Philips HeartStart MRx User training

M3535A/M3536A User Training Workbook

HeartStart MRx

Notice

About This Edition

Publication number 453564045051

Edition 1

Printed in the USA

To determine the product level version to which this guide applies to, refer to the version level on the back cover of this book or on the label of the User Documentation CD-ROM that accompanied the device. This information is subject to change without notice.

Philips shall not be liable for errors contained herein or for incidental or consequential damages in connection with the furnishing, performance, or use of this material.

Edition History

Edition Print Date

1 September, 2006

Copyright

Koninklijke Philips Electronics N.V.

All rights are reserved. Permission is granted to copy and distribute this document for your organization’s internal educational use. Reproduction and/or distribution outside your organization in whole or in part is prohibited without the prior written consent of the copyright holder.

THIS PRODUCT IS NOT INTENDED FOR HOME USE.

IN THE U.S., FEDERAL LAW RESTRICTS THIS DEVICE TO SALE ON OR BY THE ORDER OF A PHYSICIAN.

Medical Device Directive

The HeartStart MRx complies with the requirements of the Medical Device Directive 93/42/EEC and carries the

mark accordingly.

0123

Manufacturer:

Philips Medical Systems 3000 Minuteman Road Andover, MA 01810

Authorized EU-representative:

Philips Medizin Systeme Böblingen GmbH Hewlett Packard Str. 2 71034 Böblingen Germany

Canada EMC:ICES-001

China:

After Sales Service: Beijing MEHECO-PHILIPS Medical Equipment Service Center. After Sales Service Address: No. 208, 2nd District, Wang Jing Li Ze Zhong Yuan, Chao Yang District, Beijing. Postal code: 100102. Telephone: 010-64392415. Registration number: SFDA(I)20043211207. Product Standard number: YZB/USA 52-21.

SMART Biphasic is a registered trademark of Philips.

®

Microstream of Oridion Medical Ltd. Smart CapnoLine™ is a trademark of Oridion Medical Ltd. Q-CPR™ is a trademark of Laerdal Medical. The HeartStart MRx contains an Ezurio PC Card with Bluetooth wordmark and logos are owned by the Bluetooth SIG, Inc. and any use of such marks by Ezurio is under license.

Other trademarks and trade names are those of their respective owners.

Use of supplies or accessories other than those recommended by Philips may compromise product performance.

and FilterLine® are registered trademarks

®

wireless technology. The Bluetooth

For the Declaration of Conformity Statement, please see the Philips Medical web site at http:// incenter.medical.philips.com/PMSPublic. Scroll over the Quality and Regulatory Tab located in the upper left corner of the window. Click to select Regulatory by Modality. Then click to select Defibrillators and select the entry for Declaration of Conformity (DoC)

Warning

Radio frequency (RF) interference from nearby transmitting devices may degrade the performance of the HeartStart MRx. Electromagnetic compatibility with surrounding devices should be assessed prior to using the monitor/defibrillator.

.

i

This workbook should be used primarily for HeartStart MRx instructor-based end-user training, along with the 453564045041 Instructor Guide. The workbook contains the following conventions:

"Voice" represents voice prompt messages Text represents messages that appear on the HeartStart MRx display

Text represents options that appear on HeartStart MRx menus

[Soft key] represents soft key labels that appear on the display above the

button to which they correspond

ii

1Table of Contents

1 Getting Acquainted 1

Lesson Introduction 1

Objectives 1

Lesson Presentation 2

Basic Orientation 2 Display View 7 Responding to Alarms 8 Password Security 9 Printing Waveforms 9 Continued Use 9 Return to Owner 10 Carrying Case and Accessory Pouch Assembly 11 Storing Accessories 12

Review 14

2 ECG and Arrhythmia Monitoring 15

Lesson Introduction 15

Objectives 15

Lesson Presentation 16

Monitor View 16 Preparation 17 Heart Rate and Arrhythmia Alarms 19 Displaying an Annotated ECG 22 Arrhythmia Learning/Relearning 23

Review 24

3 Semi-Automated

External Defibrillation 25

Lesson Introduction 25

Objectives 25

Lesson Presentation 26

AED View 26 Preparation 27 AED Mode 28 Shock Advised 29 No Shock Advised 30

Review 31

4 Manual Defibrillation

iii

and Cardioversion 33

Lesson Introduction 33

Objectives 33

Lesson Presentation 34

Code View 34 Manual Defibrillation Preparation 35 Manual Defibrillation 36 Synchronized Cardioversion Preparation 37 Synchronized Shock Delivery 38

