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1. Q CPR Data Capture This section describes how to configure Q CPR Data Capture settings lists the data and events recorded and provides information on reviewing Q CPR data Q CPR Feedback Setting You can enable or suppress Q CPR feedback while still capturing CPR data When Q CPR feedback is enabled the MRx displays the CPR sub view with accompanying voice and or text prompts When Q CPR feedback is suppressed the HeartStart MRx behaves in the following way Manual Defib Mode e The CPR sub view chest compression waves compression rate and ventilation rate numerics and no flow time is not displayed e There is no voice prompt feedback or storage of feedback events and prompts e INOPS regarding ventilation are not displayed AED Mode e There is no Q CPR voice or text prompt feedback or storage e INOPS regarding ventilation are not displayed Research Storage Setting When you enable Research Storage in addition to the data and events listed in Table 23 the following data is captured e Compression Sensor acceleration data e Compression Sensor force data e Patient Contact Impedance PCI from multifunction electrode pads 179 Data and Events Recorded In addition to the standard HeartStart MRx defibrillation and monitoring events and ECG waveform the following data and events related to Q CPR are captured Q CPR feedback prompts are captured if the Q CPR Feedback configuration option is set to On However t
2. Shutting Down in 1 Minute Logged when warning issued Shutting Down Now Pads Paddles Leads Pads On Logged when pads are applied to patient Pads Off Logged after a Pads On event if adult pediatric multifunction electrode pads are removed from the patient or the pads cable is disconnected External Paddles On Logged when external paddles make contact with the patient External Paddles Off Logged after an External Paddles On event if paddles lose contact with patient Internal Paddles On Logged when internal paddles make contact with the patient Internal Paddles Off Logged after an Internal Paddles On event if paddles lose contact with patient Leads On Logged when monitoring electrodes for primary ECG are attached to the patient Leads Off Logged after a Leads On event if a monitoring electrode for the primary wave loses contact with the patient 207 Table 52 Event Information Measurements PVC min Limit Logged when device is turned on if ECG alarms are on when settings are VTACH Limits HR __ Changed or when ECG alarms are turned on value Run value ECG Alarms Off Logged when ECG alarms are turned off Primary ECG abel Logged for initial or change in primary ECG source Gain xY Logged for initial or change in ECG gain Learning Rhythm Logged when ST AR algorithm learns ECG rhythm SpO On Off Logged when device is turned on if measurement is con
3. A new fully charged M3538A battery operating at room temperature 25 C 77 F provides approximately 5 hours of monitoring with ECG SpO CO temperature two invasive pressures monitored continuously NBP measured every 15 minutes and 20 200 discharges A fully charged new battery provides approximately 3 5 hours of monitoring with ECG SpO CO temperature two invasive pressures monitored continuously NBP measured every 15 minutes and pacing at 180ppm at 160mA Battery Life Battery life depends on the frequency and duration of use When properly cared for the M3538A Lithium Ion battery has a useful life of approximately 2 years To optimize performance a fully or nearly fully discharged battery should be charged as soon as possible Operating Modes The HeartStart MRx has four clinical modes of operation each with a customized display view The modes are as follows Table 1 Operating Modes and Views Monitor Mode Monitoring View or Used to monitor ECG take an optional 12 lead ECG and monitor 12 Lead View optional parameters such as SpO3 EtCO3 NBP Invasive Pressures Temperature and for viewing Vital Signs Trending data AED Mode AED View Used to analyze ECG and if necessary perform semi automatic external defibrillation Q CPR available Manual Defib Mode Code View Used to perform asynchronous and synchronous defibrillation cardioversion Q CPR available Pacer Mode Pacing View Used to perform dema
4. The cuff can be disinfected by immersion in a decontamination solution of 70 85 isopropyl alcohol but remember to remove the rubber bag if you use this method The cuff should not be dry cleaned The cuff can also be machine washed or hand washed as recommended by the manufacturer the latter method will prolong the service life of the cuff Before washing remove the latex rubber bag and for machine washing close the hook and loop fastening Allow the cuff to dry thoroughly after washing then reinsert the rubber bag SpO Sensor and Cable To clean the SpO sensor and cable follow the instructions provided with the accessory Invasive Pressures Transducer and Cable To clean the invasive pressure cable follow the instructions provided with the accessory Temperature Probe and Cable To clean the temperature probe and cable follow the instructions provided with the accessory Q CPR Compression Sensor The Compression Sensor may be cleaned with a soft cloth moistened with e mild soap and water e Gluteraldehyde solution 3 4 gluteraldehyde content such as Johnson amp Johnson Cidex Plus e Sodium hypochlorite chlorine bleach 3 solution in water e Quaternary ammonium compounds 21 quaternary ammonium content such as Steris Coverage Plus NPD one part Coverage Plus NPD to 255 parts water e Isopropyl alcohol 70 solution in water CAUTION The Compression Sensor may not be immersed 241 Disposing
5. 40 Hz or 0 05 150 Hz may be selected in Configuration to apply to 12 lead ECG waveforms shown on the display Additionally the 12 Lead Report may be configured to apply either the same filter choice used for the display or a 0 05 150 Hz filter The filter setting for the 12 Lead Report is applied to both printed and stored 12 Lead Reports NOTE Although the 0 05 150 Hz or Diagnostic bandwidth filter may be selected for the display filter LCD display limitations prevent the ECG from appearing in true diagnostic quality A filter soft key is available to switch between filter settings during use When changing the filter during use the filter setting is applied to both the display and the 12 Lead Report The display and 12 Lead Report filter settings are returned to their configured settings whenever the New 12 Lead soft key is pressed or when the Therapy Knob is moved from the Monitor position Troubleshooting If your HeartStart MRx does not operate as expected during 12 Lead ECG operation see Chapter 20 Troubleshooting on page 249 144 14 12 Lead ECG Transmission This chapter provides instructions for the transmission of 12 Lead Reports from the HeartStart MRx using wireless Bluetooth technology or its RS 232 Serial Port Overview 12 Lead reports may be transmitted to printers fax machines Philips TraceMaster ECG Management System or other servers running Philips 12 Lead Transfer Station software Repo
6. INOP Tone then yellow alarm tone Generated while at least one INOP condition is occurring Cyan indicator message Lower pitched tone is repeated twice IEC INOP Tone followed by a pause Generated while at least one INOP condition is occurring Cyan indicator message Tone occurring synchronously with each QRS tone heart beat Calling for Service For telephone assistance call the Response Center nearest to you or visit our website at www medical philips com cms and follow the links for CMS Response Center Table 77 Response Center Phone Numbers Canada 800 323 2280 United States of America European International Sales 800 722 9377 41 22 354 6464 Austria 01 25125 333 Belgium 02 778 3531 Finland 010 855 2455 France 0803 35 34 33 Germany 0180 5 47 50 00 Italy 800 825087 Netherlands 040 278 7630 Sweden 08 5064 8830 Switzerland 0800 80 10 23 United Kingdom 0870 532 9741 Australia 1800 251 400 China Beijing 800 810 0038 Hong Kong 852 2876 7578 Macau 0800 923 India New Delhi 011 6295 9734 Mumbai 022 5691 2463 2431 Calcutta 033 485 3718 Chennai 044 823 2461 Bangalore 080 5091 911 Hyderabad 040 5578 7974 Indonesia 021 794 7542 Japan 0120 381 557 Korea 080 372 7777 02 3445 9010 Malaysia 1800 886 188 New Zealand 0800 251 400 Philippines 02 845 7875 Singapore 1800 PHILIPS Thailand 02 614 3569 Taiwan 0800
7. Print button Speaker WA nae oO Alarm Pause button Microphone Hardware may appear with or Summary Soft keys 4 total Navigation buttons without an X through the button Menu Select button triangle Additional controls and indicators are on the paddles if used and batteries NOTE A palette of colored decals is included with your HeartStart MRx These colored decals may be applied to the label recesses located on the device handle to aid in identification Use an indelible marker to print identification information on the decal 10 Side Panels The left side of the HeartStart MRx has ports for monitoring cables including ECG pulse oximetry SpO2 noninvasive blood pressure NBP invasive pressure 2 temperature and carbon dioxide CO3 The ECG port may be used to connect a 3 5 or 10 lead patient cable The ECG Out jack may be used to connect to an external monitor The right side of the HeartStart MRx has a therapy port for paddles external or internal or multifunction electrode pads It also has a slot for a data card to transfer patient information Figure 2 Basic Orientation Right Left Sides CO Inlet Port CO Outlet Port Therapy Connector NOTE Some devices may also have an RJ11 telephone jack on the left side The RJ11 telephone jack is not used by the HeartStart MRx 11 Top Panel The top of the HeartStart MRx has a handle and basic operating instructions If option
8. Sample Size 49 48 54 49 40 p value Fisher s Exact p lt 0 050 0 436 0 232 0 032 0 526 0 712 Historical MDS Mean Success 3 25 34 57 76 Conclusion Overall the intra thoracic defibrillation success rate for the HeartStart MRx Biphasic versus a control biphasic waveform had no significant difference p lt 0 05 except at 10J 1 Zhang Y Davies R Coddington W Jones J Kerber RE Open Chest Defibrillation Biphasic versus Monophasic Waveform Shocks JACC 2001 37 320A 296 Safety Considerations The following general warnings and cautions apply to use of the HeartStart MRx Additional warning and cautions specific to a particular feature are provided in the appropriate section General WARNING The HeartStart MRx is not intended to be deployed in settings or situations that promote use by untrained personnel Operation by untrained personnel can result in injury or death WARNING HeartStart MRx service should only be performed by qualified service personnel in accordance with the HeartStart MRx Service Manual WARNING Use of the HeartStart MRx is restricted to a single patient at a time WARNING When transporting the HeartStart MRx it is important to position it with the display facing away from the body If not the Therapy Knob may be bumped and inadvertently moved from its current position WARNING Remain attentive to the patient during the delivery of therapy Delay in delivering a shock
9. WARNING Do not perform noninvasive blood pressure measurements on patients with sickle cell disease or any condition where skin damage has occurred or is expected Do not use in a hyperbaric chamber Use clinical judgement to decide whether or not to perform automatic blood pressure measurements on patients with severe blood clotting disorders because of the risk of hematoma in the limb wearing the cuff Do not apply the cuff to a limb that has an intravenous infusion or catheter in place This could cause tissue damage around the catheter when the infusion is slowed or blocked during cuff inflation Use only approved cuffs and tubing in order to prevent inaccurate data injury or damage All specified cuffs are protected against the effects of the discharge of a defibrillator Prolonged series of noninvasive blood pressure measurements in automatic mode may be associated with purpura ischemia and neuropathy in the limb wearing the cuff When monitoring a patient examine the extremities of the limb frequently for normal color warmth and sensitivity If any abnormality is observed stop the blood pressure measurements immediately Blood pressure readings may be affected by the position of the subject his her physiologic condition the presence of arrhythmia and other factors To obtain accurate blood pressure readings the cuff must be the correct size and also be correctly fitted to the patient Incorrect size or incorrect fit
10. 5 3 to 48 1kPa Measurement Resolution 1mmHg 0 1kPa Noise lt 1mmHg 0 1kPa Alarm Response Time 60 bpm transition from 120 0 to 25 0 11 1 seconds standard deviation 0 001 seconds Alarm Signal Generation Delay lt 14 seconds after an INOP condition for that pressure channel clears or 8 seconds in the absence of an INOP for that pressure channel Transducer Dome Volume Displacement Refer to the specific device s specifications Additional Noise from EMI if operating under conditions according to EMC standard EN60601 1 2 Radiated Immunity 3 V m or Conducted Immunity 3 VRMS lt 3mmHg Pulse Rate Range 25 350 bpm Pulse Rate Accuracy 1 of full range Pulse Rate Resolution 1 bpm 282 Temperature Measurement Range 0 45 C 32 113 F Measurement Resolution 0 1 C 0 2 F Measurement Accuracy excluding any adapter cable 0 1 C from 25 C to 45 C 0 3 C from 0 C to 24 9 C temperature probe adds an additional 0 1 C Settling Time Constant lt 10 seconds Alarm Signal Generation Delay 5 seconds Averaging Time 1 second Minimum measurement time See the probe s Instructions for Use to obtain minimum measurement times for accurate readings The HeartStart MRx does not add any clinically significant time to obtain accurate readings EtCO Range 0 to 99 mmHg at sea level Resolution 1 mmHg 0 1kPa Accuracy For values between 0 and 38 mmHg 2 mmHg For values between 39 and 99 mmHg
11. Connecting the Temperature Cable To connect the temperature cable 1 Insert the temperature cable into the temperature port as shown in Figure 22 2 If needed attach the cable to your probe Figure 22 Connecting the Temperature Cable 39 Connecting the CO FilterLine To connect the CO FilterLine 1 Using the end of the FilterLine fitting slide the CO compartment door down 2 Insert the fitting into the CO Inlet port as shown in Figure 23 3 Turn the fitting clockwise into place Figure 23 Connecting the CO FilterLine 40 Connecting the Therapy or Pads CPR cables To connect the Therapy or Pads CPR cable 1 Align the white pointer on the cable with the white arrow on the green Therapy port as shown in Figure 24 2 Insert the cable into the green Therapy port Push until you hear it click into place Figure 24 Connecting the Therapy or Pads CPR Cable 41 Installing Paper 50mm Printer To install printer paper 1 Open the printer door by pushing on the latch as shown in Figure 25 2 If there is an empty or low paper roll in the printer pull up on the roll to remove it 3 Place a new roll of printer paper into the paper well positioning the roll so that the end of the roll is on the bottom and the grid faces up 4 Pull the end of the paper out past the paper roller 5 Close the printer door Figure 25 Installing Paper 50mm iS S N N N 42 75mm Printer optional To install
12. Enabling Disabling Temperature Alarms 135 Changing Degree Units 135 Disabling the Temperature Function 136 Caring For Your Temperature Cables and Probes 136 Troubleshooting 136 13 12 Lead ECG 137 Overview 137 Preview Screen 138 Preparation 138 Acquiring the 12 Lead ECG 140 12 Lead Report 141 Accessing Stored Reports 141 Improving Signal Quality 143 Adjusting Wave Size 143 12 Lead Filters 144 Troubleshooting 144 14 12 Lead ECG Transmission 145 Overview 145 Setting Up for Bluetooth Transmission 147 Adding a Bluetooth Device 147 Pairing a Bluetooth Device with the HeartStart MRx 147 Changing Bluetooth Profiles 148 Additional Bluetooth Device Information 148 Transmitting to a Configured Site using Bluetooth 149 Setting Up for RS 232 Transmission 150 Transmitting to a Configured Site Using RS 232 152 Transmitting to a Manually Entered Fax Number 153 Transmission Status 154 Transmitting Stored 12 Lead Reports 155 Cancelling Transmission 155 Troubleshooting 155 15 Vital Signs Trending 157 Overview 157 Reviewing Trending Data 157 About The Data Displayed 158 Vital Signs Trending Report Parameter List Order 159 Scrolling in the Vital Signs Trending Report 159 Vital Signs Trending Report Intervals 159 Adjusting Vital Signs Trending Report Interval 159 Printing the Vital Signs Trending Report 160 Exiting Vital Signs Trending Report 161 Troubleshooting 161 vi 16 Q CPR and Data Capture 163 Overview 163 Preparing to Use Q CPR
13. Intubated When intubation is indicated in this way the Ventilate Less Forcefully and Ventilate a Little Less Forcefully audio feedback is suppressed 173 Using Q CPR in AED Mode 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 If your No Shock Advised NSA Action configuration item is set to provide a CPR Pause interval Q CPR can be activated by delivering a compression with the Compression Sensor The Intubate soft key is also displayed in AED Mode When you press this soft key its label changes to Intubated The Ventilate Less Forcefully and Ventilate a Little Less Forcefully audio feedback is suppressed when intubation is active As in Manual Defib Mode voice prompts are issued to guide you if necessary however in AED Mode they are accompanied by a momentary text message appearing on the display A configurable CPR Timer status bar is also displayed The time period of the CPR Timer is determined by the Configuration setting for CPR Pause Time See Figure 82 NOTE The CPR sub view in AED Mode displays the ECG waveform only The compression waveform is not displayed while performing CPR in AED Mode NOTE Ifthe Pads CPR cable is not connected when you turn the Therapy Knob to AED Mode the message Connect Pads Cable is displayed NOTE Compression and ventilation measurement values are printed in the annotation area
14. NBP measured every 15 minutes and pacing at 180ppm at 160mA Battery Indicators Battery gauge on battery capacity indicator on display flashing RFU indicator chirp and LOW BATTERY message appears on display for low battery condition When LOW BATTERY message first appears there is still enough energy remaining for at least 10 minutes of monitoring time and six maximum energy discharges with a new battery at room temperature 25 C Battery Storage Storing the battery for extended periods at temperatures above 40 C will reduce battery capacity and degrade battery life 278 Thermal Array Printer Continuous ECG Strip The Print key starts and stops the strip The printer can be configured to run real time or with a 10 second delay The strip prints the primary ECG lead and a second or third wave 75mm printer only with event annotations and measurements Auto Printing The printer can be configured to automatically print on Mark Events Charge Shock and Alarm When an alarm condition occurs the unit prints the Primary ECG wave the alarming wave if configured and a third wave 75mm printer only Reports The following can be printed e Event Summary short medium and long e Vital Sign Trends e 12 Lead e Operational Check e Configuration e Status Log e Device Information Speed 25 or 50 mm s with an accuracy of 5 Amplitude Accuracy 5 or 40 uV whichever is greater Paper Size e 50 mm W x 30 m 10
15. The connection you are using does not provide dial tones Check that the cellular signal strength is sufficient Check that the connection between the Bluetooth modem and the analog line is secure Set the Wait for Dial Tone configuration parameter to No See the 12 Lead Transmission Implementation Guide for more information Transmission Failed Error configuring transmission device message The wrong Bluetooth Profile was selected The Configuration String under the Bluetooth Profile settings is not correct Check the profile to ensure it is the correct one for that Bluetooth device Work with your cell phone provider to ensure that the Configuration String is correct Transmission Failed Connection Interrupted message The network is down The Bluetooth device is not within range Check that the cellular signal strength is sufficient Move the Bluetooth device closer to the MRx within the transmitting range See the 12 Lead Transmission Implementation Guide for more information Transmission Failed Cannot reach server message No server or the connection has been lost Resend the 12 Lead Report Transmission Failed Server Unknown message The DNS has timed out or there has been a failure in the DNS Work with your ISP to ensure the Bluetooth Profile and Hub settings are correct 259 Table 66 12 Lead Transmission Problems Bluetooth Conti
16. To initiate relearning manually 1 Press the Menu Select button 2 Using the Navigation buttons select Measurements Alarms from the menu and press the Menu Select button 3 Select HR Arrhythmia and press the Menu Select button 4 Select Relearn Rhythm and press the Menu Select button The messages Learning ECG and Learning Rhythm appear in the rhythm status area of the display WARNING If arrhythmia relearning takes place during a ventricular rhythm or during a period of poor ECG signal quality ectopic beats may be incorrectly learned as the normal QRS complex This may result in missed detection of subsequent events of V tach and high PVC rates For this reason you should e take care to initiate arrhythmia relearning only when the ECG signal is noise free e be aware that arrhythmia relearning can happen automatically e respond to any INOP messages for example if you are prompted to reconnect electrodes e display an annotated wave to ensure beat labels are correct Troubleshooting If your HeartStart MRx does not operate as expected during ECG and Arrhythmia monitoring see Troubleshooting on page 249 61 5 Semi Automated External Defibrillation Defibrillation therapy is the definitive method for termination of a variety of potentially fatal arrhythmias The HeartStart MRx s Semi Automated External Defibrillation AED Mode is designed to guide you through standard treatment algorithms
17. When the HeartStart MRx is turned on in AED Mode it checks to see if the pads cable and multifunction electrode pads are properly connected If the e pads cable is not properly attached you are prompted to Connect Pads Cable e multifunction electrode pads are not connected to the pads cable pads are not applied to the patient or pads are not making proper contact with the patient s skin you are prompted to Apply Pads and Plug in Connector 67 Step 2 Follow the Screen and Voice Prompts Once an ECG is detected through the multifunction electrode pads the HeartStart MRx automatically analyzes the patient s heart rhythm and warns you not to touch the patient Figure 42 Figure 42 ECG Analysis Screen in AED Mode Shocks 0 ANALYZING DO NOT TOUCH PATIENT WARNING Handling or transporting the patient during ECG rhythm analysis can cause an incorrect or delayed diagnosis Under these circumstances if the HeartStart MRx issues a Shock Advised prompt keep the patient as still as possible for at least 10 seconds so the HeartStart MRx can reconfirm the rhythm analysis before you deliver a shock If artifact interferes with analysis the message Analyzing Interrupted Do Not Touch the Patient is annunciated while the HeartStart MRx attempts to continue analyzing If the artifact persists the message Cannot Analyze is annunciated and the message Paused Attend To Patient is displayed While paused ana
18. a Pacing lt q Markers p02 EtCO2 mmHg AwRR rpm 100 38 18 PACING ON BATTERIES Pacing lt lt 4 Status Demand Mode 70 ppm 50 mA Area Start Resume Pacer Pacer NBP Pacing _ Rate Output Pacing Soft Keys Pacing View includes a status block which appears in Wave Sector 4 of the display The first line of the status block communicates whether pacing is active or paused If pacing is powered by batteries this is indicated here as well if configured The second line of the status block identifies the Pacer Mode demand or fixed pacing rate ppm and pacing output mA Soft keys are available for setting pacing status Start Pacing Pause Pacing Resume Pacing and adjusting Pacer Rate Pacer Output 85 NOTE If pacing is interrupted for any reason the Resume Pacing soft key must be pressed to continue pacing A white pacing marker appears on the ECG waveform in Wave Sector 1 each time a pacer pulse is delivered to the patient If pacing in demand mode white R wave markers also appear on the ECG until capture occurs NOTE R wave markers do not appear on paced beats Demand Mode Versus Fixed Mode The HeartStart MRx can deliver paced pulses in either demand or fixed mode e In demand mode the pacer only delivers paced pulses when the patient s heart rate is lower than the selected pacing rate e In fixed mode the pacer delivers paced pulses at the selected rate WARNING Use demand mode p
19. alarms are enabled in Manual Defib mode using the Alarm Pause button Alarm settings for Heart Rate HR and VTACH are as configured but may be changed during operation for the current patient incident The setting for PVC Rate Limit may only be changed in response to a PVC Rate alarm condition Settings for other HR and arrhythmia alarms may not be changed Changing Heart Rate or VTACH Alarm Limits To change the HR or VTACH limits 1 Press the Menu Select G button 2 Using the Navigation buttons select Measurements Alarms from the menu and press the Menu Select button Select HR Arrhythmia and press the Menu Select button 4 Select HR or VIACH Limits and press the Menu Select button 5 Using the Navigation buttons select the new values and press the Menu Select button Enabling Disabling Heart Rate and Arrhythmia Alarms To enable disable the HR and Arrhythmia alarms 1 Press the Menu Select button 2 Select Measurements Alarms from the menu and press the Menu Select button 3 Select HR Arrhythmia and press the Menu Select button 4 Select Alarms On Off and press the Menu Select button Responding to HR and Arrhythmia Alarms When an alarm is announced the audio pause label is presented above the Navigation and Menu Select buttons Pressing any of these buttons temporarily silences the alarm audio while you are attending to the patient See Figure 38 Alarms will reannunciate if conditions exist for two minutes or another alarm con
20. select a device and press the Menu Select button 4 To change a profile select Change Profile and press the Menu Select button A menu of configured profiles for that device is displayed with the currently associated profile highlighted 5 Select the profile you want to associate with the device The MR x tests the profile to determine if the Bluetooth device can communicate with the 12 Lead Transfer Station Progress messages are displayed during the test If the test is successful the message Transmission Test Passed is displayed Press the Menu Select button to acknowledge the message Should the transmission test fail the message Transmission Test Failed is displayed along with additional information about where the failure occurred See Table 66 in Troubleshooting Additional Bluetooth Device Information Keep the following points in mind when working with Bluetooth devices e Many Bluetooth devices are not discoverable by default Check your device s documentation to see if you need to enable discovery e Asa general security practice you should not leave your Bluetooth device in discoverable mode e Some devices require that you turn on the Bluetooth functionality e Some devices may prompt you to authenticate each time Check your device s documentation to see if you can configure it to always communicate with the HeartStart MRx e Give your Bluetooth device an easily recognizable name as this is the name that appears on th
21. 005 616 271 21 Specifications and Safety This chapter describes the specifications and safety features of the HeartStart MRx monitor defibrillator Specifications General Dimensions with pads 31 5 cm W x 21 0 cm D x 29 5 cm H 12 4 in x 8 3 in x 11 7 in Dimensions with paddles 34 0 cm W x 21 0 cm D x 34 5 cm H 13 4 in x 8 3 in x 13 6 in Weight Less than 13 2 lbs including pads pads cable battery and full roll of paper Incremental weight of external standard paddles and paddle tray is less than 2 5 lbs Additional battery weighs less than 1 6 lbs Standard Operator Position Within one meter of device Defibrillator Waveform Biphasic Truncated Exponential Waveform parameters adjusted as a function of patient impedance Shock Delivery Via multifunction electrode pads or paddles 273 Delivered Energy Accuracy Selected Nominal Delivered Energy vs Patient Impedance Accuracy Energy Load Impedance ohms 25 50 75 100 125 150 175 1J 1 2 1 3 1 2 1 1 1 0 0 9 0 8 2J 2J 1 8 2 0 2 0 1 9 1 7 1 6 1 5 2J 3J 2 8 3 0 3 0 3 1 3 0 2 9 2 7 2J 4J 3 7 14 0 4 0 4 1 4 2 14 2 4 0 2J 5J 4 6 5 0 5 1 5 1 5 2 5 2 5 0 _ 2J 6J 5 5 6 0 6 1 6 2 16 3 6 3 6 1 2J 7J 6 4 7 0 7 1 7 2 7 3 7 3 7 1 2 8J 7 4 8 0 8 1 8 2 8 4 8 3 8 1 2J 9J 8 3 19 0 9 1 19 3 9 4 9 4 9 1 2J 10J 9 2 10 10 10 10 1
22. 01810 USA Authorized EU representative Philips Medizin Systeme B blingen GmbH Hewlett Packard Str 2 71034 B blingen Germany Canada EMC ICES 001 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 010 64392415 Registration number SFDA I 20043211207 Product Standard number YZB USA 52 21 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 coming from devices other than the HeartStart MRx may degrade the perfor mance of the MRx Electromagnetic compatibility with surrounding devices should be assessed prior to using the monitor defibrillator These Instructions for Use contain the following conventions WARNING Warning statements describe conditions or actions that can result in personal injury or loss of life CAUTION Caution statements describe conditions or actions that can result in damage to the equipment or loss of data NOTE Notes contain additional information on usage
23. 1 2 3 Wave Sector 1 Wave Sector 1 will only contain an ECG waveform This is the waveform used by the arrhythmia heart rate derivation and AED analysis algorithms If Pads are configured as the primary ECG source for Wave Sector 1 the ECG patient cable must be connected to the HeartStart MRx and to the monitoring electrodes on the patient in order to change the ECG source to a Leads selection NOTE When monitoring using a 3 lead ECG set the HeartStart MRx displays 1 ECG lead at a time 17 Wave Sectors 2 4 Wave Sectors 2 through 4 are automatically populated when parameter sources cables tubing are connected to the HeartStart MRx If the parameter source is the configured choice of a particular wave sector it is displayed in that wave sector If you connect a parameter source that is not configured to be displayed it is displayed in the first empty wave sector If you subsequently connect the configured parameter source it replaces the current parameter For invasive pressures you should label your waveforms as they are connected to avoid possible confusion Changing Displayed Waveforms Wave Sector 1 has a dedicated Lead Select button to change the displayed lead source Waveforms displayed in other wave sectors may be changed for the current patient through the menu See Menus on page 19 Parameter Blocks Measurements for monitored parameters are provided in the parameter blocks Parameter Block 1 always conta
24. 1 24 IP 80 MHz to 800 MH d INP 800 MHz to 2 5 GHz where P is the maximum output power rating of the transmitter in watts W according to the transmitter s specified output power and d is the recommended separation distance in meters m Field strengths from fixed RF transmitters as determined by an electromagnetic site survey should be less than the compliance level in each frequency range Interference may occur in the vicinity of equipment marked with the following symbol o gt At 80 MHz and 800 MHz the higher frequency range applies These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people Field strengths from fixed transmitters such as base stations for radio cellular cordless telephones and land mobile radios amateur radio AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy To assess the electromagnetic environment due to fixed RF transmitters an electromagnetic site survey should be considered If the measured field strength in the location in which the HeartStart MRx is used exceeds the applicable RF compliance level above the HeartStart MRx should be observed to verify normal operation If abnormal performance is observed additional measures may be necessary such as re orienting or relocating the HeartStart MRx gt Over the frequency range 150 kHz t
25. 165 Connecting the Pads CPR Cable 165 Connecting the Compression Sensor to the Pads CPR Cable 166 Attaching the Compression Sensor Adhesive Pad 167 Applying Multifunction Electrode Pads 168 Placing the Compression Sensor on the Patient 169 Using Q CPR in Manual Defib Mode 170 Compression Waveform 171 Parameter Block 2 172 Soft Keys 173 Using Q CPR in AED Mode 174 CPR Feedback 176 Adjusting CPR Feedback Volume 176 Feedback Prompts 177 Q CPR Data Capture 179 Q CPR Feedback Setting 179 Research Storage Setting 179 Data and Events Recorded 180 Reviewing Q CPR Data 180 Troubleshooting 180 17 Configuration 181 Overview 181 Accessing the Configuration Menu 181 Setting the Date and Time 182 Modifying Settings 182 Saving Configuration Settings to a Data Card 183 Loading Configuration Settings from a Data Card 183 Restoring the Default Settings 183 Printing Configuration Settings 183 Configurable Parameters 184 18 Data Management 203 Overview 203 Copying from Internal Memory 204 Viewing and Erasing the Data Card 204 Printing the Event Summary 205 Printing the Vital Signs Trending Report 206 Printing the 12 Lead ECG Report 206 Events Recorded 207 Marking Events 212 Printing Events 213 vii 19 Maintenance 215 Overview 215 Automated Tests 216 Automated Test Summary 217 Ready For Use Indicator 218 Shift Checklist 219 Weekly Shock Test 219 HeartStart MRx Shift Checklist 220 Operational Check 222 Performing the Operational Chec
26. 3 seconds 195 bpm doubled amplitude 3 seconds Patient Isolation defibrillation proof e ECG Type CF e SpO Type CF e EtCO Type CF e NBP Type CF e Invasive Pressures Type CF e Temperature Type CF e External Defib Type BF e Internal Defib Type CF Other Considerations The HeartStart MRx is suitable for use in the presence of electrosurgery Burn hazard protection is provided via a 1K current limiting resistor contained in each ECG lead wire 277 Display Size 128 mm x 171 mm Type TFT Color LCD Resolution 640 x 480 pixels VGA Sweep Speed 25mm s nominal stationary trace sweeping erase bar for ECG Invasive Pressure and SpO 6 25 mm sec for CO Wave Viewing Time 5 seconds ECG Battery Type 6 0 Ah 14 8 V rechargeable Lithium Ion Dimensions 165 mm H x 95 mm W x 42 mm D 6 5 in x 3 8 in x 1 6 in Weight Less than 1 6 Ib 0 73 kg Charge Time with instrument off Approximately 3 hours to 100 Approximately 2 hours to 80 indicated by indicator Charging the battery at temperatures above 45 C may degrade battery life Capacity At least 5 hours of monitoring with ECG SpO CO3 temperature and two invasive pressures monitored continuously NBP measured every 15 minutes and 20 200J discharges with a new fully charged battery operating at room temperature 25 C At least 3 5 hours of monitoring with ECG SpO CO temperature and two invasive pressures monitored continuously
27. 5 of reading 0 08 for every 1 mmHg above 38 mmHg Values read at sea level after gt 20 min warm up For breath rates above 80 and EtCO values gt 18 mmHg accuracy is 4mmHg or 12 of reading whichever is greater Drift of Measurement Accuracy Over any 24 hour period the accuracy claims listed above are maintained The accuracy specification is maintained to within 4 for the following gas mixtures all values are in Vol 0tol3 0to97 5 0 to 100 0to 80 dry to saturated According to EN21647 Rise Time 190 ms maximum 10ml min System Response Time with a standard length FilterLine 2 9 seconds typical includes the delay time and rise time 10 to 90 in response to a step change in the CO concentration Alarm Delay Time 5 2 seconds standard deviation 0 08 seconds includes the 2 9 second FilterLine delay Sample Flow Rate Nominally 50 ml min 7 5 to 15 ml min 283 Microstream CO Humidity Correction Factor BTPS Body Temperature and Pressure Saturated 37 C 750mmHg 100 humidity or 47mmHg is the humidity correction factor for the Microstream CO readings Correction calculation formula Parps Fcoz x Pb 47 FCO x 0 94 Where FCO2 fractional concentration of CO in dry gas Fog CO 100 Pb ambient pressure Alarm Range e Low Limit 10 to 94 mmHg Adult Pediatric e High Limit 20 to 95 mmHg Adult Pediatric AwRR Range 0 to 150 rpm Resolution 1 rpm Accuracy e 0
28. Configuration settings on the MRx as needed Bluetooth Connection Lost message The Bluetooth device is not within range Move the Bluetooth device closer to the MRx within the transmitting range See the 12 Lead Transmission Implementation Guide for information on transmission ranges Bluetooth device pairing failed message The wrong pass code was entered on the Bluetooth device The pairing process timed out The Bluetooth card is corrupt Check the pass code Select the device from the MRx Add Devices list and pair again Try pairing again Call for service No Bluetooth Devices Configured message The Bluetooth device has not been paired with the MRx Pair the Bluetooth device with the MRx Table 66 12 Lead Transmission Problems Bluetooth Continued No transmission devices detected message The Bluetooth device Make sure the Bluetooth device is turned on is not turned on The Bluetooth device is not within range The Bluetooth pairing information has been lost The Bluetooth card is corrupt Move the Bluetooth device closer to the MRx within the transmitting range See the 12 Lead Transmission Implementation Guide for more information Pair the Bluetooth device with the MRx Replace the Bluetooth card Transmission Failed No Dial Tone message Cell phone service is unavailable The Bluetooth modem connection is not secure
29. 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 If the patient is moving secure the sensor cable loosely to the patient 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 Keep power cables away from the sensor cable and connection Avoid placing the sensor in an environment with bright lights If necessary cover the sensor with opaque material Avoid placing the sensor on an extremity with an arterial catheter blood pressure cuff or intravenous infusion line WARNING Failure to apply the sensor properly may reduce the accuracy of the SpO measurement 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 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 CAUTION Do not use more than one extension cable M19414A Position the sens
30. Keys Softkey Softkey 1 2 NOTE Pictures of the HeartStart MRx display appearing in this manual are for illustration purposes only The content of these areas varies with the display view the options on your device and the function being performed 15 General Status The general status area of the display contains e Mark Event button label e Date and time e Audio recording icon If the option is enabled one of the audio recording icons is displayed to the left of the battery icons in all clinical modes to indicate the status of audio recording e Battery power indicators Battery icons labeled A and B correspond with the battery compartments located at the back of the HeartStart MRx Each battery icon displays the current available battery power ranging from hollow fully discharged to full fully charged as shown in Figure 6 If the AC Power Module is inserted in Compartment B the no battery icon is displayed Figure 6 Battery Charge Level Indicators BS Ct T 9 Ee oe No Battery Empty Battery 25 Capacity 50 Capacity 75 Capacity 100 Capacity e INOP statements INOP statements appear in the top left of the display if equipment problems are detected e ECG HR alarm status Alarm messages communicate arrhythmia alarms as well as overall alarm status alarms off alarms paused e Patient information Some modes of operation allow for the entry of patient information via a menu choice If no informat
31. NPD 5 oz per gallon water one part Coverage Plus NPD to 255 parts water Before cleaning remove all adherent soil tissue fluids etc and wipe thoroughly with a cloth dampened with water before applying the cleaning solution When cleaning do not immerse Wring any excess moisture from the cloth before cleaning Be sure to avoid pouring fluids on the device and do not allow fluids to penetrate the exterior surfaces of the device To prevent scratching the display the use of a soft cloth is recommended Printer Printhead If the printout has light or varying print density clean the printhead to remove any buildup of paper residue To clean the printhead 1 2 3 4 Push the printer door latch to open the door Remove the roll of paper Clean the printhead surface above the brush with a cotton swab dipped in isopropyl alcohol Replace the roll of paper 239 Paddles Therapy Cable External non sterilizable paddles and the Therapy cables may be cleaned with a soft cloth moistened with e Mild soap and water e Gluteraldehyde solution 3 4 gluteraldehyde content such as CidexPlus e Sodium hypochlorite chlorine bleach 3 solution in water e Quaternary ammonium compounds 21 quaternary ammonium content such as Steris Coverage Plus NPD 5 oz per gallon water one part Coverage Plus NPD to 255 parts water e Isopropyl alcohol 70 solution in water CAUTION The paddles and Therapy
32. Operational Check without a therapy cable attached Connect a therapy cable and rerun Operational Check Table 64 NBP Monitoring Problems NBP Cuff Not Deflated INOP The NBP numeric value is replaced with a The NBP cuff pressure has been greater than SmmHg 0 67kPa for more than 3 minutes Remove cuff from patient e Release pressure in the cuff disconnect cuff from tubing e Replace the cuff If the problem persists call for service NBP Cuff Overpressure INOP The NBP cuff pressure has exceeded the overpressure safety No action is required the cuff should deflate automatically If not remove cuff from patient and replaced with a for inflation deflation or the total measurement The NBP ic value i oe lwihaz limit of 300 mmHg deflate NBP Interrupted INOP The measurement needed longer Check that the cuff size is appropriate The NBP numeric value is than the arainn tims provided Check cuff placement NBP Measurement Failed INOP The NBP numeric value is replaced with a A measurement value could not be obtained Check cuff size and placement NBP Calibration Overdue INOP NBP module needs calibration Calibration should be performed once a year or every 10 000 cycles whichever comes first Call for service of the NBP module Do not use the NBP monitoring capabilities until the calibration has been performed
33. Pause for CPR soft key has been pressed or e if the time since the previous shock exceeds the Protocol Timeout setting 1 2 3 4 Protocol Timeout Sets the time interval used to determine if a delivered shock should be counted as part of the shock series see Shock Series above 30 60 90 120 150 180 210 Off seconds CPR Timer Sets the length of the pause interval that automatically starts when e a Shock Series is completed e The Pause for CPR soft key is pressed e A No Shock Advised NSA decision is made the NSA CPR pause is enabled and the conditions for using the CPR Timer setting for the NSA CPR pause interval are met see below e The Shock button is not pressed for the configured Time to Auto Disarm setting after the device is armed in AED mode or e Continuous artifact is detected during rhythm analysis 30 60 90 120 150 180 seconds No Shock Advised NSA Action Defines how the device behaves following a No Shock Advised NSA decision e Monitor directs the device to monitor the patients ECG following an NSA decision and prompts the user to periodically perform CPR The CPR prompt interval is defined by the Monitor Prompt interval e Time Setting directs the device to provide a CPR Pause interval following a NSA decision If a shock has been delivered in the current Shock Series the length of the CPR Pause interval is defined by the CPR Timer setting Ot
34. Sample Message Window Connect Pads Cable 19 High Contrast Display NOTE To optimize visibility of the HeartStart MRx display when used in bright sunlight the device provides a High Contrast feature which may be enabled In this view the MRx display appears using a yellow background with all other screen elements appearing in black or shades of gray High Contrast is enabled in Manual Defib Pacer and Monitor Modes by pressing the Menu Select button and selecting High Contrast On from the Main Menu The High Contrast feature does not display colors configured as red or blue therefore be sure your device is configured correctly with the appropriate parameter color settings Refer to Configuration on page 181 for more information Controls The Therapy Knob is used to turn the HeartStart MRx on in the desired mode of operation Operating controls are organized by function with general function buttons located along the left and bottom sides of the display defibrillation controls to the right of the display and soft keys immediately below the display See Figure 1 Therapy Knob 20 The Therapy Knob serves as the power switch for the HeartStart MRx It can be set to Off e AED to enable AED Mode for semi automated external defibrillation e Monitor to enable Monitor Mode for 3 or 5 lead ECG monitoring 12 lead ECG acquisition optional Vital Signs Trending or monitoring of optional parameters e Pacer
35. Shock button on the HeartStart MRx to deliver a shock into the test load External paddles simultaneously press the shock buttons located on the paddles to deliver a shock into the test load 6 Confirm on the printed strip that the energy delivered to the test load is 150J 23J 127J to 173J If not take the device out of use and call for service What Gets Tested in an Operational Check Operational Checks supplement the Automated Tests by verifying therapy cables the ECG cable paddles audio charge and shock buttons and the ability to deliver defibrillation and pacing therapy Operational Checks also notify you if the battery NBP module or CO module needs calibration and checks the SpO module printer and Compression Sensor If you choose to perform the weekly shock test in lieu of the Operational Check you need to ensure the ECG cable pacing functions audio battery calibration NBP and CO calibration CO and SpO modules temperature Bluetooth invasive pressures printer and Compression Sensor are checked periodically The best way to do this is through an Operational Check It is recommended that you establish a schedule for conducting periodic Operational Checks 221 Operational Check Operational Checks should be performed at regular intervals to supplement the hourly daily and weekly Automated Tests executed by the MRx Automated Tests provide adequate assurance that the device is in a functional state of readi
36. The HeartStart MRx offers one channel of real time continuous temperature monitoring The device can monitor nasopharyngeal esophageal rectal skin arterial venous core and urinary bladder temperatures Measurements which can be displayed in either Fahrenheit or Celsius may be taken while in Monitor Pacer or Manual Defib modes Selecting a Temperature Label The HeartStart MRx monitors the temperature of the area where the sensor is located To assure specific temperature settings are matched with the temperature reading assign the proper temperature label to the measurement When modifying a temperature label all settings including alarm limits associated with that label become active The default label is Temp Table 19 Temperature Labels Tesoph esophageal temperature Tnaso nasopharyngeal temperature Trect rectal temperature Tvesic urinary bladder Tskin skin temperature Tart arterial temperature Temp non specific temp label Tven venous temperature Tcore core temperature To select a temperature label perform the following 1 Press the Menu Select button 2 Using the Navigation buttons select Measurements Alarms and press the Menu Select button 3 Select the temperature label option currently assigned to your measurement default is Temp and press the Menu Select button 4 Select Label and press the Menu Select button 5 Select the appropriate label from the list provided and press the Me
37. Trunk Cable 12 pin Connector for 3 Lead 5 Lead and 12 Lead use 989803147691 1 3 meter 10 lead ECG Trunk Cable 12 pin Connector for 3 Lead 5 Lead and 12 Lead use M3526A 3 wire Lead Set with Snap AAMI M3527A Add 7 wire Lead Set for 12 Lead use AAMI M3528A 3 wire Lead Set with Snap IEC M3529A Add 7 wire Lead Set for 12 Lead use IEC M5530A Combiner Plug for 3 wire Lead Set for use with M3526A M3528A M1949A 10 lead ECG Patient Trunk Cable 12 pin ECG Input Connector for 5 Lead and 12 Lead use M1968A 10 electrode Cable Set Extremities Grabber use with M1976A AAMI M1976A 10 electrode Cable Set Chest Grabber use with M1968A AAMI M1971A 10 electrode Cable Set Extremities Grabber use with M1978A IEC M1978A 10 electrode Cable Set Chest Grabber use with M1971A IEC Beers M1500A 3 lead ECG Trunk Cable AAMI M1605A 3 lead ECG Lead Set with Snaps AAMI M1510A 3 lead ECG Trunk Cable IEC MI615A 3 lead ECG Lead Set with Snaps IEC 244 M1520A 5 lead ECG Trunk Cable AAMI M1625A 5 lead ECG Lead Set with Snaps AAMI M1530A 5 lead ECG Trunk Cable IEC M1635A 5 lead ECG Lead Set with Snaps IEC M1783A Sync Cable 8 ft M5526A Sync Cable 25 ft M1191A Reusable SpO Sensor Adult Finger M1192A Reusable SpO Sensor Pediatric Small Adult Finger M1194A Reusable SpO Sensor Adult Pediatric Ear Clip M11
38. V4 V4 C4 placement fifth intercostal space at left midclavicular line V5 C5 placement same level as V4 on anterior axillary line V6 C6 placement same level as V4 at left mid axillary line For accurate V C lead placement and measurement it is important to locate the fourth intercostal space as follows 1 Locate the second intercostal space by first palpating the Angle of Lewis the small bony protuberance where the body of the sternum joins the manubrium This rise in the sternum is where the second rib is attached and the space just below this is the second intercostal space 2 Palpate and count down the chest until you locate the fourth intercostal space Figure 35 shows the typical electrode placement for a 12 lead ECG set Figure 35 12 lead Placement Conventional 12 Lead ECG In conventional 12 Lead ECG using 10 electrodes an electrode is placed on the right arm left arm right leg and left leg Six V C electrodes are placed on the chest as shown in Figure 35 The right leg electrode is the reference electrode NOTE When you do a 12 lead ECG you should attach the limb leads to the patient s extremities 52 Lead Selection It is important to select a suitable lead for monitoring so that a QRS complex can be accurately detected The guidelines for lead selection are as follows For non paced patients e QRS complex should be tall and narrow recommended amplitude gt 0 5mV e R wave should
39. are properly applied in an anterior anterior position If not valid for ventilation detection necessary prepare the patient s skin and apply new pads Pads Off INOP Pads are not making proper contact Make sure the Pads CPR cable is connected and pads are properly applied in an anterior anterior position If necessary prepare the patient s skin and apply new pads Cannot Analyze Vent INOP Spontaneous respiration indicated by a change in the impedance signal of gt 3 Ohms Excessive noise on the impedance signal Assess the patient for the return of spontaneous respiration If present discontinue CPR Make sure the Pads CPR cable is connected and pads are properly applied If necessary prepare the patient s skin and apply new pads Audio Tones and Alarm Indications The following table describes the audio tones and alarm indications when they occur and their meaning NOTE Alarm tone volume levels exceed 60 dB See the HeartStart MRx Service Manual for alarm signal pressure ranges Table 76 Audio Tones Single beep Message tone Accompanies a new message on the display Informational such as switching to the other battery Continuous tone lower pitch than charged Charging tone Generated when the Charge button is pressed and continues tone until the device is fully charged Continuous tone Charged tone Generated when the selected defibrillation energy is reached and continu
40. are reported through the Ready For Use indicator and the Automated Test Summary report For information on responding to these results see Ready For Use Indicator on page 218 To respond to errors reported through Operational Check see Operational Check Test Results on page 231 For further technical and repair information refer to the HeartStart MRx Service Manual WARNING Product servicing and repair should only be performed by qualified service personnel 249 Symptoms The following tables list symptoms INOP statements and messages that you may encounter along with possible causes of the problem and potential solutions Symptoms are characterized by functionality Table 62 General Problems The HeartStart MRx does not turn on There is no power Insert a fully charged battery e Connect to AC DC power Audio is too low or absent The QRS Voice or Alarm volume is configured to a Very Soft or Off setting Use the Volume menu to adjust the volume of the QRS beeper voice prompts and or alarms inaccurate Low battery life appears to The battery may be nearing its end Replace the battery deplete quickly of life Battery charge indicators The battery may need calibration Calibrate the battery All Settings Have Been Reset To Default Values message A power failure or critical software error has occurred Reset alarms waveforms volumes and other settings
