Philips PageWriter XLi User reference guide
PageWriter XLi
User’s Reference Guide
Notice
About This Edition
Edition 8
Printed in the USA
Publi cation nu m ber M1 70 0 92909
The information in this
guide applies to th e
PageWriter XLi
cardiograph. This
information is subject to
change without notice.
Hewlett-Packard shall not
be liabl e for errors
conta i n e d herein or for
incidental or consequential
damages in connection with
the furnishing, performance,
or use of this material.
Edition History
Edition 1 May 1990
Editio n 2 July 1991
Editio n 3 January 1992
Edition 4 April 1993
Editio n 5 July 1993
Edition 6 June 1994
Editio n 7 January 1995
Edition 8 April 2000
Copyright
Copyrigh t © 2000
Hewlett-Packard Co.
3000 Minuteman Road
Andover, MA 01810-1099
USA
(978) 687 -1501
This do cument m a y no t b e
photoco pied, rep roduce d, or
translated to another
language without pr ior
written consent of HewlettPackard.
WARNING
As with electronic
equipment, Radio
Frequency (RF)
inter ference between the
cardiograph and any
existing RF transmitting or
receiving equipment at the
installation site, including
electrosurgical equipment ,
should be evaluated
carefully and any
limitations noted before the
equipment is placed in
service.
Radio frequency generation
from electrosur gical
equipment and close
proximity transmitters may
seriously degrade
performance.
Like al l el ec tronic de v ic es,
this cardiograph is
suscep tib le to electrostatic
discha rge (ESD).
Electrostatic discharge
typically occurs when
electrostatic energy is
transferred to the patient,
the elec trodes, or t h e
cardiograph. ESD may
result in ECG artifact that
may appear as narrow
spikes on the cardiograph
displa y or on the printed
report . Wh en ESD occurs,
the card iograph’s ECG
inter p retation ma y be
inconsistent with the
physic ia n’s inte rp retation.
Hewlett-Packard assumes
no liabil ity fo r fa ilures
resulting from RF
interference between HP
medical electronics and any
radio frequency generating
equipm e n t at le ve ls
exceedi ng those established
by applicable standards.
CAUTION
Use of accessories other
than th ose recom men ded by
Hewlett-Pac kard may
comprom ise product
performance.
THIS PRODUCT IS NOT
INTENDED FOR HOME
USE.
IN THE U.S., FEDERAL
LAW RESTRICTS THIS
DEVICE TO SALE ON OR
BY THE ORDER OF A
PHYSICIAN.
Medical Device
Directive
The PageWriter XLi
Cardiograph complies with
the requ irements of the
Medical Device Directive
93/42/EEC and carries the
mark accordingly.
0123
Author iz e d E Urepresentative:
Hewle tt-Packar d
Deutschland GmbH
Herrenbergerstrasse 130
D-71034 Boeblingen
Germany
Fax: +49-7031-14-2346
ii
Safety Summary
Safety Symb ols Marked on the Cardiogr aph
The following symbols are used on the cardiograph.
Caution - See operating instructi ons
Type CF, defib r illation prote cted
Alternating current
Equipotential (this is on the ground lug)
The following symbols appear on the cardiograph packaging.
Keep dry
:$51,1*
iii
Temperature and relative humidity
ranges
Fragile
Conventions Used in This M anual
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RUORVVRIOLIH
&$87,21
Caution state ments describe conditions or actions that can result in damage to
the equipment or software.
12 7(
Notes contain additio nal information on cardiograph usage.
Softkey
represents the temporary key labels that appear on the keyboard
display.
represents keys on the front panel.
