Zoll R User guide

OPERATOR’S GUIDE

9650-0912-01 Rev. ADecember 2008

ZOLL, R Series, M Series, pedi•padz, pro•padz, stat•padz, CodeNet, Real CPR Help, RescueNet, See-Thru CPR, “Advancing Resuscitation. T oday.”, and Code-Ready are registered trademarks, and SurePower, OneStep, Smart Alarms, CPR Index, Defib Mentor, and Rectilinear Biphasic are trademarks of ZOLL Medical Corporation. All other trad emarks and registered trademarks are property of their respectiv e owners.

the United States and/or other countries.

Ch a p t e r 1 General Information

Product Description ............................................................................................................1-1

How to Use This Manual.....................................................................................................1-2

Operator’s Guide Updates..................................................................................................1-3

Unpacking...........................................................................................................................1-3

Symbols Used on the Equipment .......................................................................................1-3

Conventions........................................................................................................................1-6

Defibrillator Function...........................................................................................................1-6

Intended Use — Manual Operation ............................................................................1-6

Intended Use — ECG Monitoring ...............................................................................1-7

Intended Use — Real CPR Help ................................................................................1-7

Defibrillator Complications ..........................................................................................1-7

Defibrillator Output Energy .........................................................................................1-7

External Pacemaker (Optional)...........................................................................................1-8

Intended Use — Pacemaker .......................................................................................1-8

Pacemaker Complications ..........................................................................................1-9

Pediatric Pacing ........................................................................................................1-10

ECG Monitoring................................................................................................................1-10

Recorder Function............................................................................................................1-10

Paddles and Electrodes....................................................................................................1-10

Batteries............................................................................................................................1-11

Code-Ready System.........................................................................................................1-12

Safety Considerations.......................................................................................................1-12

Warnings...........................................................................................................................1-13

Operator Safety ........................................................................................................1-15

Patient Safety ...........................................................................................................1-16

Cautions............................................................................................................................1-17

Restarting the Defibrillator................................................................................................1-17

FDA Tracking Requirements.............................................................................................1-18

Notification of Adverse Events ..................................................................................1-18

Software License..............................................................................................................1-19

Service..............................................................................................................................1-19

The ZOLL Serial Number..................................................................................................1-20

Ch a p t e r 2 Product Overview

Defibrillator Controls and Indicators....................................................................................2-1

The Front Panel ..........................................................................................................2-3

Display Screen ............................................................................................................2-5

Patient Cables and Connectors ..................................................................................2-6

External Paddles .........................................................................................................2-8

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Working with Menus..........................................................................................................2-10

Defib Mentor Mode (Optional) ..................................................................................2-11

Common Tasks.................................................................................................................2-12

Replacing a Battery Pack .........................................................................................2-12

Adjusting Display Brightness ....................................................................................2-13

Using Code Markers .................................................................................................2-13

Ch a p t e r 3 Manual Defibrillation

Emergency Defibrillation Procedure with Paddles..............................................................3-1

Determine the Patient’s Condition Following Local Medical Protocols .......................3-1

Begin CPR Following Local Medical Protocols. ..........................................................3-2

1 Select DEFIB ...........................................................................................................3-2

2 Charge Defibrillator ..................................................................................................3-4

3 Deliver Shock ...........................................................................................................3-5

Autoclavable External Paddles...........................................................................................3-5

Emergency Defibrillation Procedure with Hands-Free Therapy Electrodes........................3-6

Determine the Patient’s Condition Following Local Medical Protocols .......................3-6

Begin CPR Following Medical Protocols ....................................................................3-6

Prepare Patient ...........................................................................................................3-6

1 Select DEFIB ...........................................................................................................3-7

2 Charge Defibrillator ..................................................................................................3-9

3 Deliver Shock ...........................................................................................................3-9

Autoclavable Electrodes...................................................................................................3-10

Chapter 4 Advisory Defibrillation (Optional)

Advisory Defibrillation Procedure........................................................................................4-2