41. associated with filling of the lung icon will vary from patient to patient Actual tidal volumes should be determined based on chest rise Parameter Block 2 also contains a numeric value for No Flow Time If no compressions are detected the No Flow Timer starts The No Flow Time value is displayed beginning at 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 exceeds 1 minute it is assumed that CPR compression activity has stopped intentionally and the value is reset to two dashes If monitoring CO the EtCO numeric value is displayed in Parameter Block 2 along with its alarm limits Soft Keys From Code View in Manual Defib Mode press the Start CPR soft key to display the CPR sub view shown in Figure 80 This soft key is then labeled Stop CPR and may be used to switch between the CPR sub view and the standard Code View of Manual Defib Mode NOTE Pressing the Start CPR soft key turns off the Sync function Conversely pressing the Sync button turns off the CPR sub view NOTE The Start CPR soft key is disabled if patient category is Pedi or patient age is less than 8 years old The Intubate soft key is also displayed in the CPR sub view When you press this soft key its label changes to
42. card see Installing the Data Card on page 46 Turn the Therapy Knob to either Monitor Pacer or Manual Defib Press the Menu Select button Using the Navigation buttons select Other and press the Menu Select button Select Data Management and press the Menu Select button Press the Menu Select button to acknowledge the message Leaving Normal Operational Mode Use the Prev Item and Next Item soft keys to select an Event Summary Press the Menu Select button to display the Data Management menu So oo N ABA WN Re UO NHN Select Copy and press the Menu Select button The message Copying Patient Data is displayed while the Event Summary and any 12 Lead Reports are copied to the data card NOTE Do not remove the external data card from the HeartStart MRx while the device is copying 12 lead reports Viewing and Erasing the Data Card The contents and status of your data card are conveniently available for viewing To display data card information Turn the Therapy Knob to either Monitor Pacer or Manual Defib Press the Menu Select 9 button Using the Navigation buttons select the Other menu and press the Menu Select button Select Data Management and press the Menu Select button Press the Menu Select button to acknowledge the message Leaving Normal Operational Mode A v O N e Press the Menu Select button to display the Data Management menu 7 Select View Data Card and press the Menu Select button Prev Pag
43. compressions Fifteen seconds without sign of compressions 15 seconds without sign of compressions 30 seconds without sign of compressions Thirty seconds without sign of compressions 30 seconds without sign of compressions 45 seconds without sign of compressions Forty five seconds without sign of compressions 45 seconds without sign of compressions 60 seconds without sign of compressions Sixty seconds without sign of compressions 60 seconds without sign of compressions Ventilation Activity 30 seconds without sign of ventilations Thirty seconds without sign of ventilations 30 seconds without sign of ventilations Ventilation feedback not given because of poor pads to patient contact or impedance gt 140 ohms Press pads firmly to patient s bare chest Press pads firmly to patient s bare chest 177 Table 22 CPR Feedback Prompts Continued CPR Activity compressions or ventilations 15 seconds without signs of CPR Fifteen seconds without signs of CPR 15 seconds without signs of CPR 30 seconds without signs of CPR Thirty seconds without signs of CPR 30 seconds without signs of CPR 45 seconds without signs of CPR Forty five seconds without signs of CPR 45 seconds without signs of CPR 60 seconds without signs of CPR Sixty seconds without signs of CPR 60 seconds without signs of CPR
44. data Call for service Data Card was not available Cycle the power Wait at least 16 seconds after power up before attempting to print an Event Summary or trending report Table 62 General Problems Continued Event Storage Full message Event Summary data for the current patient case exceeds the storage capacity of internal memory or you ve reached the 12 hour limit e Copy or print Event Summary to retain data and then begin a new patient case e Print the Event Summary Report Begin a new patient case Power Supply Failure INOR There is a problem with the internal power supply Remove the device from use and call for service Replace Clock Battery message The battery on the internal clock needs to be replaced Call for service Shock Equip Malfunction INOP A shock can not be delivered due to a hardware failure Remove the device from use and call for service Shutting Down in 1 Minute message Very low battery and the device is not connected to AC DC power Insert a charged battery and or connect to AC DC power Shutting Down Now message Battery charge is depleted and the device is not connected to AC DC power Insert a charged battery and or connect to AC DC power Settings for the current patient may need to be reset 251 Table 63 ECG Monitoring Problems QRS beeper inaudible or beeps do not occur with each QRS complex The QRS v
45. fax number from the numeric list using the Navigation buttons Include any extra digits necessary such as 9 for an outside line or 1 plus the area code for long distance 5 Select Done and press the Menu Select button NOTE Ifyou are transmitting to a manually entered fax number using a Bluetooth device the device and landline prefix if applicable must be entered 153 Transmission Status NOTE 154 During 12 Lead Report transmittal a status bar is displayed to show the progress of the connection and report transmission Once the connection is made the status bar contains the date and time stamp of the 12 Lead Report being sent See Figure 71 Figure 71 12 Lead Transmission Status Bar 11 Aug 2004 10 52 Sending 40 complete Z The status bar continues to display in any clinical mode of operation 12 Lead Reports successfully transmitted to the hub are logged to the Event Summary and appear using the format 12 Lead 12 25 33 Transmitted to site name Transmitting Stored 12 Lead Reports 12 Lead Reports for the current patient that are stored in internal memory may also be transmitted To transmit a stored 12 Lead Report 1 From the 12 Lead Preview or Report View press the Menu Select 9 button 2 Using the Navigation buttons select Reports from the 12 Lead Main Menu 3 Using the Navigation buttons scroll through the list of stored reports and highlight the desired report Reports are identified by date tim
46. for cardiac arrest The HeartStart MRx provides therapy through the application of a brief biphasic pulse of electricity to the cardiac muscle This electrical energy is transferred through disposable multifunction electrode pads applied to the patient s bare chest Configuration choices allow you to customize AED Mode to better meet the unique needs of your organization or resuscitation team This chapter describes how to use AED Mode It explains the prompts that guide you through the defibrillation process and describes how prompts vary depending upon the condition of the patient and the configuration of your device For information on annotating storing and printing event information acquired in AED Mode see Data Management on page 203 For information on setting configuration choices see Configuration on page 181 Precautions for AED Therapy WARNING The AED algorithm is not designed to handle erratic spiking problems caused by a properly or improperly functioning pacemaker In patients with cardiac pacemakers the HeartStart MRx may have reduced sensitivity and not detect all shockable rhythms NOTES The Philips HeartStart MRx AED mode is not intended for children under 8 years of age For children 8 years of age and older the American Heart Association recommends that standard operating procedures for AEDs be followed See the American Heart Association Guidelines 2005 for Cardiopulmonary Resuscitation and Emergenc
47. may be printed by pressing the button Event Summaries stored in internal memory may be individually selected and printed Event Summaries may be selected and copied to a data card using the Data Management menu New Event Summaries are initiated each time one of the following activities occurs The arrival of a valid ECG signal e The arrival of valid SpO data e The arrival of valid CO data e The arrival of valid invasive pressure data e The arrival of valid temperature data e An NBP measurement is requested e The Charge 52 button is pressed The Mark Event button is pressed The amount of patient data collected including two ECG waveforms two invasive pressure waveforms and one CO waveform and other clinical events is determined by the amount of internal memory available The number of incidents stored in memory at any given time is determined by the length of each incident and the amount of data collected There is 12 hour data limit per incident with a maximum capacity of 55 patient incidents regardless of card capacity or size of incidents When deleting records are erased oldest first Monitoring and defibrillation functions are disabled while using the data management features of the HeartStart MRx An active patient incident is closed upon entering Data Management 203 Copying from Internal Memory To copy Event Summaries and 12 Lead ECG Reports stored in internal memory to a data card Insert a data
48. may result in a rhythm that was analyzed as shockable converting spontaneously to non shockable and could result in inappropriate delivery of a shock WARNING Use only 3 wire AC power cords with 3 pronged grounded plugs WARNING Never operate the HeartStart MRx in standing water Do not immerse or pour fluids on any portion of the HeartStart MRx If the device does get wet dry the device with a towel WARNING Do not use the HeartStart MRx in the presence of a flammable anesthetic mixture or oxygen concentrations greater than 25 or partial pressures greater than 27 5 kPa 206 27 mmHg This can cause an explosion hazard WARNING Avoid connecting the patient to several devices at once Leakage current limits may be exceeded Do not use a second defibrillator on the patient while pacing with the HeartStart MRx 29 N WARNING Electric shock hazards exist internally Do not remove assembly screws except as described in the carry bag assembly procedure Refer servicing to qualified personnel WARNING Operating the HeartStart MRx or its accessories in conditions outside the environmental specifications can result in device or accessory malfunction The HeartStart MRx should be allowed to stabilize within the operating temperature range for 30 minutes prior to operation WARNING Avoid touching monitoring electrodes and other measuring devices when they are applied to the patient Doing so can degrade s
49. not use for more than 8 hours of continuous pacing Electromagnetic Compatibility When using the HeartStart MRx electromagnetic compatibility with surrounding devices should be assessed A medical device can either generate or receive electromagnetic interference Testing for electromagnetic compatibility EMC with and without the appropriate accessories has been performed according to the international standard for EMC for medical devices IEC 60601 1 2 This IEC standard has been adopted in Europe as the European Norm EN 60601 1 2 The EMC standards describe tests for both emitted and received interference Emission tests deal with interference generated by the device being tested WARNING Radio frequency RF interference from devices other than the HeartStart MRx may degrade performance of the HeartStart MRx Electromagnetic compatibility with surrounding devices should be assessed prior to using the defibrillator Fixed portable and mobile radio frequency communications equipment can affect the performance of medical equipment See Table 89 for the minimum recommended separation distance between RF communications equipment and the HeartStart MRx Reducing Electromagnetic Interference The HeartStart MRx and associated accessories may be susceptible to interference from other RF energy sources and continuous repetitive power line bursts Examples of other sources of RF interference are medical devices cellular products
50. of MRx mode change Stopped Audio Recording Full Logged when audio recording stops because 90 minutes of audio has been recorded for the current event Q CPR NOTE Q CPR events are logged to the patient incident record but are not included in the Event Summary report printed by the HeartStart MRx Events and waveforms related to Q CPR can be viewed through Q CPR Review Q CPR feedback On Logged at the beginning of an event if the Q CPR Feedback configuration setting is On Q CPR feedback Off Logged at the beginning of an event if the Q CPR Feedback configuration setting is Off Cannot Analyze Vent Caused by ventilation events either spontaneous respiration or noise with an impedance change gt 3 ohms PCI Clear All Logged when PCI INOP conditions are cleared For example Cannot Analyze Vent Pads Off Pads are off the patient while Q CPR is active ventilation invalid Poor Pads Contact Pads are on the patient but the impedance is gt 140 ohms while Q CPR is active CPR Sensor Inverted Compression sensor is upside down CPR Sensor Compression sensor responds with an error Malfunction CPR Sensor Device cannot communicate with the compression sensor Unplugged 211 Marking Events The Mark Event button allows you to annotate the Event Summary and the ECG strip at the point in time the button is pressed If configured pressing the Mark Event button prints a 6 se
51. of Q CPR Table 22 CPR Feedback Prompts Compression Depth Too shallow Compress deeper Compress deeper A little too shallow Compress a little deeper Compress a little deeper Too deep Don t compress so deep Don t compress so deep A little too deep Don t compress quite so Don t compress quite so deep deep Compression Rate Too slow Compress faster Compress faster A little too slow Compress a little faster Compress a little faster Too fast Compress slower Compress slower A little too fast Compress a little slower Compress a little slower Compression Duration Time Too short Increase duration of each compression Increase duration of each compression Residual Pressure on the Patient s Chest Incomplete release of compression Leaning Release pressure between compressions Release pressure between compressions Ventilation Rate Too low Ventilate more often Ventilate more often Too high Ventilate less often Ventilate less often Ventilation Volume Not enough volume Give more volume Give more volume Ventilation Inflation Time Too slow Ventilate more forcefully Ventilate more forcefully Too fast Ventilate less forcefully Ventilate less forcefully A little too fast Ventilate a little less forcefully Ventilate a little less forcefully Compression Activity 15 seconds without sign of
52. operation time is limited If a battery is inserted and charging the audio chirp is not present e A solid red X and a periodic audio chirp indicate a failure has been detected that may prevent the delivery of defibrillation therapy pacing or ECG acquisition When turned on the device displays INOP messages for the failures detected e A solid red X without periodic audio chirps indicates either there is no power available or the device cannot power on If after power is supplied the indicator reverts to the blinking black hourglass symbol the device is once again ready for use NOTE The RFU indicator may briefly display a solid red X when initially turning the device on when switching between clinical and non clinical operating modes and at the start of any automated test This does not indicate a failure of the device External Power Indicator The external power indicator is located above the display It is green if power is being provided by an external AC or DC power source See Figure 12 Figure 12 External Power Indicator NOTE The external power indicator will momentarily go out when charging for defibrillation with a charged battery installed This is normal operation as the device is switching its power source to the battery for a faster charge time NOTE The AC Line Filter default setting of all HeartStart MRx devices is 60 Hz You should adjust the AC Line Filter default to the electric power frequency of
53. pads cable and test load 2 Turn knob to 150J Required 3 Connect ECG cable Exit Op Check 224 Figure 85 Operational Check Screen 02 Mar 2006 10 53 AEM fh Operational Check Model Number M3535A Serial Number US00108360 Last O perational Check 04 May 2005 9 35 P ass General System Test Pass Therapy Knob Pass Charge Button Pass Shock Button Pass Audio Test Pass Defib Test Pass Pads Pacer Test Pass Compression Sensor Test Pass Leads ECG Test Pass ECG Cable Pads Paddles ECG Test Pass Battery Compartment A Test Pass Cal Recommended Battery Compartment B Test Pass SpO2 Test In Progress NBP Test CO2 Test Invasive Pressure Test Temperature Test Bluetooth Test Printer Test Exit Op Check 225 Table 57 Operational Checks Test button lights and you are prompted to Press Shock or Press Shock buttons on paddles e Ifthe MRx does not detect a press of the Shock button within 10 seconds the message If the Shock button does not work select Shock from the menu below is displayed Note The device automatically disarms after the time specified in the configuration is reached The message Defib Disarmed is displayed General System Tests internal clock battery None None power supply and internal memory card Therapy Knob Tests if the Therapy Knob is set None None to 150J Charge Button Tests the Charge button Depending on the cable Re
54. position Connecting the ECG Cable To connect a 3 5 or 10 lead cable 1 Align the ECG cable with the white ECG port as shown in Figure 18 The white key marker on the ECG cable faces the top of the device Push the ECG cable firmly into the ECG port until the white portion of the cable connector is no longer visible Figure 18 Connecting the ECG Patient Cable 35 3 Setting Up Connecting the SpO3 Cable Connecting the SpO Cable To connect the SpO cable 1 Hold the cable connector with the flat side facing front as shown in Figure 19 2 Insert the cable into the blue SpO port on the HeartStart MRx and push until the blue portion of the cable connector is no longer visible Figure 19 Connecting the SpO Cable 36 Connecting the NBP Interconnect Tubing Setting Up Connecting the NBP Interconnect Tubing To connect the NBP Interconnect Tubing 1 Insert the NBP Interconnect Tubing into the red NBP port as shown in Figure 20 2 Attach the NBP Interconnect Tubing fitting to the NBP cuff Figure 20 Connecting NBP Interconnect Tubing NBP Cuff 37 Connecting the Invasive Pressures Cable To connect the invasive pressure cable 1 Insert the invasive pressure cable into either of the invasive pressure ports as shown in Figure 21 2 Attach the invasive pressure cable to your transducer tubing 3 Assign a label to the connection on the HeartStart MRx Figure 21 Connecting Invasive Pressure Cable 38
55. potentially life threatening decreases in oxygen saturation This additional limit setting is preset through the Configuration menu If the SpO Low Limit alarm value is set below the configured SpO Desat Limit the SpO Desat Limit value is automatically adjusted to the SpO Low Limit alarm value Should the SpO reading fall below this limit the SpO Desat Limit alarm is announced Enabling Disabling the SpO Alarms NOTE To enable the SpO Alarms perform the following steps 1 Press the Menu Select button 2 Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button 3 Select SpO and press the Menu Select button 4 Select Alarms On Off and press the Menu Select button While an NBP measurement is in progress SPO INOP messages are suppressed for up to 60 seconds Pulse Rate Alarms Pulse Rate alarms are off unless you enable them during use The configured alarm limits may be changed during use Alarms are annunciated if measurements fall outside the configured limits for high and low pulse rate Pulse Rate alarms are all categorized as non latching alarms meaning they are automatically removed when their alarm condition no longer exists Table 11 details Pulse Rate alarms Table 11 Pulse Rate Physiological Alarms Pulse High Yellow Yellow alarm message Pulse value exceeds the high alarm limit alarm tone Pulse Low Yellow Yellow alarm message Pulse value ha
56. providers PPP Password Typically not needed but may be required by 40 characters blank some cell phone service providers Static IP Address Typically not needed but may be required by 15 characters nnn nnn nnn nnn blank some cell phone service providers Primary DNS Typically not needed but may be required by nnn nnn nnn nnn blank some cell phone service providers Secondary DNS Typically not needed but may be required by nnn nnn non nnn blank some cell phone service providers http Proxy Address Typically not needed but may be required by 15 characters blank some cell phone service providers http Proxy Port Typically not needed but may be required by 15 characters blank some cell phone service providers Baud Rate Available from your cell phone documentation If 9600 19200 38400 57600 115200 your phone transmits high speed data set to 115200 Flow Control Availabe from your cell phone documentation None Hardware Table 44 12 Lead Transmission Settings Hub Server URL Hub server address Available from your ISP 40 characters blank User Name http user name Use your web server 30 characters blank documentation to create user accounts on the hub Password http password Use your web server 40 characters blank documentation to create user accounts on the hub Table 45 12 Lead Transmission Settings Site Site Name This label appears in the Send To menu when intiti
57. select button 21 navigation buttons 21 print button 21 shock button 22 Sync button 22 therapy knob 20 CPR feedback 176 D data card installing 46 internal 203 loading configuration 183 removable 204 troubleshooting 265 data management 203 204 data card 204 events recorded 207 internal memory 204 specifications 285 data storing 4 Defibrillating 91 defibrillation controls 22 display high contrast 20 menus 19 views 15 E ECG cable connecting 35 ECG and arrhythmia monitoring 47 61 59 configurable parameters 185 ECG wave size 54 electrode placement 51 12 lead 52 3 lead 51 5 lead 51 VIC 52 INOP messages 58 lead selection 53 monitoring view 48 overview 47 preparation 49 310 specifications 276 troubleshooting 252 via electrodes 49 via multifunction electrode pads 50 electrode placement 51 electromagnetic compatibility 301 emissions and immunity 302 EtCO alarms 114 changing 115 enabling disabling 115 configurable parameters 191 indications 5 specifications 283 troubleshooting 262 Event Summary 203 205 button 21 external power indicator 23 G General status area 16 H HeartStart MRx intended use 4 I INOP alarm types 25 statements 16 troubleshooting 249 Invasive Pressures 117 alarms 127 changing 128 enabling disabling 128 cable connecting 38 calibration 123 confirmation 125 Cerebral Perfusion Pressure 119 configurable parameters 186 CPP alarms 129 indicatio
58. so skin preparation is important in achieving good contact If necessary clip hair at the electrode sites or shave sites if needed Clean and abrade the skin at the electrode site Dry the electrode sites briskly to increase capillary blood flow in the tissues and to remove oil and skin cells 87 5 If pacing in demand mode apply monitoring electrodes see Electrode Placement on page 51 and connect the ECG cable to the HeartStart MRx see Connecting the ECG Cable on page 35 NOTE If pacing for long periods of time new monitoring electrodes and multifunction electrode pads should be applied periodically Refer to the manufacturer s documentation for replacement recommendations NOTE The signal from a TENS unit can cause ECG artifact which may impact pacing Demand Mode Pacing To pace in demand mode 1 Turn the Therapy Knob to the Pacer position The message Pacing Paused appears in the status block and indicates that the pacing function is enabled however pace pulses are not being delivered Pacing is enabled in demand mode with the configured lead displayed in Wave Sector 1 If the configured lead is set to Pads Lead II or the first available monitoring lead is displayed 2 Press the Lead Select button to select the best lead with an easily detectable R wave See Lead Selection on page 53 NOTE Ifyou are using anterior anterior pads placement while pacing and are experiencing difficul
59. source for the alarm Systolic Diastolic or Mean and press the Menu Select button 6 Using the Navigation buttons increase or decrease the high limit value and press the Menu Select button 7 Set the new low limit value and press the Menu Select button 109 Enabling Disabling NBP Alarms To enable disable NBP Alarms 1 Press the Menu Select 9 button 2 Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button Select NBP and press the Menu Select button 4 Select Alarms On Off and press the Menu Select button Troubleshooting If your HeartStart MRx does not operate as expected during NBP Monitoring see Chapter 20 Troubleshooting on page 249 110 10 Monitoring Carbon Dioxide This chapter 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 CO Monitoring is available in Monitor Pacer and Manual Defib modes Overview The carbon dioxide monitoring function of the HeartStart MRx together with the appropriate FilterLine and if necessary airway adapter measures the partial pressure of carbon dioxide in a sample of the patient s exhaled breath aspirated from the breathing circuit The HeartStart MRx may be used to monitor carbon dioxide in both intubated and non intubated patients The partial pressure of carbon di
60. the paddle tray 3 Apply conductive matter to the paddle electrodes Do not distribute conductive matter by rubbing the paddle electrodes together 4 Apply paddles to the patient s bare chest using the anterior anterior placement or in accordance with your organization s protocol The sternum paddle contains a patient contact indicator PCI See Figure 49 If necessary as indicated by the appearance of either a red or orange LED on the PCI adjust paddle pressure and placement to optimize patient contact Once proper contact is made the PCI shows a green LED Figure 49 Patient Contact Indicator Patient Contact Indicator PCI NOTE Reasonable effort should be made to obtain a reading of at least one green LED Due to impedance this may not be possible for some patients and orange LEDs may be the best that can be achieved 75 Using Pediatric Paddles The HeartStart MRx s external paddle set comes with pediatric paddles included The American Heart Association recommends using pediatric paddles on children weighing lt 10 Kg larger paddles may be used as long as contact between the paddles is avoided To use the pediatric paddles set 1 Depress the latch at the front of the external paddle set while pulling forward on the adult paddle electrode 2 Store the adult paddle electrodes in the paddle tray pockets 3 To defibrillate see Using External Paddles on page 75 NOTE Impedance is the resistance betw
61. the HeartStart MRx Prior to disposal remove the batteries Then dispose of the device and accessories in accordance with your country s regulations for equipment containing electronic parts WARNING Disposal of the device with the battery inserted presents a potential shock hazard To avoid contaminating or infecting personnel the environment or other equipment make sure you disinfect and decontaminate the monitor defibrillator and any appropriate device accessories appropriately prior to disposal Disposing Empty Calibration Gas Cylinders To dispose of empty calibration gas cylinders 1 Empty the cylinder completely by pushing the pin of the regulator valve or by pulling out the pin of the fill valve using a tire valve stem wrench or a pair of needle nose pliers 2 When the cylinder is empty either remove the valve stem from the fill or regulator hole or drill a hole in the cylinder 3 Write Empty on the cylinder and dispose of it appropriately for scrap metal WARNING Ensure that the cylinder is completely empty before trying to remove the valve stem or drill the tank 242 Supplies and Accessories WARNING Use only supplies and accessories approved for use with your HeartStart MRx Use of non approved supplies and accessories could affect performance and results WARNING Use single use supplies and accessories only once Approved supplies and accessories for your HeartStart MRx are liste
62. the condition of your battery Storing Batteries Batteries should be rotated regularly to ensure even usage When storing batteries make sure that the battery terminals do not come in contact with metallic objects If batteries are stored for an extended period of time they should be stored in a cool place with a partial charge of 20 1 LED illuminated to 40 2 LED s illuminated capacity Storing batteries in a cool place slows the aging process The ideal storage temperature is 15 C 60 F Batteries should not be stored at temperatures outside the range of 20 C 4 F to 60 C 140 F CAUTION Do not store batteries in the HeartStart MRx if it is out of service for an extended period of time e Storing batteries at temperatures above 38 C 100 F for extended periods of time significantly reduces a battery s life expectancy Stored batteries should be charged every 2 months to 20 40 of their full capacity They should be charged to full capacity prior to use 237 N Discarding Batteries Batteries should be discarded if there are visual signs of damage or if they fail calibration Batteries should be discarded in an environmentally safe manner Properly dispose of batteries according to local regulations WARNING Do not disassemble puncture or incinerate batteries Be careful not to short the battery terminals because this could result in a fire hazard CAUTION Use caution when handli
63. time may be changed However a password is required to change the configuration of the device Accessing the Configuration Menu To access the Configuration Main menu 1 Turn the Therapy Knob to Monitor 2 Press the Menu Select 9 button 3 Using the Navigation buttons select Other and press the Menu Select button 4 Using the Navigation buttons select Configuration and press the Menu Select button To return to normal operating mode press the Exit Config soft key The Configuration Main menu is displayed listing sub menus for each category of configurable parameters You may use this menu to view or print your device s configuration as well as to modify the date and time settings To modify any other settings you must enter the configuration password printed on the front of the HeartStart MRx User Documentation CD ROM WARNING The HeartStart MRx should never be connected to a patient while performing configuration activities 181 Setting the Date and Time To modify the date and time setting from the Configuration menu Press the Menu Select button Using the Navigation buttons select Date and Time Then press the Menu Select button Using the Navigation buttons adjust the value for the year Then press the Menu Select button Select the appropriate month Then press the Menu Select button Adjust the value for the day Then press the Menu Select button A nA RW N e Adjust the value for the hour Then pre
64. to 40 rpm 1 rpm e 41 to 70 rpm 2 rpm e 71 to 100 rpm 3 rpm e 101 to 150 rpm 5 rpm Alarm Range e Low Limit 0 to 95 rpm Adult Pediatric e High Limit 10 to 100 rpm Adult Pediatric Apnea Alarm Delay 10 40 seconds in increments of 5 Calibration Gas for CO Measurement System Ingredients 5 Carbon Dioxide 21 Oxygen 74 Nitrogen Cylinder Size BD Method of Preparation Gravimetric Blend Tolerance 0 03 Accuracy 0 03 absolute Moisture 10 PPM Maximum Expiration Period 2 years Pressure 144 PSIG Volume 10L 284 12 Lead ECG Inputs With a 10 lead cable leads I II II aVR aVL aVF V C1 V C6 can be obtained All 12 Lead ECG waves can be viewed on the display simultaneously All 12 leads can be printed on the strip chart printer in 3x4 format Patient Data Storage Internal Event Summary The internal Event Summary stores up to 12 hours of 2 continuous ECG waves 1 CO and 2 invasive pressure waves events and trending per Event Summary There is a maximum capacity of 55 Event Summaries or 240 megabytes 62 megabytes for those devices with a 64 megabyte card of patient data whichever comes first Data Card Event Summary The Data Card has a maximum capacity of 60 Event Summaries or 240 megabytes 62 megabytes for those devices with a 64 megabyte card of patient data whichever comes first Environmental M3535A Temperature 0 C to 45 C operating 20 to 70 C storage e Charging the battery a
65. to enable Pacer Mode optional for demand or fixed mode pacing e Manual Defib to enable Manual Defib Mode for asynchronous or synchronous defibrillation cardioversion at the selected energy setting In Manual Defib Mode without Pacing the defibrillation energy settings are labeled as 1 9 10 15 20 30 50 70 100 120 150 170 and 200 Joules If your unit is equipped with Pacing the energy settings are labeled as 1 10 15 20 30 50 70 100 120 150 170 and 200 Joules General Function Buttons The general function buttons control monitoring or non critical resuscitation activities They include Mark Event button allows you to insert a time stamped annotation in the Event Summary Report to note events as they occur including the administration of certain drugs A Mark Event button label appears at the top left corner of the display Lead Select button changes the ECG lead in Wave Sector 1 Pressing this button cycles through the available ECG waves changing the displayed wave and label The list of available ECG waves is based on the current lead set and device configuration and includes pads or paddles if the corresponding cable is connected to the device Alarm Pause button N The Alarm Pause button 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 Pressing the Alarm Pau
66. up to five shocks was administered four with the initial defibrillator and a fifth cross over shock was delivered with the other defibrillator if necessary The sequence of energy settings was 100J 150J 200J through the first three shocks on either type of defibrillator A fourth shock if necessary was delivered at 200J if the initial defibrillator was biphasic and at 360J if the initial defibrillator was monophasic The cross over shock was 360J monophasic if the initial defibrillator was biphasic and 200J biphasic if the initial defibrillator was monophasic Successful cardioversion was defined as the occurrence of two P waves uninterrupted by atrial fibrillation within 30 seconds of the shock Randomization to the use of monophasic or SMART Biphasic defibrillators was done in 212 elective cardioversions involving 210 patients at eleven clinical sites in the United States and Europe Of these 203 results met the protocol criteria for inclusion in this analysis The biphasic and monophasic groups were similar in terms of age sex weight current medical history cause of heart disease and estimated ejection fraction The 150J SMART Biphasic waveform successfully converted far more patients with an initial 100J shock 60 compared with 22 for the monophasic waveform and successfully converted patients at least as well with a maximum energy of 200J as the monophasic did with its maximum energy of 360 91 compared to 85 for the monophasic w
67. visual indicators are provided as feedback to the rescuer when CPR performance deviates outside of target ranges See the Q CPR Application Note for more information on Q CPR The Q CPR Data Capture option enables you to capture data on CPR quality from the HeartStart MRx using the Q CPR option The Q CPR Data Capture option enables the storage of 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 NOTE Events related to Q CPR are not stored in the HeartStart MRx Event Summary 163 WARNING Q CPR is available for use with the HeartStart MRx only The Q CPR option is not intended for use in a moving environment such as an ambulance Additional movement introduced during patient transport may reduce the accuracy of the compression and ventilation measurements If Q CPR must be used in a moving environment do not rely on the Q CPR feedback during such conditions It is not necessary to remove the Compression Sensor from the patient Q CPR is not to be used on patients under 8 years of age or less than 25 kg The Q CPR option should not be used to verify placement of airway adjuncts such as endotracheal tubes and laryngeal masks Ventilation feedback accuracy may be decreased when the patient is handled or moved or when the Q CPR option is used on patients with certain c
68. when advisory algorithm cannot complete analysis sequence No Shock Advised Logged when a non shockable rhythm is detected Shock Advised Logged when a shockable rhythm is detected Pacer Pacer Mode Demand Logged when pacing is started and when mode is changed Fixed Pacer Start or Resume Logged when pacing is started and when pacing is resumed xx ppm xx mA Pacer Rate xx ppm Logged when rate or output is changed and maintained for 2 seconds while Pacer Output xx mA pacing The logged time will be the time the setting took effect If this event is logged out of order a will be appended to the time stamp Pacer Pause Stop Logged when the Therapy Knob is moved off the Pacer position while pacing 12 Lead 12 Lead Acquired Logged when action occurs 12 Lead Printed date Logged when action occurs time 12 Lead Deleted date Logged when action occurs time 12 Lead Transmitted Logged when 12 Lead Report is successfully transmitted from the MRx date time Mark Event Mark Event Logged when Mark Event button is pressed Mark event drug Logged when user selects an entry from the Mark Event menu Print Print Strip Logged when Print button is pressed 210 Table 52 Event Information Audio Audio Recording Logged when audio recording starts or resumes after being stopped Started Audio Recording Logged when audio recording stops because
69. your country See Configurable Parameters on page 184 23 Audio Recording If your device has the Audio Recording option it is configured to On by default and cannot be turned off during use but can be turned off in Configuration Mode One of the following icons is displayed to the left of the battery icon in all clinical modes Table 2 Audio Recording Icon Audio recording on Audio recording off s Audio is not recorded if any of the following circumstances occur e The Audio Recording configuration setting is set to Off The HeartStart MRx is in Monitor 12 Lead or Pacer mode 90 minutes of audio has been recorded for the current event Reviewing Recorded Audio To review the recorded audio e Copy the event data from the HeartStart MRx internal memory to an external data card See the Data Management chapter on page 203 for information e Import the data into the Q CPR Review application See the Q CPR Review Directions for Use for more information Alarms The HeartStart MRx provides various alarm types indicating changes in patient condition or device cable conditions which may require attention Table 3 details different alarm types Table 3 HeartStart MRx Alarm Types Red High priority Life threatening alarm condition is present Immediate operator response is required Red alarm message alarm tone Yellow Medium priority Non life threatening alarm condition is prese
70. 0 1 2 Printer Format Selects the number of rhythm strips to be printed with the 12 Lead Report 0 1 or 3 3x4 3x4 1R 3x4 3R Rhythm Strip 1 Selects the first rhythm strip printed in the 3x4 I II IH aVR aVL aVE V1 V2 V3 V4 V5 1R or 3x4 3R format V6 Rhythm Strip 2 Selects the second rhythm strip printed for I IL II aVR aVL aVE V1 V2 V3 V4 V5 reports in the 3x4 3R format V6 Rhythm Strip 3 Selects the third rhythm strip printed for reports I II III aVR aVL aVF V1 V2 V3 V4 V5 in the 3x4 3R format V6 NOTE Ifthe same configuration file is used to configure multiple devices be sure to assign a unique device ID number to each device NOTE The 3x4 3R Printer Format Setting is not for use with the 12 Lead Transmission option Table 42 12 Lead Transmission Settings Bluetooth and Modem Profile Profile Name Name of the profile 20 characters blank Configuration String Available from your cell phone service provider 45 characters blank Landline Set to Yes if you are using a modem Yes No Dial Prefix Only configurable if Landline is set to Yes The 10 characters blank dial prefix is the number or numbers you dial before the phone number For example you may need to dial a 9 for an outside line or an area code in addition to the number Dial String Available from your cell phone service provider 40 character
71. 0 10 2J 15J 14 15 15 15 16 16 15 15 20J 18 20 20 21 21 21 20 15 30J 28 30 30 31 31 31 30 15 50J 46 50 51 51 52 52 50 15 70J 64 70 71 72 73 733 71 15 100J 92 100 101 103 104 104 101 15 120J 110 120 121 123 125 125 121 15 150J 138 150 152 154 157 156 151 15 170J 156 170 172 175 177 177 172 15 200J 184 200 202 206 209 209 202 15 Charge Time e Less than 5 seconds to 200 Joules with a new fully charged Lithium Ion battery pack at 25 C e Less than 15 seconds when operating without a battery using the M3539A AC power module alone at 90 100 rated mains voltage e Less than 15 seconds with a new fully charged Lithium Ion battery pack at 25 C depleted by up to 15 200 Joule discharges e Less than 25 seconds from initial power on with a new fully charged Lithium Ion battery pack at 25 C depleted by up to 15 200 Joule discharges e Less than 25 seconds from initial power on when operating without a battery using the M3539A AC power module alone at 90 100 rated mains voltage e Less than 30 seconds from initiation of rhythm analysis AED Mode with a new fully charged Lithium Ion battery pack at 25 C depleted by up to 15 200 Joule discharges e Less than 30 seconds from initiation of rhythm analysis AED Mode when operating without a battery using the M3539A A
72. 0 Temperature 283 SpO monitoring 93 alarms 100 changing 100 enabling disabling 101 applying a sensor 97 configurable parameters 192 connecting the cable 36 desat alarm 101 indications 5 overview 93 parameters 98 pleth wave 99 selecting a sensor 95 specifications 280 troubleshooting 256 supplies 243 symbol definitions 289 Synchronized Cardioversion 79 disabling 81 preparing 79 shock delivery 80 using an external monitor 79 T Temperature 133 alarms 134 changing 135 enabling disabling 135 changing degree units 135 configurable parameters 193 connecting the cable 39 indications 6 monitoring 134 selecting a label 133 specifications 283 troubleshooting 267 therapy cable connecting 41 training 7 troubleshooting 249 12 Lead ECG Transmission 258 CO 262 data card 265 ECG problems 252 general problems 250 Invasive Pressures 266 NBP problems 254 pacing 263 printing 265 pulse 267 Q CPR 268 service numbers 271 SpO problems 256 Temperature 267 U User Checks 230 V Vital Signs Trending 157 adjusting interval 159 data 158 printing report 160 report format 158 reviewing data 157 wW warnings 297 wave sectors 17 changing 18 waveforms printing 28 weekly shock test 219 Z Zeroing invasive pressures 121 last zero 126 unable to zero causes 122 311 PHILIPS 453564041991 Edition 1 Philips Medical Systems Printed in the U S A September 2006 UO AA N I T MT S
73. 0 06 10 23 103841 10 47 were taken ZA s 36 a 38 ai 95 Se 38 soy during interval ciose Print 4 4 b Trends Trends MENU Parameters A list of vital signs Trending data In the body of the monitored by the MRx during the report vital sign units of measure are displayed time period not displayed in the table About The Data Displayed 158 When trending is initially displayed the latest most recent trending data will appear in the far right column The display will auto update as new vital sign data become available as long as the latest data are displayed on screen If you have scrolled left to view older data the screen will not update to new data when available The latest data will be displayed when scrolling back to the most recent data If a parameter has not been measured during the display period it is not listed in the display If a parameter in the display has invalid information it is indicated by Questionable data are indicated by a question mark just before the numeric value and unavailable data are indicated by an empty space Aperiodic measurements e g NBP are displayed with a measurement timestamp below the readings A after the timestamp indicates multiple measurements were taken during the interval The most recent measurement within the interval is displayed If an inactive parameter becomes active when viewing a Vital Signs Trending Report the added parameter will a
74. 0 ft L e 75 mm W x 30 m 100 ft L Noninvasive Pacing Waveform Monophasic Truncated Exponential Current Pulse Amplitude 10 mA to 175 mA 5 mA resolution accuracy 10 or 5 mA whichever is greater Pulse Width 40 ms with 10 accuracy Rate 30 ppm to 180 ppm 10 ppm increments accuracy 1 5 Modes Demand or Fixed Rate Refractory Period 340 msec 30 to 80 ppm 240 msec 90 to 180 ppm 279 SpO Pulse Oximetry SpO Measurement Range 0 100 SpO Resolution 1 SpO Update Period 1 2 sec typical maximum lt 60 sec SpO Accuracy with e M1191A sensor 1 standard deviation 70 to 100 2 0 e M1192A sensor 1 standard deviation 70 to 100 2 0 e M1194A sensor 1 standard deviation 70 to 100 3 0 e M1195A sensor 1 standard deviation 70 to 100 3 0 e M1131A sensor 1 standard deviation 70 to 100 3 0 e M1903B sensor 1 standard deviation 70 to 100 3 0 e M1904B sensor 1 standard deviation 70 to 100 3 0 NOTE Accuracy outside the range indicated for each sensor is not specified The above referenced sensors were validated for use with the HeartStart MRx using the Philips picoSAT II SpO module with Fourier Artifact Suppression Technology FAST This module is not available as a stand alone device NOTE Pulse oximeter equipment measurements are statistically distributed therefore only two thirds of pulse oximeter equipment measurements can be expected to fall within Arms o
75. 1 Make sure the Sync function is still enabled as indicated by the presence of the Sync message in the upper right corner of the Wave Sector 1 2 Repeat Steps 4 6 under Delivering a Synchronized Shock The Sync function of the HeartStart MRx can be configured to either be enabled or disabled after each shock is delivered If configured to remain enabled and the Therapy Knob is moved to either Monitor or Pacer the Sync function is still enabled However should the Therapy Knob be moved to either the Off or AED positions the Sync function is disabled Disabling the Sync Function To turn off the Sync function of the HeartStart MRx press the Sync CG button Using Q CPR in Manual Mode If your HeartStart MRx has the Q CPR option refer to Using Q CPR in Manual Defib Mode on page 170 Troubleshooting If your HeartStart MRx monitor defibrillator does not operate as expected during defibrillation see Troubleshooting on page 249 81 7 Noninvasive Pacing This chapter explains the noninvasive transcutaneous pacing option available with the HeartStart MRx and describes how to perform pacing Overview NOTE NOTE NOTE Noninvasive transcutaneous pacing therapy is used to deliver pace pulses to the heart Pace pulses are delivered through multifunction electrode pads that are applied to the patient s bare chest While in Pacer Mode the ECG strip and Event Summary are easily annotated with event informatio
76. 112 Setting Up Microstream EtCO Measurements 113 Using the Nasal FilterLine 113 Using the FilterLine and Airway Adapter 113 Measuring EtCO 114 EtCO and AwRR Alarms 114 Changing the EtCO Alarm Limits 115 Enabling Disabling the EtCO Alarms 115 Changing the AwRR Alarm Limits 115 Changing the Apnea Time Alarm Limit 116 Enabling Disabling AwRR Alarms 116 Disabling the EtCO Monitoring Function 116 Troubleshooting 116 11 Invasive Pressures 117 Overview 117 Setting up for a Pressure Measurement 117 Selecting a Pressure to Monitor 119 Pressure Waves 120 Zeroing the Pressure Transducer 121 Zeroing Using the Menu Select Button 121 Zeroing Using a Soft Key in Monitor Mode 121 Calibration 123 Known Calibration Factor 123 Calibrating Reusable Transducer CPJ840J6 124 Calibration Confirmation 125 Last Zero Calibration 126 Non Physiological Artifact Suppression 126 Alarms 127 Enabling Disabling alarms 128 Viewing Changing Setting Source for Alarms 128 CPP Alarms 129 Wedge 129 Pulse 130 Pulse Sources 130 Changing Pulse Source 131 Setting Pulse Alarms 131 Enabling Disabling Pulse Alarms 131 Pulse Alarm Limits 132 Changing Default Pulse Source and Alarm Limits 132 Caring For Your Transducers and Probes 132 Troubleshooting 132 12 Temperature 133 Overview 133 Selecting a Temperature Label 133 Monitoring Temperature 134 Alarms 134 Setting Temperature Alarms 134 Changing Temperature Alarm Limits 135
77. 39 39 38 36 35 39 39 AwRR rpm 12 12 12 12 12 12 12 Sp02 100 100 100 100 100 100 100 Pulse bpm 95 95 95 95 95 95 95 Temp F 99 0 99 0 99 0 99 0 99 0 99 0 99 0 204 page See Printing the Vital Signs Trending Report on page 206 for more information NOTE Ifyour device has a 50mm printer its report will have 11 lines of text If the device has a 75mm printer the report contains 16 lines 160 Exiting Vital Signs Trending Report To exit the Vital Signs Trending Report and return to a waveform display press the soft key under the Close Trends label in the Vital Signs Trending Report display You will be returned to Monitor Mode Troubleshooting If your HeartStart MRx does not operate as expected during Vital Signs Trending see Chapter 20 Troubleshooting 161 16 Q CPR and Data Capture Overview The Q CPR option offers real time measurement and corrective feedback on the rate depth and duration of compressions as well as the frequency and volume of ventilations It also provides notification of lack of CPR activity Compressions are measured by the Compression Sensor connected to the HeartStart MRx using the M4763A Pads CPR cable Ventilation data is acquired through Philips multifunction defib electrode pads applied to the patient and connected to the HeartStart MRx using the same Pads CPR cable Q CPR is available in both Manual Defib Mode and AED Mode In both modes easy to follow audio prompts and
78. 4 76 33 61 54 0 01 Survival to Hospital Admission 33 54 61 31 61 51 0 27 Survival to Hospital Discharge 15 54 28 19 61 31 0 69 CPC 1 Good 13 15 87 10 19 53 0 04 Conclusion The 150 SMART Biphasic waveform defibrillated at higher rates than 200 360 monophasic waveforms resulting in more patients achieving return of spontaneous circulation ROSC p 0 01 EMS system outcomes of survival discharge were not significantly different statistically However patients resuscitated with the lower energy SMART Biphasic waveform were more likely to have good cerebral performance CPC cerebral performance category p 0 04 293 Clinical Performance Summary Cardioversion Methods Results 294 An international multicenter prospective double blinded randomized clinical trial was conducted to assess the effectiveness of the SMART Biphasic waveform in treatment of atrial fibrillation AF as compared to monophasic waveforms The primary objective of the study was to determine the required energy for cardioversion of AF using the SMART Biphasic waveform as compared with a monophasic damped sine waveform This section summarizes the methods and results of this study Patients enrolled for this study were adults scheduled for elective cardioversion of AF at one of 11 clinical sites Clinicians used both a defibrillator delivering the SMART Biphasic waveform and one delivering a monophasic waveform A sequence of
79. 5 Confirm the patient s pacing status is correct 138 Figure 65 12 Lead ECG Preview Screen Mark Event 10 Feb 2006 11 20 A_ ERT Jones Samuel Adult Non Paced 02 42 8 OF Temp C Pulse bpm 120 80 sts q120 i 120 SYS Ki 36 930 80x 95 9 118 77 s 3410 mms p02 EtCO2 mmig AWRR rpm o 8 15 100 38 18 ID 12345 55 Years Male Display 05 150 Hz Report 05 150 Hz Start Exit Start 05 40 Hz NBP 12 Lead Acquire Filter MENU 139 13 12 Lead ECG A quiring the 12 Lead ECG Acquiring the 12 Lead ECG Once preparation is complete to acquire a 12 lead ECG in Monitor Mode 1 Press the 12 Lead soft key The Preview Screen is displayed as shown in Figure 65 2 Check the signal quality on each lead and if necessary make adjustments as described in Improving Signal Quality on page 143 3 Check filter settings 4 Pressthe Start Acquire soft key The message Acquiring 12 Lead is then displayed while the HeartStart MRx acquires ten seconds of ECG data 5 If patient age and sex were not previously entered you are prompted to enter the information a For age use the Navigation buttons to increase or decrease the displayed value of the patient s age Then press the Menu Select button 9 b For sex use the Navigation buttons to select the patient s sex and press the Menu Select button 6 Keep the patient still while the message Acquiring 12 Lead is displayed Once ECG acquisition is comple
