than one transmission in queue data is sent according to the following preset priority e If there are multiple transmissions all patient vital signs transmissions are sent first event summary transmissions second and 12 Lead Report transmissions third e If there are multiple transmissions of the same type they are sent in chronological order e Ifa pending vital signs transmission is greater than 15 minutes old the message is not sent e If there is a pending 12 Lead report transmission and a new 12 Lead report is acquired only the newest 12 Lead Report is sent e If there is a pending event message that s greater than a minute old it is not sent Ending a PCDT Demonstrate how to end an on going PCDT 1 Press the Menu Select
221. te and applicable resources This lesson describes the basic ECG and arrhythmia monitoring functions of the HeartStart MRx Objectives Upon completion of this lesson students should be able to 1 Locate pertinent information in Monitor View Prepare a patient for ECG and arrhythmia monitoring 2 3 Set heart rate and arrhythmia alarms 4 Display an annotated ECG 5 Initiate manual relearning Time 10 20 minutes Accessories Recommended e Simulator e Hands free cable e Multifunction electrode pads e 3 5 or 10 Lead monitoring electrodes Clinical Resources e Arrhythmia Monitoring Algorithm Application Note 27 Lesson Presentation Overview Introduce MRx s Monitor Mode specific to ECG and arrhythmia monitoring Monitor Mode monitors ECG and arrhythmia using multifunction electrode pads or 3 5 or 10 Lead ECG sets The MRx uses the ST AR Basic Arrhythmia Algorithm for arrhythmia analysis Monitor Mode generates heart rate and arrhythmia alarms communicating patient status Monitor View Attach multifunction electrode pads or 3 5 or 10 Lead ECG set to the simulator and the MRx attach parameter accessories as appropriate turn the Therapy Knob to Monitor and discuss Monitor View characteristics Monitor View displays up to four ECG waves or combination of ECG pads paddles and parameter waves Monitor View displays heart rate parameter numeric values and active alarm settings Change the
222. te the following Press the Exit Data Management softkey and select Yes to exit Data Management and cancel the current transmission and any queued transmissions Select No to continue the current transmission e 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 otherwise a Cannot copy this event while printing or Cannot send this event while printing message appears For either message wait for the printing to finish or cancel the printing before proceeding Tracking Data Transmission Describe the data transmission progress displayed on the MRx screen e For events the Event ID along with the date and time of the event data being sent are displayed e For 12 Lead reports the date and time of the report are displayed e The phrases Connecting to Device and Sending are shown e A percentage complete is displayed if the MRx is sending data e Once transmission is complete a brief Confirming Stand by message appears followed by a Disconnecting message Then the transmission progress message is removed e 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 name e Ifyou exit Data Management Mode or leave a clinical mode causing a reboot of the device during transmission the transmission is
223. ted 79 Note the following When intubation is indicated the Ventilate Less Forcefully and Ventilate a Little Less Forcefully audio feedback is suppressed The Q CPR option should not be used to verify placement of airway adjuncts such as endotracheal tubes and laryngeal masks Suggestion Ask students to help point out compression waveform parameter block and soft key characteristics instead of YOU stating all characteristics Practice Exercise 2 Have students turn to 150J manual defibrillation setting and practice performing CPR alone and with another student on a manikin to experience 1 and 2 rescue person situations according to AHA guidelines for compression to ventilation ratio Make sure each student has proper hand arm and body position to perform CPR Also press the Sync button to show what happens to Q CPR when you switch to synchronized cardioversion or the Alarm Pause button to show what happens to Q CPR Pose the following questions 1 What voice prompts do you hear when performing CPR What is the most frequently heard prompt Note The prompt will vary depending on the student 2 How long can you perform CPR without getting a voice prompt How long could you perform CPR before getting totally fatigued What range of compression and ventilation rates do you achieve How full does the ventilation lungs icon get when you do ventilations How often do you get No Flow times and how long are th
