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Philips M3500B User's Manual

1. Sensor Type Patient Patient Size Ideal Site M1191A Reusable Adult gt 50 kg Finger M1192A Reusable Small adult 15 50 kg Finger Pediatric M1194A Reusable Pediatric gt 40 kg Fleshy part Adult of ear M1903A B Disposable Pediatric 10 50 kg Toe Finger Nellcor D 20 M1904A B Disposable Adult gt 30 kg Finger Nellcor D 25 M1906A Semi reus Pediatric 3 40 kg Finger Toe Nellcor P T able Infant M1907A Semi reus Neonate 3kg Foot Hand Nellcor A N able z Adult gt 40 kg Finger NOTE To use Nellcor sensors you must connect the M1943A Nellcor Adaptor patient cable to the HeartStart XLT See Connecting the SpO Patient Cable on page 10 5 M3500B HeartStart XLT Defibrillator Monitor 5 3 Selecting a Sensor The most important factor when selecting a sensor is the position of the light emitting diodes in relation to the photodetector when a sensor is applied the diodes and the photodetector must be opposite each other Sensors are designed for patients within a specific weight range and for specific sites Be sure to e Select a sensor appropriate for the patient s weight e Select a sensor site with adequate perfusion e Avoid application to sites with edematous tissue Reusable Sensors Reusable sensors may be reused on different patients after they have been cleaned and disinfected see the manufacturer s instructions supplied with the sensor Disposable Sensors Disposable sensors should be
2. Chapter 10 describes in detail the configurable parameters for AED Mode Three parameters significantly impact the defibrillation process They are Device Initiated Analysis initiates ECG analysis when the HeartStart XLT is first turned on The default configuration setting is On If you choose to set this parameter to Off you need to press ANALYZE to initiate analysis in step 2 of the defibrillation process Automatic Re analysis initiates ECG analysis in between shocks within a shock series The default configuration setting is On If you choose to set this parameter to Off you need to press ANALYZE to initiate analysis in between shocks within a shock series i e after the first and second shock of a three shock series Rhythm Monitoring monitors the ECG for potentially shockable rhythms when the HeartStart XLT is not analyzing defibrillating or paused The default setting is On If you choose to set this parameter to Off the HeartStart XLT will not look for potentially shockable rhythms during these idle times Idle times also include e power on when Device Initiated Analysis is off e in between shocks within a shock series when Auto Re analysis is off If Rhythm Monitoring is off you need to observe the patient during idle times and determine when to press ANALYZE The following sections describe the defibrillation process in detail They also describe what happens at the completion of a shock series and if a
3. Cover sensor with an opaque material Check sensor for dam age try another sen sor 5 10 Monitoring SpO Table 5 2 System Messages Continued Troubleshooting Problem or Message Possible Cause Corrective Action SpO2Cable Off e The SpO cable is not e Attach the cable to the connected to the device HeartStart XLT Sp02 Sensor Fail The transducer is bro Apply a new trans ken ducer SpO2Failure There is a hardware fail Remove device from ure in the SpO sub system active use and call for service M3500B HeartStart XLT Defibrillator Monitor 5 11 6 Defibrillating in Manual Mode In Manual Mode you assess the ECG decide if defibrillation is indicated select the discharge energy level and deliver the shock The defibrillation process is under your control There are no voice prompts however system and momentary messages provide relevant information throughout the pro cess It is important to be attentive to these messages This chapter describes how to access Manual Mode and use it for defibrilla tion For Manual Mode features such as synchronized cardioversion and pac ing see the Performing Synchronized Cardioversion and Pacing chapters For information on printing storing and retrieving patient information acquired in Manual Mode see Chapter 9 M3500B HeartStart XLT Defibrillator Monitor 6 1 Enabling Manual Mode WARNING 6 2 Ena
4. When cleaning e Avoid pouring fluids on the module Do not allow fluids to penetrate the exterior surfaces of the module e Do not use abrasive cleaners or strong solvents such as acetone or acetone based compounds M3500B HeartStart XLT Defibrillator Monitor 11 13 Cleaning Instructions Cleaning Pads Electrodes amp Cables Defibrillation pads and monitoring electrodes are single use and do not require cleaning The pads cable may be cleaned with e Alcohol free hand soap e 2 gluteraldehyde solution such as Cidex e Sodium hypochlorite chlorine bleach solution 10 in water e Quaternary ammonium compounds such as Lysol e Isopropyl alcohol The ECG cable may be cleaned by wiping it with any of the following e 2 gluteraldehyde solution such as Cidex e Alcohol free hand soap e Chlorine bleach 100ml I CAUTION 11 14 Do not ultrasonically clean immerse autoclave or steam sterilize the pads or ECG cable Do not clean the ECG cable with alcohol Alcohol can cause the plastic to become brittle and may cause the cable to fail prematurely To clean the SpO sensor and cable follow the manufacturer s instructions Maintaining the HeartStart XLT Removing amp Replacing the Carrying Case Removing amp Replacing the Carrying Case To remove the carrying case from the HeartStart XLT follow steps 1 through 7 in Figure 11 4 11 After loosening the screws step 6 lay the unit flat a
5. 2 Press the black eject button see Figure 2 8 3 Pull the Data Card from the compartment M3500B HeartStart XLT Defibrillator Monitor 2 13 3 Defibrillating in AED Mode The HeartStart XLT s AED Mode is designed to guide you through standard treatment algorithms for cardiac arrest including those provided by the Amer ican Heart Association and the European Resuscitation Council Configura tion choices allow you to customize AED Mode to better follow a specific treatment algorithm and to meet the unique needs of your life saving team This chapter describes how to use the HeartStart XLT to defibrillate in AED Mode It explains the prompts that guide you through the defibrillation pro cess and describes how prompts vary depending upon the condition of the patient and the configuration of your device For information on printing storing and retrieving patient information acquired in AED Mode see Chapter 9 M3500B HeartStart XLT Defibrillator Monitor 3 1 Figure 3 1 AED Mode Overview If Patient is e Unresponsive e Not Breathing e Pulseless Attach Pads Insert Data Card Optional Press On If Instructed Press ANALYZE Shock No Shock Advised Advised Press SHOCK gt Check Patient at completion of shock series No Pulse Pulse J Press PAUSE Do CPR within a shock series Ventilate Y i
6. 7 ppm 30mA Shocks 0 PP 00 00 8 ENERGY CHARGE SELECT NOTE Pacing will not start if there is a problem with the multifunction defib elec trode pads connections or in demand mode a problem with the ECG monitor ing electrodes connections Should a problem exist a system message is displayed Be attentive to system messages M3500B HeartStart XLT Defibrillator Monitor 8 5 Changing Pacing Modes 8 6 6 Increase the output until cardiac capture occurs Press up A on to increase the output in increments of 10 mA 7 Decrease the output to the lowest level that still maintains capture Press W on to decrease the output in increments of 5 mA un p 39 f BS A Press to stop pacing Press to exit the pacing function The green LED next to the button goes out indicating pacing is no longer active Changing Pacing Modes If paced pulses are being delivered you must stop pacing before changing the pacing mode AN 1 Press ED to stop pacing Press to change the mode Adjust the rate if needed to resume pacing we el qe Adjust the output as needed to obtain capture Defibrillating During Pacing If the patient must be defibrillated during pacing follow the procedure for defibrillating in Manual Mode on page 6 4 Pacing is automatically turned off when you charge the defibrillator and the pacing dialogue box is removed from the display After a shock pacing remains of
7. Attention See operating instructions in user s guide Power module input Input olse gt Ole 13 10 Specifications amp Safety Symbol Definitions Table 13 1 Defibrillator and Battery Symbols Continued Symbol Definition Meets IEC type BF leakage current requirements and is defibrilla tor protected Patient Applied Part is isolated and defib proof suit able for direct patient contact except the heart or major arteries Meets IEC type CF leakage current requirements and is defibrilla tor protected Patient Applied Part is isolated and defib proof suit able for direct patient contact including the heart and major arteries Alarms are active p A Alarms are inactive eS Recyclable material x Must be recycled or disposed of properly G Unlock IPX4 Ingress of fluids classification protected against splashing water M3500B HeartStart XLT Defibrillator Monitor 13 11 Symbol Definitions The following table lists the symbols that appear on the HeartStart XLT ship ping carton Table 13 2 Shipping Carton Symbols Symbol Definition cde Atmospheric pressure range Temperature range A Relative humidity range O Recyclable paper product E Fragile Right side up UAE Do not get wet 3 13 12 Specifications amp Safety Symbol Definitions Table 13
8. Tested result is displayed check that the test is set up correctly Make sure that Q the paper is in the printer LJ the test load is attached LC aData Card with enough space is inserted into the HeartStart XLT L acharged battery is inserted into the HeartStart XLT Run the Shift System Check again ensuring that no one touches any of the controls on the defibrillator unless prompted to do so If the Data Card is full the message Service Unit appears at the bottom of the screen and the message Data Card Full appears at the top of the screen Replace the Data Card and perform the Shift System Check again If the message Service Unit continues to appear do not use the device and call for service Maintaining the HeartStart XLT Operational Checks Every Shift Perform a Shift System Check every shift see Shift System Check on page 11 4 to verify that the HeartStart XLT is functioning properly and to 1 1 ensure that necessary supplies and accessories are present and ready for use Every Month Check expiration dates on multifunction defib electrode pads and monitoring electrodes every month Replace them if the expiration date has passed Every Three Months Perform a Battery Capacity Test on each battery every three months to ensure that your batteries meet the specifications for safe and effective use M3500B HeartStart XLT Defibrillator Monitor 11 3 Operational Checks 11 4 Shift System C
9. The EMC standards state that manufacturers of patient coupled equipment must specify immunity levels for their systems It is recognized that the Heart Start XLT defibrillator monitor is designed to receive and amplify low level signals in the same bandwidth as the interference Immunity is defined in the standard as the ability of a system to perform with out degradation in the presence of an electromagnetic disturbance Degrada tion in ECG quality is a qualitative assessment which can be subjective Caution should therefore be taken in comparing immunity levels of different devices The criteria used for degradation is not specified by the standard and may vary with the manufacturer NOTE For additional information about compliance with the EMC standards please see the Philips Medical web site at http www medical philips com cms and follow the regulatory link M3500B HeartStart XLT Defibrillator Monitor 13 23 A AC Power Module See Power modules Accessories arranging 10 6 checking 11 5 ordering 11 18 13 19 AED Mode 3 1 configuring 3 4 10 10 CPR 3 12 defibrillation process 3 6 display 2 5 2 7 ECG monitoring 4 1 enabling from Manual Mode 6 6 events recorded 9 3 Events Summary 9 2 indications for use 1 3 overview 1 1 3 2 3 3 pausing 3 12 3 15 preparation 3 5 re analysis 3 11 rhythm monitoring 3 14 specifications 13 3 SpO2 monitoring 5 1 training required 1 3 troubleshooting 3 18 Alarms h
10. adjusting 2 2 settings 10 10 troubleshooting 4 8 R Radio frequency RF interference 13 22 Re analysis 3 4 3 11 Recording events See Event Summary RF interference 13 22 Rhythm Monitoring 3 4 3 14 AED Mode 3 8 configuring 3 14 10 11 events recorded 9 3 Safety precautions See Precautions Saving settings to Data Card 10 16 Security password 10 13 Semi Automatic External Defibrillation See AED Mode Sensors 5 3 applying 5 5 caring for 5 9 cleaning 11 14 ordering 11 20 selecting 5 3 troubleshooting 12 4 Service 12 9 Settings See Configuration Shipping carton symbols 13 12 Shock AED Mode 3 9 events recorded 9 3 settings 10 11 troubleshooting 3 18 12 5 Shock Series Timer 10 11 Softkeys 2 3 See also Controls Specifications AED Mode 13 3 batteries 13 6 defibrillator 13 2 display 13 5 ECG monitoring 13 4 environmental 13 9 Event Summary 13 8 HeartStart XLT 13 8 Manual Mode 13 2 pacing 13 7 power supply 13 2 printer 13 5 SpO2 monitoring 13 7 SpO2 alarm 5 8 specifications 13 7 SpO2 cable cleaning 11 14 connecting 10 5 ordering 11 20 SpO2 Light Interf message 5 10 Index SpO2 monitoring 5 1 cable connection 5 6 controls 2 3 defined 1 6 5 1 discontinuing 5 9 events recorded 9 4 inaccuracies 1 6 indications for use 1 6 noisy signal 5 10 procedure 5 7 process 5 2 sensors applying 5 5 sensors caring for 5 9 11 14 settings 10 12 specifications 13 7 troubleshooting 5 1
11. covers e Connecting Patient Cables e Arranging Accessories in the Carrying Case e Configuring the HeartStart XLT Connecting Disconnecting Patient Cables This section describes how to connect and disconnect the e Pads Patient Cable e ECG Patient Cable 3 or 5 lead e SpO Patient Cable M3500B HeartStart XLT Defibrillator Monitor 10 1 Connecting Disconnecting Patient Cables Connecting the Pads Patient Cable To connect the pads patient cable to the defibrillator 1 Align the white pointer on the pads patient cable with the white arrow on the defibrillator s pads connector as shown in Figure 10 1 2 Insert the patient cable into the pads connector Push until you hear it click in place Figure 10 1 Pads Patient Cable Connector Pointer Pads connector 10 2 Setting Up and Configuring the HeartStart XLT Connecting Disconnecting Patient Cables Disconnecting the Pads Patient Cable To disconnect the pads patient cable 1 Rotate the green locking mechanism on the patient cable in the direction clockwise of the blue arrow on the defibrillator until it stops as shown in Figure 10 2 2 Hold the locking mechanism in this position as you pull the patient cable away from the defibrillator Figure 10 2 Disconnecting the Pads Patient Cable Blue arrow M3500B HeartStart XLT Defibrillator Monitor 10 3 Connecting Disconnecting Patient Cables Connecting the ECG Patient Cable To connect a
12. 2 Current mode AED Manual the current Lead the current Gain filter setting the text Sync if Sync has been enabled and the Pacer Settings consisting of the Pacer Mode Rate and Current if currently pac 13 ing the patient Prints every 12 seconds with Header 1 HEADER 3 Changes in Mode Gain Lead Sync and Pacer Settings FOOTER Drug Annotations HR SpO limits on a Limit Alarm the Results of an Analysis in AED Mode No Shock Advised Shock Advised or Cannot Analyze Charging to xxxJ Shock Delivered No Shock Deliv ered Disarm Battery Low Battery Critical SYMBOLS Mark Triangle for presses of the Mark key an Alarm Bell Alarm Limit Violations Lightening Bolt Shock Delivered Vertical stripe Boundries Pacer Sync Tick Marks Event Printing Mark Event key automatically documents events and ECG during defibrillation episodes The Mark Event key can annotate the event with one of the following labels Epinephrine Atropine Lidocaine and Other M3500B HeartStart XLT Defibrillator Monitor 13 5 Specifications Thermal Array Printer cont Auto Printing The printer can be configured to automatically print on Mark Charge Shock and Alarm Delayed Printing The printer can be configured to run real time or with a six second delay Reports The following can be printed Event Summary Configuration Extended Self Test System Log Speed 25 mm s with an accuracy of 5 Amplitude Accuracy 10 o
13. 2 Shipping Carton Symbols Continued Symbol Definition Shelf life Long term storage conditions Short term transport storage pet M3500B HeartStart XLT Defibrillator Monitor 13 13 Clinical Performance Summary Defibrillation 13 14 Clinical Performance Summary Defibrillation An international multicenter prospective randomized clinical study was conducted to assess the effectiveness of the SMART Biphasic waveform in out of hospital sudden cardiac arrests SCAs as compared to monophasic waveforms The primary objective of the study was to compare the percent of patients with ventricular fibrillation VF as the initial monitored rhythm that were defibrillated in the first series of three shocks or less This section summarizes the methods and results of this study Methods Victims of out of hospital SCA were prospectively enrolled in four emer gency medical service EMS systems Responders used either 150 SMART Biphasic AEDs or 200 360J monophasic waveform AEDs A sequence of up to three defibrillation shocks were delivered For the biphasic AEDs there was a single energy output of 150J for all shocks For monophasic AEDs the shock sequence was 200 200 360J Defibrillation was defined as termination of VF for at least five seconds without regard to hemodynamic factors Results Randomization to the use of monophasic or SMART Biphasic automatic external defibrillators AEDs was
14. 3 or 5 lead ECG patient cable 1 Align the keyed patient cable plug with the slot on the ECG connector as shown in Figure 10 3 2 Push the patient cable firmly into the ECG connector until the white por tion is no longer visible Figure 10 3 ECG Patient Cable Connector Disconnecting the ECG Patient Cable To disconnect the ECG patient cable gently pull the white patient cable plug out of the ECG connector as shown in Figure 10 3 10 4 Setting Up and Configuring the HeartStart XLT Connecting Disconnecting Patient Cables Connecting the SpO Patient Cable To connect the SpO patient cable 1 Hold the connector with the flat side up as shown in Figure 10 4 2 Insert the connector into the receptacle and push until the blue portion of the connector is no longer visible Figure 10 4 Connecting the Sp0 Patient Cable Disconnecting the SpO Patient Cable To disconnect the SpO patient cable gently pull it out of the SpO connector M3500B HeartStart XLT Defibrillator Monitor 10 5 Arranging Accessories in the Carrying Case Arranging Accessories in the Carrying Case The HeartStart XLT carrying case is designed to hold your essential defibrilla tion and monitoring accessories Figure 10 5 shows the recommended place ment for each of these accessories Figure 10 5 Recommended Accessory Placement Spare Battery Paper Pads Patient Cable ECG Patient Cable Monito
15. Charging Batteries Fe c 11 8 Battery Cap city MP 11 9 Battery Life EXpectancy serseri 11 9 Storing ARIST OS sesers iko keeseen sae hast Mieten IEE EROE KSEE Ded Eo Ru ieas 11 9 Discarding Batteri S sssesrri erior a E E E E 11 9 Contents Loading Printer Paper T 11 10 Cleaning TVS OTS sesine aks peda cet ce esata re eu ura dee Guledaca dea pu Ute u MU di HUE 11 12 Cleaning the HeartStart XLT sssscsesisasegacnancniedensiansacvancncasdaaseaesuaseetadnageraadsadsecastantoaeciane 11 12 Cleaning the Carrying 36 s dioi too ER DP eae MU ui di tn 11 12 Cleaning the Printer Printhead aieo rt eo DR IDEE dae Deb beali uu Musee bap Ui osedUUE 11 13 Cleaning the Power Modules 1d e eene eti tete Eb Haan nE ax sa deuce aep d durae pe 11 13 Cleaning Pads Electrodes amp Cables uiuo rate tee esr ap tue taxe ipse ar dea engen tede 11 14 Removing amp Replacing the Carrying Case eese enne 11 15 Putting On the Manual DOOF eiddcee n tete debts uote teo da beiclatiebe meas ao SD div ei I M ae 11 17 UDG 05 ACCESS OTIS E E tecta ba I pM ne Mu tete tasa tap b on dit opi MUS 11 18 Disposing of tbe HeartStart XE T eninin ER ce Ia Ro teles oa qub zm D asd dated 11 22 Troubleshooting NU AMNU D FI 2 12 2 Mo m nt ry IMIS cc T c 12 5 Troubleshooting Tips s oodd dtes tan tun ud E p enna aire eE EAEE E EEA raia R EA ERSS 12 7 Calling for Serv