80. 95A Reusable SpO Sensor Infant M1941A SpO Extension Cable 2 m M1943A Nellcor SpO Sensor Adapter Cable 1 m use with M1903 4B M1131A Disposable SpO Sensor Pediatric Adult Finger M1903B Disposable SpO Sensor Pediatric Finger Available outside the US only M1904B Disposable SpO Sensor Adult Finger Available outside the US only 245 Interconnect Tubing M1598B Adult Pressure Interconnect Cable 1 5 m M1599B Adult Pressure Interconnect Cable 3 m Reusable Blood Pressure Cuffs 40400A Reusable NBP Cuff Kit 3 sizes pediatric adult large adult 40400B Reusable NBP Cuff Kit 5 sizes infant pediatric adult large adult thigh 40401A Traditional Reusable NBP Cuff Infant 40401B Traditional Reusable NBP Cuff Pediatric 40401C Traditional Reusable NBP Cuff Adult 40401D Traditional Reusable NBP Cuff Large Adult 40401E Traditional Reusable NBP Cuff Thigh M4552A Antimicrobial Reusable NBP Cuff Infant M4553A Antimicrobial Reusable NBP Cuff Pediatric M4554A Antimicrobial Reusable NBP Cuff Small Adult M4555A Antimicrobial Reusable NBP Cuff Adult M4557A Antimicrobial Reusable NBP Cuff Large Adult M4559A Antimicrobial Reusable NBP Cuff Thigh M1572A Multi Patient Comfort Cuffs Pediatric M1573A Multi Patient Comfort Cuffs Small Adult M1574A Multi Patient Com
81. C power module alone at 90 100 rated mains voltage 274 e Less than 40 seconds from initial power on AED Mode with a new fully charged Lithium Ion battery pack at 25 C depleted by up to 15 200 Joule discharges e Less than 40 seconds from initial power on AED Mode when operating without a battery using the 3539A AC power module alone at 90 100 rated mains voltage Patient Impedance Range Minimum 25 Ohm external defibrillation 15 Ohm internal defibrillation Maximum 180 Ohm Note Actual functional range may exceed the above values Manual Defib Mode Manual Output Energy Selected 1 10 15 20 30 50 70 100 120 150 170 200 Joules maximum energy limited to 50J with internal paddles Controls On Off Therapy Knob Charge Shock Sync ECG Lead Select Disarm Print Mark Event Alarm Pause Event Review Energy Selection Front panel Therapy Knob Charge Control Front panel button button on external paddles Shock Control Front panel button buttons on external or switched internal paddles Synchronized Control Front panel SYNC button Indicators Text Prompts Audio Alerts QRS Beeper Battery Status Ready For Use External Power Sync Mode Armed Indicators Charging charged tones flashing shock button energy level indicated on display AED Mode AED Energy Profile 150 Joules nominal into a 50 ohm test load AED Controls On Off shock Text and Voice Prompts Extensive text audible messages guide user t
82. Charging Batteries The M3538A Lithium Ion Battery should be charged in either the HeartStart MRx or in a Philips approved battery support system The two methods of charging in the HeartStart MRx are as follows Using AC power Insert the battery to be charged into Battery Compartment A Insert the AC Power Module into Battery Compartment B and connect to an AC power source Using DC power Insert a battery to be charged into Battery Compartment A If a second battery is in need of charging insert it in Battery Compartment B Connect the DC Power Module to the HeartStart MRx and the DC power source Once AC or DC power is applied the External Power Indicator turns green and batteries in the HeartStart MRx charge Batteries are charged one at a time With the HeartStart MRx turned off and at a temperature of 25 C 77 F a fully discharged battery typically charges to 80 of its capacity in 2 hours and to 100 of its capacity in 3 hours Batteries charge at a slower rate with the device turned on Batteries should be charged at temperatures between 0 C 32 F and 45 C 113 F Charge Status You can check the battery s state of charge by e periodically pushing the fuel gauge button on the battery to illuminate the fuel gauge Each LED represents a charge of approximately 20 of capacity turning the Therapy Knob to any mode of operation and observing the battery power indicators displayed in the General Status area see Gene
83. E Iftemperature alarms are enabled alarm limits appear next to the temperature value If alarms are off the Alarms Off X symbol replaces the limits Changing Temperature Alarm Limits To change the temperature alarm limits for the current incident perform the following 1 2 3 Press the Menu Select button Using the Navigation buttons select Measurements Alarms and press the Menu Select button Select the temperature label option currently assigned to your measurement and press the Menu Select button Select Temperature Limits and press the Menu Select button Using the Navigation buttons change the high limit and press the Menu Select button Using the Navigation buttons change the low limit and press the Menu Select button Enabling Disabling Temperature Alarms Temperature alarms default to on To disable temperature alarms perform the following 1 2 4 Press the Menu Select Vv button Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button Select the temperature label option currently assigned to your measurement and press the Menu Select button Select Alarms Off and press the Menu Select button To turn alarms back on repeat the steps above except select Alarms On in Step 4 Changing Degree Units The HeartStart MRx can display temperature in either Fahrenheit or Celsius The default is Celsius and can only be changed through Configuration Mode See C
84. HeartStart MRx biphasic for use in intra thoracic application as compared to a control biphasic waveform This appendix summarizes the methods and results of the study Methods Twelve swine each weighing approximately 30 kg were anesthetized and intubated A sternotomy was performed to expose the heart VF was induced electrically by 60 Hz current via a pacemaker catheter in the right ventricle After 15 seconds of VF a defibrillating shock was applied using hand held 2 inch diameter surgical electrode paddles applied directly to the epicardium Shock energies of 2 5 10 20 and 30 J were used in random order At least 4 shocks at each energy level were administered for 4 separate VF episodes to derive a success data point at that energy Success was defined as conversion of fibrillating rhythm to non fibrillating rhythm five seconds after the shock Results The results showed that the average impedance was about 40 ohms in this study which is similar to the human impedance data encountered in direct heart defibrillation The efficacy results of the HeartStart MRx are shown in Table 84 along with historical efficacy results of a standard monophasic damped sine MDS waveform Table 84 Clinical Performance Summary Internal Defibrillation 2J 5J 10 20 30 HeartStart MRx biphasic Mean Success 4 47 77 86 88 Sample Size 48 53 53 51 41 Control Biphasic Mean Success 10 60 93 92 92
85. I DF39 requirements and AHA All other non shockable recommendation specificity gt 95 for adult defibrillation rhythms a From Philips Medical Systems ECG rhythm databases b American Heart Association AHA AED Task Force Subcommittee on AED Safety amp Efficacy Automatic External Defibrillators for Public Access Use Recommendations for Specifying and Reporting Arrhythmia Analysis Algorithm Performance Incorporation of New Waveforms and Enhancing Safety American Heart Association AHA AED Task Force Subcommittee on AED Safety amp Efficacy Circulation 1997 95 1677 1682 ECG and Arrhythmia Monitoring Inputs Up to four 4 ECG waves may be viewed on display and up to two 2 waves printed simultaneously Lead I II or III is obtained through the 3 wire ECG cable and separate monitoring electrodes With a 5 lead ECG cable leads aVR aVL aVF and V can also be obtained Pads ECG is obtained through 2 multifunction electrode pads Lead Fault LEAD OFF message and dashed line appear on the display ifan electrode or lead becomes disconnected Pad Fault Dashed line appears on the display if a pad becomes disconnected Heart Rate Display Digital readout on display from 15 to 300 bpm with an accuracy of 10 Heart Rate Arrhythmia Alarms HR Asystole VFIB VTACH VTACH Extreme Tachy Extreme Brady PVC rate Pacer Not Capture Pacer Not Pacing Common Mode Rejection Greater than 90 dB measured per AAMI sta
86. If NBP monitoring is essential to patient care take the device out of use NBP Equip Malfunction INOP NBP hardware failure Call for service of the NBP module Do not use the NBP monitoring capabilities If NBP monitoring is essential to patient care take the device out of use 254 Table 64 NBP Monitoring Problems NBP Service Required INOP The NBP module has reached its Call for service of the NBP module Do not use the end of life defined as 50 000 NBP monitoring capabilities If NBP monitoring is cycles essential to patient care take the device out of use Measurement cycle doesn t NBP is not configured for Check modify the configuration as needed automatically start automatic measurements Automatic measurements are not Use the Measurements Alarms menu to define an scheduled for the current patient automatic schedule of measurements for the current patient The Start NBP soft key has Press the Start NBP soft key not been pressed The pump operates but the Defective cuff Replace the cuff ff not inflate or fail TRE cuff does not inflate or fails t0 poon connection between the cuff Check connections and replace tubing if needed inflate fully and the HeartStart MRx NBP measurements appear The cuff size is too small large for Use the correct cuff size high low the patient 255 Table 65 SpO Monitoring Problems The SpO waveform i
87. If the INOP message persists try another transducer Make sure the transducer is on the supported accessories list Invasive Pressure Label Unplugged INOP The pressure transducer has been disconnected from the device or is faulty Try unplugging and then replugging the transducer If the symptom does not go away use a different transducer Invasive Pressure Label Zero Check Cal INOP Occurs when a new transducer is attached to the monitor Zero the transducer Check the calibration factor if applicable Check Scale displayed with pressure waveform The wave is clipped in the displayed wave area Change the scale Unable to Zero message The cause is displayed with the message Depends on the cause Unable to Calibrate message The cause is displayed with the message Depends on the cause Invasive Pressure Label one of the labels which can be applied to an Invasive Pressure pressure channel Table 73 Temperature Monitoring Problems Temperature Label Equip Malfunction INOP There has been a malfunction in the temperature hardware Contact Service Temperature Lahel Overrange INOP The temperature value is outside the measurement range of the device lt 0 C or gt 45 C Check that the temperature probe is on the list of supported accessories Try changing the application site Temperature Label Unplugged INOP The temper
88. If the new time interval is less than or the same as the time since the last measurement a measurement begins immediately NOTE You may perform a manual NBP measurement at any time even when an automatic schedule is set Simply press the Start NBP soft key To stop an NBP reading in progress press the Stop NBP soft key Changing the NBP Schedule To change the NBP schedule and or the interval of automatic measurements for the current patient 1 Press the Menu Select button 2 Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button 3 Select NBP and press the Menu Select button 4 Select NBP Schedule and press the Menu Select button 5 Using the Navigation buttons select the desired interval and press the Menu Select button NOTE Interval choices are presented in the format qx indicating measurements will be taken every x minutes from the time you first press Start NBP NOTE If no subsequent measurements are taken NBP values will removed from the display after 60 minutes but can still be obtained through Vital Signs Trending 108 Alarms An NBP alarm is annunciated when a measurement for the configured source systolic diastolic or mean falls outside the configured high or low limits NBP alarms are all categorized as non latching alarms meaning they are automatically removed when their alarm condition no longer exists Both the source of the alarm and the l
89. Menu Select button 2 Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button Select EtCO and press the Menu Select button 4 Select EtCO Limits and press the Menu Select button 5 Using the Navigation buttons increase or decrease the high limit value and press the Menu Select button 6 Set the new low limit value and press the Menu Select button Enabling Disabling the EtCO Alarms To enable or disable the EtCO alarms 1 Press the Menu Select button 2 Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button Select EtCO and press the Menu Select button 4 Select Alarms On Off and press the Menu Select button Changing the AWRR Alarm Limits To change the AwRR alarm limits 1 Press the Menu Select 9 button 2 Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button 3 Select AwRR and press the Menu Select button 4 Select AWRR Limits and press the Menu Select button 5 Using the Navigation Buttons increase or decrease the high limit value and press the Menu Select button 6 Set the new low limit value and press the Menu Select button 115 Changing the Apnea Time Alarm Limit To change the apnea time alarm limit 1 Press the Menu Select button 2 Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button 3 Select AWRR and press the Me
90. Menu Select button The alarms will now be on To turn alarms off repeat the steps above except select Alarms Off in Step 4 131 Pulse Alarm Limits Pulse alarm limits can be changed for the current incident To change alarm limits perform the following steps Press the Menu Select button Using the Navigation buttons select Measurements Alarms and press the Menu Select button Select Pulse and press the Menu Select button 1 2 3 4 Select Pulse Limits and press the Menu Select button 5 Using the Navigation buttons select the new high limit value and press the Menu Select button 6 Select the new low limit and press the Menu Select button Changing Default Pulse Source and Alarm Limits You can change the default pulse source in the pulse section of Configuration Mode See Chapter 17 Because pulse and heart rate share the same default alarm limits default pulse alarm limits can be changed in the ECG section of Configuration Mode Caring For Your Transducers and Probes Refer to the manufacturer s instructions for care and cleaning of your invasive pressure transducers and cables Inappropriate treatment of the cables will reduce their lifetime Troubleshooting If your HeartStart MRx does not operate as expected during invasive pressure monitoring see Chapter 20 Troubleshooting 132 12 Temperature This chapter describes how to monitor temperature using the HeartStart MRx Overview
91. Menu Select button The Vital Signs Trending Report is printed using the configured format Printing the 12 Lead ECG Report You can print individual 12 Lead ECG Reports for the current or most recent patient event through the 12 Lead Report View menu See Chapter 14 on 12 Lead Transmission 206 Events Recorded The following events and related information are stored in the Event Summary Italicized text in logged events is replaced by an appropriate value or selected option Table 52 Event Information Power On Off Device On Logged when device first turns on Device Off Logged when Therapy Knob is turned to Off position Continued Use Logged when device is turned on after being turned off for less than 10 seconds Mode AED Mode Monitor Mode Pacer Mode Selected Energy xx J Logged at start of incident and when mode or selected energy changes Return To Owner Display Logged when Return To Owner screen is displayed Patient Info Adult Patient Pediatric Patient Logged at start of incident and when changed Paced Patient Non Paced Patient Logged at start of incident and when changed Age xx unit Logged when set Male Female Logged when set Patient ID Logged when set Battery Status Battery Low Logged when batteries are low and external power is not available Batteries Low Logged when batteries are low and device is pacing
92. Modes Main Menu Pacer Mode Volume Displayed Waves Pacer Mode Printed Waves Measurements Alarms Patient Info Trends Other High Contrast On Exit 3 Use the Lead Select button to select the desired lead for viewing 89 NOTE Ifyou want to see the ECG waveform and related parameters while pacing you must have electrodes on the patient with pads Using pads only will give you an incorrect heart rate and inappropriate alarms 4 Press Pacer Rate and use the Navigation and Menu Select buttons to select the desired number of paced pulses per minute The initial rate is configurable 5 If needed adjust the initial pacer output To do this press Pacer Output and use the Navigation and Menu Select buttons to select the desired output The initial output is configurable 6 Press Start Pacing The message Pacing appears WARNING Use care when handling the multifunction electrode pads on the patient to avoid shock hazard during pacing 7 Verify that white pacing markers appear on the ECG waveform 8 Press Pacer Output Then use the Navigation and Menu Select buttons to a increase the output until cardiac capture occurs Capture is indicated by the appearance of a QRS complex after each pace pulse marker b decrease the output to the lowest level that still maintains capture 9 Verify the presence of a peripheral pulse 10 To pause or stop pacing Press Pause Pac
93. PHILIPS M3535A M3536A Instructions for Use HeartStart MRx HEARTSTART DEFIBRILLATORS Table of Contents 1 Introduction 3 Overview 3 Intended Use 4 Indications for Use 5 AED Therapy 5 Manual Defibrillation 5 Noninvasive External Pacing Therapy 5 Pulse Oximetry 5 Noninvasive Blood Pressure Monitoring 5 End tidal CO 5 12 Lead ECG 5 Q CPR 6 Invasive Pressures 6 Temperature 6 Safety Considerations 7 Documentation and Training 7 2 Getting Acquainted 9 Basic Orientation 10 Front Panel 10 Side Panels 11 Top Panel 12 Back Panel 13 M3538A Lithium Ion Battery 14 Battery Capacity 14 Battery Life 14 Operating Modes 14 Password Security 15 Display Views 15 General Status 16 Wave Sectors 17 Wave Sector 1 17 Wave Sectors 2 4 18 Changing Displayed Waveforms 18 Parameter Blocks 18 Turning Parameters On Off 18 Soft Key Labels 18 Menus 19 Message Windows 19 High Contrast Display 20 Controls 20 Therapy Knob 20 General Function Buttons 21 Defibrillation Controls 22 Soft Keys 22 Indicators 23 Audio Recording 24 Reviewing Recorded Audio 24 Alarms 25 Responding to Alarms 25 Entering Patient Information 27 Continued Use 27 Printing Waveforms 28 Return to Owner 29 3 Setting Up 31 Attaching the Carrying Case and Accessory Pouches 31 Storing Accessories 33 Connecting the ECG Cable 35 Connecting the SpO Cable 36 Connecting the NBP Interconnect Tubing 37 Connecting the Invasive Pressures Cable 38 Con
94. R Cable displays NOTE When using Q CPR SpO monitoring functionality is not available NOTE Compression and ventilation measurement values are printed in the annotation area of the ECG printed strip 170 Figure 80 Display View in Manual Mode with Q CPR 11 Feb 2006 22 32 m Eh wR Alarms Off Adult Non Paced 145 14 02 Selected Energy 150 Joules Shocks 0 2 0 ease mare i V U y V U V V 7 Compression Target Zone Disarm Compression Waveform If you do not have an invasive pressure waveform ABP ART Ao or PAP displayed the compression waveform appears in Wave Sector 3 and is labeled Comp The waveform is drawn at a speed of 12 5 mm second As the chest is compressed the compression is shown as a downward stroke of the wave rebounding up to a baseline as compression pressure is released The wave sector contains lines drawn at minus 38 mm and minus 51 mm minus 1 5 inches and minus 2 inches that define a target zone to help you achieve good compression depth Good compression depth is achieved when the peak or minimum value of the waveform appears between the lines When pressure is not released between compressions an asterisk will annotate the baseline segment between compressions This is also referred to as leaning If the signal from the Compression Sensor becomes invalid e g the sensor is disconnected the waveform appears as a dashed line 171 Parameter Block 2 In the CPR sub vie
95. RR rpm Area 60 343 18 Start NBP NOTE The Shock Counter displays the number of shocks delivered while in AED and Manual Defib modes 73 Preparing for Defibrillation In preparation for defibrillation 1 Connect the appropriate Therapy cable 2 Apply the paddles or pads as described below Using Multifunction Electrode Pads To prepare for defibrillation using multifunction electrode pads 1 If not pre connected connect the pads cable to the HeartStart MRx by aligning the white pointer on the pads cable connector with the white arrow on the green Therapy port Then push until you hear it click into place See Figure 46 Figure 46 Pads Internal Paddles Cable Connection 2 Check the expiration date that appears on the pads package 3 Inspect the packaging for any damage 4 Connect the pads connector to the pads cable See Figure 47 Figure 47 Pads Connector 5 Apply the pads to the patient as directed on the pads packaging or according to your organization s protocol 74 Using External Paddles To defibrillate using external paddles 1 If not pre connected connect the paddles cable to the HeartStart MRx by aligning the white pointer on the paddles cable connector with the white arrow on the green Therapy port Then push until you hear it click into place See Figure 48 Figure 48 Paddles Cable Connection 2 Remove the Paddle Set from the Paddle Tray by pulling the paddles straight up and out of
96. Rx Shift Checklist on page 220 Weekly Shock Test In addition to the shift check you must verify the ability to deliver defibrillation therapy once a week by performing one of the following e Operational Check e Weekly Shock Test See following instructions NOTE Test reusable sterilizable paddles internal or external prior to each use See the Sterilizable Defibrillator Paddles Instructions for Use for more information To perform the Weekly Shock test 1 Ifyou are using paddles make sure the paddles are secure in their pockets and that the Patient Contact Indicator PCI LEDs located on the sternum paddle are not lit If the LEDs light adjust the paddles in their pockets If the LEDs continue to light clean both the adult and pediatric paddle electrode surfaces or If you are using multifunction electrode pads attach a test load to the end of the patient Therapy cable 2 Turn the Therapy knob to 150J 3 Press the Charge button NOTE If it becomes necessary to disarm the defibrillator press Disarm 4 The strip prints if configured to do so If the strip does not print immediately press the Print button 5 If using Pads press the Shock button on the MRx to deliver a shock into the test load External paddles simultaneously press the shock buttons located on the paddles to deliver a shock into the pockets 6 Confirm on the printed strip that the energy delivered to the test load is 150J 23J 127J t
97. Sensor and cable for visible signs of damage If damaged remove from use Compression Sensor Adhesive Pads Make sure there is a Compression Sensor Adhesive Pad applied to the Compression Sensor and there is an adequate supply available Batteries Make sure a charged battery is in the HeartStart MRx Another charged battery should be available or should be charging Ensure the batteries have no visible signs of damage AC DC Power Check the AC DC power source and power cord available 1 Connect the AC DC power module to the HeartStart MRx and plug it into a power outlet 2 Verify that the external power indicator on the front panel is lit Printer Paper Make sure the printer has sufficient paper and is printing properly Data Card If applicable make sure a data card is inserted and has sufficient space available SpO Sensor Inspect the sensor and cable for visible signs of damage NBP Cuffs and Tubing Inspect the pressure cuffs and tubing for visible signs of damage CO FilterLine Confirm that at least one un opened sterile package is available Invasive Pressure Cables Inspect the cable for visible signs of damage Temperature Probes Inspect the probe and cable for visible signs of damage NOTES Upon completing the Operational Check and returning to a clinical mode Monitor Pacer Manual Defib or AED all settings will be reset to the device s configured values If your institution s protocol requires periodic alarm verification a
98. Solids Resistance IP2X EMC Complies with the requirements of standard EN 60601 1 2 2001 Safety Complies with the requirements of applicable safety standards Other Considerations e The HeartStart MRx is not suitable for use in the presence of concentrated oxygen or a flammable anesthetic mixture with air oxygen or nitrous oxide e Hazards arising from software errors were minimized by the product s compliance with the software requirements contained in EN 60601 1 4 1996 Mode of Operation Continuous AC Line Powered 100 240 VAC 50 60 Hz 1 0 46 A Class 1 Battery Powered 14 8 V Rechargeable Lithium Ion DC Powered Input 11 32 VDC 11 A e Output 18 V 5 A 90 W 286 Environmental M3536A Temperature 0 C to 45 C operating 20 to 70 C storage e Charging the battery at temperatures above 45 C may degrade battery life e Storing the battery for extended periods at temperatures above 40 C will reduce battery capacity and degrade battery life Humidity Up to 95 Relative Humidity e Printer paper may jam if paper is wet e Thermal Printer may be damaged if wet paper is allowed to dry while in contact with printer elements Altitude e Operating 0 to 15 000 ft 0 to 4 500 m e Storage 0 to 15 000 ft 0 to 4 500 m Shock e Operating Half sine waveform duration lt 3 ms acceleration gt 145 g 1 time on all six faces e Non operating Trapezoidal waveform acceleration gt 30 g velocity c
99. Start MRx you can obtain a continuous printout of the primary ECG and one additional waveform if you have the 50mm printer installed two additional waveforms if you have the 75mm printer installed Certain waveforms including invasive pressures and CO3 will include scale indications on the printout The printouts are generated either real time or with a 10 second delay depending on your configuration For devices with a 50mm printer to change wave forms for the second wave printed perform the steps below 1 Press the Menu Select Vv button 2 Using the Navigation buttons select the Printed Waves option and press the Menu Select button 3 Using the Navigation buttons select the wave form you want to print in Wave 2 and press the Menu Select button For devices with a 75mm printer to change wave forms for the second or third waves printed perform the steps below 1 Press the Menu Select Vv button 2 Using the Navigation buttons select the Printed Waves option and press the Menu Select button 3 Using the Navigation buttons select Wave 2 or Wave 3 and press the Menu Select button 4 Using the Navigation buttons select the wave form you want printed and press the Menu Select button 5 Repeat Steps 2 through 4 for the other printed wave 28 Return to Owner The Return to Owner feature allows the owner of the HeartStart MRx to enable a specified loan period When the time period is up the borrower of the HeartStart MRx will b
100. Synchronized Cardioversion Therapy 72 NOTE The HeartStart MRx provides synchronized cardioversion therapy by delivering a brief biphasic pulse of electricity to the cardiac muscle immediately following an R wave detected in the ECG measurement The SMART Biphasic waveform utilized in the HeartStart MRx has undergone clinical testing demonstrating its effectiveness for cardioversion of atrial fibrillation Successful resuscitation is dependent on many variables specific to the patient s physiological state and the circumstances surrounding the patient event Failure to have a successful patient outcome is not a reliable indicator of monitor defibrillator performance The presence or absence of a muscular response to the transfer of energy during electrical therapy is not a reliable indicator of energy delivery or device performance Code View In Manual Defib Mode an energy is selected and the Code View is displayed Code View is optimized to clearly communicate data associated with a resuscitation event Notice the increased prominence of the Event Timer as well as the enlarged ECG in Wave Sectors 1 and 2 as shown in Figure 45 Figure 45 Code View Display Mark Event 10 Feb 2006 11 20 fA_ Ex Alarms Off Adult Non Paced Heart Temp C Pulse bpm 7 Event Rate _ ae my 80x 39 0 02 4 qg Timer 36 9 36 0 80 X a enlarged ECG enlarged p gt Shock Selected Energy 150 Joules Shocks 0 Status p02 EtCO2 mmg AW
101. Voice represents voice prompt messages Text represents messages that appear on the display Soft key represents soft key labels that appear on the display above the button to which they correspond N Introduction Thank you for choosing the HeartStart MRx monitor defibrillator Philips Medical Systems welcomes you to its family of resuscitation devices The HeartStart MRx is designed to meet your monitoring and resuscitation needs by providing advanced multi parameter monitoring functions and a full range of defibrillation therapies This guide provides instructions for the safe and proper operation of the device as well as set up configuration and maintenance information Be sure to familiarize yourself with the features and operation of the HeartStart MRx prior to its use Overview The HeartStart MRx is a lightweight portable monitor defibrillator It provides four modes of operation Monitor Manual Defib AED and Pacer optional In Monitor Mode you can monitor up to four ECG waveforms acquired through a 3 5 or 10 lead ECG set Optional monitoring of pulse oximetry SpO noninvasive blood pressure NBP carbon dioxide EtCO temperature and invasive pressure are also available Measurements from these parameters are presented on the display Alarms are available to alert you to changes in the patient s condition You can also display a Vital Signs Trending Report to view all key parameters and their measureme
102. able may be faulty Ensure proper skin preparation and correction application If necessary apply new pads Check the date code on the pads Do not open the pads package until immediately prior to use Relocate or turn off equipment that may be causing RFI Try repositioning the pads cable Run the Operational Check with the pads cable If the test fails run it without the pads cable If the test passes replace the cable If not remove the device from use and call for service ECG Unplugged INOR No ECG cable is connected and the configured selected ECG in Wave Sector 1 is from leads Check that the ECG cable is firmly connected Connect an ECG cable or a pads therapy cable Leads Off INOR Electrode s for the configured selected ECG in Wave Sector 1 may be off or insecurely attached Electrode s are not making proper contact with the patient Apply electrodes pads to the patient Check that monitoring electrodes are properly applied If necessary prepare the patient s skin and apply new electrodes Solid flat line no waveform no Leads Off INOP Short in patient cable or leads Run the Operational Check with the ECG cable If the test fails run it without the ECG cable If the test passes replace the cable If not remove the device from use and call for service Table 63 ECG Monitoring Problems Continued Pads Paddles Off INOP Pads Paddles for Wave Sector 1 are
103. acing whenever possible Use fixed mode pacing when motion artifact or other ECG noise makes R wave detection unreliable or when monitoring electrodes are not available The HeartStart MRx requires a 3 5 or 10 lead ECG cable and monitoring electrodes as the source of the ECG during demand pacing Pace pulses are delivered through the multifunction electrode pads However the pads cannot be used to monitor the ECG and deliver pace pulses simultaneously NOTE The ECG derived from pads does not need to be displayed in a wave sector in order to deliver pacing therapy NOTE When using demand mode pads are not an available choice for display in Wave Sector 1 through either the Lead Select button or the Displayed Waves menu Preparing for Pacing To prepare for pacing 1 If not pre connected connect the pads cable to the HeartStart MRx by aligning the white pointer on the pads cable with the white arrow on the green Therapy port Then push until you hear it click into place See Figure 52 Figure 52 Pads Cable Connection 2 Make sure the multifunction electrode pads packaging is intact and within the expiration date shown 3 Connect the pads connector to the pads cable See Figure 53 Figure 53 Pads Connector 4 Apply the pads to the patient as directed on the pads packaging or according to your organization s protocol Prepare the patient s skin prior to applying the pads Skin is a poor conductor of electricity
104. afety and may affect results WARNING Do not touch communication ports and a patient simultaneously CAUTION Do not discharge the defibrillator with the paddles shorted together CAUTION Conductive parts of electrodes and associated connectors for applied parts including the neutral electrode should not contact other conductive parts including earth CAUTION This device is suitable for use in the presence of high frequency surgical equipment Following electrosurgery interference the equipment returns to the previous operating mode within 10 seconds without loss of stored data Measurement accuracy may be temporarily decreased while performing electrosurgery or defibrillation This does not affect patient or equipment safety See the electrosurgery device s Instructions for Use for information on reducing hazards of burns in the event of a defect in its equipment Do not expose the equipment to x ray or strong magnetic fields MRI CAUTION Be aware of patient cables including ECG monitoring equipment when used with high frequency surgical equipment NOTE This device and its accessories are not intended for home use NOTE The HeartStart MRx can be operated with only AC DC power only 14V M3538A Lithium Ion Battery or AC DC power and M3538A battery simultaneously NOTE For operation in the U S the AC power cord must have the proper NEMA type plug NOTE The HeartStart MRx does not require the practice
105. ailable parameters are displayed as well as any active alarm settings 48 There are two separate sources of ECG the ECG leads connection and the Pads Paddles connection Leads pads are displayed according to your device s configuration Lead II is configured as the primary ECG lead source and is displayed in Wave Sector 1 You may change this during use with the Lead Select button You can also configure the HeartStart MRx to display up to 3 additional leads or pads paddles when turned on see Configuration on page 181 The leads displayed may be changed during use through the Displayed Waves menu item Monitoring View displays the first valid source of ECG acquired in Wave Sector 1 For example if your HeartStart MRx has Lead II configured to display in Wave Sector 1 but pads are attached to the patient and connected to the defibrillator before a valid ECG can be obtained from the monitoring electrodes then Pads will be displayed in Wave Sector 1 However Lead II will take its place as soon as it is acquired NOTE The ECG lead source appearing in Wave Sector 1 is used to determine heart rate and monitor arrhythmia Preparing to Monitor ECG To prepare for monitoring ECG perform the following steps If monitoring via electrodes 1 Prepare the patient s skin prior to applying monitoring electrodes Skin is a poor conductor of electricity so skin preparation is important in achieving good electrode to skin contact Identi
106. aing a 12 Lead Report transmission The label should be an easy to recognize name 12 20 characters blank Site Type Indicates the type of device receiving the 12 Lead Report Fax Printer 12LTS TraceMaster Hub Phone Number Phone number for fax site type otherwise N A Note It is important that the you know the dialing rules from the 12 Lead Transfer Station For example does the 12 Lead Transfer Station need to dial a 1 or an area code in addition to the number If it does the number sent by the MRx must include these digits 20 characters blank URL URL for PC site type i e TraceMaster or another 12 Lead Transfer Station otherwise N A 40 characters blank Use Hub s Routing Indicates whether or not to use hub routing Note This field is not used by the 12 Lead Transfer Station 2 0 Yes No Default Site If yes this will be the highlighted site when the Send to menu is displayed When set to yes this field will automatically be set to no for all other sites Yes No 197 Table 46 Manual Therapy Settings Remain In Sync Mode After Shock Defines whether the device remains in Sync Mode after a synchronized shock is delivered Yes No Time To Auto Disarm Determines the amount of time the device will remain charged if a shock has not been delivered Applies to both Manual Defib and AED Modes 30 60 90 seconds are pass
107. al external paddles are present they reside on the top panel as shown Figure 3 Basic Orientation Top with Optional Paddles 12 Back Panel The back panel of the HeartStart MRx has two compartments for lithium ion batteries Compartment B may instead be used to connect an AC power module Between the battery compartments is a DC Power Input port The back panel also has an RS 232 serial port for 12 lead ECG transmission Figure 4 Basic Orientation Back a ee ED om Battery AC Compartment B PHILIPS Battery Compartment A Battery RS 232 Serial Port AC Power Module DC Power Input 13 M3538A Lithium lon Battery The HeartStart MRx uses the M3538A Lithium Ion Battery The battery has a fuel gauge with 5 LED indicators each representing a charge of approximately 20 of capacity Press the fuel gauge button to illuminate the fuel gauge CAUTION A battery should be used as the primary power source AC DC should be used as a secondary source if desired Ifan AC DC power module is used as the only power source the HeartStart MRx takes longer to charge to the desired energy level and in the event of power loss all settings reset to the default settings and a new incident is created when power is returned All stored data remains intact and can be found by retrieving the previous incident Keep your unit charged Battery Capacity
108. an Operational lead wire and ground Check ECG Cable Failure INOP A short has been detected between Replace the ECG cable a lead wire and ground Pads ECG Equip Malfunction A device hardware failure was Perform an Operational Check If the Pads Paddles INOP detected ECG Test fails with Therapy cable disconnect the Therapy cable from the device when prompted in order for the Pads Paddles ECG Test to run without the cabled connected If the Pads Paddles ECG test passes without the cable connected replace the Therapy cable ECG Equip Malfunction INOP A device hardware failure was Disconnect the ECG cable and perform an detected Operational Check If the Leads ECG Test fails remove the device from use and call for service If the Leads ECG Test passes replace the ECG cable and perform an Operational Check 253 Table 63 ECG Monitoring Problems Continued Lead Select button does not respond The 12 lead function is active Device is in AED Mode Exit the 12 lead function None Lead Select button does not display a pads choice The pads therapy cable is not connected Demand mode pacing is active Connect the pads therapy cable Exit pacing or choose fixed mode pacing One or more controls do not respond e g select lead or soft keys Faulty control or connection Remove the device from use and call for service Therapy Cable Failure INOP Performing an
109. an associated severity The severities of all selected interpretive statements are assessed to determine an overall severity for the ECG The categories of severity are No Severity Normal ECG Otherwise Normal ECG Borderline ECG Abnormal ECG and Defective ECG Stored and printed 12 Lead Reports can be configured to include all 12 leads measurements and interpretive analysis statements One or two copies of the 12 Lead Report are printed at the completion of acquisition and or analysis as configured Press the Print soft key to print another copy In addition to the information on the displayed 12 Lead Report the printed report includes up to three rhythm strips with the configured leads WARNING Should an alarm condition occur while a 12 Lead Report is 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 being printed This can cause distortion of the waveform and lead to potential misdiagnosis Accessing Stored Reports You may access stored reports to print additional copies or delete the report from internal storage You may also copy the report to a data card The list of stored reports for the current patient 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 press the Menu Select 9 butt
110. andard sphygmomanometer e sterile 10cc syringe with heparinized solution e 3 way stopcock approximately 25cm of tubing WARNING Never perform invasive pressure mercury calibration while the patient is being monitored To perform a mercury calibration on the CPJ840J6 perform the following 1 Zero the transducer see previous section 2 Connect the syringe and manometer See Figure 62 a Attach the tubing to the manometer b Connect the 3 way stopcock to the stopcock that is not connected to the patient catheter c Attach the syringe to one port and the manometer to the other port d Open the port to the manometer Figure 62 Connecting the Syringe and Manometer 124 Raise the manometer pressure to approximately 200 mmHg or 27 0 kPa Press the Menu Select button Using the Navigation buttons select Measurements Alarms and press the Menu Select button Select the pressure channel label you wish to calibrate and press the Menu Select button Select Calibration Pressure and press the Menu Select button o N A Wn A Q Using the Navigation Buttons select the Calibration Pressure you set for the manometer in Step 3 above The default is 200 mmHg 27 0 kPa Values range from 90 to 220 mmHg in increments of 1 12 0 to 30 0 kPa in increments of 0 2 9 Press the Menu Select button The HeartStart MRx will automatically set and display the calibration factor NOTE Upon successful calibration write the calibration facto
111. aning of each symbol shown on the HeartStart MRx and the M3538A battery Table 79 Monitor Defibrillator and Battery Symbols A Defibrillation Shock Attention See operating instructions in Instructions for Use Input Output Gas Sample Input lt Gas Exhaust Output Meets IEC type BF leakage current requirements and is defibrillator protected Patient Applied Part is isolated and defib proof suitable for direct patient contact except the heart or major arteries Meets IEC type CF leakage current requirements and is defibrillator Y protected Patient Applied Part is isolated and defib proof suitable for direct patient contact including the heart or major arteries Alarm Pause button Recyclable material Dispose of in accordance to your country s requirements 289 Table 79 Monitor Defibrillator and Battery Symbols Continued IP24 Protected against ingress of solid foreign objects gt 12 5mm in diameter Protected against access to hazardous parts with a finger Protected against splashing water IP2X Protected against ingress of solid foreign objects gt 12 5mm in diameter Protected against access to hazardous parts with a finger Data In Out Electrostic sensitive device Invasive Pressure Port Number indicates Port 1 or Port 2 NBP port SpO port Temperature port 290 Table 80 lists the mean
112. ation buttons select the Displayed Waves menu and press the Menu Select button Select the Wave Sector and press the Menu Select button 4 Select the desired lead and press the Menu Select button 5 If needed use the Navigation buttons to adjust the ECG wave size gain and press the Menu Select button Figure 36 Displayed Waves Menu Main Menu Displayed Waves Wave 1 TI Size Volume Pa a Printed Waves Wave 2 I x2 Measurements Alarms Wave 3 moo a aa Patient Info Wave 4 Ill x1 2 Trends Exit x114 Other Aito High Contrast On Exit Arrhythmia Monitoring The HeartStart MRx uses the ST AR Basic Arrhythmia Algorithm Arrhythmia analysis provides information on your patient s condition including heart rate and arrhythmia alarms The HeartStart MR x uses the ECG lead appearing in Wave Sector 1 for single lead arrhythmia analysis NOTE Because the ST AR Basic Arrhythmia Algorithm is the HeartStart MRx s cardiotach source and is needed to generate heart rate and heart rate alarms the algorithm can never be disabled However if desired arrhythmia and heart rate alarms can be turned off During arrhythmia analysis the monitoring function continuously e optimizes ECG signal quality to facilitate arrhythmia analysis The ECG signal is continuously filtered to remove baseline wander muscle artifact and signal irregularities Also if the Patien
113. ature transducer is faulty or has been disconnected from the device Try unplugging and then replugging the temperature transducer If the symptom does not go away use a different transducer Temperature Label one of the labels which can be applied to a temperature measurement Table 74 Pulse Problems Pulse Check Source INOP The currently selected pulse source is not available but another possible pulse source is on Switch to the secondary pulse source See SpO Table 65 and Invasive Pressures Table 72 for further troubleshooting information 267 Table 75 Q CPR Problems CPR Sensor Malfunction INOP The Compression Sensor power on self test has failed Check the Compression Sensor and cable connections If necessary replace the Compression Sensor CPR Sensor Unplugged INOP j The Compression Sensor is unplugged 2 The device cannot communicate with the Compression Sensor 1 Check the Compression Sensor and cable connections 2 Replace the Compression Sensor CPR Sensor Inverted INOP The Compression Sensor is not positioned correctly It is upside down Correctly apply the Compression Sensor to the patient See Placing the Compression Sensor on the Patient on page 169 with the patient Poor Pads Contact INOP Thoracic impedance measured at Make sure the Pads CPR cable is connected and pads gt 140 Ohms therefore the signal is
114. ave becomes non pulsatile the measurement will become mean only and be compared to the current source which may be systolic or diastolic and alarm limits WARNING Make sure you enable disable and set alarm limits for the correct label These settings apply to that particular label only Changing the label might change the alarm limits 127 Enabling Disabling alarms To enable disable alarms perform the following steps 1 Press the Menu Select button 2 Using the Navigation buttons select Measurements Alarms and press the Menu Select button 3 Select the pressure label channel label you wish to modify alarm status on and press the Menu Select button 4 Select Alarms On or Alarms Off and press the Menu Select button Viewing Changing Setting Source for Alarms Alarm sources and limits can be viewed or modified for a given pressure label To view or modify alarm settings perform the following steps 1 Press the Menu Select button 2 Using the Navigation buttons select Measurements Alarms and press the Menu Select button 3 Select the pressure label channel label you wish to view modify alarms on and press the Menu Select button 4 Select pressure label Limits and press the Menu Select button 5 Ifthe pressure label is pulsatile select the desired source of the alarm Systolic Diastolic or Mean and press the Menu Select button 6 Using the Navigation buttons increase or decrease the high limit and press
115. aveform Overall the biphasic waveform required fewer shocks 1 7 compared to 2 8 for the monophasic waveform and lower delivered energy 217 compared to 548 for the monophasic waveform Outcomes are summarized in Table 83 Table 83 Clinical Summary Cardioversion Cumulative Cardioversion Efficacy Single shock only 58 96 60 24 107 22 lt 0 0001 lt 2 shocks 74196 77 471107 44 lt 0 0001 lt 3 shocks 86 96 90 56 107 53 lt 0 0001 lt 4 shocks 87 96 91 91 107 85 0 29 Skin burn None 25 90 28 15 105 14 0 0001 Mild 50 90 56 471105 45 Moderate 15 90 17 41 105 39 Severe 0 90 0 2 105 2 Number of shocks 1 7 1 0 2 84 1 2 lt 0 0001 Cumulative delivered energy 217 176 548 331J lt 0 0001 Mild erythema no tenderness Moderate erythema tenderness Severe blistering or necrosis tenderness Skin reaction definitions evaluated 24 48 hours after procedure Conclusion The SMART Biphasic waveform cardioverted at higher rates than the monophasic damped sine waveform at each step of the protocol although the cumulative biphasic rate after 4 shocks was not significantly different from the monophasic rate Tissue damage was more pronounced in the monophasic population 295 Clinical Performance Summary Internal Defibrillation Overview A study was conducted during the first half of 2002 to assess the effectiveness of the
116. ays keep your Compression Sensor cable pre connected to the Pads CPR cable 2 Push until you hear it click into place Figure 75 Attaching the Compression Sensor to the Pads CPR Cable Pads CPR Cable Compression Sensor Cable 166 Attaching the Compression Sensor Adhesive Pad To attach the Compression Sensor Adhesive Pad to the Compression Sensor 1 Peel the rear liner from the bottom of the Compression Sensor Adhesive Pad The rear liner is blank and does not contain any graphics Figure 76 illustrates the pad Figure 76 Compression Sensor Pad a Rear liner 2 Align the bottom of the Compression Sensor Adhesive Pad with the yellow area of the Compression Sensor and press into place The diagram on the Compression Sensor bottom depicts Compression Sensor Adhesive Pad application as shown in Figure 77 Figure 77 Compression Sensor Bottom NOTE The Compression Sensor Adhesive Pad is intended for single patient use only It should be replaced after each use NOTE The Compression Sensor should always be stored with the Compression Sensor Adhesive Pad in place as described above 167 Applying Multifunction Electrode Pads To apply pads to the patient 1 Check the expiration date that appears on the pads package 2 Inspect the packaging for any damage 3 Connect the pads connector to the Pads CPR cable See Figure 78 Figure 78 Pads Connection 4 Apply the pads to the patient in the anterior anterior
117. be above or below the baseline but not biphasic e P wave should be smaller than 1 5 R wave height e T wave should be smaller than 1 3 R wave height NOTE To prevent detection of P waves or baselines noises as QRS complexes the minimum detection level for QRS complexes is set at 0 15 mV according to AAMI EC 13 specifications If the ECG signal is too weak you may get false alarms for asystole For paced patients with internal transvenous pacemakers in addition to the above the pace pulse should be e not wider than the normal QRS complex e large enough to be detected half the height of the QRS complex with no re polarization artifact NOTE Adjusting the ECG wave size on the display does not affect the ECG signal which is used for arrhythmia analysis Lead Choices Available monitoring leads vary depending upon what type of ECG cable is connected to your HeartStart MRx and its configuration Table 4 shows the choice of leads available for 3 5 and 10 lead ECG sets Table 4 Lead Choices a 3 electrode ECG set I II II a 5 electrode ECG set I II II aVR aVL aVF V a 10 electrode ECG set I I III aVR aVL aVF V1 V6 53 Selecting the Lead The ECG lead for Wave Sector 1 is selected through the Lead Select button or through the Displayed Waves menu The ECG lead for Wave Sectors 2 4 is selected through the Displayed Waves menu as follows 1 Press the Menu Select 9 button 2 Using the Navig
118. be used in the presence of a suspected cardiac arrest on patients of at least 8 years of age that are unresponsive not breathing and pulseless Manual Defibrillation Asynchronous defibrillation is the initial treatment for ventricular fibrillation and ventricular tachycardia in patients that are pulseless and unresponsive Synchronous defibrillation is indicated for termination of atrial fibrillation Noninvasive External Pacing Therapy The pacing option is intended for treating patients with symptomatic bradycardia It can also be helpful in patients with asystole if performed early Pulse Oximetry The SpO option is intended for use when it is beneficial to assess a patient s oxygen saturation level Noninvasive Blood Pressure Monitoring The NBP option is intended for noninvasive measurement of a patient s arterial blood pressure End tidal CO The EtCO option is intended for noninvasive monitoring of a patient s exhaled carbon dioxide and to provide a respiration rate 12 Lead ECG The 12 Lead ECG function is to provide a conventional diagnostic 12 Lead ECG report which may include measurements and interpretative statements Q CPR The Q CPR option provides feedback designed to encourage rescuers to perform resuscitation in accordance with AHA ERC guidelines for chest compression rate depth and duty cycle and ventilation rate volume and flow rate inflation time The Q CPR option is contraindicated as foll
119. ble 27 except for Color Selects the P2 color Red Yellow Blue Green Cyan Magenta White Table 29 Invasive Pressure Settings ABP ART Ao All setting options are exactly the same as P1 in Table 27 Table 30 Invasive Pressure Settings CVP RAP LAP Alarm Source Source is always Mean and not configurable High Limit Selects the high limit value Adult 39 360 10 mmHg Ped 39 360 4 Adjusted in increments of 1 mmHg or 0 1 kPa Low Limit Selects the low limit value Adult 40 359 0 mmHg Ped 40 359 0 Adjusted in increments of 1 mmHg or 0 1 kPa Scale Selects the default waveform scale Adult 300 240 180 150 120 110 100 90 80 70 60 50 40 30 20 10 5 10 15 20 Ped 300 240 180 150 120 110 100 90 80 70 60 50 40 30 20 10 5 10 15 20 Artifact Suppression Selects the default artifact suppression 30 sec 60 sec 90 sec Off timeframe Filter Selects the filter setting 12 Hz 40 Hz Color Selects the parameter color Red Yellow Blue Green Cyan Magenta White 187 Table 31 Invasive Pressure Settings PAP Alarm Source Selects the type of alarm source Systolic Diastolic Mean Systolic High Limit Selects the systolic high limit value Adult 39 360 35 mmHg Ped 39 360 60 Adjusted in increments of 1 mmHg or 0 1 kPa Systolic Low Limit Selects the systolic low limit va
