Home

HeartStart XL+ - Philips Healthcare

1. 42 Review Have students answer the following questions individually or as a group Correct answers are in bold 1 Identify the AED View elements message area enlarged Wave Sector 1 shock counter energy setting AED pause CPR progress bar 2 True or false Apply multifunction electrode pads for AED according to pads package directions or your organization s protocol T 3 What are the three basic steps for AED using the XL a Turn the Therapy knob to AED b Follow the voice and screen prompts c Press the orange Shock button if prompted 4 Which of the following statement s about AED Mode are TRUE a The XL automatically checks for proper pads cable and pads connection T b Ifartifact interferes with ECG analysis and persists analysis will suspend but resume automatically after 60 seconds F Analysis resumes automatically after 30 seconds c The XL automatically disarms if a shock becomes unnecessary T d The XL automatically prompts to begin CPR after a shock is delivered T 43 Instructor Guide 5 Manual Defibrillation and Cardioversion Lesson Introduction Introduce the lesson including the learning objectives estimated time to complete and applicable resources This lesson explains how to prepare for and perform manual asynchronous and synchronous cardioversion defibrillation using multifunction electrode pads and external internal paddles Objectives Upon comp
2. 3 Examine the new roll of printer paper and remove any remaining adhesive residue from the outer layer of paper 4 Place the new roll of paper in the paper well positioning the roll so that the end of the roll is on the bottom and the grid faces up 5 Pull the end of the paper out past the roller 6 Close the printer door 7 Test the printer before putting the device back into service Figure 4 Installing Printer Paper 19 Test Plug Test Load Discuss the defibrillator test plug as appropriate Your XL comes with a defibrillator test plug to assist in performing a Weekly Shock Test You can also use the M3725A Test Load ordered seperately to perform the Weekly Shock Test To use either the Test Plug or Test Load during a Weekly Shock Test insert the plug or load into the Therapy cable see Figure 5 The Test Plug and Test Load behave differently during the Weekly Shock Test The Test Plug creates an electrical short while the Test Load applies an impedence at the end of the Therapy cable Therefore similar successful Weekly Shock Test results appear differently on the device Figure 5 Connecting Defibrillator Test Plug Load Test Plug Test Load Note the following e The test plug is not compatible for use with the HeartStart MRx or HeartStart XL e Using the tie provided tie the test plug about 18 inches 46 cm from the end of the therapy cable tight enough to prevent the plug from sliding
3. Objectives Upon completion of this lesson students should be able to 1 Locate pertinent information in Monitor View 2 Prepare a patient for ECG monitoring 3 Set heart rate and arrhythmia alarms 4 Display an annotated ECG 5 Initiate manual relearning Time 10 20 minutes Accessories Recommended e ECG simulator e Hands free cable e Multifunction electrode pads e 3 or 5 Lead monitoring electrodes Clinical Resources Arrhythmia Monitoring Algorithm Application Note 23 Lesson Presentation Overview Introduce XL s Monitor Mode specific to ECG and arrhythmia monitoring e Monitor Mode monitors adult and infant child ECGs using multifunction electrode pads or 3 or 5 Lead ECG sets External paddles can be used for quick assessment only e The XL uses the ST AR Basic Arrhythmia Algorithm for arrhythmia analysis e Monitor Mode generates heart rate and arrhythmia alarms communicating patient status Preparation Discuss monitoring preparation using multifunction electrode pads or electrodes Multifunction electrode pads 1 If not pre connected insert the pads cable into the green Therapy port DEMONSTRATE 2 Connect the pads to the pads cable DEMONSTRATE 3 Prepare the patient s skin i e identify location clip shave site clean abrade site and dry site 4 Apply multifunction electrode pads to the patient according to the pads package directions or your organization s protocol Suggestion Ha
4. About This Edition Publication number 453564091541 Edition 2 Printed in the USA To determine the product level version to which this Instructor Guide is applicable refer to the version level appearing below in the Edition History table or on the label of the User Documentation CD ROM that accompanied the HeartStart XL This information is subject to change without notice The information in this document applies to the HeartStart XL defibrillator monitor Philips shall not be liable for errors contained herein or for incidental or consequential damages in connection with the furnishing performance or use of this material Edition History Ed S W Version Print Date 453564091541 1 JA August 2011 453564091541 2 A 01 Jan 2012 Copyright Copyright 2012 Koninklijke Philips Electronics N V All rights are reserved Permission is granted to copy and distribute this document for your organization s internal educational use Reproduction and or distribution outside your organization in whole or in part is prohibited without the prior written consent of the copyright holder SMART Biphasic is a registered trademark of Philips Other trademarks and trade names are those of their respective owners Medical Device Directive The HeartStart XL complies with the requirements of the Medical Device Directive 93 42 EEC and carries the CE 9123 mark accordingly Notice Manufacturer Phil
5. 26 sopo 88 Event Summary e 88 Data Management Mode ss 8 4 4 boa ss 8O Printing Data 22 dc ee HARARE Se SG RR Al Marking Events 2 2 fae bu cee Ee ADA em EG ER we 92 Review s 2 2 1 we ee ek ee I 11 Maintenance 95 Lesson Introduction 95 CIBELES a so s oa RA A RAE A A e A Time 2 o oo ee OS Accessories Recommended OS Maintenance Resources 2 2 1 ee ee OS Lesson Presentation 96 OVELVIENW os we we ee OR SY Oe Be oe ee Poe ee 2 96 Automated Tests 2 2 1 ee 97 Shift Check es so sana e ao a ao eosi nadd 98 Weekly Shock Test a amp 2 sa e e es asa a OD Operational Check 0 0 e 100 Battery Maintenance 102 Cleaning Instructions 4 4 be baw we a ao 4103 Revia 105 vi Instructor Guide Introduction This instructor guide is designed to assist you in the delivery of end user training on the HeartStart XL It provides directions and suggestions for teaching the safe and proper operation of the device and is intended only for ACLS personnel thoroughly trained in the use of the device Instruction Time It is estimated that this course will require 1 3 hours to complete depending on class size training environment number of devices available for training optional device parameters purchased and student knowledge and needs Guide Structure This guide is divided into ten 10 lessons as follows e Getting Acquainted e ECG Monitoring
6. Manual Defibrillation AED or Pacer T 2 True or false The pleth wave is auto scaled to grid lines when the signal quality is poor F The wave is auto scaled with a good signal 3 True or false SpO alarms are off unless turned on during use while pulse rate alarms are on unless turned off during use F SpO alarms are on unless turned off during use while pulse rate alarms are off unless turned on 73 74 Instructor Guide 8 Noninvasive Blood Pressure Monitoring Lesson Introduction Introduce the lesson including the learning objectives estimated time to complete and applicable resources This lesson describes how to monitor noninvasive blood pressure NBP with the HeartStart XL Objectives Upon completion of this lesson students should be able to 1 Monitor NBP 2 Set NBP alarms Time 10 15 minutes Accessories Recommended NBP cuff Clinical Resources e About Noninvasive Blood Pressure Application Note 75 Lesson Presentation Overview Review NBP characteristics respective to its use with the XL XL measures blood pressure for both adults and infant child patients using the oscillometric method NBP may be measured in Monitor Pacer or Manual Defibrillation including Synchronized Cardioversion Modes e NBP measurements can be taken automatically on a pre set schedule or manually on demand e Alarms signal changes in the patient s condition e Systolic diast
7. pulsatile reading is obtained 3 To activate SpO and pulse alarms in AED Mode press the Alarms button on the front of the HeartStart XL Configurable Resuscitation Protocols Mention AED Mode s flexibility to configure the HeartStart XL to match an institution s resuscitation protocols e Customize the XL for the number of shocks 1 4 in a series e Select the energy setting within a given shock series Set the CPR Pause interval from 1 3 minutes 41 AED Alarms Describe other AED Mode alarms as appropriate e The SMART Analysis algorithm generates AED alarms for a variety of conditions providing both audio and visual alerts when turned on See table below e When monitoring a patient the ST AR ECG Monitoring Algorithm generates ECG alarms in AED Mode if turned on Table6 AED Defibrillation Alarms Alarm Message Condition Type of Alarm Indication Pads Off With pads in use the connection High Priority between the device and patient Non Latching has been lost Alarm Shock Aborted A shock has been automatically aborted Abnormal Shock Abnormal shock dose delivered Dose Delivered due to marginal patient Red Alarm message with impedance alarm tone High Priority Pads Paddle Type The device detected a change in Latching Alarm Unknown paddles or pads type or the therapy cable identification is invalid Equipment Therapy is disabled due to an Disabled Therapy equipment failure
8. ECG acquired through pads is displayed e Previously set alarms and scheduled NBP measurements are indefinitely paused e Entry of patient information is disabled e Sync Lead Select and Alarm Pause buttons are inactive 37 Step 1 Turn the Therapy knob to AED When the XL is turned to AED it announces and displays the patient category and checks for proper pads cable and pads connection as follows If the you are prompted to pads cable is not properly Plug in Connector and Connect Pads Cable attached pads are not connected Insert connector firmly Apply pads to the pads cable pads are not applied to the patient or pads are not making proper contact with the patient s skin Practice Exercise 1 Have students turn the Therapy knob to AED without a pads cable and or pads connected to see what prompts are generated Additional points notes Step 2 Follow the Screen and Voice Prompts Next connect the pads and pads cable set the simulator to a shockable rhythm e g VF and complete the defibrillation process steps 2 and 3 Mention the following e Once an ECG is detected the XL automatically analyzes the patients heart rhythm and warns not to touch the patient e The AED Mode algorithm produces one of the following results Shock Advised No Shock Advised NSA or ECG cannot be analyzed Discuss these results in order Shock Advised If Shock Advise
9. NBP and the printer according to the device s internal clock Weekly Tests all daily components as well as various electrical Weekly after circuit tests and administers a 150J shock internally to midnight Sunday test the defibrillation circuitry morning according to the device s internal clock Test results are reported through the Automated Test Summary report the RFU indicator statements on the XL s display when the device is turned on Discuss the possible automated test summary results RFU indications what they mean and what action to take based on the result Pass Hourglass All tests passed None Fail DX_ Solid red X chirp Service required A critical device Turn the Therapy knob to Monitor A failure has been detected message indicating the problem is displayed Refer to the Troubleshooting chapter in the HeartStart XL Instructions For Use for further action Fail BW Blinking red X Service is not required but the battery is Charge the battery as soon as possible or low or malfunctioning replace it with a charged battery You can charge the battery in the HeartStart XL by connecting the device to AC power Fail C Hourglass An ECG cable failure has been Replace the ECG cable and rerun detected Operational Check Fail D Hourglass A non critical failure has been detected Turn the Therapy knob to Monitor A message indicating the problem is displayed
10. Red Alarm message with alarm tone 62 Review Have students answer the following questions individually or as a group Correct answers are in bold Consider having students correct FALSE statements to ensure comprehension 1 Which of the following statement s are TRUE related to pacing with the XL a The device requires a 3 or 5 Lead ECG cable and monitoring electrodes during demand mode pacing T b The device always delivers pace pulses in demand mode F In demand mode pace pulses are delivered when the patient s heart rate is lower than the selected pacing rate c The Pacing status bar indicates pacing mode status rate and output T d Ifyou exit Pacer Mode to defibrillate and then return to Pacer Mode the settings from the previous pacing session must be re entered F The settings remain in effect 2 Which ONE of the following steps should be performed before pacing is initiated in demand mode a Verify that a white pacing marker appears in front of each QRS complex b Verify that white R wave arrows appear above or on the ECG waveform c Increase pacer output until cardiac capture occurs d Decrease pacer output to the lowest level that still maintains capture 63 64 Instructor Guide 7 Pulse Oximetry Monitoring Lesson Introduction Introduce the lesson including the learning objectives estimated time to complete and applicable resources This lesson describes how
11. USB Drive to view all Event Summaries on an external USB drive f Exit the menu 4 Press Menu Select to perform the task Accessing Data on the USB Drive Provide further details and demonstration on using a USB drive as appropriate When you select the View USB Drive option the HeartStart XL checks that there is a compatible USB drive inserted into the USB port on top of the device If not the Internal Memory screen remains on the display If so the USB Drive screen is displayed You are only able to save Event Summaries to and delete from the USB drive Saving Data to the USB Drive You can save data to a USB drive from Data Management Mode Configuration Mode and after an Operational Check To save data 1 Confirm a USB drive is inserted into the USB port 90 2 Press the Export soft key or press the Menu Select button and select Export from the menu The HeartStart XL copies your data to the USB drive Deleting Event Summaries from the USB Drive To delete Event Summaries from the USB drive 1 Confirm you are in Data Management Mode Press the Menu Select button Using the Navigation buttons select View USB Drive and press Menu Select Once in the USB Drive screen press Menu Select 2 3 4 5 The USB Drive menu appears 6 Using the Navigation buttons select Erase Drive 7 Press Menu Select to erase all event summaries from the USB drive 8 HeartStart XL prompts you to confirm your selection Sel
12. and R Wave arrows appears only with each R wave c Press the Charge button d Press and hold the Shock button s 53 Instructor Guide 6 Noninvasive Pacing Lesson Introduction Introduce the lesson including the learning objectives estimated time to complete and applicable resources This lesson describes the noninvasive transcutaneous pacing option available with the HeartStart XL and how to perform pacing Objectives Upon completion of this lesson students should be able to 1 Identify pertinent information in Pacing View 2 Prepare a patient for pacing 3 Perform demand or fixed mode pacing Time 10 20 minutes Accessories Recommended e ECG simulator e Hands free cable e Multifunction electrode pads e 3 or 5 Lead monitoring electrodes Clinical Resources Noninvasive Pacing Application Note 55 Lesson Presentation Pacer Mode Introduce the Pacer Mode e Pacer Mode delivers monophasic pace pulses to the heart through multifunction electrode pads e The ECG strip and Event Summary are easily annotated using the Mark Event button in Pacer Mode e Waveforms ECG monitoring measurements and most alarms remain active and retain their settings when transitioning from Monitor or Manual Defibrillation Mode to Pacer Mode however the waveform in Wave Sector 3 is replaced by the pacing status bar e Pacing Mode can be used on both adult and infant child patients Use the Patient Category but
13. arrhythmia and heart rate alarms can be turned off The following tables 4 and 5 outline characteristics of the various HR and arrhythmia alarms and the figures 6 and 7 depict related alarm chains Table 4 HR Arrhythmia Physiological Alarms Alarm Message Condition Type of Alarm Indication Asystole No detectable beats for four seconds in the absence of V Fib VFib VTach A fibrillatory wave detected for four seconds VTach Consecutive PVCs and HR ree Connie nIG High Priority Red Alarm message with Extreme Brady Extreme Brady 10 bpm below Latching Alarm alarm tone HR low limit capped at 30 bpm Extreme Tachy Extreme Tachy 20 bpm above HR High limit up to 200 bpm adult 240 bpm infant child For higher rates the limit is equal to the HR High limit Pacer Not Capture No QRS following internal pacer pulse Medium Priority Pacer Not Pace No QRS or pacer internal pulse Latching Alarm detected PVC xx gt limit min The number of detected PVCs in Yellow Alarm message with detected rate gt limit a minute exceed the limit alarm tone HR High The HR exceeds the configured Coe ei HR Hish limi on Latching gh limit Alarm HR Low The HR is below the configured HR Low limit 29 Table 5 HR Arrhythmia Technical Alarms Alarm Message Condition Type of Alarm Indication Lead The multifunction electrode Pads pad paddles or leads used as the Paddles Off