16. Disabling Sync Mode To disable Sync Mode press The green LED next to goes out and the message Sync is no longer displayed Sync Mode is also disabled when you exit Manual Mode Performing Synchronized Cardioversion 8 Pacing Noninvasive transcutaneous pacing is a Manual Mode function that is used to deliver paced pulses to the heart Paced pulses are delivered through multi function defib electrode pads applied to the patient s bare chest This chapter explains the pacing options and describes how to perform pacing M3500B HeartStart XLT Defibrillator Monitor 8 1 Demand Mode Versus Fixed Mode WARNING WARNING 8 2 Demand Mode Versus Fixed Mode The HeartStart XLT can deliver paced pulses in either demand or fixed mode In demand mode the pacer only delivers paced pulses when the patient s heart rate is lower than the selected pacing rate In fixed mode the pacer delivers paced pulses at the selected rate Monitoring During Pacing Multifunction defib electrodes pads can not be used to monitor the ECG and deliver paced pulses simultaneously The HeartStart XLT always uses the 3 or 5 lead ECG cable and monitoring electrodes as the source of ECG during pacing In demand mode ECG electrodes must be used because the HeartStart XLT uses the R wave detection from this monitoring source to determine if a paced pulse should be delivered In fixed mode ECG electrodes may or may not be used however an ECG w
17. ECG source 3 or 5 lead monitoring electrodes M3500B HeartStart XLT Defibrillator Monitor 6 3 Defibrillating Defibrillating The defibrillation process is as follows 1 Select Energy The default energy setting is 150 joules To change the energy setting press any repeatedly to cycle through the energy level choices Stop when the desired energy is displayed The choices are 5 10 25 50 70 100 150 or 200 joules Figure 6 3 Energy Select Display LEAD SpO2 Shocks 0 00 00 8 2 Charge Press CHARGE As the defibrillator charges the current charge is displayed above the shock counter A charging tone beeps until the desired energy level is reached at which point you ll hear a continuous charge tone 6 4 Defibrillating in Manual Mode Defibrillating Figure 6 4 Charging Display LEAD SpO2 87 J Current Charge Shocks 0 00 00 8 ENERGY serecr PSARM J If desired you may increase or decrease the selected energy level after pressing the CHARGE button To do so press E repeatedly until the desired energy level is displayed The defibrillator charges to the selected energy automatically Wait until the current charge reaches the selected energy level before proceeding 3 Shock Confirm that a shock is still indicated Make sure no one is touching the patient or anything connected to the patient Call out Clear Then press SHOCK to deliver a shock to the patient To disarm th
18. are causing interference e Attempt to eliminate patient motion Avoid analyzing during transport or while performing CPR e Move hand held communication devices or other suspected devices away from the defibril lator when possible Shock Can celled Shock key not pressed within 30 seconds Press within 30 seconds of prompt No Shock Delivered Pads are not properly connected to the patient Check pads connection Key Inactive e The key pressed only functions in Manual Mode e The key pressed does not func tion during analysis or charging e The key pressed does not func tion while in a pause state Access manual mode prior to pressing the key e Wait for analysis or charging to complete prior to pressing the key e Press RESUME prior to pressing the key 3 18 Defibrillating in AED Mode 4 Monitoring the ECG The HeartStart XLT can be used for short or long term ECG monitoring The ECG monitoring function allows you to monitor through e multifunction defib electrode pads or e 3 or 5 lead ECG monitoring electrodes as configured When the HeartStart XLT is turned on the ECG acquired through pads is shown on the display ECG monitoring allows you to continue to monitor through the pads or to select a lead from an alternate ECG source 3 or 5 lead ECG monitoring also displays the heart rate HR and allows you to set HR alarms ECG monitoring is always a
19. are inactive in AED Mode Stop Pacer AAEN St ing bef hanging th i j is pressed while pacing pulses Per es RNC D MEE are being delivered l 12 6 Troubleshooting Troubleshooting Tips Troubleshooting Tips Table 12 3 lists some situations that you may encounter causes and actions to take Table 12 3 Troubleshooting Tips Situation The HeartStart XLT does not turn on Cause There is no power OR A corrupt Data Card may prevent the unit from powering on OR Hardware failure Possible Solution Insert a fully charged battery Attach AC Power cord Remove the Data Card Insert a new Data Card if available Turn on the device e Remove this unit from clinical use and call for service The display is blank except for SYSTEM FAILURE CYCLE POWER An internal error occurred If this occurs during actual use e Substitute another defib if possible Remove this unit from clinical use and call for service e Ifnoother defib is available turn power off then on If unit turns on normally use for this one incident After this incident remove from clini cal use and call for service e Ifunit does not turn on normally it cannot be used If this occurs during routine testing e Remove this unit from clinical use and call for service The HeartStart XLT appears to be on but the display is blank e The contrast needs adjusting e The display has overheated Adjust
20. as those in severe shock or hypothermia or in the presence of excessive motion M3500B HeartStart XLT Defibrillator Monitor 5 1 Understanding Pulse Oximetry 5 2 Understanding Pulse Oximetry A pulse oximetry sensor sends light through patient tissue to a receiver on the other side of the sensor As Figure 5 1 shows light emitting diodes transmit red and infrared light through peripheral areas of the body such as a finger Figure 5 1 Pulse Oximetry Sensor LED Photodetector A photodetector positioned opposite the light emitting diodes compares light absorption before and after pulsation The amount of light getting through reflects the blood flow in the arterioles This measurement of light absorption during pulsation is translated into an oxygen saturation percentage and an SpO value is displayed For accurate SpO measurements the following conditions must apply e The patient must have perfusion in that extremity e The light emitter and the photodetector must be directly opposite each other e All of the light from the emitter must pass through the patient s tissue e The sensor site should be free of vibration and excessive motion e Power cables should be kept away from the sensor cable and connec tor Monitoring SpO Selecting a Sensor Selecting a Sensor Table 5 1 shows the SpO sensors that may be used with the HeartStart XLT Table 5 1 Approved Sensors
21. done in 338 SCAs from four emergency medical service systems VF was observed as the first monitored rhythm in 115 patients The biphasic and monophasic groups for these 115 patients were similar in terms of age sex weight primary structural heart disease cause or location of arrest and bystanders witnessing the arrest or performing CPR The 150J SMART Biphasic waveform defibrillated 98 of VF patients in the first series of three shocks or less compared with 69 of patients treated with monophasic waveform shocks Outcomes are summarized in Table 13 3 Specifications amp Safety Clinical Performance Summary Defibrillation Table 13 3 Clinical Summary Defibrillation Biphasic Patients Monophasic Patients P Value Number Percent Number Percent chi square Defibrillation Efficacy Single shock only 52 54 96 36 61 59 lt 0 0001 lt 2 shocks 52 54 96 39 61 64 lt 0 0001 lt 3 shocks 53 54 98 42 61 69 lt 0 0001 Patients Defibrillated 54 54 100 49 58 84 0 003 Return of Spontaneous 41 54 76 33 61 54 0 01 Circulation Survival to Hospital 33 54 61 31 61 51 0 27 Admission Survival to Hospital Dis 15 54 28 19 61 31 0 69 charge CPC 1 Good 13 15 87 10 19 53 0 04 Conclusion The 150J SMART Biphasic waveform defibrillated at higher rates than 200 360J monophasic waveforms resulting in more patients achieving return of spontaneous circulation ROSC p
22. from 15 to 300 bpm with an accuracy of 10 Heart Rate Alarms Configurable pairs of low and high heart rate alarm lim its 30 to 100 60 to 140 90 to 160 and 120 to 200 bpm Defibrillation Patient Cable Length 7 ft 2 13 m ECG Cable Length 10 ft 3 05 m Common Mode Rejection Greater than 90 dB measured per AAMI stan dards for cardiac monitors EC 13 ECG Size 2 5 5 10 20 40 mm mV Frequency Response AC Line Filter 60 Hz 50Hz Pads ECG for Display Monitor 15 40 Hz EMS 1 30 Hz Pads ECG for Printer Monitor 15 40 Hz EMS 1 30 Hz Leads ECG for Display Monitor 15 40 Hz EMS 1 30 Hz Leads ECG for Printer Diag 05 150 Hz EMS 1 30 Hz Monitor 15 40 Hz Patient Isolation defibrillation proof ECG Type CF SpO Type CF Defib Type BF multi function defib electrode pads Specifications amp Safety Specifications Display Display Size 96 mm x 72 mm Display Type Transflective active matrix LCD with LED backlight Display Resolution 320 x 240 pixels Sweep Speed 25 mm s nominal stationary trace sweeping erase bar Viewing Time 4 seconds Thermal Array Printer Continuous Real Time Strip User starts and stops the print strip The Print Strip prints the selected ECG lead with the following data HEADER 1 Date Time Heart Rate the SpO Value if available and the text Delayed if the recording has been configured for Delayed Mode Prints every 12 seconds HEADER
23. if necessary was delivered at 200J if the initial defibrillator was bipha sic and at 360J if the initial defibrillator was monophasic The cross over shock was 360J monophasic if the initial defibrillator was biphasic and 200J biphasic if the initial defibrillator was monophasic Successful cardioversion was defined as the occurrence of two P waves uninterrupted by atrial fibrilla tion within 30 seconds of the shock Results Randomization to the use of monophasic or SMART Biphasic defibrillators was done in 212 elective cardioversions involving 210 patients at eleven clin ical sites in the United States and Europe Of these 203 results met the proto col criteria for inclusion in this analysis The biphasic and monophasic groups were similar in terms of age sex weight current medical history cause of heart disease and estimated ejection fraction Specifications amp Safety Clinical Performance Summary Cardioversion The 150J SMART Biphasic waveform successfully converted far more patients with an initial 100J shock 60 compared with 22 for the monophasic waveform and successfully converted patients at least as well with a maximum energy of 200J as the monophasic did with its maximum energy of 360J 91 compared to 85 for the monophasic waveform Over all the biphasic waveform required fewer shocks 1 7 compared to 2 8 for the monophasic waveform and lower delivered energy 217J compared to 548J for the monophasic wavef
24. normally it cannot be used If this occurs during routine testing Remove this unit from clinical use and call for service M3500B HeartStart XLT Defibrillator Monitor 12 3 System Messages Table 12 1 System Messages Continued Message Description Corrective Action p0 Cable Off The SpO cable is not connected to the Attach the SpO cable to the HeartStart device XLT SPQ Failure A failure has occurred in the SPO Remove the device from active use and circuitry call for service p0 Light Interf The level of ambient light is so high that the sensor cannot obtain an SpO reading or the sensor or cable is damaged e Cover the sensor with an opaque material e Check the sensor for damage try another sensor Sp0 Non Pulsatile The patient s pulse is absent or too weak to be detected e Check that the sensor is applied prop erly e Make sure the sensor site has a pulse e Relocate the sensor to a site with improved circulation e Try another sensor Sp0 Low Signal SpO signal is too low to give an accurate e Check the sensor is applied properly reading e Try another sensor type Sp0 Noisy Signal Excessive patient movement electrical e Minimize patient movement or apply interference or optical interference is the sensor to a site with less move present ment e Secure the sensor cable loosely to the patient e Reduce sources of el
25. seconds of information that occurred just prior to printing being initi ated Pace Pulse Markers Shows pace pulse markers on the ECG Leads amp Pads displayed if an internal pacemaker is Leads Only detected ECG Lead Cable Selects the monitoring electrodes source 3 lead 5 lead Power on Mode Defines the operating mode when the AED Manual device is turned on Applies to a new use not to a continued use ORS Beeper Provides an audible beep with each QRS Manual AED complex detected amp Manual Off Setting Up and Configuring the HeartStart XLT Configuring the HeartStart XLT Table 10 2 AED Settings TS Setting Parameter Description Choices AED Shock Series Defines the maximum number of shocks to 2 3 4 deliver before prompting Check Patient Check Pulse If Needed Begin CPR Shock Series Timer Defines the number of seconds that must pass 30 60 90 before the next shock is considered the first 120 150 180 shock of a new shock series rather than the 210 Off next shock of the current shock series Device Initiated Initiates ECG analysis when the HeartStart On Off Analysis XLT is turned on in AED Mode Automatic Initiates ECG analysis in between shocks On Off Re Analysis within a shock series Rhythm Monitoring Monitors the ECG for potentially shockable On Off rhythms when the HeartStart XLT is not ana lyzing defibrillating or paused Chec
26. shockable rhythm is not detected Defibrillating in AED Mode Preparation Preparation If the patient is e unresponsive e not breathing e pulseless Then 1 Apply multifunction defib electrode pads to the patient as directed on the package Use the anterior anterior electrode placement Connect the pads to the pads patient cable as shown in Figure 3 2 3 If needed insert a Data Card as described in Using a Data Card on 2 11 Figure 3 2 Connecting Pads to the Patient Cable M3500B HeartStart XLT Defibrillator Monitor 3 5 Defibrillating 3 6 Defibrillating Follow the voice and screen prompts as they guide you through the following steps 1 Press On In this first step of the defibrillation process the HeartStart XLT checks to see if the pads patient cable and the pads are connected If they are it pro ceeds to step 2 If the pads patient cable is not properly attached you are prompted to Con nect Pads Cable Figure 3 3 Connect Pads Cable Display Connect Pads 7 Cable Shocks 0 00 00 02 Once the cable is connected the HeartStart XLT checks to make sure the pads are making good contact with the patient s skin It does this by moni toring the electrical impedance between the two pads Defibrillating in AED Mode Defibrillating If the pads have not been applied or are not making proper contact with the patient you are prompted to Apply Pads and Check Connections Fig
27. used only once and then discarded They can be relocated to a different application site on the patient if the first location does not give the desired results Disposable sensors must not be reused on differ ent patients Semi disposable Sensors Semi disposable sensors can be reused but the adhesive wrap must be dis carded after each use Semi disposable sensors are recommended for single patient use only Monitoring SpO Applying the Sensor Applying the Sensor Follow the manufacturer s directions for applying and using the sensor mak ing sure to observe any warnings or cautions For the best results Make sure the sensor is dry If the patient is moving secure the sensor cable loosely to the patient Avoid excessive pressure at the sensor site ensure that circulation is not obstructed Keep power cables away from the sensor cable and connection Avoid placing the sensor in an environment with bright lights if nec essary cover the sensor with opaque material Avoid placing the sensor on any extremity with an arterial catheter blood pressure cuff or intravascular venous infusion line WARNING Failure to apply the sensor properly may reduce the accuracy of the Sp0 measur ment WARNING Inspect the sensor application site at least every two hours for changes in skin qual ity correct optical alignment and proper sensor application If skin quality is com promised change the sensor site More frequent checkin
28. y Shocks 3 Timer 35 60 90 01 40 LIN La NN The total pause duration depends on the event preceding the Pause state If you entered the Pause state e at the completion of a shock series or shortly after a shock is deliv ered the duration is equal to the Post Shock CPR Timer configuration set ting the default setting is 60 seconds e when no shock was advised the duration is equal to the NSA Timer configuration setting where NSA is an acronym for No Shock Advised the default setting is 180 seconds M3500B HeartStart XLT Defibrillator Monitor 3 17 Troubleshooting Troubleshooting When the HeartStart XLT detects a problem it provides display and or voice prompts to guide you to resolution The table below lists the prompts you may encounter in AED Mode the cause and the suggested corrective action Prompts related to the battery and Data Card are discussed in Chapter 12 Table 3 1 AED Mode Prompts Prompt Pads Off Possible Cause The multifunction defib electrode pads are not properly applied to the patient Corrective Action Check that the pads are applied to the patient as directed on the pads package Replace the pads if the prompt continues Pads Cable Off The pads cable is not connected to the defibrillator Check that the defibrillation pads connector is locked in place Artifact Detected e Patient motion interferes with analysis e Electrical sources
29. 0 12 4 SpO2 Noisy Signal message 5 10 SPO2 Non Pulsatile message 12 4 Stop message 8 7 Stop Pacer message 12 6 Strip See Print strip Supplies checking 11 5 ordering 11 18 Symbols list of 13 10 Sync After Shock setting 10 13 Vil Index Sync control 2 5 Synchronized cardioversion 7 1 delivering shock 7 2 disabling Sync Mode 7 4 enabling 2 5 indications for use 1 4 preparation 7 2 selecting leads 7 1 synchronizer specifications 13 2 System Failure Service Unit message 12 3 System messages 2 7 list of 12 2 System tests See Maintenance Telephone assistance 12 9 Thermal Array Printer See Printer Time 10 9 12 8 Training materials 1 7 Training required 1 3 13 19 Troubleshooting 12 1 AED Mode 3 18 Data Card 12 6 display 12 7 ECG monitoring 4 7 pacing 8 5 8 7 12 3 12 6 SpO2 monitoring 5 10 12 4 time and date 12 8 User messages 2 7 Ventricular fibrillation manual defibrillation 1 4 pacing 1 5 Ventricular tachycardia 1 4 Warnings See Precautions Web site 12 9 PHILIPS HEARTSTART XLT M3500 91900 Edition 3 Copyright 2002 Philips Electronics North America Corporation Printed in the U S A October 2002 eS
30. 0 01 EMS system outcomes of survival discharge were not significantly different statistically However patients resuscitated with the lower energy SMART Biphasic waveform were more likely to have good cerebral performance CPC cerebral performance cate gory p 0 04 M3500B HeartStart XLT Defibrillator Monitor 13 15 Clinical Performance Summary Cardioversion 13 16 Clinical Performance Summary Cardioversion An international multicenter prospective double blinded randomized clini cal trial was conducted to assess the effectiveness of the SMART Biphasic waveform in treatment of atrial fibrillation AF as compared to monophasic waveforms The primary objective of the study was to determine the required energy for cardioversion of AF using the SMART Biphasic waveform as compared with a monophasic damped sine waveform This section summarizes the methods and results of this study Methods Patients enrolled for this study were adults scheduled for elective cardiover sion of AF at one of 11 clinical sites Clinicians used both a defibrillator deliv ering the SMART Biphasic waveform and one delivering a monophasic waveform A sequence of up to five shocks was administered four with the initial defibrillator and a fifth cross over shock was delivered with the other defibrillator if necessary The sequence of energy settings was 100J 150J 200J through the first three shocks on either type of defibrillator A fourth shock
