Edition 3
Printed in the USA
Publication nu mber M3500-91900
The information in this gui de a pplie s to
the M3500B HeartStart XLT, release
Main 35 and earlier. This informatio n is
subject to change without n otice.
Philips Medical Systems 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 1, January 3, 2000
Edition 2, May 15, 2000
Edition 3, October 30, 2002
GmbH
Hewlett Packard Str. 2
71034 Böblingen
Germany
Canada EMC:ICES -001
Device Tracking
In the USA, the Food and Drug Administration requires defibrillator manufacturers and distributors to track the
location of their defibrillators. If your
defibrillator has been sold, donated,
lost, stolen, exported, or destroyed, or if
it was not obtained directly from Philips
Medical Systems, please notify Philips
Medical Systems at (978) 659-3202.
ii
Conventions
This guide uses the following conventions:
WA RN I N GWarning statements describe conditions or actions that can result
in personal injury or loss of life.
CAUTI ONCaution statements describe conditions or actions that can result in
damage to the equipment or loss of data.
NOTENotes contain additional information on usage.
7(;7represents messages that appear on the display
6RIWNH\
represents softkey labels that appear on the display above or
below the button to which they correspond
The M3500B HeartStart XLT Defibrillator/Monitor is designed to meet your
resuscitation and monitoring needs. This guide provides instructions for safe
and proper operation, set-up, configuration, and care of your HeartStart XLT.
In this chapter, you’ll find general information that you should become familiar with before using the defibrillator/monitor.
Overview
The HeartStart XLT is a lightweight, portable, sem i -automatic external
defibrillator. It offers two modes of operation for defibrillation:
z
Semi-Auto matic External Defibrilla tion (AED) M ode
z
Manual Mode
1
Both modes incorporates a low energy SMART Biphasic waveform for
defibrillation.
In AED Mode , the HeartStart XLT analyzes the patient’s ECG and advises
you whether or not to deliver a shock. Voice prompts guide you through the
defibrillation process by providing instructions and patient information. The
voice prompts are reinforced by messages that appear on the display.
In Manual Mode, the HeartStart XLT turns control of the defibrillation process over to you. You assess the patient’s ECG, decide if defibrillation is
advised, and select the energy setting for defibrillation. Manual Mode also
allows you to perform synchronized cardioversion and offers optional noninvasive pacing.
M3500B HeartStart XLT Defibrillator/Monitor1-1
Overview
Defibrilla tion is performed through multifunction defib elec trode pads. In
addition, both AED and Manual Mode offer monitoring through pads, 3-lead
ECG monitoring electrodes, or optional 5-lead ECG monitoring electrodes.
Optional pulse oximetry (SpO
well. While monitoring ECG or SpO
) monitoring is available in both modes, as
2
, you may set heart rate and/or SpO
2
2
alarms to alert you when these parameters are outside the limits defined.
The HeartStart XLT automa tically stor es critical events, such as shocks and
alarm violations, in its internal memory. Additional events of interest to you
may be marked for stora ge, as well . Event s may b e p rinte d as they occur or an
Event Summary may be printed at any time. The HeartStart XLT also allows
you to store data and events on a Data Card for downloading to HeartStart
Event Review Data Management systems.
The versatile HeartStart XLT is highly configurable to better meet the needs
of diverse users. The messages and softkeys vary, depending on how the
HeartStart XLT is configured. Be sure to familiarize yourself with your configuration before using the HeartStart XLT (see “Configuring the HeartStart
XLT” on page 10-7).
The HeartStart XLT is powered by a rechargeable sealed lead acid (SL A) battery that all ows the defibrillator to ch arge to 200 joules in less than t hree seconds. Proper care of your batteries will ensure that they have the energy
required to operate the Hear tStart XLT and to deliver the appropr iate therapy.
(See “Battery Maintenance” on page 11-8.) Similarly, following the specified
operational checks will ensure that the HeartStart XLT is functioning and
ready for use. (See “Operational Checks” on page 11-2.)
1-2Introduction
Intended Use
Intended Use
The M3500B HeartStart XLT Defibrillator/Monitor is for use by emergency
personnel trained in the operation of the device and qualified by training in
basic life support , advanced cardiac life suppo rt , def i bri ll ation, or other physician-authorized emergency medical response. It must be used by or on the
order of a physician.
When operating as a semi-automatic external defibrillator in AED Mode, the
HeartStart XLT is suitable for use by he alth care profe ssiona ls t raine d in bas ic
life support that includes the use of an AED.
When operating as a defibrillator/monitor in Manual Mode, the HeartStart
XLT is suitable for use by health care professionals trained in advanced cardiac life support.