Review 39

5 Q-CPR™ 41

Lesson Introduction 41

Objectives 41

Lesson Presentation 42

Overview 42 Q-CPR Preparation 43 Q-CPR in Manual Defib Mode 45 Q-CPR in AED Mode 47

Review 49

6 Noninvasive Pacing 51

Lesson Introduction 51

Objectives 51

Lesson Presentation 52

Pacer Mode 52 Pacing View 52 Demand vs. Fixed Mode 53 Preparation 54 Demand Mode Pacing 55 Fixed Mode Pacing 56 Defibrillating During Pacing 57

Review 58

7 Pulse Oximetry Monitoring 59

Lesson Introduction 59

Objectives 59

Lesson Presentation 60

Monitoring SpO Setting SpO2 Alarms 61 Setting Pulse Rate Alarms 62 Disabling SpO2 Monitoring 63

2

Review 64

60

iv

8 Noninvasive Blood Pressure Monitoring 65

Lesson Introduction 65

Objectives 65

Lesson Presentation 66

Preparing to Measure NBP 66 Measuring NBP 67 Alarms 68

Review 69

9 Carbon Dioxide Monitoring 71

Lesson Introduction 71

Objectives 71

Lesson Presentation 72

Measuring EtCO Setting Up the EtCO2 and AwRR Alarms 73 Disabling EtCO2 Monitoring 75

2

72

Review 76

10 Invasive Pressures Monitoring 77

Lesson Introduction 77

Objectives 77

Lesson Presentation 78

Overview 78 Pressure Measurement Set-up 78 Selecting a Pressure to Monitor 79 Pressure Waves 79 Zeroing the Pressure Transducer 81 Alarms 82 Pulse 83

Review 85

11 Temperature Monitoring 87

Lesson Introduction 87

Objectives 87

Lesson Presentation 88

Overview 88 Selecting a Temperature Label 88 Monitoring Temperature 88 Setting Temperature Alarms 89 Disabling Temperature Monitoring 89

Review 91

12 12-Lead ECG Monitoring 93

Lesson Introduction 93

Objectives 93

v

Lesson Presentation 94

Preview Screen 94 Preparation 95 Acquiring the 12-Lead ECG 96 12-Lead Report 97 Adjusting Wave Size 98

Review 99

13 12-Lead ECG via Bluetooth Transmission 101

Lesson Introduction 101

Objectives 101

Lesson Presentation 102

Overview 102 Setting Up for Bluetooth Transmission 103 Transmitting to a Configured Site using Bluetooth 104 Transmitting to a Fax Number 105 Transmitting Stored 12-Lead Reports 105 Cancelling Transmission 106

Review 107

14 Vital Signs Trending 109

Lesson Introduction 109

Objectives 109

Lesson Presentation 110

Reviewing Trending Data 110 Tre nd i n g R e p o r t I n t er va l s 110 Scrolling in the Trending Report 110 Printing the Trending Report 111 Exiting the Trending Report 111

Review 112

15 Data Management 113

Lesson Introduction 113

Objectives 113

Lesson Presentation 114

Overview 114 Marking Events 115 Printing the Event Summary 115 Printing the Vital Signs Trending Report 115 Using Data Management - Internal Memory 116 Using Data Management - Data Card 116

Review 117

16 Maintenance 119

Lesson Introduction 119

Objectives 119

vi

Lesson Presentation 120

Automated Tests 120 Ready For Use Indicator 120 Shift Check 121 Weekly Sh oc k Test 121 Operational Check 122 Battery Maintenance 124 Cleaning Instructions 125

Review 126

17 Review Answers 127

vii

viii

User Training Workbook

Lesson Introduction

This lesson provides an overview of the HeartStart MRx controls, indicators, operational modes, and display views. It also provides general information on use of the device.

Objectives

Upon completion of this lesson, you should be able to:

1

1Getting Acquainted

1. Identify the physical features, controls, and indicators of the MRx.

2. Identify the purpose of various controls and indicators.

3. Identify the display view characteristics associated with MRx’s operating modes.

Notes:

________________________________________________________________

1

1 Getting Acquainted Lesson Presentation

Lesson Presentation

Basic Orientation

The MRx controls are organized to facilitate ease of use.