Key
iv
Documentation
Map
Documentation Map
If you want to: Use this manual:
Verify that al l eq uipment is included Packing List
Record ECG’s Operating Guide
Enter pat ient ID
Make copies of ECG’s
Store ECG’s
Transmit or receive ECG’s
Troubleshoot problems
Maintain the car d iograph
Set up the cardiogra ph
Install the battery
Install the software
Load paper
Change applic ations
Install or use Pr ev iew Plus
Config u r e the cardiograph User’s Reference Guide
Prepare the patient
Maintain the car d iograph
Install and use the modem
v
Documentation Map
If you want to: Use this manual:
Configure and use Special Applications User’s Reference Guide
Order supplies
Use filters
Understand an alysis Physician’s Guide
vi
Contents
Safety Summary ...................................................................................................................... iii
Safety Symbols Marked on the Cardiograph .................................................................... iii
Conventions Used in This Manual ....................................................................................iii
Documentation
Map ...........................................................................................................................................v
Introduction
About This Manual ...............................................................................................................1-1
Acquiring an ECG
ECG Technique ..................................................................................................................... 2-1
Relaxing the Patient ........................................................................................................2-2
Preparing the Patient ....................................................................................................... 2-2
Preparing the Skin at the Electrode Positions ................................................................. 2-3
Securing the Electrodes ..................................................................................................2-4
Monitoring ECG Quality ......................................................................................................2-6
Quality Messages on the Cardiograph’s Display ............................................................2-7
Understanding the PageWriter XLi Special Applications
Overview ..............................................................................................................................3-1
Indic at ions for Use ........................ ........ .............. .............. ....... .............. .............. ........ ...3 -1
Understanding TPI Variables ..........................................................................................3-2
Understanding ACI TIPI Variables ................................................................................ 3-3
Using the TPI and ACI-TIPI Applications .....................................................................3-3
Analyzing an ECG with the Predictive Instruments .......................................................3-4
Generating Reports with the Special Applications Off .................................................. 3-5
Generating Reports with the Special Applications On ................................................... 3-6
Auto Analysis and the Default Choice ........................................................................... 3-7
Generating a STAT ECG Report .................................................................................... 3-8
Choosing Report Features
vii
Contents
ECG Formats ........ .............. ........ .............. .............. ........ ............. .............. ........ ...................4-1
The Auto Report ............................................................................................................. 4-1
Auto Report Information ................................................................................................4-1
Manual Formats ..............................................................................................................4-6
The Manual Lead Sets ....................................................................................................4-6
ECG Storage
Advantages of Disk Storage ................................................................................................. 5-1
Storing Reports with the Special Applications Off ........................................................ 5-2
Storing Reports Using Auto Analysis and the Default Choice .......................................5-2
Automatically Storing Reports Using Forced Auto-Store .............................................. 5-2
Disk Handling and Maintenance Instructions ....................................................................... 5-3
Using the ECG-Log and Store-Log ...................................................................................... 5-4
Printing ECG Logs ..........................................................................................................5-7
Configuring Your Cardiograph
Using Configuration Menus ..................................................................................................6-1
Selecting Configuration Parameters .....................................................................................6-3
Understanding Global Configuration .................................................................................... 6-4
Interpretation Parameters. ............................................................................................. 6-10
Line Frequ ency .... ................................ ........................ ......................... ........................ 6-11
Selecting Custom Lead Groups .................................................................................... 6-11
Selecting AutoCopy ......................................................................................................6-11
Selecting ECG Management Parameters ...................................................................... 6-12
Selecting Battery Timeout Periods ............................................................................... 6-12
Setting a Password ........................................................................................................6-13
Turning Off Unused ID Fields ............................................................................................6-13
Storing the Configuration Information ......................................................................... 6-14
Using a Stored Configuration ....................................................................................... 6-15
Printing the Configuration ............................................................................................6-16
Setting Up Your Cardiograph for Transmitting ECGs