Defibrillation Therapy
Defibrillation therapy is the definitive method for termination of a variety of
potentially fatal arrhy thmias. The HeartStart XLT provides this therapy
through the application of a brief biphasic pulse of electricity to the cardiac
muscle. This electrical energy is t ransferred through dis posa ble m ul ti fu nction
defib electrode pads applied to the patient’s bare chest.
1
NOTESuccessful resuscitation is dependent on many variables specific to the
patient’s physiological state and the circumstances surrounding the patient
event. Failure to have a successful patient outcome is not a reliable indicator
of defibrillator/monitor performance. The presence or absence of a muscular
response to the transfer of energy during electrical therapy is not a reliable
indicator of energy delivery or device performance.
Indications for AED Therapy
An AED is to be us ed in the presence of a s uspected cardiac arrest o n p atients
that are:
z
Unresponsive
z
Not breathing
z
Pulseless
M3500B HeartStart XLT Defibrillator/Monitor1-3
Defibrillation Therapy
Contraindications for AED Therapy
An AED is not to be used on patients that exhibit one or any combination of
the followin g:
z
Responsiveness
z
Spontaneous breathing
z
Palpable pulse
Precautions for AED Therapy
The AED algorithm is not des igned t o handl e err atic s pikin g probl ems cause d
by a properly or improperly functioning pacemaker. In patients with cardiac
pacemakers, the HeartStart XLT may have reduced sensitivity and not detect
all shockable rhythms.
NOTEAED mode is not intended for use on children less than 8 years of age. For
children older tha n 8 y ears, the Ameri can Hea rt Ass ociat ion re commends t hat
standard operating procedures for AEDs be followed. American Heart Association Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Dallas, Texas; AHA; 2000"
Indications for Manual Defibrillation Therapy
Asynchronous defibri llation is the initial treatment for ventricular fibrillation
and ventricular tachycardia, in patients who are pulseless and unresponsive.
Synchronous defibrillation is indicated for termination of atrial fibrillation.
The SMART Biphasic waveform utilized in the HeartStart XLT
Defibrillator/Monitor h as undergone clinical testing demonstrating its
effectiveness for cardioversion of atrial fibrillation.
The SMART Biphasic waveform utilized in the HeartStart XLT has undergone clinical testing in adults. These trials support the waveform’s effectiveness for defibrillation of ventricular tachyarrhythmias at 150J.
In manual mode operation, the HeartStart XLT incorporates some user selectable lower energy levels that were not used in the clinical trials.
1-4Introduction
Noninvasive Pacing Therapy
Contraindications for Manual Defibrillation Therapy
Asynchronous defibril lati on thera py is contr aindic ated in pat ien ts that exhibit
one or any combination of the following:
z
Responsiveness
z
Spontaneous breathing
z
Palpable pulse
Precautions for Manual Defibrillation Therapy
Defibrilla ting asystole can inhibit th e recovery o f natural pace makers in the
heart and completely eliminate any chance of recovery. Asystole should not
be routinely shocked.
Noninvasive Pacing Therapy
The HeartStart XLT provides noninvasive transcutaneous pacing by delivering a monophasic, elect rical sti mulus to th e heart . This stim ulus i s intende d to
cause cardiac d epolar izat ion an d myocar dial con tracti on. The emer ge ncy ca re
provider selects t he s timulu s curr ent an d ra te set ting s. The en er gy is del ivere d
through multifunction defib electrode pads applie d to the patient’ s bare chest.
1
Indications
Noninvasive pacing is one method of treating patients with symptomatic
bradycard ia. It can also be helpful in patients with asystole, if performed
early.
Contraindications
Noninvasive pacing is contraindi cated in the treatment of ventricular fibrillation. Noninvasive pacing in the presence of severe hypothermia may be contraindicated.
M3500B HeartStart XLT Defibrillator/Monitor1-5
SpO2 Monitoring
SpO2 Monitoring
A pulse oximeter is a noninvasive device that indicates the oxygen saturation
(SpO
) of arterial blood. This measurement is obtained through a probe that
2
directs red and near infrared light through arterial beds. Hemoglobin absorbs
these lights differently when it is bound with oxygen. Pulse oximetry measures this difference and translates the measurement into a saturation percentage that is di splayed as an SpO
Indications
SpO2 monitoring is indicated for use when it i s beneficial to assess a pa ti ent ’s
oxygen saturation level.
Contraindications
None known.
NOTEReadings should be carefully considered in the presence of certain circum-
stances. Inaccuracies may result from the use of pulse oximeters in the presence of certain cir cu ms ta nces , s uch a s hemoglobin saturated with compounds
other than oxygen (such as carbon monoxide), hypothermia, hypovolemia,
patient movement, nail polish and excessive ambient light.
reading.
2
1-6Introduction
Learning to Use the HeartStart XLT
Learning to Use the HeartStart XLT
The HeartStart XLT comes with:
z
Using the HeartStart XLT Defibrillator/Monitor, a videotape, and
z
About Sealed Lead Acid Batteries, an application note on battery
maintenance.
