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:

________________________________________________________________

4

Lesson Presentation 1 Getting Acquainted

Top Panel

Notes:

________________________________________________________________

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:

________________________________________________________________

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:

________________________________________________________________

20

Lesson Presentation 2 ECG and Arrhythmia Monitoring

Setting Alarms

• Alarms are automatically enabled in Monitor and Pacer Modes.

• In Manual Defib Mode, alarms are automatically enabled if the Sync function is enabled. If the Sync function is not enabled, alarms are enabled using the Alarm Pause button.

• Alarms alert you when values exceed or fall below defined limits.

• Heart rate (HR) and VTACH alarm settings are as configured but may be changed during operation for the current patient.

• The PVC rate limit setting may only be changed in response to a PVC rate alarm condition.

• Other HR and arrhythmia alarms may not be changed.

Changing Heart Rate or VTACH Alarm Limits

To change HR or VTACH limits:

1. Press the Menu Select button.

2. Select Measurements/Alarms and press Menu Select.

3. Select HR/Arrhythmia and press Menu Select.

4. Select HR Limits and press Menu Select.

5. Select new values and press Menu Select.

6. Select VTACH Limits and press Menu Select.

7. Select new values and press Menu Select.

Enabling/Disabling Heart Rate and Arrhythmia Alarms

To enable or disable HR and arrhythmia alarms:

1. Press Menu Select.

2. Select Measurements/Alarms and press Menu Select.

3. Select HR/Arrhythmia and press Menu Select.

4. Select Alarms On/Off and press Menu Select.

Note: Disabling alarms prevent all alarms associated with HR measurements from being annunciated. If an alarm condition occurs, no alarm indication will be given.

Responding to HR and Arrhythmia Alarms

To respond to the Audio Pause label, press the Menu Select or Navigation buttons.

To respond to alarms:

1. Acknowledge the alarm condition.

2. Adjust the limits using the New Limits menu.

21

2 ECG and Arrhythmia Monitoring Lesson Presentation

Practice Exercise 3

Change HR or VTACH limits, enable or disable alarms, and respond to HR and arrhythmia alarms.

Questions

1. What happens when you change a limit? Disable an alarm? Respond to the Audio Pause label or an

alarm?

Notes:

________________________________________________________________

Displaying an Annotated ECG

An annotated wave displays how the ST/AR Algorithm labels beats. To display an annotated ECG:

1. Press Menu Select.

2. Select Displayed Waves and press Menu Select.

3. Select Wave 2 and press Menu Select.

4. Select Annotated ECG and press Menu Select.

Practice Exercise 4

Complete the steps to display an annotated ECG.

Question

Where does the annotation first appear?

Notes:

________________________________________________________________

22

Lesson Presentation 2 ECG and Arrhythmia Monitoring

Arrhythmia Learning/Relearning

MRx automatically performs arrhythmia learning/relearning when the lead or mode of operation is changed so the ST/AR Algorithm can properly analyze the patient’s normal and/or paced complexes.

Initiate manual relearning if beat detection is not occurring or if beat classification is incorrect and results in a false alarm. To initiate relearning manually:

1. Press Menu Select.

2. Select Measurements/Alarms and press Menu Select.

3. Select HR/Arrhythmia and press Menu Select.

4. Select Relearn Rhythm and press Menu Select.

Practice Exercise 5

Complete the steps to initiate manual relearning.

Notes:

________________________________________________________________

23

2 ECG and Arrhythmia Monitoring Review

Review

Please answer the following questions related to ECG and arrhythmia monitoring.

1. Identify the Monitoring View elements.

____________ ____________

____________

Mark Event

I

nop

ECG/HR

alarm

HR

bp

m

80

II

AB

P

150

75

0

AB

mmHg

P

118/77

(95)

A

P

30

15

0

CO2

60

30

0

S

tar

t

NB

P

s

SYS

160

90

A

r

ea

s

T

emp

120

50

36.9 80

PAP

24/10

(15)

12-L

ea

d

10 Feb 2006 11:20

Patient Name

A

dul

t

Non-

P

ul

se

C

.

0

39

.

0

36

mmHg

SpO2 %EtCO2

I

A

D

16

0

100

Z

P

r

100

ero

ess

90

P

ace

bp

d

NB

P

m

120/80

mmHg

38

02:42

mmHg

(95)

AwRR

50 30

MENU

SYS

160

90

18

q

120

10

:

40

rpm

30

8

__________

24

2. You can select the ECG lead for Wave Sectors 1-4 using the Lead Select button. T or F

3. Which of the following alarms can ONLY be changed while IN RESPONSE TO AN ALARM

CONDITION?

a. HR

b. PVC

c. VTACH

4. Which of the following statement(s) are TRUE?

a. All arrhythmia alarms are classified as "latching" alarms.

b. Yellow alarms can communicate equipment failures.

c. Alarms are enabled as soon as you enter Monitor Mode if the Sync function is enabled.

d. Menu Select AND Navigation buttons can acknowledge alarms.

5. The MRx automatically performs arrhythmia learning/relearning when there is a lead selection

change for Wave Sector 1 or 2. T or F

User Training Workbook

Lesson Introduction

This lesson describes how to use AED Mode. It highlights the AED display view and explains the steps and associated prompts that guide users through the defibrillation process.

3

3Semi-Automated

External Defibrillation

Objectives

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

1. Locate pertinent information in AED View.

2. Prepare a patient for AED defibrillation.

3. Defibrillate in AED Mode.

Notes:

________________________________________________________________

25

3 Semi-Automated External Defibrillation Lesson Presentation

Lesson Presentation

AED View

Turn the Therapy Knob to AED to display the AED View.