31. 1 9 Loading Printer Paper Loading Printer Paper To load printer paper 1 Slide the printer door to the right until the paper roller pops up 2 If there is an empty or low paper roll in the printer pull up on the plastic removal tab to remove the roll Figure 11 2 Opening the Printer 11 10 Maintaining the HeartStart XLT Loading Printer Paper 3 Place a new roll of printer paper 40457C D into the printer paper well positioning the roll so that the end of the roll is on the top and the grid faces down Be sure to push the roll down so that it is firmly seated in the paper well 1 1 Pull the end of the paper past the paper roll 5 Slide the printer door to the right and hold it open Press the roller down over the paper and release the door Figure 11 3 Loading Paper M3500B HeartStart XLT Defibrillator Monitor 11 11 Cleaning Instructions Cleaning Instructions Following are recommendations for cleaning the HeartStart XLT and its asso ciated case cables etc Cleaning the HeartStart XLT The following cleaning products may be used to clean the exterior surfaces of the HeartStart XLT as well as the battery and data card e Isopropyl alcohol 70 in water e Mild soap and water e Chlorine bleach 3 in water e Quaternary ammonium compounds such as Lysol 10 in water When cleaning be sure to avoid pouring fluids on the device and do not allow fluids to penetrate the exterior surfaces of t
32. 13 15 Clinical Performance Summary Cardioversion eee 13 16 hio C 13 16 Results c C 13 16 encor 13 18 S fety Considerations ispire nieht senose fce tuum D autbdua Mti ba fua RUM du uta 13 19 Electromagnetic Compatibility uei aen success careexetetespedes tiie ee lenieee adtiabesdesacbedesiinensathteee 13 22 Reducing Electromagnetic Interference xgjccsiuss sceccteyscevasesndectauineesceseyecdnexsuzacacunsnaeaceeusd 13 22 Restrictions for WSS Ap aaa 13 23 lustig Level c 13 23 1 Introduction The M3500B HeartStart XLT Defibrillator Monitor is designed to meet your resuscitation and monitoring needs This guide provides instructions for safe and proper operation set up configuration and care of your HeartStart XLT In this chapter you ll find general information that you should become famil iar with before using the defibrillator monitor Overview The HeartStart XLT is a lightweight portable semi automatic external defibrillator It offers two modes of operation for defibrillation e Semi Automatic External Defibrillation AED Mode e Manual Mode Both modes incorporates a low energy SMART Biphasic waveform for defibrillation In AED Mode the HeartStart XLT analyzes the patient s ECG and advises you whether or not to deliver a shock Voice prompts guide you through t
33. 323 2280 M3500B HeartStart XLT Defibrillator Monitor 12 9 Calling for Service 12 10 Other International Areas Tel 131147 Tel 0803 35 34 33 Tel 0180 5 47 50 00 Tel 800 825087 Tel 31 20 547 2555 Tel 00 44 7002 432584 Fax 31 29 547 2949 Tel 32 2 525 7102 Tel 32 2 525 7103 Fax 322 525 7191 Fax 322 525 7191 Tel 34 902 30 40 50 Tel 48 22 5710499 Fax 34 91 326 39 66 Tel 43 1 60101 820 Tel 09 6158 0400 Tel 0800 80 10 23 Tel 7 095 933 0339 Fax 7 095 933 0338 Troubleshooting 13 Specifications amp Safety This section provides e Specifications for the HeartStart XLT e Symbol definitions for symbols appearing on the HeartStart XLT e A clinical performance summary e Safety related information and e Electromagnetic compatibility information M3500B HeartStart XLT Defibrillator Monitor 13 1 Specifications Specifications Defibrillator Waveform Biphasic Truncated Exponential Waveform parameters adjusted as a function of patient impedance Shock Delivery Via multifunction defib electrode pads Charge Time Less than 3 seconds to 200 Joules with a new fully charged M3516A SLA battery pack at 25 C Less than 15 seconds to 200 Joules when powered by a M3517A or M3518A power module with no battery installed Patient Impedance Range 25 to 180 Ohm Manual Mode Manual Output Energy Delivered 5 10 25 50 70 100 150 200 Jou
34. HR Alarm Disabling the HR Alarm If the heart rate is outside the HR alarm limits an alarm sounds To disable the alarm press HR ALARM appears to indicate that the alarm is disabled Adjusting the ECG Size To increase or decrease the size of the ECG press A or W on the gain con Troubleshooting Table 4 5 provides troubleshooting tips for ECG Monitoring Table 4 5 Troubleshooting Tips Situation Cause Solution Leads Off message e The monitoring elec e Check that the monitoring trodes are not applied electrodes are properly Or or are not making applied proper contact with the e Check that the monitoring dashed line patient cable is properly con e The monitoring cable is nected not connected Pads Off message e The pads are not mak e Check that the pads are ing proper contact with properly applied the patient M3500B HeartStart XLT Defibrillator Monitor 4 7 Troubleshooting 4 8 Table 4 5 Troubleshooting Tips Continued Situation Poor ECG signal quality Cause e The monitoring elec trodes are not making proper contact with the patient e The monitoring elec trodes are outdated or dried out e Radio frequency inter ference RFI is causing artifact Solution Check that the monitoring electrodes are properly applied If necessary pre pare the patient s skin and apply new electrodes Check the date code on the electrodes Do n
35. HeartStart XLT Defibrillator Monitor 10 13 Configuring the HeartStart XLT 10 14 Table 10 4 ECG Filter Settings Item Description Setting Choices AC Line Filter Selects the setting used to filter out 60 Hz 50 Hz AC line noise Pads ECG for Selects the display filter frequency Monitor 15 40Hz Display for the pads ECG EMS 1 30 Hz Pads ECG for Selects the printer filter frequency Monitor 15 40Hz Printer for the pads ECG EMS 1 30 Hz Leads ECG for Selects the display filter frequency Monitor 15 40Hz Display for the monitoring electrodes ECG EMS 1 30 Hz Leads ECG for Selects the printer filter frequency Diag 05 150 Hz Printer for the monitoring electrodes ECG EMS 1 30 Hz Monitor 15 40 Hz Setting Up and Configuring the HeartStart XLT Configuring the HeartStart XLT Modifying the Configuration To modify the configuration from the main menu Use A and WV to highlight the desired category of settings Press ENTER Use A and to highlight the item you want to change Press CHANGE Use the softkeys NEXT A or W to select the desired setting To Dee pe E select the default setting press mU F 6 Press SAVE to save the change To exit without making the change press CANCEL 7 Press MAIN to return to the main menu To make additional changes repeat steps 1 7 Returning to the Default Configuration l J simultaneously wh
36. Monitoring the ECG for information on how to apply elec trodes and select a lead M3500B HeartStart XLT Defibrillator Monitor 7 1 Preparing for Synchronized Cardioversion 7 2 Preparing for Synchronized Cardioversion In preparation for synchronized cardioversion 1 Apply multifunction defib electrode pads as directed on the package Use either the anterior anterior or anterior posterior placement as appropriate Connect the pads to the patient cable See Figure 6 2 Apply monitoring electrodes if desired See Applying Monitoring Elec trodes on page 4 2 If needed insert a Data Card as described in Using a Data Card on 2 11 Press On Enable Manual Mode See Enabling Manual Mode on page 6 2 Use sb to select the best lead that displays a large QRS complex See Selecting the Lead on page 4 5 Delivering a Synchronized Shock To perform synchronized cardioversion 1 Press to enable Sync Mode The green LED next to lights up and the message SYNC appears on the display gm aA Use the gain control Vy7 to adjust the ECG size so that the marker dot appears only once with each R wave If necessary change the energy setting the default setting is 150 joules by pressing ENERGY repeatedly until the desired energy level is displayed The choices are 5 10 25 50 70 100 150 or 200 joules Press CHARGE Wait until the current charge has reached the energy level s
37. PHILIPS HEARTSTART XLT HEARTSTART XLT INSTRUCTIONS FOR USE er _ Instructions for Use M3500B HeartStart XLT Defibrillator Monitor PHILIPS Notice About This Edition Edition 3 Printed in the USA Publication number M3500 91900 The information in this guide applies to the M3500B HeartStart XLT release Main 35 and earlier This information is subject to change without notice Philips Medical Systems shall not be liable for errors contained herein or for incidental or consequential damages in connection with the furnishing perfor mance or use of this material Edition History Edition 1 January 3 2000 Edition 2 May 15 2000 Edition 3 October 30 2002 Copyright Copyright 2002 Philips Electronics North America Corporation 3000 Minuteman Road Andover MA USA 01810 1099 978 687 1501 All rights are reserved Reproduction in whole or in part is prohibited without the prior written consent of the copy right holder SMART Biphasic is a registered trade mark of Philips Medical Systems ii Use of supplies or accessories other than those recommended by Philips Medical Systems may compromise product performance THIS PRODUCT IS NOT INTENDED FOR HOME USE IN THE U S FEDERAL LAW RESTRICTS THIS DEVICE TO SALE ON OR BY THE ORDER OF A PHY SICIAN Medical Device Directive The M3500B HeartStart XLT Defibril lator Monitor complies with the requirements of the Medical Device Di
38. an 00 12 41 00 Analyzing 12 41 03 Shock Advised 12 41 11 Last Event 03 Jan 00 01 09 04 Shock 1 12 41 17 Analyzing 12 41 24 Total Shocks 2 Shock Advised 12 41 31 Incident 0000045 Shock 2 12 41 38 Serial Number 123456789 Manual Mode 12 41 42 9 6 Storing Retrieving amp Printing Printing the Internal Event Summary The Event Summary also includes waveforms and the appropriate annotation for each of the following events Table 9 3 Event Waveform Information Event Waveform Description Shock Advised 11 seconds of ECG just prior to the message Shock Advised No Shock Advised 11 seconds of ECG just prior to the message No Shock Advised Cannot Analyze 11 seconds of ECG just prior to the message Cannot Analyze Shock Delivered 11 seconds 3 seconds prior to the shock plus 8 seconds after the shock Print Strip 11 seconds 3 seconds prior to Sip being pressed plus 8 seconds after Print Strip is pressed Mark Event sa 11 seconds 3 seconds prior to Sie being pressed plus 8 seconds after Mark Event is pressed ECG or SpO Alarm 11 seconds 3 seconds prior to the alarm plus 8 seconds after the alarm M3500B HeartStart XLT Defibrillator Monitor 9 7 Printing Events Printing Events The HeartStart XLT can be configured to print automatically when certain events occur The table below lists these events and the length of the strip printed depending on whether the print
39. art XLT is shipped to you in its carrying case with most of the accessories in their compartments All you need to do before getting started is e connect cables e connect to power and e insert the Data Card if desired This chapter will acquaint you with the HeartStart XLT and then guide you through these activities NOTE To connect cables to the HeartStart XLT or to arrange accessories in the carry ing case refer to Setting Up and Configuring the HeartStart XLT in Chapter 10 Getting Acquainted This section shows the HeartStart XLT controls buttons connections and dis play layout An overview of control functions is also provided NOTE If your HeartStart XLT does not have the SpO or Pacing option disregard these controls and the related information described in this section M3500B HeartStart XLT Defibrillator Monitor 2 1 Getting Acquainted Basic Orientation The figure below shows the general layout of the controls where the patient cables connect and where to insert the battery and Data Card Figure 2 1 Basic Orientation Audiovisual Controls Printer ECG Connector Print Controls Monitoring Controls Connector Manual Mode Defibrillation Controls Controls Speaker Ambient Light Sensor Pads Connector Module Connector 2 2 Getting Started Getting Acquainted Powers on the HeartStart XLT Powers off the HeartS
40. ata Card 10 16 Configuration Lost message 12 2 Continued Use feature 9 5 Controls 2 2 CPR 3 12 Data Card 2 11 downloading and erasing information 9 1 inserting and removing 2 12 ordering 11 20 saving and loading settings 10 16 specifications 13 8 troubleshooting 12 2 12 6 Date 10 9 12 8 DC Power Module See Power modules Default settings See Configuration Defib Disarmed message 12 5 Defib electrode pads See Pads Defibrillation 1 1 AED Mode 3 3 3 6 defined 1 3 Manual Mode 6 4 pacing 8 6 Defibrillation controls 2 3 Defibrillator See HeartStart XLT ii E Device Initiated Analysis settings 3 4 10 11 Display AED Mode 2 7 controls 2 2 layout 2 5 Manual Mode 2 8 specifications 13 5 troubleshooting 12 8 ECG analysis See Analysis ECG cables cleaning 11 14 connecting 10 4 ordering 11 20 See also Cables ECG electrodes See Electrodes ECG Fault message 12 2 ECG Filter Settings 10 14 ECG monitoring 4 1 controls 2 3 electrodes 4 2 10 10 events recorded 9 3 heart rate alarm 4 6 leads 4 5 settings 10 10 10 12 10 14 signal quality 4 8 size 4 7 specifications 13 4 synchronized cardioversion 7 1 troubleshooting 4 7 Electrode pads See Pads Electrodes applying 4 2 checking 11 3 cleaning 11 14 ordering 11 20 placing 3 5 4 3 settings 10 10 Electromagnetic compatibility EMC 13 22 Environmental specifications 13 9 safety precautions 13 20 13 21 Erratic spikin
41. ation or e offer recommendations A System Message remains on the display until the condition that generated the message no longer exists A Momentary Message is temporary and appears on the display for only a few seconds A list of messages is provided in Chapter 12 M3500B HeartStart XLT Defibrillator Monitor 2 7 Getting Acquainted 2 8 Figure 2 5 Manual Mode Display Layout Lead Displayed SpO value LEAD IHR ALARM SELECT ER SPO2 Heart Rate e 1324 RR SpO alarm HR Alarm Pleth Bar System Message Pulse Rate Momentary Message ECG 114J Current Charge Shocks 0 Shocks Delivered Selected Energy gt 150J 00 15 02 Incident Timer Defibrillation ENERGY CHARGE SHOCK Softkeys SELECT in i LCD Backlight Under normal operation the HeartStart XLT reads the ambient light and turns on the LCD back light when low light conditions exist To turn on the back light at other times press A and W on 2 simultaneously To return to normal operation press the same keys again The back light also returns to normal operation each time you turn the HeartStart XLT on Getting Started Connecting to Power Connecting to Power The HeartStart XLT is powered by the M3516A battery Prior to inserting the battery make sure that the battery is charged and has been properly main tained See Battery Maintenance on page 11 8 A fully charged battery will last for about two hours A second spar
42. ause Resume Analyze Stop Analysis Shock Lead Select SpO HR Alarms Display Contrast ECG Gain Volume Print Strip Print Summary Annotated Mark Event Manual Mode Entry Indicators LCD Display for ECG waveform and text prompts Audio Alerts Voice Prompts QRS Beeper Charging Tone Charge Done Tone 1 3 Printer Armed Indicators Charge Done Tone Available Energy indicated on display Voice Message Patient Analysis Per protocol evaluates patient ECG and signal quality to determine if a shock is appropriate and evaluates connection impedance for proper defibrillation pad contact Shockable Rhythms Ventricular fibrillation with amplitude gt 100 uV and wide complex ventricular tachycardia with rates greater than 150 bpm Sensitivity and Specificity Meets AAMI guidelines M3500B HeartStart XLT Defibrillator Monitor 13 3 Specifications ECG Monitoring Inputs Single channel ECG may be viewed on display and printed PADS ECG is obtained through two multifunction defibrillation electrode pads Lead I I or III is obtained through the 3 lead ECG cable and separate moni toring electrodes With a 5 lead cable lead aVR aVL aVF or V can also be obtained Lead Fault LEADS OFF message and dashed line appear on the monitor if a lead electrode or wire becomes disconnected Pad Fault PADS OFF message and dashed line appear on the monitor if a pad becomes disconnected Heart Rate Display Digital readout on display
43. begins when you receive a new battery and continues throughout the life of the battery Detailed information on battery care is provided in the application note About Sealed Lead Acid Batteries that came with your HeartStart XLT Table 11 2 lists battery maintenance activities and when they should be per formed Table 11 2 Battery Maintenance Activities Activity When to Perform Perform a visual inspection Daily as part of the Shift System Check Charge the battery Upon receipt after each use and when the message Low Battery is displayed Perform a Battery Capacity Test Every three months Store the battery appropriately When not in use Charging Batteries You may charge batteries while they are in either the HeartStart XLT or the M3506A Battery Charger Adapter by connecting the device with the battery to the M3517A AC Power Module Refer to the charging procedures provided in the operating instructions for the power module s you use Batteries charge to 90 of their capacity in about 2 5 hours It then takes about 12 more hours to reach a fully charged state Batteries should be charged at temperature between 10 C 50 F and 30 C 86 F for maximum battery life Maintaining the HeartStart XLT CAUTION WARNING Battery Maintenance Battery Capacity A fully charged M3516A battery operating at room temperature provides greater than 2 7 hours of monitoring or more
44. bling Manual Mode From AED Mode press to enable Manual Mode If prompted use the softkeys above the display to enter the password Figure 6 1 Manual Password Display Enter Password Shocks 3 00 00 49 msswom i EXIT To return to AED Mode without entering a password press PASSWORD Once Manual Mode is enabled the green LED next to is lit In its default configuration the HeartStart XLT powers on into AED Mode If you prefer you can configure it to power on into Manual Mode You have the option to require users to enter a password in order to enable Manual Mode from AED Mode See Configuring the HeartStart XLT on page 10 7 Use of a password for Manual Mode is recommended as a safety measure to deter untrained personnel from entering Manual Mode Defibrillating in Manual Mode Preparation Preparation In preparation for defibrillation 1 Apply multifunction defib electrode pads as directed on the package Use either the anterior anterior or anterior posterior electrode placement as appropriate Connect the pads to the pads patient cable as shown in Figure 6 2 3 If needed insert a Data Card as described in Using a Data Card on 2 11 4 Press On 5 Enter Manual Mode if AED Mode is active Figure 6 2 Connecting Pads to the Patient Cable NOTE Defibrillation is always performed through pads However during defibrilla tion you may choose to monitor ECG using an alternate
45. ccessories in the Carrying Case 2 erae pesc Io RR p UHR NK ba cee 10 6 Configuring the HeartStart XLT pP 10 7 Accessing the Configuration Menu sssssesseessssressesressrseresresstesrerresseteresrenserseesreesresee 10 7 Configurable Param t rs ca ceased qer toin bota Serie a Da aeque ne dy teaatacatlacacpeatedeadsvuatecaceuuuars 10 8 Setting the Manual Mode Password essssssecesscecesececeeeeeceseeecseneeceeeesseeeeseeeeesaeees 10 13 Modifying the Contigurati n ysccceyevnca neces aestasneslevtvetedetaidae a a i 10 15 Returning to the Default Configuration 2 026 cccsecesccesecessoesscensqeeeeesenasesecenssecessonsdonente 10 15 Saying Settings t a Data Card uices eek oci pue nic Iia EE a 10 16 Loading Settings from a Data Card 2 tedatcnus uii putet tpa pte pub eec adds dud b edu adeat 10 16 Printing Settings e aas 10 16 Maintaining the HeartStart XLT viii Operational MECH scrissi airaa oi aces a aa a 11 2 Before You BESU Maree eee meer n e nn Mere DEE MST a E diu ni meer oe 11 2 Every HUE e melanie 11 3 Every Month e 11 3 Every bres Months ao aae odi dept as or risu bass aei esu Lua esu ED Ee E MERE 11 3 Shifty S ystems Check qe 11 4 Battery Capacity TOSECG T suia v da Qe ta E ata ae 11 7 Battery WAU SAO coole bio Lens peu ibo ad a aai bi iva s tub pe secte due 11 8