224. tements STEMI culprit artery identification and Critical Value statements the latter which may prompt immediate patient care Preview Screen Attach a 10 Lead set to the MRx and a simulator set the simulator to a normal sinus rhythm NSR turn the device to the Monitor position press the 12 Lead soft key and discuss the following Preview Screen characteristics e The screen provides real time 12 Lead ECG data patient ID age and sex and approximately 2 5 seconds of each acquired lead e The screen verifies signal quality before acquiring the ECG e Waveforms are presented at a rate of 25mm sec and at the configured wave size e A dashed line indicates a lead cannot be derived e Lead Wire Off message indicates an electrode is not making adequate contact with the patient e Parameter measurements alarms and inop messages remain active and are reported in Parameter Blocks 1 and 2 and the general status area e A filter soft key is available to switch between ECG bandwidth filters Suggestion Ask students to point out characteristics instead of YOU stating them Ask students if they think it matters if age and sex are left to the default values or if accurate patient information is entered 142 Additional points notes Preparation Discuss the following points on 12 Lead monitoring preparation and demonstrate the related steps as appropriate Stress proper lead placement e Proper patient prep
225. tent Students can use the workbook to follow your instruction Be sure to familiarize yourself with the workbook before you teach It is available on the User Documentation CD ROM that comes with the MRx e As appropriate and if possible try to have one copy of each application note available for each student either before during or after the training These notes relate to several lessons in the guide They can be found on the User Documentation CD ROM as well as www medical philips com goto productdocumentation e If possible try to have one set of the latest version of the HeartStart MRx Quick Reference Cards available with each MRx used during the training Teaching Guidelines Consider the following guidelines for delivering the MRx training e Have students identify themselves and their role and or responsibilities This information gives you a better idea of what lessons topics are suitable or most important for your audience Provide a brief overview of the course structure and what is covered in each lesson e Advise students to read the HeartStart MRx Instructions For Use for details on device features and information not covered in the classroom Device intended use Device and accessory set up Configuration Device disposal Troubleshooting Specifications and safety For each lesson Introduce the learning objectives as listed in the guide advise on how much time it will take to
226. ter 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 Compression waveform e The compression waveform appears in Wave Sector 3 is labeled Comp and represents approximately 10 seconds of compressions e As the chest is compressed the chest compression is shown as a downward stroke of the wave rebounding up to a baseline as compression pressure is released e The wave sector contains horizontal lines drawn at 38 mm and 51 mm or 1 5 and 2 that define a target zone for appropriate chest compression depth Good compression depth is achieved when the peak or minimum value of the waveform appears between the lines e An asterisk annotates when pressure is not released between compressions also referred to as leaning e Ifthe Compression Sensor signal becomes invalid e g the sensor is disconnected the waveform appears as a dashed baseline Suggestion Disconnect the sensor to display the dashed baseline 78 Parameter Block 2 e Parameter Block 2 displays numeric values for compression and ventilation rates Both rates are a moving average rate measured per minute Based on the Q CPR algorithm the
227. test results and the actions to take are described in the Maintenance chapter of the MRx Instructions For Use Mention a few of the typical results that may be encountered if students ask e g indication that batteries need charging or calibration there has been a module failure or NBP or CO2 needs calibration Encourage students not to take MRx out of service on its first failure They should run Op Check again and troubleshoot as much as possible referencing the Troubleshooting chapter of the MRx Instructions For Use as needed 210 Additional points notes Operational Check Tests Discuss the Op Check tests in the order they are performed corresponding prompts and actions to take if any button lights and you are prompted to Press Shock or Press Shock buttons on paddles 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 None None set to 150J Charge Button Tests the Charge button Depending on the cable Respond to the prompt as connected as follows follows e If the Pads cable is attached