Transmitting ECGs Directly .......................................................... .......... .......... .......... .........7-3
Configuring the Cardiograph to Transmit ECGs Directly .............................................. 7-4
viii
Contents
Transmitting ECGs by Telephone to Another Site ............................................................... 7-5
Installing the Modem (For United States use only) ........................................................ 7-5
Connecting a Telephone to the Same Line as the Modem ............................................. 7-7
Configuring the Cardiograph for Modem Usage ............................................................ 7-7
Entering the Phone Number ............................................................................................ 7-9
Configuring the Cardiograph for AutoDial .................................................................... 7-9
Installing the Modem on the Cart ................................................................................. 7-10
Transmitting ECGs by FAX to Another Site ......................................................................7-11
Installing the FAX/Modem ........................................................................................... 7-12
Connecting a Telephone to the Same Line as the FAX/Modem .................................. 7-14
Configuring the Cardiograph for FAX Usage .............................................................. 7-14
Entering the Phone Number .......................................................................................... 7-15
Transmitting an ECG via FAX .....................................................................................7-16
Printing an ECG on an HP LaserJet Printer ........................................................................ 7-17
Setting up the LaserJet Printer ............................................................................................7-18
Configuring the Cardiograph to Print ECGs on the HP LaserJet .................................7-18
Receiving ECGs ..................................................................................................................7-20
Configuring the Cardiograph to Receive ECGs Directly ............................................. 7-20
Configuring the Cardiograph to Receive ECGs via Modem ........................................ 7-21
Receiving an ECG via FAX ..........................................................................................7-21
Configuring the Cardiograph to Receive via FAX ....................................................... 7-22
Receiving ECG Reports from an HP 5600C ECG Management System ..................... 7-22
Receiving ECGs from an HP M1730A or M3700A TraceMaster ECG Management System
7-23
Troubleshooting
Troubleshooting Leads Off ...................................................................................................8-1
Troubleshooting ECG Noise ................................................................................................. 8-1
Understanding Error Messages ............................................................................................. 8-3
Calling for Assistance ..................................................................................................... 8-3
Solving Eq u i p m e n t Pr o b l e m s .... ................ ........................ ................................. .................. 8-3
Supplies
Availability ...........................................................................................................................9-1
ix
Contents
Lead Systems
Frank Le a d s ...................... ........................ ........................ ................................. ................... A-1
Special Lead Configurations ................................................................................................ A-2
V3R, V4R, V7 and V8 ...................................................................................................A-2
VX1, VX2, VX3 and VX4 .............................................................................................A-2
Glossary
x
1 Introduction
About This Manual
This guide contains reference information and configuration instructions for
experienced PageWriter XLi cardiograph users. If you are unfamiliar with
using this cardiograph, please view the videotape tutorial Using the Hewlett-
Packar d PageWriter XL Cardiographs. For additional help on using your
cardiogra p h refer to the HP PageWriter XLi Operating Guide.
1
1-1
About This Manual
1-2 Introduction
2 Acquiring an ECG
One of the most important aspects of recording a clear ECG is good ECG
technique. This chapter include s a review of recommended ECG technique as
well as information about using the pat ient module.
12 7(
Computerized ECG analysis should always be reviewed by a qualified
physician.
ECG Te chnique
ECG technique is very important, both to avoid difficulty when taking the
ECG and to achieve the best quality result. There are three key aspects of
good ECG technique:
l
Helping the patient to relax.
2
l
Preparing the patient for electrode connection.
l
Using the patient module to check lead connections.
For best results, perform the following steps in the order given. More details
on good technique follow this li st.
l
Check that the patient is comfortable and relaxed. Reassure the
patient that the procedur e is painless.
l
If possible, place the patient away from electrical fixtures and their
power cords, and away from the cardiograph’s power cord if AC
pow er is on.
l
Expose the patient’s forearms, lowe r legs, and chest.
l
Beginning with the right leg position, apply electrolyte and atta ch
electrodes.
2-1
ECG Technique
12 7(
Disposable ele ctrodes , when used properly, may be used for a cceptable E CGs.
For best results, prepare the skin and carefully follow manufactur er’s usa ge
instructions .
Relaxing the Patient
The more the patient relaxes, the less the ECG will be affected by noise. Your
good technique he lps the pati ent relax. You can help the patien t to rela x by the
following:
l
Make sure the patient is lying down and comfortable. The patient’s
arms and hands must be relaxed. If the table is too narrow, place the
patient’s hands under the buttocks to prevent muscle tension in the
arms.
l
When possible, take the ECG in a quiet room or area where others
can’t see the patient. Privacy is important to relaxation. Draw the
curtains around the bed area when taking the ECG in a room with
other people.
l
Gain the patient’s confidence by expla ining the test and that it won’t
hurt.
l
Your calm, relaxed attitude will help put the patient at ease.
l
Don’t let the patient move unnecessarily. It’s also best to avoid all
conversation during the actual ECG recording to keep the patient as
still as possible.