Determine the Patient’s Condition Following Local Medical Protocols .......................4-2

Begin CPR Following Local Medical Protocols ...........................................................4-2

Prepare Patient ...........................................................................................................4-2

1 Select DEFIB ...........................................................................................................4-2

2 Press ANALYZE Button ...........................................................................................4-3

3 Press SHOCK ..........................................................................................................4-5

Advisory Function Messages..............................................................................................4-6

Warning Messages.............................................................................................................4-6

Ch a p t e r 5 Synchronized Cardioversion

Synchronized Cardioversion Procedure.............................................................................5-2

Determine the Patient’s Condition and Provide Care Following Local Medical

Protocols ..................................................................................................................5-2

Prepare Patient ...........................................................................................................5-2

1 Select DEFIB ...........................................................................................................5-3

2 Charge Defibrillator ..................................................................................................5-4

3 Deliver SHOCK ........................................................................................................5-5

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Remote Synchronized Cardioversion Procedure................................................................5-5

Determine the Patient’s Condition and Provide Care Following Local Medical

Protocols ..................................................................................................................5-6

Prepare Patient ...........................................................................................................5-6

1 Select DEFIB ...........................................................................................................5-6

2 Charge Defibrillator ..................................................................................................5-7

3 Deliver SHOCK ........................................................................................................5-7

Chapter 6 Real CPR Help

Real CPR Help Field...........................................................................................................6-2

CPR Index (Optional) ..................................................................................................6-2

CPR Idle Time Display ................................................................................................6-2

CPR Metronome .........................................................................................................6-3

CPR Voice Prompts............................................................................................................6-3

Chest Compressions Waveform.........................................................................................6-3

Displaying the CPR Waveform...........................................................................................6-3

Chapter 7 See-Thru CPR (Optional)

Using See-Thru CPR..........................................................................................................7-2

Examples .................................................................................................................... 7-2

Ch a p t e r 8 Noninvasive Temporary Pacing (Optional)

Noninvasive Temporary Pacing..........................................................................................8-2

Determine Patient Condition and Provide Care Following Local Medical Protocols. ..8-2

Prepare the Patient .....................................................................................................8-2

1 Apply ECG Electrodes/Hands-Free Therapy Electrodes .........................................8-2

2 Turn Selector Switch to PACER ..............................................................................8-3

3 Set Pacer Rate ........................................................................................................8-3

4 Set Pacer Output .....................................................................................................8-4

5 Determine Capture ..................................................................................................8-5

6 Determine Optimum Threshold ................................................................................8-6

Special Pacing Applications................................................................................................8-7

Standby Pacing ...........................................................................................................8-7

Asynchronous Pacing .................................................................................................8-7

Pediatric Pacing ..........................................................................................................8-8

Ch a p t e r 9 ECG Monitoring

Preparations........................................................................................................................9-2

Electrode Placement...........................................................................................................9-2

Monitoring Electrodes Attachment......................................................................................9-3

Monitoring the Patient’s ECG..............................................................................................9-5

Set the Controls ..........................................................................................................9-5

Implanted Pacemakers.......................................................................................................9-5

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5-Lead Monitoring...............................................................................................................9-6

Simultaneous 3-Lead Printing .....................................................................................9-7

See-Thru CPR Filter (Optional) ..................................................................................9-7

Adding Traces to Be Displayed ..................................................................................9-7

Printing the ECG on a Stripchart.........................................................................................9-8

Diagnostic Bandwidth .................................................................................................9-8

Alarms.................................................................................................................................9-8

Setting Alarm Limits ....................................................................................................9-8

Heart Rate Alarm Limits ..............................................................................................9-9

Vital Sign Alarms ......................................................................................................9-10

Suspending and Silencing Alarms ............................................................................9-10

Smart Alarms ............................................................................................................9-11

Chapter 10 Event Records and Reports

Summary Report...............................................................................................................10-1

Summary Report Formats ........................................................................................10-2

Printing the Entire Summary Report .........................................................................10-7

Printing a Partial Summary Report ...........................................................................10-8