Front Panel

Mark Event button

Lead Select button

Display

External Power Indicator

Synchronized Cardioversion (Sync) Button

c

n

y

S

u

n

a

M

A D

120

b

150

i

100

f

e

70

D

l

a

50

30

20

15

1-10

n

O

n

P

acer

O

ff

AED

M

onitor

Ready For Use (RFU) Indicator

Therapy Knob

dult ose

170

200

S

elect

E

nergy

1

C

harge

Charge button

Shock button

2

S

hock

Printer (50mm)

3

Printer door

Printer door latch

Print button

Speaker

Alarm Pause button (Label may appear with or without an "X"

Summary button

Soft keys (4 total)

Navigation buttons

Microphone

Menu Select button

through the triangle)

2

Lesson Presentation 1 Getting Acquainted

Notes:

________________________________________________________________

3

1 Getting Acquainted Lesson Presentation

Side Panels

CO2 Inlet Port

CO2 Outlet Port

Temperature Port

ECG Out (Sync) Jack

Invasive Pressure ports

2

O

C

™

a

e

r

t

s

o

r

c

i

M

1

NBP Port

2

m

G

C

E

G

C

E

ECG Port

SpO2 Port

Data Card

Therapy Connector

Notes:

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4

Lesson Presentation 1 Getting Acquainted

Top Panel

Notes:

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5

1 Getting Acquainted Lesson Presentation

t

Back Panel

Bed Rail Hook Moun

Battery/AC Compartment B

LAN Connection

Battery Compartment A

RS 232 Serial Port

AC Power Module

DC Power Input

Notes:

________________________________________________________________

Battery

________________________________________________________________

6

Lesson Presentation 1 Getting Acquainted

Display View

The MRx layout is as follows.

General Status Area

Wav e Sector 1

Wav e Sector 2

Wav e Sector 3

Wav e Sector 4

Soft Keys

Mark Event

I

nop

ECG/HR

alarm

HR

bp

m

80

Primary ECG

AB

P

150

75

0

P

(95)

A

P

CO2

oftkey

mmHg

SYS

160

AB

118/77

30

15

0

60

30

0

S #1

s

90

S #2

A

oftkey

r

ea

120

50

PAP

24/10

(15)

P

atien

A

dul

T

emp

36.9 80

mmHg

I

A

D

16

0

S

oftkey

#3

10 Feb 2006 11:20

t nam

e

t

Non-

P

ul

se

C

39

.

0

.

0

36

SpO2 %EtCO2

100

S

oftkey

HH:MM:SS

P

ace

d

NB

bp

m

120/80

mmHg

90

38

M

a

in

Displayed Waves

Printed Waves

M

easurements

High Contrast On

#4

mmHg

P

SYS

160

90

(95)

AwRR

50 30

18

M

e

nu

V

olume

/

A

larms

Patient Info

T

rend

s

O

the

r

E

xit

q

10

120

rpm

Parameter

:

40

30

8

Block 1

Parameter Block 2

Menu Area

Notes:

________________________________________________________________

7

1 Getting Acquainted Lesson Presentation

Responding to Alarms

Follow the steps below to respond to an alarm condition.

1. Attend to the patient.

2. Identify the alarm(s) indicated.

3. Silence the alarm(s) using the Navigation and Menu Select buttons.

4. Address the alarm condition.

Notes:

________________________________________________________________

8

Lesson Presentation 1 Getting Acquainted

Password Security

Access to Manual Defib and Pacer Modes may be password protected if enabled in Configuration. Failure to enter the correct Manual Therapy Security password prevents manual defibrillation/ synchronized cardioversion delivery or pacing therapy. AED Mode is always available without a password.

Printing Waveforms

To change wave forms for the second wave printed with a 50mm printer:

1. Press the Menu Select button.

2. Using the Navigation buttons, select the Printed Waves option and press Menu Select.

3. Using the Navigation buttons, select the wave form you want to print in Wave 2 and press Menu Select.

To change wave forms for the second or third wave printed with a 75mm printer:

1. Press the Menu Select button.

2. Using the Navigation buttons, select the Printed Waves option and press Menu Select.

3. Using the Navigation buttons, select Wave 2 or Wave 3 and press Menu Select.

4. Using the Navigation buttons, select the wave form you want printed and press Menu Select.

5. Repeat Steps 2 through 4 for the other printed wave.

Continued Use

MRx’s Continued Use feature facilitates continued treatment of the same patient by retaining current settings and the patient record when the MRx is turned off for less than 10 seconds or switching between modes (e.g., Monitor, AED, and Manual Defib).

