Philips M3500B User Manual

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HEARTSTART XLT

INSTRUCTIONS FOR USE

M3500B

Instructions for Use

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About This Edition

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

All rights are reserved. Reproduction in whole or in part is prohibited without the prior written consent of the copyright holder.

SMART Biphasic is a registered trademark of Philips Medical Systems.

Use of supplies or accessories other than those recommended by Philips Medical Systems may compromise product perfor ma n ce .

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 M3500B HeartStart XLT Defibrillator/Monitor complies with the requirements of the Medical Dev ice Directive 93/42/EEC and carries the

mark accordingly.

0123

Authorized EU-representative: Philips Medizinsysteme Böblingen

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.

Conventions

This guide uses the following conventions:

WA RN I N G Warning statements describe conditions or actions that can result

in personal injury or loss of life.

CAUTI ON Caution statements describe conditions or actions that can result in

damage to the equipment or loss of data.

NOTE Notes contain additional information on usage.

7(;7 represents messages that appear on the display

6RIWNH\

represents softkey labels that appear on the display above or below the button to which they correspond

iii

Contents

Introduction

Overview ............................................................................................................................... 1-1

Intended Use ......................................................................................................................... 1-3

Defibrillation Therapy .......................................................................................................... 1-3

Indications for AED Therapy .........................................................................................1-3

Contraindications for AED Therapy ............................................................................... 1-4

Precautions for AED Therapy ......................................................................................... 1-4

Indications for Manual Defibrillation Therapy ............................................................... 1-4

Contraindications for Manual Defibrillation Therapy ....................................................1-5

Precautions for Manual Defibrillation Therapy .............................................................. 1-5

Noninvasive Pacing Therapy ................................................................................................ 1-5

Indications ....................................................................................................................... 1-5

Contraindications ............................................................................................................ 1-5

SpO2 Monitoring .................................................................................................................. 1-6

Indications ....................................................................................................................... 1-6

Contraindications ............................................................................................................ 1-6

Learning to Use the HeartStart XLT ..................................................................................... 1-7

Safety Considerations ...........................................................................................................1-7

Getting Started

Getting Acquainted ............................................................................................................... 2-1

Basic Orientation ............................................................................................................ 2-2

Manual Mode Controls ................................................................................................... 2-4

LCD Backlight ................................................................................................................ 2-8

Connecting to Power ............................................................................................................. 2-9

Inserting the Battery ........................................................................................................ 2-9

Removing the Battery ................................................................................................... 2-10

Low Battery Warning ................................................................................................... 2-10

Using a Data Card ............................................................................................................... 2-11

Inserting a Data Card .................................................................................................... 2-12

Removing a Data Card .................................................................................................. 2-13

Contents

Defibrillating in AED Mode

Overview ............................................................................................................................... 3-3

Defibrillation (with the default configuration) ............................................................... 3-3

Defibrillation (with a modified configuration) ............................................................... 3-4

Preparation ............................................................................................................................ 3-5

Defibrillating .........................................................................................................................3-6

Automatic Re-analysis On ...................................................................................... 3-11

Automatic Re-analysis Off ..................................................................................... 3-11

Pausing for CPR ................................................................................................................. 3-12

Monitoring Rhythm ............................................................................................................ 3-14

ERC Protocol ...................................................................................................................... 3-16

Troubleshooting ..................................................................................................................3-18

Monitoring the ECG

Applying Monitoring Electrodes ..........................................................................................4-2

Electrode Placement .......................................................................................................4-3

Selecting the Lead .................................................................................................................4-5

Setting the Heart Rate Alarm ................................................................................................ 4-6

Disabling the HR Alarm .......................................................................................................4-7

Adjusting the ECG Size ........................................................................................................ 4-7

Troubleshooting ....................................................................................................................4-7

Monitoring SpO2

Understanding Pulse Oximetry ............................................................................................. 5-2

Selecting a Sensor ................................................................................................................. 5-3

Reusable Sensors ............................................................................................................ 5-4

Disposable Sensors .........................................................................................................5-4

Semi-disposable Sensors ................................................................................................. 5-4

Applying the Sensor .............................................................................................................. 5-5

Connecting the Sensor Cable ................................................................................................ 5-6

Monitoring ............................................................................................................................5-7

Setting Alarms ...................................................................................................................... 5-8

Responding to an Alarm .......................................................................................................5-8

Contents

Discontinuing SpO2 Monitoring .......................................................................................... 5-9

Caring for Sensors ................................................................................................................5-9

Troubleshooting ..................................................................................................................5-10

Defibrillating in Manual Mode

Enabling Manual Mode ........................................................................................................6-2

Preparation ............................................................................................................................ 6-3

Defibrillating .........................................................................................................................6-4

Returning to AED Mode ....................................................................................................... 6-6

Performing Synchronized Cardioversion

Preparing for Synchronized Cardioversion ........................................................................... 7-2

Delivering a Synchronized Shock ......................................................................................... 7-2

Delivering Additional Synchronized Shocks ..................................................................7-4

Disabling Sync Mode ............................................................................................................7-4

Pacing

Demand Mode Versus Fixed Mode ...................................................................................... 8-2

Monitoring During Pacing .................................................................................................... 8-2

Preparing for Pacing ............................................................................................................. 8-3

Pacing ....................................................................................................................................8-4

Changing Pacing Modes ....................................................................................................... 8-6

Defibrillating During Pacing ................................................................................................8-6

Troubleshooting ....................................................................................................................8-7

Storing, Retrieving & Printing

Overview ............................................................................................................................... 9-1

Marking Events ..................................................................................................................... 9-2

Events Recorded ................................................................................................................... 9-3

Creating a Patient Record ..................................................................................................... 9-5

Printing the Internal Event Summary ................................................................................... 9-6

Printing Events ...................................................................................................................... 9-8

vii

Contents

Setting Up and Configuring the HeartStart XLT

Connecting/Disconnecting Patient Cables .......................................................................... 10-1

This section describes how to connect and disconnect the: .......................................... 10-1

Connecting the Pads Patient Cable ............................................................................... 10-2

Disconnecting the Pads Patient Cable ..........................................................................10-3

Connecting the ECG Patient Cable ............................................................................... 10-4

Disconnecting the ECG Patient Cable .......................................................................... 10-4

Connecting the SpO2 Patient Cable .............................................................................. 10-5

Disconnecting the SpO2 Patient Cable ......................................................................... 10-5

Arranging Accessories in the Carrying Case ...................................................................... 10-6

Configuring the HeartStart XLT ......................................................................................... 10-7

Accessing the Configuration Menu .............................................................................. 10-7

Configurable Parameters ............................................................................................... 10-8

Setting the Manual Mode Password ........................................................................... 10-13

Modifying the Configuration ...................................................................................... 10-15

Returning to the Default Configuration ...................................................................... 10-15

Saving Settings to a Data Card ...................................................................................10-16

Loading Settings from a Data Card ............................................................................ 10-16

Printing Settings .......................................................................................................... 10-16

Maintaining the HeartStart XLT

Operational Checks ............................................................................................................. 11-2

Before You Begin ......................................................................................................... 11-2

Every Shift .................................................................................................................... 11-3

Every Month .................................................................................................................11-3

Every Three Months ..................................................................................................... 11-3

Shift/System Check ....................................................................................................... 11-4

Battery Capacity Test (CT) ........................................................................................... 11-7

Battery Maintenance ........................................................................................................... 11-8

Charging Batteries ........................................................................................................ 11-8

Battery Capacity ........................................................................................................... 11-9

Battery Life-Expectancy ............................................................................................... 11-9

Storing Batteries ........................................................................................................... 11-9

Discarding Batteries ......................................................................................................11-9

viii

Loading Printer Paper ....................................................................................................... 11-10

Cleaning Instructions ........................................................................................................ 11-12

Cleaning the HeartStart XLT ...................................................................................... 11-12

Cleaning the Carrying Case ........................................................................................ 11-12

Cleaning the Printer Printhead .................................................................................... 11-13

Cleaning the Power Modules ...................................................................................... 11-13

Cleaning Pads, Electrodes & Cables ........................................................................... 11-14

Removing & Replacing the Carrying Case ....................................................................... 11-15

Putting On the Manual Door ............................................................................................. 11-17

Supplies & Accessories ....................................................................................................11-18

Disposing of the HeartStart XLT ...................................................................................... 11-22

Troubleshooting

System Messages ................................................................................................................ 12-2

Momentary Messages ................................................................................................... 12-5

Troubleshooting Tips .......................................................................................................... 12-7

Calling for Service .............................................................................................................. 12-9

United States of America ..............................................................................................12-9

Latin America ............................................................................................................... 12-9

Canada ..........................................................................................................................12-9

Other International Areas ............................................................................................ 12-10

Contents

Specifications & Safety

Specifications ......................................................................................................................13-2

Defibrillator .................................................................................................................. 13-2

Manual Mode .......................................................................................................... 13-2

AED Mode .............................................................................................................. 13-3

ECG Monitoring ...........................................................................................................13-4

Display ..........................................................................................................................13-5

Thermal Array Printer ................................................................................................... 13-5

Thermal Array Printer (cont.) ....................................................................................... 13-6

Battery and Battery Power Module ..............................................................................13-6

Noninvasive Pacing ...................................................................................................... 13-7

SpO2/Pulse Oximetry ...................................................................................................13-7

Event Storage ................................................................................................................ 13-8

General .......................................................................................................................... 13-8

Environmental ...............................................................................................................13-9

Symbol Definitions ...........................................................................................................13-10

Clinical Performance Summary - Defibrillation ............................................................... 13-14

Methods ......................................................................................................................13-14

Results .........................................................................................................................13-14

Conclusion .................................................................................................................. 13-15

Clinical Performance Summary - Cardioversion .............................................................. 13-16

Methods ......................................................................................................................13-16

Results .........................................................................................................................13-16

Conclusion .................................................................................................................. 13-18

Safety Considerations .......................................................................................................13-19

Electromagnetic Compatibility ......................................................................................... 13-22

Reducing Electromagnetic Interference ...................................................................... 13-22

Restrictions for Use ....................................................................................................13-23

Immunity Level ........................................................................................................... 13-23

1 Introduction

The M3500B HeartStart XLT Defibrillator/Monitor is designed to meet your resuscitation and monitoring needs. This guide provides instructions for safe and proper operation, set-up, configuration, and care of your HeartStart XLT.

