Physio-Control LIFEPAK 20e User Manual

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LIFEPAK® 20e

Operating Instructions

DEFIBRILLATOR /MONITOR

LIFEPAK® 20e

OPERATING INSTRUCTIONS

DEFIBRILLATOR/ MONITOR

Important Information

!USA

LIFEPAK, FAST-PATCH, DERMA-JEL, QUIK-LOOK, and QUIK-COMBO are registered trademarks of Physio-Control, Inc. ADAPTIV, CODE-STAT, CODE SUMMARY, REDI-PAK, and Shock Advisory System are trademarks of Physio-Control, Inc. Masimo and LNOP are registered trademarks of Masimo Corporation. Microstream, CapnoLine, and FilterLine are registered trademarks of Oridion Systems Ltd. The Oridion medical capnography in this product is covered by one or more of the following US patents: 6,428,483; 6,997,880; 6,437,316; 7,448,229; 7,726,954 and their foreign equivalents. Additional patent applications pending. EDGE System is a trademark of Ludlow Technical Products. Microsoft and Windows are registered trademarks of Microsoft Corporation. Specifications are subject to change without notice.

Publication Date: 11/2013

3313187-007

Rx Only

Device Tracking

The U.S. Food and Drug Administration requires defibrillator manufacturers and distributors to track the location of their defibrillators. If the device is located somewhere other than the shipping address or the device has been sold, donated, lost, stolen, exported, destroyed, permanently retired from use, or if the device was not obtained directly from Physio-Control, please do one of the following: register the device at http://www.physio-control.com, call the device tracking coordinator at 1.800.426.4448, or use one of the postage-paid address change cards located in the back of this manual to update this vital tracking information.

Text Conventions

Throughout these operating instructions, special text characters are used to indicate labels, screen messages, and voice prompts:

• Operating control labels:

• Screen messages and voice prompts:

CAPITAL LETTERS such as ON/OFF and SHOCK.

CAPITAL ITALICIZED LETTERS such as CONNECT ELECTRODES.

Version History

These operating instructions describe LIFEPAK 20e defibrillator/monitor devices with software version 3202609-084 or later.

Preface

About Automated External Defibrillation ...................................................................... viii

About Defibrillation Therapy ..........................................................................................ix

About Noninvasive Pacing ............................................................................................. x

About SpO

About ECG Monitoring ................................................................................................... x

About EtCO

1 Safety Information

Terms...........................................................................................................................1-2

General Warnings and Cautions.................................................................................. 1-2

Symbols ....................................................................................................................... 1-4

Monitoring .................................................................................................. x

Monitoring ................................................................................................xi

2 Basic Orientation

Introduction .................................................................................................................. 2-2

Unpacking and Inspecting ........................................................................................... 2-2

Controls, Indicators, and Connectors .......................................................................... 2-3

Area 3.................................................................................................................... 2-6

Area 4.................................................................................................................... 2-8

Area 7.................................................................................................................. 2-11

Changing Printer Paper ....................................................................................... 2-13

Back View............................................................................................................ 2-14

Side View of CodeManagement Module ............................................................. 2-15

Entering Patient Data................................................................................................. 2-16

Setting Alarms ........................................................................................................... 2-17

Managing Alarms ....................................................................................................... 2-19

Connecting to Power ................................................................................................. 2-20

AC Operation....................................................................................................... 2-20

LIFEPAK 20e Defibrillator/Monitor Operating Instructions iii

Battery Operation .......................................................................................................2-20

LIFEPAK 20e Defibrillator/Monitor Battery ..........................................................2-20

CodeManagement Module Battery......................................................................2-23

3 Monitoring

Monitoring the ECG......................................................................................................3-2

ECG Monitoring Warning.......................................................................................3-2

Selecting ECG Lead and Size ...............................................................................3-2

Adjusting the Systole Tone Volume.......................................................................3-3

Monitoring with the Patient ECG Cable .................................................................3-5

Troubleshooting Tips for ECG Monitoring .............................................................3-7

Monitoring S

SpO2 Warnings and Cautions................................................................................3-9

When to Use a Pulse Oximeter ...........................................................................3-10

How a Pulse Oximeter Works ..............................................................................3-10

SpO SpO SpO SpO

Sensitivity.............................................................................................................3-13

Averaging Time....................................................................................................3-13

Pulse Oximeter Sensors ......................................................................................3-13

Cleaning...............................................................................................................3-13

Troubleshooting Tips for SpO

Monitoring EtCO

EtCO2 Warnings and Cautions ............................................................................3-16

How Capnography Works ....................................................................................3-17

EtCO EtCO CO CO CO

Cleaning...............................................................................................................3-21

Troubleshooting Tips for EtCO

2 ......................................................................................................................................3-9

Monitoring Considerations .........................................................................3-11

Monitoring Procedure.................................................................................3-12

Waveform...................................................................................................3-12

Volume.......................................................................................................3-12

............................................................................3-14

2 .................................................................................................................................. 3-16

Monitoring Waveform Analysis.................................................................3-17

Monitoring Procedure ...............................................................................3-18

Display .........................................................................................................3-20

Alarms..........................................................................................................3-20

Detection......................................................................................................3-21

...........................................................................3-22

4 Therapy

General Therapy Warnings and Cautions ....................................................................4-2

Therapy Electrode and Standard Paddle Placement ...................................................4-3

Anterior-lateral Placement .....................................................................................4-3

Anterior-posterior Placement .................................................................................4-3

Special Placement Situations ................................................................................4-4

Automated External Defibrillation.................................................................................4-5

AED Warnings .......................................................................................................4-5

AED Setup .............................................................................................................4-5

AED Procedure......................................................................................................4-6

Special AED Setup Options.................................................................................4-10

Troubleshooting Tips for AED Mode....................................................................4-13

Switching from AED to Manual Mode..................................................................4-14

Manual Defibrillation...................................................................................................4-14

Manual Defibrillation Warnings ............................................................................4-15

Impedance ...........................................................................................................4-15

Defibrillation Procedure .......................................................................................4-16

CPR Metronome ..................................................................................................4-17

iv LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Synchronized Cardioversion Procedure.............................................................. 4-18

Remote Synchronization Procedure.................................................................... 4-20

Pediatric Defibrillation ................................................................................................ 4-21

Pediatric Paddle Placement ................................................................................ 4-21

Defibrillation Procedure ....................................................................................... 4-22

Troubleshooting Tips for Defibrillation and Synchronized Cardioversion............ 4-22

Noninvasive Pacing ................................................................................................... 4-25

Noninvasive Pacing Warnings............................................................................. 4-25

Demand and Nondemand Pacing ....................................................................... 4-25

Noninvasive Pacing Procedure ........................................................................... 4-26

Troubleshooting Tips for Noninvasive Pacing ..................................................... 4-27

5 Paddle Accessory Options

Therapy Electrodes...................................................................................................... 5-2

About Therapy Electrodes ..................................................................................... 5-2

Electrode Placement ............................................................................................. 5-3

Cable Connection .................................................................................................. 5-4

ECG Monitoring and Therapy Procedures ............................................................ 5-4

Replacing and Removing Electrodes .................................................................... 5-5

Testing................................................................................................................... 5-6

Cleaning and Sterilizing......................................................................................... 5-6

Standard Paddle Set (Optional) ................................................................................... 5-7

About the Standard Paddle Set ............................................................................. 5-7

Accessing the Pediatric Paddles ........................................................................... 5-7

Replacing the Adult Paddle Attachment ................................................................ 5-8

Cleaning the Standard Paddle Set ........................................................................ 5-8

Sterilizable Internal Defibrillation Paddles ................................................................... 5-9

6 Data Management

Overview of Data Storage and Retrieval ..................................................................... 6-2

Data Storage ......................................................................................................... 6-2

Report Types......................................................................................................... 6-2

Memory Capacity .................................................................................................. 6-2

CODE SUMMARY Report ........................................................................................... 6-2

Preamble ............................................................................................................... 6-3

Event/Vital Signs Log ............................................................................................ 6-3

Waveform Events .................................................................................................. 6-4

CODE SUMMARY Format .................................................................................... 6-5

Managing Archived Patient Records ........................................................................... 6-7

Entering Archives Mode............................................................................................... 6-7

Printing Archived Patient Reports ................................................................................ 6-7

Transmitting Archived Patient Records ....................................................................... 6-9

Editing Archived Patient Records .............................................................................. 6-10

Deleting Archived Patient Records ............................................................................ 6-11

Overview of Connections for Transmitting Reports ................................................... 6-12

Data Transfer from TrueCPR Device......................................................................... 6-13

Troubleshooting Tips for Data Transmission ............................................................. 6-14

7 Maintaining the Equipment

General Maintenance and Testing............................................................................... 7-2

Maintenance and Testing Schedule ...................................................................... 7-2

Daily Auto Test ...................................................................................................... 7-3

User Test............................................................................................................... 7-4

LIFEPAK 20e Defibrillator/Monitor Operating Instructions v

Cleaning.................................................................................................................7-5

Function Checks ....................................................................................................7-5

General Troubleshooting Tips ...................................................................................7-10

Service and Repair.....................................................................................................7-12

Product Recycling Information ...................................................................................7-12

Recycling Assistance...........................................................................................7-12

Preparation ..........................................................................................................7-12

Recycling of Disposable Electrodes ....................................................................7-12

Packaging ............................................................................................................7-12

Warranty.....................................................................................................................7-12

Accessories, Supplies, and Training Tools ...............................................................7-13

8 Defining Setup Options

Setup Options ..............................................................................................................8-2

Print Configurations Before Service or Repair.......................................................8-2

Passcode Security .................................................................................................8-2

Entering Setup Options ................................................................................................8-3

General Setup Menu ....................................................................................................8-4

Manual Mode Setup Menu ...........................................................................................8-5

AED Mode Setup Menu ...............................................................................................8-7

CPR Metronome Setup Menu ......................................................................................8-8

Pacing Setup Menu ......................................................................................................8-9

Monitoring Menu ..........................................................................................................8-9

Channels Setup Menu ...........................................................................................8-9

Waveform Sets Setup Menu ................................................................................8-10

Setup Menu .................................................................................................8-10

Events Setup Menu ....................................................................................................8-10

Alarms Setup Menu....................................................................................................8-11

Printer Setup Menu ....................................................................................................8-11

Clock Setup Menu......................................................................................................8-12

Reset Defaults Setup Menu .......................................................................................8-13

Print Defaults..............................................................................................................8-13

Send Configuration Setup Menu ................................................................................8-13

Set Passcodes Setup Menu .......................................................................................8-14

Service Mode .............................................................................................................8-14

Auto Print Setup Menu.........................................................................................8-12

A Specifications and Performance Characteristics

B Clinical Summaries

C Screen Messages

D Operator’s Checklist

E Shock Advisory System

F About cprMAX Technology

G Docking Station

H Electromagnetic Compatibility Guidance

Index

vi LIFEPAK 20e Defibrillator/Monitor Operating Instructions

PREFACE

Preface

About Automated External Defibrillation page viii About Defibrillation Therapy ix About Noninvasive Pacing x About SpO2 Monitoring x

About ECG Monitoring x About EtCO2 Monitoring xi

LIFEPAK 20e Defibrillator/Monitor Operating Instructions vii

Preface

ABOUT AUTOMATED EXTERNAL DEFIBRILLATION

The following considerations and guidelines apply when using the LIFEPAK® 20e defibrillator/ monitor as an automated external defibrillator (AED).

Operator Considerations

The LIFEPAK 20e defibrillator/monitor, when in AED mode, is a semiautomatic defibrillator that uses a patented Shock Advisory System™. This software algorithm analyzes the patient’s electrocardiographic (ECG) rhythm and indicates whether or not it detects a shockable rhythm. The LIFEPAK 20e defibrillator/monitor in AED mode requires operator interaction to defibrillate the patient.

The LIFEPAK 20e defibrillator/monitor in AED mode is intended for use by personnel who are authorized by a physician/medical director and have, at a minimum, the following skills and training:

• CPR training.

• AED training equivalent to that recommended by the American Heart Association.

• Training in the use of the LIFEPAK 20e defibrillator/monitor in AED mode.

Indications

The AED mode is to be used only on patients in cardiopulmonary arrest. The patient must be unconscious, pulseless, and not breathing normally before using the defibrillator to analyze the patient’s ECG rhythm.

In AED mode, the LIFEPAK 20e defibrillator/monitor is not intended for use on pediatric patients less than 8 years old.

Contraindications

None known.

viii LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Preface

ABOUT DEFIBRILLATION THERAPY

Operator Considerations

A direct current defibrillator applies a brief, intense pulse of electricity to the heart muscle. The LIFEPAK 20e defibrillator/monitor delivers this energy through disposable electrodes, standard paddles or internal paddles applied to the patient’s chest.

Defibrillation is only one aspect of the medical care required to resuscitate a patient with a shockable ECG rhythm. Depending on the situation, other supportive measures may include:

• Cardiopulmonary resuscitation (CPR)

• Administration of supplemental oxygen

• Drug therapy

Successful resuscitation is related to the length of time between the onset of a heart rhythm that does not circulate blood (ventricular fibrillation, pulseless ventricular tachycardia) and defibrillation. The American Heart Association has identified the following as critical links in the chain of survival from cardiac arrest:

• Early access

• Early CPR by first responders or bystanders

• Early defibrillation

• Early advanced life support

The physiological state of the patient may affect the likelihood of successful defibrillation. Thus, failure to resuscitate a patient is not a reliable indicator of defibrillator performance. Patients will often exhibit a muscular response (such as jumping or twitching) during an energy transfer. The absence of such a response is not a reliable indicator of actual energy delivery or device performance.

Preface

Indications

Defibrillation is a recognized means of terminating certain potentially fatal arrhythmias, such as ventricular fibrillation and symptomatic ventricular tachycardia. Delivery of this energy in the synchronized mode is a method for treating atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia and, in relatively stable patients, ventricular tachycardia.

Contraindications

Defibrillation is contraindicated in the treatment of Pulseless Electrical Activity (PEA) such as idioventricular or ventricular escape rhythms, and in the treatment of asystole.

LIFEPAK 20e Defibrillator/Monitor Operating Instructions ix

Preface

ABOUT NONINVASIVE PACING

A noninvasive pacemaker is a device that delivers an electrical stimulus to the heart, causing cardiac depolarization and myocardial contraction. The energy is delivered through large adhesive electrodes placed on the chest. In addition to noninvasive pacing, other supportive measures may be necessary.

Among other factors, it is recognized that successful pacing of a patient is related to the length of time between the onset of a dysrhythmia and the initiation of pacing. Rapid pacing and prompt follow-up care are essential. The physiologic state of the patient may affect the likelihood of successful pacing or of skeletal muscle activity. The failure to successfully pace a patient is not a reliable indicator of pacemaker performance. Similarly, the patient’s muscular response to pacing is not a reliable indicator of energy delivered. Refer to the booklet, Noninvasive Pacing: What You Should Know for further information.

Indications

Noninvasive pacing is indicated for symptomatic bradycardia in patients with a pulse.

Contraindications

Noninvasive pacing is contraindicated for the treatment of ventricular fibrillation and asystole.

ABOUT SPO2 MONITORING

A pulse oximeter is a noninvasive device that checks the saturation of oxygen in arterial blood (SpO

). It uses an optical sensor that directs light through the patient’s finger and then measures

the received light with a detector. This received light is translated into a saturation percentage and is displayed as an SpO

reading.

Indications

A pulse oximeter is indicated for use in any patient who is at risk of developing hypoxemia.

Contraindications

None known.

ABOUT ECG MONITORING

The ECG (electrocardiogram) is a recording of the electrical activity of the heart. ECG monitoring allows for identification and interpretation of cardiac rhythms or dysrhythmias and calculation of heart rate. The ECG is obtained by placing either electrodes or paddles on the patient and allows the heart’s electrical activity to be monitored and recorded.

x LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Preface

ABOUT ETCO2 MONITORING

The end-tidal carbon dioxide (EtCO2) monitor is a capnograph device that uses non-dispersive infrared spectroscopy to continuously measure the amount of CO the amount present at the end of exhalation (EtCO

). The sample is obtained by the side stream

method and can be used with intubated or nonintubated patients. Respiration rate is also measured and displayed in breaths per minute.

during each breath and report

Preface

The EtCO to assess the patient at all times; do not rely solely on the EtCO

monitor is a tool to be used in addition to patient assessment. Care should be taken

monitor.

Indications

EtCO2 monitoring is used to detect the level of expired CO2. It is used for monitoring breathing efficacy and treatment effectiveness in acute cardiopulmonary care, for example, to determine if

adequate compressions are being performed during CPR or to rapidly detect whether an endotracheal tube has been placed successfully.

Contraindications

None known.

LIFEPAK 20e Defibrillator/Monitor Operating Instructions xi

SAFETY INFORMATION

This section provides important information to help you operate the LIFEPAK 20e defibrillator/ monitor. Familiarize yourself with all of these terms, warnings, and symbols.

Te r ms page 1-2 General Warnings and Cautions 1-2 Symbols 1-4

1 Safety Information

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 1-1

Safety Information

TERMS

The following terms are used either in these operating instructions or on the LIFEPAK 20e defibrillator/monitor:

Danger: Immediate hazards that will result in serious personal injury or death.

Warning: Hazards or unsafe practices that may result in serious personal injury or death.

Caution: Hazards or unsafe practices that may result in minor personal injury, product damage, or property damage.

GENERAL WARNINGS AND CAUTIONS

The following are general warning and caution statements. Other specific warnings and cautions are provided as needed in other sections of these operating instructions.

WARNINGS!

Shock hazard.

The defibrillator delivers up to 360 J of electrical energy. Unless properly used as described in these operating instructions, this electrical energy may cause serious injury or death. Do not attempt to operate this device unless thoroughly familiar with these operating instructions and the function of all controls, indicators, connectors, and accessories.

Shock hazard.

Do not disassemble the defibrillator. It contains no operator serviceable components and dangerous high voltages may be present. Contact authorized service personnel for repair.

Shock hazard.

To avoid the risk of electrical shock, this equipment must only be connected to a supply mains with protective earth.

Shock or fire hazard.