14. clinical mode 4 Check that the patient category is appropriate for the patient and change if necessary Suggestion Have students complete the above steps during or after your demonstration Discuss SpO display characteristics e A displays in the Parameter Area while oxygen saturation is initially measured and an SpO value is calculated a value replaces and is updated continuously as the patient s oxygen saturation changes e Alarm limits display to the right of the value if SpO alarms are turned on alarms are on by default e The patients pulse rate derived from pulse oximetry is also displayed in Parameter Area e Alarm limits display to the right of the pulse rate value if pulse rate alarms are turned on alarms are off by default e The Alarms Off symbol displays if pulse rate alarms are turned off e The pleth wave is displayed in the configured Wave Sector between grid lines to indicate signal quality When the signal quality is good the pleth wave is auto scaled to the grid lines When the signal is poor the size of the wave is proportionally decreased and appears not to reach the grid lines Suggestion Ask students to point out characteristics instead of YOU stating them 68 Additional points notes SpO Alarms Mention the following SpO alarm characteristics e Physiological alarms sound if measurements fall outside the configured high or low SpO limits or below the
15. configured SpO Desat limit Technical alarms also exist for device and sensor issues e Once generated alarm messages appear in the SpO alarm status area above the SpO numeric e There are both audio and visual alarms e SpO alarms except Desat are all categorized as non latching alarms meaning they are automatically removed when their alarm condition no longer exists e Alarms are enabled unless turned off during use they remain disabled until re enabled e Ifan alarm condition occurs when alarms are disabled no alarm indication is given e SpO alarms are suppressed while an NBP measurement is in progress e The Desat alarm provides an additional limit setting below the low limit setting to notify you of potentially life threatening decreases in oxygen saturation If the SpO low limit is set below the preset Desat limit the Desat limit automatically adjusts to the low limit value if the SpO reading falls below the low limit the Desat limit alarm sounds Changing Alarm Limits Demonstrate how to change the SpO alarm limits 1 Press the Menu Select button Using the Navigation buttons select the Measurements Alarms menu and press Menu Select Select SPO and press Menu Select 2 3 4 Select S pO Limits and press Menu Select 5 Using the Navigation buttons select the new high limit value and press Menu Select 6 Select the new low limit value and press Menu Select 69 Enabling Disabling Alarms Demons
16. directly opposite each other All of the light from the emitter must pass through the patients tissue The sensor site should be free of vibration and excessive motion The sensor cable and connector should be positioned away from power cables to avoid electrical interference e You can monitor SpO in all HeartStart XL clinical modes however it needs to be configured to appear in AED Mode and does not display unless it is pulsatile e You can monitor SpO on both adult and infant child patients Use the Patient Category button to switch categories 66 Selecting a Sensor Discuss the criteria for selecting a sensor as needed e The most important factor when selecting a sensor is the position of the light emitting diodes in relation to the photodetector When a sensor is applied the diodes and the photodetector must be opposite each other Select a sensor appropriate for the patients 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 e Reusable sensors may be reused on different patients after they have been cleaned and disinfected See the manufacturer s instructions supplied with the sensor e Disposable sensors should be used only once and then discarded They may be relocated to another sensor site on the same patient but not be reused on different patients Applying the Sensor Discuss the cr
17. e Semi Automated External Defibrillation e Manual Defibrillation and Cardioversion e Noninvasive Pacing e Pulse Oximetry Monitoring e Noninvasive Blood Pressure Monitoring e Trending Data Management e Maintenance This is an optional parameter with the XL so ensure you teach only the lessons that match the organization s device configuration Preparation Prior to each class e Contact the organizations training coordinator to schedule training if applicable Suggest train the trainer sessions Make sure students understand that they must be free from other responsibilities at the scheduled time for the duration of the course A maximum of 10 students is recommended for each class e Talk to the training coordinator if applicable about which device functions students will be using on the job AED Mode Manual Mode Pacing SpO etc Use this information to select the appropriate lessons and determine your lesson presentation e Recommend to the training coordinator that students watch the latest version of the HeartStart XL User Training DVD or online video prior to the instructor based training if available Also suggest taking the HeartStart XL Web based User Training prior to or after the instructor based training e Determine the number of devices needed for training and make arrangements to have them set up at the scheduled time if possible Try not to exceed grouping 2 3 students per device e Determine w
18. increases or decreases numbers or values in a sequence may be held down to accelerate through the available choices e Print initiates a continuous print out of the primary ECG and the other selected waveforms either real time or with a 10 second delay depending on device configuration Pressing this button while printing is in progress stops the printing e Reports displays a menu from which you can print an Event Summary report or Trends Report Mark Event inserts a time stamped annotation in the Event Summary Report to note events as they occur e Alarms pauses all audible physiological and technical alarms for the configured time interval At the end of the pause interval each alarm returns to its previous setting On or Off Also returns alarms to their previous settings Defibrillation Controls Therapy knob enables AED or selects an energy for Manual Mode defibrillation or cardioversion e Charge button charges the defibrillator to the selected Manual Defibrillation energy setting Used only in Manual Mode Defibrillator charges automatically in AED Mode e Shock button delivers a shock through multifunction electrode pads or switchless internal paddles In AED Mode a 150J shock is delivered if the patient category is set to Adult 50J if set to Infant Child In Manual Mode the shock is delivered at the selected energy setting The button flashes when charged When external paddles or switched internal
19. is indicated by the fuel gauge on the battery top each light represents approximately 20 charge capacity and the battery power indicators displayed in the XL Status area Suggestion Discuss how and when batteries will be charged in students organizations to ensure charged batteries are available when needed Ask who will calibrate the batteries Recommend students check the Maintenance chapter of XL Instructions For Use for information about battery calibration storage and disposal Also stress caution when handling using and testing the batteries to prevent physical injury Additional points notes 102 Cleaning Instructions Discuss the following recommendations for cleaning the HeartStart XL and its associated accessories as appropriate e The HeartStart XL along with its accessories and supplies may not be autoclaved steam cleaned ultrasonically cleaned or immersed unless otherwise indicated in the HeartStart XL Instructions for Use that accompany the accessories and supplies e Do not use abrasive cleaners or strong solvents such as acetone or acetone based cleaners e Use a soft cloth to clean the display window to prevent scratching e Quaternary ammonium compounds such as Steris Coverage Plus NPD are not recommended for routine cleaning Do not clean electrical contacts or connectors with bleach e Disinfect the device as determined by your organization s policy to avoid long term damage to the
20. or 5 Lead ECG cable and monitoring electrodes as the ECG source while pace pulses are delivered through multifunction electrode pads however the pads cannot be used to monitor ECG and deliver paced pulses simultaneously e Pads is not an available choice for display in Wave Sector 1 The monitored lead is displayed in Wave Sector 1 Fixed mode e Asynchronous pace pulses are delivered at the selected rate e Use when motion artifact or other ECG noise makes R wave detection unreliable when monitoring electrodes are not available or at your clinical discretion e Use for pacing in the operating room in the presence of cautery tools Note the following The ECG derived from pads need not be displayed in a wave sector to deliver pacing therapy Additional points notes 57 Preparation Demonstrate preparation for pacing 1 If not pre connected connect the pads cable to the green Therapy port on the XL DEMONSTRATE 2 Prepare the patient s skin for good contact for the monitoring electrodes and multifunction electrode pads 3 Apply multifunction electrode pads to the patient as directed on the pads packaging or according to your organization s protocol 4 Connect the pads connector to the pads cable DEMONSTRATE 5 Ifpacing in demand mode apply monitoring electrodes and connect the ECG cable to the ECG port on the XL DEMONSTRATE the ECG cable connection Suggestion Have students complete steps
21. paddles are used once the XL is fully charged the shock is delivered by pressing the flashing Shock button s on the paddles NOTE Internal paddles should only be discussed with clinicians dealing with open chest defibrillation e Sync button toggles between asynchronous and synchronous cardioversion defibrillation Lights blue when Sync is active Soft Keys Perform functions presented as labels appearing immediately above the keys on the display Labels and related functions change based on the mode of operation Indicators Provide a visual display of device status Ready For Use RFU e A blinking black hourglass indicates Shock pacing and ECG functions are ready for use Sufficient battery power is available for device operation A blinking red X and a periodic audio chirp indicate either A low battery condition and the battery is not charging No battery is installed and device is running only on AC power A blinking red X without a periodic audio chirp indicates A low battery condition and the battery is charging The device can be used but its battery only operation time is limited e A solid red X and a periodic audio chirp indicate A critical failure that may prevent delivery of defibrillation therapy pacing or ECG acquisition e A solid red X without periodic audio chirps indicates No power is available or the device cannot turn on If after
22. parameter alarm limits change to the new patient category These changes are retained when you switch modes e For patients that are gt 25kg or gt 8 years old use Adult patient category e For patients lt 25kg or lt 8 years old use Infant Child patient category Table 7 Defibrillation Alarms Alarm Message Condition Type of Alarm Indication Pads Off With pads in use the connection High Priority between the device and patient Non Latching has been lost Alarm Shock Aborted A shock has been automatically aborted Abnormal Shock Abnormal shock dose delivered Dose Delivered due to marginal patient Red Alarm message with impedance alarm tone High Priority Pads Paddle Type The device detected a change in Latching Alarm Unknown paddles or pads type or the therapy cable identification is invalid Equipment Therapy is disabled due to an Disabled Therapy equipment failure Paddles Power A power overload has been Medium Priority Yellow Alarm message with Overload detected in the paddles Latching Alarm alarm tone 49 Additional points notes Synchronized Cardioversion Introduce synchronized cardioversion e Synch cardioversion delivers a biphasic pulse of current to the heart immediately following an R wave detected in the ECG waveform e It can be performed through either multifunction electrode pads or external paddles e You should monitor ECG through 3 or 5 Lead mo
23. power is supplied the indicator reverts to the blinking black hourglass symbol the device is ready for use External Power e A green AC Power Indicator indicates AC power is connected to the HeartStart XL even if the device is turned off e A green Battery Charging Indicator flashes when the battery is charging The indicator is solid green when the battery is fully charged and AC power is present The light is off if no battery is installed the battery is installed but not functioning properly or there is no AC power present The front panel also includes the printer door and latch speaker for audible alarms and AED voice prompts and the display covered in detail later Side Panels e The left panel has Ports for monitoring cables if ordered including ECG for 3 or 5 Lead patient cable pulse oximetry SpO2 and noninvasive blood pressure NBP e The right panel has A therapy port for paddles external or internal or a therapy cable with multifunction electrode pads Top Panel The top panel has a handle that includes the RFU indicator and a USB data port that lets you export data to a USB drive and import configurations and new software revisions from the drive Optional external adult infant paddles also reside here if present NOTE Be sure to demonstrate access to the infant paddles if available Back Panel The back panel has e A lithium ion battery compartments for batteries Compartmen
24. soft key a Use the upper portion of the soft key to increase the output until cardiac capture occurs Capture is indicated by the appearance of a QRS complex after each pacing marker b Use the lower portion of the soft key to decrease the output to the lowest level that still maintains capture 9 Assess the patient for a peripheral pulse To stop delivery of pace pulses press the Pause Pacing soft key Using the Navigation buttons select YeS to pause pacing select NO to continue pacing Once paused press the flashing Start Pacing soft key to resume pacing Also stop pacing by moving the Therapy knob off the Pacer position Note the following as appropriate e The ECG cable must be directly connected from the patient to the XL when in demand mode If a sync cable is used connect the cable using the ECG Out port on the XL and the ECG In port on the Philips bedside monitor e Ifyou are pacing with battery power and the Low Battery alarm sounds connect the device to external power to avoid interrupted pacing therapy e Pacing will not start if a pads connection or patient contact problem exists pace pulses will not be delivered if a monitoring electrodes connection problem exists A system message alerts you to either connection problem 59 Practice Exercise 1 Have students attach pads and electrodes to the XL and a simulator set the simulator to bradycardia and complete demand mode pacing Pose the following quest
25. source for Wave Sector 1 during Synchronized Cardioversion may be disconnected or not attached securely Cannot Analyze ECG data in Wave Sector 1 ECG cannot be analyzed an electrode used is disconnected not attached securely High Priority Non Latching Red Alarm message with The analyzing algorithm cannot Alarm alarm tone analyze the ECG signal ECG Equipment A malfunction has occurred in Malfunction the ECG hardware Pads ECG A malfunction has occurred in Equipment the Pads ECG hardware Malfunction Equipment Therapy is disabled due to an Disabled Therapy equipment failure Figure 6 Basic Mode Arrhythmia Alarm Priority Chain For Monitor Manual Defibrillation Synchronized Cardioversion and Pacing RED ALARMS High Priority Asystole V Fib VTach VTach carats Tachy ee Brady YELLOW ARRHYTHMIA ALARMS Medium Priority PVC Alarms Beat Detection Alarms Rate Alarms PVCs gt x Min Pacer Not Capture High Low HR Pacer Not Pacing 30 Figure 7 Cardiotach Mode Arrhythmia Alarm Priority Chain For AED Mode Only RED ALARMS High Priority Asystole V Fib VTach Baer Tachy ae Brady YELLOW ARRHYTHMIA ALARMS Medium Priority High Low HR Practice Exercise 4 Have students set the simulator and XL to produce a variety of latching and non latching conditions as appropriate Pose the following questions 1 What do you see and hear when a red alarm
26. the low battery condition less than 40 remaining should be charged as soon as possible Device Shutdown e Ifyou turn the XL to the Off position its screen displays a 10 second countdown before turning off e When no AC power is connected and the battery charge level drops to a critically low level the HeartStart XL can no longer guarantee correct operation and generates an Imminent Shutdown alarm You have approximately one minute to connect the device to AC power before it shuts down e If power is returned within 30 seconds and the Therapy knob is not in the Off position the HeartStart XL automatically turns back on user settings are restored to their values prior to the shutdown the HeartStart XL continues to use the current Event Summary and the duration of the shutdown is recorded in the Event Summary Note the following Pacing is not automatically restarted after the HeartStart XL recovers from a power loss You must restart pacing manually Ifthe HeartStart XL restarts after 30 seconds and the Therapy knob is not in the Off position all settings are returned to their configured values and anew Event Summary starts and you are notified that the previous Event Summary was closed Additional points notes Display View Introduce the display view characteristics of the XL starting with a brief look at the various operating modes Attach a simulator set to a normal sinus rhyth