In this chapter, you’ll find general information that you should become 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:

Semi-Auto matic External Defibrilla tion (AED) M ode

Manual Mode

Both modes incorporates a low energy SMART Biphasic waveform for defibrillation.

In AED Mode , the HeartStart XLT analyzes the patient’s ECG and advises you whether or not to deliver a shock. Voice prompts guide you through 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/Monitor 1-1

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

, you may set heart rate and/or SpO

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.)

1-2 Introduction

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.

NOTE Successful resuscitation is dependent on many variables specific to the

patient’s physiological state and the circumstances surrounding the patient event. Failure to have a successful patient outcome is not a reliable indicator of defibrillator/monitor performance. The presence or absence of a muscular response to the transfer of energy during electrical therapy is not a reliable indicator of energy delivery or device performance.

Indications for AED Therapy

An AED is to be us ed in the presence of a s uspected cardiac arrest o n p atients that are:

Unresponsive

Not breathing

Pulseless

M3500B HeartStart XLT Defibrillator/Monitor 1-3

Defibrillation Therapy

Contraindications for AED Therapy

An AED is not to be used on patients that exhibit one or any combination of the followin g:

Responsiveness

Spontaneous breathing

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.

NOTE AED 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.

1-4 Introduction

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:

Responsiveness

Spontaneous breathing

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.

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/Monitor 1-5

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

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.

NOTE Readings 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.

1-6 Introduction

Learning to Use the HeartStart XLT

The HeartStart XLT comes with:

Using the HeartStart XLT Defibrillator/Monitor, a videotape, and

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.

M3500B HeartStart XLT Defibrillator/Monitor 1-7

2 Getting 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:

connect cables,

connect to power , and

insert the Data Card (if desired).

This chapter will acquaint you with the HeartStart XLT and then guide you through these activities.

NOTE T 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.

Getting Acquainted

This section shows the HeartStart XLT controls/buttons, connections, and display layout. An overview of control functions is also provided.

NOTE If your HeartStart XLT does not have the SpO

these controls and the related information described in this section.

M3500B HeartStart XLT Defibrillator/Monitor 2-1

or Pacing option, disregard

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

Controls

ECG

Connector

SpO Connector

Manual Mode Controls

Ambient Light Sensor

Battery

Pads

Connector

2-2 Getting Started

Data Card

AC Power

Module Connector

Getting Acquainted

Summary

- 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

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

Mark Event

M3500B HeartStart XLT Defibrillator/Monitor 2-3

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

NOTE Synchronized cardioversion and pacing controls only function when Manual

Mode is enabled.

2-4 Getting 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.

Display Layout The following figures show the layout of the display in:

AED Mode, with ECG and SpO2 monitoring capabilities disabled.

AED Mode, with ECG and SpO2 monitoring capabiliti es enabled.

Manual Mode.

NOTE ECG and SpO

disabled independently in the conf ig uration.

Rate

Start

Stop

Mode

Output

monitoring capabilities for AED Mode may be enabled and

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/Monitor 2-5

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

NOTE In 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 (

).

2-6 Getting Started

Getting Acquainted

Figure 2-4 AED Mode Display Layout (ECG and SpO2 Enabled)

Lead

Displayed

SpO

value

LEAD

SELECT

Lead II

User Message

ANALYZE SHOCK

SPO2

PR 130

114J

Shocks: 0

00:15:02

SpO

alarm

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:

alert you to conditions that may require you to take action,

provide status information, or

offer recommendations.

A System Message remains on the display until the condition that generated the message no longer exists. A Momentary Message is temporary and appears on the display for only a few seconds. A list of messages is provided in Chapter 12.

M3500B HeartStart XLT Defibrillator/Monitor 2-7

Getting Acquainted

S C

S I

Figure 2-5 Manual Mode Display Layout

Displayed

Lead

SpO

value

LEAD

SELECT

Lead II

CHARGE SHOCK

SPO2

PR 130

114J

Shocks: 0

00:15:02

SpO

alarm

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.

2-8 Getting Started

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.

NOTE To save battery capacity, the HeartStart XLT shuts itself off if a patient is not

being monitored and no one has interacted with the device for 10 minutes.

Inserting the Battery

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/Monitor 2-9

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.

2-10 Getting Started

Using a Data Card

Use of a Data Card is optional; the defibrillator will power up without a Data Card inserted. If you would like to collect patient information on a Data Card, the card must be inserted into the HeartStart XLT before the device is turned on.

CAUTI ON Inserting or removing the data card while the defibrillator is on can corrupt

the Data Card and prevent th e unit f rom poweri ng on agai n. If thi s occur s, see Table 12-3, Troubleshooting Tips.

The recommended practice is to use one Data Card per patient. Once a Data Card fills, recording st ops; a second Data Card may not be inserted for the current incident, because the device will only allow the use of one Data Card per incident. Data Cards hold up to two hours of patient information.

Multiple incidents can be recorded on a single Data Card. Each incident is assigned a unique incident number.

Patient data from a Philips M3510A Data Card may be downloaded to a HeartStart Event Review Data Management system. HeartStart Event Review also allows you to erase pati ent data fr om a Data Card , allowing the card to be reused for another patient.

It’s recommended that you use a designated Data Card to configure one or more defibrillators/monitors.

CAUTI ON Use only the M3510A Data Card. These cards are specifically formatted to

work with your Philips defibrillator. Generic cards, or other types of cards (such as modems) will not work, and may cause the defibrillator to malfunction.

M3500B HeartStart XLT Defibrillator/Monitor 2-11

Using a Data Card

Inserting a Data Card

To insert a Data Card:

1. Make sure the HeartStart XLT is powered off.

2. Press up on the release latch to open the door to the Data Card compartment.

3. If a Data Card is al ready in the compa rtment, press the b lack b utton ins ide the compartment to ejec t the card (see Figure 2-8). Then pull t he ca rd out .

4. With the yellow label facing up and the pointing towards the HeartStart XLT, slide the Data Card into the comp artment.

5. Close the Data Card compartment door. Make sure that you hear a click, indicating that the door is latched shut.

Figure 2-8 Inserting a Data Card

Eject

2-12 Getting Started

Using a Data Card

Removing a Data Card

To remov e the Data Ca rd:

1. Make sure the HeartStart XLT is powered off, (wait 2 seconds).

2. Press the black eject button (see Figure 2-8).

3. Pull the Data Card from the compartment.

M3500B HeartStart XLT Defibrillator/Monitor 2-13

3 Defibrillating in AED Mode

The HeartStart XLT’s AED Mode is designed to guide you through standard treatment algori thms for c ardia c arr est, i ncludi ng tho se p rovide d by th e Amer ican Heart Association and the European Resuscitation Council. Configuration choices allow you to customiz e AED Mode to better follow a specif ic treatment algorithm and to meet the unique needs of your life-saving team.

This chapter describes how to use the H eartStart XLT to defibrillate in AED Mode. It explains the prompts that guide you through the defibrillation process and describes how prompts vary depending upon the condition of the patient and the configuration of your device.

For information on printing, storing, and retrieving patient information acquired in AED Mode, see Chapter 9.

M3500B HeartStart XLT Defibrillator/Monitor 3-1

Figure 3-1 AED Mode Overview

If Patient is:

Unresponsive

Not Breathing

Pulseless

Attach Pads

Insert Data Card

(Optional)

Press On

If Instructed,

Press

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No Shock

Check Patient

No Pulse

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Advised

Pulse

Ventilate

Advised

Press

within a shock series

Shock

6+2&.

at completion of shock series

Press

Do CPR

if Rhythm Monitoring on

3-2 Defibrillating in AED Mode

Overview

An overview of the AED Mode defibrillation process is shown in Figure 3-1. The process begins only after you have:

assessed that the pati ent is unres ponsive, not breathing , and pulseles s, and

prepared for defibrillation by attaching pads and inserting a Data Card (if desired).

Then you are ready to turn the HeartStart XLT on. The defibrillation process is dependent upon the configuration of your HeartStart XLT, as described in the following paragraphs.

Defibrillation (with the defa ult configuration)

In its default configuration, the defibrillation process is:

Press the On button.

The HeartStart XLT checks to see if the pa ds patient cable and multifunction defib electrode pads are properly connected. If either connection is compromised, you are prompted to fix the problem.

Analysis begins automatically - there is no need to press

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Once analysis is complete, the HeartStart XLT tells you 6KRFN$GYLVHG or 1R6KRFN$GYLVHG.

If a shock is advised, press .