Do not immerse any portion of this defibrillator in water or other fluids. Avoid spilling any fluids on defibrillator or accessories. Spilled liquids may cause the defibrillator and accessories to perform inaccurately or fail. Do not clean with ketones or other flammable agents. Do not autoclave or sterilize this defibrillator or accessories unless otherwise specified.

Possible fire or explosion.

Do not use this device in the presence of flammable gases or anesthetics. Use care when operating this device close to oxygen sources (such as bag-valve-mask devices or ventilator tubing). Turn off gas source or move source away from patient during defibrillation.

Possible electrical interference with device performance.

Equipment operating in close proximity could emit strong electromagnetic or radio frequency disturbances that could cause electromagnetic interference (EMI) and affect the performance of this defibrillator. EMI may result in improper defibrillator operation, distorted ECG, failure to detect a shockable rhythm, or cessation of pacing. Avoid operating the defibrillator near cauterizers, diathermy equipment, cellular phones, or other portable and mobile RF communications equipment. Maintain equipment separation of at least 1.2 m (4 ft) and do not rapidly key EMS radios on and off. Contact a technical support representative if assistance is required.

1-2 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Safety Information

WARNINGS! (CONTINUED)

Possible electrical interference.

Using cables, electrodes, or accessories not specified for use with this device may result in increased emissions or decreased resistance to electromagnetic interference which could affect the performance of this device or of equipment in close proximity. Use only parts and accessories specified in these operating instructions.

Possible electrical interference.

This defibrillator may cause electromagnetic interference (EMI) especially during charge and energy transfers. EMI may affect the performance of equipment operating in close proximity. Verify the effects of defibrillator discharge on other equipment prior to using defibrillator in an emergency situation, if possible.

Possible electrical interference.

This defibrillator should not be used adjacent to or stacked with other equipment. If adjacent or stacked use is necessary, the defibrillator should be observed to verify normal operation in the configuration in which it will be used.

Possible defibrillator shutdown.

When operating on battery power, adhere to battery maintenance and replacement intervals discussed in the Battery Performance and Life section to prevent possible defibrillator shutdown. If the defibrillator shuts down without warning, or if a LOW BATTERY: CONNECT TO AC

POWER

message appears on the monitor screen, immediately connect the AC power cord to an

outlet.

1 Safety Information

Possible device failure.

Do not modify the defibrillator or CodeManagement Module.

Possible improper defibrillator performance.

Changing factory default settings will change the behavior of the device. Changes to the default settings must only be made by authorized personnel.

Possible improper defibrillator performance.

Using other manufacturers’ cables, electrodes, or batteries may cause the device to perform improperly and invalidates the safety agency certification. Use only the accessories specified in these operating instructions.

Possible failure to detect an out of range condition.

Reselecting QUICK SET will reset the alarm limits around the patient’s current vital sign values. This may be outside the safe range for the patient.

Safety risk and possible equipment damage.

MR unsafe: keep the defibrillator away from magnetic resonance imaging (MRI) equipment.

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 1-3

Safety Information

YYYY

SYMBOLS

The symbols below may be found in these operating instructions or on various configurations of LIFEPAK 20e defibrillator/monitor and accessories:

Defibrillation-proof type CF terminal

Defibrillation protected, type BF patient connection

Attention, consult accompanying documents

Attention, consult accompanying documents. (Symbol has blue background and graphical symbol is white.)

Warning, high voltage

Type BF patient connection

Static sensitive device (SSD)

MR unsafe: keep away from magnetic resonance imaging (MRI) equipment

Safety ground. Protective earth connection

Fuse

Equipotential connector

Positive terminal

Negative terminal

Device includes RF transmitter

Lot number (batch code): yyww or yymmdd

Use by date shown: yyyy-mm-dd

Reorder number

Date of manufacture

1-4 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Single use only

(x)

Indoor use only

Alarm on

Alarm off

VF/VT alarm on

Safety Information

VF/VT alarm silenced

Greater than

Less than

Joules

Adult defibrillation paddle

Infant defibrillation paddle

Home screen button

Battery status indicator (refer to page 2-21)

1 Safety Information

Heart rate/pulse rate indicator

Shock count (x) on screen

Mark of conformity to applicable European Directives

Canadian Standards Association certification for Canada and the United States

Recognized component mark for Canada and the United States

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 1-5

Safety Information

Mark of conformity to ACA standards

DC voltage

AC voltage

On (power: connection to the AC Mains)

Off (power: disconnection from the AC Mains)

Power on/off

AC power indicator (CodeManagement Module only)

[signal] Input

[signal] Output

Input

Exhaust

This end up

Fragile/breakable Handle with care

Protect from water

Recommended storage temperature 5° to 45°C (41° to 113°F). Storage at extreme temperatures of -20° or 60°C (-4° or 140°F) is limited to seven days. If storage at these temperatures exceeds one week, the electrode shelf-life is reduced.

Recycle this item

Do not dispose of this product in the unsorted municipal waste stream. Dispose of this product according to local regulations. See www.physio-control.com/recycling for instructions on disposing of this product.

System connector/Data in

1-6 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Safety Information

!USA

CAT

Sync in/ECG out

LIFEPAK 20e defibrillator/monitor to LIFEPAK 20e defibrillator/monitor cable (refer to Send Configuration Setup Menu, page 8-13)

Turn counterclockwise to unlock

Switch on

Switch off

Pace arrow, noninvasive pacing

Pace arrow, internal pacing

1 Safety Information

IPx1

R-wave sense marker

Event marker

Biphasic defibrillation shock

Shock button

For USA audiences only

Protected from dripping water per IEC 60529

Serial number

Catalog number used for placing orders

Manufacturer’s Identification Number (part number)

Federal law restricts this device to sale by or on the order of a physician

Manufacturer

Authorized EC representative

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 1-7

BASIC ORIENTATION

This section provides a basic orientation to the LIFEPAK 20e defibrillator/monitor.

Introduction page 2-2 Unpacking and Inspecting 2-2 Controls, Indicators, and Connectors 2-3 Entering Patient Data 2-16 Setting Alarms 2-17 Managing Alarms 2-19 Connecting to Power 2-20

2 Basic Orientation

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 2-1

Basic Orientation

INTRODUCTION

The LIFEPAK 20e defibrillator/monitor with enhanced battery technology is an acute cardiac care response system intended for use by authorized healthcare providers in hospital and clinic settings.

The LIFEPAK 20e defibrillator/monitor offers the following optional features:

• Semiautomatic defibrillator

• Noninvasive pacemaker

• Pulse oximeter

• Paddle accessories

• End-tidal CO

• Data transmission

Note: These operating instructions include information and procedures related to all features of the LIFEPAK 20e defibrillator/monitor and the CodeManagement Module for use with the LIFEPAK 20e defibrillator/monitor. Your LIFEPAK 20e defibrillator/monitor may not have all of these features. For more information, contact your Physio-Control representative or call the number listed on the back cover of these operating instructions.

monitor

The LIFEPAK 20e defibrillator/monitor is available only with the biphasic defibrillation waveform. For a description of the defibrillation waveform, refer to Appendix A.

The LIFEPAK 20e defibrillator/monitor uses QUIK-COMBO or FAST-PATCH

disposable defibrillation/ECG electrodes for ECG monitoring and patient

pacing/defibrillation/ECG electrodes

therapy. The therapy cable connects the QUIK-COMBO or FAST-PATCH electrodes to the defibrillator. For more information about QUIK-COMBO or FAST-PATCH electrodes, refer to

Section 3 of these operating instructions.

The standard paddle set is an accessory for the LIFEPAK 20e defibrillator/monitor and includes adult and pediatric defibrillator (hard) paddles. The standard paddles can be used for QUIK-LOOK

ECG monitoring, defibrillation, and synchronized cardioversion therapies. When using standard paddles, a conductive interface designed for defibrillation, such as defibrillation gel or gel pads, must be used between the paddle electrode surface and the skin.

The adult standard paddles can be used for any pediatric patient weighing approximately 10 kg (22 lb) or more as long as the paddles fit completely on the chest and there is at least 2.5 cm (1 in.) of space between the paddle electrodes. Pediatric paddles should be used for patients weighing 10 kg (22 lb) or less or those whose chests are too small to accommodate the adult paddles.

Optional internal paddles are also available.

For more information about using paddle accessories, refer to Section 5 of these operating instructions.

UNPACKING AND INSPECTING

After you have removed the LIFEPAK 20e defibrillator/monitor from the shipping container, make sure you have all the required supplies and accessories including cables and ECG paper. Examine the defibrillator and all accessories for any sign of damage that may have occurred during shipping. If possible, save the shipping container and foam inserts in case you have to ship the defibrillator at a later date.

2-2 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Basic Orientation

AED Mode

Analyzing Now--Stand Clear

ANALYZE

CODE

SUMMARY

EVENT

ECG

WARNING

DANGER

Hazardous electrical output. For use only by qualified personnel.

Explosion hazard. Do not use in the presence of flammable gases.

AC Mains

Service

Speed Dial

Recommended

Adult VF Dose: XXX-XXX-XXXJ

DEFIBRILLATOR / MONITOR

SpO2

CO2

Note the label located to the right of the screen (Figure 2-1). Before the defibrillator/monitor’s first use, plug the power cord into an AC outlet for 3 hours to charge the internal battery.

Figure 2-1 Initial Battery Charge

If you purchased the CodeManagement Module, you will need to connect it to the LIFEPAK 20e defibrillator/monitor. Refer to the Installation Instructions provided with the CodeManagement Module for more information.

CONTROLS, INDICATORS, AND CONNECTORS

The following figures provide a brief description of the controls, indicators, and connectors for the LIFEPAK 20e defibrillator/monitor and CodeManagement Module. Figure 2-2 shows the front view of the LIFEPAK 20e defibrillator/monitor and Figure 2-3 shows the front view divided into seven areas. Figure 2-4 through Figure 2-15 show details of each area. Figure 2-16 and

Figure 2-17 show back views of the defibrillator with and without the CodeManagement Module.

Additional information about areas 3, 4, and 7 follow the applicable figures. The light emitting diode (LED) illuminates (turns on) indicating when the corresponding function is active. For example, the

ANALYZE button LED is on when the advisory function is active.

Figure 2-2 Front View with Door and CodeManagement Module

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 2-3

2 Basic Orientation

Basic Orientation

LEAD

Area 7

Area 5

Area 4

Area 3

Area 1

Area 2

Area 6

ENERGY SELECT

ANALYZE

CHARGE

SYNC

PACER

RATE

CURRENT

PAUSE

CODE

SUMMARY

EVENT

ALARMS

OPTIONS

AC Mains Service

Speed Dial

WARNING

DANGER

Hazardous electrical output. For use only by qualified personnel.

Explosion hazard. Do not use in the presen ce of flammable gas es.

ECG

SpO2

SIZE

CO2

DEFIBRILLATOR / MONITOR

Recommended

Adult VF Dose: XXX-XXX-XXXJ

AED MODE

The door on the LIFEPAK 20e defibrillator/monitor hides the manual defibrillation and noninvasive pacing buttons. When the door is closed, the appearance and operation of the device is simplified for the automated external defibrillator (AED) user.

To enter manual mode, press the

MANUAL button located on the lower left corner of the door.

This opens the door and automatically takes the device out of AED mode and allows access to manual mode defibrillation and pacing. After entering manual mode, closing the door does not affect operation.

Figure 2-3 Front View without Door and with CodeManagement Module

2-4 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Basic Orientation

AED MODE

LED illuminates when

AED mode is active.

Refer to page 4-5.

ANALYZE

Activates Shock Advisory

System (SAS).

Refer to page 4-7.

Switches power on or off.

SHOCK

Discharges defibrillator energy to the patient. Refer to page 4-16.

CHARGE

Charges the defibrillator in manual mode. Refer to page 4-14.

ENERGY SELECT

Selects energy levels in manual mode. Refer to page 4-14.

SYNC

Activates sychronized mode. Refer to page 4-18.

Recommended

Adult VF Dose: xxx-xxx-xxxJ

Adult Ventricular Fibrillation Energy Label

Refer to page F-2.

RATE

Selects pacing rate. Refer to page 4-25.

CURRENT

Adjusts pacing current.

Refer to page 4-25.

PAUSE

Temporarily slows pacing rate. Refer to page 4-25.

PACER

Activates the pacing function.

Refer to page 4-25.

Area 2

Figure 2-4 Area 1

Figure 2-5 Area 2

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 2-5

2 Basic Orientation

Basic Orientation

HOME SCREEN

Returns immediately

to Home Screen.

Refer to page 2-6.

OPTIONS

Accesses optional functions. Refer to page 2-7.

EVENT

Activates user-

defined events.

Refer to page 2-6.

LED

Illuminates when the Speed Dial is active. Refer to page 2-8.

LEAD

Changes ECG lead.

Refer to page 3-2.

SIZE

Changes ECG size. Refer to page 3-2.

ALARMS

Activates and silences alarms. Refer to page 2-17.

Area 3

Figure 2-6 Area 3

Area 3

The following paragraphs provide additional information about the controls shown in "Area 3,"

page 2-6.

Home Screen

The home screen is the background screen that displays during ECG monitoring. Pressing HOME

SCREEN

analysis or during manual defibrillation charging and shocking.

Event

After pressing EVENT, the screen displays the following overlay.

Generic is automatically selected when selected event and time stamp appear in the message/status area on the screen. Events are printed in the CODE SUMMARY™ Event Log. Refer to page 8-10 for information about configuring events.

2-6 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

returns you to the home screen from any menu screen or overlay, except during AED

EVENT is pressed and no other selection is made. The

Use the Speed Dial to scroll through and select menu choices.

Basic Orientation

PACING

Selects demand or

nondemand pacing.

Selects internal pacer

detection on/off.

PATIENT

Enters patient name,

patient ID, location,

age, and sex.

DATE/TIME

Sets the date and time. For changes to take effect, cycle power.

Area 4

The following paragraphs provide additional information about the Speed Dial and the therapy cable connector shown in Area 4.

Speed Dial

Use the Speed Dial to scroll through and select the desired menu item either while viewing the monitor screen or while in Options mode. Press the Speed Dial to activate the highlighted menu item. Default menu items are highlighted with a gray background; after a menu item is selected, the background is black.

Therapy Cable Connector

WARNING!

Possible equipment damage and inability to deliver therapy.

To protect the therapy cable connector from damage or contamination, keep the therapy cable connected to the defibrillator at all times.

Connecting the Therapy Cable

To connect a therapy cable connector to the therapy cable port:

1 Orient the therapy cable so that the arrow is on top with the cable angled to the right (refer to

Figure 2-9).

2 Insert the therapy cable into the therapy cable connector on the defibrillator until a “click” is

sensed.

3 Pull gently on the locking ring to check that the cable is locked in place.

Disconnecting the Therapy Cable

To disconnect a therapy cable connector from the therapy cable port:

1 Rotate the locking ring on the therapy cable in the direction of the arrow (counterclockwise)

until it stops (refer to Figure 2-10).

2 Gently pull out the cable connector.

Figure 2-9 Therapy Cable Orientation Figure 2-10 Disconnecting the Therapy Cable

2-8 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Figure 2-11 Area 5

Area 5

Starts or stops the printer.

CODE SUMMARY

Prints a CODE SUMMARY critical event record. Refer to page 6-2.

AC MAINS

LED illuminates when AC

power (line power) is

connected and providing

power.

SERVICE

Indicates that service is

required.

Area 6

CO2 Port

Refer to

page 3-16.

Power Indicator

LED illuminates when AC power

(line power) is

connected and

providing power.

Basic Orientation

Figure 2-12 Area 6 (Optional CodeManagement Module)

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 2-9

2 Basic Orientation

Basic Orientation

Area 7

MONITORING AREA

Displays heart rate, time, SpO2, battery status indicator, indicators

for VF/VT alarm and selected energy. Refer to page 2-12.

STATUS MESSAGE AREA

Displays status and alarm messages.

WAVEFORM CHANNEL AREA

Displays up to two waveform channels. Refer to

page 2-12.

Note: Your device may have either of two screen formats, depending on the software version. Refer to Figure 2-13 and

Figure 2-14 to find the format that matches your device.

Figure 2-13

2-10 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Basic Orientation

WAVEFORM CHANNEL AREA

Displays up to two waveform channels. Refer to

page 2-12.

MONITORING

PARAMETER

AREA

Displays patient

values and alarm

limits.

Time

Display

CPR

Metronome

Icon

Selected

Energy

Battery

Status

Indicator

Alarm

Icon

STATUS MESSAGE AREA

Figure 2-14

Area 7

The following paragraphs provide additional information about Area 7.

Monitoring Area—Heart Rate

The LIFEPAK 20e defibrillator/monitor displays a heart rate between 20 and 300 beats per minute (bpm). A heart rate symbol flashes with each beat. If the heart rate is below 20 bpm or pacing is enabled, the screen displays dashes (– – –). Heart rates above 300 bpm do not yield valid systole tones and the displayed heart rate will not be valid. The heart rate indicator is a tool to be used in addition to patient assessment. Care should be taken to assess the patient at all times and to not rely solely on the displayed heart rate.

WARNING!

Failure to detect a change in ECG rhythm.

Heart rate meters may continue to count the internal pacing pulses during occurrences of cardiac arrest or some arrhythmias. Do not rely entirely on heart rate meter alarms. Keep pacemaker patients under close surveillance.

QRS detection is essential for using the digital heart rate display, systole tone, synchronized cardioversion, and noninvasive demand pacing. The QRS detector in the LIFEPAK 20e defibrillator/monitor selectively detects QRS complexes. It discriminates against most noise, muscle artifact, T-waves, and other spurious signals.

The QRS detect algorithm automatically adjusts itself to the amplitude of the QRS complexes. Changing the gain of the ECG has no effect on QRS detection. For optimum QRS detection performance, use the lead with the greatest QRS amplitude.

2 Basic Orientation

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 2-11

Basic Orientation

Monitoring Area—Pulse Rate. If the ECG is not active, the SpO2 monitor can display pulse rate.

The pulse rate source is indicated by

PR (SPO2).

Monitoring Area—SpO

(pulse oximeter). The oxygen saturation level is shown as a

percentage from 50 to 100. Saturation below 50% is shown as <50%. A fluctuating bar graph represents the pulse signal strength.

Monitoring Area—EtCO

in mmHg, kPa, or Vol%. Respiratory rate is also shown below the CO

. The end-tidal CO2 value is shown as a number representing pressure

value.