228. the MRx to see what patient data changes 167 Additional points notes Sharing Information on the Network Discuss the type of information and data the MRx shares with the Information Center and how to view and manage it Patient Information Updates After the 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 MRx entered at one location is automatically reflected at the other Date Of Birth The MRx with IntelliVue Networking Option lets you to enter a patient s date of birth Without this option installed 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 until entered To enter the date of birth 1 Press the Menu Select button 2 Using the Navigation buttons select Patient Info and press Menu Select 3 Select Date Of Birth and press Menu Select Ifthe patient type is adult the default menu option is the current date 50 years ago Ifthe patient type is pediatric the default menu option is the current date 10 years ago 4 Using the Navigation buttons enter the date of birth and press Menu Select Suggestion Have students complete the above steps during or after your demonstration Note the following The date of birth automatically converts to an age for 12 Lead reports Only age is
229. the pacing change inclusive for each of the waveforms configured to be printed NOTE If you stop pacing pacing mode rate or output does not transmit 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 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 EEE oN Physiological alarm including Asystole VFIB VTACH VTACH Extreme Tachy Extreme Brady Apnea Extreme Desat Invasive pressure e Event label and time Disconnect PVC min high Pacer Not Captured Pacer Not e All data with Vital signs update e A segment consisting of the 10 seconds prior to and the five seconds following the event trigger inclusive for each of the Pacing P L When trigger event acing Pacer Output law ane en FUBE waveforms configured to be printed alarm limits for HR NBP occurs EtCO SpO Pulse rate NOTES AwRR Invasive Pressure CPP When starting PCDT within 10 seconds of turning the HeartStart and Temperature MRx on the first event does not contain any data Print button is pressed End PCDT does not send vitals or waveform data Start End PCDT e All transmitted personal p
230. ting 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 Ifthe ECG source for Wave Sector 1 becomes invalid e g a Leads Off condition or the ECG cable is disconnected in demand mode pacing a latching red alarm is generated along with a Pacing Stopped Leads Off message and pacing is stopped Once the condition is corrected resume pacing by pressing the Resume Pacing soft key Also while in demand mode if you are using a 3 lead ECG set and the lead in Wave Sector 1 is changed a latching red alarm is generated as well as a Pacing Stopped Leads Off message and pacing is stopped Once the condition is corrected resume pacing by pressing the Resume Pacing soft key Ifa Pads Off condition occurs or the pads cable is disconnected a latching red alarm and Pacing Stopped Pads Off Pads Cable Off message is generated and pacing is stopped Once the condition is corrected resume pacing by pressing the Resume Pacing soft key Note the following The Pacing Stopped red alarm cannot be disabled Heart rate displays and alarms can be unreliable during pacing so keep close observation on the patient Do not rely on the indicated heart rate or related alarm
231. ting the transfer the MRx discharges the patient and restarts with a new incident Suggestion Have students complete the above steps during or after your demonstration stating what they see during the procedure Transfer Mode e Transfer Mode allows hands off of patient data from one monitoring location to another e While in Transfer Mode patient information can t be modified e The MRx continues to send data to the Information Center without an associated patient name The data is not associated with the patient presently on the transfer list Patient data is identified by a unique bed label common to both the MRx and the specific data sector being monitored at the Information Center Re admit Patient 166 If you need to re admit a patient to the MRx the Re admit function restores the patient data association It moves the patient off of the Information Center s transfer list back into the corresponding Information Center sector when connected to the network To Re admit 1 Press the Menu Select button 2 Using the Navigation buttons select Patient Info and press Menu Select 3 Select Re admit and press Menu Select 4 When Re admit is selected a Re admit Patient message displays prompting with a Re admit Patient question Select Yes to re admit the patient or No to cancel re admission Suggestion Have students complete the above steps during or after your demonstration stating what they see during the procedure