6+2&.

After the first shock is delivered, the HeartStart XLT automatically begins analyzing the ECG a nd the p rocess re peats until a shock serie s is complete or no s hoc k i s advised. At this point, you ar e p rompt ed to check the patient.

M3500B HeartStart XLT Defibrillator/Monitor 3-3

Overview

Defibrillation (with a modified configuration)

Chapter 10 describes, in detail, th e configurable parameters for AED Mode. Three parameters signif icantly impact the defibrillation process. They are:

Device Initiated Analysis - initia tes ECG analy sis when the He artStart XLT is first turn ed on. The default configuration setting is

this paramet er to 2II, you need to press to initiate analysis in step 2

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of the defibrillation process. Automatic Re-analysis - initiates ECG analysis in between shocks within a

shock series. The default configuration setting is 2Q. If you choose to set this parameter to 2II, you need to press

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to initiate a nalysis in between

shocks within a shock series (i.e. after the first and second shock of a three shock seri es).

Rhythm Monitoring - monitors the ECG for potentially shockable rhythms when the HeartStart XLT is not analyzing, defibrillating, or paused. The default setting is 2QIf you choose to set this parameter to 2II, the HeartStart XLT will not look for potentially shockable rhythms during these idle times. Idle times also include:

power on, when Device Initiated Analysis is off.

in between shocks within a shock series, when Auto Re-analysis is off.

On. If you choose to set

If Rhythm Monitoring is of f, you need to obser ve the patie nt during idl e times and determine when to press

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The following sections describe the defibrillation process in detail. They also describe what happens at the completion of a shock series and if a shockable rhythm is not detected.

3-4 Defibrillating in AED Mode

Preparation

If the patient is:

unresponsive

not breathing

pulseless

Then:

1. Apply multifunction def ib el ectro de p ads to t he pat ient, a s dir ected o n the package. Use the anterior-anterior electrode placement.

2. Connect the pads to the pads patient cable, as shown in Figure 3-2.

3. If needed, insert a Data Card (as described in “Using a Data Card” on 2-

11).

Figure 3-2 Connecting Pads to the Patient Cable

M3500B HeartStart XLT Defibrillator/Monitor 3-5

Defibrillating

Follow the voice and screen prompts as they guide you thro ugh t he f ollowing steps:

1. Press On.

In this first st ep of the defibrillation process, the HeartStar t XLT checks to see if the pads patient cable and the pads are connected. If they are, it proceeds to step 2.

If the pads patient cable is not properly attached, you are prompted to &RQ QHFW3DGV&DEOH.

Figure 3-3 Connect Pads Cable Display

Connect Pads Cable

Shocks: 0

00:00:02

Once the cable is connected, the HeartStart XLT checks to make sure the pads are making good contact with the patient’s skin. It does this by monitoring the electrical impedance between the two pads.

3-6 Defibrillating in AED Mode

Defibrillating

If the pads have not been applied or are not making proper contact with the patient, you are prompted to $SSO\3DGV and &KHFN&RQQHFWLRQV.

Figure 3-4 Apply Pads Display

Apply Pads

Shocks: 0

00:00:03

M3500B HeartStart XLT Defibrillator/Monitor 3-7

Defibrillating

2. If instructed, press .

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If device-initiated analysis is off, the HeartStart XLT monitors the rhythm (provided Rhythm Monitoring is on) and prompts you to press

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a potentially shockable rhythm is detected.

Figure 3-5 Press ANALYZE Display

Check Patient

If No Pulse

PAUSE

Press ANALYZE

ANALYZE

Shocks: 0

00:00:04

NOTE If monitoring capabilities are enabled on your HeartStart XLT, your display

will contain monitori ng i nf ormat ion not shown in the graphics in thi s s ect ion.

NOTE ECG Analysis is always performed through multifunction defib electrode

pads. Analysis can not be performed through monitoring electrodes.

3-8 Defibrillating in AED Mode

Defibrillating

If device initiated analysis is on, you do not need to press ; ECG

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analysis begins automatically.

Figure 3-6 Analyzing Display

Analyzing

Do Not Touch Patient

Shocks: 0

00:00:08

STOP

ANALYSIS

WA RN I N G Handling or transporting the patient during ECG analysis can cause incorrect or

delayed diagnosis.

If a shockable rhythm is detected, as indicated by the message 6KRFN$GYLVHG, analysis stops and t he XLT automatically charges to 150 J. Ch arging is accompanied by an intermittent charge tone.

Figure 3-7 Charging Display

Charging to 150J

97J

Shocks: 0

00:00:10

M3500B HeartStart XLT Defibrillator/Monitor 3-9

Defibrillating

3. If shock advised, press .

6+2&.

Once charging is complete, the charge tone becomes continuous. Make sure no one is touching the patient or anything connected to the patient.

Call out "Clear." Then press to deliver a shock to the patie nt.

Figure 3-8 Press SHOCK Display

Stand Clear!

Press SHOCK

WA RN I N G Defibrillation current can cause operator or bystander injury. Do not touch the

6+2&.

150J

Shocks: 0

00:00:14

SHOCK

patient, or equipment connected to the patient, during defibrillation.

The defibrillator automatically disarms if you do not press in 30

6+2&.

seconds.

3-10 Defibrillating in AED Mode

Defibrillating

Delivery of the shock is confirmed by the message 6KRFN'HOLYHUHG and the shock counter is updated.

Figure 3-9 Shock Delivered Display

Shock Delivered

Shocks: 1

00:00:40

Automatic Re-analysis On

If Automatic Re-analysis is on, the HeartStart XLT analyzes the ECG following delivery of the shock. You are prompted to press , if an a ddi-

tional shock is advised. This cycle repeats until the rhythm converts or a shock series is complete. (A shock series may be configured to 2, 3, or 4 shocks.)

6+2&.

Automatic Re-analysis Off

If Automatic Re-analysis is off, the HeartStart XLT monitors the ECG for potentially shockable rhythms (provided Rhythm Monitoring is on) and

prompts you to press if one is detected. You can initiate analysis, without being prompted, by pressing .

M3500B HeartStart XLT Defibrillator/Monitor 3-11

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Pausing for CPR

At the completion of a shock series or when no shock is advised, the HeartStart XLT prompts y ou to &KHFN3DWLHQW&KHFN3XOVH. It allows eight seconds for you to check the pulse, then prompts you as follows:

Figure 3-10 Press Pause Display

If Needed

Press PAUSE

PAUSE

And Begin CPR

ANALYZE

Shocks: 1

00:00:50

If CPR is nee ded, press . While paused, the Pau se Timer indicates th e

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elapsed time and the total duration of the Pause state, in seconds. The Pause Timer is configurable to meet your local CPR protocol needs. Rhythm, SpO

and heart rate monitoring alarms are suspended for the duration of the pause.

NOTE * This section describes how the Pause state functions using the default con-

figuration. If your HeartStart XLT is configured to support the European Resuscitation Council G uidelines fo r Resuscitat ion, refer to the “ERC Protocol” section on page 3-16 for details.

3-12 Defibrillating in AED Mode

Figure 3-11 Pause Display

Pausing for CPR

RESUME

Paused

Timer: 21 / 60

ANALYZE

Shocks: 3

00:01:40

Elapse Time

Total Pause Duration

The pause state ends when the Pause Timer reaches the preconfigured Pause state duration, or if you press or . At the completion of the

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pause state, the defibrillation process begins again. If instructed, press

$1$/<=(

If you do not press , the HeartStart XLT begins monitoring the ECG

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rhythm (provided Rhythm Monitoring is on).

You may initia te ECG analysis at any time by pressing

$1$/<=(

M3500B HeartStart XLT Defibrillator/Monitor 3-13

Monitoring Rhythm

When the HeartStart XLT is not analyzing, defibrillating, or paused, Rhythm Monitoring alerts you to potentially shockable rhythms (provided Rhythm Monitoring is set to the default configuration, 2Q). The message 0RQLWRULQJ 5K\WKP appears on the display to let you know this feature is active and remains on the display for the duration of the m onitoring.

Figure 3-12 Monitoring Rhythm Display

Monitoring Rhythm

Shocks: 3

00:00:49

PAUSE

ANALYZE

WA RN I N G The recommended configuration setting for Rhythm Monitoring is On. If Rhythm

Monitoring is off, you are not alerted when a patient’s rhythm changes from nonshockable to shockable (as in refibrillation or an initially nonshockable rhythm that converts to a shockable rhythm).

3-14 Defibrillating in AED Mode

Monitoring Rhythm

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If Rhythm Monitoring detects a shockable rhythm, you are prompted as follows:

Figure 3-13 Shockable Rhythm

Check Patient

If No Pulse

PAUSE

Press ANALYZE

ANALYZE

Shocks: 3

00:00:55

This prompt is rep eated per iodicall y, as configure d, until or is pressed. If you press , the defibrillation process starts again.

If you press pause. is used when administering CPR, as not ed earl ier. It may also be

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$1$/<=(

, rhythm monitoring is suspended for the duration of the

$1$/<=(

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useful when performing medical procedures or encountering artifact during patient transport. Act ive SpO

and heart rate alarms are suspended during the

pause duration, as well.

5(680(

Press

to restore rhyth m mon it ori ng. Acti ve SpO

and heart rate alarms

are also restored.