9

1 Getting Acquainted Lesson Presentation

Return to Owner

To enable the Return to Owner feature:

1. Press the Menu Select button.

2. Select Other and press Menu Select.

3. Select Return To Owner and press Menu Select.

4. Press the [Activate] soft key.

5. Enter the number of days in the loan period and press Menu Select.

6. Press the [Exit Return-To] soft key.

To disable the Return to Owner feature:

1. Press the Menu Select button.

2. Select Other and press Menu Select.

3. Select Return To Owner and press Menu Select.

4. Press the [Deactivate] soft key.

5. Enter the password and press Menu Select.

6. Press the [Exit Return-To] soft key.

Notes:

________________________________________________________________

10

Lesson Presentation 1 Getting Acquainted

Carrying Case and Accessory Pouch Assembly

The following topics are for only customers who have carrying cases and accessory pouches, and require assembly procedures and recommended accessory placement and storage. The following illustrations show carrying case and accessory pouch assembly. Detailed directions can be found in the Setting Up chapter of the MRx Instructions For Use.

11

1 Getting Acquainted Lesson Presentation

(

( (

(

((

(

(((

((

(

((

(

Storing Accessories

The following illustrations show parameter cabling and accessory storage in the left pouch.

Below is right pouch storage for the Therapy cable (on the left) and back pouch storage for ECG electrodes (on the right).

(

12

Lesson Presentation 1 Getting Acquainted

Here are recommended carry bag storage instructions for Q-CPR accessories.

Option 1

PHILIPS

Option 2

PHILIPS

Notes:

________________________________________________________________________________

13

1 Getting Acquainted Review

Review

Please answer the following questions related to MRx features, controls, and display view.

1. Identify at least three controls or buttons on the MRx involved with defibrillation.

a. ______________________________________

b. ______________________________________

c. ______________________________________

2. What does a solid red "X" and periodic audio chirp indicate on the RFU?

a. No battery is present

b. No power is available

c. A low battery condition

d. Defibrillation therapy may not be available

3. The arrhythmia algorithm uses the ECG in which Wave Sector for analysis?

a. 1

b. 2

c. 3

d. all of the above

4. You can select the ECG lead for Wave Sector 2 using either the Lead Select button or Displayed Wave s menu. T or F

5. You should respond to alarms primarily by pressing the Alarm Pause button. T or F

14

User Training Workbook

Lesson Introduction

This lesson describes the basic ECG and arrhythmia monitoring functions of the HeartStart MRx. It briefly examines Monitor View, monitoring preparation, alarms, annotated ECGs, and arrhythmia learning/relearning.

2

2ECG and Arrhythmia

Monitoring

Objectives

Upon completion of this lesson, you should be able to:

1. Locate pertinent information in Monitor View.

2. Prepare a patient for ECG and arrhythmia monitoring.

3. Set heart rate and arrhythmia alarms.

4. Display an annotated ECG.

5. Initiate manual relearning.

Notes:

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15

2 ECG and Arrhythmia Monitoring Lesson Presentation

Lesson Presentation

Monitor View

Monitor View is displayed when you turn the Therapy Knob to Monitor.

INOPs ECG/HR Alarms

Heart Rate and Alarm Settings

Mark Event

I

nop

ECG/HR

alarm

HR

bp

m

80

II

AB

P

150

75

0

AB

P

118/77

(95)

P

A

P

30

15

0

CO2

60

30

0

S

tar

t

NB

P

s

mmHg

SYS

160

s

90

12-L

A

r

ea

120

50

PAP

24/10

(15)

ea

d

Patient Name

A

T

emp

36.9 80

mmHg

I

A

D

16

0

10 Feb 2006 11:20

dul

t

Non-

P

ace

d

P

ul

se

bp

Z

r

100

ero

ess

m

90

38

C

.

0

39 36

.

0

SpO2 %EtCO2

100

P

NB

mmHg

P

120/80

(95)

mmHg

AwRR

50 30

MENU

02:42

q

120

SYS

160

:

40

10

90

rpm

30

8

18

Wave 1

Wave 2

Wave 3

Wave 4

Notes:

________________________________________________________________

16

Lesson Presentation 2 ECG and Arrhythmia Monitoring

Preparation

Follow the steps below to prepare for monitoring using multifunction electrode pads or electrodes.

Multifunction electrode pads

1. Prepare the patient’s chest (i.e., remove clothing, remove moisture from chest, and remove excessive hair).

2. Apply multifunction electrode pads to the patient according to the pads package directions or your organization’s protocol.