Time Display. The time of day is displayed as hours, minutes, and seconds (HH:MM:SS). To display elapsed time beginning from power on, highlight and select the clock with the Speed Dial. Each time you select the time display, it switches between time of day and elapsed time.

CPR Metronome Icon. When the device is in AED mode and the metronome is set up to turn on during CPR, the CPR Metronome

icon appears. When the device is in manual mode, you can

select the CPR Metronome icon with the Speed Dial to turn the metronome on or off, or change the Age-Airway settings.

Battery Status Indicator. The battery status indicator shows the approximate amount of battery charge remaining in the internal Lithium-ion rechargeable battery. (Refer to page 2-20 for further information.)

Waveform Channel Area

Channel 1. This is the top channel. It displays the primary ECG waveform and is always visible when ECG is displayed.

Channel 2. This is the bottom channel. It can display an additional waveform or a continuation of the Channel 1 ECG.

Selecting Waveform Channels

The monitor power must be turned on.

1 At the home screen, rotate the

Speed Dial to highlight Channel 1 or 2.

2 Press the Speed Dial. An overlay

appears with the monitoring choices for the selected channel.

3 Rotate and press the Speed Dial to

select monitoring choices for that channel.

2-12 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Basic Orientation

Changing Printer Paper

CAUTION!

Possible printer malfunction.

Using other manufacturers’ printer paper may cause the printer to function improperly and/or damage the print head. Use only the printer paper specified in these operating instructions.

Loading 50 mm Paper

The printer is equipped with an out-of-paper sensor to protect the printhead. The sensor automatically turns off the printer if paper runs out or if the printer door is open.

To load the paper:

1 Press the black button to open the printer door. 2 Remove 3 Insert 4 Pull out a short length of paper. 5 Push the printer door in to close.

Figure 2-15 illustrates the steps for loading 50 mm paper.

the empty paper roll.

the new paper roll, grid facing upward.

Figure 2-15 Printer

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 2-13

2 Basic Orientation

Basic Orientation

Ground (equipotential) connector

AC power

connector

System connector

ECG/Sync

connector

Refer to warning, page 2-15.

ECG/Sync connector

AC power connector

Ground (equipotential)

connector

System

connector

exhaust port

Refer to warning,

page 2-15.

Refer to warning,

page 2-15.

Back View

Figure 2-16 Back View without CodeManagement Module

Figure 2-17 Back View with CodeManagement Module

The following paragraphs provide additional information about the back view.

2-14 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Basic Orientation

TrueCPR

device port

Wireless

indicators

Wireless

On/Off switch

Off

WARNING!

Shock hazard.

All equipment connected to the system or ECG/sync connector must be battery powered or electrically isolated from AC power according to EN 60601-1. For more information, contact Physio-Control Technical Support.

System Connector

For LIFEPAK 20e devices that do not have a CodeManagement Module attached, the system connector is used to transfer setup information to another LIFEPAK 20e device or connect to LIFENET

Device Agent. For LIFEPAK 20e devices that have a CodeManagement Module

attached, the system connector is used to connect to LIFENET Device Agent.

ECG/Sync Connector

The ECG/Sync connector provides remote synchronization and real-time ECG output to a third party monitor.

CO2 Exhaust Port

The CO2 exhaust port connects to a scavenger system when monitoring EtCO2 during use of anesthetics.

Side View of CodeManagement Module

The CodeManagement Module has the following indicators and connectors on the right side.

Figure 2-18 Side View of CodeManagement Module

The following paragraphs provide additional information about the side view.

TrueCPR Device Port

The TrueCPR device port is used to transfer data from the TrueCPR™ Coaching Device to the LIFENET System. Only the TrueCPR device should be connected to this port. Refer to "Data

Transfer from TrueCPR Device," page 6-13.

2 Basic Orientation

Note: The TrueCPR device may not be available in all countries. Contact your local

Physio-Control representative for more information.

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 2-15

Basic Orientation

Wireless On/Off Switch

The wireless On/Off switch enables wireless transmission to the LIFENET System. Refer to

"Troubleshooting Tips for Data Transmission," page 6-14.

Wireless Indicators

Indicator 1. LED illuminates when wireless is active.

Indicator 2. LED illuminates when the CodeManagement Module is connected to the local

network.

Indicator 3. LED illuminates when the CodeManagement Module is connected to the LIFENET server.

ENTERING PATIENT DATA

The following paragraphs describe how to enter or edit a patient’s name, identification (ID), age, or sex.

1 Press OPTIONS. 2 Select

PATIENT.

To enter or edit a patient’s name or ID:

1 Select

ID. LAST NAME is used as an

LAST NAME, FIRST NAME, or

example (for this procedure).

2-16 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Basic Orientation

2 Rotate the Speed Dial to scroll

through the alphabet.

3 Press the Speed Dial to select the

desired character. The character appears in the highlighted area.

4 Repeat Step 2 and Step 3 until the

name is complete.

5 Scroll and select

END to return to the

Options/Patient screen as shown previously.

There are three additional commands:

•

BACKSPACE – moves highlight

bar left one space

•

CLEAR – clears all characters in

the name field

•

SPACE – inserts a blank space

6 To exit, press the

SCREEN

button.

OPTIONS or HOME

To enter or edit a patient’s age:

1 Select

AGE.

2 Rotate the Speed Dial to scroll to the

desired age.

3 Press the Speed Dial.

To enter or edit a patient’s sex:

1 Select

SEX.

2 Rotate the Speed Dial to highlight

MALE or FEMALE.

3 Press the Speed Dial.

SETTING ALARMS

Alarms for the LIFEPAK 20e defibrillator/monitor can be set to ON or OFF, and are enabled when the monitor is turned on. When the alarms are set to these limits, press the To change the limits, select

ALARMS button. The limits will appear to the right of the parameter value.

QUICK SET.

ON, predetermined limits are set. To view

2 Basic Orientation

Notes: Alarm limits are not displayed for Respiration Rate or Inspired CO

. Alarm limits are

provided in Table 2-1, page 2-19. Although alarm limits for Respiration Rate are not displayed, you can determine whether wide or narrow limits are selected by pressing the

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 2-17

ALARMS button.

Basic Orientation

When the alarms are set to OFF, you must press the ALARMS button and select QUICK SET to enable the alarms.

When you press the

ALARMS button, the following Alarms overlay appears:

1 Select QUICK SET to activate the

alarms for all active parameters. The quick set limits are set automatically based on the patient’s current vital sign values (refer to Table 2-1). The alarm limits default to the setting (

WIDE or NARROW) displayed on the

overlay.

2 Select LIMITS to change the alarm

limits to

WIDE or NARROW (refer to

Ta b l e 2 - 1 ).

3 Select SUSPEND to turn off the

audible alarm for up to 15 minutes. If an alarm limit is exceeded while the alarm is silenced, the violated parameter flashes, an alarm message appears, but the alarm tone remains silent.

Select VF/VT ALARM to turn on continuous monitoring for ventricular fibrillation and ventricular tachycardia in manual mode. A symbol appears above the primary ECG when the alarm is on .

Reselect

VF/VT ALARM to turn off

this alarm. Note: When the VF/VT alarm is on, you are limited to

PADDLES

lead or lead II. Refer to "Selecting

ECG Lead and Size," page 3-2.

Note: The VF/VT alarm will be suspended when the noninvasive pacemaker is on and when standard paddles are attached and

PADDLES lead is selected.

The alarm is also suspended when the defibrillator is charging or is fully charged.

2-18 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Table 2-1 Wide and Narrow Alarm Limits

Parameter Range Wide Limits

Low High Low High

Heart Rate (bpm)

<60 -20 +35 -10 +25 30–150 100–250 50 150

60–79 -25 +40 -20 +30

80–104 -30 +40 -30 +30 105 -35 +45 -25 +25

SpO

(%)

EtCO

(mmHg/%)

Inspired CO

(mmHg/%)

Respiration Rate (RPM)

*.Numbers are + from patient’s initial value

†.Numbers are absolute range values

1.Limits for kPa are same as %

2.Inspired CO

90 -5 +3 -5 +3 50 90–100 85 100

<90 -5 +3 -5 +3

40/5.3

>40/5.3 -10/-1.3 +15/+2.0 -10/-1.3 +15/+2.0

– N/A N/A N/A N/A N/A N/A N/A 8

1,2

-10/-1.3 +15/+2.0 -10/-1.3 +15/+2.0 5/0.7 70/9.2 15 50

<15 -8 +8 -4 +4 5-15 10-60 5 30

15 -15 +15 -8 +8

and respiration rate alarm limit values are not displayed

Narrow Limits

Basic Orientation

Limits Range

†

Default Limits

Low High Low High

MANAGING ALARMS

The alarm bell symbol indicates when alarms are on or off . When alarms are on and an alarm limit is exceeded, a tone sounds, the violated parameter flashes, and an alarm message appears on the screen.

To manage an alarm:

1 Press 2 Assess the cause of the alarm. 3 Assess the appropriateness of the limits setting ( 4 If the patient is unstable, consider silencing the alarm for up to 15 minutes while attending to

5 Once the patient is stable, reselect QUICK SET if necessary.

ALARMS. This silences the alarm for 2 minutes.

WIDE or NARROW).

the patient. Do not reselect

QUICK SET.

WARNING!

Possible failure to detect an out of range condition.

Reselecting QUICK SET will reset the alarm limits around the patient’s current vital sign values. This may be outside the safe range for the patient.

2 Basic Orientation

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 2-19

Basic Orientation

When alarms are on, you can silence them preemptively for up to 15 minutes.

To silence alarms preemptively:

1 Press 2 Select

ALARMS.

SUSPEND.

3 Select a silence duration of 2, 5, 10, or 15 minutes. 4 The message

ALARMS SUSPENDED appears at the bottom of the screen.

CONNECTING TO POWER

The LIFEPAK 20e defibrillator/monitor and the optional CodeManagement Module operate on AC (line) power or their internal Lithium-ion batteries. You can switch from battery to AC power or AC power to battery while the device is on and in use by plugging in or unplugging the AC power cord.

When the CodeManagement Module is connected to the LIFEPAK 20e defibrillator, one power cord is used to power both the defibrillator and the CodeManagement Module.

IMPORTANT: The AC power cord is the safety disconnect mechanism. Maintain clear access to all connections at all times.

WARNING!

Possible defibrillator shutdown.

POWER

outlet.

message appears on the monitor screen, immediately connect the AC power cord to an

AC Operation

When the LIFEPAK 20e defibrillator/monitor operates on AC power, the AC Mains LED illuminates. When the defibrillator is not in use, the battery charge is best maintained if the power cord is connected to an AC outlet and the defibrillator is turned off.

Note: When the CodeManagement Module is attached to the defibrillator, the green LED on the CodeManagement Module and the AC Mains LED on the defibrillator are both illuminated while the device is connected to AC power.

BATTERY OPERATION

The LIFEPAK 20e defibrillator/monitor and the CodeManagement Module each have an internal battery. Battery operation for the defibrillator is explained below. Battery operation for the CodeManagement Module is explained on page 2-23.

LIFEPAK 20e Defibrillator/Monitor Battery

The internal Lithium-ion battery is rechargeable and is intended for use when AC power is unavailable or when the device is being used in a portable manner, such as in transport. The defibrillator automatically switches to battery power when the power cord is disconnected from an AC outlet or from the defibrillator.

2-20 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Basic Orientation

A new, fully charged battery provides approximately 140 360-joule discharges, 110 minutes of pacing, or approximately 210 minutes of continuous monitoring before the defibrillator turns off. When one flashing red bar appears in the battery status indicator and the

CONNECT TO AC POWER

message appears on the screen, immediately plug the power cord into

LOW BATTERY:

an AC outlet to continue use and begin recharging the battery. If low battery messages frequently appear, the battery may need to be replaced. Contact Physio-Control Technical Support or qualified service personnel for assistance.

Connect the defibrillator to AC power after each use to recharge the battery. Typically, new fully depleted batteries recharge for 4 hours to regain full capacity. Partially depleted batteries recharge for a time period equivalent to the time the defibrillator was in use. For example, if the defibrillator was used one hour, the required recharge time will be approximately one hour.

New batteries or batteries that have been stored for an extended time should be recharged before they are used. Connect the defibrillator to an AC power outlet to bring the battery to full charge.

Note: The LIFEPAK 20e defibrillator/monitor is intended to operate with the internal battery installed. In the event of a missing or faulty battery, when plugged into AC power, the device will still operate and the service light will illuminate at power on. Contact Physio-Control Technical Support or qualified service personnel for assistance.

Battery Performance and Life

Several factors can contribute to the Lithium-ion battery’s performance and life cycle, including:

1 The defibrillator’s use for assisting patients (“on time” and shocks). 2 The defibrillator’s use when the battery is at minimum capacity (low battery condition). 3 The battery’s normal self-discharge rate and the energy used by defibrillator self-tests.

To maximize battery performance and life, plug the defibrillator/monitor into an AC outlet to recharge the battery whenever the defibrillator/monitor is not in use. As a reminder, you can set up the LIFEPAK 20e defibrillator/monitor to sound a series of warning beeps, identified as

LOSS ALERT

, whenever the defibrillator is turned off and not plugged into an AC outlet (refer to

the "General Setup Menu," page 8-4).

Note: While the defibrillator is plugged into AC power, the battery condition is periodically checked. If the battery is missing or is unable to charge, a service LED illuminates the next time the defibrillator is turned on. To check the battery capacity, perform the defibrillation function test (refer to "Maintenance and Testing Schedule," page 7-2).

Note: Even when properly maintained, the internal rechargeable Lithium-ion battery should be replaced every two years.

Battery Status Indicator

The battery status indicator approximates the amount of operating time available under battery power for the LIFEPAK 20e defibrillator/monitor. It does not indicate battery status for the CodeManagement Module. The battery status indicator appears on the screen after the defibrillator is turned on. (See Figure 2-13, page 2-10.) The number of illuminated bars indicates the battery capacity and how long the battery will provide power to the defibrillator.

2 Basic Orientation

A new, fully charged battery will show four green bars, indicating the battery is charged to 100% capacity. As battery charge and battery capacity decreases, the indicator bars decrease incrementally. One flashing red bar indicates a very low or empty battery. Refer to Table 2-2.

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 2-21

Basic Orientation

Table 2-2 Battery Status Indicator

Battery

Indicator

Battery

Battery Status Messages and Tones

Capacity

(percentage)

Four green bars None 76–100

Three green bars None 51–75

Two green bars None 26–50

One green bar None 16–25

One yellow bar

LOW BATTERY

11–15

Three beeps (one time). Message remains in message area, cycling with others if necessary.

One flashing red bar

LOW BATTERY: CONNECT TO AC POWER

0–10

Three beeps (every 20 seconds). Message remains in message area, cycling with others if necessary.

It is important to note that both charge (voltage) and capacity are factors contributing to the battery status indicator’s display. For example, the battery status indicator displays two green bars when a new battery has 100% capacity and has been charged to 50%. However, an older battery that is 100% charged and only has 50% capacity also displays two green bars. The following demonstrates this example.

This battery may either be low in capacity or low in charge as follows:

• For a new battery with 100% capacity, this symbol indicates 50% charged (low in charge).

• For an older battery with 50% capacity, this symbol indicates 100% charged (low in capacity).

2-22 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Basic Orientation

CodeManagement Module Battery

The CodeManagement Module has an internal, rechargeable Lithium-ion battery. When the CodeManagement Module is properly connected to the LIFEPAK 20e defibrillator and AC power, the batteries in the defibrillator and CodeManagement Module both recharge. When the device is disconnected from AC power, both the defibrillator and CodeManagement Module automatically switch to battery power.

To ensure the CodeManagement Module is always ready for use, keep it plugged into an AC outlet whenever possible.

WARNING!

Possible CO2 monitoring shutdown.

When operating on battery power, adhere to recommended battery charging and replacement intervals to prevent possible CO

message appears on the monitor screen, immediately connect the AC power cord to an outlet.

Notes:

• One power cord is used to power both the defibrillator and the CodeManagement Module.

• If the battery in the CodeManagement Module is low and the LIFEPAK 20e defibrillator is on, the

CONNECT TO AC POWER message appears, and three beeps sound every 20 seconds.

monitoring shutdown. If a CONNECT TO AC POWER

A new, fully-charged battery for the CodeManagement Module provides 270 minutes of continuous CO

monitoring. Typically, a new, fully depleted battery recharges for 4 hours to

regain full capacity. The battery should be replaced every two years. Battery replacement must be performed by qualified service personnel.

2 Basic Orientation

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 2-23

MONITORING

3 Monitoring

This section describes the monitoring features of the LIFEPAK 20e defibrillator/monitor.

Monitoring the ECG page 3-2 Monitoring SpO

Monitoring EtCO

3-9

3-16

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 3-1

Monitoring

MONITORING THE ECG

The following subsections describe:

• ECG Monitoring Warning

• Selecting ECG Lead and Size

• Adjusting the Systole Tone Volume

• Monitoring ECG with Paddles Accessories

• Monitoring with the Patient ECG Cable

• Troubleshooting Tips for ECG Monitoring

ECG Monitoring Warning

WARNING!

Possible misinterpretation of ECG data.

The frequency response of the monitor screen is intended only for basic ECG rhythm identification; it does not provide the resolution required for diagnostic and ST segment interpretation. For diagnostic or ST segment interpretation, or to enhance internal pacemaker pulse visibility, attach the ECG cable. Then print the ECG rhythm in diagnostic frequency response (DIAG).

Selecting ECG Lead and Size

There are two methods for selecting or changing the ECG lead. Both methods are available on your LIFEPAK 20e defibrillator/monitor. The leads available depend on the ECG cable (3-wire or 5-wire) connected to the device.

To change the ECG lead using the LEAD button:

1 Press the

appears, the lead automatically changes to paddles. If appears, the lead automatically changes to lead II.

2 When the Lead menu appears, press

the Speed Dial to select another lead. The highlighted selection shows the ECG lead.

Note: When the VF/VT alarm is on, you are limited to lead or lead II in Channel 1. Refer to "Setting Alarms," page 2-17.

Note: If one or more lead sets are preconfigured, the menu displays the lead sets. Refer to

page 8-9 for information about configuring lead sets.