M3500B HeartStart XLT Defibrillator/Monitor 3-15

ERC Protocol

The HeartStart XLT can be configured to support the European Resuscitation Council (ERC) Guidelines for Resuscitation (1998). If (XURSHDQ3URWRFRl is configured to 2Q, the defibrillation process described in this chapter is the same, with the exception of how the Pause state functions (see “Pausing for CPR” on 3-12).

As described, you can enter a Pause state:

at the completion of a shock series, or

when no shock is advised

When either of these events occurs, the ERC protocol prompts you to Check Patient. Then it prompts you as follows:

Figure 3-14

If Needed

Press PAUSE

And Begin CPR

PAUSE

NOTE Using the ERC protocol, you are not prompte d to (or given time to) che ck the

ANALYZE

Shocks: 1

00:00:50

patient’s pulse.

3-16 Defibrillating in AED Mode

ERC Protocol

If CPR is needed, press . While paused, a timer indicates the elapsed

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time and the total duration of the Pause state, as shown:

Figure 3-15

RESUME

Paused

Timer: 35 / 60

ANALYZE

Shocks: 3

00:01:40

Elapsed Time Total Pause Duration

The total pause duration depends on the event preceding the Pause state. If you entered the Pause state:

at the completion of a shock series or shortly after a shock is delivered, the duratio n is eq ual to the 3RVW6KRFN&357LPHU configuration set- ting (the default setting is 60 seconds).

when no shock was advised, the duration is equal to the 16$7LPHU configuration setting, where NSA is an acronym for No Shock Advised (the default setting is 180 seconds).

M3500B HeartStart XLT Defibrillator/Monitor 3-17

Troubleshooting

When the HeartStart XLT detects a problem, it provides display and/or voice prompts to guide you to r esoluti on. The tabl e below lists the prompts you may encounter in AED Mode, the cause, and the suggested corrective action. Prompts related to the battery and Data Card are discussed in Chapter 12.

Table 3-1 AED Mode Prompts

Prompt Possible Cause Corrective Action

Pads Off The multifunction def ib electrode

pads are not properly applied to the patient.

Pads Cable Off

Artifact Detected

The pads cable is not conn ected to the defibrillator.

Patient motion interferes with analysis.

Electrical sources are causing interference.

Shock Cancelled

No Shock Delivered

Key Inactive

Shock key not pressed within 30 seconds.

Pads are not properly connected to the patient.

The key pressed only functions in Manual Mode.

The key pressed does not function during anal ys is or ch arging.

The key pressed does not function while in a pause state.

Check that th e pa ds are applied to the patient, as directed on the pads’ package. Replace the pads if the prompt continues.

Check that the defibrillation pads connector is locked in place.

Attempt to eliminate patient motion. Avoid analyzing during transpor t or while performing CPR.

Move hand-held communication devices or other suspected devices away from the defibrillator, when possible.

Press within 30 seconds of prompt.

Check pads connection.

Access manual mode prior to pressing the key.

W ait for analysis or charging to complete prior to pressing the key.

5(680(

Press prior to pressing the key.

3-18 Defibrillating in AED Mode

4 Monitoring the ECG

The HeartStart XLT can be used for short or long-term ECG monitoring. The ECG monitoring function allows you to monitor through:

multifunction defib electrode pads, or

3- or 5-lead ECG monitoring electrodes, as configured.

When the HeartStart XLT is turned on, the ECG acquired through pads is shown on the display. ECG monitoring allows you to continue to monitor through the pads or to select a lead from an alternate ECG source (3- or 5lead). ECG monitoring al so displays the heart rat e ( HR) a nd allows you to set HR alarms.

ECG monitoring is always act iv e in Manual Mode. In AED Mode, ECG monitoring is o nly active if /HDG6HOHFWis configured to on (the default is off).

A fully charged battery provides approximately 2.7 hours of continuous monitoring.

This chapter describes how to apply monitoring electrodes, select the lead to monitor, and set a heart rate (HR) alarm. To apply multifunction defib electrode pads, follow the directions on the pads packaging. For information on printing, storing, and retrieving patient information acquired while monitoring, see Chapter 9.

NOTE If you need to connect the ECG cable to the HeartStart XLT or configure the

HeartStart XLT to use the optional 5-lead monitoring cable, see Chapter 10.

M3500B HeartStart XLT Defibrillator/Monitor 4-1

Applying Monitoring Electrodes

Proper application and placement of electrodes is essential for reliable monitoring. Good contact betwee n the elect rode and the skin reduce s the eff ects of motion artifact and signal interference.

To apply electrodes:

1. Identify the appropriate electrode sites. (See Figure 4-1.)

2. Shave the electrode sites or clip hair, if necessary.

3. Clean and abrade the skin at the electrode sites.

4. Dry the skin at the electrode sites.

5. Open a new package of M2202A Radio-Translucent Monitoring Electrodes; ver ify that the " Use Before" date has not passed.

6. Snap the lead wires onto the electrodes.

7. Apply the electrodes by peeling them, one at a time, from the protective backing and sticking them firmly to the patient’s skin. Press around the entire edge of each elect rode to ensure tha t they are secure. Make sure the lead wires do not pull on the electrodes.

WA RN I N G Be sure that the electrodes do not come in contact with other conductive materials,

especially when connecting or disconnecting the electrodes to/from the patient.

NOTE If monitoring for long periods of time, new monitoring electrodes and

multifunction defib el ectrode pads may need to be applied peri odi cally. Refe r to the manufacturer’s documentation for how often to replace the monitoring electrodes or defib pads.

4-2 Monitoring the ECG

Applying Monitoring Electrodes

Electrode Placement

Figure 4-1 shows typical electrode placement for the limb leads of a 3- or 5lead patient cabl e. The V/ C lead of the 5- lead ca ble can be place d in any of the precordial lead positions (V1/C1 through V6/C6) shown in Figure 4-2.

Figure 4-1 Limb Lead Electrode Placement

AHA Labels IEC Labels

RA/R LA/L

RA Right Arm R Right LA Left Arm L Left RL Right Leg* N Negative*

RL/N LL/F

Table 4-1 3-Lead ECG Lead Formation

Lead + - Reference

I II III

LA RA LL LL RA LA LL LA RA

LL Left Leg

* Not used for 3-lead.

F Foot

M3500B HeartStart XLT Defibrillator/Monitor 4-3

Applying Monitoring Electrodes

LA + LL

RA + LA

RA + LL

RA + LA + LL

Figure 4-2 Precordial Lead Electrode Placement

Electrode Location

V1 C1 forth intercostal spac e, at righ t sternal

V2 C2 forth intercostal space, at left sternal

V3 C3 midway between V2/C2 and V4/C4 V4 C4 fifth intercostal space, at left midclav-

V5 C5 same level as V4/C4, on anterior axil-

V6 C6 same level as V4/C4, at left mid axil-

Table 4-2 5-Lead ECG Lead Formation

margin

icular line

lary line

Lead Lead Formation

ILA - RA II LL - RA III LL - LA aVR

aVF

aVL

(or Cx)

where x = 1-6

RA -

LL -

LA -

V/C -

4-4 Monitoring the ECG

Selecting the Lead

Available monitoring leads are dependent upon your device configuration:

Table 4-3 Lead Select Choices

Lead Select

Choices are:

Pads, Lead I, Lead II, Lead III 3-lead ECG cable Pads, Lead I, Lead II, Lead III, aVR,

aVL, aVF, V lead.

5-lead ECG cable

To select a lead to mon it or, cycle thr ough t he choices by pressing until

If Configured for a:

6(/(&7

/($'

the desired lead is displayed.

NOTE When V lead is selec ted, ch ange t o a dif fer ent V lea d by moving t he ele ctrod e

to a new location rather than by pressing the softkey.

Figure 4-3 ECG Monitoring Display

HR ALARM

LEAD

SELECT

Lead II

Monitoring Rhythm

/($'

6(/(&7

Shocks: 3

00:00:49

PAUSE

ANALYZE

If the desired lead is not connected or the electrodes are not making proper contact with the patient, the message /HDGV2II is displayed in the System Message Area and accompanied by a beep to alert you. A dashed line on the display indicates that there is no ECG signal.

M3500B HeartStart XLT Defibrillator/Monitor 4-5

Setting the Heart Rate Alarm

The computed heart rate (number of detected QRS complexes per minute) is displayed below the sofkey, next to the . The heart rate represents

the number of QRS complexes detected in a minu te . A QRS beeper, if configured to on, indicates each QRS complex detected.

If desired, a HR alarm may be set to alert you when the heart rate is outside the specified limits. Limit choices are listed in Table 4-4.

Table 4-4 HR Alarm Limit Choices

Alarm If Over: Or under:

+5$/$50

100 30 140 60 160 90 200 120

To set a HR alarm, cycle through the limit choices by pressing until

+5$/$50

the desired limits are shown. The then appears next to the heart rate value to indicate that the HR alarm is set.

WA RN I N G Heart rate alarms are temporarily suspended in AED Mode during ECG analysis or

3$86(

when is pressed (for the duration of the paused period). Heart rate alarms are also suspended while charging for defibrillation and delivering a shock.

WA RN I N G Heart rate displays and alarms function with internal and external pacemakers, but

they can be unreliable. Observe the patient closely if pacemakers are used.

4-6 Monitoring the ECG

Disabling the HR Alarm

If the heart rate is outside th e HR alarm limits, an alarm sounds. To disable the alarm, press . appears to indicate that the alarm is disabled.

+5$/$50

Adjusting the ECG Size

To increase or decrease the size of the ECG, press or on the gain control, .