Full Disclosure Recording.................................................................................................10-8

Incident Logs ....................................................................................................................10-8

Printing an Incident Log ............................................................................................10-8

Erasing Summary Report and Full Disclosure..................................................................10-9

Manual Erasure ........................................................................................................10-9

Automatic Erasure ....................................................................................................10-9

Formatting the Disk ...................................................................................................10-9

Related Messages............................................................................................................10-9

Chapter 11 File Transfer

Transferring Files to an External Device........................................................................... 11-1

Installing or Removing a Compact Flash Card................................................................. 11-2

Transferring a Full Disclosure File to a Compact Flash Card........................................... 11-3

Transferring Device Check and Activity Log Files to a Compact Flash Card ................... 11-3

Transferring Files Through the USB Port (Optional)......................................................... 11-4

Transferring Full Disclosure Files Through Wi-Fi (Optional)............................................. 11-5

Transferring Device Check and Activity Log Files Through Wi-Fi (Optional).................... 11-5

Related Wi-Fi Messages ...........................................................................................11-6

Chapter 12 Maintenance

Routine Procedures..........................................................................................................12-2

Daily Visual Inspection ..............................................................................................12-2

Code Readiness Test ...............................................................................................12-3

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Manual Defibrillator Testing ..............................................................................................12-3

Defibrillator Testing with Paddles .............................................................................12-4

Defibrillator Testing with Hands-Free Therapy Electrodes .......................................12-5

Pacer Testing ............................................................................................................12-5

Recorder Check ........................................................................................................12-6

Code Readiness Log ................................................................................................12-6

Setting Time and Date ..............................................................................................12-8

Cleaning the R Series Unit .......................................................................................12-8

Loading Stripchart Paper ..........................................................................................12-9

Cleaning the Print Head ..........................................................................................12-10

Operator’s Checklist for R Series Product .............................................................12-11

Chapter 13 Troubleshooting

Code-Ready ..............................................................................................................13-1

Monitor ......................................................................................................................13-2

Recorder ................................................................................................................... 13-3

Pacer ........................................................................................................................13-4

Defibrillator ................................................................................................................13-5

AC Charger ...............................................................................................................13-7

Ap p e n d i x A Specifications

Defibrillator Specifications...................................................................................................A-2

Battery Pack Specifications ........................................................................................A-6

IEC 60601-1-2 Specifications.............................................................................................A-7

Electromagnetic Emissions Declaration .....................................................................A-7

Electromagnetic Immunity Declaration (EID) ..............................................................A-8

EID for Life-Support Functions ...................................................................................A-9

Recommended Separation Distances from RF Equipment for the R Series

Life-Support Functions ...........................................................................................A-10

EID for Non–Life-Support Functions .........................................................................A-11

Recommended Separation Distances from RF Equipment for the R Series

Non–Life-Support Functions ...................................................................................A-12

R Series Rectilinear Biphasic Waveform Characteristics.................................................A-13

Clinical Trial Results for the Biphasic Waveform ..............................................................A-25

Randomized Multicenter Clinical Trial for Defibrillation of Ventricular Fibrillation (VF)

and Ventricular Tachycardia (VT) ...........................................................................A-25

Randomized Multi-Center Clinical trial for Cardioversion of Atrial Fibrillation (AF) ...A-26

Synchronized Cardioversion of Atrial Fibrillation ......................................................A-27

ECG Rhythm Analysis Algorithm Accuracy ......................................................................A-29

Appendix B R Series Accessories

Appendix C Wi-Fi Radio Module Information

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Product Description

The ZOLL® RSeries® products combine a defibrillator, ECG display, advanced monitoring capabilities, and Noninvasive T ranscutaneous Pacing (NTP) wit h communication, data prin ting and recording capabilities in a single lightweight portable instrument. The unit has been designed for all resuscitation situations and its small, compact, light we ig ht design makes it ideal for accompanying patients during transport. The product is powered by ac mains and an easily replaced battery pack that is quickly recharged in the device when it is connected to ac mains. In addition, the unit’s battery may be recharged and tested using a ZOLL SurePower™ Battery Charger.