27. to use the HeartStart XL to monitor Pulse Oximetry SpO Objectives Upon completion of this lesson students should be able to 1 Monitor SpO gt 2 Set SpO and pulse rate alarms Time 10 15 minutes Accessories Recommended e SpO sensor Clinical Resources e Philips Pulse Oximetry Application Note 65 Lesson Presentation Overview Discuss pulse oximetry in general and then respective to its use with the XL e Pulse oximetry is a noninvasive method of continuously measuring oxygen saturation SpO in arterial blood SpO reading indicates percentage of hemoglobin molecules in the arterial blood saturated with oxygen A pulse oximetry sensor sends light through patient tissue to a receiver on the other side of the sensor Light emitting diodes transmit red and infrared light through peripheral areas of the body such as a finger as illustrated in the figure below A photodetector positioned opposite the light emitting diodes compares the light absorption before and after pulsation The amount of light getting through reflects the blood flow in the aterioles This measurement of light absorption during pulsation is translated into an oxygen saturation percentage The SpO value and wave are displayed Figure 8 Pulse Oximetry Sensor e For accurate SpO measurements the following conditions must apply The patient must have perfusion in that extremity The light emitter and the photodetector must be
28. 1 4 and 5 using a simulator Additional points notes 58 Demand Mode Pacing Demonstrate how to pace in demand mode 1 Turn the Therapy knob to the Pacer position Note the following a The message Pacing Paused appears in the status bar indicating that the pacing function is enabled but pace pulses are not being delivered b Pacing is enabled in demand mode with the configured lead displayed in Wave Sector 1 used for R Wave detection If the configured lead is set to Pads Lead II or the first available monitoring lead is displayed automatically 2 Press the Lead Select button to select the best lead with an easily detectable R wave 3 Verify white R wave arrows appear above or on the ECG waveform with a single arrow for each R wave If no R wave arrows appear are incorrectly labeling beats or do not coincide with the R wave select another lead 4 Press the Rate soft key and use the upper portion of the soft key to increase the rate and the lower portion of the soft key to decrease the rate 5 If needed adjust the initial pacer output before you start pacing Press the Output soft key and use the upper portion of the soft key to increase the output and the lower portion of the soft key to decrease the output 6 Press the Start Pacing soft key The message Pacing appears in the pacing bar 7 Verify white pacing markers or white R wave arrows appear on the ECG waveform 8 Press the Output
29. 2 Have students attach a simulator and pads to the XL set the simulator to an abnormal rhythm e g AFIB and complete synchronized cardioversion Pose the following questions 1 What do you see on the display when you press the Sync button 2 How do you know if sync is active 3 How long do you need to press the Shock button 4 Once in Sync mode what happens when you turn the Therapy knob to a position other than a selected energy 5 What happens when you press the Sync button a second time 51 Additional points notes 52 Review Have students answer the following questions individually or as a group Correct answers are in bold 1 Identify the Code View elements in Manual Defibrillation enlarged Wave Sector 1 shock counter selected energy Wave Sector 2 2 What are the three basic steps for manual defibrillation using the XL a Turn the Therapy knob to a desired energy level b Press the Charge button c Press the Shock button 3 True and false The XL is ready to deliver a shock via pads when the XL sounds a continuous high pitched tone the charged value on the display matches the Therapy knob setting and the Shock button flashes T 4 What are the four basic steps for synchronized cardioversion using the XL a Turn the Therapy knob to the desired energy level and press the Sync button b Confirm that the Sync button lights up the Sync indicator is present on the XL display
30. Ifthe parameter source is the configured choice of a particular wave sector it is displayed in that wave sector when available Available waveforms include Paddles Pads I II III aVR aVL aVF V Pleth and a cascade wave from Wave Sector 1 e Can select an annotated ECG for Wave Sector 2 e Change displayed waveforms using the Menu Select button Suggestion Have students disconnect and reconnect parameter accessories to see how parameter and waveform areas are affected Ask students what they see when detaching and attaching an accessory cable or tubing Soft Key Labels e Correspond to soft key buttons e Change according to the current display view and function e Grey text labels indicate inactive soft keys e g Disarm in Manual Mode Suggestion Switch between modes to show different labels with students following along Menus e Provide controls and options specific to each XL function e Accessible through Menu Select and Navigation buttons e Used to adjust volume levels for alarms voice prompts QRS indicator select waveforms for display set alarms enter patient information generate reports etc e Menus have a wrap around scrolling feature once you hit the bottom of a menu it automatically wraps around to the top of the menu and continues scrolling e Press Menu Select button to activate selections select Exit to close menus without activating selections e Arrows at each end of a menu indicate additional
31. Passed If not confirm you did the test properly before taking the device out of use and calling for service Confirm the printed strip indicates the defibrillator test passed and the energy delivered is150J 15 135J to 165J If not confirm you did the test properly before taking the device out of use and calling for service reattach them Test complete 7 Detach test load plug from the Therapy cable so your device is ready for use when needed Do not leave the test load plug attached to the Therapy cable If you use preconnected pads Test complete Note the following If you use external paddles and have the Pacing option you should confirm pads functionality by performing an Operational Check Suggestion Ask students to complete a shock test as you demonstrate or upon completion of your demonstration 99 Operational Check Discuss Operational Check characteristics e Operational Checks supplement 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 notifies you if the battery needs calibration checks the SpO and NBP modules and printer e Operational Checks should be performed at regularly scheduled intervals to supplement the hourly daily and weekly tests the HeartStart XL performs automatically e Stress the following Disconnect the ECG leads set from the
32. Refer to the Troubleshooting chapter in the HeartStart XL Instructions For Use for further action Shift Check Introduce the shift check Hand out a copy of the XL Shift Checklist and consider covering all activities The American Heart Association AHA recommends completion of a checklist shift check at the beginning of each change in personnel to ensure that defibrillators are ready when needed The activities on this checklist 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 supports the AHA checklist recommendations and has shipped a Shift Checklist document with the XL Suggestion Ask students to complete a shift check using a Shift Checklist versus you telling them what they should do Additional points notes 98 Weekly Shock Test In addition to the shift check verify the ability to deliver defibrillation therapy once a week by performing either a Weekly Shock Test or an Operational Check Demonstrate how to perform a Weekly Shock Test on the XL If you are using pads with a test load ae If you are using pads with a test plug rn If you are using paddles 1 Connect the Therapy cable to defibrillator and test load to the end of the Therapy cable Connect the Therapy cable to defibrillator and test plug to the end of the Th
33. Units label Currently configured upper and lower alarm limits Message Area Displays key messages during an event according to the current operating mode Waveform and Display Soft Keys Area e Up to three wave sectors are available with a preconfigured waveform when powered on in Monitor Manual Defibrillation Pacing Mode two wave sectors only and AED one wave sector A dashed line in an ECG wave sector indicates that the waveform source is invalid e Wave sectors may contain a variety of information as appropriate to the parameter view and task currently being performed e The area also includes the number of shocks delivered and the selected energy Wave Sector 1 e Contains only an ECG waveform used by the arrhythmia heart rate derivation and AED analysis algorithms e Available waveforms include Paddles unavailable in AED Mode Pads I IL II aVR aVL aVF and V e Contains the lead label ECG calibration bar the auto gain indicator rhythm label and R wave arrows Calibration bar compares the actual ECG wave displayed to the selected size Auto gain indicator is displayed when auto scaling is active Rhythm label appears after ECG analysis algorithm analyzes the waveform 11 R wave arrows appear when the device is in Sync Mode Monitor Mode or Demand Mode Pacing Wave Sectors 2 amp 3 e Automatically populate when the parameter source s cable is connected to the HeartStart XL e
34. XA ss oD Time paa aso be bs Fle sas ss S Accessories ido odas aa Clinical Resources 45 Lesson Presentation 000a a a a a 4G Manual Mode a 46 Code View T aa a ee e e ee ee Se a e 4G Manual Defibrillation Depaco sa AAA a e oe AT Manual Defibrillation 00a a a a aaa 48 Synchronized Cardioversion 2 aa a a o 50 Synchronized Shock Delivery 2 2 so a a a SL Review oo e vide a A e wh 5B 6 Noninvasive Pacing 55 Lesson Introduction 2 a a 5 Objectives o ao s e as a h oge op oe e e DS Time he ee ee oe ee oe ee ee ee SOD Accessories ian eae ae a AA DD Clinical Resources SS Lesson Presentation 6 Pacer Mode 2 2 2 1 we ee ee 6 Pacing View See oe e Shee 2 4 oe Ba doa e a 256 Demand vs Fixed ode A A O 7 Preparation ie g a ae oo eee ae ae me Se oe Gt ar 8 Demand Mode Pace oa kee ee wee Ee ee O Fixed Mode Pacing SBA e et ae ee a ewe 4 amp amp ee gt oO Defibrillating During hae cH Re Ae eRe Se ass SSH Pacing Alarms oe ee E e Roe Bo Rac es ood HO bee ed ean ene al 7 Pulse Oximetry Monitoring 65 Lesson Introduction 65 OIECUNES i s ae eA BR Rw Oe Bee ae BG A OD Time Boe ee 2 ea eS SY Ee wwe Ee we ew 5165 Accessories ee ee S we Sa eo A Oy Sh A a e OD Clinical Resources 65 Lesson Presentation 66 OVELVIEW lt a we Bo ew ee foe or 41106 Selecting a Sensor y 2 or bw Ye ee Se Re 7 Applying the Senso
35. able to the XL DEMONSTRATE Additional points notes Manual Defibrillation Start with a brief demonstration of the manual defibrillation steps with a simulator set to VF VFib 1 Turn the Therapy knob to the desired energy setting 2 Press the Charge button on the XL or external paddle 3 Make sure no one is touching patient or anything connected to patient before shock call out loudly and clearly Stay Clear 4 Press the orange Shock button on the XL for pads and switchless internal paddles or the button s on both external paddles or switched internal paddle Mention the following Manual Mode characteristics during the demonstration e The energy range is 1 to 200 with 150 the recommended level for adult patients 50 is maximum energy for internal paddles e The 1 10 energy setting displays the Select Energy menu Use the Navigation buttons to increase or decrease the desired setting and the Menu Select button to complete your selection e The energy selection changes and a continuous low pitch charging tone sounds as the defibrillator charges until the desired energy level is reached Then a continuous high pitch charge done tone sounds at the end of the charge e For manual defibrillation of infant child patients follow your institution s policy AHA guidelines are 2 to 4 J kg first shock and 4 J kg per subsequent shocks e Selected energy can be increased or decreased at any time
36. along the cable The plug should be oriented such that it can easily be inserted into the cable while you have the the cable stowed Additional points notes 20 Review Have students answer the following questions individually or as a group Correct answers are in bold 1 Identify at least three controls or buttons on the XL involved with defibrillation Therapy knob Charge button Shock button Sync button 2 What does a solid red X and periodic audio chirp indicate on the RFU a No battery is present blinking red X and chirp b No power is available solid red X and no chirp c A low battery condition blinking red X and chirp d Defibrillation therapy may not be available 3 The arrhythmia algorithm uses the ECG in which Wave Sector for analysis a 1 b 2 a 3 d all of the above 4 True or false You can select the ECG lead for Wave Sector 2 using the Lead Select button False You can only use the Lead Select button to select the ECG lead for Wave Sector 1 5 True or false Silencing audio indications of active alarms can result in missed alarm conditions and inhibit indications of new alarm conditions T 21 22 Instructor Guide 3 ECG Monitoring Lesson Introduction Introduce the lesson including the learning objectives estimated time to complete and applicable resources This lesson describes the basic ECG monitoring functions of the HeartStart XL
37. apy port DEMONSTRATE 3 Remove the paddles from the paddle tray Verify there is no debris or residue including dried electrode gel on the paddle surfaces Clean if necessary DEMONSTRATE 4 Apply conductive matter as per your organizations protocol 5 Apply the paddles to the patient s bare chest using the anterior anterior placement or your organization s protocol 6 Use the Patient Contact Indicator PCI lights on the sternum paddle handle to adjust paddle pressure and placement to optimize patient contact Once proper contact is made the PCI turns green Suggestion In your demonstration include access to the infant paddles Have students complete steps 2 and 3 Quick Look Mention using external paddles for a quick look to assess a patient s ECG rhythm and then if necessary deliver therapy Use this procedure only when multifunction pads and monitoring electrodes are not immediately available To view a patient s ECG using external paddles 1 Make sure the device is turned on to Monitor 2 Apply external paddles to the patient s chest minimizing any unnecessary movement 3 After the HeartStart XL detects the ECG view the waveform on the display 47 Internal Paddles 1 Select the appropriate switched or switchless paddle electrode size 2 Ifusing switchless paddles connect the paddles to the M4740A Paddle Adapter Cable DEMONSTRATE 3 Connect the paddles cable or the paddle adapter c
38. artStart XL Instructions For Use Additional points notes 101 Battery Maintenance Discuss battery maintenance related activities and characteristics e Proper maintenance ensures the battery s charge state is accurately reported ensures there is sufficient charge and capacity to operate the XL ensures battery life is optimized begins upon receipt of a new battery and continues throughout the battery life Detailed information on battery care is available in the HeartStart XL Lithium Ion Battery Characteristics and Care application note provided with each XL Here are the battery maintenance activities and when they should be performed Perform a visual inspection As part of the Operational Check Charge the battery Upon receipt after use or if the message Low Battery is displayed Perform a calibration When the Operational Check test results state Calibration Required or every 6 months whichever comes first Store the battery When not in use for an extended period of time store the battery at a 20 40 charge Discard the battery When there are visual signs of damage or you receive a message to replace the battery e Life is approximately 3 years when properly cared for and depending on the frequency and duration of use e Charging is done in the HeartStart XL with AC power at temperatures between 0 C 32 F and 35 C 95 F e Charge status
39. assify beats i Pacer spike Above waveform where pacer spike was detected If the patient is both atrially and ventricularly paced the display shows two marks above the waveform aligned with the atrial and ventricular pacing Biventricular pace pulse Above waveform where the biventricular pace pulse was detected A Artifact noisy episode Above waveform where noise was detected I Inoperative condition e g there isa Above waveform at start of a technical alarm lead off every second of the alarm and at the end M _ Pause Missed beat No QRS Above waveform where condition detected To display an annotated ECG 1 Press Menu Select 2 Select Displayed Waves and press Menu Select 3 Select Wave 2 and press Menu Select 4 Select Annotated ECG and press Menu Select Practice Exercise 2 Have students display an annotated ECG Pose the following question 1 Where does the annotation first appear 27 Arrhythmia Learning Relearning Discuss and demonstrate how the XL learns and relearns automatically and manually e To ensure the ST AR Algorithm can properly analyze the patient s normal and or paced complexes XL automatically performs arrhythmia learning relearning when the Therapy knob is turned to Monitor Pacer AED or a selected energy when there is a change in the lead selection for Wave Sector 1 after the correction of a lead or pads off condition that has been active longer than 60 s