Preparing the Patient
Selecting th e Electrode Positio ns m, Table 2-1, shows the proper electrode
positions for taking an ECG. Put the electrodes in the correct anatomical
locations accordi ng to inf ormation in Figure 2-1.Additional information
concerning other lead systems may be found in Appendix A.
The tip of each lead wire is lettered and color cod ed for easy lead
identification. For example, make sure that the RA lead wire and electrode
connect to the right arm and the RL lead wire and electrode connect to the
right leg.
2-2 Acquiring an ECG
ECG Technique
T able 2-1 Standard 12-Lead Electrode Positions
Lead Position
RL On the right leg (inside calf, midway betw een knee and ankle)
LL On the left leg (inside calf, mid way between knee and ankle)
RA On the right arm (on the inside)
LA On the left arm (on the inside )
V1 Fourth intercostal sp ace, at right sternal margin
V2 Fourth intercostal space, at left sternal margin
V3 Midway between V2 and V4
V4 Fifth intercostal space at lef t midclavicu lar line
V5 Same transverse level as V4 , o n an terior axillary l in e
V6 Same transverse level as V4, at left midaxillary line
2
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Preparing the Skin at the Electrode Positions
Since dry skin is a relatively poor elec trical conductor, you must prepare the
skin to assure good contact between the skin and the electrode. Before
2-3
ECG Technique
securing the electr odes, you must lower the skin resistance at the electrode
site by:
l
Making sure that all electrodes are clean and bright. (Dirty or
corroded electro des pre vent a good electrical connection.)
l
Avoiding bony areas. Select flat , f le shy sites. You don’t have to shave
hair from the skin unless the hair is very thick.
l
Rubbing the skin briskl y with t he edge of the electr ode or a gauz e pad
until the skin is slightly r ed, but not bruised.
l
Applying electrol yte to the prepared areas on the skin. Rub some
electrolyte into the skin, but leave a slightly moist residue. Do not
spread electroly te o n the ch est area between electrodes . This will
cause distorted waveforms on the ECG.
127(
Do not use alcohol or acetone pads in place of the electroly te because they
impair the electrode con tact with the skin.
Securin g the Electro des
We have included two types of electro des in the accessory box:
l
Metal plate limb electrodes, held in place on the patient by rubber
straps.
l
Welsh cup chest electrode s, he ld in place by suction.
Securing the electrode s is a key part of good ECG technique and getting a
good ECG trace. To avoid jittery wavef orms, make sure th at the ele ctrodes are
secure. Do not overtighten limb plate electrodes, since this might cause
discomfort which results in muscle artifact on the waveforms.
Fasten the electrodes to the chest positions by squeezing the rubber bulb of
the suction cup. See Figure 2-3. The bulb should be partially deflated when
the electrode is firmly attached to the chest.
A good test for firm ele ctrode contact i s to gras p the electr ode and tr y to move
it. If it moves easily, the elect rod e connection is too loose. If it digs into the
flesh, the electrode is too tight. Do not allow the chest electrodes to move in
any way . Check the patient module display for indic at ions that the
connections are good. Ideally , the noise bar should remain in the green zone.
2-4 Acquiring an ECG
ECG Technique
Do not leave suction electrodes connected to the chest for prolonged periods.
The suction can cause intrade rmal hemorrhaging.
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2
2-5
Monitoring ECG Quality
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Monitoring ECG Quality
There are three ways that the PageWriter XLi helps you monitor the quality of
your ECG recordings.
l
Using the patient module displa y
l
Using the preview screen
l
Observing quality messages on the cardiograph’s display
2-6 Acquiring an ECG
Monitoring ECG Quality
You can stop the recording before or during printing if you see arti fac t or
other ECG waveform problems on the screen. Modify lead placement or
improve patient preparation and resume recording the ECG.
For further instructions on using the patient module display and the preview
screen, refer to the PageWriter XLi Operating Guide.
Quality Messages on the Cardiograph’s Display
After you start an Auto ECG recording, the cardiograph’s display will show
messages which indic ate the quality of the recording. If t here is m inimal noise
and all electrod es are s ecu r el y attach e d, the me ssa ge "‘EC G ok’’ will appear.