The product is designed for use in the hospital. All of its ruggedized features add to its durability in hospital applications.

There are multiple models of the R Series defibrillator that can contain a variety of functions. Your model may not contain all of the functions that are documented in this manual. Those features that are not contained in all models are specified as optional.

Chapter 1

General Information

The R Series is a versatile manual/advisory external defibrillator. When operating in the manual configuration, the device operates as a conventional defibrillator where the device’s charging and discharging are fully controlled by the operator. In advisory mode, some of the features of the device are automated and a sophisticated algorithm is used to identify shockable ECG rhythms (VF and wide complex VT >150 bpm) that should be treated by defibrillator shock delivery. Depending on local protocols, the unit may be configured to automatically analyze the ECG, charge the defibrillator (if appropriate), and prompt the operator to PRESS SHOCK between periods of CPR.

The R Series unit assists caregivers during cardiopulmonary resuscitation (CPR) by evaluating the rate and depth of chest compressions and providing feedback to the rescuer.

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CHAPTER 1GENERAL INFORMATION

Real CPR Help® requires the use of OneStep™ CPR electrodes or OneStep™ Complete electrodes. When using these pads, the displayed ECG waveforms can be adaptively filtered, using the See-Thru CPR

The R Series is a Code-Ready® defibrillator. It extends testing beyond shock delivery and checks more than 40 measures of readiness, including the presence of the correct cables and electrodes, the type of electrode, and other important electronic functions. The R Series also verifies the condition and expiration date of OneStep electrodes. This code readiness testing can occur automatically, without disconnecting electrodes or paddles, or requiring additional equipment to test shock delivery. The system also provides a printed, or electronic log to alert hospital personnel of any defibrillator functions or accessories that are compromised in advance of a code.

Some R Series models include an optional transcutaneous pacemaker consisting of a pulse generator and ECG sensing circuitry. The pacing option supports both demand and asynchronous noninvasive pacing for adult, pediatric, or neonatal patients. OneStep™ Pacing electrodes and OneStep Complete electrodes allow demand pacing and ECG monitoring without separate ECG electrodes when the R Series is used with the OneStep™ Pacing cable.

Information regarding the unit’s operation, ECG, and other physiological waveforms are displayed on a large 6.5 inch (16.5 cm) diagonal display which provides high contrast and visibility under virtually all lighting con ditions. Op erating and warnin g messages are displaye d on the monitor, and the unit can also be configured with voice prompts to alert the user to unit status. The R Series performs code readiness testing when the unit is OFF but connected to ac power, when the defibrillator is initially turned on, and periodically during operation.

feature, to reduce the artifact caused by chest compressions.

An annotating strip chart recorder is included to provide immediate documentation as well as summary report functions about patient care and treatment.

A sophisticated data collection system, including summary report, printer, and multiple communication ports is available for this unit. The stored data can be reviewed and archived on a properly equipped personal computer using ZOLL CodeNet RescueNet or Compact Flash cards or Wi-Fi (in either a network infrastructure or ad hoc mode).

R Series products are intended for use in Manual mode by personnel cer ti fied by appropriate federal, state, or local government authority to provide advan ced life support care.

Code Review software. R Series data files may be transferred to a PC using USB

How to Use This Manual

The R Series Operator's Guide provides information operators need for the safe and effective use and care of the R Series products. It is important that all persons using this device read and understand all the information contained within.

Please read thoroughly the safety considerations and warnings section. Procedures for daily checkout and unit care are located in “Maintenance” on page 12-1. This manual is supplemented by manual inserts for options available on the R Seri es. These

inserts contain additional warnings, precautions, and safety-related information.

Central software or ZOLL

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Operator’s Guide Updates

An issue or revision date for this manual is shown on the front cover. If more than three years have elapsed since this date, contact ZOLL Medical Corporation to determine if additional product information updates are available.