40. cable and confirm the HeartStart XL is not connected to a patient when performing an Operational Check Performing the Operational Check In preparation for the Operational Check cover the following points If you use external paddles Make sure the paddles are connected to the device paddles and the paddle tray are thoroughly clean and there is no debris or residue including all conductive material on the electrode surfaces of the paddles and tray Secure the paddles in the tray and confirm the Patient Contact Indicator PCI LEDs are not lit If the LEDs are lit adjust the paddles in the tray If the LEDs remain lit clean both the adult and infant child paddle electrode surfaces If you use multifunction electrode pads Make sure the pads therapy cable is plugged into the defibrillator test plug or test load Demonstrate how to perform the Operational Check 1 Confirm your device has a charged battery and an ECG cable connected but not connected to a patient or lead sets Turn the Therapy knob to Monitor Press the Menu Select button Using the Navigation buttons select Other and press Menu Select Select Operational Check and press Menu Select DN OY es Se o n Select Run Op Check and press Menu Select The message Leaving clinical mode Patient monitoring will be turned off appears 7 Select Yes if you wish to continue with an Operational Check Select NO to return to Monitor Mode Press Menu Select to confirm your ch
41. ck 3 What do you see and hear after delivering a shock 4 What happens when you press the Resume Analyzing soft key Additional points notes 39 No Shock Advised Set the simulator to a normal sinus rhythm NSR Tell students how their XL is configured for NSA Monitor or a pause time setting Discuss the following If a shockable rhythm is not detected the XL tells you No shock advised and you follow your institution s protocol for a No Shock Advised alert The device s next steps are determined by the No Shock Advised Action configuration choice If the configuration is set to Monitor The HeartStart XL monitors the ECG and automatically resumes analysis if a potentially shockable rhythm is detected You are periodically prompted to press CPR and to begin CPR if CPR is indicated Pause Time Analysis is suspended for the specific period which is defined by the NSA Action configuration choice You may attend to the patient and administer CPR if indicated At the end of the pause period the HeartStart XL resumes analyzing Practice Exercise 3 Have students set the simulator to NSR Consider both Monitor and Pause Time configuration choices Pose the following questions 1 What screen prompts do you see and voice prompts do you hear 2 What happens when you press the CPR soft key Additional points notes 40 ECG cannot be analyzed Discuss the following If ECG ca
42. ct 3 Select NBP and press Menu Select 4 Select Alarms On Alarms Off and press Menu Select 78 Note the following Alarms are enabled unless disabled once disabled alarms remain disabled until enabled Ifan alarm condition occurs when alarms are disabled no alarm indication is given Practice Exercise 2 Have students change NBP alarm limits and enable disable and respond to related alarms Pose the following questions 1 What happens when you change a limit Disable an alarm Respond to an alarm Additional points notes 79 Review Have students answer the following questions individually or as a group Correct answers are in bold 1 Which of the following items can display when monitoring NBP a Systolic and diastolic pressure b Alarm limits c Automatic measurement schedule d Time stamp 2 You can take manual measurements during an automatic measurement schedule T 3 NBP alarms are enabled unless disabled T 80 Instructor Guide 9 Trending Lesson Introduction Introduce the lesson including the learning objective and estimated time to complete This lesson describes the HeartStart XL Trending and related report data Objectives Upon completion of this lesson students should be able to 1 Identify data and functionality of the Trending Report Time 5 10 minutes Accessories Recommended e Simulator e Option monitoring cables to produce trending data e g S
43. ctrodes cable Maintenance Resources HeartStart XL Lithium Ion Battery Characteristics and Care Application Note e HeartStart XL Shift Checklist 95 Lesson Presentation Overview Describe the critical aspects associated with maintaining the XL e Providing power so automated tests can be run e Observing the Ready For Use RFU indicator e Performing a shift check weekly shock test and an operational check e Caring for batteries e Cleaning the device and accessories Note the following For detailed information on cleaning the XL and accessories device disposal and a listing of replacement supplies and accessories check out the HeartStart XL Instructions For Use Also XL service including calibration of the optional NBP module should only be performed by qualified service personnel in accordance with the HeartStart XL Service Manual Additional points notes 96 Automated Tests If appropriate to your audience describe the three automated tests XL runs to assess operational performance and alert users if a problem exists Point out that they occur at regularly scheduled intervals while the device is off Hourly Tests power supply charge level of the battery internal Every hour communication across all critical modules and components and also the device s internal temperature Daily Tests all hourly components as well as defibrillation Daily after midnight ECG pacing SpO
44. d the XL automatically charges to the preconfigured Joule setting default is 150J if the Adult patient category is selected or 50J if in the Infant Child category charges accompanied by voice screen prompts emits a steady high pitched tone sounds and flashes the orange Shock button Note the following You can disarm a fully charged device by turning the Therapy knob to Off or by pressing the CPR soft key Resume monitoring by turning the Therapy knob back to AED or by pressing the Resume Analyzing soft key 38 Additional points notes Step 3 Press the Orange Shock Button if Prompted Now complete the Shock step Note the following XL prompts Deliver shock now once charging is complete e No one should be touching patient or anything connected to patient Call out clearly and loudly Stay Clear Then press the orange Shock button The Attend to Patient Shock Delivered message confirms shock delivery e The shock counter gets updated XL prompts Begin CPR and commences analysis at the completion of the configured CPR Timer period or when you press the Resume Analyzing soft key Practice Exercise 2 Have students attach a simulator to the XL set it to a shockable rhythm e g VE and complete defibrillation with one shock Pose the following questions 1 What screen prompts do you see and voice prompts do you hear initially 2 How do you know the device is ready to deliver a sho
45. d as high priority alarms T c Any HR and arrhythmia alarm settings can be changed during an event F Only heart rate VTACH and PVC Rate Limit alarm settings may be changed d Menu Select AND Navigation buttons can acknowledge alarms T 33 Instructor Guide 4 Semi Automated External Defibrillation Lesson Introduction Introduce the lesson including the learning objectives estimated time to complete and applicable resources This lesson describes how to use AED Mode It highlights the AED display view and explains the steps and associated prompts that guide users through the defibrillation process Objectives Upon completion of this lesson students should be able to 1 Locate pertinent information in AED View 2 Prepare a patient for AED defibrillation 3 Defibrillate in AED Mode Time 10 15 minutes Accessories Recommended e ECG simulator e Hands free cable e Multifunction electrode pads Clinical Resources e SMART Analysis AED Algorithm Application Note 35 Lesson Presentation Overview Introduce the Semi Automated External Defibrillation AED Mode AED Mode guides you through standard treatment algorithms for cardiac arrest e It includes voice and screen prompts for defibrillation preparation ECG analysis and shock delivery e You can customize AED Mode configuration to meet your institution s or resuscitation team s needs The HeartStart XL uses Philips SMART Analysi
46. device Defibrillator Monitor Paddles Cables and Battery Hand wipe the exterior of the HeartStart XL external paddles therapy cables ECG cables and battery with a clean cloth Remove all soil tissue fluid etc and wipe thoroughly with a water dampened cloth before applying one of the following cleaning products e Isopropyl alcohol 70 solution in water e Mild soap and water e Chlorine bleach containing 6 sodium hypochlorite 3 solution in water e Cleaning solutions wipes with milder Isopropyl alcohol and chlorine bleach concentrations Printer Printhead If the printout has light or varying print density clean the printhead to remove any buildup of paper residue To clean the printhead 1 Push the printer door latch to open the door 2 Remove the roll of paper 3 Clean the printhead surface top and front of compartment with a cotton swab dipped in isopropyl alcohol 4 Replace the roll of paper and close the door Side Pouches After removing from the device clean the side pouches by hand with mild soap and water and air dry SpO Sensor and Cable Follow the manufacturer s instructions to clean the SpO sensor and cable 103 NBP Cuff Follow the manufacturers instructions to clean the cuff Additional points notes 104 Review Have students answer the following questions individually or as a group Correct answers are in bold Consider having students correct FALSE stat
47. dicators on the front panel are organized by function with the most general function buttons located along the left and bottom sides of the display defibrillation controls to the right of the display and soft keys immediately below the display Therapy knob Serves as the XL power switch and can be set to AED to enable AED Mode for semi automated external defibrillation Off Monitor to enable Monitor Mode for 3 or 5 Lead ECG monitoring or optional SpO and NBP monitoring Manual Defibrillation to enable Manual Mode or synchronized cardioversion at the selected energy setting Energy settings are 1 10 15 20 30 50 70 100 120 150 170 and 200 Joules Pacer optional to enable Pacer Mode for demand or fixed mode pacing General Function Buttons Control monitoring or non critical resuscitation activities Lead Select changes the ECG lead in Wave Sector 1 cycles through the available ECG waves changing the displayed wave and label The list of available ECG waves is based on the current lead set and device configuration including pads if the corresponding cable is connected to the XL Patient Category allows you to quickly change the patient category from adult 2 25kg or gt 8 years old to infant child lt 25kg or lt 8 years old and back again Menu Select displays the current menu or confirms a menu selection e Navigation displays the current menu moves to the next or previous item in a list
48. during charging or after charging is complete the defibrillator charges to the selected energy level automatically Press the Cancel Charge soft key if you need to disarm the XL e Monitoring alarms are indefinitely paused once energy is selected for defibrillation alarms are active once the Therapy knob is moved to Monitor an energy setting or Pacer or the Sync button is pressed 48 e Do not leave patients unattended when the XL is in Manual Defibrillation Mode with pads applied to the patient Suggestion Ask students to help point out characteristics instead of YOU stating them all Practice Exercise 1 Have students attach a simulator and parameter accessories if appropriate to the XL set the simulator to a shockable rhythm e g VF and complete manual defibrillation with 1 shock Try changing the energy level during and or after a charge Pose the following questions 1 What do you see and hear during a charge 2 How do you know the device is ready to deliver a shock 3 What do you see and hear after delivering a shock 4 How do you know if alarms are active 5 What happens when you press the Cancel Charge soft key Manual Defibrillation Alarms Discuss manual defibrillation alarms as appropriate Defibrillation alarms can be generated for the conditions shown in the following table There are both audio and visual alerts when activated by the Alarms button When you switch patient categories all
49. e is also space for additional points or notes to be made at a topical level depending on students needs Review the content presented by completing the review questions at the end of each lesson Note that answers to the questions are in bold e Periodically ask for questions to ensure comprehension e Periodically ask questions to engage students and increase learning effectiveness e Take breaks over the course of the training if time allows to ensure learning effectiveness e At the completion of a class use the Skills Checklist to test students on various functions and features of the XL Safety Considerations Some warnings and cautions specific to a particular feature of the HeartStart XL are provided in this guide however you and the students should reference the Instructions For Use for a complete description of all safety warnings and cautions Nonetheless reinforce the fact that the XL is a live device that can deliver biphasic therapy and should not be used by untrained personnel Operation by untrained personnel can result in injury or death Additional Documentation and Training Available documentation and training for the HeartStart XL includes e HeartStart XL Instructions for Use provides the most comprehensive review of XL functionality and operation for students It is available on the User Documentation CD ROM or may be purchased in hardcopy form e HeartStart XL Quick Reference Cards provide vis
50. e is large enough to be detected half the height the height of the QRS complex with no re polarization artifact Some unipolar pacemakers display pace pulses with re polarization tails which may be counted as QRSs in the event of cardiac arrest or other arrhythmias Choose a lead to minimize the size of re polarization tails e Adjusting the ECG wave size on the display does not affect the ECG signal which is used for arrhythmia analysis Monitor View Attach multifunction electrode pads or 3 or 5 Lead ECG set to the simulator and the XL attach parameter accessories as appropriate turn the Therapy knob to Monitor and discuss Monitor View characteristics e View three waves simultaneously while monitoring all current vital sign parameters e View heart rate parameter numeric values and active alarm settings e The default lead displays in Wave Sector 1 if not available or is of poor quality the device automatically searches for the ECG lead with the best quality and displays that new lead in Wave Sector 1 e The ECG lead appearing in Wave Sector 1 is used for single lead arrhythmia analysis A dashed line on your ECG display indicates an invalid ECG signal in the wave sector Suggestion Ask students to point out characteristics instead of YOU stating them Additional points notes Selecting the Waveform The ECG wave for Wave Sector 1 is selected through the Lead Select button or through the Displayed Waves m
51. econds e Initiate manual relearning if beat detection is not occurring or if beat classification is incorrect and results in a false alarm To initiate relearning manually 1 Press Menu Select 2 Select Measurements Alarms and press Menu Select 3 Select HR Arrhythmia and press Menu Select 4 Select Relearn Rhythm and press Menu Select The messages Learning ECG and Learning Rhythm appear in the rhythm status area of the display Practice Exercise 3 Have students complete the steps to initiate manual relearning as appropriate Additional points notes 28 AA E Heart Rate and Arrhythmia Alarms Introduction With the XL and a simulator produce a variety of alarms and discuss XL alarm characteristics and alarm messages as follows e Alarm conditions are detected by comparing ECG data to a set of pre defined criteria e Alarms are triggered by a rate exceeding a threshold an abnormal rhythm or an ectopic event e Alarm messages appear in the alarm status area located just above the HR numeric accompanied by both audible and visual alert signals When ECG alarms are off an ECG Alarms Off message appears above the HR numeric e There are both audio and visual alerts Note the following Because the ST AR Basic Arrhythmia Algorithm is the HeartStart XL s cardiotach source and is needed to generate heart rate and heart rate alarms the algorithm can never be disabled However if desired
52. ect Yes to erase all data on the drive Select NO to leave all data on the drive Printing Data Discuss the HeartStart XL s printing capability and associated procedures The HeartStart XL can print multiple pieces of information in both clinical and non clinical modes It can be configured to print automatically when certain events occur or you can initiate a print request at any time during an event Printing During a Patient Event The HeartStart XL allows you to print various data reports in a clinical mode during a patient event To print a strip during an event 1 Press the Print button To print an Event Summary for the current event 1 Press the Reports button 2 Using the Navigation buttons select Event Summary and press Menu Select Printing While in Data Management Mode To print an Event Summary contained in Internal Memory 1 Select the Event Summary you wish to print 2 Press the Menu Select button and select Print OR Press the Report button select Event Summary from the listing and press Menu Select to print To print a Trends Report related to an Event Summary contained in Internal Memory 1 Select the Event Summary that contains the Trends Report you wish to print 2 Press the Report button select Trends from the listing and press Menu Select 91 3 Using the Navigation buttons select the Trend Interval you want Press the Menu Select button to begin printing Suggestion Have students print a