Mark Event

Alarms Off

HR

10 Feb 2006 11:20

154 02:42

P

ads

S

Analyzing

Do Not Touch Patient

P

ause

for

CP

R

ho

MENU

cks

: 0

Enlarged Event Timer

Enlarged ECG

Shock Counter

Message Window

Notes:

________________________________________________________________

26

Lesson Presentation 3 Semi-Automated External Defibrillation

Preparation

To prepare for AED defibrillation:

1. Confirm the patient’s condition (i.e., unresponsive, not breathing, and/or pulseless).

2. Prepare the patient’s chest.

3. Apply multifunction electrode pads using the anterior-anterior electrode placement.

4. If not pre-connected, insert the pads cable into the green Therapy port.

5. Connect the pads to the pads cable.

Notes:

________________________________________________________________

27

3 Semi-Automated External Defibrillation Lesson Presentation

AED Mode

To defibrillate in AED Mode:

1. Turn the Therapy Knob to AED.

2. Follow the voice and screen prompts.

3. Press the orange Shock button, if prompted.

Practice Exercise 1

Turn the Therapy Knob to AED and to see what happens when your pads cable and/or pads are not connected.

Notes:

________________________________________________________________

28

Lesson Presentation 3 Semi-Automated External Defibrillation

Shock Advised

Practice Exercise 2

Attach an ECG simulator to the MRx via a hands-free (pads) cable, set the simulator to a shockable rhythm (e.g., VF), and follow the steps to defibrillate. Complete one shock.

Questions

1. What screen prompts do you see and voice prompts do you hear initially?

2. How do you know the device is ready to deliver a charge?

3. What do you see and hear after delivering a shock?

4. What happens when you press the [Resume Analyzing] soft key?

Notes:

________________________________________________________________

29

3 Semi-Automated External Defibrillation Lesson Presentation

No Shock Advised

Practice Exercise 3

Set the simulator to a normal sinus rhythm and see what happens.

Questions

1. What screen prompts do you see and voice prompts do you hear?

2. What happens when you press the [Pause for CPR] soft key?

Notes:

________________________________________________________________

30

Review 3 Semi-Automated External Defibrillation

Review

Please answer the following questions related to AED.

1. Identify the AED View elements.

Mark Event

Alarms Off

HR

154 02:42

P

ads

10 Feb 2006 11:20

________________

S

ho

cks

: 0

________________

Analyzing

Do Not Touch Patient

P

ause

for

CP

R

2. Apply multifunction electrode pads using anterior-posterior placement for AED. T or F

MENU

________________

3. What are the three basic steps for AED using the MRx?

a. ____________________________________________

b. ____________________________________________

c. ____________________________________________

4. Which of the following statement(s) about AED Mode are TRUE?

a. The MRx automatically checks for proper pads cable and pads connection.

b. If artifact interferes with ECG analysis and persists, analysis will suspend but resume

automatically after 60 seconds.

c. The MRx automatically disarms if a shock becomes unnecessary.

d. The MRx automatically analyzes the patient’s heart rhythm after a shock is delivered.

31

User Training Workbook

Lesson Introduction

This lesson explains how to prepare for and perform manual asynchronous and synchronous (cardioversion) defibrillation using multifunction electrode pads and external/internal paddles.

4

4Manual Defibrillation

and Cardioversion

Objectives

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

1. Locate pertinent information in Code View.

2. Prepare a patient for asynchronous and synchronous defibrillation.

3. Perform asynchronous and synchronous defibrillation.

Notes:

________________________________________________________________

33

4 Manual Defibrillation and Cardioversion Lesson Presentation

Lesson Presentation

Code View

Turn the Therapy Knob to Manual Defib to display the Code View.

Heart Rate

Enlarged ECG

Mark Event

Alarms Off

HR

bp

m

180

II

P

let

h

CO2

60

30

0

S

tar

t

NB

P

10 Feb 2006 11:20

A

dul

t

Non-

P

ace

P

ul

se

bp

80

100

90

m

02:42

34

T

emp

120

50

36.9

Selected Energy: 150 Joules

C

39

.

0

.

0

36

SpO2 %EtCO2

60

D

isar

m

d

Enlarged Event Timer

S

mmHg

ho

AwRR

50 30

MENU

cks

18

: 0

rpm

30

8

Shock Counter

Notes:

________________________________________________________________

34

Lesson Presentation 4 Manual Defibrillation and Cardioversion

Manual Defibrillation Preparation

Follow the steps below to prepare for manual defibrillation using multifunction electrode pads or external paddles.

Multifunction Electrode Pads

1. Confirm the patient’s condition (i.e., unresponsive, not breathing, and/or pulseless).

2. Prepare the patient’s chest.

3. Apply multifunction electrode pads to the patient according to pads package directions or your

organization’s protocol.

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

5. Connect the pads to the pads cable.

External Paddles

1. Confirm the patient’s condition (i.e., unresponsive, not breathing, and/or pulseless).

2. If not pre-connected, insert the paddles cable into the green Therapy port.

3. Remove the paddles from paddle tray.

4. Apply the paddles to patient’s bare chest, using the anterior-anterior placement or your

organization’s protocol.

Internal Paddles

1. Select the appropriate switched or switchless paddle electrode size.

2. If using switchless paddles, connect the paddles to the M4740A Paddle Adapter Cable.

3. Connect the paddles cable (or the paddle adapter cable) to the MRx.

Notes:

________________________________________________________________

35

4 Manual Defibrillation and Cardioversion Lesson Presentation

Manual Defibrillation

To defibrillate in Manual Mode:

1. Turn the Therapy Knob to Manual Defib and select an energy setting.

2. Press the Charge button on the MRx (or external paddle).

3. Make sure no one is touching the patient or anything connected to the patient before shock; call

out loudly and clearly “Stay Clear!”.

4. Press the orange Shock button on the MRx (or the shock buttons on the external or switched

internal paddles).

Practice Exercise 1

Attach a simulator and parameter accessories (if available and appropriate) to the MRx, set the simulator to a shockable rhythm (e.g., VF), and complete the manual defibrillation steps (with three shocks).

Questions

1. What do you see and hear during a charge?

2. How do you know the device is ready to deliver a charge?

3. What do you see and hear after delivering a shock?

4. What happens when you press the [Disarm] soft key?

Notes:

________________________________________________________________

36

Lesson Presentation 4 Manual Defibrillation and Cardioversion

Synchronized Cardioversion Preparation

Follow the steps below to prepare for synchronized cardioversion.

1. Perform the steps as described in the previous Manual Defibrillation Preparation topic.

2. If monitoring through a 3-, 5-, or 10-Lead ECG cable, plug the cable into MRx’s ECG port and

apply monitoring electrodes to the patient.