LEAD button. If ECG lead

PADDLES lead

LEAD button again or rotate the

PADDLES

3-2 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Monitoring

To select or change the ECG lead using the Speed Dial:

1 Highlight and select

then select

LEAD to obtain the

CHANNEL 1, and

primary ECG lead choices.

2 Change the ECG lead by rotating the

Speed Dial. The highlighted selection shows the ECG lead.

3 Repeat Step 1 and Step 2 to select or

change displayed waveforms for Channel 2.

You can select or change the ECG size by using the SIZE button or the Speed Dial. If an ECG is in Channel 2, the size is automatically changed to match the Channel 1 size.

To select or change the ECG size using the

SIZE button:

1 Press the

SIZE button.

2 When the Size menu appears, press

the

SIZE button again. The

highlighted selection shows the current ECG size.

3 Monitoring

To select or change the ECG size using the Speed Dial:

1 To obtain the primary ECG, highlight

and select select

CHANNEL 1, and then

SIZE.

2 Change ECG size by rotating the

Speed Dial. The highlighted selection shows the current ECG size.

Adjusting the Systole Tone Volume

To adjust the systole tone volume, highlight and select heart rate (HR) in the monitoring area of the screen.

The following overlay appears:

1 Rotate the Speed Dial to the desired

volume.

2 Press the home screen to exit.

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 3-3

Monitoring

FAST-PATCH

Electrodes

QUIK-COMBO

Electrodes

Standard

Paddles

Lateral

Sternum

Apex

Monitoring ECG with Paddles Accessories

Anterior-lateral Placement

Anterior-lateral placement is the only placement that should be used for ECG monitoring with paddles accessories.

1 Place either the

♥ or + therapy electrode or the apex paddle lateral to the patient’s left nipple in

the midaxillary line, with the center of the electrode in the midaxillary line, if possible. Refer to

Figure 3-1.

Figure 3-1 Anterior-lateral Placement

2 Place the other therapy electrode or sternum paddle on the patient’s upper right torso, lateral

to the sternum and below the clavicle as shown in Figure 3-1.

Special Placement Situations

When placing therapy electrodes or standard paddles, be aware of the special requirements in the following possible situations.

• Obese Patients or Patients with Large Breasts — Apply therapy electrodes or standard paddles to a flat area on the chest, if possible. If skin folds or breast tissue prevent good adhesion, it may be necessary to spread skin folds apart to create a flat surface.

• Thin Patients — Follow the contour of the ribs and spaces when pressing the therapy electrodes or standard paddles onto the torso. This limits air spaces or gaps under the electrodes and promotes good skin contact.

• Patients with Implanted Pacemakers — If possible, place therapy electrodes or standard paddles away from internal pacemaker generator.

• Patients with Implanted Defibrillators — Apply therapy electrodes or standard paddles in the anterior-lateral position and treat this patient as any other patient requiring emergency care.

Paddles Monitoring Procedure

To monitor using therapy electrodes or standard paddles:

1 Press 2 Prepare the patient’s skin:

ON.

• Remove excessive chest hair as much as possible. Avoid nicking or cutting the skin. If possible, avoid placing therapy electrodes or standard paddles over broken skin.

• Clean and dry the skin.

• Do not use alcohol, tincture of benzoin, or antiperspirant to prep the skin.

3-4 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Monitoring

5-Wire cable

3-Wire cable

AHA Labels IEC Labels RA Right Arm R Right

LA Left Arm L Left RL* Right Leg N Negative LL Left Leg F Foot C* Chest C Chest

*Note: Not used for 3-wire cable.

LA/LRA/R

LL/FRL/N

C/C

3 Apply the therapy electrodes or standard paddles in the anterior-lateral position.

For therapy electrodes, confirm that the package is sealed and the Use By date has not passed. For standard paddles, apply conductive gel over the entire electrode surface.

4 Connect the disposable therapy electrodes to the therapy cable. 5 Select

PADDLES lead.

Monitoring with the Patient ECG Cable

There are two ECG cables available for ECG monitoring as shown in Figure 3-2: the 3-wire and 5-wire cables.

Connecting the Patient ECG Cable

Connect the cable by inserting the main cable connector into the green electrically isolated ECG connector on the monitor.

3 Monitoring

Figure 3-2 3-wire and 5-wire ECG Cables

ECG Monitoring Procedure

1 Press ON. 2 Attach the ECG cable to the monitor. 3 Identify the appropriate electrode sites on the patient as shown in Figure 3-3.

Figure 3-3 Electrode Placement for ECG monitoring

4 Prepare the patient’s skin for electrode application:

• Shave excessive hair at electrode site. Avoid locating electrodes over tendons and major muscle masses.

• For oily skin, clean skin with an alcohol pad.

• Dry the site with a brisk rub.

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 3-5

Monitoring

5 Apply ECG electrodes:

• Confirm package is sealed and Use By date has not passed.

• Attach an electrode to each of the lead wires.

• Grasp electrode tab and peel electrode from carrier.

• Inspect electrode gel and ensure the gel is intact (discard electrode if gel is not intact).

• Hold electrode taut with both hands. Apply the electrode flat to the skin. Smooth tape outwardly. Avoid pressing the center of the electrode.

• Secure the trunk cable clasp to the patient’s clothing.

6 Select the lead on the monitor screen. 7 If necessary, adjust ECG size. 8 Press

PRINT to obtain an ECG printout.

ECG Electrode Requirements

Electrode quality is critical for obtaining an undistorted ECG signal. Always check the date code on electrode packages for the Use By date before applying the electrodes to a patient. Do not use electrodes with expired Use By date codes. Disposable electrodes are intended for a single use.

For best ECG monitoring results, use silver/silver chloride (Ag/AgCl) electrodes. These electrodes provide a rapid display of post-defibrillation ECG.

Leads Off Messages

If an electrode or lead wire disconnects during ECG monitoring, the monitor emits an audible alarm and displays a leads off message. The ECG trace becomes a dashed line

. The alarm and

messages continue until the electrode or lead wire is replaced.

Color Coding for ECG Leads

The lead wires and the electrode snaps for the patient ECG cable are color coded according to AHA or IEC standards as listed in Table 3-1.

Table 3-1 ECG Leads Color Codes

Leads AHA Label AHA Color IEC Label IEC Color

Limb Leads RA White R Red

LA Black L Yellow

RL Green N Black

LL Red F Green

CBrownCBrown

Monitoring Patients with Internal Pacemakers

The LIFEPAK 20e defibrillator/monitor typically does not use internal pacemaker pulses to calculate the heart rate. However, the monitor may detect internal pacemaker pulses as QRS complexes. This may result in an inaccurate heart rate display.

Smaller amplitude internal pacemaker pulses may not be distinguished clearly. For improved detection and display of internal pacemaker pulses, turn on the internal pacemaker detector, and/ or connect the ECG cable, select an ECG lead, and print the ECG in diagnostic frequency response.

Large amplitude pacemaker pulses may overload the QRS complex detector circuitry so that no paced QRS complexes are counted. To help minimize ECG pickup of large unipolar pacemaker pulses when monitoring patients with internal pacemakers, place ECG electrodes so the line

3-6 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Monitoring

between the positive and negative electrodes is perpendicular to the line between the pacemaker generator and the heart.

The LIFEPAK 20e defibrillator/monitor annotates internal pacemaker pulses with a hollow arrow

on the display and the printed ECG if this feature is configured or selected

ON. False

annotations of this arrow may occur if ECG artifacts mimic internal pacer pulses. If false annotations occur, you may deactivate the detection feature using the Options/Pacing/Internal Pacer menu (refer to Figure 2-7). Also refer to the "Pacing Setup Menu" in Table 8-9. Patient history and other ECG waveform data, such as wide QRS complexes, should be used to verify the presence of an internal pacemaker.

Troubleshooting Tips for ECG Monitoring

If problems occur while monitoring the ECG, check the list of observations in Table 3-2 for aid in troubleshooting. For basic troubleshooting problems such as no power, refer to "General

Troubleshooting Tips" in Section 7.

Table 3-2 Troubleshooting Tips for ECG Monitoring

Observation Possible Cause Corrective Action

1 Screen blank and ON

LED lighted.

2 Any of these

messages displayed:

CONNECT ELECTRODES CONNECT ECG LEADS ECG LEADS OFF XX LEADS OFF

3 Poor ECG signal

quality.

Screen not functioning properly.

• Print ECG on recorder as backup.

• Contact service personnel for repair.

Therapy electrodes are not connected.

One or more ECG electrodes are disconnected.

ECG cable is not connected to

• Confirm therapy electrode connections.

• Confirm ECG electrode connections.

• Confirm ECG cable connections.

monitor.

Poor electrode-to-patient adhesion.

• Reposition cable and/or lead wires to prevent electrodes from pulling away from patient.

• Prepare skin and replace electrode(s).

• Select another lead.

Broken ECG cable lead wire. • Select

PADDLES lead and use

standard paddles or therapy electrodes for ECG monitoring.

• Check ECG cable continuity.

Poor electrode-skin contact. • Reposition cable and/or lead wires

to prevent electrodes from pulling away from patient. Secure trunk cable clasp to patient’s clothing.

• Prepare skin and replace electrode(s).

Outdated, corroded, or driedout electrodes.

• Check date codes on electrode packages.

• Use only silver/silver chloride electrodes with Use By dates that have not passed.

• Leave electrodes in sealed pouch until time of use.

3 Monitoring

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 3-7

Monitoring

Table 3-2 Troubleshooting Tips for ECG Monitoring (Continued)

Observation Possible Cause Corrective Action

Loose connection. Damaged cable or connector/ lead wire.

• Check/reconnect cable connections.

• Inspect ECG and therapy cables.

• Replace if damaged.

• Check cable with simulator and replace if malfunction observed.

Misplaced electrodes/lead wire.

• Confirm correct placement.

• Select lead view with optimal QRS detection.

Noise because of radio frequency interference (RFI).

• Check for equipment causing RFI (such as a radio transmitter) and relocate or turn off equipment power.

4 Baseline wander

(low frequency/high amplitude artifact).

Inadequate skin preparation. Poor electrode-skin contact. Diagnostic frequency response.

• Prepare skin and apply new electrodes.

• Check electrodes for proper adhesion.

• Print ECG in monitor frequency response.

5 Fine baseline artifact

(high frequency/low amplitude).

Inadequate skin preparation. Isometric muscle tension in arms/legs.

• Prepare skin and apply new electrodes.

• Confirm that limbs are resting on a supportive surface.

• Check electrodes for proper adhesion.

6 Systole beeps not

heard or do not occur with each QRS

Volume too low. QRS amplitude too small to detect.

•Adjust volume.

• Change ECG lead.

complex.

7 Monitor displays

dashed lines with no ECG leads off

PADDLES lead selected but

patient connected to ECG cable.

• Select one of the limb leads.

messages.

8 Heart rate (HR)

display different than pulse rate.

Monitor is detecting the patient’s internal pacemaker pulses.

• Prepare skin and apply new electrodes in different location.

• Select lead view with optimal QRS detection.

9 Internal pacemaker

pulses difficult to see.

Pulses from pacemaker are very small. Monitor the visibility of frequency response limits.

• Turn on internal pacemaker detector (refer to page 3-6).

• Connect ECG cable and select ECG lead instead of paddles.

• Print ECG in diagnostic mode (refer to page 3-5).

3-8 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Monitoring

3 Monitoring

MONITORING SpO

The following paragraphs describe:

• SpO

Warnings and Cautions

• When to Use a Pulse Oximeter

• How a Pulse Oximeter Works

• SpO

Monitoring Considerations

Monitoring Procedure

Waveform

Volume

• Sensitivity

• Averaging Time

• Pulse Oximeter Sensors

• No Implied License

• Cleaning

• Troubleshooting Tips for SpO

SpO2 Warnings and Cautions

WARNINGS!

Shock or burn hazard.

Before use, carefully read these operating instructions, the sensor and extension cable directions for use, and precautionary information.

Shock or burn hazard.

Other manufacturers’ oxygen transducers may cause improper oximeter performance and invalidate safety agency certification. Use only oxygen transducers approved for this product.

Inaccurate pulse oximeter readings.

Do not use a damaged extension cable or one with exposed electrical contacts. Never use more than one extension cable between the pulse oximeter and the sensor.

Inaccurate pulse oximeter readings.

Do not use a damaged sensor. Do not alter the sensor in any way. Alterations or modifications may affect performance and/or accuracy.

Inaccurate pulse oximeter readings.

Sensors exposed to ambient light (such as sunlight, surgical lights, or bilirubin lamp) when incorrectly applied to a patient may exhibit inaccurate saturation readings. Securely place the sensor on the patient and check the sensor’s application frequently to help ensure accurate readings.

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 3-9

Monitoring

WARNINGS! (CONTINUED)

Inaccurate pulse oximeter readings.

Severe anemia, significant blood levels of carboxyhemoglobin or methemoglobin, elevated levels of total bilirubin, intravascular dyes that change usual blood pigmentation, excessive patient movement, venous pulsations, electrosurgical interference, exposure to irradiation and placement of the sensor on an extremity that has a blood pressure cuff, intravascular line or externally applied coloring (such as nail polish) may interfere with oximeter performance. The operator should be thoroughly familiar with the operation of the oximeter prior to use.

Inaccurate pulse oximeter readings.

The pulsations from intra-aortic balloon support can be additive to the pulse rate. Verify patient’s pulse rate against the ECG heart rate.

Skin injury.

Prolonged, continuous use of a sensor may cause irritation, blistering, or pressure necrosis of the skin. Check the sensor site regularly based on patient condition and type of sensor. Change the sensor site if skin changes occur. Do not use tape to hold the sensor in place, as this may cause inaccurate readings or damage to the sensor or skin.

Possible strangulation.

Carefully route patient cabling to reduce the possibility of patient entanglement or strangulation.

CAUTION!

Possible equipment damage.

To avoid damaging the extension cable or the sensor, hold the connectors, rather than the cables, when disconnecting.

When to Use a Pulse Oximeter

A pulse oximeter is a noninvasive tool that checks the saturation of oxygen in arterial blood (SpO

) and is not to be used as an apnea monitor or as a replacement or substitute for ECG

based arrhythmia analysis. It is used for monitoring patients who are at risk of developing hypoxemia. If a pulse oximeter is not used, the only indications of hypoxemia are a patient’s dusky skin, nail beds, and mucous membranes, accompanied by restlessness and confusion. These indications are not conclusive, however, and do not appear until after the patient has developed hypoxemia. Pulse oximetry is to be used in addition to patient assessment. Care should be taken to assess the patient at all times and to not solely rely on the SpO

reading. If a

trend toward patient deoxygenation is indicated, blood samples should be analyzed using laboratory instruments to completely understand the patient’s condition.

How a Pulse Oximeter Works

A pulse oximeter sensor directs light through a fleshy body site (usually the finger or earlobe). The sensor sends light from the emitting diodes to the receiving detector as shown in Figure 3-4. Oxygen saturated blood absorbs light differently as compared to unsaturated blood. The pulse oximeter translates the amount of light received into a saturation percentage and displays an SpO

reading. Normal values typically range from 95% to 100% at sea level.

3-10 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Monitoring

Sensor (holds LEDs

and detector)

Red Infrared

Light emitting

diodes

Light receiving

detector

Figure 3-4 How a Pulse Oximeter Works

The quality of the SpO2 reading depends on correct sensor size and placement, adequate blood flow through the sensor site, patient motion, and exposure to ambient light. For example, with very low perfusion at the monitored site, readings may read lower than core arterial oxygen saturation. Test methods for accuracy are available by contacting your local Physio-Control representative.

3 Monitoring

SpO2 Monitoring Considerations

Each oximeter sensor is applied to a specific site on the patient. Use the following criteria to select the appropriate sensor:

• Patient weight

• Patient perfusion to extremities

• Patient activity level

• Available application sites on the patient’s body

• Sterility requirements

• Anticipated duration of monitoring

To help ensure optimal and accurate performance:

• Use a dry and appropriately sized sensor.

• Keep the sensor site at the same level as the patient’s heart.

• Apply the sensor according to the Directions for Use provided with the sensor.

• Observe all warnings and cautions noted in the sensor’s Directions for Use.

The sensors are sensitive to light. If excessive ambient light is present (such as sunlight, surgical lights, or bilirubin lamp), cover the sensor site with an opaque material to block the light. Failure to do so could result in inaccurate measurements.

If patient movements present a problem, consider the following possible solutions:

• Be sure the sensor is secure and properly aligned.

• Use a new sensor with fresh adhesive backing.

• If possible, move the sensor to a less active site.

Note: Wrapping the sensor too tightly or using supplemental tape to hold the sensor in place may cause inaccurate measurements.

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 3-11

Monitoring

SpO2 Monitoring Procedure

The defibrillator controls power to the pulse oximeter. When the defibrillator is turned on, the oximeter turns on and performs a self-test that requires up to 10 seconds. When the defibrillator is turned off, the oximeter also turns off.

To conserve battery power, the pulse oximeter goes into “sleep mode” when not in use. Sleep mode is activated within 10 seconds of disconnecting the sensor. During sleep mode, the screen does not display SpO or a patient signal. The oximeter performs the self-test when it returns from sleep mode to active mode.

information. The oximeter returns to normal mode after detecting a sensor

The pulse oximeter measures SpO

levels between 1% and 100%. When SpO2 levels are

between 70% and 100%, oximeter measurements are accurate within ±3 digits. When the pulse oximeter measures SpO

To measure the patient’s SpO

1 Connect the SpO

2 Attach the sensor to the SpO

3 Press

ON.

levels less than 50%, the display shows < 50%.

levels:

cable to the monitor.

cable and the patient.

4 Observe the pulse bar for fluctuation. Amplitude of the pulse bar indicates relative signal

quality.

5 Adjust sensitivity, averaging time, and SpO

volume as necessary.

SpO2 Waveform

The SpO2 waveform can be displayed on waveform Channel 2 by selecting waveform Channel 2 and then selecting SpO

from the Waveform menu. The SpO2 waveform automatically sizes itself

to provide optimum waveform viewing.

SpO2 Volume

To adjust the pulse tone volume, highlight and select SPO2 on the home screen. The following overlay appears:

1 Highlight and select SPO2 VOLUME. 2 Rotate the Speed Dial to the desired

volume.