3. If not pre-connected, insert the pads cable into MRx’s green Therapy port.

4. Connect the pads to the pads cable.

Electrodes

1. Prepare the patient’s skin at appropriate electrode sites.

– If necessary, clip hair at the electrode sites (or shave sites if needed).

– Clean and abrade the skin at each electrode site.

– Dry the electrode sites briskly to increase capillary blood flow in the tissues and to remove oil

and skin cells.

2. Attach the snaps to the electrodes.

3. Apply the electrodes.

4. If not pre-connected, connect the ECG patient cable to the MRx.

Lead Selection

Use the Lead Select button to select the ECG lead for Wave Sector 1. To select a lead for Wave Sectors 2-4:

1. Press the Menu Select button.

2. Select Displayed Waves and press Menu Select.

3. Select the appropriate Wave Sector and press Menu Select.

4. Select the desired lead (with the clearest signal) and press Menu Select.

17

2 ECG and Arrhythmia Monitoring Lesson Presentation

Practice Exercise 1

Attach a simulator and 3-, 5-, and 10-Lead ECG set to the MRx (5- or 10-Lead set preferred), set the simulator to a normal sinus rhythm, and complete a variety of lead selections for Wave Sectors 2, 3, and 4, as appropriate.

Questions

1. How do Wave 2, 3, and/or 4 menus differ from each other in terms of available leads? From the Wave 1 m enu ?

2. What wave size(s) provide the clearest wave form?

3. What happens if you add a parameter?

Notes:

________________________________________________________________

18

Lesson Presentation 2 ECG and Arrhythmia Monitoring

Heart Rate and Arrhythmia Alarms

Introduction

The ST/AR Basic Arrhythmia Algorithm generates heart rate and heart rate alarms, and can never be disabled. Here are the various alerts MRx generates:

• Red alarms

• Yellow alarms

• INOP messages

HR/Arrhythmia Red Alarms

Alarm Message Condition Indicator Latching/

Non-Latching

Asystole No detectable beats for four

VFIB/VTACH A fibrillatory wave detected

VTACH Consecutive PVCs and HR

Extreme Brady 10 bpm below HR Low

Extreme Tachy 20 bpm above HR High

HR/Arrhythmia Yellow Alarms

Alarm Message Condition Indication Latching/

HR High The HR exceeds the configured

HR Low The HR is below the configured

PVC/min. High (value > limit)

Pacer Not Capture No QRS following a pacer pulse Yellow alarm

Pacer Not Pacing No QRS or pacer pulse detected Yellow alarm

Red alarm message, seconds in the absence of Vfib

for four seconds

exceed defined limits

limit, capped at 30 bpm

limit capped at 200 bpm (adult) or 240 bpm (pedi)

HR high limit

HR low limit

The number of detected PVCs in a minute exceeds the limit of 15 (adult/pedi)

alarm tone

Red alarm message,

alarm tone

Red alarm message,

alarm tone

Red alarm message,

alarm tone

Red alarm message,

alarm tone

Yellow alarm message, alarm tone

message, alarm tone

Latching

Non-Latching

Latching

19

2 ECG and Arrhythmia Monitoring Lesson Presentation

Alarm Chain for Basic Arrhythmia Monitoring

(RED ALARMS)

Asystole

V-Fib/V-Tach

V-Tach

Practice Exercise 2

Set the simulator and MRx to produce a variety of latching, non-latching, and INOP conditions, as directed.

Questions

1. What do you see and hear when a red alarm goes off? A yellow alarm? An INOP message?

Frequent PVCs

PVCs>xx/Min.

Extreme Tachy

(YELLOW ALARMS)

Beat Detection Alarms Rate AlarmsPVC Alarms

PNC*

First level timeout period

Second level timeout period

Extreme Brady

PNP*

* PNC = Pacer Not Capture PNP = Pacer Not Pacing

High HR Low HR

Notes:

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20

Philips HeartStart MRx User training

Specifications and Main Features

Frequently Asked Questions

User Manual

Lesson Introduction

Objectives

1Getting Acquainted

Notes:

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Lesson Presentation

Basic Orientation

Front Panel

Notes:

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Side Panels

Notes:

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Top Panel

Notes:

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Back Panel

Notes:

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Display View

Notes:

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Responding to Alarms

Notes:

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Password Security

Printing Waveforms

Continued Use

Return to Owner

Notes:

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________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

Carrying Case and Accessory Pouch Assembly

Storing Accessories

Notes:

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________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Review

Lesson Introduction