All users should carefully review each manual update to understand its significance and then file it in its appropriate section wi thin this manual for subsequent refere nc e.

Product documentation is available through the ZOLL website at www.zoll.com. From the Products menu, choose Product Manuals.

Unpacking

Carefully inspect each container for damage. If the shipping container or cushion material is damaged, keep it until the contents have been checked for completeness and the instrument has been checked for mechanical and electrical integrity. If the contents are incomplete, if there is mechanical damage, or if the defibrillator does n ot pass its electrical self-t est, U.S.A. customers should call ZOLL Medical Corporation (1-800-348-9011). Customers outside of the U.S.A. should contact the nearest ZOLL authorized representative. If the shipping container is damaged, also notify the carrier.

Operator’s Guide Updates

Symbols Used on the Equipment

Any or all of the following symbols may be used in this manual or on this equipment:

Symbol Description

Dangerous voltage.

Attention, consult accompanying documents.

Fragile, handle with care.

Keep dry.

This end up.

Temperature limitation.

Conformité Européenne Complies with medical device directive 93/42/EEC.

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CHAPTER 1GENERAL INFORMATION

Symbol Description

Type B patient connection.

Type BF patient connection.

Type CF patient connection.

Defibrillator-proof type BF patient connection.

Defibrillator-proof type CF patient connection.

Fusible link.

,I)/.

RECYCLE

,I)/.

Equipotentiality.

Alternating current (ac).

Direct current (dc).

2%452.

Contains lithium. Recycle or dispose of properly.

Keep away from open flame and high heat.

Do not open, disassemble, or intentionally damage.

Do not crush.

Do not discard in trash. Recycle or dispose of properly.

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Symbol Description

Return to a collection site intended for waste electrical and electronic equipment (WEEE). Do not dispose of in unsorted trash.

Date of manufacture.

Use by.

Latex-free.

Do not reuse.

Do not fold.

Symbols Used on the Equipment

Not sterile.

Nonionizing electromagnetic radiation from Wi-Fi during data transfer.

Manufacturer.

Authorized representative in the European Community.

Serial Number.

Catalogue number.

Consult instructions for use.

Prescription only.

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CHAPTER 1GENERAL INFORMATION

Symbol Description

Maximum energy.

Test port.

Conventions

This guide uses the following conventions: Within text, the names and labels for physical buttons and softkeys appear in boldface type (for

example, “Press the SHOCK button or the Code Marker softkey”). This guide uses uppercase italics for audible prompts and for text messages displayed on the

screen (for example, CHECK PATIENT).

WARNING! Warni ng stat ements aler t yo u to cond itions o r ac tions that can result in personal injury

or death.

Caution Caution statements alert you to conditions or actions that can result in damage to the unit.

Defibrillator Function

The R Series product contains a direct curre nt (d c) de fibril lator cap able o f del iveri ng up to 200 joules. It may be used in synchronized mode to perform synchronized cardioversion using the patient’s R-wave as a timing reference. The unit uses paddles or disposable, preg ell ed electrodes for defibrillation.

Intended Use — Manual Operation

Use of the R Series products in the manual mode for defibrillation is indicated on victims of cardiac arrest where there is apparent lack of circulation as indicated by:

• Unconsciousness.

• Absence of breathing.

• Absence of pulse.

This product should be used only by qualified medical personnel for converting ventricular fibrillation and rapid ventricular tachycardia to sinus rhythm or other cardiac rhythms capable of producing hemodynamically significant heart beats.

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In manual mode, the unit can also be used for synchronized cardioversion of certain atrial or ventricular arrhythmias. A qualified physician must decide when synchronized cardioversion is appropriate.

The advisory function should be used to confirm ventricular fibrillation or wide complex ventricular tachycardia (greater than 150 beats per minute) in patients meeting the thre e conditions indicating lack of circulation (listed above).

Intended Use — ECG Monitoring

The unit is intended for use when ECG monitoring is indicated to evaluate the patient’s heart rate or ECG morphology. In ECG monitoring mode, the unit is intended to be used by personnel who are qualified by traini ng in t he use o f th e R Series defibrillator, basic life and/or advanced life support, or other physician-authorized emergency medical trai ning.