For additional training materials, please visit our website at:
www.medical.philips.com/cms.
Safety Considerations
General warnings and cautions that apply to use of the HeartStart XLT are
provided in Chapter 13. Additional warnings and cautions specific to a particular feature are provided in the appropriate section of this guide.
1
M3500B HeartStart XLT Defibrillator/Monitor1-7
2Getting Started
Your HeartStart XLT is shipped to you in its carrying case with most of the
accessories in their compartments. All you need to do before getting started is:
z
connect cables,
z
connect to power , and
z
insert the Data Card (if desired).
This chapter will acquaint you with the HeartStart XLT and then guide you
through these activities.
NOTET o conne ct cabl es to the HeartS tar t XLT or to arrange accessor ies in th e carry -
ing case, refer to “Setting Up and Configuring the HeartStart XLT” in Chapter
10.
2
Getting Acquainted
This section shows the HeartStart XLT controls/buttons, connections, and display layout. An overview of control functions is also provided.
NOTEIf your HeartStart XLT does not have the SpO
these controls and the related information described in this section.
M3500B HeartStart XLT Defibrillator/Monitor2-1
or Pacing option, disregard
2
Getting Acquainted
Figure 2-1 Basic Orientation
Print Controls
Monitoring Controls
Defibrillation
Controls
Speaker
Basic Orientation
The figure below shows the general layout of the controls, where the patient
cables connect, and where to insert the battery and Data Card.
Audiovisual
Off
Printer
On
Controls
ECG
Connector
SpO
Connector
Manual Mode
Controls
Ambient Light
Sensor
2
Battery
Pads
Connector
2-2Getting Started
Data Card
AC Power
Module Connector
Getting Acquainted
Print
Summary
Print
- Powers on the HeartStart XLT.
- Powers off the H eartStart XLT.
Defibrillation Controls - softkeys that perform the defibrillation function
displayed in the softkey label above each button; control both AED and Manual Mode defibrillation.
Manual Mode Controls - provi de access to Manual Mode and cont rol of synchronized cardioversion and pacing (if the option is present).
Audiovisual Controls:
Adjusts the display contrast.
Adjusts the size of the ECG waveform displayed, printed, and stored.
Pressing and simultaneously generates a 1 mV calibration pulse.
Adjusts the volume of voice prompts and the QRS beeper.
Monitoring Controls - softkeys that perform the monitoring function displayed in the softkey label below each button; control heart rate and SpO
2
alarms and select the ECG source to monitor.
Print Controls - perform the function shown above each button. The print
controls from left to ri ght are:
Print
Strip
Prints ECG data, defibrillation events, and marked events realtime or with a 6 second delay (as configured). Press to start printing; press again to stop printing.
Print
Summary
Prints the Event Summary. (See “Storing, Retrieving & Printing”
for more information.) Printing ma y be stopped by pressing the
or button.
Strip
2
Mark
Event
M3500B HeartStart XLT Defibrillator/Monitor2-3
Inserts a time-stamped annotation in the Event Summary. May be
configured to print an annotated ECG strip when pressed.
Getting Acquainted
Manual Mode Controls
The figure below shows the Manual Mode controls. These controls are
accessed by lifting the door labeled "Manual."
Figure 2-2 Manual Mode Controls
Manual
Sync
Pacer
Rate
Start
Stop
LEDs indicating the function is
active (green light) or inacti ve ( no light)
Mode
Output
NOTESynchronized cardioversion and pacing controls only function when Manual
Mode is enabled.
2-4Getting Started
Getting Acquainted
Manual
Sync
Pacer
Toggles between Manual Mode and AED Mode. Manual
Mode is enabled whe n the gr een LED next to the key i s li t.
A password may be required for Manual Mode entry.
Enables synchronized cardioversion when first pressed, as
indicated by the green LED; disables synchronized cardioversion when press ed again.
Activates the pacing function buttons (as indicated by the
green LED), allowing you to use the buttons below to
define pacing rate, mode, and curr ent output. Also turns off
the Pacer when pressed a second time.
2
Display Layout
The following figures show the layout of the display in:
z
AED Mode, with ECG and SpO2 monitoring capabilities disabled.
z
AED Mode, with ECG and SpO2 monitoring capabiliti es enabled.
z
Manual Mode.
NOTEECG and SpO
disabled independently in the conf ig uration.
Rate
Start
Stop
Mode
Output
monitoring capabilities for AED Mode may be enabled and
2
Adjusts the pacing rate.
Delivers pacer pulses when first pressed;
stops pacing when pressed again.
Selects Demand or Fixed Mode for pacing.
Adjusts the current output for pacing.