232. tion buttons select the Printed Waves option and press Menu Select 3 Using the Navigation buttons select Wave 2 or Wave 3 and press Menu Select 4 Using the Navigation buttons select the wave form you want printed and press Menu Select 5 Repeat Steps 2 through 4 for the other printed wave Return to Owner Discuss the Return to Owner feature and demonstrate how to enable and disable it e Lets the MRx owner specify a loan period after which the MRx borrower is reminded to return the device to its owner e Password protected in Configuration Each device should have a unique password e 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 e The appearance of the loan expiration message does not disable monitoring and defibrillation functionality To enable this feature 1 Press the Menu Select button 2 Select Other and press Menu Select 3 Select Return To Owner and press Menu Select 4 Press the Activate soft key 5 Enter the number of days in the loan period and press Menu Select 6 Press the Exit Return To soft key To disable this feature 1 Press the Menu Select button 2 Select Other and press Menu Select 3 Select Return To Owner and press Menu Select 4 Press the Deactivate soft key 19 5 Enter the passw
233. tor to enable Monitor Mode for 3 or 5 Lead ECG monitoring optional 12 Lead ECG acquisition or monitoring of optional parameters such as SpO7 CO2 NBP temperature and invasive pressures e Pacer optional to enable Pacer Mode for demand or fixed mode pacing e Manual Defib to enable Manual Mode for asynchronous or synchronous defibrillation cardioversion at the selected energy setting and optional Q CPR parameter Energy settings are 1 9 10 15 20 30 50 70 100 120 150 170 and 200 Joules If the device is equipped with optional Pacing energy settings are 1 10 15 20 30 50 70 100 120 150 170 and 200 Joules General Function Buttons Control monitoring or non critical resuscitation activities Mark Event inserts a time stamped annotation in the Event Summary Report to note events as they occur including drug administration A Mark Event button label appears at the top left corner of the display e Lead Select changes the ECG lead in Wave Sector 1 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 MRx e Alarm Pause pauses 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 Also retur
234. tor to a shockable rhythm e g VF and complete the defibrillation process steps 2 and 3 Note the following e Once an ECG is detected MRx automatically analyzes the patients heart rhythm and warns not to touch the patient If you get the message artifact interferes with Analyzing Interrupted Do Not Touch the Patient analysis artifact persists Cannot Analyze and Paused Attend To Patient e Analysis is suspended during pause time Ensure good pads contact and minimize movement Analysis resumes automatically after 30 seconds or when you press Resume Analyzing Discuss impedance related to patient preparation and pads and paddles placement and its impact on delivering an effective shock e Impedance is the resistance between the defibrillators multifunction electrode 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 hand lotions or powders on the skin The MRx s low energy SMART Biphasic waveform is an impedance compensating waveform designed to be effective across a wide range of patients with no influence of body weight on shock success However if you receive a No Shock Delivered message check that the patients skin has been washed and dried and that any chest hair has been clipped If the message persists c
235. tput is configurable and has a default setting of 30mA 6 Press Start Pacing The message Pacing appears 7 Verify white pacing markers appear above or on the ECG waveform 8 Press Pacer Output Then use the Navigation and Menu Select buttons to 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 To stop delivery of pace pulses press Pause Pacing Once paused press Resume Pacing to resume delivery You may also stop delivery of pace pulses by moving the Therapy Knob off the Pacer position Note the following as appropriate e The ECG cable must be directly connected to the MRx when in demand mode If a sync cable is used connect the cable using the ECG Out port on the MRx and the ECG In port on the Philips bedside monitor e Ifyou are pacing with battery power and the Low Battery Alarm sounds connect the device to external power or insert a fully charged battery e Routinely assess the patient s peripheral pulses e When pacing in demand mode the ECG cable must be directly connected from the patient to the HeartStart MRx 90 e Pacing will not start if a pads connection or patient contact problem exists pace pulses will not be delivered if a monitoring electrodes connection problem exists An inop message alerts yo