3. Press the Lead Select button to select Pads, Paddles, or a lead from attached monitoring electrodes.

Notes:

________________________________________________________________

37

4 Manual Defibrillation and Cardioversion Lesson Presentation

Synchronized Shock Delivery

To deliver a synchronized shock:

1. Turn the Therapy Knob to Monitor position and press the Sync button.

2. Confirm that the Sync marker appears with each R-wave.

3. Turn the Therapy Knob to Manual Defib and select an energy setting.

4. Press the Charge button on the MRx (or external paddle).

5. Make sure no one is touching the patient or anything connected to the patient before shock; call

out loudly and clearly “Stay Clear!”.

6. Press and hold

paddles) until the shock is delivered.

the orange Shock button on the MRx (or the orange shock buttons on both

Practice Exercise 2

Attach a simulator and pads to the MRx, set the simulator to a shockable rhythm (e.g., VF), and complete synchronized cardioversion.

Questions

1. What do you see when you press the Sync button?

2. Once in Sync mode, what happens when you turn the Therapy Knob to a position other than

Manual Defib?

3. What happens when you press the Sync button again?

Notes:

________________________________________________________________

38

Review 4 Manual Defibrillation and Cardioversion

Review

Please answer the following questions related to manual defibrillation and synchronized cardioversion.

1. Identify the Code View elements.

____________

Mark Event

Alarms Off

HR

bp

m

180

II

P

let

h

CO2

60

30

0

S

tar

t

NB

P

10 Feb 2006 11:20

A

dul

t

Non-

P

ace

d

P

ul

se

bp

T

emp

120

50

36.9

Selected Energy: 150 Joules

C

.

0

39

.

0

36

SpO2 %EtCO2

60

D

isar

m

02:42

80

100

90

34

mmHg

S

ho

50 30

cks

AwRR

18

MENU

: 0

rpm

____________

30

8

2. What are the three basic steps for manual defibrillation using the MRx?

a. __________________________________________________

b. __________________________________________________

c. __________________________________________________

3. Which of the following indicate that the MRx is ready to deliver a shock via pads?

a. The device sounds a continuous high-pitched tone. Y or N

b. The Charged value on the display matches the Therapy Knob setting. Y or N

c. The disarm soft key is disabled. Y or N

d. The Shock button flashes. Y or N

4. What are the four basic steps for synchronized cardioversion using the MRx?

a. __________________________________________________

b. __________________________________________________

c. __________________________________________________

d. __________________________________________________

39

User Training Workbook

5

5Q-CPR

Lesson Introduction

This lesson describes how to set-up and use the Q-CPR™ option available on the HeartStart MRx.

Note: Q-CPR™ is a trademark of Laerdal Medical.

Objectives

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

1. Identify intended use and preparation for use related to Q-CPR.

2. Identify characteristics related to Q-CPR in Manual Defib and AED Modes.

Notes:

________________________________________________________________

™

________________________________________________________________

41

Lesson Presentation 5Q-CPR™

Lesson Presentation

Overview

Q-CPR:

• Offers measurement and corrective feedback on:

– compression rate, depth, and duration time,

– ventilation rate, volume, and flow rate (inflation time)

– CPR inactivity

• Measures compressions through a Compression Sensor and ventilations through multifunction defib electrode pads

• Is used with only the HeartStart MRx

• Is contraindicated:

– on neonatal and pediatric patients (under 8 years of age or weighing less than 25 kg)

– when CPR is contraindicated

– in a moving environment

– with any other CPR compression devices (aside from the Q-CPR Compression Sensor)

• Events related to Q-CPR are not stored in the HeartStart MRx Event Summary.

Notes:

________________________________________________________________

42

Lesson Presentation 5Q-CPR™

Q-CPR Preparation

Follow the steps below to prepare for Q-CPR use.

1. Connect the Pads/CPR cable to the MRx, aligning the white pointer on the cable with the white

arrow on the green Therapy port, inserting the cable into the port, and pushing until you hear it click into place. Compression Sensor to the Pads/CPR Cable

2. Connect the Compression Sensor to the Pads/CPR cable, aligning the key marker on the

Compression Sensor cable with the key marker on the receptacle end of the Pads/CPR cable, and pushing until you hear it click into place.

3. Attach the Compression Sensor Adhesive Pad to the Compression Sensor, peeling the white liner

from the bottom of the Compression Sensor Adhesive Pad, aligning the Sensor Adhesive Pad with the yellow area of the sensor, and pressing into place.

Note: Complete steps 1-3 before a rescue or resuscitation event to save time on set-up.

4. Prepare the patient’s chest and apply the multifunction electrode pads to the patient as directed on

the pads package, using the anterior-anterior placement.

5. Connect the pads to the Pads/CPR cable.

6. Place the Compression Sensor on the lower half of the patient’s sternum, which is at the normal

CPR hand location.

Notes:

________________________________________________________________

43

Lesson Presentation 5Q-CPR™

Practice Exercise 1

Make all cable attachments and then detach a cable to see what inop is produced. Loosen a multifunction pad to see what inop is produced.

Notes:

________________________________________________________________

44

Lesson Presentation 5Q-CPR™

Q-CPR in Manual Defib Mode

Turn the MRx Therapy Knob to Manual Defib and select the 150J energy setting.

Mark Event

Alarms Off

HRHR

bpm

145

Selected Energy:150 Joules

Comp

cpm

107

Comp

CO2

60

11 Feb 2006 22:32

Adult Non- Paced

120

50

No Flow secIIEtC02 mmHg

37

14:02

Shocks: 0

Vent

rpm

12

Com p

Compression Target Zone

Practice Exercise 2

Turn to the 150J adult manual defibrillation setting and practice performing CPR alone and with a another student on a manikin (to experience 1- and 2-rescue person situations) according to AHA guidelines for compression-to-ventilation ratio. Also, press the Sync and/or Alarm Pause button to see what happens to Q-CPR.

Questions

1. What voice prompts do you hear when performing CPR? What is the most frequently heard

prompt?

2. How long can you perform CPR without getting a voice prompt? How long could you perform

CPR before getting totally fatigued?