120. bled alarm limits appear next to the NBP value and the alarm source systolic diastolic or mean is displayed above the NBP alarm limits If alarms are off the alarms off symbol UN replaces the limits Figure 59 NBP Parameter Block 1 Temp C Pulse bpm NBP eae i 80 0 36 9 560 80x For more information on monitoring NBP refer to the Application Note About Noninvasive Blood Pressure WARNING Do not perform NBP monitoring on patients whose upper arm circumference is less than 13 cm Doing so may result in inaccurate measurements 105 The first time an NBP measurement is taken the cuffs initial inflation pressure is 160 mmHg adult or 120 mmHg pediatric If the measurement is successful the next inflation pressure is 35 40 mmHg above the systolic measurement with a minimum inflation pressure of 120 mmHg If the patient s systolic pressure measurement is higher than the inflation pressure the cuff inflation pressure is automatically increased by 35 40 mmHg and another measurement is attempted The maximum cuff inflation pressure is 2830 mmHg while the maximum systolic value is 260 mmHg WARNING Initial cuff inflation pressure is based on the configured patient type adult or pediatric If necessary select the correct patient type during use by changing the Patient Category selection through the Patient Info menu Preparing to Measure NBP To prepare for NBP measurement 1 Select the appropriately sized
121. buttons select Measurements Alarms and press the Menu Select button 3 Select the pressure label channel label you want and press the Menu Select button 4 The last zero and Mercury calibration dates and times are displayed NOTE The information listed for the last mercury calibration is the date and time of either calibrating at a known pressure or entering the calibration factor manually Figure 63 Last Zero and Mercury Calibration Dates Press 1 ABP Last Zero 28 Nov 2005 09 05 Last Mercury Cal 28 Nov 2005 09 06 Label Zero ABP Calibration Pressure Calibration Factor ABP Limits Non Physiological Artifact Suppression Various clinical procedures i e taking a blood sample may affect invasive pressure readings Your HeartStart MRx can be configured to suppress alarms when artifact is detected for a specific length of time You can configure suppression lengths in Configuration Mode Options are 30 60 and 90 seconds or off The default is 60 seconds During suppression the HeartStart MRx shows an INOP message and next to the pressure label Pressure alarms and Pressure Label Non Pulsatile INOPs are inactive during the suppressed period The CPP high alarm is not suppressed 126 Alarms Alarms are provided to alert you to a change in the patient s condition If alarms are enabled alarm limits appear next to the pressure value Invasive pressure alarms are all categorized as non latching alarms meanin
122. cables may not be ultrasonically cleaned or immersed Nor may they be autoclaved or ETO sterilized NOTE For information about cleaning and sterilizing internal and external sterilizable paddles see the Sterilizable Defibrillator Paddles Instructions for Use Philips disposable sterile internal defibrillation paddles multifunction electrode pads and monitoring electrodes are single use items and do not require cleaning ECG Cable For M3525A M3526A M3527A M3528A M3529A and 989803147691 ECG cables e Wipe clean with any of the following Isopropyl alcohol 70 solution in water Mild soap and water Gluteraldehyde solution 3 4 gluteraldehyde content such as CidexPlus Quaternary ammonium compounds 21 quaternary ammonium content such as Steris Coverage Plus NPD Dilution 5 oz per gallon water one part Coverage Plus NPD to 255 parts water Chlorine bleach 6 sodium hypochlorite 3 solution in water This solution may discolor the cable For any other approved ECG cable e Clean according to the manufacturetr s instructions CAUTION Do not ultrasonically clean immerse autoclave or steam sterilize the ECG cable Do not clean electrical contacts or connectors with chlorine bleach 240 Carrying Case The carrying case may be cleaned by hand with mild soap and water Fabric stain removers may be used to remove stubborn stains Air dry the carrying case Do not wash or dry by machine NBP Cuff
123. charges the battery to full capacity drains the battery in preparation for calibration calibrates the battery and then charges it again following calibration Once you see the message Calibration Complete The battery charges faster when the device is turned off you may turn the Therapy Knob to Off to allow the battery to charge more quickly Calibration takes approximately 11 hours to complete in the HeartStart MRx Progress is shown on the display It takes significantly less time to calibrate in a Philips approved battery support system Monitoring therapy functions are not available during battery calibration in the MRx If it is necessary to terminate calibration to resume clinical use press the Cancel soft key WARNING Battery calibration is terminated if external power or the battery being calibrated is removed before the calibration process is completed If calibration is terminated the battery will not be calibrated and its capacity may be very low Calibration Results At the completion of battery calibration a Pass or Fail is reported to indicate whether calibration completed successfully In addition an estimate of battery capacity is provided so that you can determine if the battery is fit for use If the capacity is e gt 80 continue to use the battery e lt 80 discard the battery NOTE After successfully calibrating your batteries perform an Operational Check You may be prompted to recalibrate depending upon
124. choice 1 on the Mark Events 20 characters ET Access menu Mark Event 2 Defines menu choice 2 on the Mark Events 20 characters IV Access menu Mark Event 3 Defines menu choice 3 on the Mark Events 20 characters Adrenaline for Europe menu Epinephrine for the rest of the world Mark Event 4 Defines menu choice 4 on the Mark Events 20 characters Lidocaine menu Mark Event 5 Defines menu choice 5 on the Mark Events 20 characters Atropine menu Mark Event 6 Defines menu choice 6 on the Mark Events 20 characters Morphine menu Mark Event 7 Defines menu choice 7 on the Mark Events 20 characters Nitroglycerin menu Mark Event 8 Defines menu choice 8 on the Mark Events 20 characters Aspirin menu 201 18 Data Management This chapter describes the data management features of the HeartStart MRx Overview NOTE The HeartStart MRx automatically creates an Event Summary for each patient incident Each Event Summary is assigned a unique event identification number and is date time stamped Measurements are stored for viewing reporting and printing in the Vital Signs Trending Report Event Summaries including any trending and associated 12 Lead reports are automatically stored in internal memory When internal memory reaches capacity with each addition of an Event Summary to internal memory the oldest Event Summary is subsequently deleted The current or most recent Event Summary or Vital Signs Trending report
125. ck pacing or ECG acquisition Turn the Therapy Knob to Monitor An inop message describing the failure is displayed See Chapter 20 Troubleshooting for the corrective action 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 periodic chirp No power or device failure cannot turn on Insert a charged battery or connect to AC DC power If the condition persists take the device out of use and call for service NOTE The RFU indicator may briefly display a solid red X when initially turning on the device switching between clinical and non clinical operating modes and at the start of any Automated test This does not indicate a failure of the device Shift Checklist 19 Maintenance Shift Checklist In order to ensure defibrillators are ready when needed the American Heart Association AHA recommends that users complete a checklist often referred to as a shift check at the beginning of each change in personnel The activities on this check list include verifying that the appropriate supplies and accessories are present the device is plugged in and has sufficient battery power and the device is ready for use Philips Medical Systems supports the AHA checklist recommendations and has provided a Shift Checklist document with the device and published a copy in this book See the HeartStart M
126. ck failed is displayed along with one or more of the following messages depending upon the severity of the failed functionality e Service device e Replace battery e Replace Compression Sensor e Replace Pads cable e Replace Paddles cable e Replace Therapy cable e Replace ECG cable You must fix the problem and successfully run the Operational Check to clear the failure If the HeartStart MRx is equipped with multifunction defib pads only and does not have a paddle tray you cannot test paddles during an Operational Check To test paddles you must have a test load Run the Weekly Shock Test delivering the shock into the test load See Weekly Shock Test on page 219 Performing the Operational Check To perform the Operational Check Insert a charged battery capacity of 20 or greater Turn the Therapy Knob to Monitor Press the Menu Select 9 button Using the Navigation buttons select Other and press the Menu Select button Select Operational Check and press the Menu Select button A v oA O N e Select Run Operational Check and press the Menu Select button The message window Leaving Normal Operating Mode appears to let you know that you are exiting from clinical functionality and entering a test mode of the monitor defibrillator 7 Press the Menu Select button to acknowledge the message Operational Check Setup Carefully read the setup instructions on the screen Once the HeartStart MRx is set up p
127. cond ECG strip Depending on configuration the ECG strip is either printed real time or prepended with the previous 10 seconds of data leading up to the marked event Once pressed the Mark Event label in the upper left corner of the display changes to Select Event and the Mark Events menu is displayed see Figure 83 Figure 83 Mark Events Menu Epinephrine Nitroglycerin Aspirin Other Use the Navigation buttons to select the desired event and press the Menu Select Y button The ECG strip is annotated with the mark event J gt symbol and the selected annotation If an annotation item is not selected within five seconds after the Mark Event button is pressed only the generic mark event symbol will appear on the ECG strip The marked event is stored in the Event Summary NOTE Entries on the Mark Events menu are as configured Changes are made using the Configuration menu Printing Events The HeartStart MRx can be configured to print automatically when certain events occur Table 53 lists these events and the length of the strip printed depending on whether the printer is configured to print real time or with a 10 second delay Table 53 Printed Strip Lengths HeartStart MRx charges to Continuous 10 seconds just prior to charging plus deliver a shock continuous printing through the charge duration Shock delivered 12 seconds 10 seconds just prior to shock plus 12 seconds after shock Shock failed 12 seco
128. cuff for the patient The cuff width should be either 40 of the limb circumference or 2 3 of the upper arm length The inflatable part of the cuff should be long enough to encircle 50 80 of the limb The wrong cuff size may give false and misleading results If you do not have the correct cuff size use a larger one to minimize error 2 Attach the cuff to the NBP tubing making sure that air can pass through the tubing and that the tubing is not squeezed or kinked see Figure 60 Figure 60 Connecting the NBP Cuff Tubing 3 Insert the NBP tubing into the NBP port as described in Connecting the NBP Interconnect Tubing on page 37 106 4 Apply the blood pressure cuff to the patient s arm or leg as follows a Ensure that the cuff is completely deflated b The cuff should not be placed on the same extremity as an SpO sensor Wrap the cuff around the arm making sure that the artery marker is aligned over the brachial artery Ensure that the cuff is not wrapped too tightly around the limb Excessive tightness may cause discoloration and eventual ischemia of the extremities Also ensure that the NBP tubing from the defibrillator to the cuff is not compressed crimped or damaged c Check that the edge of the cuff falls within the range identified by the lt gt markings If it does not use a larger or smaller cuff that fits better Place the limb used for taking the measurement at the same level as the patient s heart
129. d in the following tables To order In the USA call 1 800 225 0230 pads electrodes cables paper etc Outside the USA contact your local Philips Medical Systems Sales Office your authorized Philips Medical Systems Dealer or Distributor or visit our website at http shop medical philips com and follow the Supplies link Table 61 Supplies and Accessories M3542A Standard External Paddles M3543A Water Resistant External Paddles M4745A Sterilizable External Paddles M1741A 7 5 cm Switchless M1742A 6 0 cm Switchless M1743A 4 5 cm Switchless M1744A 2 8 cm Switchless M4741A 7 5 cm Switched M4742A 6 0 cm Switched M4743A 4 5 cm Switched M4744A 2 8 cm Switched M4740A Internal Paddles Adapter Cable 24 Qe M3713A Adult Plus M3716A Adult Radiolucent M3717A Pediatric Plus M3718A Adult Radiotransparent Reduced Skin M3719A Pediatric Radiotransparent Reduced Skin M3501A Defib Adult AAMI M3502A Defib Adult IEC M3503A Defib Pediatric IEC M3504A Defib Pediatric AAMI ae ee M3507A Defib Hands free Pads Cable barrel style 2 2m 7 ft M3508A Hands free Pads Cable plug style 2 2m 7 ft 05 10200 Pads Adapter use with M3507A M2202A High Tack Foam ECG Electrodes 5 electrodes pack 60 packs case ASictinese tee M3525A 2 7 meter 10 lead ECG
130. d reload the printer paper e Make sure the printer door is closed Printer Malfunction message The printer is faulty or there is a problem communicating with the printer Turn the HeartStart MRx off for 15 seconds and then turn it on again If the problem persists call for service If printing is essential to patient care take the device out of use Printer Temperature High message The temperature of the print head exceeds the recommended operating temperature Wait until the printer cools down and restart printing Table 71 Data Card Problems Incompatible Data Card message Data card is not compatible with the HeartStart MRx Use only compatible Data Cards For a listing of compatible Data Cards see Maintenance chapter Data Card Full message The data card has reached capacity Insert new data card or erase data from card No Data Card Present message A data card is not inserted in the device Sufficient time not allowed for data card recognition Insert data card Once inserted wait 5 seconds before trying to access the data card 265 Table 72 Invasive Pressure Monitoring Problems Invasive Pressure wave not displayed The sensor is not properly connected or the sensor cable is damaged The pressure waveform is not configured to be displayed and there is not an unused wave sector e Check the sensor connection and cable Try anoth
131. ding to Alarms Alarm limits are displayed with each parameter if alarms for the parameter are on When an alarm condition occurs and an alarm is indicated visually and audibly there are several ways to respond Initially 1 Attend to the patient 2 Identify the alarm s indicated 3 Silence the alarm s When a physiological alarm is announced the audio pause label see Figure 13 is displayed above the Navigation and Menu Select buttons Pressing any of these buttons will silence the audio for all active alarms while you are attending to the patient If the alarming condition continues to exist it will re alarm in two minutes Silencing a specific alarm does not prevent another alarm condition from sounding If you also silence the second alarm it resets the two minute audio pause for all active alarms When an INOP is announced without a concurrent physiological alarm the audio off label is displayed above the Navigation and Menu Select buttons Pressing any of these buttons will silence the audio for all active alarms while you are attending to the patient INOPs do not reannunciate after pressing audio off 2x AUDIO PAUSE Figure 13 Audio Pause Label Then 4 Address the alarm condition on the HeartStart MRx The menu shown in Figure 14 appears Figure 14 Sample Alarm Response Menu SpO2 Alarm Alarms Off Acknowledge New Limits Alarms Off Turns the monitoring parameter s alarms off and prevents future parameter a
132. dition is generated Figure 38 Audio Pause Label EN AUDIO PAUSE Then respond to the alarm condition on the HeartStart MRx There are two ways to respond to an HR or Arrhythmia alarm 1 Acknowledge the alarm condition 2 Adjust the limits using the New Limits menu 59 Displaying an Annotated ECG You may choose to display an annotated ECG with arrhythmia beat labels in Wave Sector 2 The same ECG source appearing in the Wave Sector 1 is displayed with a six second delay along with white arrhythmia beat labels See Table 8 below for additional information on beat classification Table 8 Arrhythmia Beat Labels N Normal Above QRS V Ventricular Ectopic Above QRS P Paced Above QRS Pacer spike Above the waveform where the pacer spike is detected If the patient is both atrially and ventricularly paced the display will show two marks above the waveform aligned with the atrial and ventricular pacing L Learning Patients ECG Above QRS A Artifact noisy episode Above the waveform where the noise is detected Insufficient information to classify beats Above QRS I Inoperative condition e g LEAD OFF Above the waveform at start of INOR every second of INOR and at end of INOP M Pause Missed Beat No QRS Above the waveform where the condition is detected To display an annotated ECG Press the Menu Select button Using the Navigation buttons select Displayed Waves and press th
133. e and Next Page soft keys appear to navigate to additional display pages Use the Erase Card menu entry to delete the contents of the data card 204 Printing the Event Summary You can print the current Event Summary at any time during the event by pressing the Summary button and selecting Event Summary from the menu If an event is not in progress pressing the Summary button and selecting Event Summary prints the most recent Event Summary The printed format of the Event Summary is defined in Configuration WARNING Should an alarm condition occur while an Event Summary is printing an alarm strip is not printed However the corresponding ECG waveform is stored and available in the Event Summary To select and print an Event Summary after an event Turn the Therapy Knob to either Monitor Pacer or Manual Defib Press the Menu Select 9 button Using the Navigation buttons select the Other menu and press the Menu Select button 1 2 3 4 Select Data Management and press the Menu Select button 5 Press the Menu Select button to acknowledge the message Leaving Normal Operational Mode 6 Use the soft keys labeled Prev Item and Next Item to select the Event Summary you want to print N Press the Menu Select button to display the Data Management menu 8 Select Print and press the Menu Select button 9 Using the Navigation buttons select Event Summary from the menu and press the Menu Select button The Event Summa
134. e and are reported in Parameter Blocks 1 and 2 and the general status area CAUTION Data transmission via cell phone can sometimes be unreliable A strong signal and stationary transmission will improve the transmittal success rate Follow the directions provided with your cell phone CAUTION Many institutions prohibit the use of cell phones on their premises Please abide by local rules and regulations NOTE Patient Name and ID must be entered prior to 12 Lead acquisition in order for it to appear on the 12 Lead Report NOTE The 05 40 Hz 12 Lead filter setting is supported by TraceMasterVue version A 02 01 or higher Setting Up for Bluetooth Transmission 12 Lead ECG Transmission using Bluetooth requires the configuration and set up of wireless devices that will send the 12 Lead Report to the hub NOTE For further information concerning the setup and configuration of transmission devices and the HeartStart MRx refer to the 12 Lead Transmission Implementation Guide For further information concerning the 12 Lead Transfer Station refer to the 12 Lead Transfer Station Instructions for Use Adding a Bluetooth Device Up to 20 Bluetooth devices may be configured for use Adding a twenty first device replaces the device used least recently NOTE Bluetooth devices may not be added or modified during 12 Lead transmission Conversely 12 Lead transmission is not allowed during Bluetooth device configuration To add a Blueto
135. e derived from an SpO pleth wave or one of the two invasive pressure waves in Monitor Pacing and Manual Defib modes The pulse reading will be displayed in the color of its source e g if your pleth wave is cyan and pulse is being derived from the pleth wave then the pulse reading will appear in cyan Pulse is on and displayed if one of the possible sources is activated SpO is the factory default but can be modified in Configuration Mode If the default pulse source is not active during an event but a secondary source is the pulse value will appear on screen but it will be invalid and display a where the value should be A Pulse Check Source INOP will also appear on the screen To obtain a pulse rate you must modify the pulse source to an active source for this incident If the pulse source you are using to obtain a pulse rate is disconnected during active measuring and a secondary pulse source is available the pulse rate does not automatically switch to the secondary source The pulse value and the value of your source measurement remains on screen but becomes invalid and displays a where the value should be An INOP message also appears on screen To reactivate a pulse reading reconnect the original pulse source or change the pulse source to the secondary option 130 Changing Pulse Source To change pulse source for the current incident perform the following steps 1 Press the Menu Select C button 2 Using the Navigatio
136. e Check that pads paddles are properly applied If off or insecurely attached necessary replace the pads e Change the ECG in Wave Sector 1 to a lead derived from monitoring electrodes There is a dashed line on ECG data is not being acquired Check the pads paddles or ECG cable is the display instead of an ECG connected e Check the pads paddles or monitoring electrodes are properly applied e Check that the desired lead is selected Lead wire Off message The specified monitoring electrode Check that monitoring electrodes are properly applied displayed in wave sector is off or not making proper contact If necessary prepare the patient s skin and apply new with the patient electrodes Check Limb Leads message 2 or more limb lead electrodes are Check that the limb lead electrodes are properly displayed in wave sector off or not making proper contact applied with the patient Pads Off message displayed in a Pads are not making proper Make sure the pads therapy cable is connected and wave sector contact with the patient pads are properly applied If necessary prepare the patient s skin and apply new pads Cannot Analyze ECG INOP The arrhythmia algorithm cannot Check ECG signal quality If necessary improve lead reliably analyze the ECG data position or reduce patient motion Pads ECG Cable Failure INOP A short was detected between a Replace the pads cable and perform
137. e Configuration menu if your device has the Invasive Pressures option 192 Table 38 Temperature Settings Unit Selects measurement units C F Label Selects the default temperature label Temp Tskin Trect Tnaso Tesoph Tart Tven Tvesic Tcore High Limit Selects the high limit value Adult 0 1 to 45 0 39 0 C 32 2 to 113 F Ped 0 1 to 45 0 39 0 C Adjusted in increments of 0 1 C or 0 2 ok Low Limit Selects the low limit value Adult 0 0 to 44 9 36 0 C 32 0 to 112 8 F Ped 0 0 to 44 9 36 0 C Adjusted in increments of 0 1 C or 0 2 F Color Selects the temperature color Red Yellow Blue Green Cyan Magenta White Table 39 Wave Sector Settings Wave 1 Selects the waveform displayed in Wave Sector 1 Pads I II II aVR aVL aVF V Wave 2 Selects the waveform displayed in Wave Sector 2 Pads I II III aVR aVL aVF V CO Pleth Press 1 Press 2 Cascade Annotated ECG None Default Press 1 if you have the Invasive Pressures option Cascade otherwise Wave 3 Selects the waveform displayed in Wave Sector 3 Pads I II III aVR aVL aVE V CO Pleth Press 1 Press 2 None Default Press 2 if you have the Invasive Pressures option Pleth if you have SpO none otherwise Wave 4 Selects the waveform displayed in Wave Sector 4 Pads I II III aVR aVL aVF V CO Pleth Press 1 Press 2 Cascade None Default CO if you have the CO
138. e MRx menus The name should be no more than 15 characters in order for it to display properly on the HeartStart MRx e Bluetooth modems and fax machines use analog lines to transmit data If you are transmitting using a Bluetooth modem plug it into the analog line used by the fax machine 148 Transmitting to a Configured Site using Bluetooth 14 12 Lead ECG Transmission Transmitting to a Configured Site using Bluetooth Upon acquisition of the 12 Lead ECG the 12 Lead Report View is displayed To transmit the displayed 12 Lead Report to a previously configured destination 1 Press the Menu Select 0 button 2 Using the Navigation buttons select Send from the 12 Lead Main Menu and press the Menu Select button 3 Using the Navigation buttons select the destination site from the configured list see Figure 70 and press the Menu Select button to select 4 Select the transmission device from the configured list and press the Menu Select button to select NOTE Ifthe profile associated with the Bluetooth device is configured as a landline use the numeric menu to edit the configured dial prefix if necessary To confirm the prefix select Done from the menu and press the Menu Select button 149 Setting Up for RS 232 Transmission 12 Lead ECG Transmission using RS 232 requires a serial cable connected to the RS 232 Serial Port located on the back panel of the HeartStart MRx See Figure 68 The cell phone is connected to the se
139. e Menu Select button Select Wave 2 and press the Menu Select button BR WwW N e Select Annotated ECG and press the Menu Select button Arrhythmia Learning Relearning When arrhythmia monitoring starts a learning process is initiated The goal is to learn the patient s normal complexes and or paced complexes if the patient with an internal transvenous pacemaker is in paced rhythm The learning process involves the first 15 valid non noisy beats encountered during the learning phase The family selected to represent the normal complex includes the beat that is the most frequently seen narrowest on time beat For this reason learning should not be initiated when the patient s rhythm is primarily ventricular Arrhythmia learning relearning automatically occurs when the Therapy Knob is turned on to Monitor Pacer or Manual Defib any time there is a change in the lead selection for Wave Sector 1 and after the correction of a Leads or Pads Off INOP condition that has been active longer than 60 seconds Manual relearning should be initiated if the beat detection is not occurring or if beat classification is incorrect and results in a false alarm Remember however that if the same signal condition which caused the algorithm to perform poorly still persists relearning will not be able to correct the problem The problem can only be corrected by improving the quality of the signal e g by selecting a different lead
140. e View 73 Preparing for Defibrillation 74 Using Multifunction Electrode Pads 74 Using External Paddles 75 Using Pediatric Paddles 76 Using Internal Paddles 76 Defibrillating asynchronously 77 Performing Synchronized Cardioversion 79 Preparing for Synchronized Cardioversion 79 Delivering a Synchronized Shock 80 Delivering Additional Synchronized Shocks 81 Disabling the Sync Function 81 Using Q CPR in Manual Mode 81 Troubleshooting 81 iii 7 Noninvasive Pacing 83 Overview 83 Alarms 84 Pacing View 85 Demand Mode Versus Fixed Mode 86 Preparing for Pacing 87 Demand Mode Pacing 88 Fixed Mode Pacing 89 Defibrillating During Pacing 91 Troubleshooting 91 8 Pulse Oximetry 93 Overview 93 Understanding Pulse Oximetry 94 Selecting a Sensor 95 Applying the Sensor 97 Monitoring SpO 98 Pleth Wave 99 SpO Alarms 100 Changing the SpO Alarm Limits 100 SpO Desat Alarm 101 Enabling Disabling the SpO Alarms 101 Pulse Rate Alarms 101 Enabling Disabling the Pulse Rate Alarms 102 Changing the Pulse Rate Alarm Limits 102 Disabling the SpO Monitoring Function 102 Caring for Sensors 103 Troubleshooting 103 9 Noninvasive Blood Pressure 105 Overview 105 Preparing to Measure NBP 106 Measuring NBP 108 Changing the NBP Schedule 108 Alarms 109 Changing NBP Alarms 109 Enabling Disabling NBP Alarms 110 Troubleshooting 110 10 Monitoring Carbon Dioxide 111 Overview 111 Preparing to Measure EtCO 112 Selecting the Accessories
141. e adapter cable available in Europe and Asia only Disposable Temperature Probes 21090A Esophageal rectal 21091A Skin surface 21093A Esophageal stethoscope 21094A Esophageal stethoscope 21095A Esophageal stethoscope 21096A Foley catheter 21097A Foley catheter M1837A Esophageal rectal M2255A Foley catheter Reusable Temperature Probes 21075A Esophageal rectal adult 21076A Esophageal rectal pediatric 21078A Skin surface Reusable Temperature Probe Extension Cables 21082A 3 0m 2 pin plug extension cable for mini phone plug 21082B 1 5m 2 pin plug extension cable for mini phone plug 247 248 M3538A Lithium Ion Battery M3539A AC Power Module M5529A DC Power Module M5528A DC Power Module Mounting Bracket 989803135301 2 Bay Battery Support System for Lithium Ion Batteries 989803135331 4 Bay Battery Support System for Lithium Ion Batteries 989803135341 4 Bay Battery Support System for Sealed Lead Acid and Lithium Ion Batteries M4761A Compression Sensor M4762A Compression Sensor Adhesive Pads Package of 10 M4763A Pads CPR Cable 40457C 50 mm Chemical Thermal Paper Gray Grid 10 rolls 40457D 50 mm Chemical Thermal Paper Gray Grid 80 rolls 989803138171 75 mm Chemical Thermal Paper Gray Grid 10 rolls 989803138181 75 mm Chemical Thermal Paper Gray Grid 80 rolls M5521A Green M5522A Bl
142. e reminded to return the device to its owner as identified on the display The feature is password protected in Configuration and enabled through the Other Menu where the owner can activate deactivate and specify the length of the loan period NOTE Monitoring and defibrillation functions are suspended while the Return to Owner set up screen is displayed Alarms Off is indicated on the display Monitoring and defibrillation functions will return when exiting the Return to Owner screen NOTE The appearance of the loan expiration message does not disable monitoring and defibrillation functionality To enable the Return to Owner feature 1 Press the Menu Select button 2 Select Other from the menu and press the Menu Select button 3 Select Return To Owner and press the Menu Select button 4 Press the Activate soft key 5 Enter the number of days in the loan period and press the Menu Select button 6 Pressthe Exit Return To soft key To disable the Return to Owner feature Press the Menu Select 9 button Select Other from the menu and press the Menu Select button Select Return To Owner and press the Menu Select button 1 2 3 4 Pressthe Deactivate soft key 5 Enter the password and press the Menu Select button 6 Press the Exit Return To soft key 29 3 Setting Up This chapter provides the basic set up information you need to prepare your HeartStart MRx for operation and to connect the optional monitoring acce
143. e stamp and sequence number Press the Menu Select button to select 4 Select Send from the 12 Lead Report Menu and press the Menu Select button 5 Using the Navigation buttons select the destination site or to manually enter a fax number Press the Menu Select button to select 6 For manual fax number entry enter the fax number from the numeric list select Done and press the Menu Select button Subsequent 12 Lead Reports can be placed in queue for transmittal while transmission is in progress or the originally selected 12 Lead Report can be chosen for transmission to multiple sites NOTE I stored 12 Lead Reports are transmitted using a Bluetooth device the Bluetooth device must be selected Cancelling Transmission To cancel a transmission once a connection has been initiated perform the following steps 1 From the 12 Lead Preview or Report View press the Menu Select 9 button 2 Select Cancel Transmission from the 12 Lead Main Menu and press the Menu Select button 3 Confirm the cancellation by pressing the Menu Select button The transmission of any pending 12 Lead Reports is also canceled Troubleshooting If your HeartStart MRx does not operate as expected during 12 lead transmission see Troubleshooting on page 249 155 15 Vital Signs Trending This chapter describes how to review patient data using HeartStart MRx Vital Signs Trending Overview In Monitor Mode your HeartStart MRx provides the abilit
144. ed message accompanied by a Connection Interrupted message The connection with the network server has terminated Choose the destination site again and re connect Transmission Failed message accompanied by a Settings Configured Incorrectly message The URL or Proxy configuration settings are incorrect Modify the Serial Phone Profile Hub or Site configuration settings as needed For more information refer to the 12 Lead Transmission Implementation Guide Transmission Failed message The 12 Lead Report did not transmit correctly The network is down Choose the destination site again and re connect Check the cell phone connection to the HeartStart MRx Check with your internet provider to see if your service is unavailable Table 68 CO Monitoring Problems The CO waveform does not appear on the display The FilterLine is not properly connected The CO waveform is not configured to be displayed and there is not an unused wave sector e Check the FilterLine connection e Check tubing for knots kinks or pinches Use the Displayed Waves menu to select a wave sector for display of the CO waveform CO Unplugged INOP The FilterLine is disconnected e Check the FilterLine connection and tubing e Check the tubing for knots kinks or pinches CO Purging INOP A blockage in the FilterLine or airway adapter has been detected If it is not successful a CO Occ
145. een the defibrillator s pads or paddles that the defibrillator must overcome to deliver an effective discharge of energy The degree of impedance differs from patient to patient and is affected by several factors including the presence of chest hair moisture and lotions or powders on the skin The low energy SMART Biphasic waveform is an impedance compensating waveform that is designed to be effective across a wide range of patients However if you receive a No Shock Delivered message check that the patient s skin has been washed and dried and that any chest hair has been clipped If the message persists change the pads and or the pads cable Using Internal Paddles To defibrillate using internal paddles 1 Select the appropriate paddle electrode size 2 Ifusing switchless internal paddles connect the paddles to the M4740A Paddle Adapter Cable 3 Connect the paddles cable or the paddle adapter cable to the HeartStart MRx by aligning the pointer on the paddles cable or paddle adapter cable with the white arrow on the green Therapy port Then push until you hear it click into place See Figure 46 76 Defibrillating asynchronously Once you have performed the necessary preparation for defibrillation perform the following steps 1 Select Energy To select the energy setting rotate the Therapy Knob to the desired energy level as shown in Figure 50 Energy choices range from 1 to 200 with 150 the recommended level for ad
146. elf with your device s configuration before using the HeartStart MRx See Chapter 17 Configuration for more details Intended Use The HeartStart MRx is intended for use in hospital and pre hospital settings by qualified medical personnel trained in the operation of the device and qualified by training in basic life support advanced cardiac life support or defibrillation When operating as a semi automatic external defibrillator in AED Mode the HeartStart MRx is suitable for use by medical personnel trained in basic life support that includes the use of an AED When operating in Monitor Manual Defib or Pacer Mode the HeartStart MRx is suitable for use by healthcare professionals trained in advanced cardiac life support The SMART Biphasic waveform utilized in the HeartStart MRx has previously undergone clinical testing in adults These trials support the waveform s effectiveness for defibrillation of ventricular tachyarrhythmias at 150J There are currently no clinical studies related to the use of the SMART Biphasic waveform in pediatric applications Indications for Use The HeartStart MRx is for use for the termination of ventricular tachycardia and ventricular fibrillation The device is for use by qualified medical personnel trained in the operation of the device and qualified by training in basic life support advanced cardiac support or defibrillation It must be used by or on the order of a physician AED Therapy To
147. emergency medical service EMS systems Responders used either 150J SMART Biphasic AEDs or 200 360J monophasic waveform AEDs A sequence of up to three defibrillation shocks were delivered For the biphasic AEDs there was a single energy output of 150J for all shocks For monophasic AEDs the shock sequence was 200 200 360J Defibrillation was defined as termination of VF for at least five seconds without regard to hemodynamic factors Results Randomization to the use of monophasic or SMART Biphasic automatic external defibrillators AEDs was done in 338 SCAs from four emergency medical service systems VF was observed as the first monitored rhythm in 115 patients The biphasic and monophasic groups for these 115 patients were similar in terms of age sex weight primary structural heart disease cause or location of arrest and bystanders witnessing the arrest or performing CPR The 150J SMART Biphasic waveform defibrillated 98 of VF patients in the first series of three shocks or less compared with 69 of patients treated with monophasic waveform shocks Outcomes are summarized in Table 82 Table 82 Clinical Summary Defibrillation Defibrillation Efficacy Single shock only 52 54 96 36 61 59 lt 0 0001 lt 2 shocks 52 54 96 39 61 64 lt 0 0001 lt 3 shocks 53 54 98 42 61 69 lt 0 0001 Patients Defibrillated 54 54 100 49 58 84 0 003 Return of Spontaneous Circulation 41 5
148. eplace Pads Paddles ECG Test failed the Therapy cable and rerun with cable Disconnect therapy Operational Check cable to rerun test without cable If the Pads Paddles test fails with and without the cable see Troubleshooting on page 249 Battery A Checks the total battery None None Battery B capacity combination of both batteries and calibration status of the batteries in Compartments A and B SpO Checks the internal SpO PCA None None The SpO cable is not tested NBP Checks to see if the NBP None None module is functioning determines if it is due for calibration CO Checks to see if the CO None None module is functioning determines if it is due for calibration Invasive Pressures Checks to see if the invasive None None pressure hardware is working properly Temperature Checks to see if the temperature None None hardware is working properly Bluetooth Checks for the presence of the None None Bluetooth card and database integrity Printer Runs a printer self test None None Operational Check Report The Operational Check takes only a short time to complete When it is done a report is printed as shown in Figure 86 The first part of the report lists test results The second part lists checks to be performed by the user Figure 86 Operational Check Report Operational Check Report Current Test Results Model Number M3535A General System Test Pass Battery Compartment A Test Serial N
149. er sensor Use the Displayed Waves menu to select a wave sector for display of the pressure waveform CPP Check Sources INOP The ICP and or arterial pressure used to derive CPP is invalid Make sure ICP and arterial pressure cables are connected to the device and zeroed Invasive Pressure Label Artifact INOP The device has detected a pressure change A resulting alarm most likely a high limit alarm will be suppressed In the event you do not think you created a non physiological event check cable and tubing Rezero and try again Invasive Pressure Label Equip Malfunction INOP There has been a malfunction in the Invasive Pressure hardware Contact Service Invasive Pressure Label Noisy Signal INOP This can only occur when pulse is determined from a pressure wave The pulse rate is higher than 350 bpm May be caused by movement artifact or electrical interference Stop movement Minimize possible electrical interference Invasive Pressure Label Non pulsatile INOP This can only occur when pulse is determined from a pressure wave The pulse rate is less than 25 bpm or the amplitude of the pressure wave is less than 3 mmHg Check the catheter and connections to the patient Invasive Pressure Label Overrange INOP The pressure wave is outside the measurement range Make sure the measurement has been properly prepared and zeroed and that the transducer is level with the heart
150. es or switched internal paddles are used once the HeartStart MRx is fully charged the shock is delivered by pressing the Shock button s on the paddles Sync Button Toggles between synchronized energy delivery used during cardioversion and asynchronous energy delivery used during defibrillation Figure 11 Defibrillation Controls Sync Button Therapy Knob Charge Button Shock Button Soft Keys The soft keys perform the function displayed as a label appearing immediately above on the display The labels and therefore the function change appropriately for the various modes of operation and are described in the following chapters 22 Indicators The HeartStart MRx indicators provide a visual display of device status Ready For Use Indicator The Ready For Use RFU indicator is located on the upper right corner of the device It indicates the status of the therapy delivery functions of the monitor defibrillator using the following definitions e A blinking black hourglass symbol x indicates the shock pacing and ECG functions of the device are ready for use Sufficient battery power is available for device operation Additionally a blinking black hourglass together with the presence of external power AC or DC indicates that installed battery s are being charged A blinking red X and a periodic audio chirp indicate no battery is present or a low battery condition The device can be used but its
151. es until the Shock button is pressed the Disarm soft key is pressed or the device disarmed automatically after the configured time had elapsed since pressing the Charge button Periodic chirp Low battery or RFU failure Repeated periodically while the condition exists Continuous tone alternating pitch Device will shut down in one minute Tone repeated once a second Philips Red Alarm Tone Red alarm indicator message for applicable Generated while at least one red alarm is occurring HR arrhythmia apnea extreme desat and pressure disconnect alarms High pitched tone repeated five times IEC Red Alarm Tone followed by a pause Generated while at least one red alarm is occurring Red alarm indicator message for applicable HR arrhythmia apnea extreme desat and pressure disconnect alarms Tone repeated every two seconds lower pitch Philips Yellow Alarm Tone than red alarm tone Generated while at least one yellow alarm is occurring Yellow alarm indicator message for applicable HR arrhythmia SpO NBP Invasive Pressures Temperature Pulse and EtCO alarms 269 Lower pitched tone is repeated three times IEC Yellow Alarm Tone followed by a pause Generated while at least one yellow alarm is occurring Yellow alarm indicator message for applicable HR arrhythmia SpOz NBP Invasive Pressures Temp Pulse and EtCO alarms Tone repeated every two seconds lower pitch Philips
152. evice from monitoring or analyzing the ECG INOP messages are displayed just above the HR Arrhythmia alarm status area If multiple INOP conditions exist the associated INOP messages will cycle through alternating every 2 seconds Table 7 ECG INOPs Cannot Analyze ECG Cannot reliably monitor the ECG in INOP message INOP tone Wave Sector 1 ECG Cable Failure During the Operational Check a short INOP message INOP tone has been detected between a lead wire and ground Leads Off An electrode used for Wave Sector 1 INOP message INOP tone may be off or not attached securely Pads Paddles Off The multifunction electrode pads or INOP message INOP tone paddles used as the source for the Wave Sector 1 may be off or not attached securely ECG Unplugged The primary ECG is derived from leads INOP message INOP tone and the ECG cable is not connected ECG Equip Malfunction A malfunction has occurred in the INOP message INOP tone ECG hardware Pads Paddles Cable During the Operational Check a INOP message INOP tone Failure failure was detected in the pads or paddles cable during the pads paddles ECG test Pads ECG Equip A device hardware failure was detected INOP message INOP tone Malfunction Setting Alarms Alarms are automatically enabled in Monitor and Pacer modes In Manual Defib Mode alarms are automatically enabled if the Sync function is enabled If the Sync function is not enabled
153. f 1 mmHg or 0 1 kPa Low Limit Selects the low limit value Adult 40 359 0 mmHg Ped 40 359 0 Adjusted in increments of 1 mmHg or 0 1 kPa Scale Selects the default waveform scale Adult 300 240 180 150 120 110 100 90 80 70 60 50 40 30 20 10 5 10 15 20 Ped 300 240 180 150 120 110 100 90 80 70 60 50 40 30 20 10 5 10 15 20 Artifact Suppression Selects the default artifact suppression timeframe 30 sec 60 sec 90 sec Off Filter Selects the filter setting 12 Hz 40 Hz Color Selects the parameter color Also applies to CPP Red Yellow Blue Green Cyan Magenta White Table 33 Invasive Pressure Settings CPP Alarm Source Source is always Mean and not configurable High Limit Selects the high limit value Adult 35 360 130 mmHg Ped 35 360 100 Adjusted in increments of 5 mmHg or 1 kPa Low Limit Selects the low limit value Adult 40 355 50 mmHg Ped 40 355 40 Adjusted in increments of 5 mmHg or 1 kPa 189 Table 34 Noninvasive Blood Pressure Settings systolic is the selected alarm source NBP Schedule Selects the schedule for NBP measurements Manual q1 q2 5 q5 q10 q15 q30 q60 manual or automatic at the selected frequency q120 NBP Alarm Source Selects the alarm source Systolic Diastolic Mean Unit Selects t
154. f the value measured by a CO oximeter The HeartStart MRx is calibrated to display functional oxygen saturation Ambient Light Sensitivity Interference from fluorescent light is lt 2 SpO perfusion between 0 3 and 1 typical transmission 50nA mA 10 to 1000 1x light intensity 50Hz 0 5Hz as well as 60Hz 0 5Hz line frequency SpO Alarm Range Low Limit 50 to 99 Adult Pediatric High Limit 51 to 100 Adult Pediatric SpO and Pulse High Low Alarm Signal Generation Delay 10 seconds SpO Response Time 90 to 80 average 18 9 seconds standard deviation 0 88 seconds SpO Averaging Time 20 seconds Maximum Power Output lt 15mW Wavelength Range 500 1000nm Information about wavelength range can be useful to clinicians especially those performing photodynamic therapy average 18 9 seconds standard deviation 0 88 seconds Desat Alarm Signal Generation Delay 20 seconds Pulse Rate Measurement Range 30 300 bpm 280 Pulse Rate Resolution 1bpm Pulse Rate Accuracy 2 or 1 bpm whichever is greater over the measurement range Pulse Alarm Range Low Limit 30 to 195 Adult 30 to 235 Pediatric High Limit 35 to 200 Adult 35 240 Pediatric Pulse Response Time 90 to 120 bpm average 18 0 seconds standard deviation 0 86 seconds NBP Pressure Range e Systolic 40 260 mmHg e Diastolic 20 200 mmHg Pulse Rate Range 30 to 220 bpm Initial Pressure 160 mmHg Adult 120 mmHg Pediatric Maximum Pressure 280
155. ff SpO Low Perfusion INOP The SpO numeric value is replaced with a The SpO signal is too low to give an accurate reading Check the sensor is applied properly Try another sensor type 257 Table 66 12 Lead Transmission Problems Bluetooth discover the Bluetooth device The Bluetooth device is not turned on The Bluetooth device is not authorized to pair with the MRx The Bluetooth device is not within range The Bluetooth card is corrupt Bluetooth Malfunction INOP The MRx does not e Call for service have a Bluetooth card The Bluetooth card is Call for service incompatible The Bluetooth card is Call for service corrupt No Bluetooth Devices Detected message The MRx could not Try searching again for Bluetooth devices Make sure the Bluetooth device is turned on See the Bluetooth device s documentation to set authorization Move the Bluetooth device closer to the MRx within the transmitting range See the 12 Lead Transmission Implementation Guide for information on transmission ranges Call for service No Bluetooth Profiles Configured message There are no profiles configured for the Bluetooth device Create a profile for the Bluetooth device See the 12 Lead Transmission Implementation Guide for more information Transmission Settings Have Not Been Configured message The Hub information settings are not correct Modify the Hub
156. fibrillator charges to the selected energy level automatically To disarm the defibrillator press Disarm If the Shock button has not been pressed within the time period specified in the Time to Auto Disarm Configuration setting the defibrillator disarms automatically 3 Shock Confirm that a shock is still indicated and that the defibrillator has charged to the selected energy level Make sure no one is touching the patient or anything connected to the patient Call out loudly and clearly Stay Clear If using pads or switchless internal paddles press the flashing Shock button to deliver a shock to the patient external paddles simultaneously press the shock buttons located on the paddles to deliver a shock to the patient switched internal paddles press the Shock button located on the paddles to deliver a shock to the patient The number of shocks delivered is displayed in the Shock Status area of the display This number includes any shocks administered while in AED Mode WARNING Defibrillation current can cause operator or bystander injury Do not touch the patient or equipment connected to the patient during defibrillation CAUTION Alarms are turned off when an energy is selected for asynchronous defibrillation and the Alarms Off message is displayed Alarms remain paused until toggled on using the Alarm Pause button the Sync function is enabled or the Therapy Knob is moved to Monitor
157. fort Cuffs Adult M1575A Multi Patient Comfort Cuffs Large Adult Disposable Blood Pressure Cuffs M4572A Soft Single Patient Disposable Cuff Infant M4573A Soft Single Patient Disposable Cuff Pediatric M4574A Soft Single Patient Disposable Cuff Small Adult M4575A Soft Single Patient Disposable Cuff Adult M4576A Soft Single Patient Disposable Cuff Adult X Long M4577A Soft Single Patient Disposable Cuff Large Adult M4578A Soft Single Patient Disposable Cuff Large Adult X Long M4579A Soft Single Patient Disposable Cuff Thigh 246 Intubated Circuits M1920A FilterLine Set Adult Pediatric 25 sets case M1921A Filter H Set Adult Pediatric 25 sets case M1923A Filter H Set Infant Neonatal yellow 25 sets case Non Intubated Dual Purpose Circuits CO O3 M2520A Smart CapnoLine Pediatric M2522A Smart CapnoLine Adult Non Intubated Single Purpose Circuits CO3 M2524A Smart CapnoLine Pediatric M2526A Smart CapnoLine Adult CP 840 6 Reusable pressure transducer CPJ84022 Sterile disposable pressure dome for use with CPJ840J6 CPJ84046 Transducer holder for CPJ840J6 M1567A Single channel disposable blood pressure kit available in Europe and Asia only M1568A Dual Line blood pressure kit for measuring CVP ABP and other pressure measurements available in Europe and Asia only M1634A Reusabl
158. from the analysis is displayed stored and printed as configured The Philips 12 Lead Algorithm provides an analysis of the amplitudes durations and morphologies of the ECG waveforms and the associated rhythm The algorithm is age gender specific and very dependent on the patient s paced status Patient age and gender are used to define normal limits for heart rate axis deviation time intervals and voltage values for interpretation accuracy in tachycardia bradycardia prolongation or shortening of PR and QT intervals hypertrophy early repolarization and myocardial infarction Adult criteria apply if the patient age is 16 years old or older Pediatric criteria apply if the patient age is less than 16 WARNING Computerized ECG interpretation is not intended to be a substitute for interpretation by a qualified physician NOTE NOTE For information on the Philips 12 Lead Algorithm see The Philips 12 Lead Algorithm Physicians Guide available at http www medical philips com main products resuscitation under Documentation and Downloads The HeartStart MRx offers only the Non paced and Paced Pacing Detection Settings with Non paced the default setting For information related to the standard IEC 60601 2 51 please go to www medical philips com goto productdocumentation 137 Preview Screen The 12 lead function s Preview Screen allows you to see real time 12 lead ECG data and verify signal quality before ac