3 Press the Speed Dial to set the

volume.

3-12 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Monitoring

Sensitivity

The sensitivity setting allows you to adjust the oximeter for differing perfusion states. To adjust the sensitivity to either normal or high, highlight and select select

SENSITIVITY.

SPO2 on the home screen and then

The normal sensitivity setting is the recommended setting for most patients. The high sensitivity setting allows for SpO shock. However, when the SpO

monitoring under low perfusion states such as the severe hypotension of

sensitivity is set to high, the signal is more susceptible to

artifact. It is recommended that the patient be monitored closely when the high sensitivity setting is in use.

Averaging Time

The averaging time setting allows you to adjust the time period used to average the SpO2 value. Four time periods are provided for averaging: 4, 8, 12, and 16 seconds. To adjust the averaging time, highlight and select

The averaging time of 8 seconds is recommended for most patients. For patients with rapidly changing SpO

values, the 4-second time is recommended. The 12- and 16-second periods are

used when artifact is affecting the performance of the pulse oximeter.

SPO2 on the home screen and select AVERAGING TIME.

3 Monitoring

Pulse Oximeter Sensors

The Accessory Catalog describes the sensors that can be used with the LIFEPAK 20e defibrillator/monitor. To order compatible sensors and extension cables, refer to the accessories catalog or contact your local Physio-Control sales representative.

Masimo Sp02 Sensors

Carefully read the directions for use provided with sensors and cables for complete descriptions, instructions, warnings, cautions, and specifications.

Compatibility with Nellcor Sensors

The LIFEPAK 20e defibrillator/monitor can be ordered to have compatibility with Nellcor sensors. To use the Nellcor sensor with the LIFEPAK 20e defibrillator/monitor, the Masimo MNC-1 adapter cable must be used. Carefully read the directions for use provided with the Nellcor sensors and the Masimo MNC-1 adapter cable for complete description, instructions, warnings, cautions, and specifications.

No Implied License

Possession or purchase of this oximeter does not convey any express or implied license to use the oximeter with replacement parts which would, alone or in combination with the oximeter, fall within the scope of one or more of the patents relating to this device.

Cleaning

To clean the sensors, first remove them from the patient and disconnect them from the connector cable. Clean LNC and LNOP DCI sensors by wiping them with a 70% isopropyl alcohol pad. Allow the sensors to dry before placing them on a patient. Do not attempt to sterilize.

To clean the connector and adapter cables, first remove them from the defibrillator and then wipe them with a 70% isopropyl alcohol pad. Allow them to dry before reconnecting them to the defibrillator. Do not attempt to sterilize.

Note: Do not soak or immerse the cables in any liquid solution.

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 3-13

Monitoring

Troubleshooting Tips for SpO

Table 3-3 Troubleshooting Tips for SpO

Observation Possible Cause Corrective Action

1 The oximeter measures a

pulse, but there is no oxygen saturation or pulse rate.

Excessive patient motion. • Keep patient still.

• Check that sensor is secure.

• Relocate sensor.

• Replace sensor.

SpO

or pulse rate changes

rapidly; pulse amplitude is erratic.

Patient perfusion may be too low.

Excessive patient motion. • Keep patient still.

• Check patient.

• Increase sensitivity.

• Check that sensor is secure.

• Relocate sensor.

• Replace sensor.

• Increase sensitivity.

An electrosurgical unit (ESU) may be interfering with performance.

• Move the monitor as far as possible from the ESU.

• Plug the ESU and monitor into different circuits.

• Move the ESU ground pad as close to the surgical site as possible.

• Sensor may be damp, replace it.

• Remove sensor extension cable and connect the sensor directly.

3 No

SpO

value is displayed. Oximeter may be performing a

• Wait for completion.

self-test (requires 10 seconds).

SPO2: NO SENSOR DETECTED

message

appears.

SPO2: CHECK SENSOR

message appears.

Sensor is not connected to patient or cable disconnects from device.

Sensor is disconnected from patient or cable.

• Check that sensor and cable are connected properly.

• Attach the sensor.

• Check that sensor is secure.

Excessive ambient light. • Remove or block light

source if possible.

• Cover sensor with opaque material, if necessary.

Patient has a weak pulse or low blood pressure.

• Test sensor on someone else.

• Check if patient perfusion is adequate for sensor location.

• Check if sensor is secure and not too tight.

• Check that sensor is not on extremity with blood pressure cuff or intravascular line.

• Change sensor location.

3-14 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Monitoring

3 Monitoring

Table 3-3 Troubleshooting Tips for SpO

Observation Possible Cause Corrective Action

6 SPO2: UNKNOWN SENSOR

message appears.

SPO2: SEARCHING FOR PULSE

message appears.

(Continued)

A sensor is connected to the device that is not compatible with the Masimo Sp0

module.

A sensor is connected to the patient and is searching for a

• Refer to "Pulse Oximeter

Sensors," page 3-13 for

sensor compatibility.

• Wait for completion.

pulse.

SPO2: LOW PERFUSION

Patient has a weak pulse. • Change sensor location.

message appears.

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 3-15

Monitoring

MONITORING ETCO

The following paragraphs describe:

• EtCO

Warnings and Cautions

• How Capnography Works

• EtCO

• CO

Monitoring Waveform Analysis

Monitoring Procedure

Display

Alarms

Detection

• Cleaning

• Troubleshooting Tips for EtCO

EtCO2 Warnings and Cautions

WARNINGS!

Fire hazard.

Before use, carefully read these operating instructions, the FilterLine® tubing directions for use, and precautionary information.

Fire hazard.

The FilterLine tubing may ignite in the presence of O2 when directly exposed to laser, electrosurgical devices, or high heat. Use with caution to prevent flammability of the FilterLine

tubing.

Fire hazard.

Flammable anesthetics become mixed with the patient’s air that is sampled by the capnometer. When using the EtCO

certain other anesthetics, connect the EtCO

monitor in the presence of flammable gases, such as nitrous oxide or

gas port to a scavenger system.

Possible inaccurate patient assessment.

The EtCO2 monitor is intended only as an adjunct in patient assessment and is not to be used as a diagnostic apnea monitor. An apnea message appears if a valid breath has not been detected

for 30 seconds and indicates the time elapsed since the last valid breath. It must be used in conjunction with clinical signs and symptoms.

Possible inaccurate CO2 readings.

Using other manufacturers’ CO2 accessories may cause the device to perform improperly and invalidate the safety agency certifications. Use only the accessories that are specified in these

operating instructions.

Possible inaccurate CO2 readings.

If calibration is not performed as specified in the Service Manual for the LIFEPAK 20e defibrillator/monitor, the EtCO

monitor may be out of calibration. A monitor that is out of

calibration may provide inaccurate readings.

3-16 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Monitoring

WARNINGS! (CONTINUED)

Possible strangulation.

Carefully route the patient tubing (FilterLine) to reduce the possibility of patient entanglement or strangulation.

Infection hazard

Do not reuse, sterilize, or clean Microstream® CO2 accessories as they are designed for singlepatient one-time use.

How Capnography Works

An EtCO2 sensor continuously monitors carbon dioxide (CO2) that is inspired and exhaled by the patient. The sensor employs Microstream non-dispersive infrared (IR) spectroscopy to measure the concentration of CO

The CO

FilterLine system delivers a sample of the exhaled gases directly from the patient into

the CodeManagement Module for CO reduces liquid and secretion accumulation and prevents obstruction, which maintains the shape of the CO

The CO

waveform.

sensor captures a micro sample (15 microliters). This extremely small volume allows for

fast rise time and accurate CO

The Microbeam IR source illuminates the sample cell and the reference cell. This proprietary IR light source generates only the specific wavelengths characteristic of the CO spectrum. Therefore, no compensations are required when concentrations of O agent, or water vapor are present in the exhaled breath.

molecules that absorb infrared light.

measurement. The low sampling flow rate (50 ml/min)

readings, even at high respiration rates.

absorption

, anesthetic

3 Monitoring

The LIFEPAK 20e defibrillator/monitor is set at the factory to use the capnography Body Temperature Pressure Saturated (BTPS) conversion method. This option corrects for the difference in temperature and moisture between the sampling site and alveoli. The correction formula is 0.97 x the measured EtCO Setup Options. Refer to "CO

Setup Menu," page 8-10, for more information.

value. The BTPS conversion can be turned off in the

EtCO2 Monitoring Waveform Analysis

Valuable information concerning the patient’s expired CO2 can be acquired by examination and interpretation of the waveform.

The Phases of the Waveform

Figure 3-5 is a graphic representation of a normal capnograph waveform. Four phases of the waveform require analysis. The flat I–II baseline segment (Respiratory Baseline) represents continued inhalation of CO Upstroke), a sharp rise, represents exhalation of a mixture of dead space gases and alveolar gases from acini with the shortest transit times. Phase III–IV (Expiratory Plateau) represents the alveolar plateau, characterized by exhalation of mostly alveolar gas. Point IV is the end-tidal (EtCO

) value that is recorded and displayed by the monitor. Phase IV–V (Inspiratory

Downstroke), a sharp fall, reflects the inhalation of gases that are CO normal capnograph or EtCO ventilation, or equipment function.

-free gas. This value normally is zero. The II–III segment (Expiratory

-free. Alterations of the

values are the result of changes in metabolism, circulation,

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 3-17

Monitoring

III

Figure 3-5 Phases of the Respiratory Waveform

Respiratory Baseline. Elevation of the waveform baseline (I–II segment) usually represents

rebreathing CO Rebreathing CO hypoventilation. Precipitous rises in both baseline and EtCO

. This elevation usually is accompanied by gradual increases in the EtCO2 value.

is common in circumstances of artificially produced increased dead space and

values usually indicate

contamination of the sensor.

Expiratory Upstroke. In the normal waveform, the rising phase (II–III segment) is usually steep. When this segment becomes less steep, CO

delivery is delayed from the lungs to the sampling

site. The causes of this delay can be physiologic or mechanical and include bronchospasm, obstruction of the upper airway, or obstruction (or kinking) of an endotracheal tube (ETT).

Expiratory Plateau. The plateau of the waveform, which represents the remainder of expiration (III-IV segment), should be nearly horizontal. The end of the plateau represents the EtCO

value.

Upward slanting of the expiratory plateau occurs when there is uneven emptying of the alveoli. Similar to the diminished slope of the Expiratory Upstroke, this pattern can occur in asthma, chronic obstructive pulmonary disease (COPD), partial upper-airway obstruction, or partial mechanical obstruction such as a partially kinked ETT.

Inspiratory Downstroke. The fall to baseline (IV-V segment) is a nearly vertical drop. This slope can be prolonged and can blend with the expiratory plateau in cases of leakage in the exhale portion of the breathing circuit. The peak EtCO

value (IV) is often not reached. Relying on the

numeric end-tidal value without observing the breathing waveform may obscure the presence of a leak.

EtCO2 Monitoring Procedure

The EtCO2 monitor is activated when the FilterLine set is attached. Initialization, self-test, and warm-up of the EtCO one-half minutes.

Carefully read the Instructions for Use that are provided with the FilterLine for placement instructions, use instructions, warnings, cautions, and specifications.

CAUTION!

Possible equipment damage.

Failure to replace a broken or missing CO2 port door may allow water or particulate contamination of the internal CO

Possible equipment damage.

Do not use excessive force when connecting the FilterLine to the CO2 port. This may damage the connector.

monitor is typically less than 30 seconds, but may take up to two and

sensor. This may cause the CO2 module to malfunction.

To monitor EtCO

1 Press

ON.

2 Select the appropriate EtCO

3-18 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

accessory for the patient.

Monitoring

Note: To decrease the likelihood of the FilterLine connection coming loose during use,

hand-straighten the tubing after removal from the package before connecting to patient or device.

3 Monitoring

3 Open the CO

FilterLine connector into the CO

port door and insert the FilterLine connector. Using the tabs, screw the

port clockwise until it can no longer be turned. Do not use

excessive force.

4 Verify that the CO

area is displayed. The EtCO2 monitor performs the autozero routine as

part of the initialization self-test.

Note: If you use a ventilation system, do not connect the FilterLine set to the patient/ ventilation system until the EtCO

5 Display CO

6 Connect the CO

7 Confirm that the EtCO

waveform in Channel 2.

FilterLine set to the patient.

value and waveform are displayed. The monitor automatically selects

monitor has completed its self-test and warm-up.

the scale for the best visualization of the waveform. You can change the scale, if desired, as described in the next section.

Note: It is possible for the FilterLine set to become loose at the device connection and still have an EtCO

value and CO2 waveform, but they may be erroneously low. Make sure the

FilterLine connection is firmly seated and can no longer be turned.

Note: The capnography module performs self-maintenance within the first hour of monitoring and once an hour during continuous monitoring. The self-maintenance includes “autozeroing.” Self-maintenance is also initiated when the surrounding temperature changes 8°C (14.4°F) or more, or the surrounding pressure changes more than 20 mmHg. The CO

module detects this change and attempts to purge the tubing. To clear the

PURGING

or CO2 FILTERLINE BLOCKAGE messages, remove the FilterLine tubing and

CO2 FILTERLINE

reconnect it to the monitor.

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 3-19

Monitoring

CO2 Display

The following scales are available to display the CO2 waveform. The LIFEPAK 20e defibrillator/monitor automatically selects the scale based on the measured EtCO change the CO

scale, outline and select the CO2 area using the Speed Dial and then select the

desired scale from the scale menu.

• Autoscale (default)

• 0–20 mmHg (0–4 Vol% or kPa)

• 0–50 mmHg (0–7 Vol% or kPa)

• 0–100 mmHg (0–14 Vol% or kPa)

The CO

waveform is compressed (displayed at 12.5 mm/sec sweep speed) to provide more data

in the 3.7-second screen. There is a slight delay between when the breath occurs and when it appears on the screen. Printouts are at 25 mm/sec.

value. To

The monitor shows the maximum CO

value over the last 20 seconds. If the EtCO2 values are

increasing, the change can be seen with every breath. However, if the values are continually decreasing, it will take up to 20 seconds for a lower numerical value to be displayed. Because of this, the EtCO

value may not always match the level of the CO2 waveform.

CO2 Alarms

The EtCO2 monitor provides:

•EtCO

•FiCO

• Apnea alarm (automatic and not adjustable)

• Respiration Rate high and low alarms (controlled by activating Alarms (refer to "Setting

high and low alarms (controlled by activating Alarms (refer to "Setting Alarms,"

page 2-17)).

(inspired CO2) alarm (controlled by activating Alarms; automatically set to default values

and not adjustable)

Alarms," page 2-17)).

Note: The apnea alarm occurs when a breath has not been detected for 30 seconds. The message

ALARM APNEA appears in the message area along with the time since the last

detected breath.

3-20 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Monitoring

CO2 Detection

A CO2 waveform appears when any CO2 is detected, but CO2 must be greater than 3.5 mmHg for a numerical value to be displayed. However, the CO CO

is at least 8 mmHg (1.0% or 1 kPa). Valid breaths must be detected in order for the apnea

alarm to function and to count the respiratory rate (RR).

module will not recognize a breath until the

3 Monitoring

When CO

is not detected in the cardiac arrest situation—for example, the CO2 waveform is

either dashes “---” or a flat solid line at or near zero—several factors must be quickly evaluated. Assess for the following causes:

Equipment Issues

• FilterLine set is disconnected from the endotracheal tube (ETT)

• System is purging due to fluid in the patient/sensor connection from ET administration of medications

• System is auto-zeroing

• FilterLine connection to device is loose

Loss of Airway Function

• Improper placement of ETT

• ETT dislodgment

• ETT obstruction

Physiological Factors

• Apnea

• Loss of perfusion

• Exsanguination

• Massive pulmonary embolism

• Inadequate CPR

Cleaning

Accessories for CO2 monitoring are disposable and are intended for single-patient use. Do not clean and reuse a FilterLine set. Dispose of the contaminated waste according to local protocols.

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 3-21

Monitoring

Troubleshooting Tips for EtCO

Table 3-4 Troubleshooting Tips for EtCO

Observation Possible Cause Corrective Action

1 ALARM APNEA message

appears and waveform is solid line at or near zero.

No breath has been detected for 30 seconds since last valid breath.

FilterLine connection to device is loose.

• Check the patient.

• Twist FilterLine connector clockwise until firmly seated and can no longer be turned.

FilterLine set is disconnected from patient or ETT.

• Check ventilation equipment (if used) for leaks or disconnected tubing.

CO2 FILTERLINE OFF

message appears and waveform is “---”.

FilterLine set disconnected from device.

FilterLine set not securely connected to device.

• Connect FilterLine set to device port.

• Twist FilterLine connector clockwise until firmly seated and can no longer be turned.

CO2 FILTERLINE PURGING

message appears and

FilterLine set is kinked or clogged with fluid.

• Disconnect and then reconnect the FilterLine set.

waveform is “---”.

CO2 FILTERLINE BLOCKAGE

message appears and waveform is “---”.

The message appears after 30 seconds of unsuccessful purging. FilterLine set is kinked

• Disconnect and then reconnect the FilterLine set.

• Change the FilterLine set.

or clogged.

CO2 INITIALIZING message

appears and waveform is “---”.

AUTO ZEROING message

appears and waveform is

FilterLine set connected to device while module is initializing.

Module is performing selfmaintenance.

• None.

“---”.

7 EtCO

values are erratic. FilterLine connection to device

is loose.

• Twist FilterLine connector clockwise until firmly seated and can no longer be turned.

A leak in the FilterLine set. • Check for connection leaks

and line leaks to patient, and correct, if necessary.

A mechanically ventilated

• No action required.

patient breathes spontaneously or patient is talking.

3-22 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Monitoring

3 Monitoring

Table 3-4 Troubleshooting Tips for EtCO

Observation Possible Cause Corrective Action

8 EtCO2 values are

consistently higher than expected.

(Continued)

Physiological cause such as

• None.

COPD.

Inadequate ventilation. • Check ventilator; increase

ventilatory rate/bagging.

Patient splinting during breathing.

• Supporting measures such as pain relief.

Improper calibration. • Contact qualified service

personnel.

9 EtCO

values are

consistently lower than expected.

FilterLine connection to device is loose.

• Twist FilterLine connector clockwise until firmly seated and can no longer be turned.

Physiological cause. • See Physiological factors in

"CO

Detection," page 3-21.