53. ell as http incenter medical philips com default aspx alias incenter medical philips com pmspublic e If possible try to have one set of the latest version of the HeartStart XL Quick Reference Cards available with each XL used during the training Teaching Guidelines Consider the following guidelines for delivering the XL training e Have students identify themselves and their role and or responsibilities This information gives you a better idea of what lessons topics are suitable or most important for your audience e Provide a brief overview of the course structure and what is covered in each lesson e Advise students to read the HeartStart XL Instructions For Use for details on device features and information not covered in the classroom Device intended use Device and accessory set up Configuration Device disposal Troubleshooting Specifications and safety e For each lesson Introduce the learning objectives as listed in the guide advise on how much time it will take to complete a lesson and point out what related resources e g application notes are available to students for further education Present the lesson content Annotate and or highlight material in your copy of the guide to ensure you stress information that you feel is important to your students needs Note that instructor directions are in bold Look for suggestions that raise the level of student interaction Ther
54. ements to ensure comprehension 1 True of false As a result of the automated test a blinking red X on the RFU indicates a critical device failure and service is required False A solid red X and chirp indicates this result The blinking red X indicates a low or malfunctioning battery and no required service 2 Which of the following statement s are TRUE related to the Operational Check a It checks therapy and ECG cables charge and shock buttons and the ability to deliver therapy T b The ECG lead set should be connected to the ECG cable for the check F The ECG lead set should be disconnected c Ifyou use multifunction electrode pads the pads therapy cable should be plugged into the defibrillator test plug or test load T d The Therapy knob must be set to 170J and then 150J and then the check runs automatically T 3 Which of the following statement s are TRUE related to battery maintenance a Batteries should be inspected as part of the Operational Check T b Discard the battery when there are visual signs of damage T c Charge the battery in the XL connected to AC power T d Frequency and duration of use have a direct correlation on battery life T 4 Which of the following statement s are TRUE related to XL and accessory cleaning a You can clean the exterior of the XL and the battery with chlorine bleach T b You can clean the printer printhead surface with isopropyl alcohol T c You s
55. enu Demonstrate ECG wave selection for Wave Sectors 2 3 which is accomplished through the Displayed Waves menu l 2 3 4 5 Press the Menu Select button Select Displayed Waves and press Menu Select Select the appropriate wave sector and press Menu Select Select the desired wave type and press Menu Select If needed select the appropriate ECG wave size and press Menu Select Practice Exercise 1 Have students attach a simulator and 5 Lead ECG set to the XL set the simulator to a normal sinus rhythm and complete a variety of lead selections for Wave Sectors 2 and 3 as appropriate Try adding an SpO2 sensor cable if available to see how a wave sector is affected Pose the following questions 1 How do Wave 2 and or 3 menus differ from each other in terms of available leads From Wave 1 menu 2 What wave size s provide the clearest wave form 3 How does the display change when you add a parameter Additional points notes 26 Displaying an Annotated ECG Demonstrate how to display an annotated ECG e Beat labels appear in Wave Sector 2 based on the ST AR Algorithm analysis e Beat labels appear in Wave Sector 1 after a six second delay e Below are the various beat labels with related descriptions Table 3 Arrhythmia Beat Labels Label Description Where Displayed N Normal V Ventricular ectopic Pees Above QRS L Learning patients ECG Insufficient information to cl
56. erapy cable Make sure the paddles and the paddle tray are thoroughly clean and there is no debris or residue including all conductive material on the electrode surfaces of the paddles and tray Secure the paddles in the tray and confirm the Patient Contact Indicator PCI LEDs are not lit If the LEDs are lit adjust the paddles in the tray If the LEDs continue to light clean both the adult and infant paddle electrode surfaces Turn the device on by turning the Therapy knob to 150J Charge 3 Press the Charge button on the front panel If it becomes necessary to disarm the defibrillator press Cancel Press the Charge button on the paddles sitting in the tray If it becomes necessary to disarm the defibrillator press Cancel Charge 4 A strip prints if configured to do so If the strip does not print immediately press the Print button A strip prints if configured to do so If the strip does not print immediately press the Print button 5 Press the Shock button on the HeartStart XL Simultaneously press the Shock buttons located on the paddles 6 Confirm the printed strip indicates Test Passed and the energy delivered is150J 15 135J to 165J If not confirm you did the test properly before taking the device out of use and calling for service Confirm that you hear a Shock Cancelled audio message see a Shock Aborted alarm on the display and the printed strip indicates Test
57. fication number is date time stamped and stored in the device s internal memory Data related to the current event including vital sign parameters is available for viewing reporting and printing The current Event Summary or Trends Report may be printed by pressing the Reports button on the front of the HeartStart XL When the internal memory is full each additional summary causes one or more of the oldest event summaries to be overwritten Event Summaries stored in internal memory can be printed or copied to a USB flash drive in Data Management Mode for transfer to a data management application e g HeartStart Event Review Pro Additional points notes Event Summary 88 Discuss the characteristics of an Event Summary Suggestion Print out copies of an Event Summary ahead of class and share with students while discussing the characteristics A new Event Summary is initiated the first time one of the following occurs after the device is powered on The arrival of a valid ECG signal either through electrodes or pads paddles The arrival of valid SpO data The arrival of valid NBP data The Charge button is pressed The Mark Event button is pressed There is an 8 hour data limit per incident for an Event Summary When the limit is reached the HeartStart XL stops recording and displays a message The number of Event Summaries that can be stored is related to the duration of each individ
58. goes off A yellow alarm 2 Ifyou acknowledge the Alarm Pause message in response to an alarm will you be alerted if the patient s condition persists or recurs Additional points notes Setting Alarms Introduce setting alarms e Heart rate HR VIACH and PVC Rate Limit alarm settings for the current patient may be changed during an event Other HR and arrhythmia alarms may not be changed 31 Changing Alarm Limits Demonstrate the steps to change HR VIACH or PVC Rate limits 1 2 3 4 5 Press the Menu Select button Select Measurements Alarms and press Menu Select Select HR Arrhythmia and press Menu Select Select HR Limits or VTACH Limits or PVC Rate Limits and press Menu Select Select new values and press Menu Select Enabling Disabling Alarms Demonstrate the steps to enable or disable HR and arrhythmia alarms 1 2 3 4 Press Menu Select Select Measurements Alarms and press Menu Select Select HR Arrhythmia and press Menu Select Select Alarms On Alarms Off and press Menu Select Note the following Disabling alarms prevent all alarms associated with HR measurements from being annunciated If an alarm condition occurs no alarm indication will be given Responding to HR and Arrhythmia Alarms Discuss and demonstrate how to respond to alarms 1 2 The Audio Pause label appears when an alarm is announced Menu Select or Navigation buttons silence alarm audi
59. he measurement is complete Press the Stop NBP soft key to stop an NBP reading Suggestion Have students complete the above steps during or after your demonstration NBP Schedule Discuss the NBP schedule NBP measurements can be taken on a manual or predetermined automatic basis based on device configuration and patient s needs Manual There is no schedule for additional measurements One measurement is taken each time you press the Start NBP soft key Take additional measurements by pressing the Start NBP soft key e Automatic The measurement is repeated at the configured interval of 1 2 5 5 10 15 30 60 or 120 minutes from the time one measurement ends to the beginning of the next Additional manual measurements can be taken without affecting the automatic measurement schedule by pressing the Start NBP soft key The configured NBP measurements schedule may be changed during an event Demonstrate how to change the NBP schedule 1 Press the Menu Select button 2 Using the Navigation buttons select the Measurements Alarms menu and press Menu Select 3 Select NBP and press Menu Select 4 Select NBP Schedule and press Menu Select 5 Using the Navigation buttons select the desired interval and press Menu Select Practice Exercise 1 Have students complete manual and automatic NBP measurements including changing the NBP schedule Pose the following questions 1 What displays when you start a measurement Sto
60. ho in the organization makes decisions about configuration Arrange a time to discuss the organization s desired configuration and set up the devices used in training to that configuration Use the configuration worksheet available on the User Documentation CD ROM to help you complete the configuration procedure e Perform an Operational Check on each device to be used in training prior to training Refer to the latest version of the HeartStart XL Instructions For Use to complete the Op Check if necessary e Try to have fully charged batteries and external power available if needed e Try to have one simulator for each device to be used in training as well as extra batteries for the simulators e Try to have appropriate sets of parameter accessories cables etc for each device e Try to have one copy of the latest HeartStart XL User Training Workbook available for each student if possible The workbook contains a similar lesson flow to the guide but only a summary of the content Students can use the workbook to follow your instruction Be sure to familiarize yourself with the workbook before you teach It is available on the User Documentation CD ROM that comes with the XL e As appropriate and if possible try to have one copy of each application note available for each student either before during or after the training These notes relate to several lessons in the guide They can be found on the User Documentation CD ROM as w
61. hould not steam sterilize any XL accessories T d You can clean the side pouches by hand or machine with mild soap and water F You should not machine wash the pouches 105 106 453564091541 Edition 2 Koninklijke Philips Electronics N V Printed in the U S A Jan 2012
62. ions 1 What display changes do you see when completing each step i e turn on pacing set pacing status adjust pacer rate and output and stop pacing 2 How do you know when pace pulses are being delivered Additional points notes Fixed Mode Pacing Demonstrate how to pace in fixed mode 1 Turn the Therapy knob to Pacer Note the following The message Pacing Paused appears in the status block indicating that the pacing function is enabled though pace pulses are not being delivered 2 Change the pacer mode to Fixed using the Pacer Mode menu off the Main Menu 3 Press the Lead Select button to select the desired lead for viewing if one is available Note that the remaining steps are similar to demand mode pacing 4 Select the pacer rate by pressing the Rate soft key Use the upper portion of the soft key to increase the rate and the lower portion of the soft key to decrease the rate 5 Ifneeded adjust the initial pacer output Press the Output soft key Use the upper portion of the soft key to increase the output and the lower portion of the soft key to decrease the output Press Start Pacing Pacing appears in the Pacing Bar If you have an ECG waveform verify white pacing markers appear Verify the presence of a peripheral pulse and increase output if required Press the Output soft key a Use the upper portion of the soft key to increase the output until cardiac capture occurs If the ECG i
63. ips Medical Systems 3000 Minuteman Road Andover MA USA 01810 1099 978 687 1501 Authorized EU representative Philips Medizin Systeme B blingen GmbH Hewlett Packard Str 2 71034 B blingen Germany Canada EMC ICES 001 For the Declaration of Conformity Statement please see the Philips Healthcare 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 see the regulatory by Modality Then click to select Defibrillators and select the entry for Declaration of Conformity DoC Chemical Content REACH requires Philips Healthcare to provide chemical content information for Substances of Very High Concern SVHC if they are present above 0 1 of the product weight Components of within electric and electronic equipment may contain phthalates above the threshold e g bis 2 ethyl hexyl phthalate CAS nr 117 81 7 the REACH SVHC list is updated on a regular basis Therefore please refer to the following Philips REACH website for the most up to date information on products containing SVHC above the threshold http www philips com about sustainability reach page Warning Radio frequency RF interference coming from devices other than the HeartStart XL may degrade the performance of the device Electromagnetic compatibility with surrounding devices should be assessed prior to using the defibrillator monitor Use of su
64. iscuss pacing alarms as appropriate Pacing alarms can be generated for the conditions shown in the following table They appear as alarm messages in the Pacer Bar There are both audio and visual alerts When you switch patient categories all parameter alarm limits change to the new patient category These changes are retained when you switch modes e For patients that are 25kg or gt 8 years old use Adult patient category e For patients lt 25kg or lt 8 years old use Infant Child patient category Table 8 Pacing Alarms Pads Cable Off cable is disconnected from the device Equipment Disabled Therapy Therapy is disabled due to an equipment failure Pacing Stopped Leads Off Pacing has stopped The primary ECG lead has become invalid in Demand Mode pacing Pacer Output Low The actual delivered pace pulse current is less than the selected output Battery Low The battery s charge level is low Non Latching Alarm Alarm Message Condition Type of Alarm Indication Pacing Stopped Pacing has stopped There has Power been a power failure during Interrupted pacing Pacing Stopped Pacing has stopped A pads off Pads Off condition has been detected during pacing Pacing Stopped Pacing has stopped The Device Error HeartStart XL has detected an error which prevents delivery of pacing therapy Pacing Stopped Pacing has stopped The pads High Priority
65. iteria for applying a sensor as needed Follow the manufacturer s directions for applying and using the sensor making sure to observe any warnings or cautions For the best results Make sure the sensor is dry e Ifthe patient is moving secure the sensor cable loosely to the patient e Make sure the transducer is not too tight Too much pressure can cause venous pulsation or can impede the blood flow resulting in low readings e Keep power cables away from the sensor cable and connection e Avoid placing the sensor in an environment with bright lights If necessary cover the sensor with opaque material e Avoid placing the sensor on an extremity with an arterial catheter blood pressure cuff or intravenous infusion line e Failure to apply the sensor properly may reduce the accuracy of the SpO measurement e Inspect the sensor application site at least every two hours for changes in skin quality correct optical alignment and proper sensor application If skin quality is compromised change the sensor site Change the application site at least every four hours More frequent checking may be required due to an individual patients condition 67 Additional points notes Monitoring SpO Attach an SpO sensor cable to the XL the sensor to yourself and demonstrate preparation for monitor SpO 1 Connect the appropriate sensor cable to the XL 2 Apply the sensor to the patient 3 Turn the Therapy knob to a