3. What range of compression and ventilation rates do you achieve?

4. How full does the ventilation (lungs) icon get when you do ventilations?

5. How often do you get ‘No Flow’ times and how long are those times?

30

0

Start

NBP

Disarm

Stop

CPR

Intubate

MENU

45

Lesson Presentation 5Q-CPR™

6. What happens to Q-CPR when you press the Sync and/or Alarm Pause button?

Notes:

________________________________________________________________

46

Lesson Presentation 5Q-CPR™

Q-CPR in AED Mode

Turn the Therapy Knob to AED and press the Pause for CPR soft key.

Mark Event

Alarms Off

HR

bpm

180

Pads

11 Feb 2006 22:25

02:09

COMPRESS FASTER

Shocks: 0

CPR Timer Status Bar

Practice Exercise 3

Tu rn to AED, press the Pause for CPR soft key, and practice performing CPR alone and with a another student on a manikin (to experience a 1- and 2-rescue person situation) according to AHA guidelines for compression-to-ventilation ratio.

Questions

1. What voice and text prompts do you get when performing CPR? What is the most frequent voice

or text prompt produced?

2. How long can you perform CPR without getting a voice or text prompt? How long could you

perform CPR before getting totally fatigued?

Resume

Analyzing

Intubate

MENU

47

Lesson Presentation 5Q-CPR™

Notes:

________________________________________________________________

CPR Feedback Volume Adjustment

To mute the CPR feedback voice prompts (once you start CPR):

1. Press Menu Select.

2. Select Mute CPR Voice and press Menu Select.

To resume voice prompts set at the previously selected volume:

1. Press Menu Select.

2. Select Resume CPR Voice and press Menu Select.

To adjust the volume of CPR feedback voice prompts:

1. Press the Menu Select button.

2. Select Vol um e and press Menu Select.

3. Select Voi ce and press Menu Select.

4. Select the desired volume level and press Menu Select.

48

Review 5Q-CPR™

Review

Please answer the following questions related to Q-CPR.

1. Q-CPR can be used on patients 8 years and older. T or F

2. The multifunction pads should be placed in an anterior/posterior position to ensure the ventilation

algorithm interprets ventilations properly. T or F

3. The compression sensor should be positioned on the upper half of the patient’s sternum to

perform compressions. T or F

4. In Manual Defib Mode, good compression depth is indicated by the downward “peak” of the

waveform appearing between the horizontal lines representing the target zone. T or F

5. The ventilation volume icon indicates ventilation has been detected but not the actual filling of

both lungs. T or F

6. Only AED Mode provides voice and text prompts associated with compression and ventilation

activity. T or F

49

User Training Workbook

Lesson Introduction

This lesson describes the noninvasive transcutaneous pacing option available with the HeartStart MRx and how to perform pacing.

Objectives

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

6

6Noninvasive Pacing

1. Identify pertinent information in Pacing View.

2. Prepare a patient for pacing.

3. Perform demand or fixed mode pacing.

Notes:

________________________________________________________________

51

6 Noninvasive Pacing Lesson Presentation

Lesson Presentation

Pacer Mode

In this mode:

• Pace pulses are delivered through multifunction electrode pads.

• Waveforms, ECG monitoring, measurements, and most alarms* (from Monitor or Manual Defib Mode) remain active if enabled and retain settings.

*Arrhythmia alarms for Pacer Not Pacing and Pacer Not Capture (associated with non-transcutaneous pacing) are off. All other red and yellow alarms are active if enabled and their limits may be changed while in Pacer Mode. ECG INOPs are also annunciated.

Pacing View

Turn the Therapy Knob to Pacer to display the Pacing View.

10 Feb 2006 11:20

Jones, Samuel

A

dul

t

P

ul

se

39 36

C

.

0

.

0

emp

36.9 70

02:02:42

NB

P

bp

m

120/80

(95)

mmHg

SYS

160

90

q

120

10

:

40

Pacing Markers

Mark Event

HR

70

II

120

50

T

mmHg

38

50 30

MENU

90

r

t

18

30

8

Pacing Status Area

P

let

h

PACING ON BATTERIES

D

ema

nd

M

od

e

S

tar

t

R

esum

NB

P

e

P

ac

ing

SpO2 %EtCO2

100

70

pp

m

P

ace

r

R

ate

50

P O

ace

100

mA

utpu

rpm

AwRR

Notes:

________________________________________________________________

52

Lesson Presentation 6 Noninvasive Pacing

Demand vs. Fixed Mode

Demand mode

• Pace pulses are delivered when the patient’s heart rate is lower than the selected pacing rate.

• This mode uses monitoring electrodes AND pads for pacing.

• Demand mode is the suggested pacing mode.

Fixed mode

• Pace pulses are delivered at a selected rate.

• Use when motion artifact or ECG noise makes R-wave detection unreliable or when monitoring electrodes are not available.

Notes:

________________________________________________________________

53

6 Noninvasive Pacing Lesson Presentation

Preparation

Follow the steps below to prepare for pacing.

1. Prepare the patient’s chest. Wipe moisture away and, if necessary, clip or shave excessive chest hair.

2. Apply multifunction electrode pads to the patient as directed on the pads packaging or according

to your organization’s protocol.

3. If not pre-connected, connect the pads cable to green Therapy port on the MRx.

4. Connect the pads connector to the pads cable.

5. If pacing in demand mode, apply monitoring electrodes and connect the ECG cable to the ECG

port on the MRx.

Notes:

________________________________________________________________

54

Lesson Presentation 6 Noninvasive Pacing

Demand Mode Pacing

To pace in demand mode:

1. Turn the Therapy Knob to the Pacer position.

2. Press the Lead Select button to select the best lead with an easily detectable R-wave.

3. Verify white R-wave markers appear above or on the ECG waveform, with a single marker for each

R-wave. If no R-wave markers appear or coincide with the R-wave, select another lead or increase wave size.

4. Press the [Pacer Rate] soft key and use the Navigation and Menu Select buttons to select the

desired number of pace pulses per minute.

5. If needed, adjust the initial pacer output. Press [Pacer Output] and use the Navigation and

Menu Select buttons to select the desired output.

6. Press [Start Pacing].

7. Verify white pacing markers appear above or on the ECG waveform.

8. Press [Pacer Output]. Then use the Navigation and Menu Select buttons to adjust the output

to the lowest level that still maintains capture.