Intended Use — Real CPR Help

The Real CPR Help function provides visual and audio feedback designed to encourage rescuers to perform chest compressions at the AHA/ERC recommended rate of 100 compressions per minute. Voice and visual prompts encourage a compression depth of 1.5 to 2 inches (3.8 to 5.0 cm) for adult patients.

Defibrillator Function

Real CPR Help is not intended for use on patients under 8 years of age.

Defibrillator Complications

Inappropriate defibrillation or cardioversion of a patient (for example, with no malignant arrhythmia) may precipitate ventricular fibrillation, asystole, or other dangerous arrhythmias.

Defibrillation without proper application of electrodes or paddle electrolyte gel might be ineffective and cause burns, particularly when repeated shocks are necessary. Erythema or hyperemia of the skin under the paddles, or electrodes often occurs; this effect is usually enhanced along the perimeter of the paddles or electrodes. This reddening should diminish substantially within 72 hours.

Defibrillator Output Energy

R Series defibrillators can deliver as much as 200 joules into a 50 ohm impedance. The energy delivered through the chest wall, however, is determined by the patient’s transthoracic impedance. An adequate amount of e lectrolyte gel mu st be applied t o the paddles and a force of 10 to 12 kilograms (22 to 26.4 pounds) must be applied to each paddle in order to minimize this impedance. If hands-free therapy electrodes are used, make sure that they are properly applied. (Refer to the instructions on the electrode package).

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CHAPTER 1GENERAL INFORMATION

External Pacemaker (Optional)

Some R Series products include an optional transcutaneous pacemaker consisting of a pulse generator and ECG-sensing circuitry. Noninvasive transcutaneous pacing (NTP) is an established and proven technique. This therapy is easily and rapidly applied in both emergency and nonemergency situations when temporary cardiac stimulation is indicated.

The output current of the pacemaker is continuously variable from 0 to 140 mA. The rate is continuously variable from 30 to 180 pulses per minute (ppm), by increments of 2.

The pacing output pulse is delivered to the heart via ZOLL hands-free defibrillatio n/ pacing electrodes placed on the patient’s back and the precordium.

The characteristics of the output pulse, together with the design and placement of the electrodes, minimize cutaneous nerve stimulation, cardiac stimulation threshold currents, and reduce discomfort due to skeletal muscle contraction.

The unique design of the R Series products allow clear viewing and interpretation of th e electrocardiogram on the display without offset or distortion during external pacing.

Proper operation of the device, together with correct electrode placeme nt, is critical to obtaining optimal results. Every operator must be thoroughly familiar with these operating instructions.

Intended Use — Pacemaker

This product can be used for temporary external cardiac pacing in conscious or unconscious patients as an alternative to endocardial stimulation.

The purposes of pacing include:

• Resuscitation from standstill or bradycardia of any etiology.

Noninvasive pacing has been used for resuscitation from cardiac standstill, reflex vagal standstill, drug-induced standstill (due to procainamide, quinidine, digitalis, b-blockers, verapamil, etc.) and unexpected circulatory arrest (due to anesthesia, surgery, angiography, and other therapeutic or diagnostic procedures). It has also been used for temporary acceleration of bradycardia in Stokes-Adams disease and sick-sinus syndrome. It is safer, more reliable, and more rapidly applied in an emergency than endocardial or other temporary electrodes.

• As a standby when standstill or bradycardia might be expected.

Noninvasive pacing can be useful as a standby when cardiac arrest or symptomatic bradycardia might be expected due to acute myocardial infarction, dru g toxicity, anesthesia, or surgery . It is also useful as a temporary treatment in patients awaiting pacema ker implants or the introduction of transvenous therapy. In standby pacing applications, noninvasive pacing might provide an alternative to transvenous therapy that avoids the risks of displacement, infection, hemorrhage, embolization, perforation, phlebitis, and mechanical or electrical stimulation of ventricular tachycardia or fibrillati on associated with endocardial pacing.