66. le wrap to unsnap Figure 1 Cable Wrap Et 17 Accessory Storage System Demonstrate Accessory Storage System use as appropriate Filling the Accessory Pouches The XL accessory pouches hold your essential monitoring and defibrillation accessories Recommended accessory placement includes e Monitor side see Figure 2 e Connect the NBP tubing to the NBP port Coil the remaining tubing with the NBP cuff Place them in the outside slot of the double sided black bag e Connect the SpO cable to the SpO port Coil the remaining cable and finger sensor and place them in the inside slot of the double sided bag Connect the ECG cable to the ECG port Coil the remaining cable and leads and place it in the large pouch Therapy side see Figure 3 e Connect the Therapy Cable to the Therapy port Coil the remaining cable and place it in the large pouch e Ifyou are using the Pads Cable place pads in the inside slot of the double sided bag If you use paddles place gel pads or conductive material in the inside slot Figure 2 Monitor Side Accessories Figure 3 Therapy Side Accessories 18 Installing Paper Demonstrate printer paper installation as appropriate The XL uses 50 mm graphed paper for printing To install the paper 1 Open the printer door by pushing on the printer door latch see Figure 4 2 Ifthere is an empty or almost empty paper roll in the printer pull up on the roll to remove it
67. lect the letter b Repeat the process with the remaining letters of the last name Once you have completed spelling the last name select Done The XL stores the last name and prompts you to enter a first name 5 Repeat Step 4 to insert the patient s first name Selecting Done saves the first name and prompts you to enter a Patient ID 15 Note the following If you had previously entered the last name first name or patient ID the HeartStart XL remembers the information and populates the screen for you There are 18 letter limits for a first name and a last names 16 character limit for Patient ID 6 Ifyou are entering the Patient ID the Patient ID screen appears with a menu of letters and numbers to enter the ID 7 Ifyou are entering the patients sex the sex menu appears with Male and Female options to select 8 Ifyou are entering the patients internal paced status the Paced Menu appears with Yes and No options Select Yes if the patient is paced and No if they are not paced Note the following Set the patient s correct paced status in order to optimize ECG analysis Suggestion Have students enter some patient info just to get the feel for the procedure Continued Use Cover the characteristics associated with XL s continued use feature e Activated once in a clinical mode e Facilitates continued treatment of the same patient by retaining current settings and the patient record when the XL is turned off for les
68. letion of this lesson students should be able to 1 Locate pertinent information in Code View 2 Prepare a patient for asynchronous and synchronous defibrillation 3 Perform asynchronous and synchronous defibrillation Time 10 20 minutes Accessories Recommended ECG simulator Hands free cable Multifunction electrode pads External paddles Internal paddles include M4740A Paddle Adapter Cable for switchless paddles 3 or 5 Lead monitoring electrodes Clinical Resources SMART Biphasic Application Note 45 Lesson Presentation Manual Mode Introduce the Manual Defib Mode e The entire defibrillation process is under your control i e you assess the ECG decide if defibrillation or cardioversion is indicated select the appropriate energy setting charge the device and deliver the shock e Text messages are present voice prompts are not present e Defibrillation is always performed through paddles or pads e You can monitor the ECG using an alternate ECG source 3 or 5 Lead monitoring electrodes Code View Connect a simulator to the XL set it to a normal sinus rhythm NSR and turn the Therapy knob to the desired energy setting on the XL Introduce the unique Code View characteristics e Enlarged Wave Sector 1 For easier viewing e Shock Counter Displays the number of shocks for the current event including shocks delivered in AED Mode e Selected Energy Displays the currently selected ene
69. lly or as a group Correct answers are in bold Consider having students correct FALSE statements to ensure comprehension 1 Data from continuous measurements is the average of multiple measurements over the trend time period T 2 Which of the following statement s are TRUE regarding data displayed on the Trending Report a Ifyou scroll left to view older data the screen will update the newest data when you scroll right T b Questionable data is indicated by F Questionable data is indicated by a question mark just before the numeric value c Unavailable data is indicated by an empty space T d Multiple measurements taken during an interval is indicated by a after the timestamp T 85 Instructor Guide 10 Data Management Lesson Introduction Introduce the lesson including the learning objectives and estimated time to complete This lesson describes the data management features of the HeartStart XL Objectives Upon completion of this lesson students should be able to 1 Identify XL data management features 2 Identify characteristics associated with printing data 3 Mark patient events Time 5 15 minutes Accessories Recommended e USB drive 87 Lesson Presentation Overview Provide a summary of the HeartStart XL data management features The HeartStart XL automatically generates an Event Summary for each patient event Each Event Summary is assigned a unique event identi
70. m 3 or 5 Lead ECG set and all available parameter accessories to the XL Feel free to switch between modes to illustrate display view characteristics however consider spending most of your time in Monitor Mode as it provides the most comprehensive view You will cover details of the AED Manual Defibrillation and Pacing Mode views in related lessons later in this guide Suggestion Have students set up their devices with accessories they will use and turn them on to the operating mode s you cover to follow your display view introduction Ask students what they see in each display view you cover versus just telling them what they see Operating Modes The XL has four clinical modes of operation each with a customized display view function being performed Monitor Monitors ECG and optional parameters such as SpO and NBP and allows viewing Vitals Signs Trending data AED Analyzes ECG and if necessary performs semi automated external defibrillation Manual Defibrillation Performs asynchronous and synchronous defibrillation cardioversion Pacer Performs demand or fixed mode pacing Note The XL also has four non clinical modes Operational Check covered in detail later Data Management covered in detail later Configuration and Service Upon returning to a clinical mode from a non clinical mode all settings are re set to the device s default values Display Layout The XL display has four basic areas Stat
71. mber is related to the duration of each individual Event Summary d You should not enter Data Management Mode when monitoring a patient True or false You can only save Event Summaries to and delete from the USB drive T True or false The XL can print information in BOTH clinical and non clinical modes T True or false If configured the Mark Event button prints a 5 second ECG strip leading up to the marked event the event itself and the 5 seconds after the event F The Mark Event button can print a 10 second vs 5 second ECG strip leading up to the marked event 93 94 Instructor Guide 11 Maintenance Lesson Introduction Introduce the lesson including the learning objectives estimated time to complete and applicable resources This lesson describes how to care for the HeartStart XL including a brief look at battery maintenance and cleaning Objectives Upon completion of this lesson students should be able to 1 Identify the meaning of automated test summary results 2 Perform the necessary steps to complete an operational check on the XL 3 Identify the appropriate steps related to battery maintenance 4 Identify the appropriate steps to clean the XL and its associated accessories Time 10 20 minutes Accessories Recommended e ECG simulator or test plug e Hands free cable or Pads cable when appropriate e Multifunction electrode pads or external paddles e 3 or 5 Lead monitoring ele
72. nitoring electrodes when using external paddles e Perform synch cardioversion with multifunction electrode pads directly connected to the HeartStart XL and an ECG signal coming from a Philips bedside monitor into the HeartStart XL Preparation Discuss cardioversion preparation 1 Perform the tasks as described in the previous Manual Defibrillation Preparation topic 2 If monitoring through a 3 or 5 Lead ECG cable plug the cable into XL s ECG port and apply monitoring electrodes to the patient 3 Use the Lead Select button to select pads paddles or a lead from attached monitoring electrodes for Wave Sector 1 Suggestion Have students complete steps 2 using a simulator and 3 Additional points notes 50 Synchronized Shock Delivery Demonstrate synchronized cardioversion with a simulator set to AFib 1 Turn the Therapy knob to the desired energy setting and press the Sync button 2 Confirm that the Sync button lights up the Sync indicator is present on the XL display and R Wave arrows appears only with each R wave If arrows do not appear select another lead Press the Charge button on the XL or external paddle 4 Make sure no one is touching the patient or anything connected to the patient before delivering a shock call out loudly and clearly Stay Clear 5 Check your ECG and then re confirm your energy dose and waveform Press and hold the Shock button on the XL or orange butt
73. nnot be analyzed the XL alerts you and attempts to continue analyzing If artifact persists and device announces that the ECG can t be analyzed it enters a pause period and analysis is suspended Check for good pads contact with the patient s skin and minimize movement Analysis resumes automatically in 30 seconds or when you press the Resume Analyzing soft key ES A Exeron Deicnses Using AED Mode to Monitor Discuss AED Mode ability to monitor a patients ECG SpO and pulse and activate related alarms Demonstrate the following procedures and have students follow along as appropriate To monitor ECG in AED Mode and activate alarms 1 Turn the Therapy knob to AED The HeartStart XL announces the patient category currently set If not correct use the Patient Category button to select the appropriate patient category e For patients that are gt 25 kg or gt 8 years old use Adult patient category e For patients lt 25 kg or lt 8 years old use Infant Child patient category 2 After performing an initial ECG rhythm analysis if the rhythm is not shockable the HeartStart XL begins to monitor the patient 3 To activate ECG alarms in AED Mode press the Alarms button on the front of the HeartStart XL To monitor optional SpO and pulse in AED Mode and activate alarms 1 Once in AED Mode attach an SpO sensor to the patient 2 If you have the device configured to monitor SpO in AED Mode SpO monitoring begins once a
74. ny of the above data reports during or after your discussion Additional points notes Marking Events Discuss the characteristics associated with marking events e Use the Mark Event button to annotate the Event Summary and the ECG strip at the point in time the button is pressed e Ifso configured the Mark Event button prints a 10 second ECG strip leading up to the marked event the event itself and the 5 seconds after the event To mark an event 1 Press the Mark Event button The Events menu is displayed 2 Using the Navigation buttons select the desired event 3 Press the Menu Select button to mark the event If configured an ECG strip prints including the mark event symbol and the selected event label Suggestion Have students mark and print an event during or after your discussion 92 Review Have students answer the following questions individually or as a group Correct answers are in bold Consider having students correct FALSE statements to ensure comprehension 1 a Which of the following statement s are TRUE related to XL s data management Data management includes Event Summaries that have a unique event identification number and are automatically stored in internal memory New Event Summaries are initiated by the arrival of valid SpO or NBP data along with other activities The number of Event Summaries stored in memory is related to the USB drive space available F The nu
75. o The alarm reannunciates ifan alarm condition still exists beyond the configured alarm pause period or another alarm condition occurs Respond to an alarm as follows Acknowledge the alarm condition Adjust the limits using the New Limits menu Practice Exercise 5 Have students change HR VTACH or PVC Rate limits and enable disable and respond to alarms Pose the following questions What happens when you change a limit Disable an alarm Additional points notes 32 Review Have students answer the following questions individually or as a group Correct answers are in bold Consider having students correct FALSE statements to ensure comprehension 1 Identify the Monitoring View elements status area parameter area message area 3 wave sectors 2 True or false You can select the ECG wave for Wave Sectors 1 3 using the Lead Select button F The Lead Select button can only be used with Sector 1 True or false You can show an annotated ECG with beat labels appear in Wave Sector 2 T True or false The XL automatically performs arrhythmia learning relearning when there is a lead selection change for Wave Sector 1 or 2 F Automatic relearning takes places when there is a lead change for Wave Sector 1 only 5 Which of the following statement s are TRUE a All arrhythmia alarms are classified as latching alarms F Some are non latching b HR and arrhythmia technical alarms are classifie
76. oice 8 Ifyou selected Yes the HeartStart XL displays the Operational Check Screen and starts the Operational Check automatically Note the following If the HeartStart XL is not set up correctly the display prompts you to make the required changes for a successful Operational Check The Therapy knob must be set to 170J to begin Operational Check Once the check begins set the knob back to 150J when prompted to do so Operational Check runs automatically If you choose to proceed without setting up properly the Operational Check may fail 9 During the Operational Check when a response is required use the Navigation buttons to select your answer and the Menu Select button to confirm your choice As each test runs the name of the test appears highlighted on the display with the message In Progress 100 Note the following Once you have pressed the Sync button you can leave the HeartStart XL unattended as Operational Check completes its process If you cancel the Operational Check before it completes all tasks there is no record of the check in the Operational Check Summary 10 After the automated part of Operational Check concludes an Operational Check Report is printed if configured to do so Suggestion Have students complete the Operational Check steps with you or after you have demonstrated the procedure Advise students that further Operational Check details are described in the Operational and Shift Checks chapter of the He
77. olic and mean pressure measurement schedule manual or automatic intervals and a time stamp are displayed in the Parameter Area e Ifenabled NBP alarm limits appear next to the NBP value and the alarm source systolic diastolic or mean is displayed above the limits e Ifalarms are disabled the Alarms Off symbol replaces the limits e Initial cuff inflation pressure 160 mmHg 21kPa adult or 120 mmHg 16kPa infant child for first time measurement next pressure 30mmHg 4 kPa above systolic measurement with a minimum inflation pressure of 120 mmHg 16kPa e If the systolic pressure is higher than the inflation pressure the inflation pressure is automatically increased by 30mmH 4 kPa and another measurement is attempted Additional points notes 76 Measuring NBP Demonstrate the steps to measure NBP 1 Select the appropriately sized cuff for the patient 2 Attach the cuff to the NBP tubing making sure that air can pass through the tubing and the tubing is not squeezed or kinked 3 Insert the NBP tubing into the NBP port on the XL 4 Apply the blood pressure cuff to the patient s arm or leg Note the following Do not perform NBP monitoring on patients whose upper arm circumference is less than 13 cm Doing so may result in inaccurate measurements 5 Place the limb used for taking the measurement at the same level as the patient s heart 6 Press the Start NBP soft key NBP values display when t
78. on Have students enter Data Management Mode during or after your demonstration and follow along the subsequent topics 89 Internal Memory Describe the contents of the Internal Memory screen when first entering Data Management Mode D Indicates if the event data record contains any patient information which could uniquely identify the individual Y indicates there is N indicates there isn t Date and Time Date and time the event began e Elapsed Event duration e Paced Total paced time for the event Event ID Unique ID for the event Shocks Total number of shocks delivered during the event Event Storage Used Free Amount of space used available in internal memory Number of Events Stored Number of events currently stored in internal memory Internal Memory Menu Access and describe the options of the Data Management Internal Memory menu Suggestion Have students access the menu during your demonstration and follow along To use the Data Management Internal Memory menu 1 Confirm you are in Data Management Mode 2 Press the Menu Select button 3 Using the Navigation buttons select your desired operation You can a Print the currently selected Event Summary b Export the currently selected Event Summary to the USB drive c Export All Event Summaries currently in Internal Memory to the USB drive d Remove All Patient Info to de identify all Event Summaries in Internal Memory e View