236. tting to a Fax Number Demonstrate how to transmit a displayed 12 Lead Report to a manually entered fax number First acquire a 12 Lead ECG display the report and then complete the following procedure 1 Press Menu Select 189 2 Using the Navigation buttons if necessary select Send from the 12 Lead Main Menu and press Menu Select Select Fax Number from the Send To menu Enter the fax number from the numeric list using the Navigation buttons Include any extra digits necessary e g 9 for an outside line or 1 plus the area code for long distance 5 Select Done and press Menu Select Transmitting to a Personal Computer e Using Bluetooth FTP the MRx can send 12 leads and periodic data to a PC during an event and send event summaries to a PC after an event e Transfer data is used by an ePCR or Event Review Pro on the receiving personal computer or forwarded on to a remote destination using HeartStart Data Messenger software Practice Exercise 2 Have students complete a transmission in 12 Lead Mode to a configured site fax number and or PC as appropriate Ask them to point out what display changes they see when completing each transmission procedure and differences between each procedure Additional points notes 190 Periodic Clinical Data Transmission Optional Optional topic This topic is for students who use Periodic Clinical Data Transmission technology to transmit MRx data Describe PC
237. u to either connection problem For the pads problem you should check the pads cable is connected the pads are properly applied or apply new pads as needed For the electrode problem ensure the ECG cable is connected the electrodes are applied properly or reduce patient motion Resume pacing once either problem is corrected e If using a MRx M3536A with software version R 02 and later when enabled in Configuration Mode the MRx can automatically switch from Demand to Fixed Mode pacing when the primary ECG lead driving Demand Pacing is lost or otherwise compromised Practice Exercise 1 Have students attach pads and electrodes to the MRx and a simulator set the simulator to bradycardia and complete demand mode pacing Pose the following questions 1 What display changes do you see when completing each step i e turn on pacing set pacing status adjust pacer rate and output and stop pacing 2 How do you know when pace pulses are being delivered Additional points notes 91 Fixed Mode Pacing Demonstrate how to pace in fixed mode 1 2 3 Turn the Therapy Knob to Pacer Note the following The message Pacing Paused appears in the status block indicating that the pacing function is enabled though pace pulses are not being delivered Change the pacer mode to Fixed using the Pacer Mode menu off the Main Menu Press the Lead Select button to select the desired lead for viewing Note that the re
238. up Correct answers are in bold 1 Which of the following items can display when monitoring NBP a Systolic and diastolic pressure b Alarm limits c Automatic measurement schedule d Time stamp 2 You can take manual measurements during an automatic measurement schedule T 3 NBP alarms are enabled unless disabled T 112 Instructor Guide 11 Carbon Dioxide Monitoring Lesson Introduction Introduce the lesson including the learning objectives estimated time to complete and applicable resources This lesson describes how to monitor carbon dioxide CO and measure end tidal carbon dioxide EtCO and Airway Respiration Rate AwRR with the HeartStart MRx using the Microstream sidestream method Objectives Upon completion of this lesson students should be able to 1 Monitor CO 2 Set EtCO and AwRR alarms Time 10 15 minutes Accessories Recommended e Nasal FilterLine or Smart CapnoLine Clinical Resources e Uses of Capnography The Microstream Method Application Note Note Microstream and FilterLine are trademarks of Oridion Medical Ltd 113 Lesson Presentation Overview Briefly review the CO monitoring function It measures the partial pressure of CO in a sample of the patient s exhaled breath with the appropriate FilterLine and if necessary airway adapter It monitors in both intubated and non intubated patients It is available in Monitor Pacer and Manua