159. fy the appropriate electrode sites See Figures 32 and 33 If necessary clip hair at the electrode sites or shave sites if needed Clean and abrade the skin at the electrode site Dry the electrode sites briskly to increase capillary blood flow in the tissues and to remove oil and skin cells 2 Attach the snaps to the electrodes before placing them on the patient 3 Apply the electrodes by peeling them one at a time from the protective backing and sticking them firmly to the patient s skin Refer to Figures 32 and 33 for proper electrode placement Press around the entire edge of each electrode to ensure they are secure Make sure the lead wires do not pull on the electrodes WARNING Be sure that the electrodes do not come in contact with other conductive materials especially when connecting or disconnecting the electrodes to from the patient NOTE A signal from a TENS unit can cause ECG artifact 4 Ifnot preconnected connect the ECG patient cable Align the keyed patient cable connector with the ECG port on the Measurement module as shown in Figure 31 Push the patient cable firmly into the ECG port until the white portion is no longer visible Figure 31 ECG Cable Connection If monitoring via multifunction electrode pads 1 If not preconnected connect the pads cable to the HeartStart MRx See Figure 40 on page 65 2 Connect the pads to the pads cable See Figure 41 on page 66 3 Apply the pads a
160. g they are automatically removed when their alarm condition no longer exists Table 18 details invasive pressure alarms Table 18 Invasive Pressure Red Yellow Physiological 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 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 Each pressure label has its own unique set of default alarm limits which are set in Configuration mode See Configuration on page 181 for details If the alarm is from a pulsatile source the source is displayed above the alarm limits If alarms are off the Alarms Off ON symbol replaces the limits If a w
161. g to your hospital s standard procedure then begin the infusion Position the transducer so that it is level with the heart approximately at the level of the midaxillary line WARNING If measuring intracranial pressure ICP with a sitting patient level the transducer with the top of the patient s ear Incorrect leveling may lead to an incorrect reading Selecting a Pressure to Monitor You need to assign a label to each pressure channel as it is connected Channels are identified as Press 1 and Press 2 You can apply labels to each pressure channel by selecting the appropriate pressure label using the Menu Select button Once you select a label the HeartStart MRx will use that label s stored information color alarm source and limits scale as the default You should check each pressure channel label as the cable is connected and make changes as appropriate To select a pressure label perform the following steps 1 Press the Menu Select button 2 Using the Navigation buttons select Measurements Alarms and press the Menu Select button 3 Select Press 1 or Press 2 and press the Menu Select button 4 Select Label and press the Menu Select button 5 Select the appropriate label from the list provided see Table 15 for list and press the Menu Select button 6 Select the size of your scale See Pressure Waves on page 120 7 Select Alarm Source type See Alarms on page 127 8 Set the high and low alarm limi
162. hange 742 cm s 10 on all six faces Bump EN60068 2 29 Bump Half sine 40 g peak 6 msec duration 1 000 bumps x 3 axes e Free Fall IEC 68 2 32 Free Fall Drops on all faces onto a steel surface excluding bed rail hook 30 in 76 2 cm with carrying case 16 in 40 6 cm without carrying case Vibration e Operating MIL STD 810E 514 4 Category 6 Helicopter General Storage UH60 e Non Operating IEC 68 2 6 Vibration sinusoidal 10 57 Hz 0 15mm 58 150 Hz 2g 20 sweeps x 3 axes IEC 68 2 64 Vibration broad band random 10 20 Hz 0 05 g Hz 20 150 Hz 3 dB octave 150 Hz 0 0065 g Hz 1 5 hours x 3 axes Solids Water Resistance IP24 Water testing performed with cables connected to the device EMC Complies with the requirements of standard EN 60601 1 2 2001 Safety Complies with the requirements of applicable safety standards Other Considerations e The HeartStart MRx is not suitable for use in the presence of concentrated oxygen or a flammable anesthetic mixture with air oxygen or nitrous oxide e Hazards arising from software errors were minimized by the product s compliance with the software requirements contained in EN 60601 1 4 1996 287 Mode of Operation Continuous AC Line Powered 100 240 VAC 50 60 Hz 1 0 46 A Class 1 Battery Powered 14 8 V Rechargeable Lithium Ion DC Powered Input 11 32 VDC 11 A Output 18 V 5 A 90 W 288 Symbol Definitions Table 79 lists the me
163. hapter 17 for more information 135 Disabling the Temperature Function To turn off the Temperature function disconnect the temperature cable from the HeartStart MRx port The message Temp or the label currently activated unplugged Turn off Temp appears Select Yes and press the Menu Select button Should the temperature cable get disconnected accidentally or if the probe and cable separate the message Temp unplugged Turn off Temp appears to notify you of the disconnection To continue monitoring temperature select No and press the Menu Select button Reconnect the temperature cable to restart the temperature monitoring function See Turning Parameters On Off on page 18 Caring For Your Temperature Cables and Probes Refer to the manufacturer s instructions for care and cleaning of your cables Inappropriate treatment of the cables will reduce their lifetime Troubleshooting If your HeartStart MRx does not operate as expected during temperature monitoring see Chapter 20 Troubleshooting 136 13 12 Lead ECG This chapter describes how to use the diagnostic 12 lead ECG function of the HeartStart MRx Overview The optional 12 lead ECG function is available in Monitor Mode and allows you to preview acquire print copy and store a 12 lead ECG In addition the 12 lead function provides computerized ECG analysis using the Philips 12 Lead Algorithm A report with measurements and interpretive statements
164. he 150J Manual Defib setting the CPR sub view is automatically displayed only if the Sync function is disabled patient category is Adult and patient age is equal to or greater than 8 years old The CPR sub view is automatically displayed after the Manual Therapy Security password is entered only if Manual Defib Mode is password protected When the Therapy Knob is located on any other Manual Defib setting a compression of the Compression Sensor displays the CPR sub view The CPR sub view may also be manually displayed by pressing the Start CPR soft key Also the patient category must be Adult and the patient age must be equal to or greater than 8 years old to display the sub view for either action Wave forms for ECG invasive pressure ABP ART Ao or PAP and CO parameters can be viewed during the use of Q CPR Ifan ABP ART Ao or PAP pressure measurement is active the waveform always appears in Wave Sector 3 and the pressure value displays in Parameter Block 2 If two pressures labeled ABP ART Ao or PAP are available the label assigned to Pressure 1 is displayed If no pressure is active then the compression waveform appears in Wave Sector 3 Parameter Block 2 displays compression and ventilation measurement information The EtCO waveform will appear in Wave Sector 4 if present AwRR numeric values are not displayed NOTE Ifthe Pads CPR cable is not connected when you turn the Therapy Knob to Manual Defib Mode the message Connect Pads CP
165. he HeartStart MRx Service Manual 215 Automated Tests The HeartStart MRx independently performs many maintenance activities including three tests that run automatically at regularly scheduled intervals while the device is off to assess operational performance and alert you if a problem exists Results of tests associated with critical functionality of the device are reported through the Ready For Use indicator and the Automated Test Summary report Results are also reported through INOP statements on the display when the HeartStart MRx is turned on Table 54 provides a brief explanation of the tests and lists the frequency with which each is performed Table 54 Automated Tests Hourly Tests batteries internal power supplies and internal Hourly memory Daily Tests batteries internal power supplies internal memory Daily between 11 pm internal clock battery defibrillation pacing ECG SpO and 1 am EtCO NBP Invasive Pressure Temperature Bluetooth and printer The defibrillation test includes low energy internal discharges If a 3 5 or 10 lead ECG cable is attached the cable is tested as well Weekly Performs the Daily Test described above plus deliversa Weekly between high energy internal discharge to further exercise the 11PM Sunday and defibrillation circuitry 1 AM Monday NOTE Automated tests do not test therapy cables paddles buttons audio or the display An ECG cable is tested if c
166. he Menu Select button Zeroing begins Zeroing Using a Soft Key in Monitor Mode To Zero using the soft key in Monitor Mode perform the following 1 Place the transducer at the appropriate level for the measurement site 2 Close the transducer stopcock to the patient and vent the transducer to atmospheric pressure 3 Press the button under Zero Pressure on the display 4 Using the Navigation buttons select the pressure s you wish to zero from the Zero menu and press the Menu Select button Zeroing begins 121 WARNING Invasive pressure alarms and pulse alarms if they are derived from invasive pressure readings are temporarily turned off while the transducer is zeroing The alarms will turn back on 30 seconds after zeroing is complete During the zeroing process a message will appear on the HeartStart MRx display If the process was successful the message on the screen changes to Pressure label zero done at date time for example ABP zero done at 25Jan2006 9 26 If the process is unsuccessful you get an Unable to zero message with a probable cause message displayed Table 16 lists probable cause messages Table 16 Unable to Zero Probable Causes Equipment Malfunction Hardware is faulty Contact your service personnel Excessive Offset Make sure the transducer is vented to the air and try again If this doesn t Unstable Signal work replace the transducer cable and try again If it still doesn t zero re
167. he Q CPR option refer to Using Q CPR in AED Mode on page 174 Troubleshooting If your HeartStart MRx does not operate as expected during defibrillation see Troubleshooting on page 249 6 NOTE Manual Defibrillation and Cardioversion This chapter explains how to prepare for and perform asynchronous and synchronous cardioversion defibrillation using multifunction electrode pads external paddles and internal paddles Defibrillation is always performed through paddles or pads However during defibrillation you may choose to monitor the ECG using an alternate ECG source 3 5 or 10 lead monitoring electrodes If an alternate ECG source is connected any available lead may be displayed For information on monitoring optional measurements while in Manual Defib Mode see the corresponding chapters in these Instructions for Use Overview NOTE Defibrillation therapy is the definitive method for termination of a variety of potentially fatal arrhythmias The HeartStart MRx provides this therapy through the application of a brief biphasic pulse of electricity to the cardiac muscle This electrical energy is transferred through attached paddles or disposable multifunction electrode pads applied to the patient s bare chest Internal paddles for open chest intrathorasic defibrillation can also be used In Manual Defib Mode you must assess the ECG decide if defibrillation or cardioversion is indicated select the app
168. he Shock button must be pressed to deliver a shock The HeartStart MRx will not automatically deliver a shock Delivery of the shock is confirmed by the message Shock Delivered and the shock counter on the display is updated to reflect the number of shocks given The defibrillator will announce Paused If needed begin CPR The HeartStart MRx pauses for the configured CPR Timer period Prompts may be brief or detailed as defined by the CPR Prompt Configuration Choice Analysis begins again at the completion of the pause period or when you press Resume Analyzing If you press Pause for CPR after a shock is delivered in the current Shock Series the length of the CPR Pause is defined by the CPR Timer Configuration Choice NOTE You may return to analyzing the patient s heart rhythm at any time by pressing the Resume Analyzing soft key NOTE Once prompted to Deliver Shock Now Press the Orange Button Now if you do not do so within the configured Auto Disarm time interval the HeartStart MRx disarms itself and provides a pause for CPR The device resumes analyzing at the end of the configurable pause period or when the Resume Analyzing soft key is pressed NOTE Rhythm Monitoring is intended to provide a backup or secondary measure of potentially shockable rhythms in various environments but is not a substitute for being attentive to the state of the patient Using Q CPR in AED mode If your HeartStart MRx is equipped with t
169. he measurement units mmHg kPa Systolic High Limit Selects the high limit alarm value used when Adult 35 270 160 mmHg Pediatric 35 180 120 adjusted in increments of 5 mmHg or 1 kPa Systolic Low Limit Selects the low limit alarm value when systolic is the selected alarm source Adult 30 265 90 mmHg Pediatric 30 175 70 adjusted in increments of 5 mmHg or 1 kPa Diastolic High Limit Selects the high limit alarm value when diastolic is the selected alarm source Adult 15 245 90 mmHg Pediatric 15 150 70 adjusted in increments of 5 mmHg or 1 kPa Diastolic Low Limit Selects the low limit alarm value when diastolic is the selected alarm source Adult 10 240 50 mmHg Pediatric 10 145 40 adjusted in increments of 5 mmHg or 1 kPa Mean High Limit Selects the high limit alarm value when mean is the selected alarm source Adult 25 255 110 mmHg Pediatric 25 160 90 adjusted in increments of 5 mmHg or 1 kPa Mean Low Limit Selects the low limit alarm value when mean is the selected alarm source Adult 20 250 60 mmHg Pediatric 20 155 50 adjusted in increments of 5 mmHg or 1 kPa Color Selects the NBP color Red Yellow Blue Green Cyan Magenta White Table 35 End Tidal Carbon Dioxide Settings Unit Selects the unit of measure mmHg kPa EtCO High Limit Selects the high limit alarm value Adult 20 95 50 mmHg Pediatric 20 95 50 adjus
170. herwise the length of the CPR Pause interval is defined by the NSA Action time setting Monitor 30 60 90 120 150 180 seconds CPR Prompt Defines the level of detail provided in the CPR reminder voice prompts provided at the completion of a Shock Series e Long provides detailed instruction to check airway breathing and pulse circulation before beginning CPR e Short provides instruction to begin CPR if needed only Long Short Monitor Prompt Interval Sets the interval for patient care prompts provided during AED monitoring of the patient s ECG following an NSA decision Off means there are no prompts during AED monitoring 30 60 90 120 150 180 Off seconds 199 Table 48 Q CPR Settings Deep Compression Prompt lying on a compliant surface Selects whether the prompts regarding compressions that are too deep are issued This setting is provided to prevent unwanted voice prompts from being issued when chest compressions are performed on a patient On Off Comp Color Selects the color of the compression and no flow time waveform and values for compression rate Magenta White Table 49 Q CPR Data Capture Settings Q CPR Feedback Enables or suppresses Q CPR feedback On Off Research Storage Enables storage of special research data On Off Table 50 Print Settings Print on Alarm Prints a 15 second strip 10 second
171. hese Q CPR related events are not included in the Event Summary report printed by the HeartStart MRx Table 23 Q CPR Captured Data Compression Waveform Waveform showing compression depth versus time Ventilation Waveform Waveform showing change in chest impedance versus time Ventilation Inflation Time Duration of each ventilation Ventilation Volume Maximum change in chest impedance for each ventilation CO Waveform Waveform showing CO output versus time EtCO End tidal CO measurement for each change in value Reviewing Q CPR Data To review Q CPR data e Copy the event data from the HeartStart MRx internal memory to an external data card See the Data Management chapter for information e Import the data into the Q CPR Review application See the Q CPR Review Directions for Use for more information Troubleshooting If your HeartStart MRx does not operate as expected during Q CPR see Chapter 20 Troubleshooting 17 Configuration This chapter describes the configurable parameters of the HeartStart MRx and the procedures for modifying configuration Overview Configuration settings allow you to customize the HeartStart MRx to best meet your needs Configuration is performed through the Configuration menu of the device and may be saved to a data card for replication on multiple devices At any time configuration settings may be viewed and exported to a data card and the date and
172. hock Test Do one of the following at least once a week to verify the ability to deliver defibrillation therapy Operational check See Instructions for Use for details Signature Date Deliver a 150J shock into a test load See instructions below Signature Date Note If the HeartStart MRx has Software Release B 05 or greater with the Pacing option you cannot test external paddles through Operational Check Perform the Weekly Shock Test to test the external paddles Additionally test reusable sterilizable paddles internal or external prior to each use See the Sterilizable Defibrillator Paddles Instructions for Use How to Perform the Weekly Shock Test Test each type of patient therapy cable used multifunction electrode pads or paddles 1 Ifyou are using paddles make sure the paddles are secure in their pockets and that the Patient Contact Indicator PCI LEDs located on the sternum paddle are not lit If the LEDs light adjust the paddles in their pockets If the LEDs continue to light clean both the adult and pediatric paddle electrode surfaces OR If you are using multifunction electrode pads attach a test load to the end of the patient Therapy cable 2 Turn the Therapy Knob to 150J 3 Press the Charge button NOTE If it becomes necessary to disarm the defibrillator press Disarm 4 The strip prints if configured to do so If the strip does not print immediately press the Print button 5 If using Pads press the
173. hospital environment Surge IEC 61000 4 5 1 kV differential mode 1 kV differential mode Mains power quality should be that of a typical commercial or hospital 2kV common 2 kV common environment mode mode Voltage dips short lt 5 Ur lt 5 Ur Mains power quality should be that interruptions and gt 95 dip in Uy gt 95 dip in Uy of a typical commercial or hospital voltage variations on for 0 5 cycle for 0 5 cycle environment power supply input 40 Ur 40 Uy lines 60 dip in Ur 60 dip in Ur IEC 61000 4 11 for 5 cycles for 5 cycles 70 Ur 70 Ur 30 dip in Ur 30 dip in Ur for 25 cycles for 25 cycles lt 5 Ur lt 5 Ur gt 95 dip in Ur gt 95 dip in Ur for 5 sec for 5 sec Power frequency 3 A m 3 A m Power frequency magnetic fields 50 60 Hz magnetic field IEC 61000 4 8 should be at levels characteristic of a typical location in a typical commercial or hospital environment Uris the AC mains voltage prior to application of the test level Table 87 Electromagnetic Immunity Life Supporting Functions Portable and mobile RF communications equipment should be used no closer to any part of the HeartStart MRx including cables than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter 3 Vrms Recommended Separation Distance 150 kHz to 80 MHz 3 Vrms Conducted RE out
174. hrough configured protocol Indicators Monitor display messages and prompts voice prompts battery status Ready For Use external power Armed Indicators Charging charged tones flashing shock button energy level indicated on display ECG Analysis Evaluates patient ECG and signal quality to determine if a shock is appropriate and evaluates connection impedance for proper defibrillation pad contact Shockable Rhythms Ventricular Fibrillation with amplitude gt 100 uV and shockable wide complex tachycardias Shockable tachycardias include wide complex rhythms of ventricular or unknown origin with heart rate greater than 150 bpm and polymorphic ventricular tachycardia at any heart rate Shock Advisory Algorithm Sensitivity and Specificity Meets AAMI DF 39 275 Table 78 AED ECG Analsysis Performance Shockable Rhythm 600 Meets AAMI DF39 requirement and AHA Ventricular Fibrillation recommendation sensitivity gt 90 for adult defibrillation Shockable Rhythm 300 Meets AAMI DF39 requirement and AHA Ventricular Tachycardia recommendation sensitivity gt 75 for adult defibrillation Non shockable Rhythm 250 Meets AAMI DF39 epicene specificity gt 95 and Normal Sinus Rhythm AHA recommendation specificity gt 99 for adult defibrillation Non shockable Rhythm 500 Meets AAMI DF39 requirements and AHA Asystole recommendation specificity gt 95 for adult defibrillation Non shockable Rhythm 600 Meets AAM
175. ial to ensure that the battery s state of charge is accurately reported there is sufficient charge and capacity to operate your HeartStart MRx and battery life is optimized Remove faulty batteries from service immediately Battery maintenance begins upon receipt of a new battery and continues throughout the life of the battery Detailed information on battery care is available in the Application Note M3538A Lithium lon Battery Characteristics and Care which was provided with your HeartStart MRx Table 60 lists battery maintenance activities and when they should be performed Table 60 Battery Maintenance Procedures 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 capacity Battery Life Battery life depends on the frequency and duration of use When properly cared for the M3538A Lithium Ion battery has a useful life of approximately 2 years To optimize performance a fully or nearly fully discharged battery should be charged as soon as possible 235
176. illator press Disarm If Shock has not been pressed within the time period specified in the Time to Auto Disarm Configuration Choice the defibrillator disarms automatically If desired you may increase or decrease the selected energy level after pressing the Charge button by moving the Therapy Knob to the desired setting The defibrillator charges to the modified energy level automatically Wait until the current charge reaches the selected energy level before proceeding 5 Make sure no one is touching the patient or anything connected to the patient Call out clearly and loudly Stay Clear 6 Press and hold the Shock GS button on the HeartStart MRx or if you are using external paddles press and hold the orange buttons on both paddles The shock will be delivered when the next R wave is detected NOTE Itis important to continue to hold the Shock GS button or the paddle shock buttons until the shock is delivered The defibrillator shocks with the next detected R wave NOTE Should an ECG or pads INOP such as Leads Off occur while performing synchronized cardioversion the HeartStart MRx will not charge or if charged will disarm automatically WARNING Defibrillation current can cause operator or bystander injury Do not touch the patient or equipment connected to the patient during defibrillation Delivering Additional Synchronized Shocks If additional synchronized shocks are indicated perform the following steps
177. imits may be changed during use for the current patient incident NBP alarms are on unless you disable them Once disabled alarms remain off until enabled Table 12 lists NBP alarms Table 12 NBP Red Yellow Physiological Alarms NBPs High Yellow Yellow alarm message The NBP systolic value exceeds the high alarm tone alarm limit NBPd High Yellow Yellow alarm message The NBP diastolic value exceeds the alarm tone high alarm limit NBPm High Yellow Yellow alarm message The NBP mean value exceeds the high alarm tone alarm limit NBPs Low Yellow Yellow alarm message The NBP systolic value has fallen below alarm tone the low alarm limit NBPd Low Yellow Yellow alarm message The NBP diastolic value has fallen below alarm tone the low alarm limit NBPm Low Yellow Yellow alarm message The NBP mean value has fallen below the alarm tone low alarm limit WARNING Turning off alarms prevents all alarms associated with the NBP measurement from being annunciated If an alarm condition occurs NO alarm indication will be given Changing NBP Alarms To change the NBP alarm source and or limits for the current patient incident 1 Press the Menu Select G button 2 Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button Select NBP and press the Menu Select button 4 Select NBP Limits and press the Menu Select button 5 Select the desired
178. information technology equipment and radio television transmission Should interference be encountered as demonstrated by artifact on the ECG or dramatic variations in parameter measurement values attempt to locate the source Assess e Is the interference intermittent or constant e Does the interference occur only in certain locations e Does the interference occur only when in close proximity to certain medical devices e Do parameter measurement values change dramatically when the AC line cord is unplugged Once the source is located attempt to attenuate the EMC coupling path by distancing the monitor defibrillator from the source as much as possible If assistance is needed call your local service representative 301 Restrictions for Use Artifact on the ECG and parameter waveforms caused by electromagnetic interference should be evaluated by a physician or physician authorized personnel to determine if it will negatively impact patient diagnosis or treatment Emissions and Immunity The HeartStart MRx is designed and tested to comply with the radiated and conducted emissions requirement of international and national standards IEC 60601 1 2 2001 and EN 60601 1 2 2002 See Tables 85 through 89 for detailed information regarding declaration and guidance WARNING The use of accessories transducers and cables other than those specified may result in increased emissions or decreased immunity of the HeartStart MRx The list
179. ing A prompt message will ask you to confirm your action Figure 55 Pause Pacing Message Confirm your action Use the Navigation buttons to highlight Yes and press the Menu Select button OR Move the Therapy Knob off the Pacer position 90 Defibrillating During Pacing Should it be necessary to defibrillate the patient during pacing refer to the procedure for defibrillating in Manual Defib Mode in Chapter 6 or AED Mode in Chapter 5 Once the Therapy Knob is moved from the Pacer position to a Manual Defib Mode energy setting or AED pacing is stopped To resume pacing after defibrillation repeat the pacing procedure as described in Demand Mode Pacing on page 88 or Fixed Mode Pacing on page 89 When pacing is resumed pacing settings selected prior to defibrillation mode rate and output are retained Be sure to confirm that cardiac capture has been maintained CAUTION Pacing must be turned off before defibrillating with a second defibrillator Failure to do so could damage the HeartStart MRx Troubleshooting If your HeartStart MRx does not operate as expected during pacing see Chapter 20 Troubleshooting on page 249 8 Pulse Oximetry Pulse Oximetry SpO monitoring is one of the tools available to assist in assessing a patient s cardiac and respiratory systems This chapter explains how pulse oximetry works and describes how to use the HeartStart MRx to monitor SpO O
180. ing of the symbols that may appear on the shipping carton Table 80 HeartStart MRx Shipping Carton Symbols Atmospheric pressure range a Temperature range 1 Relative humidity range ES Recyclable paper product Fragile gt Right side up e Do not get wet 291 Units and Abbreviations Table 81 lists units and abbreviations used with the HeartStart MRx Table 81 Abbreviations bpm beats per minute cpm compressions per minute C degrees Celsius sec seconds F degrees Fahrenheit min minutes mmHg millimeters of mercury mm mV millimeter per millivolt kPa kilo Pascal Hz Hertz percent ppm pulses per minute rpm respirations per minute mA milliAmpere mm millimeter J Joule Clinical Performance Summary Defibrillation Methods An international multicenter prospective randomized clinical study was conducted to assess the effectiveness of the SMART Biphasic waveform in out of hospital sudden cardiac arrests SCAs as compared to monophasic waveforms The primary objective of the study was to compare the percent of patients with ventricular fibrillation VF as the initial monitored rhythm that were defibrillated in the first series of three shocks or less This section summarizes the methods and results of this study Victims of out of hospital SCA were prospectively enrolled in four
181. ins specific information about the Bluetooth device that enables it to communicate with the 12 Lead Transfer Station Your administrator sets up the profiles and can tell you which one to choose 147 Once the Bluetooth device is paired with the HeartStart MRx and the profile selected the HeartStart MRx performs a transmission test After successfully connecting to the device and network the message Transmission Test Passed is displayed Press the Menu Select button to acknowledge the message Should the transmission test fail the message Transmission Test Failed is displayed along with additional information about where the failure occurred See Table 66 in Troubleshooting NOTE There may be exceptions to the pairing process particularly for devices that do not have a user interface Please refer to the documentation for your Bluetooth device Additionally pairing may sometimes be referred to by other names such as bonding NOTE Pairing information is not retained when importing a configuration file from the data card The devices must be paired again using the process above Changing Bluetooth Profiles Once you have added and paired a Bluetooth device you can change its profile using the following steps 1 In 12 lead mode press the Menu Select Vv button 2 From the 12 Lead Main Menu select Bluetooth Devices and press the Menu Select button A list of paired Bluetooth devices is displayed Using the Navigation buttons
182. ins the heart rate and HR alarm settings The position of the other parameters are in fixed locations depending upon the options which were included in your HeartStart MRx Each measurement is labeled and displays the current value and the high and low alarm limit settings or the alarms off icon A is displayed until a valid measurement can be obtained Your parameter text colors will always match their corresponding wave Parameter Alarm Messages are displayed in the space above each numeric value replacing the parameter label except HR Turning Parameters On Off SpO Invasive Pressures EtCO and Temperature parameters are activated when the associated parameter cable tubing is connected To turn the parameter off disconnect the cable tubing from the HeartStart MRx A prompt message see Figure 8 alerts you that the parameter has been disconnected and requests confirmation to turn the parameter off Turn off Sp02 Yes Figure 8 Parameter Message Press the Menu Select 0 button to select Yes confirm your action and turn off the parameter If you do not wish to turn the parameter off use the Navigation Buttons to highlight No Press the Menu Select button to keep the parameter on and reconnect the cable tubing You can also ignore the message and reconnect the cable tubing The HeartStart MRx will detect the connection and remove the message Soft Key Labels 18 The four soft key labels correspond to the soft ke
183. ion is entered the patient category is defaulted to Adult unless configured otherwise and the pacing status is set to Non Paced unless the Paced status has been previously set to paced for an internally paced patient or the HeartStart MRx is pacing the patient 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 Event Timer An Event Timer communicates the elapsed time for the current patient incident 16 Wave Sectors The HeartStart MRx is configured to populate each wave sector with a predetermined waveform when powered on in Monitor Manual Defib or Pacer Mode Figure 7 shows the default Waves configuration choices for a device containing all monitor options See Configuration on page 181 for more information A dashed line in a wave sector or an empty wave sector indicates that the waveform source is invalid Wave sectors may contain a variety of information as appropriate to the parameter view and task Figure 7 Default Waves Configuration Mark Event 10 Feb 2006 11 20 A_ EM Patent name HH MM SS ECG HR alarms Adult Non Pace HR Temp C Pulse bpm NBP mmHg qi20 bpm 80 120 39 0 120 80 sys s 36 930 80 95 so Primary ECG rhythm status ABP __ mmHg PAp mmHg SpO2 EtCO2mmHg AWRR P 118 77 ss 24 10 is 45 100 383 183 Measurements Alarms Patient Info Softkey Softkey Softkey Softkey s
184. ires calibration SpO e Pass SpO passed its self test If the test fails call for service to repair the e Fail SbO is not functionin SpO module If SpO monitoring is essential poe j to patient care take the device out of use NBP e Pass NBP passed its self test If the test fails call for service to repair the e Fail NBP is not functionin NBP module If NBP monitoring is essential j to patient care take the device out of use e Pass Cal Due NBP passed its self test and is due to o be calibrated If calibration is due or overdue arrange for a qualified service provider to perform the e Fail Cal Overdue NBP passed its self test but is calibration due for calibration M b aa a a If replacement is recommended call for service e Fail Replacement Recommended NBP passed its self test but has exceeded 50 000 cycles CO e Pass CO passed its self test If the test fails call for service to repair the e Fail CO is not functionin CO module If CO monitoring is essential 2 E to patient care take the device out of use e Pass Cal Due CO is passed its self test and is due oe ae eee If calibration is due or overdue arrange for a qualified service provider to perform the e Fail Cal Overdue CO passed its self test and is calibration due for calibration M b ee a Sa If replacement is recommended call for service Fail Replacement Recommended CO passed its self test but has exceeded 15 000 opera
185. is not kinked and is free of blockages If necessary replace the tubing CO Equip Malfunction INOP CO hardware failure Do not use the CO monitoring capabilities and call for service of the CO module If CO monitoring is essential to patient care take the device out of use CO Service Required INOP The CO module has reached its end of life defined as 15 000 operating hours Do not use the CO monitoring capabilities and call for service of the CO module If CO monitoring is essential to patient care take the device out of use Table 69 Defibrillation and Pacing Problems Analyzing Stopped or Cannot Analyze ECG message in AED Mode Excessive patient movement Radio or electrical sources are interfering with ECG analysis Minimize patient movement If the patient is being transported stop if necessary Remove possible sources of interference from the area Charge Button Failure INOP During an Operational Check when the Charge button was pressed there was no response Remove the device from use and call for service Defib Disarmed message The Shock button was not pressed within the time period specified in the Time to Auto Disarm Configuration setting Therapy cable not attached Pads paddles connection compromised No action required If desired charge the device and press the Shock button Make sure the therapy cable is connected and the pads paddle
186. itor invasive pressures using the HeartStart MRx Overview The Invasive Pressures option on your HeartStart MRx offers two channels of real time continuous invasive pressure measurements and waveforms in Monitor Manual Defib and Pacer modes If the pressure signal is pulsatile numeric values are displayed for systolic diastolic and mean pressure If the pressure signal is non pulsatile then only the mean is displayed Alarms are provided to alert you to a change in the patient s condition If alarms are enabled alarm limits appear next to the pressure value and the alarm source is displayed above the alarm limits If alarms are off the Alarms Off symbol replaces the limits Setting up for a Pressure Measurement 1 Turn the HeartStart MRx on 2 Connect the pressure cable to the HeartStart MRx NOTE The HeartStart MRx will perform a check of invasive pressure functionality when the option is turned on 3 Connect the cable to the transducer 4 Prepare the flush solution 5 Flush the system to expel air from the tubing Make sure the stopcocks and transducer are also free of air bubbles WARNING If air bubbles appear in the tubing system flush the system with infusion solution again Air bubbles may lead to an incorrect reading 6 Connect the pressure line to the patient catheter 117 7 Ifyou are using an infusion pressure cuff with the pressure line attach the pressure cuff to the fluid to be infused Inflate it accordin
187. k 223 Operational Check Setup 223 Operational Check Report 229 User Checks 230 Operational Check Summary 234 Battery Maintenance 235 Battery Life 235 Charging Batteries 236 Charge Status 236 Battery Calibration 236 Calibration Results 237 Storing Batteries 237 Discarding Batteries 238 Cleaning Instructions 239 Monitor Defibrillator 239 Printer Printhead 239 Paddles Therapy Cable 240 ECG Cable 240 Carrying Case 241 NBP Cuff 241 SpO Sensor and Cable 241 Invasive Pressures Transducer and Cable 241 Temperature Probe and Cable 241 Q CPR Compression Sensor 241 Disposing the HeartStart MRx 242 Disposing Empty Calibration Gas Cylinders 242 Supplies and Accessories 243 20 Troubleshooting 249 Symptoms 250 Audio Tones and Alarm Indications 269 Calling for Service 271 viii 21 Specifications and Safety 273 Specifications 273 General 273 Defibrillator 273 Manual Defib Mode 275 AED Mode 275 ECG and Arrhythmia Monitoring 276 Display 278 Battery 278 Thermal Array Printer 279 Noninvasive Pacing 279 SpO2 Pulse Oximetry 280 NBP 281 Invasive Pressures 282 Temperature 283 EtCO2 283 AwRR 284 Calibration Gas for CO Measurement System 284 12 Lead ECG 285 Patient Data Storage 285 Environmental M3535A 285 Environmental M3536A 287 Symbol Definitions 289 Units and Abbreviations 292 Clinical Performance Summary Defibrillation 293 Methods 293 Results 293 Conclusion 293 Clinical Performance Summary Cardioversion 294 Method
188. kPa Diastolic High Limit value Selects the diastolic high limit Adult 35 360 90 mmHg Ped 35 360 70 Adjusted in increments of 5 mmHg or 1 kPa Selects the diastolic low limit value Diastolic Low Limit Adult 40 355 50 mmHg Ped 40 355 40 Adjusted in increments of 5 mmHg or 1 kPa Mean High Limit Selects the mean high limit value Adult 35 360 110 mmHg Ped 35 360 90 Adjusted in increments of 5 mmHg or 1 kPa Mean Low Limit Selects the mean low limit value Adult 40 355 70 mmHg Ped 40 355 50 Adjusted in increments of 5 mmHg or 1 kPa Selects the default wave form scale Scale Adult 300 240 180 150 120 110 100 90 80 70 60 50 40 30 20 10 5 10 15 20 Pedi 300 240 180 150 120 110 100 90 80 70 60 50 40 30 20 10 5 10 15 20 Artifact Suppression Specifies the duration for suppressing pressure alarms due to non physiological artifacts An INOP is 30 sec 60 sec 90 sec Off displayed Filter Selects the filter setting 12 Hz 40 Hz Color Selects the P1 color Red Yellow Blue Green Cyan Magenta White Note The High Contrast feature does not display the colors red or blue therefore be sure your device is configured correctly with appropriate parameter color settings Table 28 Invasive Pressure Settings P2 All setting options are exactly the same as P1 in Ta
189. l Pacer Mode offers noninvasive transcutaneous pacing therapy Pace pulses are delivered through multifunction electrode pads using a monophasic waveform If desired use of Pacer Mode may be password protected The HeartStart MRx is powered by rechargeable lithium ion batteries Available battery power is easily determined by viewing the convenient battery power indicators located on the device display or by checking the gauge on the battery itself Additionally an external AC or DC Power Module may be applied as a secondary power source and for continual battery charging The HeartStart MRx performs Automated Tests on a regular basis The results of these tests are reported to the Ready For Use RFU indicator The prominently displayed RFU indicator communicates the status of your device letting you know it is operating correctly needs attention or is unable to deliver therapy In addition performing the specified Operational Check ensures that the HeartStart MRx is functioning properly The HeartStart MRx automatically stores critical event data such as Event Summaries 12 Lead Reports and Vital Signs Trending in its internal memory The HeartStart MRx also enables you to store data and event information on an optional data card for downloading to Philips data management solution HeartStart Event Review Pro or Q CPR Review The HeartStart MRx is highly configurable to better meet the needs of diverse users Be sure to familiarize yours
190. l be reset to the device s configured values 183 Configurable Parameters The following tables list configurable parameters for each of the sub menus on the Configuration Main menu A description of each parameter is provided along with the possible choices for settings Default settings are in bold type Table 24 General Settings Voice Volume Voice prompt volume level Very Soft Soft Medium Loud Very Loud Alarm Volume Audible alarm volume level Very Soft Soft Medium Loud Very Loud Minimum Alarm Volume Minimum audible alarm level available during Very Soft Soft Medium Loud Very Loud use QRS Volume Volume of audible beep with each QRS Off Very Soft Soft Medium Loud Very Loud complex detected Time Format Selects time format to display 12 hour 24 hour Pacing on Batteries Displays the warning message Pacing on Yes No Warning Batteries if pacing using only battery power Unit Display Defines if parameter values are displayed with On Off or without corresponding measurement units Patient Category Selects the default patient category Adult Pedi Device Owner Identification for Return to Owner feature 20 characters Return to Owner Password required in order to deactivate the 4 characters Password loan period setting Audio Recording Turns audio recording on or off for Manual On Off Defib or AED modes NOTE The Return to Owner Password should be docu
191. larms from alarming The alarm message is no longer displayed and the UN icon appears next to the parameter value Acknowledge For latching alarms acknowledge clears the alarm condition when the condition no longer exists New Limits Adjust the parameter alarm limits accordingly NOTE Alarm history can be accessed in the patient s Event Summary This information is maintained after powering the device down and in the unlikely event of power loss WARNING Although the Alarm Pause button can be used when responding to alarms the response procedures described above are recommended Alarm Pause removes audio and visual indications of active alarm conditions as well as inhibiting indications of new alarm conditions A potential hazard exists if 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 Heart Rate or Arrhythmia Alarms function a bit differently than other alarms For information about responding to these alarms see Responding to HR and Arrhythmia Alarms on page 59 26 Entering Patient Information Patient information may be entered for the following e Name e ID e Patient Category Age e Sex e Paced internal paced status Information is entered using the Patient Info menu Patie
192. lead monitoring electrode ECG source or to monitor through pads Configurable heart rate and arrhythmia alarms clearly communicate patient status both audibly and visually Waveforms may be acquired through the therapy port for pads paddles or the monitoring port for 3 5 or 10 lead monitoring electrodes If the configured source is not connected to the HeartStart MRx when turned on the first valid ECG source is displayed in Wave Sector 1 Once the configured source is available it automatically populates Wave Sector 1 Should the configured source then become invalid a Leads Off condition is displayed The HeartStart MRx does not revert to the initial source of ECG but you can select a lead by pressing the Lead Select button WARNING Do not use the HeartStart MRx to monitor neonatal ECGs Doing so could result in inaccurate measurements and alarms Monitoring View Monitoring View appears on the display when the Therapy Knob is in the Monitor position Figure 30 shows the information displayed in Monitoring View Figure 30 Monitoring View Mark Event 10 Feb 2006 11 20 _ e m Patient Name 02 42 ECG HR alarms Adult Non Paced HR 8 0 Temp C Pulse bpm 120 80 ss q120 bi 120 SYS i s 36 9330 80 05 9 mmHg PAP mmHg SpO2 EtCO2Z Hs AwWRR Pm ABP 118 77 ss 24 10 ma 95 15 100 385 18 Start 12 Lead NBP Monitoring View can display up to four ECG waves Numeric values for heart rate and all other av
193. lectrical connections causing unreliable or intermittent measurements e Do not use disposable sensors on patients who have allergic reactions to the adhesive e Do not use the ear transducer on patients with small ear lobes as incorrect measurements may result NOTE To use Nellcor sensors M1903B M1904B you must connect the M1943B Nellcor adapter cable to the HeartStart MRx 95 The most important factor when selecting a sensor is the position of the light emitting diodes in relation to the photodetector When a sensor is applied the diodes and the photodetector must be opposite each other Sensors are designed for patients with a specific weight range and for specific sites Be sure to e Select a sensor appropriate for the patient s weight e Select a sensor site with adequate perfusion Improve perfusion at the site by rubbing or warming the site e Avoid application to sites with edematous tissue Reusable Sensors may be reused on different patients after they have been cleaned and disinfected see the manufacturer s instructions supplied with the sensor Disposable Sensors should be used only once and then discarded They may be relocated to another sensor site on the patient if the first location does not give the desired results Disposable sensors must not be reused on different patients NOTE A 2 meter SpO extension cable M1941A is available for use with the HeartStart MRx 96 Applying the Sensor
194. lue Adult 40 359 10 mmHg Ped 40 359 24 Adjusted in increments of 1 mmHg or 0 1 kPa Diastolic High Limit Selects the diastolic high limit value Adult 39 360 16 mmHg Ped 39 360 4 Adjusted in increments of 1 mmHg or 0 1 kPa Diastolic Low Limit Selects the diastolic low limit value Adult 40 359 0 mmHg Ped 40 359 4 Adjusted in increments of 1 mmHg or 0 1 kPa Mean High Limit Selects the mean high limit value Adult 39 360 20 mmHg Ped 39 360 26 Adjusted in increments of 1 mmHg or 0 1 kPa Mean Low Limit Selects the mean low limit value Adult 40 359 0 mmHg Ped 40 359 12 Adjusted in increments of 1 mmHg or 0 1 kPa Scale Default waveform scale Adult 300 240 180 150 120 110 100 90 80 70 60 50 40 30 20 10 5 10 15 20 Ped 300 240 180 150 120 110 100 90 80 70 60 50 40 30 20 10 5 10 15 20 Artifact Suppression Selects the default artifact suppression 30 sec 60 sec 90 sec Off timeframe Filter Selects the filter setting 12 Hz 40 Hz Color Selects the parameter color Red Yellow Blue Green Cyan Magenta White Table 32 Invasive Pressure Settings ICP Alarm Source Source is always Mean and not configurable High Limit Selects the high limit value Adult 39 360 10 mmHg Ped 39 360 4 Adjusted in increments o
195. lusion condition will occur The HeartStart MRx automatically attempts to purge the blockage CO Occlusion INOP Attempts to purge the FilterLine and exhaust tube were unsuccessful A sample cannot be taken because of the blockage Make sure the FilterLine and exhaust tubing if connected are not kinked and are free of blockages Then disconnect and reconnect the FilterLine to retry If necessary replace the FilterLine and or exhaust tubing CO Overrange INOR The CO value is higher than the measurement range If you suspect a false high value do not use the CO monitoring capabilities and call for service of the CO module If CO monitoring is essential to patient care take the device out of use CO Auto Zero INOP The automatic zero process is running It takes from 10 to 30 seconds and CO values are invalid at this time No action required The module automatically resets itself Table 68 CO Monitoring Problems Continued CO Calibration Overdue INOP The CO module should be calibrated once a year or after 4 000 operating hours Do not use the CO monitoring capabilities and call for service to calibrate the CO module If CO3 monitoring is essential to patient care take the device out of use CO Check Exhaust INOP When CO is turned on the exhaust tube is blocked to the extent that a measurement sample cannot be taken Make sure the exhaust tubing
196. lysis is suspended Check that the pads are making proper contact with the patient s skin and minimize movement Analysis resumes automatically after 30 seconds or when you press Resume Analyzing Always use the analyze function to determine if a rhythm is shockable Adjusting Voice Prompt Volume You may adjust the volume of the voice prompts at any time by accessing the Voice Volume menu Press the Menu Select C button Select the desired volume level and press the Menu Select button NOTE In loud environments you can use the display prompts in lieu of voice prompts Shock Advised If a shockable rhythm is detected the HeartStart MRx automatically charges to 150J Charging is accompanied by voice and screen prompts as shown in Figure 43 A steady high pitched tone is sounded and the orange Shock button flashes when the device is fully charged Heart rhythm analysis continues while the HeartStart MRx charges Ifa rhythm change is detected before the shock is delivered and a shock is no longer appropriate the defibrillator disarms Figure 43 Shock Advised Charging Display Shocks 0 SHOCK ADVISED CHARGING STAND CLEAR NOTE When the HeartStart MRx is fully charged you can disarm it any time by turning the Therapy Knob to the Off position or by pressing the Pause for CPR soft key Resume monitoring the patient by turning the Therapy Knob back to AED No Shock Advised NSA If a shockable rhythm is not de
197. ment Poor electrode contact and skin preparation Respiratory interference Reassure and relax the patient Be sure lead wires are not pulling on the electrodes Move electrodes away from areas with the greatest respiratory motion if possible Power line AC Interference jinn Inet Ine IN Poor electrode contact Dry or dirty electrodes Interference from poorly grounded instrument near patient Reapply electrodes Route electrode wires along the limbs and away from other electrical equipment Intermittent or jittery waveform Poor electrode contact Dry electrodes Faulty lead wires Clean the site and reapply electrodes Apply new electrodes Repair or replace faulty leads Adjusting Wave Size Adjusting ECG wave size may improve signal viewability To do this 1 2 3 off power for more than 10 seconds While in 12 Lead press the Menu Select button Using the Navigation buttons select ECG Size and press the Menu Select button Using the Navigation buttons select the desired size value and press the Menu Select button The lead size is retained when you exit and then return to 12 lead functionality without turning NOTE Selecting ECG wave size of either 10mm mV V or 20 mm mV V displays V leads at half of the selection 5 mm mV and 10 mm mV respectively 143 13 12 Lead ECG 12 Lead Filters 12 Lead Filters ECG bandwidth filters of 0 15 40 Hz 0 05
198. mented in a secure manner Should it need to be reset all configuration settings must be reset to factory default values and the device must then be re configured NOTE Do not set alarm volumes so low that you can t hear them in loud environments Table 25 Heart Rate and ECG Settings Auto Gain Determines whether ECG size is automatically On Off adjusted to the standard maximum wave size without clipping the wave sector If auto gain is off the gain is set to 1 1Omm mV AC Line Filter Selects the setting used to filter out AC line 60 Hz 50 Hz noise Adjust this setting to the power frequency of your country ECG Bandwidth for Selects the display filter frequency for the 15 40 Hz Monitor 1 30 Hz EMS Display attached therapy cable or 3 5 lead ECG cable This setting does not affect 12 Lead View ECG Bandwidth for Selects the printer filter frequency for the 0 05 150 Hz Diagnostic 15 40 Hz Monitor Printer attached therapy cable or 3 5 lead ECG cable 1 30 Hz EMS This setting does not affect 12 Lead Reports If Diagnostic is selected pads ECG is set to Monitor ECG Electrode Labels Selects electrode label format AAMI RA LA AAMI IEC LL RL V IEC R L EN C HR Pulse High Limit Selects the default High Alarm Limit for the Adult 35 200 120 bpm HR derived from the ECG and the pulse Pediatric 35 240 160 derived from SpO or Invasive Pressures adjusted in increments of 5 HR Pul