M3500B HeartStart XLT Defibrillator/Monitor2-5
Getting Acquainted
Figure 2-3 AED Mode Display Layout (ECG and SpO2 disabled)
System Message
Momentary Message
ECG
ECG Gain
Defibrillation
Soft Keys
PAUSE
User Message
ANALYZE
150J
Shocks: 0
00:15:02
SHOCK
Current Charge
Shocks Delivered
Incident Timer
NOTEIn its default configuration, the HeartStart XLT powers on in AED Mode
where voice prompts and user messages are active.
The Incide nt Timer shows the elapsed time since the HeartStart XLT was
turned on. If the HeartStart XLT is powered on after being off for less than
two minutes, the Incident Timer resumes where it left off. If power is off fo r
more than two minutes, the Incident Timer resets to zero (
).
2-6Getting Started
Getting Acquainted
Figure 2-4 AED Mode Display Layout (ECG and SpO2 Enabled)
Lead
Displayed
SpO
value
2
LEAD
SELECT
Lead II
User Message
ANALYZESHOCK
SPO2
86
PR 130
114J
Shocks: 0
00:15:02
SpO
alarm
2
Pleth Bar
Pulse Rate
Current Charge
Shocks Delivered
Incident Timer
Heart Rate
HR Alarm
ECG
Selected En ergy
Defibrillation
Soft Keys
HR ALARM
132
System Message
Momentary Message
150J
PAUSE
User messages accompany voice prompts to guide you through the defibrillation process.
System and Momentary Messages:
z
alert you to conditions that may require you to take action,
z
provide status information, or
z
offer recommendations.
A System Message remains on the display until the condition that generated
the message no longer exists. A Momentary Message is temporary and
appears on the display for only a few seconds. A list of messages is provided
in Chapter 12.
2
M3500B HeartStart XLT Defibrillator/Monitor2-7
Getting Acquainted
S
C
S
I
Figure 2-5 Manual Mode Display Layout
Displayed
Lead
SpO
value
2
LEAD
SELECT
Lead II
CHARGESHOCK
SPO2
86
PR 130
114J
Shocks: 0
00:15:02
SpO
alarm
2
Pleth Bar
Pulse Rate
urrent Charge
hocks Delivered
ncident Timer
Heart Rate
HR Alarm
ECG
elected Energy
Defibrillation
Softkeys
HR ALARM
132
System Message
Momentary Message
150J
ENERGY
SELECT
LCD Backlight
Under normal operation, the HeartStart XLT reads the ambient light and turns
on the LCD back light when low light conditions exist. To turn on the back
light at other times, press and on simultaneously. To return to
normal operation, press the same keys again. The back light also returns to
normal operation each time you turn the HeartStart XLT on.
2-8Getting Started
Connecting to Power
Connecting to Power
The HeartStart XLT is powered by the M3516A batte ry. Prior to inser ti ng the
battery, make sure that the battery is charged and has been properly maintained (See “Bat tery M aintenan ce” on pa ge 1 1 -8). A fu lly char g ed batte ry will
last for about t wo hours. A second spare ch arged battery should be kept in the
carrying case at all times.
The HeartStart XLT can also be powered by the M3517A AC Power Module
or the M3518A DC Power Module . However the d efi brilla tor will t ake longer
to charge when powered by a power module, with the battery absent. The recommended practice when using a power module is to use the module in conjunction with a battery. For information on using the power modules, see the
documentation supplied with the modules.
NOTETo save battery capacity, the HeartStart XLT shuts itself off if a patient is not
being monitored and no one has interacted with the device for 10 minutes.
Inserting the Battery
2
T o inse rt th e batte ry, slide it into th e batt ery rec eptacle as shown i n Figure 2-6.
Then push the battery in until you hear an audible click.
Figure 2-6 Inserting the Battery
M3500B HeartStart XLT Defibrillator/Monitor2-9
Connecting to Power
Removing the Battery
Before remo ving the battery, make sure the HeartStart XLT is powered off.
Then, to remove the battery, press the black battery eject button and pull the
battery out, as shown in Figure 2-7.
Figure 2-7 Removing the Battery
Low Battery Warning
The message /RZ%DWWHU\ is displayed on the HeartStart XLT when the battery
is low and needs recharging. This message indicates that the battery has sufficient remaining capa city to pro vide only about t en minutes of monitoring time
and six shocks before the HeartStart XLT shuts off. Replace the battery as
soon as possible.
If the power is off for less than 2 minutes, while you change the battery, the
HeartStart XLT assumes that you a re continuing to treat the s ame patient. It
continues to store data on the Data Card and append events to the existing
Event Summary. Alarms set prior to the power loss remain active.
If power remains off for more than 2 minutes, the HeartStart XLT assumes
you are treating a dif f erent patie nt and as signs a new inci dent numbe r. A new
Event Summary begins w ith the next event.
2-10Getting Started
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