79. onitoring enabled Turns SpO monitoring on or off e Background Analysis Available if your device is configured for No Shock Advised NSA Monitoring and you have activated NSA Pause Press it to begin NSA monitoring Pressing the Menu Select button brings up the main menu for AED Mode Menu options allow you to adjust voice prompt and alarm volumes and modify ECG wave size and alarm limits Suggestion Ask students to point out characteristics instead of YOU stating them 36 Additional points notes Preparation Discuss the AED defibrillation preparation 1 Confirm the patients condition i e unresponsive not breathing and or pulseless 2 Prepare the patient s chest Wipe moisture away and if necessary clip or shave excessive chest hair 3 Check the multifunction electrode pads package expiration date and for damage 4 Ifnot pre connected connect the pads cable into the green Therapy port DEMONSTRATE 5 If the pads are not expired and package is undamaged connect the pads to the pads cable DEMONSTRATE 6 Apply multifunction electrode pads to the patient as directed on the pads package or according to your organization s protocol Suggestion Have students complete steps 4 and 5 AED Mode Demonstrate the AED defibrillation steps with the simulator and mention the following AED Mode characteristics during the demonstration e Device capabilities are limited to those essential to AED Only the
80. ons on both paddles The shock will be delivered when the next R wave is detected Mention the following cardioversion characteristics during the demonstration e The selected energy can be changed at any time during charging or after charging is complete the XL charges to the selected energy level automatically Wait until the charge reaches the selected energy level before proceeding Press Cancel Charge to disarm the defibrillator Also if the Shock button is not pressed within the time period specified in the Time to Auto Disarm configuration setting the XL disarms automatically e This point is important to emphasize Continue to hold the Shock button or the paddle shock buttons until the shock is delivered so the defibrillator shocks the next detected R wave e To deliver additional synchronized shocks confirm the Sync function is still enabled the Sync button is lit the Sync indicator is present and the R Wave arrows are still visible Then repeat above steps 3 5 If Sync is off complete steps 1 5 e The Sync function can be configured to either be enabled or disabled after each shock is delivered e Press the Sync button again to turn off the Sync function e This point is important to emphasize REMEMBER to turn Sync off if manual defibrillation is required e Cardioversion alarms are the same as listed on the earlier Defibrillation Alarms table excluding the Paddles Power Overload condition Practice Exercise
81. options available in that direction of the menu Scroll down or up to reveal the remaining options using the Navigation buttons e Depending upon the situation options unavailable for use are grayed out e Arrows to the left of numeric values e g parameter high and low alarm limits indicate the ability to increase or decrease the values using the Navigation buttons Suggestion Direct students through different menu options to illustrate various menu functionality e g changing waveform for a sector the patient s age alarm limits etc 12 Additional points notes Alarms Discuss the various types of alarms the HeartStart XL has to indicate changes in patient condition or device cable conditions that may require attention as well as related notifications and appropriate response The HeartStart XL has two alarm types e Physiological Detected while in a clinical mode resulting from a patient related parameter being monitored Not detected in non clinical modes e Technical Results from a equipment related issue displayed in non clinical modes All alarms are either latching or non latching and fall into one of three priority categories See table below Table 1 Alarm Types Alarm Type Condition High Priority Example VFIB VTACH An immediate response is required A life threatening alarm condition is present A red alarm message is displayed and an alarm tone sounds Medium P
82. p a measurement 2 How does the display differ between a manual and automatic measurement 77 Additional points notes NBP Alarms Mention the following NBP alarm characteristics e A physiological alarm sounds when a measurement systolic diastolic or mean falls outside the configured high or low limits Technical alarms occur with cuff and device issues NBP alarms are all categorized as non latching alarms meaning they are automatically removed when their alarm condition no longer exists e The alarm source and limits can be changed during use e Alarm messages appear in the NBP alarm status area above the NBP numeric e There are both audio and visual alerts Changing NBP Alarm and Source Limits Demonstrate how to change the NBP alarm source and or limits 1 Press the Menu Select button Using the Navigation buttons select the Measurements Alarms menu and press Menu Select Select NBP and press Menu Select Select NBP Limits and press Menu Select Select the desired source for the alarm Systolic Diastolic or Mean and press Menu Select Using the Navigation buttons increase or decrease the high limit value and press Menu Select a Sy E S Oa Set the new low limit value and press Menu Select Enabling Disabling NBP Alarms Demonstrate how to enable disable NBP alarms 1 Press the Menu Select button 2 Using the Navigation buttons select Measurements Alarms and press Menu Sele
83. pO and or NBP NOTE It is recommended that you have the monitor on for at least 10 15 minutes to create enough trending data for instructional purposes 81 Lesson Presentation Overview Introduce the HeartStart XL s Trending e The XL lets you view and print numeric vital sign trending for the current incident in Monitor Mode Trending data are automatically acquired if parameters are on e When viewing trending data the Trending Report is displayed in the HeartStart XL s lower two wave sectors and takes over the soft key functions Trending data displayed for heart rate SpO and pulse are the average of multiple measurements over the trend time period Trending data for NBP appear with the timestamp of the measurement Viewing Trending Data Demonstrate how to view trending data and discuss Trending Report data and related functionality Set the trend interval to 1 minute to display a more populated report Suggestion Have students complete the steps below and follow your discussion while viewing the Trending Report 1 Turn the Therapy Knob to Monitor 2 Press the Menu Select button 3 Using the Navigation buttons select Trends and press Menu Select The Trending Report displays covering the bottom two wave sectors and the existing soft key functions The report includes Report date which is determined by the earliest time displayed in the table Parameter vital signs monitored by the XL d
84. pplies 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 BY OR ON THE ORDER OF A PHYSICIAN This Instructor Guide should be used primarily for HeartStart XL instructor based end user training along with the 453564091531 User Training Workbook It contains the following conventions Voice represents voice prompt messages Text represents messages that appear on the display Text represents bolded directions to the instructor that appear in the guide and options that appear on HeartStart XL menus Soft key represents soft key labels that appear on the display above the button to which they correspond Table of Contents 1 Introduction 1 Instruction Time 1 Guide Structure 1 Preparation a AAA AAA A A Teaching Guidelines TEE ee ee ee ee ee Safety Considerations 3 Additional Documentation and einige 4 2 Getting Acquainted 5 Lesson Introduction 5 Objectives 5 Time E A Se oe ee ee ee FD Accessories same Rt aoe b ds Se eee ae SD Lesson Presentation 6 Overview 6 Basic Orientation eee Bee eee Ee Eee eee EO Display View 2 4 2 2 SG ek ee RE eS eS Ew Ss Ee o 1 Alarms eee g ss ee ee a a oe a e S Entering Patient da a PS etAte teste eo ee ee OO Continued Use 2 2 2 eee 16 Installing the Cable Wraps 2 2 2 ee IT Accessory Storage System o n ee ee ee 18 Filling the Acces
85. r Kg oe oe Bow A oe Be we a oe ow 7 Monitoring SpO 2 2 2 ee ee 68 SpO Alarms o a eae HR ee Se ee me a RD Pulse Rate Alarms E oh ee e al Disabling the SpO4 renee eee ih ae bok e oh Eo ea R vieWw oe n c e g gmo a A oa og o a a g oe y oe a oaa 7B 8 Noninvasive Blood Pressure Monitoring 75 Lesson Introduction a ee ee ee FS Objectives 26 bb be ee Ee Pee ES ER ee Go BD Time eae nee SB se ee eo ee eee oe Accessories oe ee aane a a ee Ae ee G Clinical Resources TS Lesson Presentation 76 OWERVIEWS ia o a a a a a a a O Measuring NBP s a mo sa e a por wow opoe w w soos oe ZF NBP Alarms o s s soca ee ee kanoa 78 Review coace m acana os aoa io da e a aa a e a a a a e 80 9 Trending 81 Lesson Introduction 43 6k thee a aaa a B Objectives cs Gee ses sa assess BI Time Se ae a A we e ed Accessories Beanna E AAA O Lesson Presentation 2 2 esa osos ss a Ae BA Overview Be ae pg WE AA OL Viewing Trending Daa sunu Me ee ae SR ee es 82 Trending Report Intervals side he he Oe Ek eh ea Navigating Around the Trending Resort ie hae masas 4 BB Printing the Trending Report 2 a a ee ee 83 Closing the Trending Report 2 2 2 ee ee ee 83 REVIEW RR 10 Data Management 87 Lesson Introduction 87 Objectives s e y s s s Goa ir bee ee ss e Times a A E ap we oe 287 Accessories Recommended 2 ee ee 87 Lesson Presentation 88 Overview
86. rements Alarms menu and press Menu Select Select Pulse and press Menu Select 2 3 4 Select Pulse Limits and press Menu Select 5 Using the Navigation buttons select the new high limit value and press Menu Select 6 Select the new low limit value and press Menu Select Enabling Disabling Pulse Rate Alarms Demonstrate how to enable pulse rate alarms l Press the Menu Select button 2 Using the Navigation buttons select the Measurements Alarms menu and press Menu Select 3 Select Pulse and press Menu Select 4 Select Alarms On Alarms Off and press Menu Select Practice Exercise 2 Have students change pulse rate limits and enable disable and respond to related alarms Pose the following questions 1 What happens when you change a limit Disable an alarm Respond to an alarm Disabling the SpO Monitoring Function Demonstrate how to disable the SpO monitoring function Disconnect the sensor cable from the SpO port The message p02 Unplugged Turn off Sp04 appears Select YeS and press the Menu Select button Should the sensor cable be disconnected accidentally the message S902 Unplugged Turn off Sp04 appears Select NO and press Menu Select Then secure the connection to begin monitoring again 71 Additional points notes 72 Review Have students answer the following questions individually or as a group Correct answers are in bold 1 True or false You can monitor SpO in all XL modes Monitor
87. rgy e Wave Sector 2 Displays the currently configured waveform If Cascade is selected depending on the ECG size parts of the wave may be clipped due to the smaller sector size e Patient Category Displays the current Patient Category Triggers specific alarm limits and AED energy settings for defibrillation Suggestion Ask students to point out characteristics instead of YOU stating them Additional points notes 46 Manual Defibrillation Preparation Discuss defibrillation preparation using multifunction electrode pads external paddles and or internal paddles Multifunction electrode pads 1 Confirm the patients condition i e unresponsive not breathing and or pulseless 2 Prepare the patient s chest Wipe moisture away and if necessary clip or shave excessive chest hair 3 Check the multifunction electrode pads package expiration date and for damage 4 If not pre connected connect the pads cable into the green Therapy port DEMONSTRATE 5 If the pads are not expired and package is undamaged connect the pads to the pads cable DEMONSTRATE 6 Apply multifunction electrode pads to the patient as directed on the pads package or according to your organization s protocol Suggestion Have students complete steps 4 and 5 External paddles 1 Confirm the patients condition i e unresponsive not breathing and or pulseless 2 If not pre connected insert the paddles cable into the green Ther
88. riority Example Prompt response is required A non life threatening alarm condition exists A yellow alarm message is displayed and an alarm tone sounds Low Priority Example Awareness is required A non life threatening alarm condition exists A Printer Door Open_ cyan alarm message is displayed and an alarm tone sounds Latching The alarm remains active regardless if the alarm condition continues to exist or not A latching alarm is not removed until it is either acknowledged or a higher priority alarm condition occurs Non Latching The HeartStart XL automatically removes the alarm when the alarm condition no longer exists 13 Note the following Given the possibility of multiple alarm conditions at the same time the XL prioritizes and categorizes alarms so the highest priority alarm condition is announced If multiple same parameter same priority alarms occur all alarms are displayed one at a time Clinical Mode Alarm Notification When in a clinical mode the HeartStart XL can be configured to react differently when an alarm condition occurs as seen in the table below Table2 Alarm Notification Types Notification Indication on Display Indication Status Alarms On None Both visual and audio indications are on Audio Pause timeframe which is configurable When the pause timeframe is complete both audio and visual Pause Alarm Audio A Only visual indications are on for the dura
89. rmation on use of the device Objectives Upon completion of this lesson students should be able to 1 Identify the physical features controls and indicators of the XL 2 Identify the purpose of various controls and indicators 3 Identify the display view characteristics associated with XL s operating modes 4 Identify the correct procedure for responding to an alarm Time 10 20 minutes Accessories Recommended e ECG simulator e Hands free cable e Multifunction electrode pads e 3 or 5 Lead monitoring ECG e Optional SpO and NBP parameter accessories Lesson Presentation Overview Describe the high level features of the XL It is designed to meet the advance requirements of hospital code teams nurses physicians and biomedical engineers It has controls indicators and menus organized to facilitate ease of use It displays information specific to the current task Basic Orientation Introduce the physical features controls and indicators on the front left right top and back panels of the XL Also discuss the lithium ion battery Suggestion Have students identify the features controls and indicators on their devices and the battery while following your orientation NOTE Consider not turning on the XL during your initial orientation so students focus on each panel and NOT the display Then turn on the device to illustrate display output of features and controls Front Panel Controls and in
90. s algorithm to make a shock decision in AED Mode The algorithm makes aggressive shock decisions concerning ventricular fibrillation e AED Mode can be used on both adult and infant child patients e You can also monitor a patient s ECG SpO2 and pulse in AED Mode AED View Connect a simulator to the XL set it to normal sinus rhythm NSR and turn the Therapy knob to AED Then introduce the unique AED View characteristics including soft keys AED Message Area Displays important messages for the user while in AED Mode Enlarged Wave Sector 1 waveform e Shock Counter Displays the number of shocks for the current event including shocks delivered in Manual Defibrillation Mode e Configured Energy Displays the configured energy for the current patient category e Wave Sector 2 Displays the SpO waveform if your device has the option and is configured to do so or the AED Pause CPR Progress Bar e AED Pause CPR Progress Bar When in use replaces the wave in Wave Sector 2 and tracks the progress of the analysis pause and CPR periods e Patient Category Displays the current Patient Category The patient category triggers specific alarm limits and AED energy settings for defibrillation AED Soft Keys e CPR initiates the configured pause period to perform CPR e Resume Analyzing initiates the AED analysis algorithm to resume or restart analysis e SpO On Off Available if you have the SpO option installed and AED SpO m
91. s on the display capture is indicated by the appearance of a QRS complex after each pacing marker mo ND b Use the lower portion of the soft key to decrease the output to the lowest level that still maintains capture 60 10 Assess the patient for a peripheral pulse To pause or stop pacing Press Pause Pacing or Move the Therapy knob off the Pacer position Practice Exercise 2 Have students attach pads and electrodes to the XL and a simulator set the simulator to bradycardia or to a sinus rhythm of HR 40 and complete fixed mode pacing Pose the following questions 1 What display changes do you see when completing each step i e turn on pacing set pacing status adjust pacer rate and output and stop pacing 2 How do you know when pace pulses are being delivered Additional points notes Defibrillating During Pacing Discuss how switching to Manual or AED Mode affects pacing e Once the Therapy knob is moved from Pacer to a Manual Defibrillation energy setting or AED pacing is stopped To resume pacing after defibrillation repeat the pacing procedure 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 e Turn off pacing before defibrillating with a second defibrillator to prevent damage to the XL 61 Additional points notes Pacing Alarms D