9. Verify the presence of a peripheral pulse.

10. Press [Pause Pacing] to stop pacing. Press [Resume Pacing] to resume delivery, as

appropriate.

Note: You may also stop pacing by turning the Therapy Knob from Pacer to another position.

Practice Exercise 1

Attach pads and electrodes to the MRx and a simulator, set the simulator to bradycardia, and complete the demand mode pacing steps.

Questions

1. What display changes do you see when completing each step (i.e., turn on pacing, set pacing status,

adjust pacer rate and output, and stop pacing)?

2. How do you know when pace pulses are being delivered?

Notes:

________________________________________________________________

55

6 Noninvasive Pacing Lesson Presentation

Fixed Mode Pacing

To pace in fixed mode:

1. Turn the Therapy Knob to Pacer.

2. Change the pacer mode to Fixed.

3. Press the Lead Select button to select the desired lead.

Note: The remaining steps are similar to demand mode pacing.

4. Press [Pacer Rate] and use the Navigation and Menu Select buttons to select the desired

number of pace pulses per minute.

5. If needed, adjust the initial pacer output by pressing [Pacer Output] and using the Navigation

and Menu Select buttons to select the desired output.

6. Press [Start Pacing].

7. Verify the presence of a peripheral pulse.

8. Press [Pacer Output] and use the Navigation and Menu Select buttons to adjust the output,

as needed.

9. Press [Pause Pacing] to stop pacing.

Practice Exercise 2

Attach pads and electrodes to the MRx and a simulator, set the simulator to bradycardia, and complete the fixed mode pacing steps.

Questions

1. What display changes do you see when completing each step (i.e., turn on pacing, set pacing status,

adjust pacer rate and output, and stop pacing)?

2. How do you know when pace pulses are being delivered?

Notes:

________________________________________________________________

56

Lesson Presentation 6 Noninvasive Pacing

Defibrillating During Pacing

To defibrillate, turn the Therapy Knob to Manual Defib or AED. Note that:

• Pacing stops in either Manual Defib or AED Mode.

• Pacing settings selected prior to defibrillation are retained once pacing recommences.

Notes:

________________________________________________________________

57

6 Noninvasive Pacing Review

Review

Please answer the following questions related to pacing.

1. Which of the following statement(s) are TRUE related to pacing with the MRx?

a. The device requires a 3-, 5- or 10-Lead ECG cable and monitoring electrodes during demand

mode pacing.

b. The device always delivers pace pulses in demand mode.

c. The Pacing status area indicates pacing mode, status, rate, and output.

d. If you exit Pacing Mode to defibrillate and then return to pacing, the settings from the

previous pacing session must be re-entered.

2. Which ONE of the following steps should be performed before pacing is initiated in demand

mode?

a. Verify that a white pacing marker appears in front of each QRS complex.

b. Verify that white R-wave markers appear above or on the ECG waveform.

c. Increase pacer output until capture occurs.

d. Decrease pacer output to the lowest level that still maintains capture.

58

User Training Workbook

7Pulse Oximetry Monitoring

Lesson Introduction

This lesson describes how to use the HeartStart MRx to monitor Pulse Oximetry (SpO2).

Objectives

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

7

1. Monitor SpO

2. Set SpO

Notes:

________________________________________________________________

.

2

and pulse rate alarms.

2

59

7 Pulse Oximetry Monitoring Lesson Presentation

Lesson Presentation

Monitoring SpO

To m o ni t or Sp O2:

1. Connect the appropriate sensor cable to the MRx.

2. Apply the sensor to the patient. If a finger sensor is used, the cable should come down the back of

3. Turn the Therapy Knob to Monitor.

2

the hand.

Notes:

________________________________________________________________

60

Lesson Presentation 7 Pulse Oximetry Monitoring

Setting SpO2 Alarms

Changing Alarm Limits

To change the SpO2 alarm limits:

1. Press the Menu Select button.

2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.

3. Select SpO

4. Select SpO

5. Using the Navigation buttons, select the new high limit value and press Menu Select.

6. Select the new low limit value and press Menu Select.

and press Menu Select.

2

Limits and press Menu Select.

2

Enabling/Disabling Alarms

To e na bl e t he SpO2 alarms:

1. Press the Menu Select button.

2. Select Measurements/Alarms and press Menu Select.

3. Select SpO

4. Select Alarms On/Off and press Menu Select.

and press Menu Select.

2

Practice Exercise 1

Change the SpO2 limits, and enable/disable and respond to related alarms.

Questions

What happens when you change a limit? Disable an alarm? Respond to an alarm?

Notes:

________________________________________________________________

61

7 Pulse Oximetry Monitoring Lesson Presentation

Setting Pulse Rate Alarms

Changing Pulse Rate Alarm Limits

To change pulse rate alarm limits:

1. Press the Menu Select button.

2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.

3. Select Pulse and press Menu Select.

4. Select Pulse Limits and press Menu Select.

5. Using the Navigation buttons, select the new high limit value and press Menu Select.

6. Select the new low limit value and press Menu Select.

Enabling/Disabling Pulse Rate Alarms

To enable pulse rate alarms:

1. Press the Menu Select button.

2. Select Measurements/Alarms and press Menu Select.

3. Select Pulse and press Menu Select.

4. Select Alarms On/Off and press Menu Select.

Practice Exercise 2

Change the pulse rate limits, and enable/disable and respond to related alarms.

Question

What happens when you change a limit? Disable an alarm? Respond to an alarm?

Notes:

________________________________________________________________

62

Lesson Presentation 7 Pulse Oximetry Monitoring

Disabling SpO2 Monitoring

To disable SpO2 monitoring:

• Disconnect the sensor cable from the SpO appears. Select Ye s and press Menu Select.

• Should the sensor cable be disconnected accidentally, select No and press Menu Select. Then, secure the connection to re-enable the function.

port. The message SpO

2

Unplugged. Turn off SpO

2

Notes:

________________________________________________________________

?

2

63

7 Pulse Oximetry Monitoring Review

Review

Answer the following questions related to SpO2 monitoring.