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External Pacemaker (Optional)

• Suppression of tachycardia.

Increased heart rates in response to external pacing often suppress ventricular ectopic activity and might prevent tachycardia.

WARNING! This device must not be connected to internal pacemaker electrodes.

Pacemaker Complications

Ventricular fibrillation does not respond to pacing and requires immediate defibrillation. Therefore, the patient’s dysrhythmia must be determined immediately, so that you can employ appropriate therapy . If t he patient is in ventricula r fibrillation and defibrilla tion is successful but cardiac standstill (asystole) ensues, you should use the pacemaker.

Ventricular or supraventricular tachycardias can be interrupted with pacing, but in an emergency or during circulatory collapse, synchronized cardioversion is faster and more certain.

Pulseless electrical activity (PEA) can occur following prolonged cardiac arrest or in other disease states with myocardial depression. Pacing might then produce ECG responses wi th out effective mechanical contractions, making other effective treatment necessary.

Pacing can evoke undesirable repetitive resp onses, tachycardia, or fibrillation in the presence of generalized hypoxia, myocardial ischemia, cardiac drug toxicity, electrolyte imbalance, or other cardiac diseases.

Pacing by any method tends to inhibit intrinsic rhythmicity. Abrupt cessation of pacing, particularly at rapid rates, can cause ventricular standstill and should be avoided.

Noninvasive temporary pacing can cause discomfort of varying intensity, which occasionally can be severe and preclude its continued use in conscious patients.

Similarly, unavoidable skeletal muscle contraction might be troublesome in very sick patients and might limit continuous use to a few hours. Erythema or hyperemia of the skin under the hands-free therapy electrodes often occurs; this effect is usually enhanced along the perimeter of the electrode. This reddening should lessen substantially withi n 72 hours.

There have been reports of burns under the anterior electrode when pacing adult patients with severely restricted blood flow to the skin. Prolonged pacing should be avoided in these cases and periodic inspection of the underlying skin is advised.

There are reports of transient inhibition of spontaneous respiration in unconscious patients with previously available units when the anterior electrode was placed too low on the abdomen.

WARNING! This device must not be connected to internal pacemaker electrodes.

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CHAPTER 1GENERAL INFORMATION

Pediatric Pacing

Pacing can be performed on pediatric patients weighing 33 lb. (15 kg) or less using ZOLL pediatric hands-free therapy electrodes. Prolonged pacing (in excess of 30 minutes), particularly in neonates, can cause burns. Periodic inspection of the underlying skin is recommended.

ECG Monitoring

The patient’s ECG is monitored by connecting the patient to the unit via a 3- or 5-lead patient cable, hands-free therapy electrodes, or through paddles. Five seconds of ECG is presented on the display along with the following information:

• averaged heart rate, derived by measuring R to R intervals

• lead selection - I, II, III, aVR, aVL, aVF, V (with ECG cable), PADDLES or PADS, P1, P2,

P3 (when using OneStep Pacing cable with OneStep Complete electrodes). P1, P2, and P3 are non-standard ECG leads derived from electrodes within particular

OneStep electrodes. While ECG signals acquired from these leads are appropriate for rhythm assessment and determining electrical capture during pacing, they should not be used for ECG morphological evaluation. Attach conventional ECG electrodes for diagnostic purposes.

• ECG size - 0.5, 1, 1.5, 2, 3 cm/mV

• other operational prompts, messages, and diagnostic codes

Monitoring or diagnostic ECG bandwidth is selectable.

Recorder Function

The strip recorder is provided to document events. The strip recorder normally operates in the delay mode (6 seconds) to ensure the capture of ECG information immediately preceding critical events. The recorder may be activated manually by pressing the RECORDER button. It is activated automatically whenever a defibrillation SHOCK is delivered, a heart rate alarm occurs, or the rhythm analysis function is activated. The strip recorder may also be configured not to print during these events.