199. mmHg Overpressure Safety Limits Maximum of 300 mmHg Cuff Inflation Time 75 second maximum pediatric or adult Pressure Transducer Accuracy 3mmHg Alarm Range e Systolic high limit 35 270 Adult 35 180 Pediatric e Systolic low limit 30 265 Adult 30 175 Pediatric e Diastolic high limit 15 245 Adult 15 150 Pediatric e Diastolic low limit 10 240 Adult 10 145 Pediatric e Mean high limit 25 255 Adult 25 160 Pediatric e Mean low limit 20 250 Adult 20 155 Pediatric Rated Life 50 000 measurement cycles 36 day for 2 3 years Auto Mode Repetition Time 1 2 5 5 10 15 30 60 or 120 minutes Maximum Measurement Time 120 sec Interconnect Tube Length e M1598B Connect tubing 1 5 m e M1599B Connect tubing 3 0 m Recommended frequency of pressure transducer calibration yearly Invasive Pressures Transducer Sensitivity 5uV V mmHg 37 5uV V kPa Sensitivity Adjustment Range 10 Transducer Load Resistance 195 to 2200 Ohms Transducer Output Resistance 0 to 3000 Ohms Frequency Response 0 12Hz or 0 40Hz Zero Adjustment Range 200mmHg 26 7kPa Zero Adjustment Accuracy 1 0mmHg 0 1kPa Zero Setting Drift lt 0 1mmHg C 0 013kPa C Gain accuracy excluding transducers 1 of reading or 1mmHg 0 1kPa whichever is greater Gain Drift less than 0 05 C Overall Accuracy included listed transducers 4 of reading or 4mmHg 0 5kPa whichever is greater Measurement Range 40 to 361mmHg
200. mode 67 using Q CPR 174 automated tests 216 AwRR Alarms 114 changing 115 enabling disabling 116 B basic orientation 10 batteries calibration 236 capacity 14 charge level indicators 16 Index charging 236 discarding 238 installing 44 life expectancy 14 235 M3538A Lithium Ion Battery 14 maintenance 235 specifications 278 storing 237 warnings 300 beat labels 60 Bluetooth setup 147 transmission 149 troubleshooting 258 C Calibrating invasive pressures 123 confirmation 125 cautions 297 cleaning 239 carrying case 241 ECG cable 240 invasive pressure transducer 241 monitor defibrillator 239 NBP cuff 241 paddles 240 printer printhead 239 Q CPR Compression Sensor 241 SpO sensor 241 temperature probe cable 241 therapy cable 240 clinical performance summary cardioversion 294 defibrillation 293 internal defibrillation 296 CO monitoring 111 connecting filter line 40 measuring EtCO 114 overview 111 selecting accessories 112 setting up 113 code view 73 compression sensor 166 configuration 181 accessing menu 181 183 configurable parameters 184 loading configuration from a data card 183 modifying settings 182 309 printing configuration settings 183 restoring default settings 183 saving configuration to a data card 183 setting date time 182 continued use 27 controls 20 alarm pause button 21 charge button 22 event summary button 21 lead select button 21 mark event button 21 menu
201. mpedance is the resistance between the defibrillator s pads or paddles that the defibrillator must overcome to deliver an effective discharge of energy The degree of impedance differs from patient to patient and is affected by several factors including the presence of chest hair moisture and lotions or powders on the skin The low energy SMART Biphasic waveform is an impedance compensating waveform that is designed to be effective across a wide range of patients However if you receive a No Shock Delivered message check that the patient s skin has been washed and dried and that any chest hair has been clipped If the message persists change the pads and or the pads cable Nn nN Using AED Mode Semi Automated External Defibrillation Using AED Mode To operate the HeartStart MRx in AED Mode follow these three basic steps 1 Turn the Therapy Knob to AED 2 Follow the voice and screen prompts 3 Press the orange Shock button if prompted These steps are described more fully in the sections that follow While operating in AED Mode the capabilities of the device are limited to those essential to the performance of semi automated external defibrillation Only the ECG acquired through pads is displayed Previously set alarms and scheduled measurements are indefinitely paused and entry of patient information is disabled Additionally the Sync Lead Select and Alarm Pause buttons are inactive Step 1 Turn the Therapy Knob to AED
202. n using the Mark Event function button See Marking Events on page 212 for more information For treatment of patients with implantable devices such as permanent pacemakers or cardioverter defibrillators consult a physician and the instructions for use provided by the device s manufacturer Waveforms ECG monitoring measurements and most alarms remain active and retain their settings when you transition from Monitor or Manual Defib Mode to Pacer Mode However the waveform displayed in Wave Sector 4 is replaced by the pacing status bar The use of Pacer Mode may be password protected as defined in Configuration See Password Security on page 15 83 Alarms Arrhythmia alarms for Pacer Not Pacing and Pacer Not Capture are associated with non transcutaneous pacing such as internal transvenous or epicardial pacing therefore these alarms are off when the HeartStart MRx is in Pacer Mode All other red and yellow alarms are active if enabled and their limits may be changed while in Pacer Mode Refer to the specific chapter for each measurement for information on red and yellow alarms and changing alarm limits While pacing should a Pads Off condition occur or the pads cable get disconnected a latching red alarm is generated and pacing is stopped The message Pacing Stopped Pads Off Pads Cable Off is displayed in the top line of the pacing status bar Once the condition is corrected resume pacing by pressing the Re
203. n anterior posterior position 29 Ne Battery WARNING Properly dispose of or recycle depleted batteries according to local regulations Do not puncture disassemble or incinerate batteries WARNING Built in safety circuits can not protect against handling abuse Adhere to all warnings and cautions in handing and using lithium ion batteries WARNING Do not expose batteries to temperatures greater than 60 C 140 F Excess temperatures may result in battery damage WARNING Keep batteries away from flame and other heat sources WARNING Do not short circuit the battery Avoid placing batteries around metal objects that may short circuit the battery WARNING Avoid getting batteries wet or using batteries in high humidity environments WARNING Do not crush dent or allow any deformation of the batteries WARNING Do not disassemble or open batteries Do no attempt to alter or bypass the safety circuit WARNING Avoid extreme shock and vibration to the battery WARNING Do not use or connect the battery to batteries of other chemistries QD 00 Supplies and Accessories WARNING Use only the multifunction electrode pads battery and accessories as listed in this guide Substitutions may cause the HeartStart MRx to function improperly WARNING Use multifunction electrode pads prior to their expiration date Discard pads after use Do not reuse pads Do
204. n buttons select Measurements Alarms and press the Menu Select button 3 Select Pulse and press the Menu Select button 4 Select Pulse Source and press the Menu Select button Pick a source with an arterial or pulmonary waveform 5 Using the Navigation buttons highlight the pulse source desired and press the Menu Select button Figure 64 Pulse Source Main Menu Measurements Alarms Pulse Pulse Source Displayed Waves Press 1 ABP Alarms On Press 1 ABP Printed Waves Press 2 PAP Pulse Limits Press 2 PAP Measurements Alarms CPP Exit Patient Info NBP Trends EtCO2 Oth er AwRR High Contrast On Sp02 Exit Temp lt Setting Pulse Alarms When on pulse alarms annunciate if measurements fall outside of the limits for high or low pulse Alarms are turned off unless you turn them on during use Once turned on alarms remain on until they are turned back off NOTE If pulse alarms are enabled alarm limits appear next to the pulse value If alarms are off the Alarms Off X symbol replaces the limits Enabling Disabling Pulse Alarms Pulse alarms are turned off by default To turn the pulse alarms on for the current incident perform the following steps 1 Press the Menu Select Vv button 2 Using the Navigation buttons select Measurements Alarms and press the Menu Select button 3 Select Pulse and press the Menu Select button 4 Select Alarms On and press the
205. n is not functioning Shock Button e Pass The Shock Button passed its self test Repeat the test being sure to press the Shock e Fail Proceed was selected from the No Button Button before reaching the Auto Disarm time Respedse Manu If the test continues to fail call for service e Fail The Shock Button was not pressed before the configured Auto Disarm time period ended Audio e Pass You responded Yes that you were able to hear Take the device out of use and call for service the test voice prompt e Fail You responded No to hearing the voice prompt Defib e Pass cable type The defib test passed with the If the test fails repeat it using a different specified cable type pads external paddles attached therapy cable A passing result with a different Fail cable type The test failed with the specified cable indicates the previous cable is defective cabile type connected and should be replaced If the test continues to fail take the device out of use and call for service Pacer e Pass Pacing is functioning If the pacer fails attach a different pads cable Pil Pang tenet imane and test load and repeat the test If the pacer fails again take the device out of use and call for service Compression e Pass The Compression Sensor passed its self test If the test fails call for service to test the Sensor e Fail The Compression Sensor failed its self test Comp ression Sensor If QCPR is essential to patient care take
206. n s on the paddles to deliver a shock R Wave Not Detected message During synchronized cardioversion the r wave was not detectable Choose a lead with a clearly define QRS complex Pacing Stopped Leads Off message Pacing has stopped because the ECG source for Wave Sector 1 has become invalid because of a Leads Off condition or an ECG cable disconnection Check that the monitoring electrodes are applied properly to the patient Check cable connections Press the Resume Pacing soft key to continue pacing Pacing Stopped Pads Off Pads Cable Off message Pacing has stopped because of poor pads patient contact or a pads cable disconnection Check that the pads are applied correctly to the patient Check cable connections Press the Resume Pacing soft key to continue pacing Shock Button Failure INOP During an Operational Check when the Shock button was pressed there was no response Remove the device from use and call for service Therapy Knob Failure INOP During an Operational Check the Therapy Knob test failed Remove the device from use and call for service Time to charge to selected energy is slow The device is being operated with only AC DC power no battery or the battery power is low Install a fully charged battery Device displays a No Shock Delivered message but you see a physiological response from the patient Poor skin contact pads a
207. nal from the monitor into the HeartStart MRx where it is displayed and synchronization occurs The signal from the bedside monitor is displayed as Lead II on the HeartStart MRx even though it is not necessarily Lead II coming from the bedside monitor WARNING Ifyou use an external monitor as the ECG source a biomedical technician MUST verify that the external monitor and the HeartStart MRx combination will deliver a synchronized shock within 60 ms of the peak of the R wave Use a 1 mV QRS complex with a QRS width of 40 ms This performance cannot be guaranteed with all commercially available monitors e When monitoring through paddles only artifact introduced by paddle movement may resemble an R wave and trigger a defibrillation shock 79 Delivering a Synchronized Shock To perform synchronized cardioversion 1 With the Therapy Knob in the Monitor position press the Sync G button located beside the Therapy Knob see Figure 50 to activate the Sync function A Sync message appears in the upper right corner of Wave Sector 1 2 Confirm that the Sync marker appears with each R wave Turn the Therapy Knob to the desired energy level setting 4 Press the Charge _ Cp button on the HeartStart MRx on if using paddles the yellow charge button located on the handle of the paddle with the C amp symbol Wait until the charge has reached the energy level selected and you hear a continuous charge done tone To disarm the defibr
208. nd or fixed mode pacing NOTE Upon returning to a clinical mode from a non clinical mode such as Configuration or Data Management all settings reset to the default settings Password Security Access to Manual Defib Mode and Pacer Mode may be password protected if configured If enabled you will be prompted to enter the password upon moving the Therapy Knob to either the Pacer position or an energy selection The password is entered by using the Navigation b buttons to select the password numbers and then selecting Done to complete the entry The Charge C52 button and the Start Pacing soft key remain inactive until the password is entered AED mode is always available without a password WARNING Use of the Manual Therapy security password requires the clinician to know and remember the password as defined in Configuration Failure to enter the correct password will prevent the delivery of manual defibrillation or pacing therapy Prior to selecting this Configuration option review this potential risk with your Risk Manager Display Views The HeartStart MRx display layout is segmented as shown in Figure 5 Figure 5 Display Layout General Status Mark Event 10 Feb 2006 11 20 A_ Ex ae alarms Adult Non Paced HH MM SS Temp C Pulse bpm 150 80 ss q120 an 8 Qs 120 39 0 _ 36 930 80x 95 s Primary ECG ae Sp02 EtCO2 49 AwRR P R e Tein Menu Volume Sector 3 Displayed Waves Soft
209. nd you wish to perform an alarm verification test in a non clinical environment outside of the Operational Check testing you can connect the HeartStart MRx up to a simulator manually change the alarm limits to a setting which should cause an alarm to annunciate Look at the display and listen for the alarm Be sure to reset the alarm limits to the appropriate settings before returning the device to a clinical environment 230 Table 58 Operational Check Test Results General System Pass The clock battery power supplies and internal If the test fails with the AC DC power memory are functioning module present remove the module and o Pail Thedodk battery bower qucwlics andlor repeat the test If the test continues to fail call i P EONS SEEE Srn for service If the test passes replace the power internal memory are not functioning A failure may dul abort the remaining tests MOGIS Therapy Knob e Pass The Therapy Knob is set to 150J If the test fails confirm that the Therapy s Fale The Therapy Kadt knor atot Knob is set to 150J and repeat the test If the i test continues to fail call for service e Fail The Therapy Knob is not functioning Charge Button e Pass The Charge Button passed its self test Repeat the test If the test continues to fail e Fail Proceed was selected from the No Button berane there wna ae ae from the Chae Response Menu Button call for service e Fail The Charge Butto
210. ndard for cardiac monitors EC 13 ECG Size 2 5 5 10 20 40 mm mV autogain Maximum T wave amplitude Meets recommended minimum 1 2mV T wave amplitude rejection 276 Frequency Response e AC Line Filter 60 Hz or 50 Hz e Pads ECG for Display Monitor 15 40 Hz or EMS 1 30 Hz e Pads ECG for Printer Monitor 15 40 Hz or EMS 1 30 Hz e Leads ECG for Display Monitor 15 40 Hz or EMS 1 30 Hz e Leads ECG for Printer Diagnostic 05 150 Hz or Monitor 15 40 Hz or EMS 1 30 Hz Heart rate accuracy and response to irregular rhythm Meets AAMI standard for ventricular bigeminy HR 80 bpm slow alternating ventricular bigeminy HR 60 bpm rapid alternating ventricular bigeminy HR 120 bpm bidirectional systoles HR 90 bpm Heart rate averaging For heart rates gt 50 bpm heart rate is determined by averaging the 12 most recent R R intervals Beats N P and V are included When heart rate drops below 50 bpm the 4 most recent R R intervals are used in the average Note For ventricular tachycardia alarms which have a user definable PVC run length limit the heart rate is based on the user selected PVC length up to 9 PVCs maximum Heart Rate Response Time e 80 to 120 bpm 7 seconds e 80 to 40 bpm 6 seconds Time to Alarm for Tachycardia e 206 bpm 1 mV 3 seconds e 206 bpm halved amplitude 3 seconds e 206 bpm doubled amplitude 3 seconds e 195 bpm 2 mV 3 seconds 195 bpm halved amplitude
211. nds 10 seconds just prior to the message No Shock Delivered plus 12 seconds after the message Alarm condition 15 seconds 10 seconds of pre alarm data and 5 seconds of post alarm data when specified alarm type occurs Same as real time strip Mark Event gt button pressed 6 seconds from the start of the annotation text or from the time the Events menu is removed from the display 10 seconds prior to the Mark Event plus 6 seconds from the start of the annotation text or from the time the Events menu is removed from the display 213 19 Maintenance This chapter describes how to care for your HeartStart MRx and its accessories Overview Proper maintenance of the HeartStart MRx is a very simple yet important factor in dependability It involves e Providing power so automated tests can be run e Observing the Ready For Use RFU indicator e Performing the Operational Check e Caring for batteries e Cleaning the device and accessories e Ordering replacement supplies and accessories WARNING Electric shock hazards exist internally Do not remove assembly screws HeartStart MRx service should only be performed by qualified service personnel in accordance with the HeartStart MRx Service Manual NOTE Calibration of the optional end tidal CO and noninvasive blood pressure modules of the HeartStart MRx needs to be performed yearly by a qualified service provider as described in t
212. nected and subsequently EtCO On Off when measurement is disconnected connected Pressure Label On Off Temperature Label Onl Off HR Limits low high Logged with measurement on event if measurement alarms are on when settings SpO Limits low high are changed or when measurement alarms are turned on EtCO Limits low high Pressure Label Limits source low high Temperature Label Limits low high AwRR Limits low high Pulse Limits ow high SpO Alarms Off Logged when measurement alarms are turned off EtCO Alarms Off Pressure Label Alarms Off Temperature Label Alarms Off Pulse Alarms Off AwRR Alarms Off Apnea Time limit sec Logged when AwRR alarms are turned on and EtCO when settings are changed Pulse Alarms Off Logged when Pulse alarms are turned off Press 1 Press 2 Logged when a pressure label is set or changed Label Pressure Label Pressure Label zeroed Logged when pressure label is zeroed Pressure Label cal factor Logged when cal factor for pressure label is entered or a mercury calibration is value completed Pulse Source source Logged when the pulse source is initially determined and when changed NBP Schedule Logged when schedule is changed Manual q1 NBP On Logged when Start NBP is initially pressed manually or configured schedule NBP Limits source low Logged when Start NBP soft key pressed and when settings are changed high NBP Alarm
213. necting the Temperature Cable 39 Connecting the CO FilterLine 40 Connecting the Therapy or Pads CPR cables 41 Installing Paper 42 50mm Printer 42 75mm Printer optional 43 Installing Batteries 44 Charging Batteries 44 Battery Safety 44 Installing the AC Power Module 45 Installing the Data Card 46 4 ECG and Arrhythmia Monitoring 47 Overview 47 Monitoring View 48 Preparing to Monitor ECG 49 Electrode Placement 51 Lead Selection 53 Lead Choices 53 Selecting the Lead 54 Arrhythmia Monitoring 54 Aberrantly Conducted Beats 55 Intermittent Bundle Branch Block 55 Heart Rate and Arrhythmia Alarms 56 Arrhythmia Alarm Latching 56 INOP Messages 58 Setting Alarms 59 Changing Heart Rate or VTACH Alarm Limits 59 Enabling Disabling Heart Rate and Arrhythmia Alarms 59 Responding to HR and Arrhythmia Alarms 59 Displaying an Annotated ECG 60 Arrhythmia Learning Relearning 61 Troubleshooting 61 5 Semi Automated External Defibrillation 63 Precautions for AED Therapy 63 AED View 64 Preparation 65 Using AED Mode 67 Step 1 Turn the Therapy Knob to AED 67 Step 2 Follow the Screen and Voice Prompts 68 Adjusting Voice Prompt Volume 68 Shock Advised 69 No Shock Advised NSA 69 Step 3 Press the Orange Shock Button if Prompted 70 Using Q CPR in AED mode 70 Troubleshooting 70 6 Manual Defibrillation and Cardioversion 71 Overview 71 Precautions for Manual Defibrillation Therapy 72 Synchronized Cardioversion Therapy 72 Cod
214. ness Operational Checks supplement the Automated Tests by verifying therapy cables the ECG cable paddles audio the Charge and Shock buttons Therapy Knob and Compression Sensor along with replicating the Weekly test Operational Checks also notify you if the battery NBP module or CO module need calibration WARNING Be sure the HeartStart MRx is not connected to the patient when performing an Operational Check NOTE NOTE NOTE It is important to establish a schedule for conducting Operational Checks as well as for checking supplies and accessories associated with the HeartStart MRx This will ensure that the device is ready to monitor and deliver therapy The Operational Check is run with a battery installed to reflect optimal operating conditions for defibrillation The device automatically disconnects AC DC power If you have the Pacing option test external paddles using the Weekly Shock test You must run Operational Check with a pads cable in order to pass the Pacer test Prior to performing the Operational Check ensure that the paddles if tested are secure in their pockets and that the PCI LEDs are not lit Should the LEDs light adjust the paddles in their pockets If the LEDs continue to light clean both the adult and pediatric paddle electrode surfaces At completion of the Operational Check the message Operational Check Passed is displayed if all of the tests pass If any test fails the message Operational Che
215. nfiguration settings Check the MRx and the12 Lead Transfer Station to ensure that the correct product versions are installed Table 67 12 Lead Transmission Problems RS 232 First attempt to solve the problem by disconnecting the serial cable from the cell phone reconnecting it and resending the 12 Lead Report Transmission Settings Have Not Been Configured message Hub information has not been entered or is entered incorrectly in Configuration Modify the Hub configuration settings as needed No Transmission Devices Detected message The cell phone is not an approved model for 12 Lead Transmission The cell phone s RS 232 port has not been configured The cell phone is not connected properly The serial cable is defective or incompatible Use an approved cell phone model See the requirements listed in the 12 Lead Transmission Implementation Guide Check the cell phone configuration settings Check that the cell phone is turned on and the connection is secure Disconnect and reconnect the serial cable Work with your cell phone provider to obtain a serial cable that connects to your phone with a 9 pin D serial cable connection No Dial Tone message There is no dial tone Cell phone service is unavailable Check that the connections are secure Check that the cellular signal strength is sufficient Transmission Failed message accompanied by an Error Configuring Tran
216. ng using and testing the batteries Do not short circuit crush drop mutilate puncture apply reverse polarity expose to high temperatures or disassemble Misuse or abuse could cause physical injury NOTE Wash skin with large amounts of water in the event of electrolyte leakage to prevent skin irritation and inflammation 38 Cleaning Instructions Listed below are recommendations for cleaning the HeartStart MRx and its associated accessories CAUTION The HeartStart MRx along with its accessories and supplies may not be autoclaved steam sterilized ultrasonically cleaned or immersed unless otherwise indicated in the Instructions for Use that accompany the accessories and supplies Do not use abrasive cleaners or strong solvents such as acetone or acetone based cleaners Do not mix disinfecting solutions such as bleach and ammonia as hazardous gases may result Do not clean electrical contacts or connectors with bleach Disinfect the device as determined by your institution s policy to avoid long term damage to the device Monitor Defibrillator The following cleaning products may be used to clean the exterior surfaces of the monitor defibrillator as well as the batteries and data card Isopropyl alcohol 70 solution in water Mild soap and water Sodium hypochlorite chlorine bleach 3 solution in water Quaternary ammonium compounds 21 quaternary ammonium content such as Steris Coverage Plus
217. ng the changes you are prompted with the message Configuration Not Saved Exit Anyway Select No and press the Menu Select button Then press the Save Changes soft key 182 Saving Configuration Settings to a Data Card To save configuration settings to a data card 1 Make sure a data card is in the HeartStart MRx 2 Press the Export soft key The HeartStart MRx copies the configuration settings to the data card Loading Configuration Settings from a Data Card To load configuration settings from a data card 1 2 3 4 5 Insert the data card with the saved configuration in the HeartStart MRx Press the Change Config soft key and enter the configuration password Press the Import soft key Make any device specific configuration changes such as 12 Lead location code Press the Save Changes soft key Restoring the Default Settings To return to using the configuration settings initially entered during manufacture 1 2 3 4 Press the Change Config soft key Enter the Configuration password Press the Factory Defaults soft key Press the Save Changes soft key Printing Configuration Settings To print the configuration settings select Print Configuration from the Configuration Main menu and press the Menu Select button The configuration report is printed on the printer NOTE Upon exiting Configuration and returning to a clinical mode Monitor Pacer Manual Defib or AED all settings wil
218. ns 6 last zero 126 non physiological artifact suppression 126 overview 117 pressure labels 119 pressure waves 120 reusable transducers 124 selecting a pressure 119 setting up 117 specifications 282 troubleshooting 266 wedge 129 zeroing 121 M Maintenance 215 automated tests 216 batteries 235 cleaning instructions 239 disposing the HeartStart MRx 242 Operational Check 222 Performing an Operational Check 223 Ready For Use RFU Indicator 218 Shift Checklist 219 User Checks 230 weekly shock test 219 manual defibrillation 71 code view 73 configurable parameters 198 defibrillating 77 indications 5 Manual Defib Mode 73 overview 71 precautions 72 preparation 74 specifications 275 using Q CPR 170 marking events 212 monitoring view 48 N Noninvasive Blood Pressure NBP 105 alarms 109 changing 109 enabling disabling 110 configurable parameters 190 connecting tubing 37 indications 5 measuring 106 changing schedule 108 overview 105 specifications 281 troubleshooting 254 Noninvasive Pacing 83 alarms 84 defibrillating 91 demand mode 88 fixed mode 89 indications 5 overview 83 pacing view 85 preparation 87 specifications 279 troubleshooting 263 O operating modes 14 Operational Check 222 performing 223 report 229 summary 234 test results 231 tests 226 User Checks 230 P Pacing see Noninvasive Pacing 83 paddles using external 75 using internal 76 using pediatric 76 pads multifunc
219. nt Prompt operator response is required Yellow alarm message alarm tone INOP Low priority Most technical alarms are grouped together as INOPs and are handled as low priority alarms indicating a problematic condition exists related to the ability of part or all of the device to perform its intended monitoring function Operator awareness is required Exception conditions which stop or may stop the delivery of pacing therapy and invasive pressure disconnect These are classified as high priority technical alerts They are potentially life threatening conditions Latching Alarm is announced and remains present regardless of whether the alarm condition continues to exist A latching alarm is not removed until it is either acknowledged or a higher priority alarm condition occurs Non latching Alarm is automatically removed when the alarm condition no longer exists NOTE The presence of multiple alarm conditions is quite possible Announcing all of the detected alarms would cause confusion and a less serious condition might hide a more serious condition For this reason alarms are prioritized and categorized so that the most serious or highest priority alarm condition is the one announced If multiple same parameter same priority alarms occur all alarms will be displayed NOTE Audio is suppressed for INOP alarms for the first 60 seconds after the HeartStart MRx is turned on INOP messages do appear on the display Respon
220. nt Name is entered using 2 alphabetical lists one to enter the last name followed by another to enter the first name When each name is complete select Done Select Cancel to close the patient name menu without saving Continued Use Once a patient incident begins the Continued Use feature is activated This feature facilitates continued treatment of the same patient by retaining the current settings and the patient record when the HeartStart MRx is turned off for less than 10 seconds for instance when switching between AED and Manual Defib Modes or when the Therapy Knob is inadvertently moved to Off When turned on within the 10 second time period the HeartStart MRx retains the most recent settings including e Alarm settings e Wave Sector settings e Event Timer e QRS alarm tone and voice prompt volumes e ECG gain e Vital Signs Trending data e Pacing settings The device DOES NOT automatically resume pacing e Patient record in the Event Summary Report new data is appended to the record The Sync feature remains active if the HeartStart MRx is turned off for less than 10 seconds However Sync is disabled when AED Mode is activated and must be turned on upon returning to Manual Defib Mode NOTE The Continued Use feature will not function if all sources of power battery and external AC DC power modules are removed from the device even briefly 27 Printing Waveforms By using the Print Button on the front of the Heart
221. nts at a glance Monitor Mode also provides an optional 12 Lead ECG function enabling you to preview acquire store and print 12 lead ECG reports with or without analysis interpretation You can also transmit 12 Lead reports via the 12 Lead ECG Transmission option Manual Defib Mode offers simple 3 step defibrillation You analyze the patient s ECG and if appropriate 1 select an energy setting 2 charge and 3 deliver the shock Defibrillation may be performed using paddles or multifunction electrode pads Manual Defib Mode also allows you to perform synchronized cardioversion and internal defibrillation If desired use of Manual Defib Mode may be password protected In AED Mode the HeartStart MRx analyzes the patients ECG and determines whether a shock is advised Voice prompts guide you through the 3 step defibrillation process providing easy to follow instructions and patient information Voice prompts are reinforced by messages on the display The Manual Defib and AED modes incorporate the Philips low energy SMART Biphasic waveform for defibrillation Both modes also offer the Q CPR option Q CPR offers real time measurement and corrective feedback on the rate depth and duration of CPR compressions as well as the frequency and volume of ventilations It also provides notification of lack of CPR activity The two modes also have an optional Audio function which allows you to record audio during a patient incident Optiona
222. nu Select button 133 Monitoring Temperature NOTE To monitor temperature perform the following 1 Connect the temperature cable to the HeartStart MRx 2 Select the correct temperature label for your measurement 3 Check that the current device settings including alarm settings are appropriate for the patient 4 Apply the temperature probe to the patient The temperature function performs a self test when initially turned on and also performs hourly system tests when active Alarms Setting Temperature Alarms Temperature alarms are annunciated if measurements fall outside the configured limits for high and low temperatures Temperature alarms are all categorized as non latching alarms meaning they are automatically removed when their alarm condition no longer exists Table 20 details Temperature alarms Table 20 Temperature Physiological Alarms Temperature Yellow Yellow alarm message The temperature value exceeds the high label High alarm tone alarm limit Temperature Yellow Yellow alarm message The temperature value has fallen below label Low alarm tone the low alarm limit Alarms are on unless you turn them off during use Once turned off alarms remain off until they are turned back on WARNING Make sure you enable disable and set alarm limits for the correct label These settings are stored for that particular label only Changing the label may change the alarm limits NOT
223. nu Select button 4 Select Apnea Time and press the Menu Select button 5 Using the Navigation buttons increase or decrease the limit and press the Menu Select button Enabling Disabling AwRR Alarms To enable the AwRR alarms 1 Press the Menu Select 9 button 2 Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button 3 Select AwRR and press the Menu Select button 4 Select Alarms On Off and press the Menu Select button WARNING e The safety and effectiveness of the respiration measurement method in the detection of apnea particularly the apnea of infancy has not been established The selected apnea alarm may be delayed by up to 17 seconds if apnea occurs during the automatic zero process Disabling the EtCO Monitoring Function To disable the EtCO monitoring function disconnect the FilterLine from the CO inlet port The message C02 Unplugged Turn off EtC02 appears Select Yes and press the Menu Select button Should the FilterLine be disconnected accidentally the message C02 Unplugged Turn off EtCO2 appears to notify you of the disconnection Select No and press the Menu Select button Secure the connection The CO monitoring function is once again enabled Troubleshooting If your HeartStart MRx does not operate as expected during CO Monitoring see Chapter 20 Troubleshooting on page 249 11 Invasive Pressures This chapter describes how to mon
224. nued Transmission Failed Settings Configured Incorrectly message There is a problem with the Server URL Proxy user name Proxy password Work with your ISP to ensure the Bluetooth Profile and Hub settings are correct Transmission Failed Connection Failed message The wrong Bluetooth Profile was selected The Dial String under the Phone Profile settings is incorrect Data transfer service is unavailable on the phone Wrong number Check the profile to ensure it is the correct one for that Bluetooth device Work with your cell phone provider to ensure that the Dial string is correct Work with your cell phone provider to ensure that your cell phone plan has data transfer capability Check the number and re send Invalid Password message The wrong Bluetooth Profile was selected The PPP User Name or PPP Password under the Profile Phone settings is incorrect The server User Name or Password is incorrect Check the profile to ensure it is the correct one for that Bluetooth device Modify the Bluetooth Profile setting as needed Modify the Hub settings as needed Transmission Failed message The network is down The server connection has timed out TCP IP Failure The web server has rejected the data Check with your ISP to see if your service is down Re send the 12 lead report Re send the 12 lead report If still unsuccessful check the MRx co
225. o 173J If not take the device out of use and begin troubleshooting 219 19 Maintenance Shift Checklist HeartStart MRx Shift Checklist Inspect the MRx accessories and supplies at the change of every shift per AHA guidelines Place a check mark in the box as you check each item in the list below or place a dash or N A if not applicable Then initial the list to indicate the check was performed for that shift Device Name or Serial Number Unit or Department RFU Indicator Hourglass If blinking X Plug into AC DC power or insert charged battery If solid X Insert charged battery or AC DC power If condition persists call for service Cables connectors present and inspected Paddles Therapy cable present and inspected Pads Present sufficient supply Compression Sensor and Adhesive Pads Monitoring Electrodes present sufficient supply Charged Batteries one in device spares AC DC Power Cord plugged in green light on Printer Paper present sufficient supply Data Card present sufficient supply SpO Sensors present sufficient supply NBP cuffs tubing present sufficient supply CO FilterLine present sufficient supply Invasive Pressure Tranducers present and inspected Temperature Sensors present and inspected 220 Shift Checklist page 2 HeartStart MRx Weekly S
226. o 80 MHz field strengths should be less than 3 V m 307 Recommended Separation Distances The HeartStart MRx is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled The customer or the user of the HeartStart MRx can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment transmitters and the HeartStart MRx as recommended below according to the maximum output power of the communications equipment Table 89 Recommended Separation Distances Rated Maximum Output 150 kHZ to 800 MHz 800 MHz to 2 5 GHz Power of Transmitter W d 12VP d 2 3VP 0 01 0 1m 0 2 m 0 1 0 4m 0 7 m 1 1 2m 2 3 m 10 4m 7m 100 12m 23 m For transmitters rated at a maximum output power not listed above the recommended separation distance d in meters m can be determined using the equation applicable to the frequency of the transmitter where P is the maximum output power rating of the transmitter in watts W according to the transmitters manufacturer At 80 MHz and 800 MHz the higher frequency range applies These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people 12 Lead ECG 137 acquiring 140 adjusting wave sizes 143 algorithm 137 configurable parameters 194 filters 144 indications 5 prepara
227. o mrxtraining Enter training access password meetMRx e HeartStart MRx User Training Videotape and DVD Other Application Notes can be found on the Philips website at www medical philips com goto productdocumentation N 2 Getting Acquainted The HeartStart MRx is designed with your needs in mind Controls indicators and menus are carefully organized to facilitate ease of use Display information is tailored to the current task This chapter will acquaint you with the HeartStart MRx operational modes display views controls and indicators It also provides general information on use of the device NOTE If your HeartStart MRx does not have some of the optional functionality listed in this chapter disregard these controls and the related information described throughout this manual Basic Orientation HeartStart MRx controls indicators and connections are carefully organized for ease of use Front Panel The front panel contains operational controls and indicators as shown below Figure 1 Basic Orientation Front External Power Indicator Synchronized Cardioversion Sync Button PO Es aa aa Ready For Use RFU eS e Indicator Label Recess p e Mark Event Therapy Knob button T Lead Select Charge button button S Shock button Display Printer 50 mm Printer Door Printer Door Latch Sooo A AN yO
228. ock test the voice prompt No Shock Delivered is annunciated Defib Tests defibrillation circuitry and None None delivers a shock through e pads into a test load and or e external paddles into the MRx Note The Defib test has two components a high energy internal discharge and a low energy 5J external discharge The results of the device s ability to charge and shock are reported in the Defib test Pacer Tests pacing functionality and None None delivers a paced pulse into a 50 ohm test load Compression Sensor Checks the basic None None communication circuity of the sensor Leads ECG Tests leads ECG acquisition None if test passes If test fails the If the ECG test fails with the and the ECG cable following prompt is displayed at cable and passes without the the end of all remaining tests cable the ECG cable is bad Leads ECG Test failed with cable Replace the ECG cable and Disconnect ECG cable to rerun rerun Operational Check test without cable If the ECG test fails with and without the cable see Troubleshooting on page 249 227 Table 57 Operational Checks Test Continued Pads Paddles ECG Checks ECG acquisition None if test passes 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 R
229. of any special ElectroStatic Discharge ESD precautionary procedures N 98 Defibrillation WARNING Keep hands and feet clear of paddle electrode edges Use your thumbs to depress the shock buttons on the paddle handle WARNING Do not allow multifunction electrode pads to touch each other or to touch other ECG monitoring electrodes lead wires dressings etc Contact with metal objects may cause electrical arcing and patient skin burns during defibrillation and may divert current away from the heart WARNING During defibrillation air pockets between the skin and multifunction electrode pads may cause patient skin burns To help prevent air pockets make sure the pads completely adhere to the skin Do not use dried out pads do not open pads package until just prior to use WARNING Never touch the patient or any equipment connected to the patient including the bed or gurney during defibrillation WARNING Avoid contact between the patient and conductive fluids and or metal objects such as the gurney Contact with metal objects could cause unintentional current pathways WARNING Medical electrical equipment which does not incorporate defibrillator protection should be disconnected during defibrillation WARNING In AED Mode the multifunction electrode pads must be in the anterior anterior position as shown on the packaging The HeartStart MRx was not designed to assess data acquired from pads in a
230. of cables transducers and other accessories with which Philips claims compliance with the emissions and immunity requirements of IEC standard 60601 1 2 are listed in Supplies and Accessories on page 243 The local area network LAN connector of the HeartStart MRx is marked with the Ated label The pins of connectors marked with this warning symbol should not be touched or connections made to until the following precaution is taken Discharge yourself to a conductive metal surface which is connected to earth ground before making connections or touching the marked connector All staff using the HeartStart MRx should be instructed on these precautionary measures in order to avoid damage to this sensitive medical equipment The EMC standards state that manufacturers of patient coupled equipment must specify immunity levels for their systems See Tables 85 through 88 for this detailed immunity information See Table 89 for recommended minimum separation distances between portable and mobile communications equipment and the HeartStart MRx Immunity is defined in the standard as the ability of a system to perform without degradation in the presence of an electromagnetic disturbance Degradation in ECG quality is a qualitative assessment which can be subjective Caution should therefore be taken in comparing immunity levels of different devices The criteria used for degradation is not specified by the standard and may vary with the manufact
231. of the ECG printed strip 174 Figure 82 Display View in AED Mode with Q CPR 11 Feb 2006 22 25 E e m Alarms Off 180 02 09 Pads Shocks 0 OO Bm CPR Timer Status Bar COMPRESS FASTER 175 CPR Feedback Adjusting CPR Feedback Volume To adjust the volume of CPR feedback voice prompts 1 Press the Menu Select G button 2 Using the Navigation buttons select Volume from the menu and press the Menu Select button 3 Select Voice and press the Menu Select button 4 Select the desired volume level and press the Menu Select button A sample voice prompt is annunciated to confirm your selection NOTE In AED Mode steps 2 and 3 are not applicable unless Q CPR is active If desired CPR feedback voice prompts may also be muted When muted a CPR Voice Muted text message displays in the middle of the wave sector containing the compression waveform during Manual Defib Mode or below the text prompt in AED Mode CPR inactivity time is indicated by an audible tone To mute the CPR feedback voice prompts 1 Press the Menu Select 9 button 2 Press the Menu Select button again to select Mute CPR Voice To resume voice prompts set at the previously selected volume 1 Press the Menu Select 9 button 2 Press the Menu Select button again to select Resume CPR Voice NOTE Mute is only available when Q CPR is active 176 Feedback Prompts Table 22 lists the feedback prompts that may be issued during the use
232. olume is configured to Off or the setting is too low The QRS volume was turned Off or set too low through the Volume menu The amplitude of the QRS complex is too small to detect Configure the QRS beeper volume Adjust the volume through the Volume menu Select a different lead Poor ECG signal quality noisy trace wandering baseline etc from signal acquired through monitoring electrodes The monitoring electrodes are not making proper contact with the patient The monitoring electrodes are outdated or dried out Radio frequency interference RFI is causing artifact The ECG cable may be faulty Check that the monitoring electrodes are properly applied If necessary prepare the patient s skin and apply new electrodes Check the date code on the electrodes Do not open the electrode package until immediately prior to use Relocate or turn off equipment that may be causing RFI Try repositioning cables leads Run the Operational Check with the ECG cable If the test fails run it without the ECG cable If the test passes replace the cable If not remove the device from use and call for service Poor ECG signal quality noisy trace wandering baseline etc from signal acquired through paddles pads The paddles pads are not making proper contact with the patient The pads are outdated or dried out Radio frequency interference RFI is causing artifact The paddles pads c
233. on 2 Using the Navigation buttons select Reports Reports for the current patient event are listed by date time and sequence number 3 Use the Navigation buttons to select a report and press the Menu Select button 4 Select Print Copy or Delete and press the Menu Select button 5 To select another report repeat steps 1 through 3 or press Exit to close the menu 141 Figure 66 Displayed Report Mark Event 10 Feb 2006 11 20 A EM Jones Samuel 0 P A 4 P Adult Non Paced Temp C Pulse bpm NBP mmHg q120 ide 80a 26 Qs 80 120 80 I 10 40 ABD are PAP pe SPO2 EtCO2 mig AWRR rn w 15 100 385 18 11 Aug 2006 11 19 00 55 years Male Atrial rhythm rate 80 Ventricular premature complex Diffuse T wave abnormalities Consistent with ischemia 233 ABNORMAL ECG Unconfirmed diagnosis Start Exit New Print NBP 12 Lead 12 Lead MENU 142 Improving Signal Quality quality problems Table 21 ECG Signal Problems Signal quality can impact ECG analysis Refer to Table 21 for possible solutions to common ECG Tremor or muscle artifact Poor electrode placement A cold patient Tense uncomfortable patient Patient tremors Clean the site and reapply electrodes Be sure the electrodes are placed on flat non muscular areas of the body Warm the patient Reassure and relax the patient Attach electrodes high on the extremities near the trunk Patient movement Electrode move
234. on buttons select Op Check Summary and press the Menu Select button 6 Press the Menu Select button to acknowledge the message Leaving Normal Operational Mode The Operational Check Summary screen is displayed 7 Press the Print soft key to print the report Table 59 Operational Check Summary Results Pass Hourglass All tests passed None Fail DX Solid red X chirp A problem has been detected Turn the Therapy Knob to Monitor An that may prevent the delivery inop indicating the problem is displayed of a shock pacing or ECG See Chapter 20 Troubleshooting for the acquisition corrective action 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 See Chapter 20 Troubleshooting for the corrective action Fail S Hourglass Compression Sensor failure Check the Compression Sensor and cable connections If necessary replace the Compression Sensor I The Automated Tests continually check for a low battery condition and set the RFU Indicator appropriately 234 Battery Maintenance Battery maintenance is essent
235. ondition no longer exists Table 10 lists SpO alarms Table 10 SpO Red Yellow Physiological Alarms Desat Red Red alarm message The SpO value has fallen below the alarm tone desat low limit SpO High Yellow Yellow alarm message The SpO value exceeds the high alarm alarm tone limit SpO Low Yellow Yellow alarm message The SpO has dropped below the low alarm tone alarm limit SpO alarms are on unless you turn SpO alarms off or alarms for the entire device are off Once disabled alarms remain off until they are turned on WARNING Turning off alarms prevents all alarms associated with the SpO measurement from being annunciated If an alarm condition occurs NO alarm indication will be given Changing the SpO Alarm Limits To change the SpO high and low alarm limits perform the following steps 1 Press the Menu Select button 2 Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button Select SpO and press the Menu Select button Select SpO Limits and press the Menu Select button Using the Navigation buttons select the new high limit value and press the Menu Select button A NN BR O Select the new low limit value and press the Menu Select button SpO Desat Alarm NOTE The HeartStart MRx also provides an alarm for SpO Desat Limit The SpO Desat alarm provides an additional limit setting below the low limit setting to notify you of
236. onditions such as trauma seizures reduced lung volume or high cardiac ejections CPR is best performed when the patient is lying on a firm surface If the patient is on a compliant surface such as a mattress the patient should be placed on a backboard CAUTION The Q CPR option is not intended for use with any other CPR compression devices Preparing to Use Q CPR The Q CPR option requires the use of the Pads CPR cable To set up the Q CPR option on the HeartStart MRx and prepare the patient for use follow the steps described below Connecting the Pads CPR Cable To connect the Pads CPR cable 1 Align the white pointer on the cable with the white arrow on the green Therapy port as shown in Figure 74 Insert the cable into the green Therapy port Push until you hear it click into place As a time saving measure you may choose to always keep your Pads CPR cable pre connected to the MRx Figure 74 Connecting the Pads CPR Cable NOTE The Q CPR option is operational only when the Pads CPR cable is connected to the HeartStart MRx CPR feedback is not available if the standard pads or paddles cable is connected 165 Connecting the Compression Sensor to the Pads CPR Cable To connect the 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 as shown in Figure 75 As a time saving measure you may choose to alw
237. onnected at the time of the test 216 Automated Test Summary An Automated Test Summary ATS showing the results of recent tests may be printed as evidence that the HeartStart MRx is tested regularly To display the ATS and print its results 1 Turn the Therapy knob to Monitor Press the Menu Select 9 button Using the Navigation buttons select Other and press the Menu Select button 2 3 4 Select Operational Check and press the Menu Select button 5 Using the Navigation buttons select Automated Test Summary and press the Menu Select button The Automated Test Summary is displayed The message Leaving Normal Operating Mode appears to let you know that you are exiting from clinical functionality of the monitor defibrillator 6 Press the Print soft key to print the report The report shows the results of the most recent Hourly Test the Daily Tests that have run since the last Weekly Test and the last 53 Weekly Tests Test results are reported as described in Table 55 Table 55 Automated Test Summary Results Pass Hourglass All tests passed None Fail _ Solid red X chirp A problem has been detected Turn the Therapy Knob to Monitor An DX that may prevent the delivery of inop indicating a problem has occurred is a shock pacing or ECG displayed Refer to Chapter 20 acquisition Troubleshooting for the action to take Fail BF Blinking X The total battery capacity Charge the battery as s