239. ure Viewing and Erasing the External Data Card Demonstrate how to view a list of Event Summaries and 12 Lead ECG Reports located on the data card 1 Turn the Therapy Knob to Monitor 2 Press the Menu Select button 3 Using the Navigation buttons select the Other menu and press Menu Select Note Using T 00 software on the MRx M3536A you can access Data Management Mode by pressing the Summary i button thus eliminating steps 2 and 3 above 4 Select Data Management and press Menu Select 5 Press Menu Select to acknowledge the message Leaving Normal Operational Mode 6 Press Menu Select to display the Data Management menu 7 Select View Data Card and press Menu Select Prev Page and Next Page soft keys appear to navigate to additional display pages Use the Erase Card menu entry to delete the data card contents Note the following If you format a Philips data card in a PC card reader a FAT 16 file system must be used to format the data card Using a FAT32 format makes the card incompatible with the MRx 176 Also do not use the data card as a long term storage device Follow your organization s protocol for backing up electronic data Suggestion Have students complete the view procedure during or after your demonstration Additional points notes Printing During a Patient Event Point out the characteristics and steps associated with printing data reports during a patient event Event Summ
240. value and press Menu Select Enabling Disabling EtCO Alarms Demonstrate how to enable or disable the EtCO alarms 1 Press Menu Select Using the Navigation buttons select Measurements Alarms and press Menu Select 2 Select EtCO and press Menu Select 3 Select Alarms On Off and press Menu Select 116 Changing AwRR Alarm Limits Demonstrate how to change the AwRR alarm limits 1 Press Menu Select Using the Navigation buttons select Measurements Alarms and press Menu Select Select AwRR and press Menu Select 2 3 4 Select AwRR Limits and press Menu Select 5 Using the Navigation Buttons increase or decrease the high limit value and press Menu Select 6 Set the new low limit value and press Menu Select Changing Apnea Time Alarm Limit Demonstrate how to change the Apnea Time alarm limit 1 Press Menu Select 2 Using the Navigation buttons select Measurements Alarms and press Menu Select 3 Select AWRR and press Menu Select 4 Select Apnea Time and press Menu Select 5 Using the Navigation buttons increase or decrease the limit and press Menu Select Enabling Disabling AwRR Alarms Demonstrate how to enable the AwRR alarms 1 Press Menu Select 2 Using the Navigation buttons select Measurements Alarms and press Menu Select 3 Select AWRR and press Menu Select 4 Select Alarms On Off and press Menu Select Practice Exercise 1 Have students change EtCO AwRR and Apnea Time limits and enabl
241. ve pads Philips multifunction electrode pads Ambu bag Resusci Anne manikin to perform compressions only Note To perform and measure both compressions and ventilations the Resusci Anne SkillReporter manikin and Q CPR Trainer are required Clinical Resources Q CPR Measurement and Feedback Application Note M3535 91980 Note Q CPR is a trademark of Laerdal Medical 73 Lesson Presentation Overview Introduce the Q CPR option and its intended use e Q CPR offers real time measurement and corrective feedback on compression rate depth and duration as well as ventilation rate volume and flow rate inflation time It also provides notification of CPR inactivity e Compressions are measured through the signal acquired by the Compression Sensor Ventilation data is acquired through multifunction defib electrode pads in conjunction with signals from the sensor Note the following as appropriate The Compression Sensor and associated Pads CPR cable can only be used on a MRx with software version 9 xx or lower Institutions with mixed fleets of MRxs with Compression Sensors and MRxs with software version F 01 or higher with CPR meters should develop a way for end users to identify which CPR devices go with which HeartStart MRx units e Q CPR is intended for use with only the HeartStart MRx and available in Manual Defib Mode and AED Mode Both modes provide audio prompts and visual indicators when CPR performance deviat