Some messages indicate problems with the leads. They list the condition and
the action to take. There are four conditions which affect the ECG:
l
Leads off
l
AC noise
l
Artifact
l
Baseline wander
2
If any of these conditions are severe, the mess ag e dire ct s you to retry the
recording. Correct the problem and then resume recording the ECG.
2-7
Monitoring ECG Quality
2-8 Acquiring an ECG
3 Understanding the PageW riter XLi Special
Applications
Overview
The ACI TIPI (Acute Cardiac Ischemia - Time Insensitive Predictive
Instrument) and the TPI (Thrombolytic Predictive Instrument) are software
products that enhance the computer-assisted ECG analysis capabilities of the
PageWriter XLi Cardiograph. These "Predictive Instruments" generate 0100% Predicted Probabili ty scores of ACI (Acute Cardiac Ischemia) and
patient outcome with and without thrombolytic therapy for acute myocardial
infarction (AMI). These pr edicted probabilities are based on ECG featur es,
patient age, gender, blood pressure, chest pain status and time since ischemic
symptom onset. The cardiograph can be configured to automatically print
these probabilit ies on the Auto ECG report.
3
Indications for Use
The ACI-TIPI is intended for use as an aid to clinicians in the diagnosis and
triaging decision process of patients with ACI, which includes unstable
angina pectoris and acute myocardial infarction (AMI).
The TPI is intended for use as an aid to clinicians identifying which patients
with AMI are appropriate candidate s for thrombolytic ther apy . TPI is intended
for adult patients, aged 35-75, diagnosed with symptoms of acute myocardial
infarction.
These programs can be used in real-time and retrospective settings since they
rely on information that is rea dily available in the emergency depar tment
(ED), or by retrospective review of the patient’s medical record. The
emergency physi cian’s real-time decision making process is aided by havin g
the predictive instruments incorporated into the electrocardiograph. The
predictive scores, once acquired, can then be used along with actual patient
outcome to help improve patient management practices retrospectively.
3-1
Overview
The predictive instr uments provide the physician with tools to:
l
Aid diagnosis and triage of some patients with symptoms suggestive
of ACI
l
Identify those patie nts most likely to benefit from thrombolytic
therapy
l
Facilitate the earliest possible administration of thrombolytic therapy
127(
12 7(
For intended use and contraindication information, consult the Predictive
Instrument Physician’s Guide for important information.
Understanding TPI Variables
There are nine predictors of thro mbolytic-related benefits and risks which
include six clinical factors and detailed information on three ECG features.
The six clinical factor s are:
l
Time since ischemic onset
l
Patient age
l
Patient gender
l
Patient Blood Pressure (systolic and diastolic)
l
Patient’s history of diabetes
l
Patient’s history of hypertension
For each of the clinical factors listed above, patient data must be entered in
order to produce a TPI report.
3-2 Understandin g the P ageWriter XLi Speci al Applications
Overview
The three ECG features are:
l
the presence or absence of pathological or significant Q waves
l
the presence and degree of ST segment elevati on or depression
l
the presence and degree of T wave elevation or inversion
Understanding ACI TIPI Variables
Seven variables are used to predict Acute Cardiac Ischemia. These variables
include four clinical factors and detailed information on three ECG features.
The four clinical factor s are :
l
the presence or absence of chest pain or pressur e, or left arm pain
l
whether chest pain or pressur e, or lef t arm pain is the patient’s most
important present ing symptom
l
patient age
l
patient gender
127(
For each of the clinical factors listed above, patient data must be entered in
order to produce the ACI-TIPI report.
The three ECG features are:
l
the presence or absence of pathological or significant Q waves
l
the presence and degree of ST segment elevati on or depression
l
the presence and degree of T wave elevation or inversion
The exclusionary cases for both the TPI and ACI-TIPI applications are listed
in the Predictive Instrument Physician’s Guide. Please refer to this document
for this information.
Using the TPI and ACI-TIPI Applications
To use the TPI and ACI-TIPI applications, you must configure the
cardiograph and enable the appli cations. There are several types of reports
that are produced by the cardiograph. These reports are summarized in Table
3-1.