Troubleshooting

Table 4-5 provides troubleshooting tips for ECG Monitoring.

Table 4-5 Troubleshooting Tips

Situation Cause Solution

/HDGV2IImessage

dashed line (------)

The monitoring electrodes are not applied or are not making proper contact with the patient.

The monitoring cable is not connected.

Check that the monitoring electrodes are properly applied.

Check that the monitoring cable is properly connected.

3DGV2IImessage

M3500B HeartStart XLT Defibrillator/Monitor 4-7

The pads are not making proper contact with the patient.

Check that the pads are properly applied.

Troubleshooting

Table 4-5 Troubleshooting Tips (Continued)

Situation Cause Solution

Poor ECG signal quality

QRS beeper inaudible or beeps do not occur with each QRS complex.

The monitoring electrodes are not making proper contact with the patient.

The monitoring electrodes are outdated or dried-out.

Radio frequency interference (RFI) is causing artifact.

The QRS beeper is configured to Off.

The amplitude of the QRS complex is too small to detect.

Check that the monitoring electrodes are properly applied. If necessary, prepare the patient’ s sk in and apply new electrodes.

Check the date code on the electrodes. Do not open the electrode package until immediately prior to use.

Relocate or turn off equipment that may be causing RFI.

Check that the QRS beeper is configured to On.

Adjust the volume.

Adjust the size of the ECG.

4-8 Monitoring the ECG

5 Monitoring SpO

Pulse oximetry is a noninvasive method of continuously measuring oxygen saturation (SpO

percentage of hemoglobin molecules in the arterial blood which are saturated with oxygen. SpO

ing a patient’s cardiac and respiratory systems. This chapter explains how pulse oximetry works and des cribes ho w to use th e HeartS tart XLT to monitor SpO

SpO2 monitoring is always available in Manual Mode (if the option is purchased). In AED Mode, SpO ured to 2Q.

For information on printing, storing, and retrieving patient information acquired while monitoring, see Chapter 9.

) in arterial blood. The resultant SpO2 reading indicates the

monitoring is one of the tools available to assist in assess-

monitoring is only available if SpO2 is config-

WA RN I N G Do not rely solely on SpO

may be inaccurate in the presence of significant levels of carboxyhemoglobin or methemoglobin, in patients with restricted blood flow to the extremities (such as those in severe shock or hypothermia), or in the presence of excessive motion.

M3500B HeartStart XLT Defibrillator/Monitor 5-1

readings; assess the patient at all times. SpO2 readings

Understanding Pulse Oximetry

A pulse oximetry s ens or se nds light through patient t is sue t o a r eceiver on the other side of the sensor. As Figure 5-1 shows, light emitting diodes transmit red and infrared light through peripheral areas of the body, such as a finger.

Figure 5-1 Pulse Oximetry Sensor

LED

Photodetector

A photodetector positioned opposite the light emitting diodes compares light absorption before and after pulsation. The amount of light getting through reflects the blood f lo w i n t he a rt er iol es . Thi s meas urement of light absorption during pulsation is translated into an oxygen saturation percentage and an SpO

value is displayed.

For accurate SpO

The patient must have perfusion in that extremity.

The light emitter an d the photodete ctor must be direct ly opposit e each

measurements, the following conditions must apply:

other.

All of the light from the emit te r must pas s throu gh t he pati ent’s tissue.

The sensor site should be free of vibration and excessive motion.

Power cables should be kept away from the sensor cable and connector.

5-2 Monitoring SpO

Selecting a Sensor

Table 5-1 shows the SpO2 sensors that may be used with the HeartStart XLT.

Table 5-1 Approved Sensors

Sensor Type Patient Patient Size Ideal Site

M1191A Reusable Adult > 50 kg Finger M1192A Reusable Small adult

Pediatric

M1194A Reusable Pediatric

Adult

M1903A/B (Nellcor D-20)

M1904A/B (Nellcor D-25)

M1906A (Nellcor P/I)

M1907A (Nellcor A/N)

NOTE To use Nellcor sensors, you must connect the M1943A Nellcor Adaptor

Disposable Pediatric 10-50 kg Toe/Finger

Disposable Ad ul t > 30 kg Finger

Semi-reusable

Pediatric Infant

Neonate < 3 kg Foot/Hand Adult > 40 kg Fin ger

patient cable to the HeartStart XLT. (See “Connecting the SpO

15-50 kg Finger

> 40 kg Fleshy part

of ear

3-40 kg Finger/Toe

Patient

Cable” on page 10-5.)

M3500B HeartStart XLT Defibrillator/Monitor 5-3

Selecting a Sensor

The most important factor when selecting a sensor is the position of the light emitting diodes in relation to the photodetector; when a sensor is applied, the diodes and the photodetector must be opposite each other. Sensors are designed for patients within a specific weight range and for specific sites. Be sure to:

Select a sensor appropriate for the patient’s weight.

Select a sensor site with adequate perfusion.

Avoid application to sites with edematous tissue.

Reusable Sensors

Reusable sensors may be reused on different patients after they have been cleaned and disinfect ed (see t he manu factu rer’ s instr uction s supp lied wi th the sensor).

Disposable Sensors

Disposable sensors shou ld be use d only onc e an d then di scarded. The y can be relocated to a different application site on the patient if the first location does not give the desired results. Disposable sensors must not be reused on different patients.

Semi-disposable Sensors

Semi-disposable sensors can be reused, but the adhesive wrap must be discarded afte r each use. Semi-disposable sensors are recommended for singlepatient use only.

5-4 Monitoring SpO

Applying the Sensor

Follow the manufacturer’s directions for applying and using the sensor, making sure to observe any warnings or cautions. For the best results:

Make sure the sensor is dry.

If the patient is moving, secure the sensor cable loosely to the patient.

Avoid excessive pressure at the sensor sit e; ensure that circulation is not obstructed.

Keep power cables away from the sensor cable and connection.

Avoid placing the sensor in an environment with bright lights (if necessary, cover the sensor with opaque material).

Avoid placing the sensor on any extremity with an arterial catheter, blood pressure cuff, or intravascular venous infusion line.

WA RN I N G Failure to apply the sensor properly may reduce the accuracy of the SpO

measur-

ment.

WA RN I N G Inspect the sensor application site at least every two hours for changes in skin qual-

ity, correct optical alignment, and proper sensor application. If skin quality is compromised, change the sensor site. More frequent checking may be required due to an individual patient’s condition.

M3500B HeartStart XLT Defibrillator/Monitor 5-5

Connecting the Sensor Cable

To connect a sensor cable:

1. Hold the connector with the flat side up so that the part number is visible.

2. Insert the connector into the receptacle and push until the blue portion of the connector is no longer visible.

Figure 5-2 Connecting the Sensor Cable

5-6 Monitoring SpO

Monitoring

To monitor SpO2:

1. If the HeartStart XLT is not on, press On.

2. Apply the appropriate sensor to the patient.

3. Make sure the sensor cable is connected to the HeartStart XLT.

4. Press to turn on SpO

6S2



monitoring.

Monitoring

A dashed line (---) is displayed under , while the oxygen saturation is measured and an SpO

value is calculat ed. In a few se con ds the S pO2 value is

6S2



displayed in place of the dashed line. As the patient’s oxygen saturation changes, the SpO

Figure 5-3 SpO2 Monitoring Display

HR ALARM

PAUSE

value is updated continuously.

LEAD

SELECT

Pads

Monitoring Rhythm

ANALYZE

SpO2

PR 62

Shocks: 3

00:00:49

To the ri ght of the SpO2 value, a pleth bar and SpO2 alarm indicator are displayed. The pleth bar should be observed for fluct uation. It is an indication of

pulsation detected by the sensor. The pleth bar should not be used as the sole indicator of pulsation because it can be influenced by movement and artifact.

The symbol indicates no alarm is set.

Below the SpO

M3500B HeartStart XLT Defibrillator/Monitor 5-7

value is the pulse rate derived from the pulse oximetry.

Setting Alarms

An alarm may be set to al ert you if the SpO2 value falls below a specified lower limit. Lower li mit ala rm c hoi ces ar e (no alarm), 90, 85, o r 8 0. Pr es s

6S2

repeatedly to cycle th rough the choic es. Stop when the desired choi ce is



displayed. A appears in three seco nds, i ndicat ing t hat t he sel ected alar m is active. To review the alarm limit, press .

6S2



WA RN I N G SpO

3$86(

pended while charging for defibrillation and delivering a shock.

Responding to an Alarm

When the SpO2 value falls below the alarm l imit, a continuou s t one ale rts you and the SpO

Figure 5-4 SpO2 Alarm Triggered

HR ALARM

alarms are temporarily suspended in AED Mode during ECG analysis or when

is pressed (for the duration of the paused period). SpO

value is displayed in inverse video.

LEAD

SELECT

Pads

SpO2

PR 80

alarms are also sus-

Monitoring Rhythm

Shocks: 3

00:00:49

PAUSE

ANALYZE

6S2

Press to turn off the alarm. R efer to “Setting Alarms” if subsequent



alarms are desired.

5-8 Monitoring SpO

Discontinuing SpO2 Monitoring

Discontin uing SpO2 Monitoring

To shut off SpO2 monitoring, press repeatedly until nothing appears

PAUSE

6S2



LEAD

SELECT

Pads

Monitoring Rhythm

ANALYZE

below the softkey.