46. cing and patient skin burns during defibrillation and may divert current away from the heart During defibrillation air pockets between the skin and multifunction defib electrode pads may cause patient skin burns To help prevent air pockets make sure the pads completely adhere to the skin Do not use dried out pads do not open pads package until just prior to use Never touch the patient or any equipment connected to the patient including the bed or gurney during defibrillation Do not operate the HeartStart XLT in standing water When using the HeartStart XLT in wet environments make sure the Data Card door is securely shut Do not immerse or pour fluids on any portion of the HeartStart XLT Do not use the HeartStart XIT in a flammable or oxygen rich atmosphere This can cause an explosion hazard Avoid connecting the patient to several devices at once Leakage current limits may be exceeded Do not use a second defibrillator on the patient while pacing with the HeartStart XLT Specifications amp Safety Safety Considerations WARNING Avoid contact between the patient and conductive fluids and or metal objects such as the gurney Contact with metal objects could cause unintentional current path ways WARNING Operating the HeartStart XLT or its accessories in conditions outside the environ mental specifications can result in device or accessory malfunction WARNING Avoid exposing the display to direct sunli
47. ctive in Manual Mode In AED Mode ECG mon itoring is only active if Lead Select is configured to on the default is off A fully charged battery provides approximately 2 7 hours of continuous mon itoring This chapter describes how to apply monitoring electrodes select the lead to monitor and set a heart rate HR alarm To apply multifunction defib elec trode pads follow the directions on the pads packaging For information on printing storing and retrieving patient information acquired while monitor ing see Chapter 9 NOTE If you need to connect the ECG cable to the HeartStart XLT or configure the HeartStart XLT to use the optional 5 lead monitoring cable see Chapter 10 M3500B HeartStart XLT Defibrillator Monitor 4 1 Applying Monitoring Electrodes Applying Monitoring Electrodes Proper application and placement of electrodes is essential for reliable moni toring Good contact between the electrode and the skin reduces the effects of motion artifact and signal interference To apply electrodes 1 Identify the appropriate electrode sites See Figure 4 1 2 Shave the electrode sites or clip hair if necessary 3 Clean and abrade the skin at the electrode sites 4 Dry the skin at the electrode sites 5 Open a new package of M2202A Radio Translucent Monitoring Elec trodes verify that the Use Before date has not passed 6 Snap the lead wires onto the electrodes 7 Apply the electrodes by peel
48. dial Lead Electrode Placement Location forth intercostal space at right sternal forth intercostal space at left sternal midway between V2 C2 and V4 C4 fifth intercostal space at left midclav same level as V4 C4 on anterior axil Electrode VI CI v2 C2 V3 C3 V4 C4 V5 C5 V6 C6 same level as V4 C4 at left mid axil Table 4 2 5 Lead ECG Lead Formation Lead Lead Formation I LA RA II LL RA III LL LA aVR LA LL mS 2 VF RA LA a ic 2 aVL RA LL LA 2 V RA LA LL x or C4 VIC where x 1 6 Monitoring the ECG Selecting the Lead Selecting the Lead Available monitoring leads are dependent upon your device configuration Table 4 3 Lead Select Choices Lead Select Choc dre If Configured for a Pads Lead I Lead II Lead III 3 lead ECG cable Pads Lead I Lead II Lead III aVR 5 lead ECG cable aVL aVF V lead To select a lead to monitor cycle through the choices by pressing chr until the desired lead is displayed NOTE When V lead is selected change to a different V lead by moving the electrode to a new location rather than by pressing the sh softkey Figure 4 3 ECG Monitoring Display Y 78 redu Monitoring Rhythm Shocks 3 00 00 49 If the desired lead is not connected or the electrodes are not making proper contact with the patient the message Lead
49. e charged battery should be kept in the carrying case at all times The HeartStart XLT can also be powered by the M3517A AC Power Module or the M3518A DC Power Module However the defibrillator will take longer to charge when powered by a power module with the battery absent The rec ommended practice when using a power module is to use the module in con junction with a battery For information on using the power modules see the documentation supplied with the modules NOTE To save battery capacity the HeartStart XLT shuts itself off if a patient is not being monitored and no one has interacted with the device for 10 minutes Inserting the Battery To insert the battery slide it into the battery receptacle as shown in Figure 2 6 Then push the battery in until you hear an audible click Figure 2 6 Inserting the Battery M3500B HeartStart XLT Defibrillator Monitor 2 9 Connecting to Power 2 10 Removing the Battery Before removing the battery make sure the HeartStart XLT is powered off Then to remove the battery press the black battery eject button and pull the battery out as shown in Figure 2 7 Figure 2 7 Removing the Battery Low Battery Warning The message Low Battery is displayed on the HeartStart XLT when the battery is low and needs recharging This message indicates that the battery has suffi cient remaining capacity to provide only about ten minutes of monitoring time and six shocks befo
50. e defibrillator press DISARM If SHOCK is not pressed in 30 sec onds the defibrillator disarms automatically If additional shocks are indicated repeat the defibrillation process WARNING Defibrillation current can cause operator or bystander injury Do not touch the patient or equipment connected to the patient during defibrillation M3500B HeartStart XLT Defibrillator Monitor 6 5 Returning to AED Mode Returning to AED Mode To enable AED Mode from Manual Mode press Canal The green LED next to goes out indicating Manual Mode is no longer active If ECG and or SpO monitoring are enabled in AED Mode alarms set in Manual Mode remain active when you switch to AED Mode 6 6 Defibrillating in Manual Mode 7 Performing Synchronized Cardioversion Synchronized cardioversion is a Manual Mode function that allows you to synchronize the defibrillator shock with the R wave of the ECG being moni tored During synchronized cardioversion the ECG being monitored is shown on the display and may be derived from e the multifunction defib electrode pads or e the3 or 5 lead monitoring electrodes When selecting a lead choose the best lead that displays a large QRS com plex The synchronized shock is delivered through the mulifunction defib electrode pads regardless of the lead being monitored This chapter describes how to perform synchronized cardioversion with the HeartStart XLT NOTE See Chapter 4
51. e professionals trained in advanced car diac life support Defibrillation Therapy Defibrillation therapy is the definitive method for termination of a variety of potentially fatal arrhythmias The HeartStart XLT provides this therapy through the application of a brief biphasic pulse of electricity to the cardiac muscle This electrical energy is transferred through disposable multifunction defib electrode pads applied to the patient s bare chest NOTE Successful resuscitation is dependent on many variables specific to the patient s physiological state and the circumstances surrounding the patient event Failure to have a successful patient outcome is not a reliable indicator of defibrillator monitor performance The presence or absence of a muscular response to the transfer of energy during electrical therapy is not a reliable indicator of energy delivery or device performance Indications for AED Therapy An AED is to be used in the presence of a suspected cardiac arrest on patients that are e Unresponsive e Not breathing e Pulseless M3500B HeartStart XLT Defibrillator Monitor 1 3 Defibrillation Therapy Contraindications for AED Therapy An AED is not to be used on patients that exhibit one or any combination of the following e Responsiveness e Spontaneous breathing e Palpable pulse Precautions for AED Therapy The AED algorithm is not designed to handle erratic spiking problems caused by a properly o
52. eart rate 4 6 8 2 interruption of power 9 5 SpO2 monitoring 5 8 symbols 13 11 Analysis 3 8 AED Mode 3 8 re analysis 3 11 settings 3 4 Artifact Detected message 3 18 Asynchronous defibrillation 1 4 Asystole 1 5 pacing 1 5 Attach Pads message 12 5 Audiovisual controls 2 2 2 3 Automatic Re analysis 3 11 setting 3 4 10 11 Index B Batteries 1 2 2 9 charging 11 8 checking 11 6 inserting and removing 2 9 maintenance 11 8 operational checks 11 3 ordering 11 21 specifications 11 9 13 6 storing and discarding 11 9 symbols 13 10 troubleshooting 12 2 See also Power supply Battery Capacity Test 11 7 Battery charger 11 21 Bradycardia 1 5 Index C Cables checking 11 5 cleaning 11 14 connecting 2 2 3 6 ECG 10 4 Pads 3 6 10 2 SpO2 5 6 10 5 Cal Pulse 2 3 Carrying case arranging accessories in 10 6 cleaning 11 12 ordering 11 21 removing amp replacing 11 15 Check Patient Timer setting 10 11 Check Printer message 12 5 Cleaning carrying case 11 12 HeartStart XLT 11 12 pads electrodes amp cables 11 14 power modules 11 13 printer printhead 11 13 Clinical Performance 13 14 13 16 Configuration 10 7 accessing menu 10 7 AED Mode 3 4 Automatic Re analysis 3 4 default 10 15 Device Initiated Analysis 3 4 ECG filters 10 14 heart rate alarm 4 6 list of configurable items 10 8 modifying 10 15 password 10 13 printing settings 10 16 Rhythm Monitoring 3 4 3 14 saving and loading from D
53. ectrical or optical interference Sp0 Sensor Fail The SpO transducer is broken Try another sensor 12 4 Troubleshooting Momentary Messages System Messages Momentary messages are temporary and only appear on the display for a few seconds Each message is accompanied by a three second beep to alert you Table 12 2 lists momentary messages Table 12 2 Momentary Messages Message Attach Pads Possible Cause The multifunction defib electrode pads are not making proper contact with the patient Corrective Action e Check the pads are applied to the patient as directed on the pads pack age e Replace the pads if the prompt contin ues Attach Leads An attempt was made to begin pacing in Demand Mode without ECG leads attached to the patient Attach leads to patient Defib Disarmed e The pads connection is compromised e The mode is changed from Manual to AED while the defibrillator is charged e SHOCK is not pressed within 30 sec onds of the defibrillator being charged e DISARM is pressed e Check the pads are applied to the patient properly e lfashock is indicated deliver the shock before changing modes e To deliver a shock press SHOCK within 30 seconds of the defibrillator being charged No Shock Delivered Patient impedance is too high e Make sure the pads are applied prop erly e Replace the pads if necessary Check Printer Pri
54. eeds of diverse users The messages and softkeys vary depending on how the HeartStart XLT is configured Be sure to familiarize yourself with your con figuration before using the HeartStart XLT see Configuring the HeartStart XLT on page 10 7 The HeartStart XLT is powered by a rechargeable sealed lead acid SLA bat tery that allows the defibrillator to charge to 200 joules in less than three sec onds Proper care of your batteries will ensure that they have the energy required to operate the HeartStart XLT and to deliver the appropriate therapy See Battery Maintenance on page 11 8 Similarly following the specified operational checks will ensure that the HeartStart XLT is functioning and ready for use See Operational Checks on page 11 2 Introduction Intended Use Intended Use The M3500B HeartStart XLT Defibrillator Monitor is for use by emergency personnel trained in the operation of the device and qualified by training in basic life support advanced cardiac life support defibrillation or other physi cian authorized emergency medical response It must be used by or on the order of a physician When operating as a semi automatic external defibrillator in AED Mode the HeartStart XLT is suitable for use by health care professionals trained in basic life support that includes the use of an AED When operating as a defibrillator monitor in Manual Mode the HeartStart XLT is suitable for use by health car
55. eeressessees 1 4 Precautions for AED Therapy seccccanctecsceuleasescsuseauasveaddchaseeuddaeptatuestsvenencevauedanentcveeebearendiete 1 4 Indications for Manual Defibrillation Therapy eee 1 4 Contraindications for Manual Defibrillation Therapy eee 1 5 Precautions for Manual Defibrillation Therapy eene 1 5 Noninvasive Pacing lici d at 1 5 lrsicniten Merc CENSENT 1 5 COMM ALI C der 1 5 RN Monitorning siseringi a ses sioen 1 6 inicio ct ese octets seca karen a RE AA E A AA E T R E 1 6 CODIEGTDOICOEIGTIS sissien iE E EEEE E A A 1 6 Learning to Use the HeartStart XLT ssseesdebetquectduime sette ico pad beta iun du idt pii ni ae Gas ilc RM eC 1 7 Safety Considerations M 1 7 Getting Started Getting ACQUALRBO 3e iodii Pedro aqu m Dude uM eme dti 2 1 Basie Oreilles eoa one noe manera dodenus iai eia idum T A dina UR i Ma Nee 2 2 Manual M d rode C ctc 2 4 LCD Backlight M M 2 8 Connecting to POWBE ce aca a teat dees ceca Mic saanee nieee ba n aiee soia aa risie stude 2 9 Toserting the Battery ie e pee baee Ia deu De eti EIU Hb De S tesi e tbe dei KESSE 2 9 Removing th Battery MR euestuaceevelueas 2 10 ocu rl ME 2 10 Usina Data C ard E R 2 11 Inserting a Data Cafta E 2 12 Removing a Data Card ied tto Depuis d
56. elected and you hear a continuous charge done tone Performing Synchronized Cardioversion Delivering a Synchronized Shock Figure 7 1 Charging in Sync Mode 87 J Shocks 0 Sync 00 00 8 ENERGY corer DSAM If desired you may increase or decrease the selected energy level after pressing CHARGE by pressing ENERGY repeatedly until the desired energy level is displayed The defibrillator charges to the modified energy level automatically Wait until the current charge reaches the selected energy level before proceeding 5 Make sure no one is touching the patient or anything connected to the patient Call out Clear Then press SHOCK and continue to hold SHOCK down until the shock is delivered The defibrillator shocks with the next detected R wave WARNING Defibrillation current can cause operator or bystander injury Do not touch the patient or equipment connected to the patient during defibrillation M3500B HeartStart XLT Defibrillator Monitor 7 3 Disabling Sync Mode 7 4 Delivering Additional Synchronized Shocks If additional synchronized shocks are indicated make sure Sync Mode is still enabled and repeat steps 2 5 In its default configuration the HeartStart XLT remains in Sync Mode after a shock is delivered as indicated by the message Sync on the display and the lighted green LED next to CSync 5 The HeartStart XLT can be configured to exit Sync Mode after each shock is delivered
57. er is configured to print real time or with a 6 second delay Table 9 4 Printing Events Real Time Delayed Event a Strip Length Strip Length Defibrillator charges continuous 6 seconds just prior to charging plus continuous printing throughout the charge duration Shock Delivered 12 seconds 6 seconds just prior to shock plus 12 seconds after shock Shock Failed 6 seconds 6 seconds just prior to the message No Shock Delivered plus 6 seconds after the message Defibrillator disarmed 6 seconds 6 seconds just prior to shock plus 6 seconds after shock Alarm Violation 6 seconds 6 seconds just prior to alarm viola tion plus 6 seconds after alarm vio lation Mark pressed 6 seconds 6 seconds just prior to marking plus 6 seconds after button pressed Printing is configured independently for each of these events You can stop the printing before it has printed the entire strip by pressing Siint To print additional events that you observe in the course of caring for your patient press Sant An ECG strip will print continuously until you press Sip a second time to stop printing If the printer is configured to have a 6 second delay the printout contains an additional 6 seconds of the ECG that occurred just prior to pressing Sti Storing Retrieving amp Printing 10 Setting Up and Configuring the HeartStart XLT This chapter describes how to set up and configure your HeartStart XLT It
58. f To resume pacing refer to Pacing on page 8 4 When you resume the rate mode and output settings start at the settings selected prior to defibrillation Pacing Troubleshooting Troubleshooting The table below lists the pacing related system and momentary messages that you may encounter during pacing Table 8 1 Pacing System Messages Message Leads Off Possible Cause e The selected monitoring lead is not making proper contact with the patient e Pacing was attempted in demand mode without monitoring electrodes attached Corrective Action e Check that the monitoring electrodes are properly applied e Check that the monitoring cable and electrodes are properly connected Pacer Failure The pacing system is not func tioning Remove the device from active use and call for service Pacer Output Low High patient impedance is resulting in the delivery of less current to the patient than specified in the output current setting Check that the pads are applied properly Stop Pacer C Mod 2 is pressed while paced pulses are being deliv ered Stop pacing before changing the pacing mode Key Inactive ES pacing function keys is pressed when Manual Mode is not active Make sure Manual Mode is active before pressing CP er or one of the other pacing function keys M3500B HeartStart XLT Defibrillator Monitor 8 7 9 Stor
59. f Rhythm Monitoring on 3 2 Defibrillating in AED Mode Overview Overview An overview of the AED Mode defibrillation process is shown in Figure 3 1 The process begins only after you have e assessed that the patient is unresponsive not breathing and pulseless and e prepared for defibrillation by attaching pads and inserting a Data Card if desired Then you are ready to turn the HeartStart XLT on The defibrillation process is dependent upon the configuration of your HeartStart XLT as described in the following paragraphs Defibrillation with the default configuration In its default configuration the defibrillation process is Press the On button The HeartStart XLT checks to see if the pads patient cable and multi function defib electrode pads are properly connected If either con nection is compromised you are prompted to fix the problem X Analysis begins automatically there is no need to press ANALYZE Once analysis is complete the HeartStart XLT tells you Shock Advised or No Shock Advised jJ If a shock is advised press SHOCK After the first shock is delivered the HeartStart XLT automatically begins analyzing the ECG and the process repeats until a shock series is complete or no shock is advised At this point you are prompted to check the patient M3500B HeartStart XLT Defibrillator Monitor 3 3 Overview 3 4 Defibrillation with a modified configuration
60. g 1 4 European 10 11 F Index European Protocol 10 11 Event Review 2 11 Event Summary 9 1 events recorded 9 3 information included 9 6 interruption of power 9 5 marking events 9 2 printing 9 6 9 8 specifications 13 8 Failure message 8 7 H Heart rate alarm disabling 4 7 events recorded 9 3 interruption of power 9 5 pacing 8 2 settings 4 6 specifications 13 4 See also ECG monitoring HeartStart Event Review 9 1 iii Index iv HeartStart XLT 1 1 assessment of 1 3 cleaning 11 12 configuring 10 7 controls 2 2 operational checks 11 3 11 4 safety precautions 13 20 specifications 13 2 13 8 symbols 13 10 training materials 1 7 training required 1 3 troubleshooting 12 7 HR alarm See Heart rate alarm Hypothermia pacing 1 5 SpO2 monitoring 5 1 Incident number See Event Summary Incident Timer 2 6 Incompatible Data Card message 12 6 Indications for use AED mode 1 3 Manual Mode 1 4 pacing 1 5 SpO2 monitoring 1 6 INOP Alerts 13 7 Key Inactive message 3 18 8 7 12 6 Leads formation 4 3 Lead Select setting 10 12 selecting 4 5 7 1 8 3 troubleshooting 4 7 8 7 12 2 Leads Off message 4 7 8 7 12 2 Loading printer paper 11 10 settings from Data Card 10 16 Low Battery message 12 2 Maintenance batteries 11 8 carrying case 11 15 cleaning 11 12 operational checks 11 2 supplies and accessories 11 18 Manual Mode 6 1 controls 2 2 2 4 current c