3
3-3
Overview
T able 3-1 PageWriter XLi Reports
Report Type Contents of Report Notes
Standard 09 (Std 09) ECG waveforms, mea-
surements, ECL 09 Adult
Interpretation
Standard P4 (Std P4) ECG waveforms, mea-
surements, ECL P4 Pediatric Interpretation
ACI-TIPI (T0) ECG waveforms, TIPI
Analysis,
No Risk Management
Report
Risk Managemen t Risk Management Report
—1 page summarizing
clinical information and
can be used by the Clinician to docu ment clinical
decisions
TPI (H0) ECG waveforms, TPI
Analysis
Only available when
T0 is enabled
The ACI-TIPI
Report will also be
printed.
Analyzing an ECG with the Predictive Instruments
The flexibility of the Page Writer XLi allows you to configure the Predictive
Instruments based on the type of patients presenting in your clinical setting.
Using the Configuration Menu, you can set up your cardiogr aph to provide
the desired analysis .
When first turned on the PageWriter XLi cardiograph will have the Special
Applications turne d off. The Special Application choices are part of the
Global Configuration Menu and enable access to the following settings.
3-4 Understandin g the P ageWriter XLi Speci al Applications
T able 3-2 Special Applications Setti ngs
Overview
Parameter Choices
Research Leads Off/VX 1-V X 4 / V 4 R-V 8 Off
Default Adul t Cr iteria 09/P4 09
Default Pediatric Criteria 09/P4 P4
Patient ID Criteria On/Off Off
ACI-TIPI On/Off Off
Risk Mgmt. On/Off Off
Risk Range 0%-100% TPI On/Off Off
Screening On/Off Off
Leads Normal/Cabrera Normal
Storage Mode Standard/Special Normal
VCG Off/vcg1/vcg2/vcg3/vcg4 Off
Default Storage Cri teria Def Adult/Ped, TIPI, TPI Def Adult/Ped
Default value when Special Apps =
off
3
It is important to under stand that it is possi ble to set the Defaul t Adult Crite ria
and the Default Pediatric Criteria to be either 09 or P4. This flexibility is
designed for unusual clinical settings, and you should always be aware of just
how your cardiograph is set up.
Generat ing Reports with the Special Applications Off
This method of working enables any kind of report to be generated, however
it does not allow for generation of multiple simul taneous reports. Through the
top level "Auto Analysis" menu, you can specify the kind of report to be
made. There are five choices availa ble: Adult, Pediatric, TIPI, or TPI, or
Default.
3-5
Overview
F3
For each of these report options, here are the resulting reports given that
Special Applications are Off and the Auto button has been pressed:
l
Adult - The XLi will do an 09 report (regardless of patient age).
l
Pediatric - The XLi will do a P4 report (regardless of patient age).
l
TIPI - The XLi will do a TIPI report. A Risk Management report wi ll
not be generated.
l
TPI - The XLi will do a TPI report. TPI screening will not occur.
l
Default - The XLi will do an 09 report if the age is unspecified or
above 15 years. The XLi will do a P4 report if the age is 15 years or
less.
1. From the main display, press the key until ’Auto Analysis’ appears.
F1
2. Press the key to select the desired report format.
Generat ing Reports with the Special Applications On
It is possible to configure the PageWriter XLi to produce multiple reports.
When the settin g for Specia l Applic ation s is turned t o On, and t he Auto butt on
is pressed, there are five choices of reports available - Adult , Pedia tric, ACITIPI, TPI or Default. The first four choices and their resulting outcomes are
described below:
l
Adult - The XLi wil l do the Default Adult Criteria Report (regardless
of the patient’s age).
l
Pediatric - The XLi will do the Default Pediatric Criteria Report
(regardless of the patient’s age).
l
ACI-TIPI - The XLI will do a TIPI report. Also, if the Risk
Management Report i s set to o n in the S pecial Applicati ons M enu and
the ACI-TIPI Report risk factor falls within the limits set up, a Risk
Management Report will be produced.
l
TPI - The XLi will do a TPI report. TPI Screening will not occur.