242. ve students turn to AED Mode and practice performing CPR alone and with a another student on a manikin to experience a 1 and 2 rescue person situation according to AHA guidelines for compression to ventilation ratio Make sure each student has proper hand arm and body position to perform CPR Pose the following questions 1 What voice and text prompts do you get when performing CPR What is the most frequent voice or text prompt produced Note The prompt will vary depending on the student 2 How long can you perform CPR without getting a voice or text prompt How long could you perform CPR before getting totally fatigued Additional points notes 81 CPR Feedback Volume Adjustment Turn the MRx Therapy Knob to a Manual Defib setting e g 150J and demonstrate the volume adjustment Press the Start CPR soft key and mute the voice prompts To mute the CPR feedback voice prompts once you start CPR 1 Press Menu Select 2 Select Mute CPR Voice and press Menu Select Note the following When muted a CPR Voice Muted text message displays in the middle of the compression waveform and CPR inactivity time is indicated by an audible tone To resume voice prompts set at the previously selected volume 1 Press Menu Select 2 Select Resume CPR Voice and press Menu Select To adjust the volume of CPR feedback voice prompts 1 Press the Menu Select button 2 Select Volume and press Menu Select 3 Select Voice an
243. ve the button to which they correspond Table of Contents 1 Introduction 1 2 Getting Acquainted 7 Lesson Introduction 7 Objectives 7 Time 7 Accessories ON 7 Lesson Presentation 8 Overview 8 Basic Orientation Soe ee AAA AA AA 8 Display View Ge ke wae eaeicais anaes G ee a Go oe B Responding to Alarms y y 4 5 4 G xs AA we A ed 16 Device Identification 17 Entering Patient Information 2 eee ee ee 18 Continued Use 2 2 2 1 eee 18 Printing Waveforms 4 a a 2 aa a tk See ewe ae O Return to Owner 19 Audio Recording a p a g uag e r g aa ad Carrying Case and one Po ch Ien LARA al Storing Accessories o n ee 23 Review La he Gb eA hw Ae Ame 4 26 3 ECG and oi Monitering 27 Lesson Introduction 2 2 a a a 27 Ob j ctiyes y s w m Be ayala eH oa ea EE A oe OT Time SG Me ee See 2 ew eb oe eK a a e a 27 Accessories epale oP os a e eo te e p Clinical Resources 2 2 1 ee a 27 Lesson Presentation 2 2 o 28 Oyeryiew o s p s pororaa a a a 28 Monitor View a a a 28 Preparation bo Roe 2 OM Bok p eop ooe woe ooe 29 Heart Rate and Teba Ries bee ok ee eee eA we a Displaying an Annotated ECG 44 4 24 be ww wm w BF Arrhythmia Learning Relearning 2 2 2 ee ee ee 38 REVIEW 4 e emoa 6 Rw a aaa eR Boe we ss 4 BD 4 Semi Automated External Defibrillation 41 Lesson Introduction 1 Objectives y 2 oe de ss a ee A we eee
244. ved when their alarm condition no longer exists e The alarm source and limits can be changed during use e Alarms are enabled unless disabled once disabled alarms remain disabled until enabled e Ifan alarm condition occurs when alarms are disabled no alarm indication is given Changing NBP Alarms Demonstrate how to change the NBP alarm source and or limits 1 Press the Menu Select button Using the Navigation buttons select the Measurements Alarms menu and press Menu Select Select NBP and press Menu Select Select NBP Limits and press Menu Select Select the desired source for the alarm Systolic Diastolic or Mean and press Menu Select Using the Navigation buttons increase or decrease the high limit value and press Menu Select we GN MY ey OY a Set the new low limit value and press Menu Select Enabling Disabling NBP Alarms Demonstrate how to enable disable NBP alarms 1 Press the Menu Select button 2 Using the Navigation buttons select Measurements Alarms and press Menu Select 3 Select NBP and press Menu Select 4 Select Alarms On Off and press Menu Select 110 Practice Exercise 2 Have students change NBP alarm limits and enable disable and respond to related alarms Pose the following questions 1 What happens when you change a limit Disable an alarm Respond to an alarm Additional points notes 111 Review Have students answer the following questions individually or as a gro
245. w and types of use cases e Transmitting MRx data occurs during an acute care event or after the event Transmission of vital signs and related data e g 12 lead waveforms ahead of a patient alerts a healthcare facility of the patient s condition to prepare for the next level of care prior to patient arrival Post event data can be used for quality review billing and eventual archiving e 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 Figures 1 and 2 for details Figure 1 Bluetooth and Rosetta Options for Periodic Clinical Data E N 12 lead PCDT Printer Se Q Cell Phone PDA 12 lead PCDT gt Pocket PC Patient report lt gt p Fax al Mobile sai ed 12 lead PCDT F See a mu gt gt LandLine BT Modem i gt 12 lead PCDT S Firewall S 3 Laptop Tablet Data Messenger S W Telemedicine Server Telemedicine Server 12 lead SD TraceMasterVue Datamed FT GE MUSE 12 lead PCDT 12 lead PCDT 182 Figure 2 Wireless Link Option for Periodic Clinical Data Transmission Printer 12 lead PCDT Patient report E mail Cellular addtese Ey 12 lead 20 ineme gt gt 12 lead PCDT Telemedicine y Server WiFi y transmission ae Firewall Telemedicine Server 12 lead TraceMasterVue hotspot 12 le

HeartStart MRx Instructor Guide

Contents

Download Pdf Manuals

Related Search

Related Contents