61. g may be required due to an individual patient s condition M3500B HeartStart XLT Defibrillator Monitor 5 5 Connecting the Sensor Cable Connecting the Sensor Cable To connect a sensor cable 1 Hold the connector with the flat side up so that the part number is visible 2 Insert the connector into the receptacle and push until the blue portion of the connector is no longer visible Figure 5 2 Connecting the Sensor Cable 5 6 Monitoring SpO Monitoring Monitoring To monitor SpO gt If the HeartStart XLT is not on press On Apply the appropriate sensor to the patient SS Make sure the sensor cable is connected to the HeartStart XLT 4 Press Sp 0 to turn on SpO monitoring A dashed line is displayed under Sp0 while the oxygen saturation is measured and an SpO value is calculated In a few seconds the SpO value is displayed in place of the dashed line As the patient s oxygen saturation changes the SpO value is updated continuously Figure 5 3 Sp0 Monitoring Display LEAD mex IET T ses Monitoring Rhythm Shocks 3 00 00 49 To the right of the SpO value a pleth bar and SpO alarm indicator are dis played The pleth bar should be observed for fluctuation It is an indication of pulsation detected by the sensor The pleth bar should not be used as the sole indicator of pulsation because it can be influenced by movement and artifact The AY symbol indicates no alarm is set Bel
62. gh arterial beds Hemoglobin absorbs these lights differently when it is bound with oxygen Pulse oximetry mea sures this difference and translates the measurement into a saturation percent age that is displayed as an SpO reading Indications SpO monitoring is indicated for use when it is beneficial to assess a patient s oxygen saturation level Contraindications None known NOTE Readings should be carefully considered in the presence of certain circum stances Inaccuracies may result from the use of pulse oximeters in the pres ence of certain circumstances such as hemoglobin saturated with compounds other than oxygen such as carbon monoxide hypothermia hypovolemia patient movement nail polish and excessive ambient light Introduction Learning to Use the HeartStart XLT Learning to Use the HeartStart XLT The HeartStart XLT comes with e Using the HeartStart XLT Defibrillator Monitor a videotape and e About Sealed Lead Acid Batteries an application note on battery maintenance For additional training materials please visit our website at www medical philips com cms Safety Considerations General warnings and cautions that apply to use of the HeartStart XLT are provided in Chapter 13 Additional warnings and cautions specific to a partic ular feature are provided in the appropriate section of this guide M3500B HeartStart XLT Defibrillator Monitor 1 7 2 Getting Started Your HeartSt
63. ght on a hot day Overheating can occur and cause the display to black out making the HeartStart XLT temporarily unusable WARNING Medical electrical equipment which does not incorporate defibrillator protection should be disconnected during defibrillation WARNING Electric shock hazards exist internally Do not remove assembly screws Refer ser 13 vicing to qualified personnel CAUTION This device has not been evaluated for use with electrosurgery equipment M3500B HeartStart XLT Defibrillator Monitor 13 21 Electromagnetic Compatibility WARNING 13 22 Electromagnetic Compatibility When using the M3500B defibrillator monitor with or without the M3517A AC Charger electromagnetic compatibility with surrounding devices should be assessed A medical device can either generate or receive electromagnetic interference Testing for electromagnetic compatibility EMC of the M3500B with and without the appropriate accessories has been performed according to the inter national standard for EMC for medical devices IEC 60601 1 2 This IEC standard has been adopted in Europe as the European Norm EN 60601 1 2 The EMC standards describe tests for both emitted and received interference Emission tests deal with interference generated by the device being tested According to the EMC standards the M3517A AC Power Module does not generate interference Radio frequency RF interference from nearby transmitting devices may degrade perfor
64. harge 6 4 defibrillation process 6 4 delivering shock 6 5 display 2 5 2 8 ECG monitoring 4 1 enabling 2 5 6 2 energy setting 6 4 Events Summary 9 2 indications for use 1 4 overview 1 1 password 10 13 preparation 6 3 returning to AED Mode 6 6 settings 10 10 specifications 13 2 SpO2 monitoring 5 1 training required 1 3 Marking events 9 2 See also Event Summary Messages defined 2 7 list of 12 2 Momentary messages 2 7 list of 12 5 Monitoring See ECG monitoring Monitoring electrodes See Electrodes Monitoring Rhythm See Rhythm Monitoring Multifunction defib electrode pads See Pads Nellcor sensors 5 3 No Data Card Present message 12 6 No Pads message 12 3 No Shock Advised Timer 3 17 10 12 No Shock Delivered message 3 18 12 5 Non Pulsatile message 5 10 5 11 Noninvasive transcutaneous pacing See Pacing Operational checks 11 2 Output Low message 8 7 Oxygen saturation See SpO2 monitoring Pace Pulse Markers 10 10 Pacemakers AED therapy 1 4 heart rate alarm 4 6 Pacing 8 1 defibrillation 8 6 defined 1 5 8 1 demand v fixed mode 8 2 8 4 8 6 ECG monitoring 8 2 events recorded 9 4 function buttons 2 5 indications for use 1 5 messages 12 3 preparation 8 3 procedure 8 4 selecting leads 8 3 8 7 specifications 13 7 system messages 8 7 troubleshooting 8 5 8 7 12 6 Index Pads applying 3 6 13 19 13 20 cleaning 11 14 ECG monitoring 4 1 4 7 events recorded 9 3 safe
65. he defibrillation process by providing instructions and patient information The voice prompts are reinforced by messages that appear on the display In Manual Mode the HeartStart XLT turns control of the defibrillation pro cess over to you You assess the patient s ECG decide if defibrillation is advised and select the energy setting for defibrillation Manual Mode also allows you to perform synchronized cardioversion and offers optional nonin vasive pacing M3500B HeartStart XLT Defibrillator Monitor 1 1 Overview 1 2 Defibrillation is performed through multifunction defib electrode pads In addition both AED and Manual Mode offer monitoring through pads 3 lead ECG monitoring electrodes or optional 5 lead ECG monitoring electrodes Optional pulse oximetry SpO monitoring is available in both modes as well While monitoring ECG or SpO you may set heart rate and or SpO alarms to alert you when these parameters are outside the limits defined The HeartStart XLT automatically stores critical events such as shocks and alarm violations in its internal memory Additional events of interest to you may be marked for storage as well Events may be printed as they occur or an Event Summary may be printed at any time The HeartStart XLT also allows you to store data and events on a Data Card for downloading to HeartStart Event Review Data Management systems The versatile HeartStart XLT is highly configurable to better meet the n
66. he device Use of a soft cloth is recommended for cleaning the display to prevent scratching CAUTION 11 12 The HeartStart XLT may not be autoclaved ultrasonically cleaned or immersed Do not use abrasive cleaners or strong solvents such as acetone or acetone based cleaners Cleaning the Carrying Case Clean the carrying case by hand using a mild soap and water A brush may be used on stubborn spots and a fabric cleaner may be used to remove grease spots Air dry the carrying case when cleaning is complete If it is necessary to remove the carrying case for cleaning refer to directions on page 11 15 Maintaining the HeartStart XLT Cleaning Instructions Cleaning the Printer Printhead If the printout has light or varying density printing clean the printhead to remove any buildup of paper residue 1 1 To clean the printhead 1 Slide the printer door to the right until the paper roller pops up 2 Pull up on the plastic removal tab to remove the roll of paper 3 Clean the printhead surface above the brush with a cotton swab dipped in rubbing alcohol 4 Replace the roll of paper see Loading Printer Paper on page 11 10 Cleaning the Power Modules The following cleaning products may be used to clean the exterior surfaces of the AC power modules e Isopropyl alcohol 70 in water e Mild soap and water e Chlorine bleach 3 in water e Quaternary ammonium compounds such as Lysol 10 in water
67. heck To perform the Shift System Check 1 Turn the HeartStart XLT off 2 Connect a 50 ohm test load to the pads patient cable instead of pads 3 Ifa Data Card is routinely used insert a Data Card into the HeartStart XLT If a power module is used unplug the power module Insert a charged battery While pressing grint press On to start the test TOIA Sm Follow the prompts on the display to proceed with the test If the message Service Unit appears check the information in Table 12 2 and Table 12 3 If the message continues to appear do not use the device and call for service The test takes less than a minute to complete When it is done a report is printed as shown in Figure 11 1 Test results are listed as Pass or Fail with the exception of the Data Card Test For the Data Card Test the results indi cate either the amount of storage time remaining on the data card or that no data card is present Figure 11 1 Shift System Check Report Shift System Check 8 Jan 1999 13 52 17 SN US00000001 Qty Check List Current Tests _ Defibrillator Inspection General System Test Pass ___ Cables Connectors ECG Test Pass ___ Defibrillation Pads Backup Power Test Pass Monitoring Electrodes SpO2 Test Pass ___ Charged Batteries Data Card Test 2 00 ___ AC DC Power Module Defib Test Pass Printer Paper Pacer Test Pass Data Card Ancillary Supplies SpO2 Sensor Maintaining the HeartStart XLT Operat
68. ib pads special purpose for X ray and special procedures M3719A Multifunction Pediatric Radiotransparent Reduced Skin Irrita tion Pads Pediatric Radiotransparent Reduced Skin Irritation multifunction defib pads special purpose for X ray and special procedures M3508A Defibrillator pads cable plug connector M3725A 50 ohm defibrillator test load plug connector M3500B HeartStart XLT Defibrillator Monitor 11 19 Supplies amp Accessories Table 11 3 Supplies and Accessories Continued Part Number Description ECG Cables M1733A 3 lead ECG Trunk cable AAMI 8 pin M1734A 5 lead ECG Trunk cable AAMI 8 pin M1735A 3 lead ECG Trunk cable IEC 8 pin M1736A 5 lead ECG Trunk cable IEC 8 pin M1580A 3 lead ECG Trunk cable AAMI 8 pin M1600A 5 Lead ECG Trunk Cable AAMI 8 pin M1590A 3 lead ECG Trunk Cable IEC 8 pin MI610A 5 Lead ECG Trunk Cable IEC 8 pin Monitoring Electrodes M2202A High Tack Foam ECG Electrodes 5 electrodes pouch 300 electrodes case SpO Cable Sensors M1191A Adult Reusable SpO sensor M1192A Pediatric Reusable SpO sensor M1194A Adult Pediatric Ear Clip Reusable SpO sensor M1941A SpO extension cable 2 m M1943A Nellcor SpO Sensor adapter cable Data Card M3510A Data Card 11 20 Maintaining the HeartStart XLT Supplies amp Accessories Table 11 3 Supplies and Accessories Conti
69. ice RE E E E A EE EE A 12 9 Unit d States OF AMETIGA OP siacnezn Gateentocecieedeu cee nE iaa TERE ESE 12 9 Latin luu 12 9 Bon M T 12 9 Other International Areas P 12 10 Contents Specifications amp Safety Specifications qe 13 2 Defibrillatot P 13 2 Manual Mode etr 13 2 ASPICE 13 3 ECG MONON ccs T Teasa enas 13 4 Display Ens 13 5 Thermal Array Printet T enredo ee anse i ataei sii 13 5 Thermal Array Printer cont sseeeseseeeeeseseeseeeseseseeeseseesseessesseersseessseesseerseessereseseeseees 13 6 Battery and Battery Power Module sssssseesseeeseseesessessessrseresressersresresseesrrsrensersserreesresee 13 6 Nonmyasiye PCIE seesi a e T E E E E a E 13 7 SpO2 Pulse OXIImelty eee tpe pe a be sennae DM adu Ea E ESE IRSE Sa EESE 13 7 Event Storage sesu soeia za cana eses EEA 13 8 E snc E E 13 8 Enyironm ntal iut eie O E E E A E eiit 13 9 gui cell Definitions M 13 10 Clinical Performance Summary Defibrillation eene 13 14 M thodg A T HERO 13 14 lj s leeward 13 14 erdt 3 3 caters
70. ifact Detected Cannot Analyze Shock Advised No Shock Advised Mode Change AED Mode or Manual Mode Rhythm Monitoring Check Patient Pause Resume Charging ECG waveform Energy charged to Shock ECG waveform Shock Delivered energy Peak current and Patient impedance Shock Failed No Shock Delivered Disarm ECG waveform ECG Monitoring Leads on Leads off Lead change Gain change Heart Rate Alarm Violation Lead Heart Rate and Heart Rate alarm limits M3500B HeartStart XLT Defibrillator Monitor 9 3 Events Recorded Table 9 1 Event Information Continued Event Related Information Stored SpO Violation SpO value and SpO alarm limit Mark ECG waveform with annotation A Epi Atro Lido or Other Print Strip ECG waveform Sync Sync on Sync off Sync marker Pacing Pacer start Pacer stop Pacer settings 9 4 Storing Retrieving amp Printing Creating a Patient Record Creating a Patient Record The HeartStart XLT creates an Event Summary patient record for each new patient Each record is assigned a unique incident number The HeartStart XLT keeps the Event Summary in its internal memory until you begin caring for a new patient It assumes that Table 9 2 Patient Record Summary If Power is off for more than 2 minutes and a new event is recorded Then You are caring for a new patient The last internal Event Sum
71. ile in the main configuration menu to return all settings to their default settings Although there is no visi ble change in the display default settings are restored Press A and W on M3500B HeartStart XLT Defibrillator Monitor 10 15 Configuring the HeartStart XLT 10 16 Saving Settings to a Data Card Configuration settings may be saved to a Data Card and used to load the same configuration into other HeartStart XLTs or to restore the configuration if necessary To save the configuration 1 Make sure a Data Card is in the HeartStart XLT before turning the unit on 2 Select Save Settings to Data Card from the main configuration menu 3 Press SAVE in response to the question Save Settings to Data Card The HeartStart XLT saves the configuration settings to the Data Card and returns to the main configuration menu Loading Settings from a Data Card To load configuration settings 1 Make sure a Data Card is in the HeartStart XLT 2 Select Load Settings from Data Card from the main configuration menu 3 Press LOAD in response to the question Load Settings from Data Card The HeartStart XLT loads the configuration settings from the Data Card and returns to the main configuration menu Printing Settings To print the configuration settings select Print All Settings from the main config uration menu Setting Up and Configuring the HeartStart XLT 11 Maintaining the HeartStart XLT This chapter desc
72. ill only be displayed if ECG monitoring electrodes are used Use demand mode pacing whenever possible Use fixed mode pacing when motion artifact or other ECG noise makes R wave detection unreliable Heart rate displays and alarms function during pacing but they can be unreliable Observe the patient closely while pacing Do not rely on heart rate alarms or the indicated heart rate as a measure of the patient s perfusion status Pacing Preparing for Pacing Preparing for Pacing In preparation for pacing 1 4 5 Apply multifunction defib electrode pads as directed on the package Use either the anterior anterior or anterior posterior placement as appropriate Connect the pads to the patient cable See Figure 6 2 If needed insert a Data Card as described in Using a Data Card on 2 11 Press On Enable Manual Mode See Enabling Manual Mode on page 6 2 In addition for demand mode pacing 1 Apply monitoring electrodes See Applying Monitoring Electrodes on page 4 2 Use tet to select the best lead with an easily detectable R wave See Selecting the Lead on page 4 5 If you do not select a lead i e pads is the selected ECG source Lead is automatically selected when the pacing function is turned on NOTE If pacing for long periods of time new monitoring electrodes and multifunc tion defib electrode pads may need to be applied periodically Refer to the manufacture
73. incident number Patient data from a Philips M3510A Data Card may be downloaded to a HeartStart Event Review Data Management system HeartStart Event Review also allows you to erase patient data from a Data Card allowing the card to be reused for another patient It s recommended that you use a designated Data Card to configure one or more defibrillators monitors CAUTION Use only the M3510A Data Card These cards are specifically formatted to work with your Philips defibrillator Generic cards or other types of cards such as modems will not work and may cause the defibrillator to malfunction M3500B HeartStart XLT Defibrillator Monitor 2 11 Using a Data Card Inserting a Data Card To insert a Data Card 1 2 Make sure the HeartStart XLT is powered off Press up on the release latch to open the door to the Data Card compart ment If a Data Card is already in the compartment press the black button inside the compartment to eject the card see Figure 2 8 Then pull the card out With the yellow label facing up and the A pointing towards the Heart Start XLT slide the Data Card into the compartment Close the Data Card compartment door Make sure that you hear a click indicating that the door is latched shut Figure 2 8 Inserting a Data Card 2 12 Getting Started Using a Data Card Removing a Data Card To remove the Data Card 1 Make sure the HeartStart XLT is powered off wait 2 seconds
74. ing Retrieving amp Printing This chapter describes how the HeartStart XLT creates a patient record called an Event Summary for later retrieval and printing It covers how to mark events for storage in the Event Summary as well as how to print individual events as they occur Overview The HeartStart XLT automatically creates an Event Summary for each patient The Event Summary is stored in the HeartStart XLT s internal memory and on a Data Card if one is used The internal Event Summary stores up to 300 pieces of critical information called events and 50 ECG strips 11 seconds each Events include things such as charging shocks and alarm violations In addition you trigger an event each time you press Euan or Siint Storage on a Data Card is limited only by available space on the card In addi tion to storing all of the events that occur a continuous copy of the displayed ECG and Patient Contact Impedance is also stored You can print the internal Event Summary at any time You can also configure the HeartStart XLT to print individual events automatically as they occur and of course you can activate printing of individual events and patient informa tion at any time by pressing S s To print the Event Summary stored on the Data Card the information must first be downloaded to the HeartStart Event Review Data Management system Refer to the HeartStart Event Review Instructions for Use for instruc tions M3500B Hea
75. ing prompted by pressing ANALYZE M3500B HeartStart XLT Defibrillator Monitor 3 11 Pausing for CPR Pausing for CPR At the completion of a shock series or when no shock is advised the Heart Start XLT prompts you to Check Patient Check Pulse It allows eight seconds for you to check the pulse then prompts you as follows Figure 3 10 Press Pause Display If Needed Press PAUSE And Begin CPR Shocks 1 00 00 50 ner eel If CPR is needed press PAUSE While paused the Pause Timer indicates the elapsed time and the total duration of the Pause state in seconds The Pause Timer is configurable to meet your local CPR protocol needs Rhythm SpO and heart rate monitoring alarms are suspended for the duration of the pause NOTE This section describes how the Pause state functions using the default con figuration If your HeartStart XLT is configured to support the European Resuscitation Council Guidelines for Resuscitation refer to the ERC Proto col section on page 3 16 for details Defibrillating in AED Mode Pausing for CPR Figure 3 11 Pause Display Paused Elapse Time 2 Total Pause Duration Shocks Timer 21 60 00 01 40 The pause state ends when the Pause Timer reaches the preconfigured Pause state duration or if you press RESUME or ANALYZE At the completion of the pause state the defibrillation process begins again If instructed press ANALYZE If you d