Hyperventilation. • Check ventilator; decrease

ventilatory rate/bagging.

Improper calibration. • Contact qualified service

personnel.

10 CO

waveform stays

elevated for several seconds.

Expiration is prolonged due to bagging technique.

• Release bag reservoir completely with expiration. Observe that elevated baseline returns to normal level.

11 Sudden extreme increase in

EtCO

CHECK CO2 message

appears.

Fluid has entered CO

FilterLine blockage • Disconnect and then

module. • Contact qualified service

personnel.

reconnect the FilterLine set.

• Change the FilterLine set.

Exhaust port blockage • Ensure exhaust port on the

back of the device is not blocked.

• Check exhaust tubing (if present) for blockages or kinks.

RF equipment too close to defibrillator

• Separate RF equipment from defibrillator. See recommended separation distances in Table 4, page

H-4.

XXX appears instead of

EtCO

value.

module malfunction. • Turn device off and then on

again.

• If problem persists, contact qualified service personnel.

14 There is no EtCO

and the CO

waveform is

value

Measured CO

3.5 mmHg.

is less than

•See "CO2 Detection,"

page 3-21.

flat.

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 3-23

Monitoring

Table 3-4 Troubleshooting Tips for EtCO

Observation Possible Cause Corrective Action

15 CO2 does not appear on

screen when FilterLine is connected.

(Continued)

CodeManagement Module not properly connected to defibrillator.

• Contact qualified service personnel.

Low battery voltage. • Connect to AC power.

Defective battery in CodeManagement Module.

CodeManagement Module malfunction.

• Contact qualified service personnel.

3-24 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

THERAPY

This section describes patient therapy.

General Therapy Warnings and Cautions page 4-2 Therapy Electrode and Standard Paddle Placement 4-3 Automated External Defibrillation 4-5 Manual Defibrillation 4-14 Pediatric Defibrillation 4-21 Noninvasive Pacing 4-25

4 Therapy

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 4-1

Therapy

GENERAL THERAPY WARNINGS AND CAUTIONS

WARNINGS!

Shock hazard.

The defibrillator delivers up to 360 J of electrical energy. When discharging the defibrillator, do not touch the paddle electrode surfaces or disposable therapy electrodes.

Shock hazard.

If a person is touching the patient, bed, or any conductive material in contact with the patient during defibrillation, the delivered energy may be partially discharged through that person. Clear everyone away from contact with the patient, bed, and other conductive material before discharging the defibrillator.

Shock hazard.

Do not discharge the defibrillator into the open air. To remove an unwanted charge, change the energy selection, select disarm, or turn off the defibrillator.

Possible fire, burns, and ineffective energy delivery.

Do not discharge standard paddles on top of therapy electrodes or ECG electrodes. Do not allow standard paddles (or therapy electrodes) to touch each other, ECG electrodes, lead wires, dressings, transdermal patches, etc. Such contact can cause electrical arcing and patient skin burns during defibrillation and may divert defibrillating energy away from the heart muscle.

Possible defibrillator shutdown.

LOW BATTERY: CONNECT TO AC POWER

message appears on the monitor screen, immediately connect the AC power cord to an outlet.

Possible skin burns.

During defibrillation or pacing, air pockets between the skin and therapy electrodes may cause patient skin burns. Apply therapy electrodes so that entire electrode adheres to skin. Do not reposition the electrodes once applied. If the position must be changed, remove and replace with new electrodes.

Possible skin burns and ineffective energy delivery.

Therapy electrodes that are dried out or damaged may cause electrical arcing and patient skin burns during defibrillation. Do not use therapy electrodes that have been removed from foil package for more than 24 hours. Do not use electrodes beyond expiration date. Check that electrode adhesive is intact and undamaged. Replace therapy electrodes after 50 shocks.

Possible interference with implanted electrical device.

Defibrillation may cause implanted devices to malfunction. Place standard paddles or therapy electrodes away from implanted devices if possible. Check implanted device function after defibrillation.

CAUTION!

Possible equipment damage.

Prior to using this defibrillator, disconnect all equipment from the patient that is not defibrillatorprotected.

4-2 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Therapy

FAST-PATCH

Electrodes

QUIK-COMBO

Electrodes

Standard

Paddles

Lateral

Sternum

Apex

THERAPY ELECTRODE AND STANDARD PADDLE PLACEMENT

The following paragraphs describe therapy electrodes and standard paddles placement, including special placement situations.

Anterior-lateral Placement

Anterior-lateral placement allows for ECG monitoring, defibrillation, synchronized cardioversion, and noninvasive pacing.

1 Place either the

♥ or + therapy electrode, or apex paddle lateral to the patient's left nipple in

the midaxillary line, with the center of the electrode in the midaxillary line, if possible. Refer to

Figure 4-1.

Figure 4-1 Anterior-lateral Placement

2 Place the other therapy electrode or sternum paddle on the patient’s upper right torso, lateral

to the sternum, and below the clavicle as shown in Figure 4-1.

Anterior-posterior Placement

Anterior-posterior is an alternative position for noninvasive pacing, manual defibrillation, and synchronized cardioversion, but not for ECG monitoring or automated defibrillation. The ECG signal obtained through electrodes in this position is not a standard lead. (For pediatric applications, see "Pediatric Defibrillation," page 4-21.)

4Therapy

1 Place either the

♥ or + therapy electrode over the left precordium as shown in Figure 4-2. The

upper edge of the electrode should be below the nipple. Avoid placement over the nipple, the diaphragm, or the bony prominence of the sternum if possible.

2 Place the other electrode behind the heart in the infrascapular area as shown in Figure 4-2.

For patient comfort, place the cable connection away from the spine. Do not place the electrode over the bony prominences of the spine or scapula.

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 4-3

Therapy

QUIK-COMBO Electrodes

FAST-PATCH Electrodes

ANTERIO R

POSTERIOR

Figure 4-2 Anterior-posterior Placement for Noninvasive Pacing or Defibrillation

Special Placement Situations

When placing therapy electrodes or standard paddles, be aware of the special requirements in the following possible situations.

Synchronized Cardioversion

Alternative anterior-posterior placements for cardioversion of supraventricular arrhythmias include:

• Place the

♥ or + therapy electrode over the left precordium and the other electrode on the

patient’s right posterior infrascapular area

– or –

•Place the

♥ or + therapy electrode to the right of the sternum and the other electrode on the

patient’s posterior left infrascapular area.

Obese Patients or Patients with Large Breasts

Apply therapy electrodes or standard paddles to a flat area on the chest, if possible. If skin folds or breast tissue prevent good adhesion, it may be necessary to spread skin folds apart to create a flat surface.

Thin Patients

Follow the contour of the ribs and spaces when pressing the therapy electrodes onto the torso. This limits air spaces or gaps under the electrodes and promotes good skin contact.

Patients with Implanted Pacemakers

If possible, place therapy electrodes or standard paddles away from the internal pacemaker generator to help prevent damage to the pacemaker. Treat the patient like any other patient requiring care. When operating the defibrillator in AED mode, pacemaker pulses may prevent advisement of an appropriate shock, regardless of the patient’s underlying rhythm.

Patients with Implanted Defibrillators

Apply therapy electrodes or standard paddles in the anterior-lateral position and treat this patient as any other patient requiring emergency care. If defibrillation is unsuccessful, it may be necessary to try alternate electrode placement (anterior-posterior) due to the insulative properties of implanted defibrillator electrodes.

4-4 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

AUTOMATED EXTERNAL DEFIBRILLATION

The following paragraphs include:

• AED Warnings

• AED Setup

• AED Procedure

• Special AED Setup Options

• Troubleshooting Tips for AED Mode

• Switching from AED to Manual Mode

AED Warnings

Therapy

WARNING!

Possible misinterpretation of data.

Do not analyze while patient is moving or being transported. Motion artifact may affect the ECG signal resulting in an inappropriate may delay analysis. Stop motion and stand clear of patient during analysis.

Pediatric patient safety risk.

In AED mode, the LIFEPAK 20e defibrillator/monitor is not intended for use on pediatric patients less than eight years old.

SHOCK or NO SHOCK ADVISED message. Motion detection

AED Setup

You can set up the LIFEPAK 20e defibrillator/monitor to turn on in AED mode before placing the defibrillator in use (refer to Section 8).

When illuminated, the AED mode LED indicates that the Continuous Patient Surveillance System (CPSS) is active. CPSS automatically monitors the patient ECG for a potentially shockable rhythm.

When the ECG analysis system that advises the user if it detects a shockable or nonshockable rhythm.

The LIFEPAK 20e defibrillator/monitor can be setup to display the ECG waveform in AED mode or to not display a waveform. The operation in AED mode remains the same whether or not the ECG waveform is displayed.

ANALYZE button is pressed, the Shock Advisory System (SAS) is activated. SAS is an

4Therapy

When the ECG waveform is set to ON in the setup options (refer to Section 8), the ECG appears with all of the AED messages and prompts, as shown in the screen to the left.

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 4-5

Therapy

When the ECG waveform is set to OFF in the setup options, the messages and prompts fill the screen as shown in the screen to the left.

When the CPR metronome is set to ON in the setup options (refer to Section 8), the CPR metronome icon is displayed and the metronome sounds automatically during CPR times. You cannot enable or disable the CPR metronome while in AED mode. Refer to "CPR

Metronome," page 4-17, for more information.

AED Procedure

The following descriptions of voice prompts and messages are based on the factory default settings for AED mode. The default settings are consistent with 2010 American Heart Association (AHA) and European Resuscitation Council (ERC) guidelines. Changing the setup options may result in different AED behavior. Refer to Section 8 for setup option choices.

1 Verify that the patient is in cardiopulmonary arrest (unresponsive, not breathing normally, and

showing no signs of circulation.) 2 Press 3 Prepare the patient for electrode placement (refer to "Paddles Monitoring Procedure" on

4 Connect the therapy electrodes to the therapy cable, and confirm cable connection to the

5 Apply the electrodes to the patient's chest in the anterior-lateral position (refer to "Anterior-

ON.

page 3-4).

The CONNECT ELECTRODES message and voice prompt occur until the patient is connected to the AED.

defibrillator.

lateral Placement," page 4-3).

4-6 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

6 Press the ANALYZE button to initiate analysis. Stop CPR.

The PUSH ANALYZE message and voice prompt occur when the patient is properly connected to the AED. The

PUSH ANALYZE message will stay on the

screen and the analyze LED flashes until

ANALYZE is pressed.

7 Follow screen messages and voice prompts provided by the AED.

You will see and hear ANALYZING NOW,

STAND CLEAR

the patient or therapy cable during analysis. ECG analysis requires approximately 6 to 9 seconds. The analyze LED illuminates during analysis.

Therapy

. Do not touch or move

4Therapy

The SAS analyzes the patient's ECG and advises either

ADVISED

Shock Advised

SHOCK ADVISED or NO SHOCK

If the AED detects a shockable ECG rhythm, you will see and hear

ADVISED

. The AED begins charging to

SHOCK

the setup joule setting for shock #1. A rising tone indicates that the AED is charging.

When charging is complete, the AED displays the available energy.

You will see and hear STAND CLEAR,

PUSH TO SHOCK

( ) followed by a “shock ready” tone. The shock LED flashes. Clear everyone away from the patient, bed, or any equipment connected to the patient.

Press the button to discharge the AED.

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 4-7

Therapy

Note: If you do not press the

button within 60 seconds, the AED disarms the shock button, and the

DISARMING message appears.

When the button is pressed you will see the message

ENERGY DELIVERED

indicating energy transfer was completed.

When energy transfer is complete the shock counter increases by 1. This will continue to increase incrementally with every energy transfer.

No Shock Advised

After a shock is delivered you will see and hear

START CPR. A countdown

timer (min:sec format) continues for the duration specified in the

CPR TIME 1

setup option.

Note: If the CPR metronome is set to be on during CPR times, you will hear audible “tocks” and ventilation prompts or tones.

When the CPR countdown time ends, you will see and hear

PUSH ANALYZE.

This message stays on the screen and the voice prompt will repeat every 20 seconds until you press the

ANALYZE

button.

If the AED detects a nonshockable rhythm, you will see and hear

SHOCK ADVISED

. The AED will not

charge, and a shock can not be delivered.

4-8 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Proper Connection

Therapy

After a NO SHOCK ADVISED prompt you will see and hear

START CPR. A

countdown timer (min:sec format) continues for the duration specified in the

CPR TIME 2 setup option. (Refer to

Section 8).

Note: If the CPR metronome is set to be on during CPR times, you will hear audible “tocks” and ventilation prompts or tones.

When the CPR countdown time ends, you will see and hear

PUSH ANALYZE.

This message stays on the screen and the voice prompt will repeat every 20 seconds until you press the

ANALYZE

button.

4Therapy

If therapy electrodes are not connected to the therapy cable or not placed on the patient’s chest, the

ELECTRODES

CONNECT

message and voice prompt occur until the patient is connected to the AED.

If the therapy cable is not connected to the defibrillator, you will see the

CONNECT CABLE message until the

cable is connected.

If the test plug is connected to the therapy cable when analysis is initiated, the

REMOVE TEST PLUG message and

voice prompt occurs.

After you remove the test plug from the therapy cable, the message and voice prompt

CONNECT ELECTRODES occurs

until the patient is connected to the AED.

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 4-9

Therapy

Motion Detected

Continuous Patient Surveillance System

If motion is detected during the ECG analysis, you will see and hear

DETECTED, STOP MOTION

MOTION

followed by a warning tone. Analysis is inhibited up to 10 seconds. After 10 seconds, even if motion is still present, the analysis proceeds to completion. Refer to Tab le

4-1 for possible motion causes and

Special AED Setup Options

The following descriptions of voice prompts and messages explain special cprMAX technology setup options (refer to Appendix F).

Initial CPR - CPR First

When the INITIAL CPR option is set to CPR FIRST, you will be prompted to START CPR immediately after the AED is turned on.

You will see and hear START CPR.

4-10 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Therapy

After 3 seconds, a countdown timer continues for the duration specified in the initial CPR period and you will see and hear

ARREST, PUSH ANALYZE

IF YOU WITNESSED THE

. This provides an opportunity to end the initial CPR early and proceed to analysis.

• If you did witness the arrest, you should press ANALYZE and proceed directly to analysis. This will end the CPR period and you will see and hear

ANALYZING NOW, STAND CLEAR.

Note: The decision to end CPR early is based on your hospital protocol.

• If you did not witness the arrest, you should perform CPR and not press

INITIAL CPR countdown timer continues for the duration specified in the INITIAL CPR TIME

setup option, for example, 90 seconds. When

PUSH ANALYZE.

INITIAL CPR TIME ends, you will see and hear

ANALYZE. The

Initial CPR - Analyze First

When the INITIAL CPR option is set to ANALYZE FIRST, you will be prompted to perform analysis after the AED is turned on. CPR is prompted after the AED completes the analysis.

If the electrodes are not attached to the patient, you will see and hear before you are prompted to perform analysis.

No Shock Advised

If the AED detects a nonshockable rhythm, you will be prompted to

CPR.

A countdown timer (min:sec format) continues for the duration specified in the option. (Refer to Section 8).

CONNECT ELECTRODES

START

INITIAL CPR TIME setup

4Therapy

When initial CPR time ends, you will see and hear NO SHOCK ADVISED followed by PUSH

ANALYZE

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 4-11

Therapy

Shock Advised

If the AED detects a shockable rhythm, you will see and hear followed by

ARREST, PUSH ANALYZE

IF YOU WITNESSED THE

START CPR

. This provides an opportunity to end the initial CPR early and proceed directly to delivering a shock.

• If you did witness the arrest, you should press ANALYZE and proceed directly to shock. This will end the CPR period and you will see and hear

TO SHOCK

( ). Proceed according to your training with the AED for delivering the shock.

SHOCK ADVISED and STAND CLEAR, PUSH

Note: The decision to end CPR early is based on your hospital protocol.

• If you did not witness the arrest, you should perform CPR and not press

INITIAL CPR countdown timer continues for the duration specified in the INITIAL CPR TIME

ANALYZE. The

setup option, for example, 90 seconds. When initial CPR time ends, you will see and hear

SHOCK ADVISED. Proceed according to your training with the AED for delivering a shock.

PreShock CPR Time

When PRESHOCK CPR time is set to 15 seconds or more, you are prompted to start CPR immediately after a shockable rhythm is detected, before the shock is delivered.

After analysis is complete, you will see and hear timer (min:sec format) continues for the duration specified in the

CPR

seconds). When CPR time ends you will then see

and hear according to your training with the AED for delivering a shock.

The

SHOCK button is disabled during the preshock CPR interval to avoid accidental shock

delivery while the defibrillator is charged and a responder is performing CPR.

START CPR. A countdown

PRESHOCK

time setup option (for example, 15

SHOCK ADVISED. Proceed

4-12 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Troubleshooting Tips for AED Mode

Table 4-1 Troubleshooting Tips for AED Mode

Observation Possible Cause Corrective Action

1 CONNECT ELECTRODES

message appears.

REMOVE TEST PLUG

message appears.

MOTION DETECTED and STOP MOTION messages

appear during analysis.

DISARMING message

appears.

5 Voice prompts sound faint

or distorted.

LOW IMPEDANCE– RECHARGING

message

appears.

7 Metronome not heard. Metronome only sounds during

Inadequate connection to defibrillator.

Electrodes do not adhere properly to the patient.

• Check for electrode connection.

• Press electrodes firmly on patient’s skin.

• Clean, shave, and dry the patient’s skin as recommended.

Electrodes are dry, damaged,

• Replace the electrodes.

or out of date.

Test plug connected to therapy cable.

• Disconnect test plug from therapy cable.

• Connect electrodes to therapy cable.

Patient movement. • Stop CPR during analysis.

• When patient is being manually ventilated, press

ANALYZE after complete

exhalation

• Move patient to stable location when possible.

Patient movement because of agonal respirations.

• Press

ANALYZE immediately

after exhalation or wait until agonal respirations are slower or absent.

Electrical/radio frequency interference.

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

Therapy cable or electrodes disconnected from AED or

• Confirm secure connection and press

ANALYZE.

patient.

Shock button not pressed within 60 seconds or door is open.

• Press

ANALYZE again. SHOCK immediately

when directed.