1. You can monitor SpO

2. The pleth wave is auto scaled to grid lines when the signal quality is poor. T or F

3. SpO

4. How many seconds are SpO

alarms are off unless turned on during use while pulse rate alarms are on unless turned off

2

during use. T or F

a. 15

b. 30

c. 45

d. 60

in all MRx modes (Monitor, Manual Defib, AED or Pacer). T or F

2

INOP messages suppressed during an NBP measurement?

2

64

User Training Workbook

8Noninvasive Blood Pressure

Lesson Introduction

This lesson describes how to monitor noninvasive blood pressure (NBP) with the HeartStart MRx.

8

Monitoring

Objectives

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

1. Monitor NBP.

2. Set NBP alarms.

Notes:

________________________________________________________________

65

8 Noninvasive Blood Pressure Monitoring Lesson Presentation

Lesson Presentation

Preparing to Measure NBP

To prepare to measure NBP:

1. Select the appropriately sized cuff.

2. Attach the cuff to the NBP tubing.

3. Insert the NBP tubing into the NBP port on the MRx.

4. Apply the blood pressure cuff to the patient’s arm.

5. Place the limb used for taking the measurement at the same level as the patient’s heart.

Notes:

________________________________________________________________

66

Lesson Presentation 8 Noninvasive Blood Pressure Monitoring

Measuring NBP

To measure NBP:

1. Press the [Start NBP] soft key.

2. Press the [Stop NBP] soft key to stop a reading.

Changing the NBP Schedule

To change the NBP schedule and/or the interval of automatic measurements:

1. Press the Menu Select button.

2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.

3. Select NBP and press Menu Select.

4. Select NBP Schedule and press Menu Select.

5. Using the Navigation buttons, select the desired interval and press Menu Select.

Practice Exercise 1

Complete manual and automatic NBP measurements, including changing the NBP schedule.

Questions

1. What displays when you start a measurement? Stop a measurement?

2. How does the display differ between a manual and automatic measurement?

Notes:

________________________________________________________________

67

8 Noninvasive Blood Pressure Monitoring Lesson Presentation

Alarms

Changing NBP Alarms

To change the NBP alarm source and/or limits:

1. Press the Menu Select button.

2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.

3. Select NBP and press Menu Select.

4. Select NBP Limits and press Menu Select.

5. Select the desired source for the alarm and press Menu Select.

6. Using the Navigation buttons, increase or decrease the high limit value and press Menu Select.

7. Set the new low limit value and press Menu Select.

Enabling/Disabling NBP Alarms

To enable/disable NBP alarms:

1. Press the Menu Select button.

2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.

3. Select NBP and press Menu Select.

4. Select Alarms On/Off and press Menu Select.

Practice Exercise 2

Change the alarm limits, and enable/disable and respond to related alarms.

Questions

1. What happens when you change a limit? Disable an alarm? Respond to an alarm?

Notes:

________________________________________________________________

68

Review 8 Noninvasive Blood Pressure Monitoring

Review

Answer the following questions related to monitoring NBP.

1. Which of the following items can display when monitoring NBP?

a. Systolic and diastolic pressure

b. Alarm limits

c. Automatic measurement schedule

d. Time stamp

2. You can take manual measurements during an automatic measurement schedule. T or F

3. NBP alarms are “on” unless disabled. T or F

69

User Training Workbook

9Carbon Dioxide Monitoring

Lesson Introduction

This lesson describes how to monitor carbon dioxide (CO2) and measure end-tidal carbon dioxide (EtCO (sidestream) method.

Note: Microstream® is a trademark of Oridion Medical Ltd.

) and Airway Respiration Rate (AwRR) with the HeartStart MRx using the Microstream®

2

9

Objectives

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

1. Monitor CO

2. Set EtCO

Notes:

________________________________________________________________

.

2

and AwRR alarms.

2

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9 Carbon Dioxide Monitoring Lesson Presentation

Lesson Presentation

Measuring EtCO

To prepare and measure EtCO2:

1. Select the appropriate Microstream accessories based on the type and airway status of the patient.

2. Set up the Microstream accessories.

Using the nasal FilterLine

a. Attach the FilterLine tubing to the CO

b. Position the nasal FilterLine on the patient. If using dual purpose FilterLine tubing, connect the

green tubing to the oxygen source.

Note: FilterLine® is a trademark of Oridion Medical Ltd.

Using the FilterLine and airway adapter

a. Attach the FilterLine tubing to the CO2 Inlet port.

b. Connect the wide end of the airway adapter to the endotracheal tube.

c. Connect the narrow end of the airway adapter to the ventilator tubing or manual resuscitator.

3. A measurement is automatically turned on when the FilterLine is connected to the CO

Note: The Outlet port is used for removing anesthetic gases from MRx.

2

®

Inlet port.

2

Inlet port.

2

Notes:

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Lesson Presentation 9 Carbon Dioxide Monitoring

Setting Up the EtCO2 and AwRR Alarms

Changing EtCO2 Alarm Limits

To change the EtCO2 alarm limits:

1. Press the Menu Select button.

2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.

3. Select EtCO

4. Select EtCO

5. Using the Navigation buttons, increase or decrease the high limit value and press Menu Select.

6. Set the new low limit value and press Menu Select.

and press Menu Select.

2

Limits and press Menu Select.

2

Enabling/Disabling EtCO2 Alarms

To enable or disable the EtCO2 alarms:

1. Press Menu Select. Using the Navigation buttons, select Measurements/Alarms and press Menu

Select.

2. Select EtCO

3. Select Alarms On/Off and press Menu Select.

and press Menu Select.

2

Changing AwRR Alarm Limits

To change the AwRR alarm limits:

1. Press Menu Select.

2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.

3. Select AwRR and press Menu Select.

4. Select AwRR Limits and press Menu Select.

5. Using the Navigation buttons, increase or decrease the high limit value and press Menu Select.

6. Set the new low limit value and press Menu Select.

Changing Apnea Time Alarm Limit

To change the Apnea Time alarm limit:

1. Press Menu Select.

2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.

3. Select AwRR and press Menu Select.

4. Select Apnea Time and press Menu Select.

5. Using the Navigation buttons, increase or decrease the limit and press Menu Select.

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9 Carbon Dioxide Monitoring Lesson Presentation

Enabling/Disabling AwRR Alarms

To enable the AwRR alarms:

1. Press Menu Select.

2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.