76. ing them one at a time from the protective backing and sticking them firmly to the patient s skin Press around the entire edge of each electrode to ensure that they are secure Make sure the lead wires do not pull on the electrodes WARNING Be sure that the electrodes do not come in contact with other conductive materials especially when connecting or disconnecting the electrodes to from the patient NOTE If monitoring for long periods of time new monitoring electrodes and multifunction defib electrode pads may need to be applied periodically Refer to the manufacturer s documentation for how often to replace the monitoring electrodes or defib pads 4 2 Monitoring the ECG Electrode Placement Applying Monitoring Electrodes Figure 4 1 shows typical electrode placement for the limb leads of a 3 or 5 lead patient cable The V C lead of the 5 lead cable can be placed in any of the precordial lead positions V1 C1 through V6 C6 shown in Figure 4 2 Figure 4 1 Limb Lead Electrode Placement e AHA Labels IEC Labels RA R LA L RA Right Arm R Right o o LA Left Arm L Left Pa N RL Right Leg N Negative RL N LL F LL Left Leg F Foot e e Not used for 3 lead Table 4 1 3 Lead ECG Lead Formation Lead Reference I LA RA LL II LL RA LA Il LL LA RA M3500B HeartStart XLT Defibrillator Monitor 4 3 Applying Monitoring Electrodes 4 4 Figure 4 2 Precor
77. ion of the pause PAUSE is used when administering CPR as noted earlier It may also be useful when performing medical procedures or encountering artifact during patient transport Active SpO and heart rate alarms are suspended during the pause duration as well Press RESUME to restore rhythm monitoring Active SpO and heart rate alarms are also restored M3500B HeartStart XLT Defibrillator Monitor 3 15 ERC Protocol ERC Protocol The HeartStart XLT can be configured to support the European Resuscitation Council ERC Guidelines for Resuscitation 1998 If European Protocol is con figured to On the defibrillation process described in this chapter is the same with the exception of how the Pause state functions see Pausing for CPR on 3 12 As described you can enter a Pause state e at the completion of a shock series or e when no shock is advised When either of these events occurs the ERC protocol prompts you to Check Patient Then it prompts you as follows Figure 3 14 If Needed Press PAUSE And Begin CPR Shocks 1 00 00 50 NOTE Using the ERC protocol you are not prompted to or given time to check the patient s pulse Defibrillating in AED Mode ERC Protocol If CPR is needed press PAUSE While paused a timer indicates the elapsed time and the total duration of the Pause state as shown Figure 3 15 Paused Elapsed Time Total Pause Duration
78. ional Checks The report also lists additional checks that you should do Perform each of these checks and record the results The guidelines for completing the checks are as follows Defibrillator Inspection make sure the HeartStart XLT is clean clear of objects on top and has no visible signs of damage Cables Connectors make sure there are no cracks broken wires or other visible signs of damage Make sure the connectors engage securely Supplies make sure the carrying case has two sets of multifunction defib electrode pads in sealed packages within the expiration date an adequate supply of monitoring electrodes within the expiration date alcohol wipes hand towel Scissors razor an extra roll of printer paper a spare charged battery a Data Card SpO sensors if monitoring SpO gt M3500B HeartStart XLT Defibrillator Monitor 11 5 Operational Checks _ Power Supply Battery make sure e acharged battery is in the HeartStart XLT e another battery is charged or being charged e the batteries have no visible signs of damage AC Power Module 1 Make sure a battery is in the HeartStart XLT 2 Plug the power module into a power outlet and connect it to the Heart Start XLT 3 Verify that the power and charging indicators on the power module are lit 4 Remove the battery from the HeartStart XLT and verify that the charg ing indicator on the power module is no longer lit Replace
79. iui E aE a ea dd e add 2 13 Contents Defibrillating in AED Mode OVETVIEW ceases idea es 3 3 Defibrillation with the default configuration seen 3 3 Defibrillation with a modified configuration seen 3 4 PRS eripe M RE CH UTR 3 5 IR read ia c T 3 6 Automatic Re analysis On 1 2 Mb obese i ob iviee etd tle eb En P eqe ka easi 3 11 Automati Re n lysis Off sissies ieiuna oun dii pEu drum eb td t EE dna dE 3 11 Pausin fo CPR FD eai 3 12 Monitoring dO ctcss hein T 3 14 ERC Protocol c a n E E E 3 16 Troubleshooting M 3 18 Monitoring the ECG Applying Monitoring Electrodes 1 2 ie roter E D tse tea betae Edu aa Leid V Re Denuo Add 4 2 Electr de Placement E 4 3 Selectins the Lead E T 4 5 Setting the Heart Bate Alarmi quain dicio tacite ea qoe cidem e a aa 4 6 Disabling th HR AJarmi tc 4 7 Adjusting the ECG Size Nei aneii aea 4 7 hinein e a NONU a T ccm 4 7 Monitoring SpO2 Underst nding Pulse OXUDBELUY 129 9 i etant Uie dieu eae edu caa ma i ME Vei S Rc 5 2 POLSON a SenSoft asesor inps aea en Nl cp ue Eu E uU Mis Depot epit BI edil cbeede 5 3 Reusable Sensors Re 5 4 Disposable Se SOUS Lass ci nsu an aai doubt
80. k Patient Defines how often in seconds the Check 30 45 60 90 Timer Patient prompt is repeated when Rhythm Mon Off itoring detects a potentially shockable rhythm European Protocol Modifies Pause state prompts and replaces the Off On Pause Timer with either the Post Shock CPR Timer or the NSA Timer depending on the event preceding the Pause state If European protocol is set to On the following two configuration cho ices appear Post Shock CPR Timer Defines the duration of the Pause time in sec onds when PAUSE is pressed and the time since the last shock is less than or equal to the Shock Series Timer setting typically at the com pletion of a shock series 30 60 120 180 M3500B HeartStart XLT Defibrillator Monitor 10 11 Configuring the HeartStart XLT Table 10 2 AED Settings Continued onds when PAUSE is pressed and the time since the last shock is greater than the Shock Series Timer setting typically when No Shock Advised ae Setting Parameter Description Choices NSA Timer Defines the duration of the Pause time in sec 30 60 120 180 If European Protocol is set to Off the following configuration choice appears Pause Timer Defines the duration of the pause time in sec onds when PAUSE is pressed when European Protocol is set to Off 30 60 120 180 The following two configuration choices are always a
81. lator Monitor 3 9 Defibrillating 3 If shock advised press SHOCK Once charging is complete the charge tone becomes continuous Make sure no one is touching the patient or anything connected to the patient Call out Clear Then press SHOCK to deliver a shock to the patient Figure 3 8 Press SHOCK Display Stand Clear Pres SHOCK 150J Shocks 0 00 00 14 L I Ex WARNING Defibrillation current can cause operator or bystander injury Do not touch the patient or equipment connected to the patient during defibrillation The defibrillator automatically disarms if you do not press SHOCK in 30 seconds Defibrillating in AED Mode Defibrillating Delivery of the shock is confirmed by the message Shock Delivered and the shock counter is updated Figure 3 9 Shock Delivered Display Shock Delivered Shocks 1 00 00 40 Automatic Re analysis On If Automatic Re analysis is on the HeartStart XLT analyzes the ECG fol lowing delivery of the shock You are prompted to press SHOCK if an addi tional shock is advised This cycle repeats until the rhythm converts or a shock series is complete A shock series may be configured to 2 3 or 4 shocks Automatic Re analysis Off If Automatic Re analysis is off the HeartStart XLT monitors the ECG for potentially shockable rhythms provided Rhythm Monitoring is on and prompts you to press ANALYZE if one is detected You can initiate analysis without be
82. les Controls On Energy Select Off Charge Disarm Shock ECG Lead Select SpO HR Alarms Manual Mode Sync Pacer Pacer Start Stop Pacer Rate Pacer Current Pacer Mode Display Contrast ECG Gain Vol ume Print Strip Print Summary Annotated Mark Event Indicators LCD display for ECG waveform and text prompts Audio alerts QRS Beeper Charging Tone Charge Done Tone Manual Mode LED Sync LED Pacer LED Printer Armed Indicators Charge done tone and available energy indicated on display Energy Selection Front Panel 1 key Charge Control Front Panel 2 key Shock Control Front Panel 3 key Synchronizer SYNC message appears on the monitor and is annotated on the printer if printing while in Sync Mode An audible beep sounds with each detected R wave while a tick mark on the monitor and printed strip indicate the discharge points Synchronizer delay is less than 60 msec from peak R wave to peak current of the defibrillation discharge Specifications amp Safety Specifications Defibrillator cont AED Mode AED Energy Protocol Fixed Energy 150 Joules AED Shock Series 2 3 or 4 Shock Series Timer off 30 60 90 120 150 180 or 210 seconds Text and Voice Prompts Extensive text audible messages guide user through protocol Protocol Follows pre configured settings Can be configured to meet American Heart Association and European Resuscitation Council guide lines AED Controls On Off P
83. mance of the HeartStart XLT defibrillator monitor Electromagnetic compati bility with surrounding devices should be assessed prior to using the defibrillator Reducing Electromagnetic Interference The M3500B defibrillator monitor and M3517A AC Charger are susceptible to interference from other RF energy sources and continuous repetitive power line bursts Examples of other sources of RF interference are medical devices cellular products information technology equipment and radio tele vision transmission Should interference be encountered as demonstrated by artifact on the ECG or dramatic variations in SpO gt values attempt to locate the source Assess e Is the interference intermittent or constant e Does the interference occur only in certain locations e Does the interference occur only when in close proximity to certain medical devices e Does the SpO value change dramatically when the M3517A AC Charger is unplugged Specifications amp Safety Electromagnetic Compatibility Once the source is located attempt to attenuate the EMC coupling path by distancing the defibrillator from the source as much as possible If assistance is needed call your local service representative Restrictions for Use Artifact on the ECG caused by electromagnetic interference should be evalu ated by a physician or physician authorized personnel to determine if it will negatively impact patient diagnosis or treatment Immunity Level
84. mary is deleted a new Event Summary is started and a new incident record is created on the Data Card Power is off less than 2 minutes You are continuing to care for the same patient Additional events are appended to the Event Summary the annotation Continued Use is printed on the Event Summary The Continued Use feature allows you to change batteries or shut the Heart Start XLT off briefly for 2 minutes while preserving the current patient record Events recorded after the power interruption are appended to the patient record Continued use also preserves alarm settings M3500B HeartStart XLT Defibrillator Monitor 9 5 Printing the Internal Event Summary Printing the Internal Event Summary Print ee To print the internal Event Summary press Summary To stop printing before Print x Print the complete summary is printed press Summary 48aiN Or press Strip The Event Summary includes the following information in the order listed e aheader with a place for you to write in the patient s name and the operator s name e adirectory list of events that occurred during the incident and the time of their occurrence e ECG strips of the events in the directory list where relevant Figure 9 2 shows the beginning of an Event Summary Figure 9 2 Event Summary Patient Device On 12 41 00 AED Mode 12 41 00 Operator Pads On 12 41 01 Leads On 12 41 03 Device On 03 J
85. nd lift the defib up off the metal mounting plates to disengage it from the two metal pins at the rear of the case Then slide the defib out of the case as shown in step 7 Figure 11 4 Removing the Carrying Case M3500B HeartStart XLT Defibrillator Monitor 11 15 Removing amp Replacing the Carrying Case To put the carrying case on the HeartStart XLT follow the steps 1 through 7 in Figure 11 5 Slide the unit into the case as shown in step 1 then lower it onto the two metal pins at the rear of the case before tightening the screws step 2 Figure 11 5 Putting the Carrying Case On 11 16 Maintaining the HeartStart XLT Putting On the Manual Door Putting On the Manual Door To put on the manual door align the door with the door hinges as shown in Figure 11 6 Then push as shown in Figure 11 7 until the door snaps in place 1 1 Figure 11 6 Aligning the Manual Door M3500B HeartStart XLT Defibrillator Monitor 11 17 Supplies amp Accessories Supplies amp Accessories Approved supplies and accessories for the HeartStart XLT are listed in Table 11 3 To order e Inthe USA call 1 800 225 0230 electrodes cables paper etc or 1 800 934 7372 HeartStart Pads adapters only e Outside the USA contact your local Philips Medical Systems Sales Office your authorized Philips Medical Systems Dealer or Distribu tor or visit our online store at www medical philips com cms and f
86. ng the battery at temperatures above 35 C may degrade battery life e Storing the battery for extended periods at temperatures above 40 C will reduce battery capacity and degrade battery life e Operating and storage specifications for electrodes may vary Refer to the manufacturer s specifications for details Humidity Up to 95 Relative Humidity e Printer paper may jam if paper is wet e Thermal printer may be damaged if wet paper is allowed to dry while in contact with printer elements Altitude Operating up to 15 000 ft Shipping up to 20 000 ft Shock drops onto concrete Unit survives 39 1 m drops onto all surfaces faces corners and edges enclosed in carrying case Exposed handle surfaces survive 24 drops Vibration Mil Std 810E 514 4 Category 6 Helicopter General Storage UH60 Water Resistance IPX4 splash proof per IEC 60529 with Data Card door closed EMC Meets EN 60601 1 2 This ISM device complies with Canadian ICES 001 Other Considerations Equipment not suitable for use in the presence of a flammable anesthetic mixture with air oxygen or nitrous oxide Mode of Operation Continuous M3500B HeartStart XLT Defibrillator Monitor 13 9 Symbol Definitions Symbol Definitions The following table lists the meaning of each symbol shown on the HeartStart XLT and the M3516A battery Table 13 1 Defibrillator and Battery Symbols Symbol Definition Off Shock hazard
87. nter paper is absent or jammed the printer door is not closed properly Reload printer paper Make sure the door is closed properly M3500B HeartStart XLT Defibrillator Monitor 12 5 System Messages Table 12 2 Momentary Messages Continued Message Data Card Full Possible Cause e The incident is more than 2 hours in duration causing the Data Card to fill e Anempty Data Card was not inserted for the incident causing the Data Card to fill sooner Corrective Action e None A new Data Card can not be inserted during an incident e Use one Data Card per incident patient to decrease the chance of the card filling Data Card Interrupted The Data Card is removed during an inci dent e None The Data Card can not be re inserted during an incident e Do not remove the Data Card during an incident Data Card Not In Service The Data Card is inserted while the Heart Start XLT is on None A Data Card must be inserted prior to turning the HeartStart XLT on for the current patient Incompatible Data Card A Data Card other than the M3510A is inserted Use only M3510A Data Cards No Data Card Present A Data Card is not in the HeartStart XLT Turn the HeartStart XLT off and insert a Data Card prior to the first event for the patient Key Inactive The key pressed is currently inactive i e Use the appropriate mode for the key P CSync 5 and
88. nued Part Number Description Battery Power Modules Adapter M3516A Sealed Lead Acid Battery M3517A AC power module M3518A DC Power Module M3506A Battery charger adapter Extension Cable M4748A Adapter extension cable Carrying Case M3509A Carrying case If a new Quick Reference Card is needed for the carrying case it must be ordered separately M3500B HeartStart XLT Defibrillator Monitor 11 21 Disposing of the HeartStart XLT Prior to disposing of the HeartStart XLT remove the battery Then dispose of the device and its accessories in accordance with local standards WARNING Disposal of the device with the battery inserted presents a potential shock hazard 12 Troubleshooting If the HeartStart XLT detects an error or potential problem during use it dis plays a system or momentary message In AED Mode these messages are often accompanied by a voice prompt This chapter describes the messages 12 and what you should do in response In addition this chapter provides general troubleshooting tips and information on calling for service NOTE For instructions for repair or for further technical information refer to the service manual part number M3500 90900 M3500B HeartStart XLT Defibrillator Monitor 12 1 System Messages Table 12 1 System Messages System Messages System messages remain on the display until the specified action is taken or no longe
89. o not press PAUSE the HeartStart XLT begins monitoring the ECG rhythm provided Rhythm Monitoring is on You may initiate ECG analysis at any time by pressing ANALYZE M3500B HeartStart XLT Defibrillator Monitor 3 13 Monitoring Rhythm WARNING Monitoring Rhythm When the HeartStart XLT is not analyzing defibrillating or paused Rhythm Monitoring alerts you to potentially shockable rhythms provided Rhythm Monitoring is set to the default configuration On The message Monitoring Rhythm appears on the display to let you know this feature is active and remains on the display for the duration of the monitoring Figure 3 12 Monitoring Rhythm Display Monitoring Rhythm Shocks 3 00 00 49 wel The recommended configuration setting for Rhythm Monitoring is On If Rhythm Monitoring is off you are not alerted when a patient s rhythm changes from non shockable to shockable as in refibrillation or an initially nonshockable rhythm that converts to a shockable rhythm Defibrillating in AED Mode Monitoring Rhythm If Rhythm Monitoring detects a shockable rhythm you are prompted as fol lows Figure 3 13 Shockable Rhythm Check Patient If No Pulse Press ANALYZE Shocks 3 00 00 55 pause O This prompt is repeated periodically as configured until ANALYZE or PAUSE is pressed If you press ANALYZE the defibrillation process starts again If you press PAUSE rhythm monitoring is suspended for the durat
90. ol low the Supplies link Table 11 3 Supplies and Accessories Part Number Description Paper 40457C 50 mm Strip Chart Thermal Paper box 10 rolls 40457D 50 mm Strip Chart Thermal Paper box 80 rolls Defibrillation Pads Pads Cables and Test Load white twist lock connector M3501A Multifunction Adult defib pads AAMI M3502A Multifunction Adult defib pads IEC M3503A Multifunction Pediatric defib pads IEC M3504A Multifunction Pediatric defib pads AAMI M3507A Defib pads cable barrel connector M1781A 50 ohm defibrillator test load barrel connector 05 10200 HeartStart Pads Adapter barrel connector Connects to M3507A pads connector cable 11 18 Maintaining the HeartStart XLT Supplies amp Accessories Table 11 3 Supplies and Accessories Continued Part Number Description Defibrillation Pads Pads Cables Adapters and Test Load gray flat connector M3713A Multifunction Adult Plus Pads Adult Plus multifunction defib pads general use M3716A Multifunction Adult Radiolucent Pads Adult Radiolucent multifunction defib pads special purpose for X ray and special procedures M3717A Multifunction Pediatric Plus Pads Pediatric multifunction defib pads general use M3718A Multifunction Adult Radiotransparent Reduced Skin Irritation Pads Adult Radiotransparent Reduced Skin Irritation multi function def