3-6 Understandin g the P ageWriter XLi Speci al Applications
Overview
Auto Analysis and the Default Choice
If the Default choice is selected from the Auto Analysis menu, multiple
reports may be produced when the Auto button is pressed, depending on what
has been enabled in the Special Applications in the Global Configuration
Menu.
l
TPI - If TPI is on and TPI Screening is off, a TPI report will be
generated. If TPI is on and TPI Screening is On and the TPI Analysis
Criteria are met, a TPI report will be gene rate d. If both TPI and TPI
Screening are on, but the TPI Analysis Crite ria are not met, a TPI
report will not be generated.
l
ACI-TIPI - I f ACI-TIPI is on, this will be the next report produced. If
the Risk Management Report is also on and the ACI-TIPI calculated
risk is between the low and high risk limits as set up in the Special
Applications, then a Risk Management report will be produced.
l
Standard ECG (consisting of one of the following):
Patient ID Criteria Off - The XLi will do the Default Adult Repor t if
the patient’s age is spe cifie d as ove r 15. If the patie nt’s age is 15 years
or under, the Default Pediatric Report will be produc ed.
Patient ID Criteria On and Patient ID Criteria Loaded - This custom
interpretation report will be generated.
Patient ID Criteria On but Patient I D Criteria No t Loaded - A Null
report will be produced.
Patient ID Criteria On but Patient I D Criteria No t Entered by the
User - The XLi will do the Default Adult Report if the patie nt’s age is
specified as ove r 15. If the patie nt’s age 15 yea rs or under, the Defa ult
Pediatric Report will be produc ed.
3
l
Vectorcardiography - If VCG is on and at least one of the X, Y or Z
leads is included as a rhythm lead in the repor t type , a nd Research
leads is set to off, then the XLi will produce a VCG report.
3-7
Overview
Generating a STAT ECG Report
If your cardiograph has been configured with the Special Applications On,
and with TPI and/or TIPI interpre ta tions enabled, you may omit these
interpretations by running a "STAT" ECG. A STAT ECG is guaranteed to
generate a single stand ard repor t (typically 09 Adult Criteria or P4 Pediatric
Criteria) without the need for Patient ID information. A STAT ECG is
initiated by pressing the AUTO key twice in succession. A STAT report is
produced even if "Print Auto = OFF" in the global configuration menu.
3-8 Understandin g the P ageWriter XLi Speci al Applications
4 Choosing Report Featu res
This chapter describe s the vari ous ECG reports and how to print the Extended
Measurements report.
ECG Formats
The Auto Report
Twelve-lead Auto reports display a ten second ECG in an Auto 3 x 4, Auto 3
x 5, Auto 4 x 4 or Auto 6 x 2 format. The Auto 3 x 4 format displays
consecutive 2.5 second segments of 12 leads, three leads at a time. The Auto
3 x 5 format displays consecutive 2 second segments of 12 leads with the 5th
lead column showing the extended pediatric leads, V3R, V4R, and V7. The
Auto 4 x 4 format displays consecutive 2.5 sec ond segments of 12 leads with
the 4th row consisting of the extende d rese arch leads VX1-VX4 or V3R,
V4R, V7, and V8. The Auto 6 x 2 format displays consecutive 5 second
segments of 12 leads, six leads at a time. One or three leads c an be displa yed
as rhythm strips at the bottom of Auto 3 x 4 and Auto 3 x 5 reports. The
rhythm strips show the same 10 second s egments as in the Auto 3 x 4 or Auto
3 x 5 section of the report. The Auto 4 x 4 report can show 1 rhythm strip.
4
Auto Report Information
The Auto report may be printed with patient I D inform ation only or with
various types of analysi s information included. You can select which
information appear s on the printe d report. See Chapter 6, Configuri n g Your
Cardiograph, for informat ion on choosing which features will be printed on
the report.
4-1
ECG Formats
Basic Measurements Re port. The Basic Measu rements report has pat ient ID
information and basic measurements for the ECG. These measurements,
which include heart rate, interval and axis measurements, are in the table
below with their abbreviations on the report.
T able 4-1 Basic Measurements
Symbol Description Units
Rate heart rate beats per minute
PR PR interval milliseconds
QRSD QRS duration m illiseconds
QT QT interval milliseconds
QTc QT interval corrected for rate milliseconds
P Frontal P axis degrees
QRS Frontal mean QRS axis degrees
T Frontal T axis degrees
4-2 Choosing Report Feat ures
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