3. Select AwRR and press Menu Select.

4. Select Alarms On/Off and press Menu Select.

Practice Exercise 1

Change EtCO2, AwRR, and Apnea Time limits, and enable/disable and respond to related alarms.

Questions

1. What happens when you change a limit? Disable an alarm? Respond to an alarm?

Notes:

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74

Lesson Presentation 9 Carbon Dioxide Monitoring

Disabling EtCO2 Monitoring

To disable EtCO2 monitoring:

• Disconnect the FilterLine from the CO appears. Select Ye s and press Menu Select.

• Should the FilterLine be disconnected accidentally, select No in response to the message and press Menu Select. Then, secure the connection to re-enable the function.

inlet port. The message CO2 Unplugged - Turn Off EtCO2?

2

Notes:

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75

9 Carbon Dioxide Monitoring Review

Review

Answer the following questions related to monitoring CO2.

1. EtCO

2. The CO

3. FilterLine or exhaust tubing blockage can generate an apnea alarm. T or F

4. AwRR alarms are disabled unless turned enabled during use. T or F

values may be significantly low if a patient is breathing through their mouth when using a

2

nasal FilterLine. T or F

waveform only displays in Wave Sector 3. T or F

2

76

User Training Workbook

10Invasive Pressures Monitoring

Lesson Introduction

This lesson describes how to monitor invasive pressures using the HeartStart MRx.

Objectives

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

10

1. Set up a pressure measurement.

2. Select a pressure to monitor.

3. Zero the pressure transducer.

4. Set pressure alarms and view related settings.

5. Identify how pulse works with the Invasive Pressures option.

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10 Invasive Pressures Monitoring Lesson Presentation

Lesson Presentation

Overview

• Two channels of real-time continuous invasive pressure measurements and waveforms are available in Monitor, Manual Defib and Pacer Modes.

• Systolic, diastolic and mean pressure values display for pulsatile pressure signals and mean value for non-pulsatile pressure signals.

Pressure Measurement Set-up

To set up medical equipment to display a pressure measurement on the MRx:

1. Turn the HeartStart MRx to Monitor.

2. Connect the pressure cable to the MRx.

3. Connect the pressure cable to the transducer.

4. Prepare the flush solution.

5. Flush the system to expel air from the tubing. Make sure the stopcocks and transducer are also free

of air bubbles.

6. Connect the pressure line to the patient catheter.

7. If you are using an infusion pressure cuff with the pressure line, attach the pressure cuff to the fluid

to be infused. Inflate it according to your hospital’s standard procedure and then begin the infusion. Position the transducer so that it is level with the heart, approximately at the level of the midaxillary line.

Notes:

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78

Lesson Presentation 10 Invasive Pressures Monitoring

Selecting a Pressure to Monitor

To select a pressure label:

1. Press the Menu Select button.

2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.

3. Select Press 1 (or Press 2) and press Menu Select.

4. Select Label and press Menu Select.

5. Select the appropriate label from the list provided and press Menu Select.

Label Description Label Description

ABP Arterial Blood Pressure LAP Left Atrial Pressure

ART Arterial Blood Pressure PAP Pulmonary Artery Pressure

Ao Aortic Pressure RAP Right Atrial Pressure

CVP Central Venous Pressure P1 Non-specific pressure label

(Channel 1)

ICP Intracranial Pressure P2 Non-specific pressure label

(Channel 2)

6. Verify and change the size of your scale, as appropriate.

7. Verify and change the alarm source type, as appropriate.

8. Set the high and low alarm limits.

Pressure Waves

To select a pressure wave and the associated scale for the display or printed strip:

1. Press the Menu Select button.

2. Using the Navigation buttons, highlight Displayed Waves and press Menu Select.

3. Select Wave Position (Wave 1 , Wave 2 , Wa ve 3 or Wave 4) and press Menu Select.

4. Select the appropriate wave and press Menu Select.

5. Select the appropriate scale and press Menu Select.

Practice Exercise 1

Attach a simulator (e.g., Dale14 multiparameter simulator) and pressure cable(s) to the MRx, select different pressure waves and associated scales, and display and print out the results, as appropriate.

Questions

1. How does the display (or printout) differ from one pressure wave to another? From Wave 1 menu?

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

3. How would you assign a specific label to pressure channel 1 if it is already assigned to channel 2?

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10 Invasive Pressures Monitoring Lesson Presentation

Notes:

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80

Lesson Presentation 10 Invasive Pressures Monitoring

Zeroing the Pressure Transducer

Zeroing Using the Menu Select Button

To zero the transducer using the Menu Select button:

1. Place the transducer at the appropriate level for the measurement site.

2. Close the transducer stopcock to the patient and vent the transducer to atmospheric pressure.

3. Press the Menu Select button.

4. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.

5. Select the pressure label you wish to zero.

6. Press Zero and press Menu Select. Zeroing begins.

Zeroing in Monitor Mode

To zero the transducer in Monitor Mode:

1. Place the transducer at the appropriate level for the measurement site.

2. Close the transducer stopcock to the patient and vent the transducer to atmospheric pressure.

3. Press the soft key under the [Zero Pressure] label.

4. Using the Navigation buttons, select the pressure(s) you wish to zero from the Zero menu and press

Menu Select. Zeroing begins.

Last Zero

To view dates and times for a channel’s last zero:

1. Press the Menu Select button.

2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.

3. Select the pressure label (channel: label) you want and press Menu Select.

4. The last zero dates and times are displayed.

Notes:

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10 Invasive Pressures Monitoring Lesson Presentation

Alarms

Enabling/Disabling Alarms

To enable/disable alarms:

1. Press the Menu Select button.

2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.

3. Select the pressure label (channel: label) you wish to modify alarm status on and press Menu

Select.

4. Select Alarms On (or Alarms Off) and press Menu Select.

Viewing/Changing/Setting Source for Alarms

To view or change alarm settings for a given pressure label:

1. Press the Menu Select button.

2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.

3. Select the pressure label (channel: label) you wish to view/modify alarms on and press Menu

Select.