238. oon as possible and combination of both batteries or replace the battery with a charged is less than 20 battery Charging may be done in the HeartStart MRx or by connecting to AC DC power or in a Philips approved battery support system Fail D Hourglass A problem has been detected Turn the Therapy Knob to Monitor An with a component that does not inop indicating the failed component is affect therapy delivery displayed Refer to Chapter 20 Troubleshooting for the action to take 217 Ready For Use Indicator The results from Automated Tests are reported through the Ready For Use RFU indicator Be sure to observe the RFU indicator periodically and take the appropriate action as described in Table 56 Table 56 RFU Indicator Status Blinking black hourglass Shock pacing and ECG functions are ready for use and sufficient battery power is available None without a periodic chirp Blinking red X with or Low battery The device can be used but run time is limited Chirping indicates the battery is not being charged No chirping indicates the battery is being charged Charge the battery as soon as possible and or replace the battery with a charged battery Charging may be done in the HeartStart MRx by connecting to AC DC power or in a Philips approved battery support system Solid red X and a periodic chirp A failure has been detected that may prevent the delivery of a sho
239. option none otherwise Table 40 Alarm Settings Alarm Tone Selects either traditional Philips or IEC Standard Philips IEC alarm tones Alarm Pause Time Selects the interval of time during which alarms 1 2 3 5 10 indefinite are paused after the Alarm Pause button is minutes pressed 193 Table 41 12 Lead Settings Institution Name Enters your organization s name for printing on the 12 Lead ECG Report 32 characters blank Location Code Enters an institution number and a department number for printing on the 12 Lead Report 3 digits blank institution number 2 digits blank department number Device ID Enters a device identification number 4 digits blank Analysis Defines the analysis information included on the 12 Lead Report None prints waveforms Event patient ID date and time Measurements Only adds HR interval and axis measurements Standard adds severity interpretive statements and reasons None Measurements Only Standard ECG Bandwidth for 12 Defines the default ECG bandwidth for the 12 15 40 Hz 05 40 Hz 05 150 Hz Lead Display Lead preview display ECG Bandwidth for 12 Defines the default ECG bandwidth for printed Same as Display 05 150 Hz Lead Report and stored 12 Lead Reports Number of Automatic Printouts Selects the number of 12 Lead ECG Reports printed at the completion of analysis
240. or Pacer Performing Synchronized Cardioversion Synchronized Cardioversion allows you to synchronize delivery of the defibrillator shock with the R wave of the ECG being monitored in Wave Sector 1 You may choose to perform synchronized cardioversion through either e multifunction electrode pads or e external paddles When using paddles you should monitor the ECG through monitoring electrodes connected to a 3 5 or 10 lead ECG cable or a Philips bedside monitor You may choose to monitor through an alternate source when using pads as well Cardioversion is still delivered through either pads or paddles Preparing for Synchronized Cardioversion In preparation for synchronized cardioversion 1 Perform the tasks as described in Preparing for Defibrillation on page 74 2 If monitoring through a 3 5 or 10 lead ECG cable plug the ECG cable into the ECG port on the HeartStart MRx and apply monitoring electrodes to the patient See ECG and Arrhythmia Monitoring on page 47 3 Use the Lead Select button to select pads paddles or a lead from attached monitoring electrodes The selected ECG source should have a clear signal and a large QRS complex See Lead Selection on page 53 NOTE When the patient is already connected to Philips bedside monitoring equipment an external Sync cable plugs into the ECG Output jack of the bedside monitor and connects to the ECG port of the HeartStart MRx This connects the ECG sig
241. or cable and connector away from power cables to avoid electrical interference Monitoring SpO To monitor SpO 1 Connect the appropriate sensor cable to the to the HeartStart MRx as described in Connecting the SpO Cable on page 36 2 Apply the sensor to the patient 3 If the HeartStart MRx is not turned on turn the Therapy Knob to Monitor 4 Check that the patient category is appropriate for the patient If necessary use the Patient Info menu to access Patient Category and select the correct patient category setting adult pediatric This is used to optimize the calculation of the SpO and pulse values A is displayed in Parameter Block 2 while the oxygen saturation is initially measured and a value is calculated In a few seconds a value appears replacing the As the patient s oxygen saturation changes the SpO value is updated continuously See Figure 57 If SpO alarms are turned on alarm limits are displayed to the right of the SpO value If alarms are turned off the X symbol is displayed instead of the alarm limits SpO alarms are on by default See SpO Alarms on page 100 The patient s pulse rate as derived from pulse oximetry is displayed in Parameter Block 1 see Figure 59 If pulse rate alarms are turned on alarm limits are displayed to the right of the pulse rate value If alarms are turned off the JX symbol is displayed instead of the alarm limits Pulse alarms are off by default See P
242. or positioned opposite the light emitting diodes compares light absorption before and after pulsation The amount of light getting through reflects the blood flow in the arterioles This measurement of light absorption during pulsation is translated into an oxygen saturation percentage and an SpO value is displayed For accurate SpO measurements the following conditions must apply e The patient must have perfusion in that extremity e The light emitter and the photodetector must be directly opposite each other e All of the light from the emitter must pass through the patient s tissue e The sensor site should be free of vibration and excessive motion e Power cables should be kept away from the sensor cable and connector 94 Selecting a Sensor Table 9 SpO Sensors Table 9 shows the SpO sensors that may be used with the HeartStart MRx M1191A Reusable Adult gt 50 kg Finger M1192A Reusable Pediatric 15 50 kg Finger Small Adult M1194A Reusable Adult gt 40 kg Ear Pediatric M1195A Reusable Pediatric 4 15 kg Finger M1131A Disposable Adult gt 20 kg Finger Pediatric M1903B Disposable Pediatric 10 50 kg Finger M1904B Disposable Adult gt 30 kg Finger NOTE M1903B and M1904B sensors are only available outside the US CAUTION Do not use disposable sensors in high humidity environments or in the presence of fluids which may contaminate sensor and e
243. oth device to the list of Transmission Devices 1 Once in 12 Lead mode press the Menu Select 9 button 2 Using the Navigation buttons select Bluetooth Devices and press the Menu Select button A list of discovered Bluetooth devices is displayed 3 Select Add Device and press the Menu Select button The message Searching for Bluetooth Devices is displayed 4 From the Add Device menu select the desired device and press the Menu Select button The selected device must now go through the Pairing process described below NOTE All Bluetooth devices within the specified range are discovered by the HeartStart MRx and are displayed on the Add Device menu even if you have already paired with the device Pairing a Bluetooth Device with the HeartStart MRx Once a Bluetooth device is selected from the Add Devices menu a passkey sequence must be performed in order to communicate or pair the wireless device with the HeartStart MRx The passkey is user defined character sequence such as 000 or 1234 etc Some Bluetooth devices only allow pairing for 30 seconds so be ready to enter the passkey 1 Use the Navigation buttons to enter the passkey on the MRx and select Done The Bluetooth device prompts you for a passkey 2 Enter the same passkey on your Bluetooth device See the documentation that came with your Bluetooth device for instructions 3 Select the designated profile from the Phone Modem Profiles menu NOTE The profile conta
244. ows e The Q CPR option is contraindicated for use on neonatal and pediatric patients under 8 years of age or weighing less that 25 kg e The Q CPR option is not for use when CPR is contraindicated Invasive Pressures The Invasive Pressures option is indicated for measuring arterial venous intracranial and other physiological pressures on patients Temperature The Temperature option is indicated for measuring temperature in patients Safety Considerations General warnings and cautions that apply to use of the HeartStart MRx are provided in Specifications and Safety on page 273 Additional warnings and cautions specific to a particular feature are provided in the appropriate section of this guide WARNING Electric shock hazards exist internally Do not attempt to open the device Refer servicing to qualified personnel WARNING Use only supplies and accessories approved for use with your HeartStart MRx Use of non approved supplies and accessories could affect performance and results WARNING Use single use supplies and accessories only once Documentation and Training Available documentation and training for the HeartStart MRx includes e HeartStart MRx Instructions for Use e HeartStart MRx Quick Reference Cards e HeartStart MRx Battery Application Note e HeartStart MRx Improving ECG Quality Application Note e HeartStart MRx Web based User Training Located at www medical philips com got
245. oxide is derived by multiplying the measured carbon dioxide concentration with the ambient pressure From the partial pressure measurement the end tidal carbon dioxide EtCO is derived EtCO is the peak CO value measured during expiration It is used to monitor the patient s respiratory status The EtCO measurement uses a technique based on the absorption of infrared radiation by some gases It indicates the change in e The elimination of CO3 The delivery of O to the lungs The CO monitoring function of the HeartStart MRx provides an EtCO value a CO waveform and an airway respiration rate AwRR WARNING The EtCO readings do not always correlate closely with blood gas values especially in patients with pulmonary disease pulmonary embolism or inappropriate ventilation Do not measure CO in the presence of pharmaceuticals in aerosols NOTE For more information on capnography and EtCO refer to the Application Note Uses of Capnography and Benefits of the Microstream Method 111 Preparing to Measure EtCO Selecting the Accessories There are some factors to consider when selecting accessories e the type of patient adult pediatric or neonate e airway status of the patient ventilated or not ventilated e ifa ventilated patient whether humidified or non humidified ventilation is used WARNING Do not re use clean or sterilize Microstream CO accessories as they are intended for single patient one time
246. place the transducer and try again If it still will not zero contact your service personnel No Transducer Reconfirm that the transducer is connected and try again If this doesn t work replace the transducer Pulsatile Pressure Make sure that the transducer is vented to air and not the patient Try again NOTE Upon successful completion of the process close the stopcock to atmospheric pressure which opens the stopcock to the patient Calibration The HeartStart MRx allows you to input the calibration factor see documentation supplied by the transducer s manufacturer of a new transducer plugged into the pressure line Known Calibration Factor To set a known calibration factor perform the following Zero the transducer see previous section Press the Menu Select C button Using the Navigation buttons select Measurements Alarms and press the Menu Select button Select the correct pressure channel label and press the Menu Select button Select Calibration Factor and press the Menu Select button A uv oA O N e Set the calibration factor using the Navigation buttons Values range from 180 0 to 220 0 in 0 2 increments Press the Menu Select button NOTE Calibration only needs to be done on reusable transducers 123 Calibrating Reusable Transducer CPJ840J6 Perform a mercury calibration when you use a new reusable transducer and at regular intervals according to your hospital policy You will need e st
247. place 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 as described in Operational Check on page 222 1 Attach the side pouches using the snaps located inside the pouch pockets or if equipped use the hook and loop fastener with the flaps and slots Figure 15 Accessory Pouch Assembly 32 Storing Accessories Suggested parameter cabling and accessories storage is shown below Figure 16 Storing Accessories 1 Attach the Therapy cable and route it through cable fastener loop securing the cable just below the strain relief 2 Attach the rear pouch using the buckles provided NOTE Depressions are provided on the inside of the rear pouch should you wish to make a cut out to accommodate external power Some devices may come with the cut outs already made Figure 17 Connecting Cables WARNING When using the carry bag to transport the HeartStart MRx it is important to position it with the display facing away from the body If not the Therapy Knob may be bumped and inadvertently moved from its current
248. pletely blocked or the patient is breathing through the mouth the displayed EtCO values may be significantly low e Reflux of gastric contents mucus pulmonary edema fluid or endotracheal epinephrine introduced into the detector can increase airway resistance and affect ventilation Discard accessory if this occurs e The presence of carbonated beverage or antacids in the stomach may cause incorrect readings and unreliable capnography in identifying esophageal intubation Using the Nasal FilterLine To set up EtCO measurements using the nasal FilterLine perform the following steps 1 Attach the FilterLine tubing to the CO Inlet port as described in Connecting the CO FilterLine on page 40 2 Check that both nostrils are clear and position the nasal FilterLine on the face by inserting the FilterLine tips into the nostrils 3 Pass the FilterLine tubing over the ears then slide the sleeve up the tubing towards the neck to a comfortable fit under the chin If using dual purpose FilterLine tubing connect the green tubing to the oxygen source Check the positioning of the FilterLine regularly to ensure proper monitoring function 4 Change the nasal FilterLine every 24 hours if the C02 Occlusion INOP message appears or if measurement readings become erratic Using the FilterLine and Airway Adapter To set up EtCO measurements using the FilterLine and airway adapter 1 Attach the FilterLine tubing to the CO Inlet po
249. pm below HR Low Red alarm message Latching limit capped at 30 bpm _ alarm tone Extreme Tachy 20 bpm above HR High Red alarm message Latching limit capped at 200 bpm alarm tone adult or 240 bpm pedi Figure 37 Alarm Chain for Basic Arrhythmia Monitoring RED ALARMS Asystole V Fib V Tach V Tach Extreme Tachy Extreme Brady YELLOW ALARMS PVC Alarms Beat Detection Alarms Rate Alarms y 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 Table 6 HR Arrhythmia Yellow Alarms HR High The HR exceeds the configured Yellow alarm Non Latching HR high limit message alarm tone HR Low The HR is below the configured Yellow alarm Non Latching HR low limit message alarm tone PVC min High The number of detected PVCs in Yellow alarm Non Latching value gt limit a minute exceeds the limit of message alarm tone 15 adult pedi Pacer Not Capture No QRS following a pacer pulse Yellow alarm Latching message alarm tone Pacer Not Pacing No QRS or pacer pulse detected Yellow alarm Latching message alarm tone NOTE Pacer Alarm Messages are associated with internal transvenous pacemakers only 57 INOP Messages INOP messages communicate conditions that prevent the d
250. position as shown on the pads package CAUTION Philips multifunction defib electrode pads are required to measure ventilation activity as well as acquire an ECG signal and deliver a shock as appropriate WARNING Anterior posterior pad placement should not be used with the Q CPR option 168 Placing the Compression Sensor on the Patient To place the 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 Using the yellow pull tab on the top liner peel the green liner away from the Compression Sensor Adhesive Pad See graphic 1 in Figure 79 3 Position the Compression Sensor on the patient as shown in graphic 2 displayed on the green liner applying the Compression Sensor Adhesive Pad on the patient The proper location is on the lower half of the sternum See graphic 2 in Figure 79 Figure 79 Compression Sensor Adhesive Pad When the Compression Sensor is on the patient s chest the flat gray surface should be facing up When using Q CPR place the heel of your hand on the flat gray surface in the same way that you would position your hand on the patient s chest if performing CPR without the Compression Sensor WARNING Do not apply the Compression Sensor to an open wound or recent incision site 169 16 Q CPR and Data Capture Using Q CPR in Manual Defib Mode _ Using Q CPR in Manual Defib Mode When the Therapy Knob is moved to t
251. previously defined for the current patient All Settings Have Been Set To Factory Default Values message accompanied by a Power Interrupted or Device Restarted message Corrupt or incomplete configuration file Reload device configuration file Batteries Low message The batteries may not have enough remaining charge to provide 10 minutes of monitoring time or six 200J shocks e Insert a fully charged battery e Connect to AC DC power Battery A Low Switching to Battery B or vice versa message The specified battery needs charging Charge the low battery Device Error Service Required message Failure detected during start up Take the device out of use and call for service External Power Interrupted message AC DC power was removed now operating from battery power Connect to AC DC power if appropriate Fan Failure message The internal fan should be running but it is not Call for service Internal Memory Failure message INOP message appears every time the device is turned on The internal memory card has been reformatted after failing an automated test Patient data cannot be stored in internal memory because the internal memory card is not recognized An attempt to print an Event Summary or trending report was requested during power up Although all previous data stored on the card has been erased it is now ready once again to record
252. printer paper 1 Open the printer door by pushing on the latch as shown in Figure 26 2 If there is an empty or low paper roll in the printer pull up on the tab holding the paper roll to remove it Place a new roll of printer paper into the paper well positioning the roll as shown in Figure 26 4 Pull the end of the paper out past the paper roller 5 Close the printer door Figure 26 Installing Paper 75mm kak pees 43 Installing Batteries To install the batteries 1 Align the M3538A Lithium Ion battery in a battery compartment 2 Insert the battery and press until you hear it click into place Ensure that the latches located on both sides of the battery are engaged fully Figure 27 Installing Batteries Charging Batteries Charge batteries fully upon receipt and prior to use Be sure to familiarize yourself with the battery maintenance procedures discussed in Battery Maintenance on page 235 Battery Safety Review the Application Note M3538A Lithium Ion Battery Characteristics and Care provided with your HeartStart MRx Additionally read the battery related warnings in Specifications and Safety on page 273 prior to using the M3538A Lithium Ion Battery 44 Installing the AC Power Module If not presently installed in your device insert the M3539A AC power module as follows 1 Align the M3539A AC power module in Compartment B 2 Insert the AC powe
253. quiring the ECG As shown in Figure 65 it displays patient information and approximately 2 5 seconds of each of the 12 leads acquired Waveforms are presented at a rate of 25mm sec and the configured wave size A dashed line is displayed if a lead cannot be derived The message Lead Wire Lead Off is displayed if an electrode is not making adequate contact with the patient The Preview Screen s patient information includes ID age and sex The Event ID is displayed until you enter the patient s ID Age and sex are displayed once entered see Entering Patient Information on page 27 Although waveforms for monitored parameters such as ECG SpO3 Invasive Pressures and CO are not visible on the Preview Screen related alarms measurements and INOP messages remain active and are reported in Parameter Blocks 1 and 2 and the general status area Preparation Proper patient preparation and electrode placement are the most important elements in producing a high quality 12 lead ECG The patient should be supine and relaxed when an ECG is acquired In preparation for acquiring the ECG 1 Connect the 10 lead cable to the HeartStart MRx as described in Connecting the ECG Cable on page 35 2 Prepare the patient and apply electrodes as described in Preparing to Monitor ECG on page 49 Turn the Therapy Knob to Monitor 4 Enter the patient s ID name age and sex as described in Entering Patient Information on page 27
254. r 2 Make sure the multifunction electrode pads packaging is intact and within the expiration date shown 3 Apply multifunction electrode pads to the patient as directed on the pads package Use the anterior anterior electrode placement 4 If not pre connected insert the pads cable into the green Therapy port located on the right side of the device See Figure 40 Figure 40 Pads Cable Connection 65 5 Connect the pads to the pads cable as shown in Figure 41 Figure 41 Pads Connection WARNING Do not use anterior posterior pads placement multifunction electrode pads placed on the patient s chest and back The AED algorithm used by the HeartStart MRx has not been validated using this placement WARNING Do not let the multifunction electrode pads touch each other or other monitoring electrodes lead wires dressings transdermal patches etc Such contact can cause electrical arcing and patient skin burns during defibrillation and may divert defibrillation current away from the heart WARNING During defibrillation air pockets between the skin and multifunction electrode pads can cause patient skin burns To help prevent air pockets make sure defibrillation pads completely adhere to the skin Do not use dried out multifunction electrode pads CAUTION Aggressive handling of multifunction electrode pads in storage or prior to use can damage the pads Discard the pads if they become damaged NOTE I
255. r module and press until you hear it click into place Ensure that the latched located on both sides of the AC power module are engaged fully 3 Insert the power cord into the AC power receptacle 4 Plug into an AC power outlet 5 Check that the External Power indicator on the front panel is illuminated Figure 28 Installing the AC Power Module 45 Installing the Data Card If not presently installed in your device install the data card as follows 1 Insert the data card in the data card tray sliding it under the tray clip 2 With the front of the tray facing forward insert the tray fully into the data card slot located on the right side of the HeartStart MRx Figure 29 Installing the Data Card Tray CAUTION Even if a data card is not used the data card tray should always be installed to protect the device from the ingress of liquids or solids 46 4 ECG and Arrhythmia Monitoring This chapter describes the basic ECG and arrhythmia monitoring functions of the HeartStart MRx monitor defibrillator For specific information related to taking a 12 Lead ECG refer to Chapter 13 12 Lead ECG on page 137 Overview The HeartStart MRx can be used for ECG and arrhythmia monitoring allowing you to monitor through e multifunction electrode pads or e 3 5 or 10 lead monitoring electrode ECG sets If both pads and monitoring electrodes are connected monitoring allows you to select a lead from the 3 5 or 10
256. r on the transducer for future reference Calibration Confirmation If the calibration process is successful a brief message appears on the HeartStart MRx display with the date and time the calibration was completed and the new calibration factor If calibration is not successful an Unable to Calibrate message appears with a probable cause See Table 17 for probable cause messages Table 17 Unable to Calibrate Probable Causes Equipment Malfunction Hardware is faulty Contact your service personnel Out of range Make sure you have selected a value for the calibration pressure that you are applying to the transducer Repeat calibration Unstable Signal Make sure there are no disturbances to the transducer Repeat calibration No Transducer Reconfirm that the transducer is connected and try again Perform Zero first A valid zero does not exist Zero the transducer WARNING Fach time you use a reusable transducer you should confirm the calibration factor written on the transducer is the same as the calibration factor displayed on your HeartStart MRx Different calibration factors may lead to an inaccurate measurement 125 Last Zero Calibration You can view dates and times for a channel s last zero or mercury calibration through the HeartStart MRx menu To view a channel s last zero and mercury calibration dates perform the following steps 1 Press the Menu Select button 2 Using the Navigation
257. r to the manufacturer s instructions for care and cleaning of sensors To get the best results from your reusable SpO sensors always handle the sensor and cable with care and protect them from sharp objects The sensor sleeve houses a sensitive electronic device that can be damaged Harsh treatment of sensors will drastically reduce their lifetime WARNING Do not use a damaged sensor or one with exposed electrical circuits Troubleshooting If your HeartStart MRx does not operate as expected during SpO Monitoring see Chapter 20 Troubleshooting on page 249 103 9 Noninvasive Blood Pressure This chapter describes how to monitor noninvasive blood pressure NBP with the HeartStart MRx Overview Your HeartStart MRx measures blood pressure for both adult and pediatric patients using the oscillometric method Systolic diastolic and mean measurements are provided and alarms are available to alert you to changes in the patient s condition NBP measurements may be taken while in Monitor Pacer or Manual Defib modes NBP measurements can be taken automatically on a schedule or manually on demand While an NBP measurement is in progress the current cuff pressure is displayed in Parameter Block 1 Once the measurement is complete the values for systolic diastolic and mean pressure are displayed along with the measurement schedule manual or automatic intervals and a time stamp see Figure 59 If NBP alarms are ena
258. ral Status on page 16 Battery Calibration Battery capacity diminishes with use and age Battery calibration checks to see if the battery is nearing the end of its useful life and should be discarded Battery calibration also ensures that the fuel gauge provides accurate estimates of the battery s state of charge based on the total available capacity Calibrate a battery when the Cal Recommended message appears during an Operational Check or every 6 months whichever comes first Battery calibration may be performed in the HeartStart MRx or in a Philips approved battery support system To calibrate a battery in the HeartStart MRx Connect the HeartStart MRx to AC or DC power Insert the battery to be calibrated into Battery Compartment A or B Turn the Therapy Knob to Monitor Press the Menu Select 9 button Using the Navigation buttons select Other and press the Menu Select button Select Battery Calibration and press the Menu Select button N A WW OA WOW Ne Press the Menu Select button to acknowledge the message Leaving Normal Operational Mode The Calibration view is displayed If external power is not detected you are prompted to Apply External Power If there is no battery in either battery compartment you are prompted to Insert Battery If there are batteries in both battery compartments you must select which battery to calibrate 236 8 Pressthe Start soft key to begin calibrating The calibration procedure
259. re not properly connected to the patient Minimal patient movement is possible in this situation as the defibrillator may deliver a small amount of energy The shock counter will remain at zero e Make sure the pads are applied properly e Replace pads in necessary Table 70 Printer Problems Paper won t move Paper improperly loaded or jammed or paper is wet Reload paper or clear jam If paper is wet replace with fresh dry roll Paper moves then stops e Door improperly latched e Paper improperly loaded or jammed e Check door latch e Reload paper or clear jam Paper moves but printing is faint or absent e Paper roll improperly installed e Incorrect paper type e Printhead temperature e Check that the paper is installed correctly e Use only recommended paper type e Wait until the printer cools down and restart approaching maximum printing recommended operating temperature Paper moves but print quality Dirty printhead Clean the printhead poor or some dots missing Loud buzzing or grinding Door improperly latched Check door latch noise White line running along Dirt on printhead Clean the printhead Paper Incompatible Printer message The installed printer does not support the fonts required Asian fonts require the 75 mm printer e Install the 75 mm printer Check Printer message The printer is out of paper or the door is open e Loa
260. rial cable as shown in Figure 69 NOTE For further information concerning the setup and configuration of transmission devices and the HeartStart MRx refer to the 12 Lead Transmission Implementation Guide For further information concerning the 12 Lead Transfer Station refer to the 12 Lead Transfer Station Instructions for Use Figure 68 RS 232 Serial Port Connection 150 14 12 Lead ECG Transmission Transmitting to a Configured Site Using RS 232 Transmitting to a Configured Site Using RS 232 Upon acquisition of the 12 Lead ECG the 12 Lead Report View is displayed To transmit the displayed 12 Lead Report to a previously configured destination 1 Press the Menu Select 0 button 2 Using the Navigation buttons select Send from the 12 Lead Main Menu and press the Menu Select button 3 Using the Navigation buttons select the destination site from the configured list see Figure 70 and press the Menu Select button to select Figure 70 12 Lead Send To Menu AWE Send To St Mary s ED St Joseph s Cath Lab Site 7 152 Transmitting to a Manually Entered Fax Number Upon acquisition of the 12 Lead ECG the 12 Lead Report View is displayed To manually enter a fax number destination 1 Press the Menu Select 0 button 2 Using the Navigation buttons select Send from the 12 Lead Main Menu and press the Menu Select button 3 Using the Navigation buttons select Fax Number from the Send To Menu 4 Enter the
261. rial waveform when using an intra aortic balloon pump connect your invasive pressure device directly to the balloon pump 119 Pressure Waves Each pressure label has a set of scales for the pressure wave You can adapt the displayed wave to the offset and amplitude of the signal The scale can be modified through the Displayed Waves menu To select a pressure wave and the associated scale for the display or printed strip perform the following steps Press the Menu Select button Using the Navigation buttons highlight Displayed Waves and press the Menu Select button Select Wave Position Wave 1 Wave 2 Wave 3 or Wave 4 and press the Menu Select button Select the appropriate label and press the Menu Select button aO O N e Select the appropriate scale and press the Menu Select button Available scales in mmHg 300 240 180 150 120 110 100 90 80 70 60 50 40 30 20 10 5 10 15 and 20 Available scales in kPa 38 0 32 0 26 0 24 0 22 0 20 0 18 0 16 0 14 0 13 0 12 0 11 0 10 0 9 0 8 0 7 0 6 0 5 0 4 0 3 0 2 0 1 0 1 5 2 0 2 5 NOTE A positive scale sets the top gridline to your selected scale and the bottom to zero A negative scale will set the bottom gridline to the selected negative unit and the middle gridline to zero 120 Zeroing the Pressure Transducer To avoid inaccurate pressure readings the HeartStart MRx requires a valid zero be performed on the pressure channel It
262. ribute 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 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 under license Coverage Plus and Coverage Plus NPD are registered trademarks of Steris Corp CidexPlus is a registered trademark of Advanced Sterilization Products Nellcor is a registered trademark of Nellcor Puritan Bennett Inc Other trademarks and trade names are those of their respective owners Notice Use of supplies or accessories other than those recommended by Philips may compromise product performance THIS PRODUCT IS NOT INTENDED FOR HOME USE U S FEDERAL LAW RESTRICTS THIS DEVICE TO SALE ON OR BY THE ORDER OF A PHYSICIAN Medical Device Directive The HeartStart MRx complies with the requirements of the Medical Device Directive 93 42 EEC and carries the CE 0123 mark accordingly Manufacturer Philips Medical Systems 3000 Minuteman Road Andover MA
263. roperly you can proceed with the Operational Check If the device has the Q CPR option you should run the Operational Check with the Pads CPR cable and the Compression Sensor keeping the Compression Sensor still during the test If the HeartStart MRx has the Pacing option you must run the Operational Check with a Pads cable WARNING Be sure to safely discharge internal and external paddles tested during the Operational Check NOTE Ifyou choose to proceed without setting up properly the Operational Check may fail When a response is required use the Navigation buttons to select your answer and the Menu Select button to confirm your choice Table 57 shows the tests in the order in which they are performed explains the prompts that may appear and describes the actions you should take if any As each test is run the name of the test appears on the display with the message In Progress as shown in Figure 85 Once you have answered the last prompt Audio test you can leave the HeartStart MRx unattended and the Operational Check will complete If you cancel the Operational Check before it completes there is no record of it in the Operational Check Summary 223 Figure 84 Operational Check Setup Screen 02 Mar 2006 10 52 A__ EM hh Operational Check Model Number M3535A Serial Number US00108360 Last Operational Check 01 Mar 2006 9 35 Pass Setup 1 Connect pads CPR cable compression sensor and test load Or Connect
264. ropriate energy setting charge the monitor defibrillator and deliver the shock The entire defibrillation process is under your control Voice prompts are not present However text messages on the display provide relevant information throughout the process It is important to be attentive to these messages when displayed The ECG strip and Event Summary are easily annotated with event information using the Mark Event function button See Marking Events on page 212 for more information Monitoring alarms are available in Manual Defib Mode however they are turned off once an energy is selected for defibrillation unless Sync is active Alarms may be turned on in Manual Defib Mode by pressing the Alarm Pause button Alarms are also reactivated once the Therapy Knob is moved to Monitor or Pacer or Sync is selected When an energy is selected automatic NBP measurements are discontinued Ifa manual NBP measurement is requested by pressing the Start NBP soft key the NBP information including the current schedule is displayed in its normal position and scheduled NBP measurements resume The use of Manual Defib Mode may be password protected as defined in Configuration See Password Security on page 15 71 Precautions for Manual Defibrillation Therapy Defibrillating asystole can inhibit the recovery of natural pacemakers in the heart and completely eliminate any chance of recovery Asystole should not be routinely shocked
265. rrhythmia Alarms The HeartStart MRx detects arrhythmia alarm conditions by comparing ECG data to a set of pre defined criteria An alarm can be triggered by a rate exceeding a threshold for example HR gt XX an abnormal rhythm for example Ventricular Tachycardia or an ectopic event for example PVC gt limit HR Arrhythmia Alarms can be generated for the conditions shown in Tables 5 and 6 Once generated they appear as alarm messages in the alarm status area of the display located just above the HR numeric The notification of an alarm is indicated by both an audible and visual alert signal Arrhythmia Alarm Latching 56 Arrhythmia alarms are categorized as latching or non latching alarms Latching alarms are announced and remain present regardless of whether the alarm condition still exists until they are either acknowledged or a higher priority alarm condition occurs Indications for non latching alarms are automatically removed when their alarm condition no longer exists Latching and non latching alarms are categorized in Tables 5 and 6 Table 5 HR Arrhythmia Red Alarms Asystole No detectable beats for four Red alarm message Latching seconds in the absence of alarm tone Vfib VFIB VTACH A fibrillatory wave detected Red alarm message Latching for four seconds alarm tone VTACH Consecutive PVCs and HR Red alarm message Latching exceed configured limits alarm tone Extreme Brady 10 b
266. rt as described in Connecting the CO3 FilterLine on page 40 2 Connect the wide end of the airway adapter to the endotracheal tube and connect the narrow end of the airway adapter to the ventilator tubing or manual resuscitator Disconnect the FilterLine during suctioning and nebulizing therapies For best results for non humidified use change the FilterLine after 24 hours of continuous use For humidified use change the FilterLine H after 72 hours of continuous use 113 WARNING When using the Microstream EtCO measurement on patients who are receiving or have recently received anesthetics connect exhaust tubing from the CO Outlet port to a scavenging system or to the anesthesia machine ventilator to prevent exposing medical staff to anesthetics Use an exhaust tube to remove the sample gas to a scavenging system Attach scavenging tube to the CO outlet port NOTE Should the FilterLine or exhaust tubing be blocked when the HeartStart MRx is turned on the C02 Check Exhaust INOP message is displayed Should the blockage occur during CO monitoring the CO waveform appears as a flat line and if alarms are on an apnea alarm is annunciated Measuring EtCO The EtCO measurement is automatically turned on when you connect a FilterLine to the CO Inlet port The CO waveform is displayed in the configured Wave Sector if available The measurement values for EtCO and AwRR are displayed in Parameter Block 2 see Figure 61 Fig
267. rts are sent from the HeartStart MRx to the hub a web server running Philips 12 Lead Transfer Station software Using Bluetooth transmission they are transmitted to the hub using configured wireless devices such as cell phones and handheld devices Using RS 232 Transmission they 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 reports can be sent to a wireless modem connected to an analog line for areas where cell transmission is unavailable See Figure 67 for an overview of the transmission process Figure 67 12 Lead Report Transmission Process Internet External Modem via Bluetooth TraceMaster Server MRx Data to es Cell Phone E Bluetooth or serial cal 4 RS 232 Cable 7 Cell 2 N sal a ISP q_ r Hub server running 12 Lead Transfer Station we Analo fe 7 MRxDatato L2 A z Printer 12 Lead Transfer Station i TraceMaster Server 145 Waveforms for all monitored parameters can be viewed during the 12 Lead Report 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 activ
268. ry is printed using the configured format To print an Event Summary stored on the removable data card the information must first be downloaded to the HeartStart Event Review Pro data management system Refer to the HeartStart Event Review Pro Instructions for Use for download instructions 205 Printing the Vital Signs Trending Report You can print the current Vital Signs Trending Report at any time during the event by pressing the Summary button and selecting Trends and then a Trends Interval from the menu or by hitting the soft key under the Print Trends label If an event is not in progress pressing the Summary button and selecting Trends and then a Trends Interval prints the most recent Vital Signs Trending Report To select and print a Vital Signs Trending Report after an event Turn the Therapy Knob to either Monitor Pacer or Manual Defib Press the Menu Select 9 button Using the Navigation buttons select the Other menu and press the Menu Select button 1 2 3 4 Select Data Management and press the Menu Select button 5 Press the Menu Select button to acknowledge the message Leaving Normal Operational Mode 6 Use the soft keys labeled Prev Item and Next Item to select the Vital Signs Trending Report you want to print N Press the Menu Select button to display the Data Management menu 8 Select Print and press the Menu Select button 9 Using the Navigation buttons select Trends from the menu and press the
269. s Pause Pacing Once paused press Resume Pacing to resume delivery of pace pulses You may also stop delivery of pace pulses by moving the Therapy Knob off the Pacer position WARNING When Pacing in demand mode the ECG cable must be directly connected from the patient to the HeartStart MRx WARNING Ifyou are using the pacing function with battery power and the Low Battery Alarm is annunciated connect the device to external power or insert a fully charged battery NOTE Routinely assess the patient s cardiac output by assessing peripheral pulses NOTE Pacing will not start if there is a problem with the multifunction electrode pads connection or patient contact Pace pulses will not be delivered if there is a problem with the ECG monitoring electrodes connections If either situation occurs a system message is displayed to alert you that a lead is disconnected or that the pads have a poor connection Fixed Mode Pacing To pace in fixed mode 1 Turn the Therapy Knob to the Pacer position The message Pacing Paused appears and indicates that the pacing function is enabled however pace pulses are not being delivered Pacing is enabled in demand mode with the configured lead displayed in Wave Sector 1 If the configured lead is set to Pads Lead II or the first available monitoring lead is displayed 2 Change the pacer mode to fixed mode using the menu selections shown below in Figure 54 Figure 54 Changing Pacer
270. s blank Wait for Dial Tone Available from your cell phone service provider Yes No PPP User Name Typically not needed but may be required by some 30 characters blank cell phone service providers PPP Password Typically not needed but may be required by some 40 characters blank cell phone service providers Static IP Address Typically not needed but may be required by some 15 characters nnn nnn nnn nnn blank cell phone service providers Primary DNS Typically not needed but may be required by some nnn nnn nnn nnn blank cell phone service providers Secondary DNS Typically not needed but may be required by some nnn nnn nnn nnn blank cell phone service providers http Proxy Address Typically not needed but may be required by some 15 characters blank cell phone service providers http Proxy Port Typically not needed but may be required by some 15 characters blank cell phone service providers 195 Table 43 12 Lead Transmission Settings Serial Phone Profile Profile Name Name of the profile Serial Phone Profile Configuration String Available from your cell phone service provider 45 characters blank Dial String Available from your cell phone service provider 40 characters blank Wait for Dial Tone Available from your cell phone service provider Yes No PPP User Name Typically not needed but may be required by 30 characters blank some cell phone service
271. s 294 Results 294 Conclusion 295 Clinical Performance Summary Internal Defibrillation 296 Overview 296 Methods 296 Results 296 Conclusion 296 Safety Considerations 297 General 297 Defibrillation 299 Battery 300 Supplies and Accessories 301 Electromagnetic Compatibility 301 Reducing Electromagnetic Interference 301 Restrictions for Use 302 Emissions and Immunity 302 Guidance and Manufacturer s Declaration 302 Recommended Separation Distances 308 Index 309 About This Edition Publication number 453564041991 Edition 1 Printed in the USA To determine the product level version to which these Instructions for Use are applicable refer to the version level appearing on the back cover of this book or on the label of the User Documentation CD ROM that accompanied this device This information is subject to change without notice Edition 1 September 2006 Print Date NOTE To obtain Jnstructions for Use for previous versions of the HeartStart MRx visit the Philips Documentation and Downloads web site at http www medical philips com main products defibrillation and look for part number M3535 91900 Philips shall not be liable for errors contained herein or for incidental or consequential damages in connection with the furnishing performance or use of this material Copyright Copyright 2006 Koninklijke Philips Electronics N V All rights are reserved Permission is granted to copy and dist
272. s Off Logged when NBP alarms are turned off 208 Table 52 Event Information Temperature Label Temperature Label Logged when a temperature label is set or changed Alarms yellow or red alarm Logged when alarm condition occurs Alarms Paused Logged when action occurs Alarms Resumed Logged when action occurs Alarms Off Logged when action occurs Audio Paused Logged when action occurs Audio Resumed Logged when action occurs 209 Table 52 Event Information INOPs See Chapter 20 for information regarding INOP statements Defibrillation Charging to xx J Logged when device starts charging to selected energy setting Disarm Manual Auto Logged when device disarmed by user or automatically after time out period Shock x Logged when discharge to patient energy delivered impedance and peak current are stored with the waveform No Shock Delivered Logged when discharge to patient fails Sync On Logged when Sync function turned on by user Sync Off Logged when Sync function turned off by user AED Mode Pause Resume Logged when the Pause for CPR or Resume Analyzing soft keys are pressed Analyzing Logged when advisory algorithm begins analysis Artifact Detected Logged when advisory algorithm detects noise or motion artifact Auto Disarm Logged when HeartStart MRx is automatically disarmed Cannot Analyze ECG Logged
273. s are making proper contact with the patient Maximum Energy 50J message Attempted delivery of greater than 50J using internal paddles Only energies up to 50J are available for internal defibrillation Select a lower energy No Shock Delivered Replace Pads Now message Faulty pads or poor pads application to patient Low impedance Make sure pads are applied properly If the problem persists replace the pads No Shock Delivered Press Pads Firmly message Poor pads contact with the patient High impedance Make sure pads are applied properly Firmly press pads on the patient s chest No Shock Delivered Low High Impedance message Poor paddles contact with patient skin Paddles failure Make sure paddles are making adequate contact with the patient s skin If the problem persists replace the paddles Pacer Equip Malfunction INOP Pacing hardware failure Call for service If pacing functionality is essential to patient care take the device out of use 263 Table 69 Defibrillation and Pacing Problems Continued Press Charge Before Shock message The device is not charged to the selected energy Make sure the desired energy is selected Then press the Charge button Press Shock Buttons on Paddles message The Shock button on the device is disabled because external paddles or switched internal paddles are connected Press the Shock butto
274. s directed on the package NOTE If monitoring for extended periods of time monitoring electrodes and multifunction electrode pads may need to be changed periodically Refer to the manufacturer s documentation for how often to replace the monitoring electrodes or pads 50 Electrode Placement Figure 32 shows the typical electrode placement for a 3 lead ECG set Figure 32 3 lead Placement Na Black Yellow L F ed een iii ki RA R placement directly below the clavicle and near the right shoulder LA L placement directly below the clavicle and near the left shoulder LL F placement on the left lower abdomen Figure 33 shows the typical electrode placement for a 5 lead ECG set Figure 33 5 lead Placement Green 0 Black een RA R placement directly below the clavicle and near the right shoulder LA L placement directly below the clavicle and near the left shoulder RL N placement on the right lower abdomen LL F placement on the left lower abdomen V C placement on the chest the position depends on your required lead selection See Figure 34 51 The V C lead may be placed in any of the precordial electrode positions as shown in Figure 34 V1 C1 through V6 C6 Figure 34 V C Electrode Placement V1 C1 placement fourth intercostal space at right sternal margin V2 C2 placement fourth intercostal space at left sternal margin V3 C3 placement midway between V2 and
275. s fallen below the low alarm tone alarm limit 101 Enabling Disabling the Pulse Rate Alarms To enable disable the Pulse Rate Alarms perform the following steps 1 Press the Menu Select 9 button 2 Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button Select Pulse and press the Menu Select button 4 Select Alarms On Off and press the Menu Select button Changing the Pulse Rate Alarm Limits To change the Pulse Rate Alarm Limits perform the following steps 1 Press the Menu Select G button 2 Using the Navigation buttons select the Measurements Alarms menu and press the Menu Select button Select Pulse and press the Menu Select button Select Pulse Limits and press the Menu Select button Using the Navigation buttons select the new high limit value and press the Menu Select button A ON BR O Select the new low limit value and press the Menu Select button Disabling the SpO Monitoring Function To disable the SpO monitoring function disconnect the sensor cable from the SpO port The message p02 Unplugged Turn off Sp02 appears Select Yes and press the Menu Select button Should the sensor cable be disconnected accidentally the message Sp02 Unplugged Turn off Sp02 appears to notify you of the disconnection Select No and press the Menu Select button Secure the connection The SpO monitoring function is once again enabled 102 Caring for Sensors Refe
276. s not displayed The sensor is not properly connected or the sensor cable is damaged The SpO waveform is not configured to be displayed and there is not an unused wave sector e Check the sensor connection and cable e Try another sensor Use the Displayed Waves menu to select a wave sector for display of the SpO waveform SpO Non Pulsatile INOP The patient s pulse is absent or too weak to be detected The sensor has come off e Check perfusion at the measurement site e Check that the sensor is applied properly e Make sure the sensor site has a pulse e Relocate the sensor to another site with improved circulation e Ifthe message occurs due to NBP measurement on the same limb wait until the NBP measurement is finished e Try another sensor SpO Erratic INOP The SpO numeric value is replaced with a SpO measurement readings are erratic e Check that the sensor is applied properly e Make sure the sensor site has a pulse e Relocate the sensor to another site with improved circulation e Try another sensor SpO Noisy Signal INOP Excessive patient movement or electrical interference e Minimize patient movement e Make sure the sensor cable is not positioned too close to power cables SpO Interference INOP The SpO numeric value is replaced with a Ambient light is too high There is too much interference The sensor is damaged Cover the
277. s of pre alarm data and 5 seconds of post alarm data when selected alarm type occurs Red Yellow Red Print on Charge Prints a continuous strip during charging Printing continues until a shock is delivered the device is disarmed or the Print button is pressed Yes No Print on Shock Prints a 12 second strip when a shock is delivered or when a shock is attempted but unable to be delivered Yes No Print on Mark Prints a strip when the Mark Event button is pressed The strip includes the printer delay if configured and extends 6 seconds from the start of the annotation text or from the time the Events menu is removed from the display Yes No Printer Delay Defines whether printed strips including those requested manually and those generated by an event mark charge or shock include an additional 10 seconds of information the 10 seconds occurring just prior to printing being initiated No Delay 10 sec Event Summary Report Selects the Event Summary Report format Short includes a log of events and vitals Medium adds waveforms Long adds 12 Lead Reports Short Medium Long Strip Print Speed Selects the ECG strip print speed 25 50 mm sec 12 Lead Print Speed Selects the 12 Lead ECG Report print speed 25 50 mm sec 200 Red Yellow Blue Green Cyan Table 51 Mark Event Settings Mark Event 1 Defines menu