Low battery power. • Connect to AC power.

Patient impedance <15 ohms

• No action required.

detected.

• No action required.

CPR time.

Metronome not set to be AED mode.

ON in

• Refer to "AED Mode Setup

Menu," page 8-7.

Therapy

4Therapy

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 4-13

Therapy

Switching from AED to Manual Mode

If the front console door is closed, you can enter manual mode by pressing the MANUAL button located in the lower left corner of the door. This opens the door and automatically takes the defibrillator out of AED mode, allowing you to access manual mode defibrillation and pacing.

Note: Closing the door again will not place the defibrillator in AED mode. Pressing

ANALYZE

while the defibrillator is in manual mode will place the defibrillator in AED mode.

If the door is not installed, or to manually switch to manual mode, press one of the following keys:

ENERGY SELECT, CHARGE, PACER, LEAD.

Depending on the defibrillator’s configuration, continue to manual mode as follows:

• Direct. No restrictions to manual mode - access is immediate.

• Confirm. A confirmation overlay appears:

Select YES to change to manual mode.

• Passcode. A passcode overlay appears:

Enter the passcode to change to manual mode.

Refer to Section 8 for information about changing the defibrillation mode.

Note: If the CPR metronome is sounding in AED mode, it continues sounding when the device switches to manual mode. If the CPR metronome is silent in AED mode, it continues to be silent in manual mode. To turn the metronome on or off while in manual mode, use the Speed Dial to select the

CPR METRONOME icon. Refer to "CPR Metronome," page 4-17, for

more information.

MANUAL DEFIBRILLATION

The following paragraphs describe:

• Manual Defibrillation Warnings

• Impedance

• Defibrillation Procedure

• CPR Metronome

• Synchronized Cardioversion Procedure

• Remote Synchronization Procedure

4-14 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Manual Defibrillation Warnings

WARNINGS!

Possible fire, burns, and ineffective energy delivery.

Precordial lead electrodes and lead wires may interfere with the placement of standard paddles or therapy electrodes. Before defibrillation, remove any interfering precordial lead electrodes and lead wires.

Shock hazard.

Conductive gel (wet or dry) on the paddle handles can allow the electrical energy to discharge through the operator during defibrillation. Completely clean the paddle electrode surfaces, handles, and storage area after defibrillation.

Possible patient skin burns.

During defibrillation, air pockets between the skin and standard paddles can cause patient skin burns. Completely cover paddle electrode surfaces with fresh conductive gel and apply 11.3 kg (25 lb) of pressure per paddle during discharge.

Possible paddle damage and patient skin burns.

Discharging the defibrillator with the standard paddle surfaces shorted together can pit or damage the paddle electrode surface. Pitted or damaged paddle surfaces may cause patient skin burns during defibrillation. Discharge the defibrillator only as described in these operating instructions.

Therapy

4Therapy

Possible burns and ineffective energy delivery.

A gel pathway on the skin between the standard paddles will cause defibrillating energy to arc between paddles and divert energy away from the heart muscle. Do not allow conductive gel (wet or dry) to become continuous between paddle sites.

Possible damage to defibrillator and defibrillator shutdown.

When used in conjunction with another defibrillator to deliver more than 360J, one or both defibrillators may be damaged and shutdown may occur due to excessive currents. Avoid simultaneous discharge from both defibrillators and maintain a backup defibrillator in case one or both defibrillators shut down. If the defibrillator shuts down, take the defibrillator out of service and contact a qualified service technician.

To use the LIFEPAK 20e defibrillator/monitor primarily as a manual defibrillator, configure the defibrillator before placing the defibrillator in use. To configure the defibrillator, refer to Section 8.

Impedance

LIFEPAK biphasic defibrillators measure the patient's transthoracic impedance and automatically adjust the defibrillation waveform voltage and current duration to meet the needs of the individual patient.

Impedance is measured whenever the defibrillator is charged. To ensure correct patient impedance readings, you should always charge the defibrillator when the standard paddles (hard paddles) or QUIK-COMBO electrodes are in contact with the patient's chest.

If the standard paddles are in the paddle wells or touching face to face (shorted paddles) when the defibrillator is charged, the defibrillator limits the available energy to 79 joules This prevents damage to the internal circuits, in the event the energy is discharged while the hard paddles are still in the paddle wells or shorted together. If the defibrillator is charged to 80 joules or more and energy is discharged when the hard paddles are seated in the paddle wells, the display indicates the selected energy available and the automatic printout annotates time, date and Shock 1 79 J.

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 4-15

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If the defibrillator is charged to 80 joules or more with paddles in the paddle wells, and then the paddles are removed and placed on a patient, the defibrillator continues charging to the selected energy and defibrillation may be completed as usual. When charging the defibrillator with the paddles on the patient’s chest, the defibrillator automatically adjusts the waveform voltage and current duration based on the patient's impedance. It is important to understand that this automatic adjustment does not occur when the defibrillator is charged with the paddles seated in the paddle wells.

When the paddles or QUIK-COMBO electrodes are on the patient's chest when the defibrillator is charged and the defibrillator measures an impedance of 15 ohms or less, the defibrillator disarms the capacitor and automatically recharges to a lower energy setting. When this condition occurs, the

LOW IMPEDANCE-RECHARGING message appears on the display. When charging is

complete, defibrillation may be completed as usual.

Defibrillation Procedure

You can configure the LIFEPAK 20e defibrillator/monitor to automatically sequence energy levels. Refer to "Manual Mode Setup Menu," page 8-5.

1 Press

ON.

2 Identify the electrode or paddle sites on the patient. Use either the anterior-lateral or anterior-

posterior position as described on page 4-3.

3 Prepare the patient’s skin for electrode application:

• If possible, place the patient on a firm surface away from standing water.

• Remove clothing from the patient’s upper torso.

• Remove excessive hair from the electrode sites; if shaving is necessary, avoid cutting the skin.

• Clean the skin and dry it briskly with a towel or gauze.

• Do not apply alcohol, tincture of benzoin, or antiperspirant to the skin.

4 Connect the therapy electrodes to the therapy cable, and confirm cable connection to the

defibrillator.

Note: When in

PADDLES lead, if the REMOVE TEST PLUG message appears, disconnect

test plug and connect therapy electrodes to QUIK-COMBO therapy cable.

5 Apply therapy electrodes to the patient in anterior-lateral or anterior-posterior position. If using

standard paddles, apply conductive gel to the paddles and place paddles on the patient’s

chest. 6 Press 7 Press

ENERGY SELECT.

CHARGE. While the defibrillator is charging, a charging bar appears and a ramping tone

sounds, indicating the charging energy level. When the defibrillator is fully charged, an overlay

appears (refer to "Defibrillation Procedure," page 4-16). 8 Make certain all personnel, including the operator, stand clear of the patient, bed, and any

equipment connected to the patient. 9 Confirm ECG rhythms and available energy. 10 Press the

SHOCK button on the defibrillator or the SHOCK buttons on the standard paddles to

discharge energy to the patient. For standard paddles, apply firm pressure with both paddles to

the patient’s chest, and press both paddle buttons simultaneously to discharge energy to the

patient. For safety reasons, the

SHOCK button on the defibrillator front panel is disabled when

using standard paddles.

Note: To disarm (cancel the charge), press the Speed Dial. The defibrillator disarms

automatically if shock buttons are not pressed within 60 seconds, or if you change the energy selection after charging begins. Press

CHARGE to restart charging.

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11 Observe the patient and the ECG rhythm. If an additional shock is necessary, repeat the

procedure beginning at Step 6. Note: If the

ABNORMAL ENERGY DELIVERY message appears and the shock is not

effective, increase energy, if necessary, and repeat shock. (Also refer to page 4-24.)

CPR Metronome

When CPR is required during cardiac arrest, the CPR metronome provides audible prompts that guide the user to deliver CPR with proper timing in accordance with the 2010 American Heart Association and European Resuscitation Council CPR guidelines.

CPR Metronome Warnings

WARNING!

CPR Delivered When Not Needed.

The metronome sounds do not indicate information regarding the patient’s condition. Because patient status can change in a short time, the patient should be assessed at all times. Do not perform CPR on a patient who is responsive or is breathing normally.

Note: The CPR metronome is a tool to be used as a timing aid during CPR. Assess the patient at all times and provide CPR only when indicated. Provide CPR according to your training and protocols.

How the CPR Metronome Works

The metronome provides audible “tocks” at a rate of 100/minute to guide the rescuer in performing chest compressions. The metronome also provides audible ventilation prompts (either a tone or verbal “ventilate”) to cue the rescuer when to provide ventilations. The metronome prompts the rescuer to perform CPR at the selected compression to ventilation (C:V) ratio.

Age-Airway Considerations

The default C:V ratio for the metronome (in both AED and Manual modes) is Adult - No Airway (30:2) because most patients in cardiac arrest are adults who have an initially unsecured airway. In Manual mode, the user can choose the most appropriate C:V ratio based on the patient’s age and current airway status. The Age-Airway selection determines the C:V ratio of the metronome sounds. The default C:V ratios are shown in Table 4-2.

Table 4-2 Default Age-Airway C:V Ratios in Manual Mode

Age-Airway C:V Ratio

Adult - No Airway* 30:2

Adult - Airway** 10:1

Youth - No Airway*** 15:2

Youth - Airway 10:1

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* No Airway = No artificial airway in place ** Airway = Advanced artificial airway in place *** Youth = Pre-pubescent child

Note: The compression-to-ventilation ratio selections can be set up according to local medical protocols. For more information, refer to "CPR Metronome Setup Menu," page 8-8.

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 4-17

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1 Use the Speed Dial to select the CPR

METRONOME

icon. The CPR Metronome menu appears and the metronome is activated using the AdultNo Airway default setting.

2 Use the Speed Dial to highlight and

select the desired Age-Airway setting.

CPR Metronome

Adult - No Airway

Adult - Airway

Youth - No Airway

Youth - Airway

Stop Metronome

Adult - No Airway 30:2

When the metronome is on, a message appears in the message area that indicates the current Age-Airway selection.

Activating and Deactivating the Metronome

To activate the CPR metronome in Manual mode:

Note: The CPR metronome cannot be activated during noninvasive pacing.

Note: If the VF/VT alarm is on, it is suspended when the metronome is on to prevent false

VF/VT alarms. If other vital sign alarms activate when the metronome is on, the visual indicators occur, but the alarm tone is suppressed until the metronome is deactivated.

The metronome provides “tocks” and ventilation prompts continuously until it is deactivated. To stop the metronome, select recorded in the CODE SUMMARY Event Log when CPR metronome is turned ON or OFF and when the Age-Airway setting is changed. To adjust the volume of the metronome, press

OPTIONS, select ALARM VOLUME, and change the VOLUME.

Note: If all Age-Airway selections are set to the same C:V ratio (for example, Adult - No

Airway, Adult - Airway, Youth - No Airway, and Youth - Airway all set to 10:1), the CPR metronome always provides “tocks” and ventilation prompts at the set ratio for both AED mode and Manual mode. In this situation, the CPR Metronome menu does not appear when the

CPR METRONOME icon is selected during use—selecting the CPR METRONOME icon only

activates and deactivates the metronome at the fixed C:V ratio.

STOP METRONOME in the CPR Metronome menu. An event is

Synchronized Cardioversion Procedure

Note: The LIFEPAK 20e defibrillator/monitor can be configured to remain in synchronous

mode or to return to asynchronous mode after discharge. It is important that you know how your defibrillator is configured. Refer to "Manual Mode Setup Menu," page 8-5.

1 Press 2 Attach patient ECG cable and ECG electrodes as described previously on page 3-5. 3 Select lead II or the lead with greatest QRS complex amplitude (positive or negative).

ON.

Note: To monitor the ECG through therapy electrodes, place the electrodes in the

anterior-lateral position and select

PADDLES lead.

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WARNING!

Possible lethal arrhythmia.

Ventricular fibrillation may be induced with improper synchronization. DO NOT use the ECG from another monitor (slaving) to synchronize the LIFEPAK 20e defibrillator/monitor discharge. Always monitor the patient’s ECG directly through the ECG cable, therapy cable or use the remote synchronization procedure. Confirm proper placement of the sense markers on the ECG.

4 Press SYNC. Confirm the sync LED blinks with each detected QRS complex.

Note: Press

SYNC again to deactivate synchronous mode.

5 Observe the ECG rhythm. Confirm that a triangle sense marker appears near the middle of

each QRS complex. If the sense markers do not appear or are displayed in the wrong locations (for example, on the T-wave), select another lead. (It is normal for the sense marker location to vary slightly on each QRS complex.)

6 Prepare the patient’s skin for therapy electrode application as described in Step 3 of

Defibrillation Procedure, page 4-16.

7 Connect the therapy electrodes to the therapy cable, and confirm cable connection to the

defibrillator.

8 Apply therapy electrodes to the patient in the anterior-lateral or anterior-posterior position. If

using standard paddles, apply conductive gel to the paddles and place paddles on the

patient’s chest. 9 Press 10 Press

ENERGY SELECT. CHARGE.

Note: If the

REMOVE TEST PLUG message appears, disconnect test plug and connect

therapy electrodes to QUIK-COMBO therapy cable and press

CHARGE.

11 Make certain all personnel, including operator, stand clear of the patient, bed, and any

equipment connected to the patient. 12 Confirm ECG rhythm. Confirm available energy. 13 Press and hold the

appears on the screen. For standard paddles, press and hold both

paddles simultaneously until the

Release buttons. For safety reasons, the

SHOCK button on the defibrillator until the ENERGY DELIVERED message

SHOCK buttons on the

ENERGY DELIVERED message appears on the screen.

SHOCK button on the defibrillator is disabled when

using standard paddles.

Note: To disarm (cancel a charge), press the Speed Dial. The defibrillator disarms

automatically if shock buttons are not pressed within 60 seconds, or if you change the

energy selection after charging begins. Press

CHARGE to restart charging.

14 Observe patient and ECG rhythm. Repeat procedure from Step 4, if necessary.

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LIFEPAK 20e Defibrillator/Monitor Operating Instructions 4-19

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Remote Synchronization Procedure

WARNINGS!

Possible lethal arrhythmia.

Ventricular fibrillation may be induced with improper synchronization. The hospital’s biomedical engineering staff should perform synchronization delay measurements on the system, as a whole, to ensure that the 60 ms limit for synchronization delay is not exceeded, per requirements as specified in AAMI DF2 (1996). Always confirm proper placement of the sense markers on the ECG.

Possible monitor incompatibility

If the R-wave synchronization markers do not appear to be nearly simultaneous with the Rwaves on the remote monitor display or are not present, do not proceed with synchronized cardioversion.

The LIFEPAK 20e defibrillator/monitor can be configured to receive an ECG source from a remote monitor (such as a bedside ECG monitoring system) by means of the ECG/Sync connector on the back of the defibrillator/monitor. Refer to "Manual Mode Setup Menu,"

page 8-5. The remote monitor must have a sync out connector and a cable must be provided to

make this connection. Refer to the LIFEPAK 20e Defibrillator/Monitor Service Manual for more details.

Note: The LIFEPAK 20e defibrillator/monitor can be configured to remain in synchronous mode or to return to asynchronous mode after discharge. It is important that you know how your defibrillator is configured. Refer to "Manual Mode Setup Menu," page 8-5.

To perform the synchronized cardioversion using a remote monitoring ECG source:

1 Ensure defibrillator/monitor is connected to AC power. 2 Connect the sync cable to the defibrillator/monitor ECG/Sync connector and the remote

monitor.

3 Press

ON.

4 Attach the ECG cable from the remote monitor to the patient. 5 Press 6 Select

SYNC on the defibrillator/monitor.

REMOTE SYNC from the menu.

Note: The screen on the defibrillator/monitor will display the message

REMOTE SYNC in

place of any waveforms.

7 Observe the ECG rhythm on the remote monitor. Confirm that a sense marker appears above

each QRS complex.

8 Confirm that the sync LED on the defibrillator/monitor blinks with each detected QRS on the

remote monitor.

9 Follow Step 6 through Step 14 from "Synchronized Cardioversion Procedure" provided

previously.

4-20 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

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Sternum

Apex

Sternum

Apex

PEDIATRIC DEFIBRILLATION

Pediatric paddles are part of the standard paddle set (refer to page 5-7).

Pediatric Paddle Placement

Pediatric paddles should be used for patients weighing less than 10 kg (22 lb) or for patients whose chest size cannot accommodate the adult therapy electrodes.

Adult paddles are recommended if the paddles will fit completely on the patient’s chest. Allow at least 2.5 cm (1 in.) of space between the paddles.

For neonates with very small chests, pediatric paddles may be too large to place in the anteriorlateral position. In this situation, place paddles in the anterior-posterior position. Holding the paddles against the chest and back will support the patient on his/her side.

Do not use the pediatric paddles on adults or older children. Delivery of recommended adult energies through this relatively small electrode surface increases the possibility of skin burns.

Anterior-Lateral

The following is the standard pediatric paddle placement (refer to Figure 4-3):

• Sternum paddle to the patient’s right upper torso, lateral to the sternum and below the clavicle.

• Apex paddle lateral to the patient’s left nipple in the midaxillary line, with the center of the

paddle in the midaxillary line if possible.

Figure 4-3 Anterior-lateral Paddle Position

Anterior-Posterior

Place the sternum paddle anteriorly over the left precordium and the apex paddle posteriorly behind the heart in the infrascapular area (refer to Figure 4-4)

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Figure 4-4 Anterior-posterior Paddle Position

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 4-21

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Defibrillation Procedure

To defibrillate the patient:

1 Press

ON to turn on the defibrillator.

2 To access the pediatric paddles, slide the adult paddle forward until it releases. 3 Apply defibrillation gel to the pediatric paddle electrode surfaces. 4 Select the appropriate energy for the weight of the child according to American Heart

Association recommendations (or equivalent guidelines). 5 Place the paddles firmly on the patient's chest. 6 Press

CHARGE.

7 Make certain all personnel, including the operator, are clear of the patient, the bed, and any

equipment connected to the patient. 8 Confirm ECG rhythm and available energy. 9 Press the

SHOCK button on the defibrillator or the SHOCK buttons on the standard paddles to

discharge energy to the patient. For standard paddles, apply firm pressure with both paddles to

the patient’s chest, and press both paddle buttons simultaneously to discharge energy to the

patient. For safety reasons, the

SHOCK button on the defibrillator front panel is disabled when

using standard paddles.