4. Select pressure label Limits and press Menu Select.

5. If the pressure label is pulsatile, select the desired source of the alarm (Systolic, Diastolic or Mean)

and press Menu Select.

6. Using the Navigation buttons, increase or decrease the high limit and press Menu Select.

7. Set the new low limit and press Menu Select.

Practice Exercise 2

Change invasive pressure alarm limits, and enable/disable and respond to related alarms.

Questions

1. What happens when you change a limit? Disable an alarm? Respond to an alarm?

Notes:

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Lesson Presentation 10 Invasive Pressures Monitoring

Pulse

Changing Pulse Source

To change pulse source for the current incident:

1. Press the Menu Select button.

2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.

3. Select Pulse and press Menu Select.

4. Select Pulse Source and press Menu Select. Pick a source with an arterial or pulmonary waveform.

5. Using the Navigation buttons, highlight the pulse source desired and press Menu Select.

Enabling/Disabling the Pulse Alarm

To enable/disable the pulse alarm:

1. Press the Menu Select button.

2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.

3. Select Pulse and press Menu Select.

4. Select Alarms On/Off and press Menu Select.

Changing Pulse Alarm Limits

To change pulse alarm limits:

1. Press the Menu Select button.

2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.

3. Select Pulse and press Menu Select.

4. Select Pulse Limits and press Menu Select.

5. Using the Navigation buttons, select the new high limit value and press Menu Select.

6. Select the new low limit and press Menu Select.

Practice Exercise 3

Change pulse alarm limits, and enable/disable and respond to related alarms.

Questions

1. What happens when you change a limit? Disable an alarm? Respond to an alarm?

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10 Invasive Pressures Monitoring Lesson Presentation

Notes:

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84

Review 10 Invasive Pressures Monitoring

Review

Answer the following questions related to monitoring invasive pressures.

1. You must flush the tubing system to remove air bubbles to prevent potential incorrect readings. T

or F

2. Which of the following statement(s) are TRUE regarding pressure selection and related wave scale

adjustment?

a. When selecting a label, you need to specify its color, alarm source and limits, and scale.

b. Controls for scale and alarm settings automatically appear after selecting a new label.

c. You can not select the same label for both pressure channels.

d. The available pressure wave scale spans from 300 to -20 in mmHg and from 38 to -2.5 in kPa.

3. Which of the following statement(s) are TRUE regarding zeroing a pressure?

a. You must zero a pressure every time you reconnect the transducer cable to the MRx.

b. Before zeroing a pressure, you must vent pressure transducers to atmospheric pressure and close

the stopcock to the patient.

c. Invasive pressure alarms are active while the transducer is zeroing.

d. The message Unable to zero message displays if the zeroing process fails.

4. Which of the following statement(s) are TRUE regarding pressure alarms?

a. All invasive pressure alarms cease when their alarm condition no longer exists.

b. The PAPd High message means the pulmonary artery diastolic pressure has exceeded the high

alarm limit.

c. If the pressure label is non-pulsatile, you select either Systolic, Diastolic or Mean as the desired

alarm source.

d. When CPP and ICP are displayed together, only one of them can have related alarms enabled.

5. If SpO2, as the default pulse source, is not active but the ABP source is, the pulse value displays but

it is invalid. T or F

85

User Training Workbook

11Temperature Monitoring

Lesson Introduction

This lesson describes how to monitor temperature using the HeartStart MRx.

Objectives

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

11

6. Select a temperature to monitor.

7. Set temperature alarms and related limits.

Notes:

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87

11 Temperature Monitoring Lesson Presentation

Lesson Presentation

Overview

• MRx offers one channel of real-time continuous temperature monitoring (in Fahrenheit or Celsius) while in Monitor, Pacer or Manual Defib Modes.

• It can monitor nasopharyngeal, esophageal, rectal, skin, arterial, venous, core and urinary bladder (vesic) temperatures.

Selecting a Temperature Label

Label Ty pe Label Ty pe

Tesoph esophageal temperature Tnaso nasopharyngeal temperature

Trect rectal temperature Tvesic urinary bladder

Tskin skin temperature Tart arterial temperature

Temp non-specific temp label Tven venous temperature

Tcore core temperature

To select a temperature label:

1. Press the Menu Select button.

2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.

3. Select the temperature label option currently assigned to your measurement and press Menu Select.

4. Select Label and press Menu Select.

5. Select the appropriate label from the list provided and press Menu Select.

Monitoring Temperature

To monitor a temperature:

1. Connect the temperature cable to the HeartStart MRx.

2. Select the correct temperature label for your measurement.

3. Check that the current device settings (including alarm settings) are appropriate for the patient.

4. Apply the temperature probe to the patient.

Notes:

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88

Lesson Presentation 11 Temperature Monitoring

Setting Temperature Alarms

Changing Alarm Limits

To change the temperature alarm limits for the current incident:

1. Press the Menu Select button.

2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.

3. Select the temperature label option currently assigned to your measurement and press Menu Select.

4. Select Temperature Limits and press Menu Select.

5. Using the Navigation buttons, change the high limit and press Menu Select.

6. Using the Navigation buttons, change the low limit and press Menu Select.

Disabling/Enabling Alarms

To disable/enable temperature alarms:

1. Press the Menu Select button.

2. Using the Navigation buttons, select the Measurements/Alarms menu and press Menu Select.

3. Select the temperature label option currently assigned to your measurement and press Menu Select.

4. Select Alarms Off/Alarms On and press Menu Select.

Disabling Temperature Monitoring

To disable the Temperature monitoring:

• Disconnect the temperature cable from the MRx Temperature port. The message Temp (or the label currently activated) Unplugged. Turn Off Temp (or the label currently activated)? appears. Select Ye s

and press the Menu Select button.

• Should the temperature cable get disconnected accidentally or if the probe and cable separate, and

you want to continue monitoring temperature, select No and press Menu Select. Reconnect the

temperature cable to restart the temperature monitoring function.

Practice Exercise 1

Change temperature alarm limits, and disable/enable and respond to related alarms.

Questions

1. What happens when you change a limit? Disable an alarm? Respond to an alarm?

89

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

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Side Panels

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Top Panel

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Back Panel

Notes:

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Display View

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Responding to Alarms

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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