278. se Low Limit Selects default Low Alarm Limit for the HR Adult 30 High Alarm Limit 50 bpm derived from the ECG and the pulse derived Pediatric 30 High Alarm Limit 80 from SpO or Invasive Pressures adjusted in increments of 5 VTACH Detection of ventricular tachycardia based on Heart Rate Limit heart rate limit and PVC run limit Adult 95 150 100 bpm Pediatric 95 150 120 adjusted in increments of 5 PVC run limit Adult 3 20 5 Pediatric 3 20 5 adjusted in increments of 1 Color Selects the HR ECG color Red Yellow Blue Green Cyan Magenta White Note Red and blue text and numerics are not visible in high contrast mode 185 Table 26 Invasive Pressure Settings Default Labels Unit and Default Selects measurement units for all invasive mmHg kPa Labels pressures Press 1 Label Selects default label for pressure channel 1 P1 ABP ART Ao CVR ICP LAP PAP RAP Press 2 Label Selects default label for pressure channel 2 P2 ABP ART Ao CVR ICP LAP PAP RAP Table 27 Invasive Pressure Settings P1 Alarm Source Selects the type of alarm source Systolic Diastolic Mean Systolic High Limit Selects the systolic high limit value Adult 35 360 160 mmHg Ped 35 360 120 Adjusted in increments of 5 mmHg or 1kPa Systolic Low Limit Selects the systolic low limit value Adult 40 355 90 mmHg Ped 40 355 70 Adjusted in increments of 5 mmHg or 1
279. se button during the pause interval also returns alarms to their previous settings Print button The Print button initiates a continuous print out of the primary ECG and other selected waveform s either real time or with a 10 second delay depending on your configuration Summary button The Summary button displays a menu from which you can print the current or most recent Event Summary report or Vital Signs Trending Report Menu Select button 0 Pressing the Menu Select button either brings up the current menu or confirms a menu selection Navigation buttons V The Navigation buttons display the current menu just as the Menu Select button does Additionally within any menu or list these buttons move to the next or previous item in the list They also increase or decrease numbers or values in a sequence 21 Defibrillation Controls The defibrillation controls are shown in Figure 11 They include Therapy Knob Enables AED or selects an energy for Manual Defib Mode defibrillation or cardioversion Charge Button Charges the defibrillator to the selected Manual Defib energy setting Used only in Manual Defib Mode In AED Mode the defibrillator charges automatically Shock Button Delivers a shock through multifunction electrode pads or switchless internal paddles In AED mode a 150J shock is delivered In Manual Defib Mode the shock is delivered at the selected Manual Defib energy setting NOTE When external paddl
280. sensor with an opaque material to minimize ambient light Make sure the sensor cable is not positioned too close to power cables Make sure that the sensor cable is not damaged SpO Unplugged INOR The SpO sensor is not connected Check the SpO connection SpO Unplugged Turn off SpO message appears when the device is turned on and the SpO sensor is not connected The SpO sensor is not connected The software was not upgraded after an SpO repair or upgrade was performed e Check that the sensor connection is secure Try another sensor e Call for service Table 65 SpO Monitoring Problems Continued Sp0 Sensor Malfunction INOP The SpO numeric value is replaced with a The SpO sensor or cable is faulty Try another sensor If the problem persists call for service of the SpO module If SpO monitoring is essential to patient care take the device out of use SpO Equip Malfunction message Faulty SpO hardware Call for service of the SpO module If SpO monitoring is essential to patient care take the device out of use SpO Extended Update INOP The SpO numeric value is replaced with a An NBP measurement or an excessively noisy signal is delaying display update of the SpO measurement for more than 60 seconds e Try another sensor site Wait until the NBP measurement is complete Move sensor to a different limb from the NBP cu
281. should be zeroed according to your hospital policy at least once per day Also you should rezero in the following circumstances e Every time you reconnect the transducer cable to the HeartStart MRx e After a patient is moved e During changes in altitude when using the HeartStart MRx aboard an aircraft Re zero when reaching a cruising altitude e When you use a new transducer or tubing e When you think the pressure readings are not correct NOTE The numeric value will be invalid displayed as when the transducer is plugged in until zeroed successfully For each assigned label the pressure channel can be zeroed through the Menu Select button menu or when in Monitor Mode through the use of a soft key You can zero the pressure channels separately or together WARNING Before zeroing a pressure make sure related pressure transducers are vented to atmospheric pressure and the stopcock to the patient is closed Zeroing Using the Menu Select Button To Zero using the Menu Select button perform the following Place the transducer at the appropriate level for the measurement site Close the transducer stopcock to the patient and vent the transducer to atmospheric pressure On the HeartStart MRx press the Menu Select button 1 2 3 4 Using the Navigation buttons select Measurements Alarms and press the Menu Select button 5 Select the pressure label you wish to perform the zero procedure on 6 Press Zero and press t
282. side ISM bands 19 P ES GOONS Ta Venus Recommended Separation Distance 150 kHz to 80 MHz 10 Vrms in ISM bands d 1 2VP 305 Table 87 Electromagnetic Immunity Life Supporting Functions Continued Radiated RF 10 V m 10 V m IEC 61000 4 3 80 MHz to 2 5 GHz d 1 24P 80 MHz to 800 MHz d IWP 800 MHz to 2 5 GHz where P is the maximum output power rating of the transmitter in watts W according to the transmitter s specified output power and d is the recommended separation distance in meters m gt Field strengths from fixed RF transmitters as determined by an electromagnetic site survey should be less than the compliance level in each frequency range Interference may occur in the vicinity of equipment marked with the following symbol K At 80 MHz and 800 MHz the higher frequency range applies These guidelines my not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people a The ISM industrial scientific and medical bands between 150 kHz and 80 MHz are 6 765 MHz to 6 795 MHz 13 553 MHz to 13 567 MHz and 26 957 MHz to 27 283 MHz and 40 66 MHz to 40 70 MHz gt The compliance levels in the ISM frequency bands between 150 kHz and 80 MHz and in the frequency range 80 MHz to 2 5 GHz are intended to decrease the likelihood that mobile portable communications equipment could cause interference if i
283. smission Device message The phone configuration settings are invalid incorrect Wrong number Modify the Serial Phone Profile configuration settings as needed For more information refer to the 12 Lead Transmission Implementation Guide Check the number and re send Invalid Password message The Internet Service Provider ISP or Hub user name or password is incorrect Modify the Serial Phone Profile or Hub configuration settings as needed For more information refer to the 12 Lead Transmission Implementation Guide Transmission Failed message accompanied by a Connection Failed message The connection with the ISP cannot be made Modify the Serial Phone Profile configuration settings as needed For more information refer to the 12 Lead Transmission Implementation Guide Transmission Failed message accompanied by a Cannot Reach Server message The network server is unavailable Contact the network administrator 261 Table 67 12 Lead Transmission Problems RS 232 Continued First attempt to solve the problem by disconnecting the serial cable from the cell phone reconnecting it and resending the 12 Lead Report Transmission Failed message accompanied by a Server Unknown message Server Name or address is not recognized Modify the Server configuration settings as needed For more information refer to the 12 Lead Transmission Implementation Guide Transmission Fail
284. spond to the prompt as connected as follows follows e Ifthe Pads cable is attached Check the test load is you are prompted to Verify attached and press the Test Load is Attached and Charge button Press the Charge Button e Ifexternal paddles are e Make sure the paddles are attached you are prompted to seated in their pockets and Verify Paddles are in Holders press the Charge button and Press the Charge Button e Ifno cable is attached the test is marked Not Tested If the MRx does not detect a press ae Charge een 7 a h of the Charge button within 10 Ko Me P ae arge pet seconds the message If the Charge ee eon ae button does not work select Charge button test is marked Charge from the menu below is Fail and the Operational Check fails displayed Shock Button Tests the Shock button e Once charged the Shock Press the Shock button e Ifthe Shock button is not working press Shock from the No Button Response menu The Shock button test is marked Fail Select Shock from the menu to continue the Operational Check or press Exit Op Check The Shock button test is marked Fail Table 57 Operational Checks Test Continued Audio If a shock was delivered during Did you hear Shock No Shock Use the navigation buttons to the Shock test the voice Delivered respond Yes or No Then press prompt Shock Delivered is the Menu Select button annunciated If no shock was delivered during the Sh
285. ss the Menu Select button If the device is configured to use a 12 hour clock format am or pm is displayed next to the hour For a 24 hour format only the hour is shown with choices from 0 to 23 7 Press the Exit Config soft key if finished with configuration Date and time should be changed to correspond with local clock changes for Daylight Savings Time and Summer Time Modifying Settings When modifying configuration settings the device should be connected to external power and have a battery with at least 20 capacity installed To modify configuration settings from the Configuration Main menu 1 Pressthe Change Config soft key 2 When prompted enter the configuration password 3 Press the Menu Select button Use the Navigation buttons to select the sub menu for the category of parameters to be changed Then press the Menu Select button 4 Use the Prev Item and Next Item soft keys to select a parameter 5 Use the Navigation buttons to highlight the desired choices Press the Menu Select button to select the highlighted choice 6 Repeat steps 3 4 and 5 to select another sub menu and modify additional settings 7 Once the desired setting changes have been made from the Configuration Main screen press the Save Changes soft key You may press the Cancel Changes soft key to return to the previous settings 8 Pressthe Exit Config soft key to return to normal operating mode If you press Exit Config before savi
286. ssories NOTE Ifyour HeartStart MRx does not have some of the optional functionality or accessory pouches listed in this chapter disregard these features and related information Before using the HeartStart MRx review the configuration settings of your device Confirm and update the settings as appropriate Attaching the Carrying Case and Accessory Pouches The HeartStart MRx accessory pouches are designed to hold your essential monitoring and defibrillation accessories Follow the procedures below for assembly and recommended accessory placement 1 Disconnect all external power and remove all batteries 2 Lower the device into the sleeve of the carry case The rear base of the device fits in the sleeve socket Paddle Tray a If paddles are connected disconnect them from the Therapy port and remove them from the paddle tray b Remove the 4 T 15 screws from the tray plates c Gently lift the paddle tray up leaving all wires connected Handle Only a Remove the handle cover by pushing in on either side of the handle cover and lifting up or by lifting the corners of the label to expose the two T 15 screws b Remove the 2 T 15 screws c Remove the handle d Gently lift the cap plate up 31 3 Fold the two sleeve flaps over the top of the device positioning them so that the screw holes are exposed 4 Replace the paddle tray or cap plate as appropriate so that the molded openings fit over the sleeve flaps 5 Re
287. sume Pacing soft key While pacing in demand mode should the ECG source for Wave Sector 1 become invalid e g a Leads Off condition or the ECG cable is disconnected a latching red alarm is generated and pacing is stopped The message Pacing Stopped Leads Off is displayed in the top line of the pacing status bar Once the condition is corrected resume pacing by pressing the Resume Pacing soft key When pacing in demand mode using a 3 lead ECG set if the lead in Wave Sector 1 is changed a latching red alarm is generated The message Pacing Stopped Leads Off is displayed in the top line of the pacing status bar Resume pacing by pressing the Resume Pacing soft key NOTE The Pacing Stopped red alarm cannot be disabled WARNING Heart rate displays and alarms function during pacing but they can be unreliable Observe the patient closely while pacing Do not rely on the indicated heart rate or heart rate alarms as a measure of the patient s perfusion status NOTE When pacing is stopped due to a power interruption a red Pacing Stopped Power Interrupted alert will appear on the HeartStart MRx display when power is eventually restored Pacing View Pacing View appears when the Therapy Knob is set to the Pacer position Figure 51 shows information displayed in Pacing View Figure 51 Mark Event 10 Feb 2006 11 20 B e m J Samuel AD o 02 02 42 HR 7 0 Temp C Pulse bpm 120 80 ss q120 120 SYS s 36 9330 70 95
288. t Paced status is set to Yes pace pulses are filtered out to avoid processing them as QRS beats e measures signal features such as R wave height width and timing e creates beat templates and classifies beats to aid in rhythm analysis and alarm detection e examines the ECG signal for ventricular arrhythmias asystole 54 Aberrantly Conducted Beats As P waves are not analyzed it is difficult and sometimes impossible for the algorithm to distinguish between an aberrantly conducted supraventricular beat and a ventricular beat If the aberrant beat resembles a ventricular beat it is classified as a ventricular beat You should always select a lead where the aberrantly conducted beats have an R wave that is as narrow as possible to minimize incorrect classifications Intermittent Bundle Branch Block Bundle branch and other fascicular blocks create a challenge for the arrhythmia algorithm If the QRS complex changes considerably from the learned normal due to a bundle branch block the blocked beat may be incorrectly identified as ventricular and may cause false PVC alarms You should always select a lead where the bundle branch block beats have an R wave that is as narrow as possible to minimize incorrect classifications NOTE For more information on arrhythmia analysis refer to the Application Note Arrhythmia Monitoring Algorithm available on the web at www medical philips com goto productdocumentation 55 Heart Rate and A
289. t is inadvertently brought into patient areas For this reason an additional factor of 10 3 is used in calculating the recommended separation distance for transmitters in these frequency ranges Field strengths from fixed transmitters such as base stations for radio cellular cordless telephones and land mobile radios amateur radio AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy To assess the electromagnetic environment due to fixed RF transmitters an electromagnetic site survey should be considered If the measured field strength in the location in which the HeartStart MRx is used exceeds the applicable RF compliance level above the HeartStart MRx should be observed to verify normal operation If abnormal performance is observed additional measures may be necessary such as re orienting or relocating the HeartStart MRx d Over the frequency range 150 kHz to 80 MHz field strengths should be less than 3 V m Table 88 Electromagnetic Immunity Nonlife Supporting Functions Portable and mobile RF communications equipment should be used no closer to any part of the HeartStart MRx including cables than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter Recommended Separation Distance Conducted RF 3 Vrms 3 Vrms IEC 61000 4 6 150 kHz to 80 MHz d o P Radiated RF 3 V m 3 V m IEC 61000 4 3 80 MHz to 2 5 GHz d
290. t temperatures above 45 C may degrade battery life e Storing the battery for extended periods at temperatures above 40 C will reduce battery capacity and degrade battery life Humidity Up to 95 Relative Humidity e Printer paper may jam if paper is wet e Thermal Printer may be damaged if wet paper is allowed to dry while in contact with printer elements Altitude e Operating 0 to 15 000 ft 0 to 4 500 m e Storage 0 to 15 000 ft 0 to 4 500 m Shock e Operating Half sine waveform duration lt 3 ms acceleration gt 145 g 1 time on all six faces e Non operating Trapezoidal waveform acceleration gt 30 g velocity change 742 cm s 10 on all six faces Vibration e Operating Random vibration 0 30 Grms 5 500 Hz for gt 10 minutes axis PSD 0 0002 g Hz from 5 to 350 Hz 6 dB octave slope from 350 to 500 Hz e Non operating Random vibration 2 41 Grms 5 500 Hz for gt 10 minutes axis PSD 0 02 g Hz from 5 to 100 Hz 6 dB octave slope from 100 to 137 Hz 0 dB octave slope from 137 to 350 Hz 6 dB octave slope from 350 to 500 Hz Swept sine vibration 0 75 g 0 to peak 5 to 500 Hz resonant search 1 octave minute sweep rate 5 minute resonant dwell at 4 resonances per axis 285 Water Solids Resistance Water Resistance Meets EN60601 2 4 Water testing performed with cables connected to the device IPX4 when used with water resistant paddles M3543A the M3535A is protected against splashing water e
291. te ECG analysis begins automatically and is accompanied by the message Analyzing 12 Lead The patient does not need to be still during this time Following analysis the 12 Lead Report is displayed printed and stored internally To acquire another 12 Lead ECG press New 12 Lead To exit the 12 lead function press Exit 12 Lead WARNING Failure to enter correct patient age sex and pacing status can result in erroneous diagnosis NOTE The Lead Select button is disabled when the 12 lead function is active T2 Lead Report 18 12Lead ECG 12 Lead Report The 12 Lead Report View is in a format similar to Monitor View so that you may monitor the patient while viewing the report In this view the 12 Lead Report replaces Monitoring View s Wave Sectors 3 and 4 as shown in Figure 66 and includes the following information if configured Measurements The measurements component of the algorithm generates standard interval and duration measurements in milliseconds limb lead axis measurements in degrees and heart rate in beats per minute Interpretive statements Measurements and patient information age gender paced status are used by the Philips 12 Lead Algorithm to generate statements describing the patient s cardiac rhythm and waveform morphology Statements regarding signal quality problems encountered during ECG acquisition are also included in this section ECG severity Each interpretive statement on the report has
292. tected the HeartStart MRx tells you No shock advised If the NSA Action Configuration Choice is set to Monitor the HeartStart MRx monitors the ECG and automatically resumes analysis if a potentially shockable rhythm is detected You are periodically prompted to If needed press Pause and begin CPR The frequency of these prompts is defined in the Monitor Prompt Interval Configuration Choice You may press Pause for CPR to suspend monitoring and administer CPR The pause period is defined by the CPR Timer Configuration Choice Pause Time analysis is suspended for the specified period and you may administer CPR and attend to the patient A Pause status bar is displayed as shown in Figure 44 The pause period is defined by the NSA Action Configuration Choice At the completion of the pause period the HeartStart MRx resumes analyzing Figure 44 Paused Display Shocks 0 PAUSED ATTEND TO PATIENT 69 Step 3 Press the Orange Shock Button if Prompted Once charging is complete the HeartStart MRx prompts you to Deliver Shock Now Press the Orange Button Now Make sure no one is touching the patient or anything connected to the patient Call out clearly and loudly Stay Clear Then press the orange Shock button to deliver a shock to the patient WARNING Defibrillation can cause operator or bystander injury Do not touch the patient or equipment connected to the patient during defibrillation WARNING T
293. ted in increments of lmmHg or 0 1 kPa EtCO Low Limit Selects the low limit alarm value Adult 10 94 30 mmHg Pediatric 10 94 30 adjusted in increments of lmmHg or 0 1 kPa AwRR High Limit Selects the high limit alarm value Adult 10 100 30 rpm Pediatric 10 100 60 adjusted in increments of 1 AwRR Low Limit Selects the low limit alarm value Adult 0 99 8 rpm Pediatric 0 99 12 adjusted in increments of 1 Apnea Time Length of time without respiration required to Adult 10 40 20 seconds trigger an apnea alarm Pediatric 10 40 20 adjusted in increments of 5 Color Selects the EtCO and AwRR color Red Yellow Blue Green Cyan Magenta White 191 Table 36 SpO Settings SpO High Limit Selects high limit alarm value Adult 51 100 100 Pediatric 51 100 100 adjusted in increments of 1 SpO Low Limit Selects low limit alarm value Adult 50 99 90 Pediatric 50 99 90 adjusted in increments of 1 SpO Desat Limit Selects extreme low limit alarm value Adult 50 low limit 80 Pediatric 30 low limit 80 adjusted in increments of 1 Color Selects the SpO color Red Yellow Blue Green Cyan Magenta White Table 37 Pulse Settings Pulse Source Sets default pulse source SpO2 Press 1 label Press 2 label Default SpO2 if device has SpO2 option otherwise Press 1 Note Pulse is only included in th
294. the Menu Select button 7 Set the new low limit and press the Menu Select button 128 CPP Alarms Wedge With CPP and ICP only one of the two parameters can have alarms enabled at one time If CPP alarms are turned on then ICP alarms are turned off Both alarms can be turned off at the same time The parameter with alarms off will be displayed at the bottom of the ICP CPP parameter area with the Alarms Off X symbol ICP alarms default to on CPP to off Perform a pulmonary artery wedge procedure according to your hospital protocol The wedge numeric will not be stored in the Vital Signs Trending WARNING For Pulmonary Artery Wedge Pressure PAWP readings due to a measurement delay do not use Microstream sidestream CO as a direct reference for determining the end expiratory point in the pressure curve If the pulmonary artery flotation catheter drifts into the wedge position without inflation of the balloon the pulmonary artery pressure waveform will assume a wedged appearance To correct the situation take appropriate action in accordance with standard procedures 129 Pulse The HeartStart MRx can provide pulse readings from either the SpO or Invasive Pressures options To understand how pulse works with SpO only read Chapter 8 Pulse Oximetry If your device has both options read the following section Pulse Sources When both SpO and Invasive Pressures options are present on the HeartStart MRx pulse can b
295. the device out of use Leads ECG e Pass ECG Cable leads ECG acquisition and the If the test fails without an ECG cable ECG cable connected are both functioning connected take the device out of use and call bccn for service If the test fails with a cable repeat Pass No Cable leads ECG t gt TEP A ee a the test without an ECG cable attached A amp passing result without a cable attached e Fail ECG Cable leads ECG acquisition and or the indicates the cable is defective and should be ECG cable connected are not functioning replaced If the test continues to fail take the e Fail No Cable leads ECG acquisition is not device out of use and call for service functioning 231 Table 58 Operational Check Test Results Continued Pads Paddles ECG Pass cable type ECG acquisition and the cable are both If the test fails with a cable connected remove functioning the cable and repeat the test If the test passes Pass No cable ECG acquisition is functioning a cable without the cable replace the cable If the test Seas auntie continues to fail take the device out of use and call for service Fail cable type ECG acquisition and or the cable specified are not functioning Battery A e None There is no battery in the slot Charge the battery Battery B e Pass The battery has 20 or greater capacity Calibrate the battery e Fail The battery has 20 or less capacity e Cal Recommended The battery requ
296. ting hours Table 58 Operational Check Test Results Continued Invasive Pressures Pass Invasive Pressures passed its self test If the test fails call for service to replace the i va Invasive Pressures Temperature board If e Fail Invasive Pressures is not functioning FN E A invasive pressure monitoring is essential to patient care take the device out of use Temperature e Pass Temperature passed its self test If the test fails call for service to replace the OE Invasive Pressure Temperature board If e Fail Temperature failed its self test a ae i temperature monitoring is essential to patient care take the device out of use Bluetooth Pass A Bluetooth card is detected and If the test fails call for service communicating e Fail A Bluetooth card is not installed or is not functioning Printer e Pass The printer passed its self test If the test fails call for service e Fail The printer needs repair 233 Operational Check Summary The Operational Check Summary lists the results from the last 60 Operational Checks Test results are reported as described in Table 58 To view the Operational Check Summary Turn the Therapy Knob to Monitor Press the Menu Select 4 button Using the Navigation buttons select Other and press the Menu Select button 1 2 3 4 Select Operational Check and press the Menu Select button 5 Using the Navigati
297. ting may result in incorrect readings CAUTION Do not compress or restrict pressure tubes during an NBP measurement If a spill occurs and liquid appears to be inside the tubing contact your service personnel NOTE When using the HeartStart MRx aboard aircraft NBP measurements should only be taken while on the ground or once cruising altitude is reached Measurements taken during ascent or descent may not be accurate 107 9 Noninvasive Blood Pressure Measuring NBP Measuring NBP To measure NBP press the Start NBP soft key The cuff pressure is displayed as the cuff inflates and deflates When the measurement is complete the NBP values are displayed Additional measurements are taken according to the configured NBP schedule If the schedule is configured to Manual There is no schedule for additional measurements One measurement is taken each time you press Start NBP Take additional measurements by pressing Start NBP Automatic The measurement is repeated at the configured interval of 1 2 5 5 10 15 30 60 or 120 minutes from the time you press the Start NBP soft key Additional manual measurements may be taken without affecting the automatic measurement schedule by pressing Start NBP The configured NBP schedule may be changed during use through the Measurements Alarms menu If the automatic measurement schedule is changed the new time interval is applied to the start time of the last measurement
298. tion 138 preview screen 138 139 report 141 signal problems 143 specifications 285 12 Lead ECG transmission 145 Bluetooth setup 147 Bluetooth transmission 149 cancelling 155 configurable parameters 195 overview 145 RS 232 setup 150 RS 232 transmission 152 settings 196 status 154 transmitting 12 Lead reports 155 troubleshooting 258 A abbreviations units 292 AC power module installing 45 accessories 243 connecting pouches 31 alarms 25 apnea time limit 116 audio indications 269 AwRR changing 115 enabling disabling 116 chain for basic arrhythmia 57 configurable parameters 193 CPP 129 EtCO changing 115 enabling disabling 115 EtCO and AwRR 114 heart rate and arrhythmia 56 changing 59 enabling disabling 59 latching 56 invasive pressures 127 changing 128 enabling disabling 128 Noninvasive Blood Pressure NBP 109 changing 109 enabling disabling 110 noninvasive pacing 84 pulse 131 enabling disabling 131 setting limits 132 pulse rate from SpO 101 responding to 25 SpO monitoring 100 changing 100 desat 101 enabling disabling 101 temperature 134 changing limits 135 enabling disabling 135 types 25 annotated ECG 60 Apnea Time Alarm 116 arrhythmia alarms chain 57 learning relearning 61 monitoring 54 audio tones 269 audio recording 24 Automated External Defibrillation AED 63 AED therapy precautions 63 AED view 64 configurable parameters 199 indications 5 preparation 65 specifications 275 using AED
299. tion electrode 74 parameter blocks 18 password security 15 patient category 16 entering data 27 name 16 pleth wave 99 printing cleaning printhead 239 configurable parameters 200 configuration settings 183 Event Summary 205 installing paper 42 printer specifications 279 strip lengths 213 troubleshooting 265 Vital Signs Trending Report 206 Vital Signs Trending report 160 waveforms 28 pulse configurable parameters 192 pulse rate alarms 101 changing 102 enabling disabling 102 source 130 changing 131 troubleshooting 267 Pulse Oximetry see SpO monitoring 93 Q Q CPR 163 compression sensor 166 on patient 169 compression waveforms 171 configurable parameters 200 CPR feedback 176 data capture 163 179 configurable parameters 200 data events recorded 180 reviewing data 180 in Manual Defib Mode 170 indications 6 overview 163 preparing to use 165 troubleshooting 268 using in AED Mode 174 QRS beeper 252 R Ready For Use RFU Indicator 4 23 218 Return to Owner 29 S safety considerations 7 297 service numbers 271 setting alarms 59 setting date time 182 Shift Checklist 219 copy of 220 specifications 273 12 Lead ECG 285 Automated External Defibrillation AED 275 batteries 278 data management 285 display 278 ECG and arrhythmia monitoring 276 environmental 285 EtCO 283 Invasive Pressures 282 manual defibrillation 275 Noninvasive Blood Pressure NBP 281 Nonivasive Pacing 279 SpO 28
300. to 1 5 10 15 30 or 60 minutes The default is 5 minutes Adjusting Vital Signs Trending Report Interval To adjust the intervals in the Vital Signs Trending report perform the following steps 1 With Vital Signs Trending active on your display press the Menu Select 9 button 2 Using the Navigation buttons select Trend Interval and press the Menu Select button 3 Using the Navigation buttons select the trend interval you want and press the Menu Select button 159 Printing the Vital Signs Trending Report You can print the Vital Signs Trending Report two ways 1 Press the soft key under the Print Trends label A report for the displayed period and interval is printed 2 Press the Summary button and select Trends and then Trends Interval A report for the entire incident period is printed Figure 73 Sample Vital Signs Trending Report Printout Trend Report 26 Apr 10 55 10 50 10 45 10 40 10 35 10 30 10 25 DD Mon YYYY HH MM HR bpm 100 100 100 100 100 100 100 P2s mmHg 25 25 25 25 25 25 25 Event ID 0302 P2s mmHg 10 10 10 10 10 10 10 LastName First Name P2s mmHg 16 16 16 16 16 16 16 Patient ID 12345 ABPs mmHg 118 118 118 118 118 118 118 ABPd mmHg 72 72 72 72 72 72 72 ABPm mmHg 95 95 95 95 95 95 95 M3535A S N US00112345 SW Rev 7 00 00 American English 1st page 26 Apr 10 55 10 50 10 45 10 40 10 35 10 30 10 25 NBPs mmHg 120 120 117 NBPd mmHg 70 60 64 NBPm mmHg 82 80 81 10 47 10 30 10 23 EtCO2 mmHg
301. ts Repeat the steps to label the other pressure channel NOTE Changing the pressure site label activates scales and alarm settings associated with the new label You will be presented with the controls for scale and alarm settings after selecting a label from the menu to either confirm or adjust the value Table 15 lists pressure labels Table 15 Pressure Labels ABP Arterial Blood Pressure LAP Left Atrial Pressure ART Arterial Blood Pressure PAP Pulmonary Artery Pressure Ao Aortic Pressure RAP Right Atrial Pressure CVP Central Venous Pressure P1 Non specific pressure label Channel 1 ICP Intracranial Pressure P2 Non specific pressure label Channel 2 Cerebral Perfusion Pressure CPP is automatically displayed with ICP when one pressure is already set to ABP ART or Ao and the other pressure is set to ICP CPP will be displayed in the same color as ICP Only one of the ICP or CPP alarms can be enabled at the same time See Alarms page 127 NOTE When selecting a pressure label for a pressure channel the label assigned to the other pressure channel appears in your options list only if the other channel is not connected to a transducer If you select the same label as the other channel the label for the other channel changes to a non specific label P1 or P2 If you decide to re label the first channel the other channel s label remains non specific P1 or P2 NOTE To monitor a pressure from an arte
302. ty with Lead II select another lead 3 Verify that white R wave markers appear above or on the ECG waveform A single marker should be associated with each R wave If the R wave markers do not appear or do not coincide with the R wave select another lead 4 Press Pacer Rate and use the Navigation and Menu Select buttons to select the desired number of pace pulses per minute The initial rate is configurable 5 If needed adjust the initial pacer output To do this press Pacer Output and use the Navigation and Menu Select buttons to select the desired output The initial output is configurable 6 Press Start Pacing The message Pacing appears WARNING Use care when handling the multifunction electrode pads on the patient to avoid shock hazard during pacing 7 Verify that white pacing markers appear on the ECG waveform 8 Press Pacer Output Then use the Navigation and Menu Select buttons to a increase the output until cardiac capture occurs Capture is indicated by the appearance of a QRS complex after each pacing marker b decrease the output to the lowest level that still maintains capture 9 Verify the presence of a peripheral pulse NOTE Spontaneous beats may be present which are not associated with the delivery of pace pulses Additionally if the patient s heart rate is above the pacer rate pace pulses are not delivered and therefore pacing markers do not appear To stop delivery of pace pulses pres
303. ue M5523A Yellow M5524A Rose M5525A Gray M1781A Test Load for use with M3507A Pad Cable M3725A Test Load for use with M3508A Pad Cable M3541A Carrying Case 989803146981 Data Card and Tray M3544A Data Card Tray M4737A Display Cover M3549A Wide bedrail hook 20 Troubleshooting If the HeartStart MRx detects an error or potential problem during use it displays an INOP statement or a message window with text to guide you INOP statements and messages are often accompanied by a voice prompt or an audible beeping tone This chapter describes the INOP statements and messages that you may see along with other symptoms and provides suggestions for what to do In addition this chapter provides an explanation of audible tones and information on contacting your service representative If you are unable to resolve a problem using the suggestions in this chapter e Run an Operational Check to determine if there is a malfunction requiring service e Ifa malfunction is identified call for service e Take the HeartStart MRx out of use if there is a malfunction affecting ECG monitoring defibrillation or pacing For malfunctions related to SpO NBP Invasive Pressures Temperature CO monitoring or 12 Lead functionality take the device out of service if the function is essential to patient care in your organization Results of Automated Tests associated with critical functionality of the device
304. ulse Rate Alarms on page 101 Figure 57 SpO Parameter Block 2 mmHg PAP mmHg SpO2 EtCO2mmHg AWRR rpm 118 77 sys 24 10 DA 95 s 15 i 100 383 18 98 Pleth Wave When the sensor is connected to the HeartStart MRx the pleth wave is displayed in the configured Wave Sector or the first available empty Wave Sector It is drawn at an approximate speed of 25 mm second Grid lines are displayed to indicate signal quality When signal quality is good the pleth wave is auto scaled to the grid lines When signal quality is poor the size of the pleth wave is proportionately decreased Figure 58 Pleth Wave Size When the Therapy Knob is moved to an energy setting the SpO values and pleth wave continue to be displayed as long as they are not located in Wave Sector 2 or you re in Q CPR View When the Therapy Knob is moved to Pacer the pacing status bar appears in Wave Sector 4 replacing the waveform in that sector If the pleth wave was removed the SpO and Pulse values and alarm settings are retained If the Therapy Knob is moved to AED SpO and pulse related information is no longer monitored 99 8 Pulse Oximetry SPO 2 Alarms SpO Alarms Alarms are annunciated if measurements fall outside the configured limits for high or low SpO or if the measurement falls below the configured SpO Desat Limit SpO alarms are all categorized as non latching alarms meaning they are automatically removed when their alarm c
305. ult patients Figure 50 Energy Selection O fault 120 150 oO CX bs 170 200 Select 1 Energy Selecting the 1 10 1 9 energy setting displays the Select Energy menu with a default setting of 6J The low energy setting can be changed using the Navigation buttons to increase or decrease the desired setting Complete your selection by pressing the Menu Select button Your current energy selection is shown in the Shock Status area of the display as shown in Figure 45 WARNING Clinicians must select an appropriate energy level for defibrillation of pediatric patients WARNING The HeartStart MRx has a built in limitation of 50 Joules when using internal paddles WARNING Do not leave patients unattended when the HeartStart MRx is in manual defibrillation mode with pads applied to the patient 7 N 2 Charge Press the Charge 2 button on the front panel If using external paddles the charge button on the paddles may be used instead As the defibrillator charges the energy selection shown in the Shock Status area changes to show the current charge energy A continuous low pitch charging tone sounds until the desired energy level is reached at which point you will hear a continuous high pitch charge done tone You may increase or decrease the selected energy at any time during charging or after charging is complete Simply move the Therapy Knob to the desired energy level as explained above The de
306. umber USD0123456 Therapy Knob Pass Battery Compartment B Test Ver 7 00 00 Charge Button Pass SpO2 Test Shock Button Pass NBP Test Current Operational Check Audio Test Pass CO2 Test DD Mon YYYY HH MM SS Pass Defib Test Pass Pads Invasive Pressure Test Pacer Pass Temperature Test Last Operational Check Compression Sensor Pass Bluetooth Test DD Mon YYYY HH MM SS Pass Leads ECG Test Pass ECG Cable Printer Test Pads Paddles ECG Test Pass Pads Qty Check List _ Defibrillator Inspection ____ SpO2 Sensor Comments ___ Cables Connectors NBP Cuffs amp Tubing ____ Paddles Pads _ CO2 FilterLine _ Compression Sensor Inspection ____ Invasive Pressure Cables _ Compression Sensor Pads _ Temperature Probes ____ Monitoring Electrodes _ Charged Batteries _ AC DC Power amp Cord ___ Printer Paper _ Data Card Inspected by Press the Print soft key when the Operational Check is complete to print an additional copy of the report 229 User Checks The guidelines for completing user checks are as follows Defibrillator Inspection Make sure the HeartStart MRx is clean clear of objects and has no visible signs of damage Cables Connectors Paddles Pads Monitoring Electrodes Make sure there are no cracks broken wires or other visible signs of damage Make sure the connections are secure Check expiration date and quantity of pads and monitoring electrodes Compression Sensor Inspect the Compression
307. ure 61 EtCO and AwRR Parameter Block 2 ABP mmHg PAP mmHg SpO2 EtCO2mmHg AwRR rpm 118 77 sys 24 10 0 5 8 15 100 383 18 EtCO and AwRR Alarms Alarms are annunciated if measurements fall outside the configured limits for high or low EtCO3 high or low Airway Respiration Rate AwRR and Apnea time EtCO alarms are all categorized as non latching alarms meaning they are automatically removed when their alarm condition no longer exists Table 14 EtCO Red Yellow Physiological Alarms Apnea Red Red alarm message alarm tone No detectable breaths for the configured number of seconds EtCO High Yellow Yellow alarm message alarm tone The EtCO value exceeds the high alarm limit EtCO Low Yellow Yellow alarm message alarm tone The EtCO value has fallen below the low alarm limit AwRR High Yellow Yellow alarm message alarm tone The AwRR value exceeds the high alarm limit AwRR Low Yellow Yellow alarm message alarm tone The AwRR value has fallen below the low alarm limit EtCO and AwRR alarms are on unless you turn them off or alarms for the entire device are off Once disabled alarms remain off until they are turned back on WARNING Turning off alarms prevents all alarms associated with EtCO or AwRR measurements from annunciating If an alarm condition occurs NO alarm indication will be given Changing the EtCO Alarm Limits To change the EtCO alarm limits 1 Press the
308. urer Guidance and Manufacturer s Declaration The HeartStart MRx is intended for use in the electromagnetic environment specified in the tables below The customer or the user of the HeartStart MRx should assure that it is used in such an environment Table 85 Electromagnetic Emissions RF emissions Group 1 The HeartStart MRx uses RF energy only for its CISPR 11 internal function Therefore its RF emissions are very low and not likely to cause interference in nearby electronic equipment RF emissions Class B CISPR 11 Harmonic Class A The HeartStart MRx is suitable for use in all emissions establishments including domestic establishments or IEC 61000 3 2 those directly connected to the public low voltage power supply network that supplies buildings used for domestic purposes Voltage Complies fluctuations flicker emissions IEC 61000 3 3 303 304 Table 86 Electromagnetic Immunity General Electrostatic discharge ESD IEC 61000 4 2 6 kV contact 8kV air 6 kV contact 8kV air Floors should be wood concrete or ceramic tile If floors are covered with synthetic material the relative humidity should be at least 30 Electrical fast transient burst IEC 61000 4 4 2 kV for power supply lines 1 kV for input output lines 2 kV for power supply lines 1 kV for input output lines Mains power quality should be that of a typical commercial or
309. use Table 13 shows CO accessories with their corresponding application areas Table 13 Microstream CO Accessories M1920A Intubated FilterLine Set Adult Pediatric 25 sets case M1921A Intubated FilterLine H Set Adult Pediatric 25 sets case M1923A Intubated FilterLine H Set Infant Neonatal yellow 25 sets case M2520A Non Intubated Smart CapnoLine Pediatric Dual Purpose M2522A Non Intubated Smart CapnoLine Adult Dual Purpose M2524A Non Intubated Smart CapnoLine Pediatric Single Purpose M2526A Non Intubated Smart CapnoLine Adult Single Purpose WARNING Use only Microstream accessories as listed above to ensure correct functioning of the CO sidestream measurement WARNING Dueto a measurement delay do not use Microstream sidestream CO as a direct reference for determining the end expiratory point in the pressure curve NOTE The HeartStart MRx is equipped with automatic barometric pressure compensation _ 12 CEEE Setting Up Microstream EtCO Measurements WARNING Danger explosion hazard sidestream measurement should not be used in the presence of flammable anesthetics such as flammable anesthetic mixture with air flammable anesthetic mixture with oxygen or nitrous oxide e CO should not be measured in the presence of aerosolized pharmaceuticals e When using the nasal FilterLine if one or both nostrils are partially or com
310. utomatically appear in the report when the interval is updated and the latest data is available NOTE When the time interval in the Vital Signs Trending Report is one minute data from continuous measurements represents the average reading for that one minute period For all other time intervals the measurement shown is the one minute average from the most recent minute in the time interval Vital Signs Trending Report Parameter List Order Vital Signs Trending Reports list parameters in the following order beginning at the top of the table HR P1 P2 ABP Ao ART PAP RAP CVP LAP ICP CPP NBP EtCO AwRR SpO3 Pulse Temp If a parameter has not been measured during the display period it is not listed in the display Scrolling in the Vital Signs Trending Report Use the lt lt or gt gt softkeys to scroll left and right backward and forward in the Vital Signs Trending Report The softkey will be displayed as inactive if there is no more data to be viewed in a particular direction If there are more vital signs than can be shown on the screen use the Navigation buttons next to the Menu Select button to scroll up and down with the vertical scroll bar on the display Make sure there is not a menu active at the same time Vital Signs Trending Report Intervals Vital Signs Trending data can be shown at selected intervals for up to 12 hours of monitoring You can adjust the display s time interval for the current incident
311. verview Pulse oximetry is a noninvasive method of continuously measuring functional oxygen saturation SpO gt in arterial blood The resultant SpO reading indicates the percentage of hemoglobin molecules in the arterial blood which are saturated with oxygen WARNING Do not rely solely on SpO readings assess the patient at all times Inaccurate measurements can be caused by e Incorrect sensor application or use e Significant levels of dysfunctional hemoglobins such as carboxyhemoglobin or methemoglobin e Injected dyes such as methylene blue or intravascular dyshemoglobins such as methemoglobin or carboxyhemoglobin e Exposure to excessive illumination such as surgical lamps especially those with a xenon light source bilirubin lamps fluorescent lights infrared heating lamps or direct sunlight The HeartStart MRx allows you to monitor SpO while in Monitor Manual Defib and Pacer modes When using the Q CPR option SpO monitoring functionality is not available NOTE For more information on SpO refer to the Application Note Philips Pulse Oximetry 93 Understanding Pulse Oximetry A pulse oximetry sensor sends light through patient tissue to a receiver on the other side of the sensor As Figure 56 shows light emitting diodes transmit red and infrared light through peripheral areas of the body such as a finger Figure 56 Pulse Oximetry Sensor Light Emitting Diodes Photodetector A photodetect
312. w Parameter Block 2 contains the numeric values for compression rate as well as ventilation rate Both rates are a moving average rate measured per minute Based on the Q CPR algorithm the target compression rate is 100 compressions per minute within an acceptable range of 90 120 compressions per minute The acceptable range for ventilation rate while CPR is being administered is 4 16 ventilations per minute to reflect 2005 resuscitation guidelines The acceptable range for ventilation rate following 60 seconds without compressions such as while rescue breathing is being administered is 9 16 ventilations per minute If your device does not have invasive pressure active the ventilation volume icon is displayed in Parameter Block 2 and depicts the level of ventilation volume A set of lungs graphically shows the four states of volume gradually moving from empty to one third full then two thirds full and full See Figure 81 After a brief display the icon returns to the empty state If ventilation cannot be measured lungs marked with a appear Figure 81 Ventilation Volume Icons BR 4B ON 0 NOTE The filling of the ventilation volume icon indicates that a ventilation was detected and the ventilation s magnitude is indicated by the filling of the icon WARNING The graphical display of a set of lungs does not signify the actual filling ventilation or presence of both lungs in the patient The actual ventilation volume
313. word protected A password entry screen is displayed when the setting is changed to On Using the Menu enter a 4 character password Selecting Cancel during password entry resets the setting to Off Once the password is set changing the setting to Off clears the password from the device memory Pacing Rate Upon entering the selected Pacer Mode 30 180 70 ppm Demand or Fixed defines the default rate of di a adjusted in increments of 10 delivery of paced pulses Pacing Output Upon entering the selected Pacer Mode 10 175 30 mA Demand or Fixed defines the default current di fo b adjusted in increments of 5 setting at which paced pulses are delivered Manual Therapy Security Defines whether Manual Defib and Pacer Modes Off On See Warning below WARNING Use of the Manual Therapy Security password requires the clinician to know and remember the password as defined in Configuration Failure to enter the correct password will prevent the delivery of manual defibrillation or pacing therapy Prior to selecting this Configuration option review this potential risk with your Risk Manager Table 47 AED Settings Shock Series Sets the number of shocks that must be delivered to activate an automatic CPR Pause The length of the CPR pause is determined by the CPR Timer Setting A new Shock Series begins when a shock is delivered e after the device is turned on e after the automatic CPR pause e after the
314. y Cardiovascular Care Dallas Texas AHA 2005 Successful resuscitation is dependent on many variables specific to the patient s physiological state and the circumstances surrounding the patient incident Failure to have a successful patient outcome is not a reliable indicator of monitor defibrillator performance The presence or absence of a muscular response to the transfer of energy during electrical therapy is not a reliable indicator of energy delivery or device performance AED View Once the Therapy Knob is moved to AED AED View is displayed Figure 39 AED View Display Mark Event 10 Feb 2006 11 20 B e m X Alarms Off HR 154 02 42 AVAVAVAVAVAVAVAVAVAVATATATAVAL Shocks 0 Analyzing Do Not Touch Patient Pause for CPR Wave Sectors 1 and 2 are combined so that a large ECG may be shown The Event Timer is also large for easier viewing A Shock Counter is displayed just below the ECG and shows the total number of shocks delivered to the patient in AED and Manual Defib Mode Also below the ECG is a prominent text message window which accompanies the voice prompts annunciated in AED Mode NOTE Only the ECG acquired through multifunction electrode pads is displayed in AED Mode 64 Preparation Confirm that the patient is unresponsive e not breathing e pulseless Then 1 Remove clothing from the patient s chest Wipe moisture from the patients chest and if necessary clip or shave excessive chest hai
315. y buttons located immediately below These labels change as appropriate according to the current display view and function Soft key labels appearing as gray text indicate that the soft key is inactive Menus Menus with controls and options specific to each function of the HeartStart MRx are easily accessible using the Menu Select and Navigation buttons located on the front panel Menus are used to adjust volume select waveforms for display select waves for printed strips set alarms schedule measurements enter patient information perform the Operational Check generate reports and a variety of other tasks Menus and submenus are organized to allow you to conveniently make selections and enter information To display a menu press the Menu Select G button Then use the up A or down V Navigation buttons to scroll through the available choices until the desired selection is highlighted To activate the selection press the Menu Select button Select Exit to close the menu without activating a selection Figure9 Sample Menu HR Arrhythmia Relearn Rhythm Alarms Off HR Limits VTACH Limits Exit Message Windows Periodically message windows appear on the display to provide additional status information alert you to an error or a potential problem or direct you to take action Remain alert to these messages If a response is required use the Navigation and Menu buttons to highlight and select the appropriate answer Figure 10
316. y to view and print numeric vital sign trending for the current incident Trending data are automatically acquired if parameters are on When viewing trending the Vital Sign Trending Report is displayed in the HeartStart MRx s lower two wave sectors and takes over the soft key functions Trending data are presented at the selected interval for up to the most recent 12 hours of monitoring The newest data appear when trending is initially displayed The oldest measurements are deleted as needed to store the newest measurements Reviewing Trending Data To review trending data 1 Place the HeartStart MRx into Monitor Mode 2 Press the Menu Select button 3 Using the Navigation buttons select Trends and press the Menu Select button The Vital Signs Trending Report takes over the bottom two wave sectors See Figure 72 157 Figure 72 Vital Signs Trending Report Time intervals Vital Sign trends are displayed at the selected time interval See Vital Signs Trending Report Intervals on page 159 Date of report The earliest time displayed in the table determines the date of the report 26 Apr 10 10 10 15 10 20 10 25 10 30 10 35 10 40 10 45 10 50 N o o n m a m 72 n nha Nim 95 95 95 95 95 95 95 95 95 a 9 o ol ol oj 8l l 9 9f Timestamp Gda 86 86 86 se 86 87 87 86 86f indicator N 120 d 7 a o 120 120 indicates M so o o do oea AS T eof 708 multiple Mea 95 do tT A828 measurements f1

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