Figure 5-5 SpO2 Monitoring Off

HR ALARM

6S2

SpO2

Shocks: 3

00:00:49



Caring for Sensors

Refer to the manufacturers instructions for care and cleaning of sensors. To get the best results from your SpO

and cable with care and protect them from sharp objects. The sensor sleeve houses a sensitive electronic device that can be damaged. Harsh treatment of sensors will drastically reduce their lifetime.

reusable senso rs, always handle the s ensor

WA RN I N G Do not use a damaged sensor or one with exposed electrical circuits.

M3500B HeartStart XLT Defibrillator/Monitor 5-9

Troubleshooting

The table below lists syst em messag es t hat you ma y enc ount er when monitoring SpO

Table 5-2 System Messages

6S21RQ3XOVDWLOH

6S2/RZ6LJQDO

Problem or Message Possible Cause Corrective Action

Pulse absent or too weak to be detected.

SpO2 signal is too low to give an accurate read-

ing.

Check the sensor is applied properly.

Make sure the sensor site has a pulse.

Relocate the sensor to a site with improved circulation.

Try another sensor type.

Check the sensor is applied properly.

Try another sensor type.

6S21RLV\6LJQDO

Excessive patient movement, electrical interference, or optical interference.

Minimize patient motion or apply se nsor to site with less movement.

Secure the sensor

cable loosely to the patient.

Reduce sources of electrical or optical interference.

6S2/LJKW,QWHUI

The level of ambient light is so high that the sensor cannot obtain an

reading.

SpO

Sensor or cable is dam-

Cover sensor with an opaque material.

Check sensor for damage; try another se nsor.

aged.

5-10 Monitoring SpO

Troubleshooting

Table 5-2 System Messages (Continued)

Problem or Message Possible Cause Corrective Action

6S2&DEOH2II

6S26HQVRU)DLO

6S2)DLOXUH

The SpO2 cable is not connected to the device.

The transducer is broken.

There is a hardware failure in the SpO

system.

sub-

Attach the cable to the HeartStart XLT.

Apply a new transducer.

Remove device from active use and call for service.

M3500B HeartStart XLT Defibrillator/Monitor 5-11

6 Defibrillating in Manual Mode

In Manual Mode you assess the ECG, decide if defibrillation is indicated, select the discharge energy level, and deliver the shock. The defibrillation process is under your control. There are no voice prompts, however, system and momentary messages provide relevant information throughout the process. It is important to b e attentive to these messages.

This chapter describes how to access Manual Mode and use it for defibrillation. For Manual Mode features such as synchronized cardioversion and pacing, see the “Performing Sync hro nized Car diover sion” and “Pacing” ch apt ers.

For information on printing, storing, and retrieving patient information acquired in Manual Mode, see Chapter 9.

M3500B HeartStart XLT Defibrillator/Monitor 6-1

Enabling Manual Mode

From AED Mode, press to enable Manual Mode. If prompted, use

Manual

the softkeys above the display to enter the password.

Figure 6-1: Manual Password Display

EXIT

PASSWORD

Enter Password

To return to AED Mode, without entering a password, press .

Once Manual Mode is enabled, the green LED next to is lit.

Shocks: 3

00:00:49

3$66:25'

Manual

(;,7

In its default configuration, the HeartStart XLT powers on into AED Mode. If you prefer, you can configure it to power on into Manual Mode. You have the option to require users to enter a password in order to enable Manual Mode from AED Mode. (See “Configur ing t he Hear tS tart XLT ” on page 10-7.

WA RN I N G Use of a password for Manual Mode is recommended as a safety measure to deter

untrained personnel from entering Manual Mode.

6-2 Defibrillating in Manual Mode

Preparation

In preparation for defibrillation:

1. Apply multifunction def i b el ect ro de pads as directed on the packa ge. Us e either the anterior-anterior or anterior-posterior electrode placement, as appropriate.

2. Connect the pads to the pads patient cable, as shown in Figure 6-2.

3. If needed, insert a Data Card (as described in “Using a Data Card” on 2-

11).

4. Press On.

5. Enter Manual Mode, if AED Mode is active.

Figure 6-2 Connecting Pads to the Patient Cable

NOTE Defibrillation is always performed through pads. However, during defibrilla-

tion, you may choose to monitor ECG usi ng an a lt er nat e ECG sou rce (3- or 5 lead monitoring electrodes).

M3500B HeartStart XLT Defibrillator/Monitor 6-3

Defibrillating

The defibrillation process is as follows:

1. Select Energy

The default energy setting is 150 joules. To change the energy setting,

(1(5*<

press repeatedly to cycle through the energy level choices. Stop

6(/(&7

when the desired energy is displayed. The choices are 5, 10, 25, 50, 70, 100, 150, or 200 joules.

Figure 6-3 Energy Select Display

HR ALARM

LEAD

SELECT

Pads

SpO2

150 J

ENERGY

SELECT

CHARGE

Shocks:0

00:00:8

2. Charge

&+$5*(

Press . As the defibrillator charges, the curre nt charge is displayed above the

shock counter. A charging tone beeps until the desired energy level is reached, at which point you’ll hear a continuous charge tone.

6-4 Defibrillating in Manual Mode

Figure 6-4 Charging Display

&+$5*(

HR ALARM

LEAD SELECT

Pads

Defibrillating

SpO2

Current Charge

150 J

ENERGY

SELECT

87 J

Shocks:0

00:00:8

DISARM

If desired, you may increase or decrease the selected energy level after pressing the button. To do so, press repeatedly until the

(1(5*<

6(/(&7

desired energy level is displayed. The defibrillator charges to the selected energy automatically. Wait until the current charge reaches the s elected energy level before proceeding.

3. Shock

Confirm that a shock is still indicated. Make sure no one is touching the patient or anything connected to the patient. Call out “Clear.” Then press

6+2&.

to deliver a shock to the patient.

To disarm the defibrillator, press . If is not pressed in 30 seconds, the de fibrillator disarms auto matically.

If additional shocks are indicated, repeat the defibrillation process

WA RN I N G Defibrillation current can cause operator or bystander injury. Do not touch the

patient, or equipment connected to the patient, during defibrillation.

',6$50 6+2&.

M3500B HeartStart XLT Defibrillator/Monitor 6-5

Returning to AED Mode

Manual

Returning to AED Mode

To enable AED Mode, from Manual Mode, press . The green LED

Manual

next to goes out, indicating Manual Mode is no longer active. If ECG and/or SpO

monitoring are enabled in AED Mode, alarms set in

Manual Mode remain active when you switch to AED Mode.

6-6 Defibrillating in Manual Mode

7 Performing Synchronized Cardioversion

Synchronized cardioversion is a Manual Mode function that allows you to synchronize the defibrillator shock with the R-wave of the ECG being monitored.

During synchronized cardioversion, the ECG being monitored is shown on the display and may be derived from:

the multifunction defib electrode pads, or

the 3- or 5-lead monitoring electrodes.

When selecting a lead, choose the best lead that displays a large QRS complex. The synchronized shock is delivered through the mulifunction defib electrode pads, regardless of the lead being monitored.

This chapter describes how to perform synchronized cardioversion with the HeartStart XLT.

NOTE See Chapter 4, “Monitoring the ECG” for information on how to apply elec-

trodes and select a lead.

M3500B HeartStart XLT Defibrillator/Monitor 7-1

Preparing for Synchronized Cardi over sio n

Sync

(1(5*< 6(/(&7

Preparing for Synchronized Cardioversion

In preparation for synchronized cardioversion:

1. Apply multifunction def i b el ect ro de pads as directed on the packa ge. Us e either the ant er ior-anterior or ante ri or-posterior placemen t, as appropriate.

2. Connect the pads to the patient cable. (See Figure 6-2.)

3. Apply monitoring elect rodes, if des ired. (See “Applyi ng Monito ring El ectrodes” on page 4-2.)

4. If needed, insert a Data Card (as described in “Using a Data Card” on 2-

11).

5. Press On.

6. Enable Manual Mode. (See “Enabling Manual Mode” on page 6-2.)

7. Use to select the best lead that displays a lar ge QRS complex. (See “Selecting the Lead” on page 4-5.)

Delivering a Synchronized Shock

/($'

6(/(&7

To perform synchronized cardioversion:

1. Press to enable Sync Mode. The green LED next to

Sync

lights up and the message 6<1& appears on the display.

2. Use the gain control, , to adjust the ECG size so that the marker dot appears only once with each R-wave.

3. If necessary, change the energy setting (the default setting is 150 joules), by pressing repeatedly until the desired energy level is displayed.

The choices are 5, 10, 25, 50, 70, 100, 150, or 200 joules.

4. Press . Wait until the current charge has reached the energy level

&+$5*(

selected and you hear a continuous charge done tone.

7-2 Performing Synchroni zed Cardioversion

Delivering a Synchronized Shock

&+$5*(

Figure 7-1: Charging in Sync Mode

HR ALARM

LEAD

SELECT

Pads

SpO2

87 J

150 J

ENERGY

SELECT

Sync

DISARM

If desired, you may increase or decrease the sele cted energy level after pressing

, by pressing repeatedly until the desired energy

level is displayed. The defibrillator charges to the modified energy level automatically. Wait until the curr ent charge reaches the selected energy level before proceeding.

5. Make sure no one is touching the patient or anything connected to the patient. Call out “Clear.” Then press and continue to hold

down until the shock is delivered.

Shocks:0

00:00:8

(1(5*<

6(/(&7

6+2&. 6+2&.

The defibrillator shocks with the next detected R-wave.