92. s than 10 seconds or switching between modes e g from Monitor to AED e Ifyou turn the XL back on within 10 seconds it retains the most recent Alarm settings and conditions Wave Sector settings Event timing Volume settings SpO value NBP value and measurement frequency Vital signs trending data Synchronized cardioversion settings Pacing settings Event Summary Note the following The Sync feature remains active if the XL is turned off for less than 10 seconds However Sync is disabled when AED Mode is activated and must be turned back on upon returning to Manual Defibrillation Mode Also the feature will not function if both battery and external AC power are removed from the device even briefly Suggestion Have students shut off the XL and turn it back on within 10 seconds Then ask them to state some of the settings that are retained Consider having students complete this task before giving them the above list of retained settings 16 Additional points notes Installing the Cable Wraps Demonstrate cable wrap installation as appropriate See Figure 1 The XL comes with cable wraps to assist in cable management To attach the cable wraps to the device 1 Snap the cable wrap into the Cable Management Connector snap on the back of the device 2 Loop your cable around the cable wrap and snap into place 3 To remove the cable tug on the loose end of the cab
93. sory Pouches 2 2 3 2 we ko 4 0 4 18 Installing Pap r o e gw 2 4 4 4 BY EE Aaa Test Plug amp Test Load 6 bp bw a ke we we eee eH 20 Review 6 ios ae we a ew a we Ee ee ew l 3 ECG Monitoring 23 Lesson Introduction 23 Objectives ss ss ass A Time She amp be eRe Se Ee Ee Za Accessories pena oem eee Be a fe Clinical Resources 23 Lesson Presentation 24 Ouen 24 Preparation o as s e s m amp ea E eo bw a 24 Monitor View Soe wh ow Sak Suess a FY Sou e 4 229 Displaying an cae ECG DEERE A ew aay Arrhythmia Learning Relearning a ee ee eee 28 iii Heart Rate and Arrhythmia Alarms ee ee ee 29 REVIEW ae we be Ree Be SRA eo eB ewe EE Se ee Ee aa 4 Semi Automated External Defibrillation 35 Lesson Introduction 2 2 1 eee ee BS Objectives 3 eke ekRSaRBeBEa Re ERE DEE oS 4H 35 Time Sb oe s amp Y amp eb ee e ba a amp a 4535 Accessories dd E ee ee ee OD Clinical Resources 2 2 ee BS Lesson Presentation 2 e 36 Overview o o sos 36 AED Vier 36 Preparation w oe s 6 om a a E ss O AED Mode sa e A ee e eS as ot es wo a a Using AED Mode to Monitor ee ee as A a e el Configurable Resuscitation Protocols ew wee 4 AED Alarms 2 1 ee ee 42 REVIEWS 2 5 2 BS CER EH ERS REARS ER EES eB 5 Manual Defibrillation and Cardioversion 45 Lesson Introduction 45 Objectives 2 bu eb aia dass
94. t B also used to connect an AC power module NOTE Be sure to demonstrate how to install and remove the battery e An AC power connection e An inactive LAN port e An ECG Out jack to connect to an external monitor Lithium lon Battery e Has a fuel gauge with 5 LED indicators each representing a charge of approximately 20 of capacity Press the fuel gauge button to illuminate the fuel gauge A flashing green light closest to the button means the battery is too weak and must be recharged before use e If AC power is used as the only power source during defibrillation the XL may take 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 event is created when power is returned All saved data remains intact and can be found by retrieving the previous event Keep your battery installed and charged Anew fully charged battery operating at room temperature 20 C 68 F provides at least 175 full energy charge shock cycles 3 hours of monitoring ECG and SpO monitored continuously and NBP measured every 15 minutes followed by 20 full energy charge shock cycles or 2 hours of pacing 180ppm at 140mA with 40msec pulse and monitoring followed by 20 full energy charge shock cycles e Battery life depends on the frequency and duration of use When properly cared for useful life is approximately 3 years To optimize performance a battery that is in
95. tion of the ES Audio Pause indications are on Alarm Audio Off Only visual indications are on DX Audio Off Alarms Off KX Alarms Off Both audio and visual indications are off for a set period of time e All alarm conditions are cleared when you switch from a clinical mode to a non clinical mode e Ifyou intentionally disconnect a sensor an alarm sounds Press the Menu Select button to stop the alarm The HeartStart XL prompts you to confirm your selection Press the Menu Select button again Emphasize the following e Silencing either audio or audio and visual indications of active alarms can result in missed alarm conditions and inhibit indications of new alarm conditions e Confirm alarm limits are appropriate for the patient each time there is a new patient event e Do not set alarm limits to such extreme values that render the alarm system useless e A potential hazard exists if different alarm limits are used for the same or similar equipment in any single area Responding to Alarms Create an alarm condition and cover the following steps to respond to the condition Have students complete the procedure as well 1 Attend to the patient 2 Identify the alarm s indicated 3 Silence pause the alarm s Press the Menu Select button to acknowledge the alarm and press it again to pause the alarm for the configured pause period while you attend to the patient If the alarming condition continues to e
96. ton to switch categories e Use only approved lead sets when pacing with the HeartStart XL e For treatment of patients with implantable devices permanent pacemakers or cardioverter defibrillators consult a physician and the instructions for use provided by the device s manufacturer Pacing View Turn the Therapy knob to Pacer on the XL and introduce the unique Pacing View characteristics e A status bar appears in Wave Sector 3 The first line communicates status Pacing or Pacing on Battery if active Pacing Paused if not active or alarm message and the second line identifies the pacing mode demand or fixed pacing rate ppm and pacing output mA e Soft keys set the pacing status Start Pause and adjust the pacer rate and output e Pacing markers indicating a pace pulse was delivered appear in Wave Sector 1 and in Wave Sector 2 if the wave is cascading each time a pacer pulse is delivered R Wave arrows appear in Wave Sector 1 and in Wave Sector 2 if the wave is cascading when in Demand Mode pacing R Wave arrows do not appear on paced beats Suggestion Ask students to point out characteristics instead of YOU stating them Additional points notes 56 Demand vs Fixed Mode Introduce demand and fixed mode pacing Demand mode e Synchronous pace pulses are delivered when the patients heart rate is lower than the selected pacing rate Use this mode whenever possible e XL requires a 3
97. trate how to enable the SpO alarms 1 2 3 4 Press the Menu Select button Using the Navigation buttons select the Measurements Alarms menu and press Menu Select Select SpO and press Menu Select Select Alarms On Alarms Off and press Menu Select Note the following Turning alarms off prevents all alarms associated with the SpO measurement from being annunciated If an alarm condition occurs no alarm indication is announced Practice Exercise 1 Have students change SpO limits and enable disable and respond to related alarms Pose the following questions 1 What happens when you change a limit Disable an alarm Respond to an alarm Additional points notes 70 Pulse Rate Alarms Mention the following pulse rate alarm characteristics e Alarms sound if measurements fall outside the configured high and low pulse rate limits Once generated alarm messages appear in the Pulse alarm status area above the Pulse numeric e There are both audio and visual alarms e Pulse rate alarms are all categorized as non latching alarms meaning they are automatically removed when their alarm condition no longer exists e Pulse alarms are off by default except when the HeartStart XL enters Pacing Mode e Limits can be changed during use Changing Pulse Rate Alarm Limits Demonstrate how to change pulse rate alarm limits 1 Press the Menu Select button Using the Navigation buttons select the Measu
98. ual step by step summaries of key functions parameters and related operation Device Overview Ready For Use Indicator Alarms Selecting Waves AED Mode Manual Defibrillation Synchronized Cardioversion Noninvasive Pacing Weekly Shock Test Operational Check e HeartStart XL Web based User Training provides a comprehensive self paced interactive training on similar content found in the instructor guide It is located on Philips Healthcare s web site Students need to enter the training access password meetXL to get started e HeartStart XL User Training Video provides an overview of XL functions features and operation The video serves as valuable preparation for the classroom or as a refresher after the training e Application Notes Arrhythmia Monitoring Algorithm AED Algorithm SMART Biphasic Noninvasive Transcutaneous Pacing Philips Pulse Oximetry About Noninvasive Blood Pressure HeartStart XL Lithium Ion Battery Characteristics and Care Vital Signs Trending with the HeartStart XL Improving ECG Quality ECG Out Cable Instructor Guide 2 Getting Acquainted Lesson Introduction Introduce the lesson including the learning objectives estimated time to complete and applicable resources This lesson provides an overview of the HeartStart XL controls indicators operational modes and display views It also provides general info
99. ual Event Summary e Event Summary data collected if available includes Two ECG waveforms with beat labels One pleth waveform Patient event information Technical device event information Research data e You can print an Event Summary Report during a patient event or from Data Management Mode after the event has concluded e Events and wave segments can be stored in an Event Summary Not all events listed are possible based on your device s configuration Additional points notes Data Management Mode Briefly describe Data Management Mode and demonstrate how to enter it e Data Management Mode is a non clinical mode used to manage event data records You can print or export an individual Event Summary or export all Event Summaries configure the HeartStart XL to remove patient information from Event Summaries prior to exporting them manage Event Summary data on an external USB drive To enter Data Management Mode 1 Turn the Therapy knob to either Monitor Pacer or Manual Defibrillation Press the Menu Select button 2 3 Using the Navigation buttons select Other and press Menu Select 4 Select Data Management and press Menu Select 5 Confirm your selection Use the Navigation buttons to select Yes and press Menu Select If you select NO you are returned to the mode you started from Note the following Do not enter Data Management Mode while monitoring a patient Suggesti
100. uring the displayed time period Time intervals for vital signs Trend data without related units of measure e When trending is initially displayed the most recent trending data appear in the far right column e The display automatically updates as new data become available with the newest data appearing in the far right column of the display and older data moving over to the left If the display is full the oldest displayed data is removed e Ifyou scroll horizontally to view older data the HeartStart XL updates the newest data when you scroll back Invalid data displays Questionable data displays a question mark before the numeric value Unavailable data are indicated by a blank space e A after the timestamp indicates multiple measurements taken during the interval e Ifa parameter has not been measured during the display period it is not listed in the far left column The Heart Rate parameter is always the top entry in the report followed by SpO and Pulse and then NBP if your device has those options and they are available 82 Trending Report Intervals Demonstrate how to adjust the trend interval Suggestion Have students complete the steps below and follow your discussion while viewing the Trending Report Trending data can be shown at 1 5 10 15 30 or 60 minute intervals for up to the last 8 hours of monitoring The default is 5 minutes To adjust the interval 1 With Trending active on
101. us Area e Date and time e Patient information Event timer The elapsed time for the current event displayed in hours minutes second Paced status Internally paced or non paced The area remains blank if paced status has not been selected This information is not displayed in Pacing Mode 10 Name The patient s name for the current event if entered Patient category and weight range Adult 25kg or Infant Child lt 25kg The neonatal patient category is not supported for AED Mode and all monitoring functions e Device information Battery status Ifa battery is installed the battery icon indicates the level of charge remaining Clinical alarm indicator Indicates the state of global alarms If alarms are on the indicator is blank If they are off the indicator says Alarms Off and uses the Alarms Off icon Technical alarms Indicates technical alarms not related to the battery or pacing A triangle means multiple alarms are present The alarms alternate on the display Parameter Area Displays the key physiological parameters currently available and being monitored heart rate SpO2 pulse rate and or NBP Information for each parameter includes Parameter label Possible current value e Number a valid value was obtained e an invalid value was obtained e with a number the value obtained is questionable e blank the parameter is unavailable or off
102. ve students complete steps 1 and 2 Electrodes 1 Prepare the patient s skin at the appropriate electrode sites i e identify location clip shave site clean abrade site and dry site 2 Attach the snaps to the electrodes 3 Apply the electrodes You will likely apply them to the ECG simulator Note Review typical electrode placement for a 3 and 5 Lead ECG set and lead selection for an accurate QRS complex detection as appropriate Also stress the use of only approved lead sets with the XL 4 Ifnot pre connected connect the ECG patient cable DEMONSTRATE Suggestion Have students complete step 4 Additional points notes 24 Lead Choices Review the choice of leads available for 3 and 5 Lead ECG sets if connected to the XL a 3 Lead ECG set I I II One a 5 Lead ECG set I II II aVR aVL aVF V Three Lead Selection Discuss the guidelines for lead selection e Select a suitable lead for monitoring so that a QRS complex can be accurately detected e For non paced patients the QRS complex should be tall and narrow recommended amplitude gt 0 5mV R wave should be above or below the baseline but not biphasic P wave should be smaller than 1 5 R wave height T wave should be smaller than 1 3 R wave height e For paced patients with internal transvenous pacemakers in addition to the above confirm the paced status is set correctly on the XL pace puls
103. xist it re alarms after the configured pause period ends 14 Silencing a specific alarm does not prevent another alarm from sounding If you silence the second alarm it resets the pause period for all active alarms If you press the Alarms button you are silencing all parameter alarms for the configured pause period 4 Address the alarm condition with one of the following options Acknowledge For latching alarms acknowledge clears the alarm condition when the condition no longer exists New Limits Adjust the parameter limits accordingly Alarms Off Turns the monitoring parameter s alarms off and prevents future alarms from alarming The alarm message is no longer displayed and the Alarm Off icon appears next to the parameter value Additional points notes Entering Patient Information Discuss the patient information that can be entered on the XL and demonstrate accordingly e Name e ID e Sex e Paced internal paced status To enter patient information 1 Press the Menu Select button to activate the Main Menu 2 Using the Navigation buttons select Patient Info and press Menu Select 3 Select the category you want to enter information for and press Menu Select 4 When entering the patient s name the Last Name screen appears with a menu of letters to enter the last name Using the Navigation buttons select the first letter of the patient s last name a Press the Menu Select button to se
104. your display press the Menu Select button 2 Using the Navigation buttons select Trend Interval and press Menu Select 3 Using the Navigation buttons select the trend interval you want and press Menu Select Navigating Around the Trending Report Demonstrate how to navigate the report e Use the horizontal scroll soft keys to scroll left and right in the Trending Report A soft key is inactive grayed out if there is no more data to be viewed in that direction e If there are more lines of data than can be shown on the screen use the Navigation buttons above the Menu soft key to scroll up and down the report Printing the Trending Report Demonstrate how to print the report To print the Trending Report 1 Press the Report button 2 Using the Navigation buttons select Trends and then the appropriate interval Trends Reports can also be printed from Data Management Mode Closing the Trending Report To close the Trending Report and return to a waveform display simply press the Close Trends soft key Practice Exercise 1 Have students change report time intervals scroll through data and print out sample reports Pose the following questions 1 Does the layout of a report change in any way when you increase or decrease the time interval 2 Does the information on a printout differ from what you see on the display 83 Additional points notes 84 e Review Have students answer the following questions individua

HeartStart XL+ - Philips Healthcare

Contents

Download Pdf Manuals

Related Search

Related Contents