91. or 1 standard deviation 70 to 100 M1192A sensor 1 standard deviation 70 to 10096 2 5 M1194A sensor 1 standard deviation 70 to 100 4 0 1 3 NELLCOR sensors 1 standard deviation 80 to 100 3 0 Resolution 1 SpO Alarm Limits Three preset low alarm limits 90 85 and 80 default Is off INOP Alerts Triggered by disconnected sensor noisy signal light interfer ence or low signal non pulsatile 2 5 I I I M3500B HeartStart XLT Defibrillator Monitor 13 7 Specifications Event Storage Internal Event Summary The internal Event Summary stores up to 300 events and up to 50 waveforms Events can be marked with a Mark Event symbol and if configured for drug annotation the following labels can be added Epinephrine Atropine Lidocaine or Other The Print Summary key on the front panel is used to print the internal Event Summary Data Card Event Summary One Data Card can store approximately 2 hours of continuous ECG waveforms and events General Dimensions 4 05 H x 11 25 W x 13 65 D 103 mm x 286 mm x 347 mm Weight Standard Configuration weighs approximately 10 Ibs 4 55 kg including battery full roll of paper defibrillator patient cable 1 set of pads and without the carrying case Specifications amp Safety Specifications Environmental Temperature 0 to 50 C operating 20 to 70 C storage e Thermal paper may darken above 55 C e Chargi
92. orm Outcomes are summarized in Table 13 4 Table 13 4 Clinical Summary Cardioversion Biphasic Patients Monophasic Patients P Value Number Percent Number Percent Cumulative Cardioversion Efficacy Single shock only 58 96 60 24 107 22 lt 0 0001 lt 2 shocks 74 96 77 47 107 44 lt 0 0001 lt 3 shocks 86 96 90 57 107 53 lt 0 0001 lt 4 shocks 87 96 91 91 107 85 29 Skin burn 0 0001 None 25 90 28 15 105 14 Mild 50 90 56 47 105 45 Moderate 15 90 17 41 105 39 Severe 0 90 0 2 105 2 Number of shocks 1 7 1 0 2 8 1 2 0 0001 Cumulative delivered 217 176J 548 331J 0 0001 energy Skin reaction definitions Evaluated 24 48 hours after procedure Mild erythema no tenderness Moderate erythema tenderness Severe blistering or necrosis tenderness M3500B HeartStart XLT Defibrillator Monitor 13 17 Clinical Performance Summary Cardioversion Conclusion The SMART Biphasic waveform cardioverted at higher rates than the monophasic damped sine waveform at each step of the protocol although the cumulative biphasic rate after 4 shocks was not significantly different from the monophasic rate Tissue damage was more pronounced in the monophasic population 13 18 Specifications amp Safety WARNING WARNING WARNING WARNING WARNING Safety Considerations Safety Considerations The following general warnings and cautions ap
93. ot open the electrode pack age until immediately prior to use Relocate or turn off equip ment that may be causing RFI QRS beeper inau dible or beeps do not occur with each QRS com plex e The QRS beeper is con figured to Off e The amplitude of the QRS complex is too small to detect Check that the QRS beeper is configured to On Adjust the volume Adjust the size of the ECG Monitoring the ECG 5 Monitoring SpO WARNING Pulse oximetry is a noninvasive method of continuously measuring oxygen saturation SpO in arterial blood The resultant SpO reading indicates the percentage of hemoglobin molecules in the arterial blood which are saturated with oxygen SpO monitoring is one of the tools available to assist in assess ing a patient s cardiac and respiratory systems This chapter explains how pulse oximetry works and describes how to use the HeartStart XLT to monitor SpO SpO monitoring is always available in Manual Mode if the option is pur chased In AED Mode SpO monitoring is only available if SpO is config ured to On For information on printing storing and retrieving patient information acquired while monitoring see Chapter 9 Do not rely solely on Sp0 readings assess the patient at all times Sp0 readings may be inaccurate in the presence of significant levels of carboxyhemoglobin or methemoglobin in patients with restricted blood flow to the extremities such
94. ous defibrillation therapy is contraindicated in patients that exhibit one or any combination of the following e Responsiveness e Spontaneous breathing e Palpable pulse Precautions for Manual Defibrillation Therapy Defibrillating asystole can inhibit the recovery of natural pacemakers in the heart and completely eliminate any chance of recovery Asystole should not be routinely shocked Noninvasive Pacing Therapy The HeartStart XLT provides noninvasive transcutaneous pacing by deliver ing a monophasic electrical stimulus to the heart This stimulus is intended to cause cardiac depolarization and myocardial contraction The emergency care provider selects the stimulus current and rate settings The energy is delivered through multifunction defib electrode pads applied to the patient s bare chest Indications Noninvasive pacing is one method of treating patients with symptomatic bradycardia It can also be helpful in patients with asystole if performed early Contraindications Noninvasive pacing is contraindicated in the treatment of ventricular fibrilla tion Noninvasive pacing in the presence of severe hypothermia may be con traindicated M3500B HeartStart XLT Defibrillator Monitor 1 5 SpO2 Monitoring SpO Monitoring A pulse oximeter is a noninvasive device that indicates the oxygen saturation SpO of arterial blood This measurement is obtained through a probe that directs red and near infrared light throu
95. ow the SpO value is the pulse rate derived from the pulse oximetry M3500B HeartStart XLT Defibrillator Monitor 5 7 Setting Alarms WARNING 5 8 Setting Alarms An alarm may be set to alert you if the SpO gt value falls below a specified lower limit Lower limit alarm choices are INI no alarm 90 85 or 80 Press Sp0 repeatedly to cycle through the choices Stop when the desired choice is displayed A A appears in three seconds indicating that the selected alarm 1s active To review the alarm limit press Sp05 Sp0 alarms are temporarily suspended in AED Mode during ECG analysis or when PAUSE is pressed for the duration of the paused period Sp0 alarms are also sus pended while charging for defibrillation and delivering a shock Responding to an Alarm When the SpO value falls below the alarm limit a continuous tone alerts you and the SpO gt value is displayed in inverse video Figure 5 4 Sp0 Alarm Triggered LEAD Monitoring Rhythm Shocks 3 00 00 49 Press Sp0 to turn off the alarm Refer to Setting Alarms if subsequent alarms are desired Monitoring SpO Discontinuing SpO2 Monitoring Discontinuing SpO Monitoring To shut off SpO monitoring press Sp0 repeatedly until nothing appears below the Sp0 softkey Figure 5 5 Sp0 Monitoring Off Monitoring Rhythm Shocks 3 00 00 49 Caring for Sensors Refer to the manufacturers instructions for care and cleaning of sensor
96. ply to use of the HeartStart XLT Additional warning and cautions specific to a particular feature are pro vided in the appropriate section The HeartStart XLT is not intended to be deployed in settings or situations that pro mote use by untrained personnel Operation by untrained personnel can result in injury or death Remain attentive to the patient during the delivery of therapy Delay in delivering a shock may result in a rhythm that was analyzed as shockable converting spontane ously to non shockable and could result in inappropriate delivery of a shock Use only the multifunction defib electrode pads battery and accessories listed in Supplies amp Accessories on page 11 18 Substitutions may cause the HeartStart XLT to function improperly Use multifunction defib electrode pads prior to their expiration date Discard pads after use Do not reuse pads In AED Mode the multifunction defib electrode pads must be in the anterior anterior position as shown on the packaging The HeartStart XLT was not designed to assess data acquired from pads in an anterior posterior position M3500B HeartStart XLT Defibrillator Monitor 13 19 Safety Considerations WARNING WARNING WARNING WARNING WARNING WARNING WARNING 13 20 Do not allow multifunction defib electrode pads to touch each other or to touch other ECG monitoring electrodes lead wires dressings etc Contact with metal objects may cause electrical ar
97. quainted Manual Mode Controls The figure below shows the Manual Mode controls These controls are accessed by lifting the door labeled Manual Figure 2 2 Manual Mode Controls LEDs indicating the function is active green light or inactive no light NOTE Synchronized cardioversion and pacing controls only function when Manual Mode is enabled 2 4 Getting Started Getting Acquainted Toggles between Manual Mode and AED Mode Manual Mode is enabled when the green LED next to the key is lit A password may be required for Manual Mode entry Enables synchronized cardioversion when first pressed as indicated by the green LED disables synchronized cardio version when pressed again Activates the pacing function buttons as indicated by the green LED allowing you to use the buttons below to define pacing rate mode and current output Also turns off the Pacer when pressed a second time 0 00 Adjusts the pacing rate Delivers pacer pulses when first pressed stops pacing when pressed again Selects Demand or Fixed Mode for pacing Adjusts the current output for pacing 0000 Display Layout The following figures show the layout of the display in e AED Mode with ECG and SpO monitoring capabilities disabled e AED Mode with ECG and SpO monitoring capabilities enabled e Manual Mode NOTE ECG and SpO monitoring capabilities for AED Mode may be enabled and disabled independently in
98. r 50 uV whichever is greater Paper Size 50 mm by 30 m 100 ft Battery and Battery Power Module Battery Type 2 Ah 12V rechargeable Sealed Lead Acid Battery Dimensions 2 4 H x 0 94 W x 7 2 D 61 7 mm H x 23 9 mm W x 182 mm D Weight 1 4 lb 0 65 kg Charge Time Approximately 14 5 hours to 100 indicated by LED on power module Approximately 2 5 hours to 90 indicated by LED on power module Capacity 2 7 hours ECG monitoring or 50 full energy discharges or 2 1 hours ECG monitoring while pacing with a new fully charged battery and temperature above 20 C Battery Indicators LOW BATTERY message appears on monitor when at least 10 minutes of monitoring time and 6 maximum energy discharges remain with a new battery and temperature above 20 C Battery Storage Should not be stored above 40 C for extended periods of time Charger Output Unit can be operated using Class I AC power module alone with no battery installed Specifications amp Safety Specifications Noninvasive Pacing Waveform Monophasic Truncated Exponential Current Pulse Amplitude 10 mA to 200 mA 5 mA resolution accuracy 10 mA 50 mA 5mA 50mA 200mA 10 Pulse Width 20 ms with accuracy 0 5 ms Rate 30 ppm to 180 ppm 10 ppm increments accuracy 1 5 Modes Demand or Fixed Rate Refractory Period 340 msec 40 to 80 ppm 240 msec 90 to 180 ppm SpO Pulse Oximetry Accuracy with M1191A sens
99. r improperly functioning pacemaker In patients with cardiac pacemakers the HeartStart XLT may have reduced sensitivity and not detect all shockable rhythms NOTE 1 4 AED mode is not intended for use on children less than 8 years of age For children older than 8 years the American Heart Association recommends that standard operating procedures for AEDs be followed American Heart Asso ciation Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Dallas Texas AHA 2000 Indications for Manual Defibrillation Therapy Asynchronous defibrillation is the initial treatment for ventricular fibrillation and ventricular tachycardia in patients who are pulseless and unresponsive Synchronous defibrillation is indicated for termination of atrial fibrillation The SMART Biphasic waveform utilized in the HeartStart XLT Defibrillator Monitor has undergone clinical testing demonstrating its effectiveness for cardioversion of atrial fibrillation The SMART Biphasic waveform utilized in the HeartStart XLT has under gone clinical testing in adults These trials support the waveform s effective ness for defibrillation of ventricular tachyarrhythmias at 150J In manual mode operation the HeartStart XLT incorporates some user select able lower energy levels that were not used in the clinical trials Introduction Noninvasive Pacing Therapy Contraindications for Manual Defibrillation Therapy Asynchron
100. r relevant Each message is accompanied by a three second beep to alert you Table 12 1 lists system messages Message Attach Pads Cable Description The pads cable is not properly attached to the device Corrective Action Check the cable connection Configuration Lost The configuration is reset to the default settings e Reconfigure the HeartStart XLT e Ifthe message persists call for ser vice Data Card Disabled The PC card is not in use because it is If possible turn the HeartStart XLT off full incompatible absent or inserted for more than 2 minutes insert an empty after the HeartStart XLT was turned on compatible Data Card and turn the device on ECG Fault The ECG data acquisition system failed Remove the device from active use and and data is unavailable from the 3 or 5 lead monitoring electrodes call for service Low Battery The battery has sufficient capacity remaining to provide only about ten min utes of monitoring time and six shocks before the HeartStart XLT shuts off Replace the battery with a fully charged battery Leads Off e The monitoring electrodes are not e Check the monitoring electrodes are applied properly applied e The monitoring electrodes are not e Check the monitoring cable is prop making proper contact with the erly connected patient e The monitoring cable is not con nected 12 2 Troubleshooting Table 12 1 System Mes
101. r s documentation for how often to change monitoring electrodes or defib pads M3500B HeartStart XLT Defibrillator Monitor 8 3 Pacing Pacing To perform pacing P s s 1 Press Pacer logue box appears Figure 8 1 Pacing Display Pacer Stop Demand Mode 70ppm 30mA Shocks 0 PP 00 00 8 ENERGY CHARGE SELECT E The message Stop indicates that the pacing function is on but paced pulses are not being delivered The pacer turns on in the mode last used 2 Verify that the dot markers appears near the middle of the QRS complexes of the ECG If the dot markers do not appear or are in the wrong location adjust the ECG size or select another lead See Monitoring the ECG in Chapter 4 The ECG will only appear if the 3 or 5 lead monitoring cable and elec trodes are used ZR T r 3 Press to change to fixed mode if R wave detection is unreliable The pacing dialogue box displays the current mode To switch back to a demand mode press 8 4 Pacing Pacing 4 Adjust the rate to the desired number of paced pulses per minute ppm Press up A or down W on d D to increase or decrease the num ber of paced pulses per minute 5 Press to start pacing The message Pacing indicates that paced pulses are being delivered in the selected mode at the rate and output level displayed Figure 8 2 Pacing Display Y 78 Lead Il Pacing Demand Mode
102. re the HeartStart XLT shuts off Replace the battery as soon as possible If the power is off for less than 2 minutes while you change the battery the HeartStart XLT assumes that you are continuing to treat the same patient It continues to store data on the Data Card and append events to the existing Event Summary Alarms set prior to the power loss remain active If power remains off for more than 2 minutes the HeartStart XLT assumes you are treating a different patient and assigns a new incident number A new Event Summary begins with the next event Getting Started Using a Data Card Using a Data Card Use of a Data Card is optional the defibrillator will power up without a Data Card inserted If you would like to collect patient information on a Data Card the card must be inserted into the HeartStart XLT before the device is turned on CAUTION Inserting or removing the data card while the defibrillator is on can corrupt the Data Card and prevent the unit from powering on again If this occurs see Table 12 3 Troubleshooting Tips The recommended practice is to use one Data Card per patient Once a Data Card fills recording stops a second Data Card may not be inserted for the current incident because the device will only allow the use of one Data Card per incident Data Cards hold up to two hours of patient information Multiple incidents can be recorded on a single Data Card Each incident is assigned a unique
103. rective 93 42 EEC and carries the CE 0123 mark accordingly Authorized EU representative Philips Medizinsysteme B blingen GmbH Hewlett Packard Str 2 71034 B blingen Germany Canada EMC ICES 001 Device Tracking In the USA the Food and Drug Admin istration requires defibrillator manufac turers and distributors to track the location of their defibrillators If your defibrillator has been sold donated lost stolen exported or destroyed or if it was not obtained directly from Philips Medical Systems please notify Philips Medical Systems at 978 659 3202 Conventions This guide uses the following conventions Warning statements describe conditions or actions that can result WARNING in personal injury or loss of life CAUTION Caution statements describe conditions or actions that can result in damage to the equipment or loss of data NOTE Notes contain additional information on usage TEXT represents messages that appear on the display Softkey represents softkey labels that appear on the display above or below the button to which they correspond iii Contents Introduction loca gue ee ee ene OO an Re ee Ne nee eee 1 1 Intended US em 1 3 Defibrillation co A eee 1 3 Tndications fot AED Th f py T P 1 3 Contraindications for AED Therapy sssesssseesessessesrrssreesrserssreerssressrseresrensessrerr
104. ribes how to care for your HeartStart XLT Defibrillator Monitor and its accessories It provides Operational checks Battery maintenance procedures Instructions on loading printer paper Cleaning instructions Instructions for removing and replacing the carrying case A list of approved supplies and accessories and Instructions for disposal of the device The operational checks described must be performed at the specified intervals in order to help prevent and detect electrical and mechanical problems The battery maintenance procedures specified must be adhered to in order to ensure that your batteries have the energy required to operate the defibrillator and deliver the appropriate therapy M3500B HeartStart XLT Defibrillator Monitor 11 1 Operational Checks Operational Checks The following operational checks are intended to quickly verify the proper operation of the HeartStart XLT Perform these checks regularly at the inter vals specified along with visual inspection of the device and all cables con trols accessories and supplies Also regularly check expiration dates of all supplies such as multifunction defib electrode pads and monitoring electrodes Before You Begin Before you run the Shift System Check be aware of the following conditions Do not touch any of the controls on the HeartStart XLT while the Shift System Check is running If a Failure or Service Unit message is displayed or if an unexpected Not
105. ring Electrodes SpO5 Patient Cable 10 6 Setting Up and Configuring the HeartStart XLT Configuring the HeartStart XLT Configuring the HeartStart XLT Configuration options allow you to customize the HeartStart XLT to best meet your needs This section describes e How to access the configuration menu e Configurable items and their setting options e How to change the configuration e How to save the configuration to a Data Card e How to load the configuration from a Data Card e How to print the configuration Accessing the Configuration Menu There is a special combination of softkeys that when pressed simultaneously turn the HeartStart XLT on in Configuration Mode For the purposes of exe cuting this procedure softkeys are assigned numbers as shown in Figure 10 6 Figure 10 6 Softkey Numbers OOO XD C CD 6 CD C O M3500B HeartStart XLT Defibrillator Monitor 10 7 Configuring the HeartStart XLT 10 8 To turn the HeartStart XLT on in Configuration Mode 1 If the device is already on press Off 2 While holding down softkeys 4 amp 5 press 1 The configuration menu appears as shown in Figure 10 7 The menu lists the categories of settings that may be configured Figure 10 7 Configuration Menu ah 4 NG AED Settings Manual Settings ECG Filter Settings Save Settings to Data Card Load Settings from Data Card Print All Settings o Exit Configuration Configurable Parame