WA RN I N G Defibrillation current can cause operator or bystander injury. Do not touch the

patient, or equipment connected to the patient, during defibrillation.

M3500B HeartStart XLT Defibrillator/Monitor 7-3

Disabling Sync Mode

Delivering Additional Synchronized Shocks

If additional synchroni ze d shoc ks ar e indicated, make sure Sync Mode is still enabled and repeat steps 2-5. In its default configuration, the HeartStart XLT remains in Sync Mode after a shock is delivered, as indicated by the message

6\QF on the display and the lighted green LED next to .

Sync

The HeartStart XLT can be configured to exit Sync Mode after each shock is delivered.

Disabling Sync Mode

T o disable Sync Mode, press . The green LED next to goes out and the message 6\QF is no longer displayed. Sync Mode is also disabled when you exit Manual Mode.

Sync Sync

7-4 Performing Synchroni zed Cardioversion

8Pacing

Noninvasive transcutane ous pac ing is a Manual Mode functi on that is use d to deliver paced pulses to the heart. Paced pulses are delivered through multifunction defib electrode pads applied to the patient’s bare chest.

This chapter explains the pacing options and describes how to perform pacing.

M3500B HeartStart XLT Defibrillator/Monitor 8-1

Demand Mode Versus Fixed Mode

The HeartStart XLT can deliver paced pulses in either demand or fixed mode. In demand mode, the pacer only delivers paced pulses when the patient’s

heart rate is lower than the selected pacing rate. In fixed mode, the pacer delivers paced pulses at the selected rate.

Monitoring During Pacing

Multifunction defib electrodes pads can not be used to monitor the ECG and deliver paced pulses simultaneously. The HeartStart XLT always uses the 3or 5-lead ECG cable and monitoring electrodes as the source of ECG during pacing.

In demand mode, ECG electrodes must be used, bec aus e the HeartStart XLT uses the R-wave det ection fro m this monitoring source t o determi ne if a p aced pulse should be delivered.

In fixed mode, ECG electrodes may or may not be used; however, an ECG will only be displayed if ECG monitoring electrodes are used.

WA RN I N G Use demand mode pacing whenever possible. Use fixed mode pacing when motion

artifact or other ECG noise makes R-wave detection unreliable.

WA RN I N G Heart rate displays and alarms function during pacing, but they can be unreliable.

Observe the patient closely while pacing. Do not rely on heart rate alarms or the indicated heart rate as a measure of the patient’s perfusion status.

8-2 Pacing

Preparing for Pacing

In preparation for pacing:

1. Apply multifunction def i b el ect ro de pads as directed on the packa ge. Us e either the anterior-anterior or anterior-posterior placement, as appropriate.

2. Connect the pads to the patient cable. (See Figure 6-2.)

3. If needed, insert a Data Card (as described in “Using a Data Card” on 2-

11).

4. Press On.

5. Enable Manual Mode. (See “Enabling Manual Mode” on page 6-2.)

In addition, for demand mode pacing:

1. Apply monitoring electrodes. (Se e “Applyi ng Mon it ori ng Ele ctr ode s” on page 4-2.)

2. Use to select the best lead with an easily detectable R-wave (See

/($'

6(/(&7

“Selecting the Lead” on page 4-5.) If you do not select a lead (i.e. pads is the selected ECG source), /HDG, is automatically sele cted when the pac ing function is turned on.

NOTE If pacing for long periods of time, new monitoring electrodes and multifunc-

tion defib electrode pads may need to be applied periodically. Refer to the manufacturer’s documen tation for how often t o change moni tori ng elect rodes or defib pads.

M3500B HeartStart XLT Defibrillator/Monitor 8-3

Pacing

Pacer

Mode

Pacing

To perform pacing:

1. Press . The green LED next to lights up and the dia-

Pacer

logue box appears.

Figure 8-1 Pacing Display

HR ALARM

LEAD

SELECT

Lead II

SpO2

Pacer Stop

Demand Mode

150 J

ENERGY

SELECT

70ppm 30mA

CHARGE

Shocks:0

00:00:8

The message 6WRS indicates that th e pacing funct ion is on but pace d pulses are not being delivered. The pacer turns on in the mode last used.

2. Verify that the dot markers appears near t he middle of the QRS compl exes of the ECG.

If the dot markers do not appear, or are in the wrong location, adjust the ECG size or select another lead. (See “Monitoring the ECG” in Chapter

4.) The ECG will only appear if the 3- or 5-lead monitoring cable and elec-

trodes are used.

3. Press to change to fixed mode, if R-wave dete ction is unrel iable . The pacing dialogue box displays the current mode. To switch back to

demand mode, press again.

8-4 Pacing

Mode

Pacing

Start Stop

4. Adjust the rate to the desired number of paced pulses per minute (ppm). Press up, , or down, , on to increase or decrease the num-

Rate

ber of paced pulses per minute.

5. Press to start pacing. The message 3DFLQJ indicates that paced pulses are being delivered in the

selected mode at the rate and output level displayed.

Figure 8-2: Pacing Display

HR ALARM

LEAD

SELECT

Lead II

SpO2

Pacing

Demand Mode

150 J

ENERGY

SELECT

70ppm 30mA

CHARGE

Shocks:0

00:00:8

NOTE Pacing will not start if there is a problem with the multifunction defib elec-

trode pads connectio ns or, in demand mode, a pro blem wit h the E CG monitor ing electrodes connections. Should a problem exist, a system message is displayed. Be attentive to system messages.

M3500B HeartStart XLT Defibrillator/Monitor 8-5

Changing Pacing Modes

Start Stop

Mode

Start Stop

6. Increase the output until cardiac capture occurs.

Press up on to increase the output in increments of 10 mA.

Output

7. Decrease the output to the lowest level that still maintains capture.

Press on to decrease the output in increments of 5 mA.

Press to stop pacing. Press to exit the pacing function. The

Output

Pacer

green LED next to the button goes out, indicating pacing is no longer active.

Changing Pacing Modes

If paced pulses are bei ng deli vered, y ou must st op pacin g befo re changi ng the pacing mode:

1. Press to stop pacing.

2. Press to change the mode.

3. Adjust th e rate, if needed.

4. Press to resume pacing.

5. Adjust the output, as needed to obtain capture.

Defibrillating During Pacing

If the patient must be defibrillated during pacing, follow the procedure for defibrillating in Manual Mode on page 6-4.

Pacing is automatically turned off when you charge the defibrillator and the pacing dialogue box is removed from the display. After a shock, pacing remains off.

To resume pacing, refer to “Pacing” on page 8-4. When you resume, the rate, mode, and output settings start at the settings selected prior to defibrillation.

8-6 Pacing

Troubleshooting

The table below lists the pacing-relat ed system and momentary messag es that you may encounter during pacing.

Table 8-1 Pacing System Messages

Message Possible Cause Corrective Action

/HDGV2II

The selected monitoring lead is not making prope r contact with the patient.

Pacing was attempted in demand mode without monitoring electrodes attached.

Check that the monitoring electrodes are properly applied.

Check that the monitoring cable and electrodes are properly connected.

3DFHU)DLOXUH

3DFHU2XWSXW /RZ

6WRS3DFHU

.H\,QDFWLYH

The pacing system is not functioning.

High patient impedance is resulting in the delivery of less current to the patient than specified in the output current setting.

Mode

paced pulses are being delivered.

Pacer

pacing function keys, is pressed when Manual Mode is not active.

is pressed while

, or one of the other

Remove the device from active use and call for service.

Check that the pads are applied properly.

Stop pacing before changi ng the pacing mode.

Make sure Manual Mode is active before pressing

or one of the other

Pacer

pacing function keys.

M3500B HeartStart XLT Defibrillator/Monitor 8-7

9 Storing, Retrieving & Printing

Mark E

This chapter describes how the HeartStart XLT creates a patient record, called an Event Summary, for later retrieval and printing. It covers how to mark events for storage in the Event Summary, as well as how to print individual events as they occur.

Overview

The HeartStart XL T automatically creates an Event Summary for each patient. The Event Summary is stored in the HeartStart XL T’ s internal memory and on a Data Card (if one is used).

The internal Event Summary stores up to 300 pieces of critical information, called events, and 50 ECG strips (11 seconds each). Events include things such as charging, shocks, and alarm violations. In addition, you trigger an

event each time you press or .

ven

Strip

Storage on a Data Card is limited only by available spac e on t h e c ard . In a ddi tion to storing all of the events that occur, a continuous copy of the displayed ECG and Patient Contact Impedance is also stored.

You can print the i nternal Eve nt Summary at any time. You can also configure the HeartStart XL T to print individual events automatically as they occur and, of course, you can activate printing of individual events and patient informa-

tion, at any time, by pressing .

Summar

To print the Event Summary stored on the Data Card, the inform ation must first be downloaded to th e HeartStart Event Review Data Management system. Re fer to the Hea rtStart Event Review Instructions for Use for instructions.

M3500B HeartStart XLT Defibrillator/Monitor 9-1

Marking Events

Mark E

Print Strip

Marking Events

ven

The button allows you to anno tate the ECG strip at the point in time the button is pressed. In AED Mode, when monitoring is disabled, the event is

marked with a . In Manual Mode, or when monitoring is enabled in AED Mode, you use the softkeys to select the annotation from the choices displayed (See Figure 9-1)*. If no selection is made, the event is marked with a

Figure 9-1 Annotations

EPI

ATRO

Pads

LIDO

OTHER

150 J

ENERGY

SELECT

CHARGE

Shocks:0

00:00:8

NOTE *In Australia and the U. K., (3, is replaced by $'51 (adrenaline).