Note: To disarm (cancel the charge), press the Speed Dial. The defibrillator disarms

automatically if shock buttons are not pressed within 60 seconds, or if you change the energy selection after charging begins. Press

Note: If the

ABNORMAL ENERGY DELIVERY message appears and the shock is not effective,

CHARGE to restart charging.

increase energy, if necessary, and repeat shock. (Also refer to page 4-24.)

Troubleshooting Tips for Defibrillation and Synchronized Cardioversion

Table 4-3 Troubleshooting Tips for Defibrillation and Synchronized Cardioversion

Observation Possible Cause Corrective Action

1 Charge time to 360 J

exceeds 10 seconds.

Battery low. • Connect to AC power.

• Defibrillator operating in low temperature environment (<25°C or 77°F).

2 Energy not delivered to

patient when

SHOCK

button(s) are pressed.

Defibrillator in sync mode and QRS complexes are not detected.

Defibrillator in sync mode;

SHOCK button(s) not pressed

and held until next detected

• Change ECG lead for optimum sensing QRS or deactivate

SYNC.

• Hold shock buttons until discharge occurs or next detected QRS.

QRS.

SHOCK button(s) pressed

before full charge reached.

Sixty seconds elapsed before

SHOCK button(s) pressed

• Wait for tone and message indicating full charge.

• Press

SHOCK button(s) within

60 seconds of full charge.

after full charge. Energy internally removed.

ENERGY selection changed. • Press CHARGE again.

Test plug connected to QUIK-COMBO therapy cable.

• Disconnect test plug and connect electrodes to QUIK-COMBO therapy cable.

4-22 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Table 4-3 Troubleshooting Tips for Defibrillation and Synchronized Cardioversion (Continued)

Observation Possible Cause Corrective Action

3 REMOVE TEST PLUG

message appears.

Test plug connected to QUIK-COMBO therapy cable.

• Disconnect test plug and connect electrodes to QUIK-COMBO therapy cable.

Radio frequency interference during ablation procedure.

• Monitor patient using ECG cable and therapy cable as follows:

1 Connect ECG electrodes

to patient and ECG cable.

2 Confirm device displays

patient’s ECG waveform in Channel 1 in Lead I, II, or III.

3 Connect Therapy

electrodes to patient and Therapy cable.

4 Confirm device displays

patient’s ECG waveform in Channel 2 in Paddles lead.

CONNECT CABLE or ENERGY NOT DELIVERED

message appears.

ENERGY FAULT message

appears (selected and available energy).

DISARMING message

appears.

Therapy cable became disconnected and energy was removed internally.

Defibrillator is out of calibration.

Discharge button not pressed within 60 seconds after

• Reconnect cable and press

CHARGE again.

• May still transfer energy.

• Contact qualified service personnel.

• Recharge the defibrillator if desired.

charge complete.

Energy selected after charge

• Recharge the defibrillator.

complete.

Therapy cable disconnects. • Reconnect electrode/cable.

7 Patient didn’t jump (no

muscle response) during defibrillator discharge.

Patient muscle response is variable and depends on patient condition. Lack of

• No action needed.

visible response to defibrillation does not necessarily mean the discharge did not occur.

Therapy cable not connected to therapy electrodes.

• Connect electrodes to therapy cable.

Therapy

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LIFEPAK 20e Defibrillator/Monitor Operating Instructions 4-23

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Table 4-3 Troubleshooting Tips for Defibrillation and Synchronized Cardioversion (Continued)

Observation Possible Cause Corrective Action

8 ABNORMAL ENERGY

DELIVERY

message appears and Shock XJ Abnormal annotated on printout.

Open air discharge with standard paddles.

Discharge occurs with

• Press paddles firmly on patient’s chest when discharging.

• Perform test discharges with defibrillation checker.

• Refer to warning, page 4-15.

standard paddles shorted together.

Patient impedance out of range.

• Increase energy and/or repeat discharges as needed.

• Consider replacing disposable therapy electrodes with new.

CONNECT ELECTRODES

message appears.

Inadequate connection to defibrillator.

Electrodes do not adhere properly to the patient.

• Check for electrode connection.

• Press electrodes firmly on patient’s skin.

• Clean, shave, and dry the patient’s skin as recommended.

Electrodes are dry, damaged,

• Replace the electrodes.

or out of date.

CONNECT TO AC POWER

message appears.

CONNECT SYNC CABLE TO

REMOTE MONITOR

message

appears.

Remote sync is selected and the defibrillator is not connected to AC power.

Remote sync is selected and the defibrillator is not connected to the remote

• Connect to AC power.

• Press

SYNC to turn off remote

sync.

• Connect to remote monitor.

• Press

SYNC to turn off remote

synchronization.

monitor.

LOW IMPEDANCE–

RECHARGING

message

Patient impedance of <15 ohms detected.

• No action required.

appears.

SEARCHING FOR SIGNAL

message appears.

Remote sync is selected and the defibrillator is qualifying

• No action required.

the input signal.

4-24 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

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NONINVASIVE PACING

The LIFEPAK 20e defibrillator/monitor provides noninvasive pacing using QUIK-COMBO electrodes.

The following paragraphs include:

• Noninvasive Pacing Warnings

• Demand and Nondemand Pacing

• Noninvasive Pacing Procedure

• Troubleshooting Tips for Noninvasive Pacing

For information about noninvasive pediatric pacing, refer to the Physio-Control Therapy Electrodes Operating Instructions.

Noninvasive Pacing Warnings

WARNINGS!

Possible inducement of ventricular fibrillation.

Sinus bradycardia may be physiologic in severe hypothermia (i.e., appropriate to maintain sufficient oxygen delivery when hypothermia is present), and cardiac pacing is usually not indicated.

Possible interruption of therapy.

Observe the patient continuously while the pacemaker is in use. Patient response to pacing therapy, e.g., capture threshold, may change over time.

Possible inability to pace.

Using other manufacturers’ combination therapy electrodes with this device could cause a decrease in pacing efficacy or the inability to pace because of unacceptably high impedance levels.

Possible patient skin burns.

Prolonged noninvasive pacing may cause patient skin irritation and burns, especially with higher pacing current levels. Discontinue noninvasive pacing if skin becomes burned and another method of pacing is available.

Demand and Nondemand Pacing

The noninvasive pacemaker can be used for either demand (synchronous) or nondemand (asynchronous) pacing modes.

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The demand mode is used for most patients. In the demand mode, the LIFEPAK 20e defibrillator/ monitor/pacemaker inhibits pacing when it senses the patient’s own beats (intrinsic QRSs). In demand mode, if the ECG amplitude is too low to detect the patient’s beats, or if an ECG lead becomes detached so that the ECG rhythm is not present, the pacemaker generates pacing pulses asynchronously. This means that the pacemaker generates pacing pulses at the selected rate, regardless of the patient’s ECG rhythm.

Asynchronous or nondemand mode can be selected if noise or artifact interferes with proper sensing of QRS complexes. Press the

OPTIONS button to access the nondemand mode. (Refer

to page 2-7.)

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 4-25

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The LIFEPAK 20e defibrillator/monitor has an integrated pulse oximeter that can be used in conjunction with a noninvasive pacemaker to help confirm capture. To confirm capture, compare the pulse rate measured by the oximeter to the set pacing rate of the pacemaker.

Noninvasive Pacing Procedure

ECG monitoring during pacing must be performed with the ECG electrodes and patient ECG cable. Pacing therapy electrodes cannot be used to monitor ECG rhythm and deliver pacing current at the same time. Be sure to place the therapy electrodes in the proper locations as described in the pacing procedure. Improper electrode placement may make a difference in the capture threshold.

To pace, perform the following:

1 Press

ON.

2 Connect the patient ECG cable, apply ECG electrodes to the ECG cable and patient, and

select Lead I, II, or III. To receive the best monitoring signal, ensure there is adequate space between the ECG electrodes and the therapy electrodes.

3 Identify the QUIK-COMBO electrode sites on the patient. For pacing, use either the anterior-

lateral or anterior-posterior position (refer to page 4-3).

4 Prepare patient's skin for electrode application as described in Step 3 of the Defibrillation

Procedure. 5 Apply QUIK-COMBO electrodes to the patient. 6 Connect the therapy electrodes to the therapy cable. 7 Press

PACER. Confirm the LED illuminates, indicating that the power is on.

Note: If the

REMOVE TEST PLUG message appears, disconnect test plug and connect

therapy electrodes to QUIK-COMBO therapy cable.

8 Observe the ECG rhythm. Confirm that a triangle sense marker appears near the middle of

each QRS complex. If the sense markers do not appear or are displayed in the wrong location

(for example, on the T-wave)

, select another lead. (It is normal for the sense marker location

to vary slightly on each QRS complex.) 9 Press

RATE or rotate the Speed Dial to select the desired pacing rate.

Note: The

RATE button changes the rate in 10 pulse per minute (ppm) increments; the

Speed Dial changes the rate in 5 ppm increments.

10 Press

CURRENT or rotate the Speed Dial to increase current until electrical capture occurs.

For each delivered pacing stimulus, the

PACER indicator flashes off and a positive pace

marker displays on the ECG waveform. 11 Palpate the patient's pulse or check blood pressure and compare the SpO

pulse rate with the

set pacing rate to assess for mechanical capture. Consider use of sedation or analgesia if

patient is uncomfortable.

Note: The

CURRENT button changes the current in 10 mA increments; the Speed Dial

changes the current in 5 mA increments.

Note: To change rate or current during pacing, press

RATE or CURRENT, and then rotate

the Speed Dial.

Note: To interrupt pacing and view the patient's intrinsic rhythm, press and hold the

PAUSE button. This causes the pacer to pace at 25% of the set rate. Release the PAUSE

button to resume pacing at the set rate.

12 To stop pacing, reduce current to zero or press

Note: To defibrillate and stop noninvasive pacing, press

PACER.

ENERGY SELECT or charge the

defibrillator. Pacing automatically stops. Proceed with defibrillation.

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If the monitor detects ECG leads off during pacing, pacing continues at a fixed rate until the ECG lead is reattached. During fixed-rate pacing, the pacemaker delivers pulses at the set pace rate regardless of any intrinsic beats that the patient may have. The monitor continues to display the pacing rate (ppm) and the current (mA). To reestablish demand pacing, reattach the ECG lead.

While pacing, visually monitor the patient at all times, do not rely on the

ECG LEADS OFF warning

to detect changes in pacing function. Routinely assess the ECG for proper sensing, pace pulse delivery, electrical capture, and mechanical capture.

If pacing electrodes detach during pacing, the

CONNECT ELECTRODES and PACING STOPPED

messages appear and an alarm sounds. The pacing rate is maintained and the current resets to 0 mA. Reattaching the pacing electrodes silences the alarm and removes the

ELECTRODES

message. The current remains at 0 mA until you increase the current manually.

CONNECT

Troubleshooting Tips for Noninvasive Pacing

Table 4-4 Troubleshooting Tips for Noninvasive Pacing

Observation Possible Cause Corrective Action

1 Device does not function

PACER is pressed.

when

PACER LED on, but CURRENT (MA) will not

increase.

PACER LED on, CURRENT (MA) >0, but

pace markers absent (not pacing).

4 Pacing stops

spontaneously.

Power off. • Check if power is

ON.

Low battery. • Connect to AC power.

Therapy electrodes off. • Check for message

displayed.

• Inspect therapy cable and electrode connections.

Pacing rate set below patient's

• Increase pacing rate.

intrinsic rate.

Pacer oversensing (ECG artifact, ECG size too high).

• Establish clean ECG; decrease ECG size.

• Select nondemand pacing.

PACER button pressed off. • Press PACER and increase

the current.

Internal error detected. Service message indicates an internal failure.

• Check for service indicator.

• Cycle power and start pacing again.

• Obtain service by qualified service personnel.

Therapy electrode off. • Check for message. Check

pacing cable and electrode connections.

ENERGY SELECT or CHARGE

pressed.

• Press PACER and increase current.

• Check for service message.

• Cycle power and start pacing again.

Radio frequency interference. • Move radio equipment away

from pacemaker.

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LIFEPAK 20e Defibrillator/Monitor Operating Instructions 4-27

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Table 4-4 Troubleshooting Tips for Noninvasive Pacing (Continued)

Observation Possible Cause Corrective Action

5 Monitor screen displays

distortion while pacing.

ECG electrodes not optimally placed with respect to pacing

• Reposition electrodes away from pacing electrodes.

electrodes.

• Select another lead (I, II, or III).

• Consider changing pacing rate.

(Administer sedation/

6 Capture does not occur

with pacing stimulus.

Patient response to pacing is highly variable with respect to capture threshold and ECG distortion.

Current (mA) set too low. • Increase pacing current.

analgesia as needed.)

CONNECT ELECTRODES

message appears.

Pacing cable or electrode disconnected.

• Reconnect and set current.

Electrodes not adhering to skin. • Prepare skin.

Electrodes outdated. • Apply new electrodes and set

current.

8 Pacing stops

spontaneously and

FAULT

message appears.

PACER

Internal error detected. • Cycle power and start pacing

again.

• Obtain service by qualified service personnel.

REMOVE TEST PLUG

message appears.

Test plug connected to therapy cable.

• Disconnect test plug from therapy cable.

• Connect electrodes to therapy cable.

10 Intrinsic QRS complexes

not sensed when pacing.

ECG amplitude too low to be sensed.

Intrinsic QRS complexes are

• Select another lead.

• Adjust pacing rate.

occurring during pacemaker's refractory period.

11 Pacing starts

spontaneously.

Patient’s heart rate falls below set pacing rate.

During standby pacing, ECG

• Appropriate pacemaker function assess patient.

• Reconnect ECG lead.

lead disconnects.

12 Set pacing rate (ppm)

and ECG paced rate do

Internal error detected. • Print ECG and calculate the

pace rate.

not appear to match.

13 Improper sensing

(for example, sensing on

QRS complex too small. T-wave too large.

• Select another lead.

T-waves).

4-28 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

PADDLE ACCESSORY OPTIONS

Therapy Electrodes page 5-2 Standard Paddle Set (Optional) 5-7 Sterilizable Internal Defibrillation Paddles 5-9

5 Paddle Accessory Options

LIFEPAK 20e Defibrillator/Monitor Operating Instructions 5-1

Paddle Accessory Options

THERAPY ELECTRODES

The following paragraphs describe:

• About Therapy Electrodes

• Electrode Placement

• Cable Connection

• ECG Monitoring and Therapy Procedures

• Replacing and Removing Electrodes

• Testing

• Cleaning and Sterilizing

About Therapy Electrodes

There are two pre-gelled, self-adhesive therapy electrodes available: QUIK-COMBO pacing/ defibrillation/ECG electrodes and FAST-PATCH defibrillation/ECG electrodes (Figure 5-1). QUIK-COMBO electrodes are used for defibrillation, synchronized cardioversion, ECG monitoring, and pacing. FAST-PATCH electrodes can be used for defibrillation, synchronized cardioversion, and ECG monitoring, but not for pacing. To use FAST-PATCH electrodes with the LIFEPAK 20e defibrillator/monitor requires the addition of a FAST-PATCH defibrillation adapter cable.

Figure 5-1 QUIK-COMBO and FAST-PATCH Electrodes

A QUIK-COMBO or FAST-PATCH electrode set:

• Is a substitute for standard paddles.

• Provides a Lead II monitoring signal when placed in the anterior-lateral position.

• Quickly restores the ECG trace on the monitor following defibrillation.

To help prevent electrode damage:

• Do not fold the electrodes.

• Do not trim the electrodes.

• Do not crush, fold, or store the electrodes under heavy objects.

• Store therapy electrodes in a cool, dry location. These electrodes are designed to withstand environmental temperature fluctuations between -40° to 50°C (-40° to 122°F). Continuous exposure to temperatures above 23°C (73°F) reduces the shelf life of electrodes.

There are several types of QUIK-COMBO electrodes available as described in Table 5-1.

5-2 LIFEPAK 20e Defibrillator/Monitor Operating Instructions

Physio-Control LIFEPAK 20e User Manual

Specifications and Main Features

Frequently Asked Questions

User Manual

CONTENTS

1 Safety Information

2 Basic Orientation

3 Monitoring

4 Therapy

5 Paddle Accessory Options

6 Data Management

7 Maintaining the Equipment

8 Defining Setup Options

A Specifications and Performance Characteristics

B Clinical Summaries

C Screen Messages

D Operator’s Checklist

E Shock Advisory System

F About cprMAX Technology

G Docking Station

H Electromagnetic Compatibility Guidance

PREFACE

ABOUT AUTOMATED EXTERNAL DEFIBRILLATION

Operator Considerations

Indications

Contraindications

ABOUT DEFIBRILLATION THERAPY

Operator Considerations

Indications

Contraindications

ABOUT NONINVASIVE PACING

Indications

Contraindications

ABOUT SPO2 MONITORING

Indications

Contraindications

ABOUT ECG MONITORING

ABOUT ETCO2 MONITORING

Indications

Contraindications

SAFETY INFORMATION

TERMS

GENERAL WARNINGS AND CAUTIONS

SYMBOLS

BASIC ORIENTATION

INTRODUCTION

UNPACKING AND INSPECTING

CONTROLS, INDICATORS, AND CONNECTORS

Area 3

Area 4

Area 7

Changing Printer Paper

Back View

Side View of CodeManagement Module

ENTERING PATIENT DATA

SETTING ALARMS

MANAGING ALARMS

CONNECTING TO POWER

AC Operation

BATTERY OPERATION

LIFEPAK 20e Defibrillator/Monitor Battery

CodeManagement Module Battery

MONITORING

MONITORING THE ECG

ECG Monitoring Warning

Selecting ECG Lead and Size

Adjusting the Systole Tone Volume

Monitoring ECG with Paddles Accessories

Monitoring with the Patient ECG Cable

Troubleshooting Tips for ECG Monitoring

SpO2 Warnings and Cautions

When to Use a Pulse Oximeter

How a Pulse Oximeter Works

SpO2 Monitoring Considerations

SpO2 Monitoring Procedure

SpO2 Waveform

SpO2 Volume

Sensitivity

Averaging Time

Pulse Oximeter Sensors