106. rtStart XLT Defibrillator Monitor 9 1 Marking Events Marking Events The Event button allows you to annotate the ECG strip at the point in time the button is pressed In AED Mode when monitoring is disabled the event is marked with a A In Manual Mode or when monitoring is enabled in AED Mode you use the softkeys to select the annotation from the choices dis played See Figure 9 1 If no selection is made the event is marked with a A Figure 9 1 Annotations ATRO LDO OTHER Shocks 0 00 00 8 ENERGY HAR SELECT NOTE In Australia and the U K EPI is replaced by ADRN adrenaline 9 2 The marked event is stored in the Event Summary If the printer is configured to Print on Mark an ECG strip prints when Event is pressed If the printer is configured to 6 second delay the strip is 9 seconds and includes 6 seconds pre ceding the event and 3 seconds following the event If No Delay is configured a 3 second ECG strip prints in real time To stop printing before the entire strip i i Print is printed press Strip Storing Retrieving amp Printing Events Recorded Events Recorded The following events and related information are stored in the Event Summary Table 9 1 Event Information Event Power Change Related Information Stored Power on Power off Continued use Battery low Pads Change Pads on Pads off AED Mode Analysis Analyzing Analysis Stopped Art
107. s To get the best results from your SpO reusable sensors always handle the sensor and cable with care and protect them from sharp objects The sensor sleeve houses a sensitive electronic device that can be damaged Harsh treatment of sensors will drastically reduce their lifetime WARNING Do not use a damaged sensor or one with exposed electrical circuits M3500B HeartStart XLT Defibrillator Monitor 5 9 Troubleshooting Troubleshooting The table below lists system messages that you may encounter when monitor ing SpO5 Table 5 2 System Messages Problem or Message Sp02 Non Pulsatile Possible Cause e Pulse absent or too weak to be detected Corrective Action Check the sensor is applied properly Make sure the sensor site has a pulse Relocate the sensor to a site with improved circulation Try another sensor type Sp02 Low Signal e SpO signal is too low to give an accurate read ing Check the sensor is applied properly Try another sensor type Sp02 Noisy Signal Excessive patient move ment electrical interfer ence or optical interference Minimize patient motion or apply sen sor to site with less movement Secure the sensor cable loosely to the patient Reduce sources of electrical or optical interference SpO2Light Interf The level of ambient light is so high that the sensor cannot obtain an SpO reading Sensor or cable is dam aged
108. s Off is displayed in the System Mes sage Area and accompanied by a beep to alert you A dashed line on the dis play indicates that there is no ECG signal M3500B HeartStart XLT Defibrillator Monitor 4 5 Setting the Heart Rate Alarm WARNING WARNING 4 6 Setting the Heart Rate Alarm The computed heart rate number of detected QRS complexes per minute is displayed below the HR ALARM sofkey next to the B The heart rate represents the number of QRS complexes detected in a minute A QRS beeper if config ured to on indicates each QRS complex detected If desired a HR alarm may be set to alert you when the heart rate is outside the specified limits Limit choices are listed in Table 4 4 Table 4 4 HR Alarm Limit Choices Alarm If Over Or under 100 30 140 60 160 90 200 120 To set a HR alarm cycle through the limit choices by pressing HR ALARM until the desired limits are shown The then appears next to the heart rate value to indicate that the HR alarm is set Heart rate alarms are temporarily suspended in AED Mode during ECG analysis or when PAUSE is pressed for the duration of the paused period Heart rate alarms are also suspended while charging for defibrillation and delivering a shock Heart rate displays and alarms function with internal and external pacemakers but they can be unreliable Observe the patient closely if pacemakers are used Monitoring the ECG Disabling the
109. sages Continued System Messages with the patient Message Description Corrective Action No Pads The multifunction defib electrode pads Check the pads cable connection are not properly connected to the Heart Start XLT Pads Cable Off The pads cable is not connected to the Check pads connector is locked in place defibrillator Pads Off The pads are not making proper contact Make sure the pads are properly applied to the patient Pacer Failure The pacing system is not functioning Remove the device from active use and call for service Pacer Output Low High patient impedance is resulting in the pacer delivering less current to the patient than specified in the output current set ting Check the pads are applied properly Service Unit Appears during a Shift System Check May indicate that the Data Card is full OR There is a system failure e Replace the Data Card e Perform a Shift System Check e If Service Unit continues to appear do not use the device and call for service System Failure Cycle Power An internal error occurred If this occurs during actual use e Substitute another defib if possible Remove this unit from clinical use and call for service e Ifnoother defib is available turn power off then on If unit turns on normally use for this one incident After this incident remove from clini cal use and call for service e Ifunit does not turn on
110. ta pes ta ap eet dE 8 3 rep T ak 8 4 Changing npdiueo M 8 6 Defibrillating During Pacing 222 ooi riter ern epe ped eot io o Pea ste ue oie i es besba EP aud us 8 6 Troubleshootin et E 8 7 Storing Retrieving amp Printing VERVIEW P 9 1 hs Eg sno M c 9 2 Events Recorded d m SS 9 3 Creating a Patient otn MT c aaa REAS 9 5 Printing the Internal Event Summary ssseseesseseseseesessesstrsesresstesrestensteseesrestenserseesteeseeseeeereses 9 6 Printing EP oii qur EE TES 9 8 Vil Contents Setting Up and Configuring the HeartStart XLT Connecting Disconnecting Patient Cables eei cost ceeesenseceessceecnvesconedesannceee 10 1 This section describes how to connect and disconnect the essessss 10 1 Connecting the Pads Patient Cable suisses tier vrbi pido ede brex ict dni ir teu secun tette if ds 10 2 Disconnecting the Pads Patient Cable iuit iie iie imd aep cei rds 10 3 Conn cting the ECG Patient Cable usse ettet ones Dra era aa et sses pun bases Duda 10 4 Disconnecting the ECG Patient Cable iioi iter ttti ett Eb eaae insit aded 10 4 Connecting the SpO2 Patient Cable ou ossa QR eie ok PERCHE DUM REN HS sut ORUM pURN D BRE KE 10 5 Disconmectine the SpO2 Patient Cable aede iet Eta tr nd gU rens En RA IPM cab n i piidads 10 5 Arranging A
111. tart XLT Defibrillation Controls softkeys that perform the defibrillation function displayed in the softkey label above each button control both AED and Man ual Mode defibrillation Manual Mode Controls provide access to Manual Mode and control of syn chronized cardioversion and pacing if the option is present Audiovisual Controls Adjusts the display contrast fx Adjusts the size of the ECG waveform displayed printed and stored y Pressing A and W simultaneously generates a 1 mV calibration pulse i Adjusts the volume of voice prompts and the QRS beeper Monitoring Controls softkeys that perform the monitoring function dis played in the softkey label below each button control heart rate and SpO5 alarms and select the ECG source to monitor Print Controls perform the function shown above each button The print controls from left to right are Print Prints ECG data defibrillation events and marked events real Strip time or with a 6 second delay as configured Press to start print ing press again to stop printing Print Prints the Event Summary See Storing Retrieving amp Printing Summary for more information Printing may be stopped by pressing the Print Print Summary OF Strip button Mark Inserts a time stamped annotation in the Event Summary May be icu configured to print an annotated ECG strip when pressed M3500B HeartStart XLT Defibrillator Monitor 2 3 Getting Ac
112. ters The following tables show the configurable parameters for each category of settings A description of each parameter is provided along with the possible choices Default settings are in bold Setting Up and Configuring the HeartStart XLT Configuring the HeartStart XLT Table 10 1 General Settings Parameter Date dd mmm yyyy Description Current date where dd is the day mmm is the month and yyyy is the year Setting Choices any valid date Time hh mm Current time where hh is the hour and mm is the minutes Time is based on a 24 hour clock any valid time Print on Mark i Mark Prints a 3 second strip when Event is pressed On Off Print on Charge Prints a continuous strip during charging Printing continues until a shock is deliv Print ered the device is disarmed or Strip 18 pressed On Off Print on Shock Prints a 12 second strip when a shock is delivered On Off Print on Alarm Prints a 6 second strip during alarms On Off M3500B HeartStart XLT Defibrillator Monitor 10 9 Configuring the HeartStart XLT 10 10 Table 10 1 General Settings Continued AN Setting Parameter Description Choices Printer Delay Captures what you just saw All printed 6 Sec Delay strips including those generated by an No Delay event mark charge shock or alarm include an additional 6 seconds of infor mation the 6
113. than 50 200 joule charge shock 1 1 cycles Battery Life Expectancy Life expectancy of a battery depends on the frequency and duration of use When properly maintained and stored the life expectancy of a battery is about 2 years For more aggressive use models life expectancy may be less Storing Batteries Batteries should be used regularly and rotated to distribute the use evenly When storing batteries make sure that the battery terminals do not come in contact with metallic objects Batteries should not be stored without charging for more than one month if installed in the defibrillator or more than three months if not installed in the defibrillator Storage at temperatures between 15 C 59 F and 30 C 86 F is recommended to maximize life expectancy Storing at temperatures above 35 C 95 F for extended periods of time will significantly reduce a battery s life expectancy Discarding Batteries Batteries should be discarded two years after the first Test Date as written on the battery s back label or sooner if there are visual signs of damage or if they fail the Battery Capacity Test Batteries should be discarded in an envi ronmentally safe manner Properly dispose of batteries according to local reg ulations Do not disassemble puncture or incinerate batteries Be careful not to short the battery terminals because this could result in a fire hazard M3500B HeartStart XLT Defibrillator Monitor 1
114. the battery _ Printer make sure the printer e has sufficient paper e prints properly Maintaining the HeartStart XLT Operational Checks Battery Capacity Test CT To perform a Battery Capacity Test 1 2 Turn the HeartStart XLT off Place a Test in Progress label on the HeartStart XLT to indicate to oth ers that it may not be used Insert a charged battery If an AC power module is connected unplug the power module from the Mark HeartStart XLT While pressing Event press On to start the test Allow the test to proceed to completion The test takes approximately three hours and is complete when test results print out and the device turns itself off Review the test results and take the appropriate action as follows Table 11 1 Battery Capacity Test Results If Then Elapsed Time gt 2 5 hours 1 The battery passed the test and 2 Record pass CT and the date on Low Battery Time gt 10 minutes the bottom of the battery 3 Recharge the battery before use Elapsed Time lt 2 5 hours 1 The battery failed the test or 2 Record fail CT and the date on Low Battery Time lt 10 minutes the bottom of the battery 3 Discard the battery appropriately M3500B HeartStart XLT Defibri llator Monitor 11 7 Battery Maintenance Battery Maintenance The HeartStart XLT uses the M3516A Battery Pack It is a rechargeable sealed lead acid battery Battery maintenance
115. the configuration M3500B HeartStart XLT Defibrillator Monitor 2 5 Getting Acquainted Figure 2 3 AED Mode Display Layout ECG and SpO disabled System Message Momentary Message ECG Gain ECG gt User Message 150J Current Charge Shocks 0 Shocks Delivered 00 15 02 Incident Timer Defibrillation PAUSE ANALYZE SHOCK Soft Keys Cu NOTE In its default configuration the HeartStart XLT powers on in AED Mode where voice prompts and user messages are active The Incident Timer shows the elapsed time since the HeartStart XLT was turned on If the HeartStart XLT is powered on after being off for less than two minutes the Incident Timer resumes where it left off If power is off for more than two minutes the Incident Timer resets to zero 00 00 00 2 6 Getting Started Getting Acquainted Figure 2 4 AED Mode Display Layout ECG and SpO Enabled Lead Displayed SpO value LEAD SELECT Heart Rate gt 1324 Lead II SpO alarm HR Alarm Pleth Bar System Message Pulse Rate Momentary Message ECG User Message 114J Current Charge Shocks 0 Shocks Delivered Selected Energy gt 150J 00 15 02 Incident Timer Defibrillation PAUSE ANALYZE SHOCK Soft Keys gt gt CMM User messages accompany voice prompts to guide you through the defibrilla tion process System and Momentary Messages e alert you to conditions that may require you to take action e provide status inform
116. the contrast Avoid exposing the display to direct sunlight on a hot day M3500B HeartStart XLT Defibrillator Monitor 12 7 Troubleshooting Tips Table 12 3 Troubleshooting Tips Continued Situation There is a dashed line on the display Cause ECG data is not being acquired Possible Solution Check the patient cable is connected Check the pads or electrodes are prop instead of an ECG erly applied e Check that the desired lead is selected The HeartStart XLT e The battery is low Change the battery does not appear to be e There is a system failure Take the device out of use and call for functioning properly service The displayed time is incorrect The time was not correctly set in the con figuration Set the time in the General Settings menu of the Configuration Mode The printed date is incorrect The date was not correctly set in the con figuration Set the time in the General Settings menu of the Configuration Mode 12 8 Troubleshooting Calling for Service Calling for Service For telephone assistance call the Response Center nearest to you or visit our website at www medical philips com cms and follow the link for service United States of America Medical Response Center Tel 800 548 8833 Latin America Medical Response Center Tel 954 835 2600 Canada Medical Response Center Tel 800
117. ty precautions 13 19 troubleshooting 3 18 12 3 12 5 Pads Cable Off message 3 18 12 3 Pads cables cleaning 11 14 connecting 10 2 See also Cables Pads Off message 3 18 4 7 12 3 Paper See Printer paper Password 10 13 exiting 6 2 Patient information See Data Card Pausing AED Mode 3 12 3 15 settings 10 12 Post 10 11 Post Shock CPR Timer 3 17 10 11 Index Power modules 2 9 cleaning 11 13 electromagnetic compatibility 13 22 ordering 11 21 specifications 13 2 Power supply checking 11 6 events recorded 9 3 interruption of power 9 5 overview 2 9 specifications 13 2 troubleshooting 12 7 See also Batteries Vi Precautions 13 19 asystole 1 5 batteries 11 9 defibrillation current shock 3 10 ECG analysis 3 9 electrodes 4 2 electromagnetic compatibility 13 22 heart rate alarms 4 6 8 2 pacemakers 1 4 4 6 rhythm monitoring 3 14 safety symbols 13 10 sensors 5 5 5 9 SpO2 alarm 5 8 SpO2 monitoring 5 1 Print strip contents 13 5 controls 2 2 events recorded 9 4 settings 10 9 See also Event Summary Printer checking 11 6 cleaning printhead 11 13 specifications 13 5 Printer paper loading 11 10 ordering 11 18 specifications 13 9 troubleshooting 12 5 Printing controls 2 3 Event Summary 9 6 events automatically 9 8 settings 10 16 Pulse checking 3 12 5 10 5 11 Pulse oximetry defined 1 6 5 1 described 5 2 specifications 13 7 See also SpO2 monitoring Q QRS beeper 4 6
118. ure 3 4 Apply Pads Display Shocks 0 00 00 03 M3500B HeartStart XLT Defibrillator Monitor 3 7 Defibrillating 2 If instructed press ANALYZE If device initiated analysis is off the HeartStart XLT monitors the rhythm provided Rhythm Monitoring is on and prompts you to press ANALYZE if a potentially shockable rhythm is detected Figure 3 5 Press ANALYZE Display Check Patient If No Pulse Press ANALYZE Shocks 0 00 00 04 a NOTE If monitoring capabilities are enabled on your HeartStart XLT your display will contain monitoring information not shown in the graphics in this section NOTE ECG Analysis is always performed through multifunction defib electrode pads Analysis can not be performed through monitoring electrodes 3 8 Defibrillating in AED Mode Defibrillating If device initiated analysis is on you do not need to press ANALYZE ECG analysis begins automatically Figure 3 6 Analyzing Display Analyzing Do Not Touch Patient Shocks 0 00 00 08 STOP ANALYSIS WARNING Handling or transporting the patient during ECG analysis can cause incorrect or ss _ delayed diagnosis If a shockable rhythm is detected as indicated by the message Shock Advised analysis stops and the XLT automatically charges to 150J Charging is accom panied by an intermittent charge tone Figure 3 7 Charging Display Charging to 150J 97J Shocks 0 00 00 10 M3500B HeartStart XLT Defibril
119. us Dedi tud ite onu a edet tudin 5 4 Seint disposable Sensors 2 eei eoe ci eges ib setenta Dedi ete ce mE Mud qusia OMNE US opea es 5 4 Applying the Sensor nion ni Saec Dope dtu e DeDci mq eu ed cruise ape E EU E E 5 5 Connecting the Sensor Cable D ene 5 6 MONIt rIDS cites tay lecesat a dtc ted ican Gael ooa ne Dn atu MEM ated Code EA 5 7 SV TUT FIPS oireeseesi rss Cond steuern pac ie eei rE nudas cue sui avast E Eaa Eaa Eai 5 8 PRES POMC to a Alarmi Mp 5 8 Vi Contents Discontinuine SpO2 Monitoring E 5 9 Carins for SOM c M P 5 9 Troubleshootin T EA 5 10 Defibrillating in Manual Mode Enabling Mannal Mode Rr 6 2 Preparation T 6 3 B10 dnl Es c RE c er 6 4 Returning to AED Mode MM C 6 6 Performing Synchronized Cardioversion Preparing for Synchronized Cardioversion eene 7 2 Delivering a Synchronized Shock i4 eiecit Ee cr ste tu Iri unb ees Pectus docu Dedi Catan dun 7 2 Delivering Additional Synchronized Shocks eee 7 4 Disalblime Sync Mode Pe aa eiaa 7 4 Pacing Demand Mode Versus Fixed Mode 25 c cacslcacotnateasaasiensscnraaeqaninscausuaqeesusstncdeqsasaitenesaavvndeaananete 8 2 Monitoring During Pacing 222 peace aerated teenie eu 8 2 Preparing TOL PACU aacovssettedienttenqo tinet epe dino neus Opa anda d Mea tup R d e
120. vailable regardless of the European Protocol setting Lead Select Turns on ECG monitoring On Off Sp02 Turns on SpO monitoring Only listed as a configurable item if the SpO option was pur chased On Off NOTE If European Protocol is set to Off the Pause Timer is used during the Pause state and appears as a configurable parameter If European Protocol is set to On either the Post Shock CPR Timer or the NSA Timer are used during the Pause state and appear as configurable parameters in place of Pause Timer NOTE ured to either Off or 210 If European Protocol is set to On the setting for the Shock Series Timer must be Post Shock CPR Timer NSA Timer Also the Shock Series Timer can not be config 10 12 Setting Up and Configuring the HeartStart XLT Configuring the HeartStart XLT Table 10 3 Manual Settings Parameter Description Choices Manual Mode Requires entry of a password to access On Off Security Manual Mode Sync After Shock Determines if the Sync function stays on On Off after a synchronized shock is delivered Setting the Manual Mode Password When Manual Mode Security is set to On see Modifying the Configuration on page 10 15 the password entry screen is displayed Use the softkeys on the top of the display to enter a four digit password Figure 10 8 Password Entry Screen Enter Password p M3500B

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