The marked event is stored in the Event Summary. If t he printer is configured to 3ULQWRQ0DUN, an ECG strip pr ints when is pressed. If the printer is

ven

configured to VHFRQGGHOD\, the strip is 9 seconds and includes 6 seconds pre- ceding the event and 3 seconds following the event. If 1R'HOD\ is configured, a 3 second ECG strip prints in real time. To stop printing before the entire strip

is printed, press .

9-2 Storing, Retrieving & Printing

Events Recorded

The following events and related information are stored in the Event Summary:

Table 9-1 Event Information

Event Related Information Stored

Power Change Power on, Power off, Continued use, Battery

low. Pads Change Pads on, Pads off. AED Mode Analysis Analyzing, Analysis Stopped, Artifact

Detected, Cannot Analyze, Shock Advised,

No Shock Advised. Mode Change AED Mode or Manual Mode. Rhythm Monitoring Check Patient, Pause, Resume. Charging ECG waveform, Energy charged to. Shock ECG waveform, Shock#, Delivered energy,

Peak current, and Patient impedance. Shock Failed No Shock Delivered. Disarm ECG waveform. ECG Monitoring Leads on, Leads off, Lead change, Gain

change. Heart Rate Alarm Violation Lead, Heart Rate, and Heart Rate alarm limits.

M3500B HeartStart XLT Defibrillator/Monitor 9-3

Events Recorded

Table 9-1 Event Information (Continued)

Event Related Information Stored

SpO2 Violation SpO2 value and SpO2 alarm limit. Mark

Print Strip ECG waveform. Sync Sync on, Sync off, Sync marker. Pacing Pacer start, Pacer stop, Pacer settings.

ECG waveform with annotation ( , Epi,

Atro, Lido, or Other).

9-4 Storing, Retrieving & Printing

Creating a Patient Record

The HeartStart XLT creates an Event Summary patien t record for ea ch new patient. Each record is assigned a unique incident number. The HeartStart XLT keeps the Event Summary in its inte rnal memory u ntil you begin caring for a new patient. It assumes that:

Table 9-2 Patient Record Summary

If: Then:

Power is off for more than 2 minutes and a new event is recorded

Power is off less than 2 minutes You are continuing to care for the same

You are caring for a new patient. The last internal Event Summary is deleted; a new Event Summary is started and a new incident record is created on the Data Card.

patient. Additional events are appe nded to the Event Summary; the annotation "Continued Use" is printed on the Event Summary.

The Continued Use feature allows you to change batteries or shut the HeartStart XLT off briefly (for 2 minutes), while preserving the current patient record. Events recorded after the power interruption are appended to the patient record. Continued use also preserves alarm settings.

M3500B HeartStart XLT Defibrillator/Monitor 9-5

Printing the Internal Event Summary

Print S

Printing the Internal Event Summary

To print the internal E vent Summary, press . To stop printing before the complete summary is printed, press again or press .

umma

trip

The Event Summary includes the fo llowing info rmation, in the order listed:

a header with a place for you to write in the patient’s name and the operator’s name.

a directory list of events that occurred during the incident and the time of their occurrence.

ECG strips o f the events in the directory list, where relevant.

Figure 9-2 shows the beginning of an Event Summary.

Figure 9-2 Event Summary

Patient ___________________

Operator __________________

Device On 03 Jan 00 12:41:00

Last Event 03 Jan 00 01:09:04

Total Shocks 2 Incident: 0000045 Serial Number 123456789

Device On AED Mode

Pads On Leads On

Analyzing

Shock Advised Shock #1

Analyzing

Shock Advised Shock #2

Manual Mode

12:41:00 12:41:00 12:41:01 12:41:03 12:41:03 12:41:11 12:41:17 12:41:24 12:41:31 12:41:38 12:41:42

9-6 Storing, Retrieving & Printing

Printing the Internal Event Summary

Mark E

The Event Summary also includes waveforms and the appropriate annotation for each of the following events:

Table 9-3 Event Waveform Information

Event Waveform Description

Shock Advised 11 seconds of ECG just prior to the

message 6KRFN$GYLVHG

No Shock Advised 11 seconds of ECG just prior to the

message 1R6KRFN$GYLVHG

Cannot Analyze 11 seconds of ECG just prior to the

message &DQQRW$QDO\]H

Shock Delivered 11 seconds; 3 seconds prior to the

shock, plus 8 seconds after the shock.

Print Strip

Mark Event

ECG or SpO

11 seconds; 3 seconds prior to being pressed, plus 8 seconds after

is pressed.

Strip

11 seconds; 3 seconds prior to being pressed, plus 8 seconds after

is pressed.

ven

Alarm 11 seconds; 3 seconds prior to the

alarm, plus 8 seconds after the alarm.

Strip

ven

M3500B HeartStart XLT Defibrillator/Monitor 9-7

Printing Events

Mark

Print Strip

Printing Events

The HeartStart XLT can be co nfigured to pr int automat ically when certain events occur. The table below lists these events and the length of the strip printed, depending on whether the printer is configured to print real-time or with a 6-second delay.

Table 9-4 Printing Events

Event

Defibrillator charges continuous 6 seconds just prior to charging, plus

Shock Delivered 12 seconds 6 seconds just prior to shoc k, plu s 12

Shock Failed 6 seconds 6 seconds just prior to the message

Defibrillator disarmed 6 seconds 6 seconds just prior to shock, plus 6

Alarm Violation 6 seconds 6 seconds just prior to alarm viola-

pressed

Event

Real-Time

Str ip Length

continuous printing throu gh out the charge duration.

seconds after shock.

1R6KRFN'HOLYHUHG, plus 6 seconds after the message.

seconds after shock.

tion, plus 6 seconds after alarm violation.

6 seconds 6 seconds just prior to mar ki ng, plus

6 seconds after button pressed.

Delayed

Str ip Length

Printing is configured independently for each of these events. You can stop the printing before it has printed the entire strip by pressing

Strip

To print additional events that you observe in the course of caring for your patient, press

a second time to stop printing. If the printer is configured to have a 6-

Strip

. An ECG strip will print continuously until you press

second delay, the printout contains an additional 6 seconds of the ECG that occurred just prior to pre ssing

9-8 Storing, Retrieving & Printing

Strip

10 Setting Up and Configuring the HeartStart XLT

This chapter describes how to set-up and configure your HeartStart XLT. It covers:

Connecting Patient Cables

Arranging Accessories in the Carrying Case

Configuri ng the HeartStart XLT

Connecting/Disconnecting Patient Cables

This section describes how to connect and disconnect the:

Pads Patient Cable

ECG Patient Cable (3- or 5-lead)

SpO2 Patient Cable

M3500B HeartStart XLT Defibrillator/Monitor 10-1

Connecting/Disconnecting Patient Cables

Connecting the Pads Patient Cable

To connect the pads patient cable to the defibrillator:

1. Align the white pointer on the pads patient cable with the white arrow on the defibrillator’s pads connector, as shown in Figure 10-1.

2. Insert the patient cable into the pads connector. Push until you hear it click in place.

Figure 10-1 Pads Patient Cable Connector

Pads connector

Pointer

10-2 Setting Up and Configuring the HeartStart XLT

Philips M3500B User Manual

Specifications and Main Features

Frequently Asked Questions

User Manual

1 Introduction

Overview

Intended Use

Defibrillation Therapy

Indications for AED Therapy

Contraindications for AED Therapy

Precautions for AED Therapy

Indications for Manual Defibrillation Therapy

Noninvasive Pacing Therapy

Contraindications for Manual Defibrillation Therapy

Precautions for Manual Defibrillation Therapy

Indications

Contraindications

SpO2 Monitoring

Indications

Contraindications

Learning to Use the HeartStart XLT

Safety Considerations

2 Getting Started

Getting Acquainted

Basic Orientation

Manual Mode Controls

LCD Backlight

Connecting to Power

Inserting the Battery

Removing the Battery

Low Battery Warning

Using a Data Card

Inserting a Data Card

Removing a Data Card

3 Defibrillating in AED Mode

Overview

Defibrillation (with the defa ult configuration)

Defibrillation (with a modified configuration)

Preparation

Defibrillating

Automatic Re-analysis On

Automatic Re-analysis Off

Pausing for CPR

Monitoring Rhythm

ERC Protocol

Troubleshooting

4 Monitoring the ECG

Applying Monitoring Electrodes

Electrode Placement

Selecting the Lead

Setting the Heart Rate Alarm

Disabling the HR Alarm

Adjusting the ECG Size

Troubleshooting

Understanding Pulse Oximetry

Selecting a Sensor

Reusable Sensors

Disposable Sensors

Semi-disposable Sensors

Applying the Sensor

Connecting the Sensor Cable

Monitoring

Setting Alarms

Responding to an Alarm

Discontinuing SpO2 Monitoring

Caring for Sensors

Troubleshooting

6 Defibrillating in Manual Mode

Enabling Manual Mode

Preparation

Defibrillating

Returning to AED Mode

7 Performing Synchronized Cardioversion

Preparing for Synchronized Cardi over sio n

Delivering a Synchronized Shock

Disabling Sync Mode

Delivering Additional Synchronized Shocks

8Pacing

Demand Mode Versus Fixed Mode

Monitoring During Pacing