Paddles and Electrodes

The R Series will defibrillate, cardiovert, and monitor ECG using either defibrillation paddles or hands-free therapy electrodes.

The pacer version of the R Series will pace using ZOLL hands-free therapy electrodes. ENERGY SELECT, CHARGE and SHOCK controls are located on the paddles and front

panel. When using hands-free therapy electrodes, you must use the controls on the front panel of the unit. To switch between paddles and hands-free therapy electrodes, remove the OneStep cable from the apex paddle and connect the hands-free therapy electrodes to the cable.

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Batteries

The Advisory function cannot be activated unless ha nds-free thera py ele ctrodes are a ttache d to the OneStep cable and used as the ECG monitoring lead.

The R Series can monitor the patient’s ECG while pacing without the need for a separate ECG cable and ECG electrodes. This also allows demand pacing when separate ECG electrodes are either not connected, or unavailable. OneStep pacing capability requires the OneStep Pacing cable along with OneStep Pacing electrodes, or OneStep Complete electrodes.

Note: The ZOLL OneStep Pacing electrodes, or OneStep Complete electrodes, MFE Pads,

You should always check the expiration date on the electrode packaging. Do not use expired electrodes, which might result in false patient impedance readings and affect the level of delivered energy, or cause burns.

The R Series defibrillator reads and reports the expiration date for OneStep Pacing electrodes, OneStep CPR electrodes, and OneStep Complete electrodes. When these electrodes exceed their expiration date, the Code Readiness indicator will change to a red “X.”

Note: ZOLL electrodes contain no hazardous materials and may be disposed of in general

Batteries

R Series products use an easily replaced rechargeable lithium-ion battery pack (the ZOLL SurePower battery pack). A new, fully charged battery pack typically delivers more than 5 hours of ECG monitoring. Use of other functions (such as the defibrillator, printer, or pacemaker) reduces this time.

Pediatric MFE Pads, stat•padz

This symbol on the electrode package is accompanied by the expiration date. For stat•padz II, this symbol does not appear; the expiration date appears on the lower

right corner of the label, below the lot number.

, and ECG electrodes are disposable, single-use items.

trash unless contaminated with pathogens. Use appropriate precautions when disposing of contaminated electrodes.

When a LOW BATTERY message appears on the display and the unit emits two beeps in conjunction with the displayed message, the battery must be replaced and recharged.

You can charge the battery by either of the following methods:

• Internal charging — plug the R Series into an ac power supply to automatically begin

charging the installed battery pack. The front panel battery indicator operates as follows:

When the indicator is: It means:

Steady yellow Battery is charging Steady green Battery is charged Alternating yellow and

green Not lit The defibrillator is not connected to

No battery is installed or a battery charging fault has been detected.

ac mains.

Note: Upon power up, it takes approximately 45 seconds for the LEDs on the battery to

accurately display run time.

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 1–11

CHAPTER 1GENERAL INFORMATION

• External charging — use the ZOLL SurePower Battery Charger to charge the battery pack

and test the battery’ s capacity. For details, refer to the ZOLL Sur ePower d efibrillator batt ery Operator’s Manual.

Code-Ready System

The R Series defibrillator’s Code-Ready system tests the defibrillator whenever the unit is turned on, periodically during operation, whenever manual testing is initiated by the operator, and automatically, at pre-configured intervals.

The code readiness indicator on the front panel shows the result of the most recent readiness check. Also, OneStep Pacing, CPR or Complete electrodes provide an interface that communicates the electrode’s expiration date and condition to the defibrillator.

The Defib T est Log stores the results for as many as 1000 de fibrillator tests in internal memory. Each log entry shows the time and date of the defibrillator test. The Defib Test Log can be printed on the stripchart or transferred to a personal computer for printing and archiving.

Safety Considerations

All operators should review these safety considerations before using the R Series. R Series products are high-ener gy defibrillators capable of delivering 200 joules. To completely

deactivate the unit, turn the Mode Selector to OFF. To manually disarm a charged (or charging) defibrillator, do one of the following:

• Turn the Mode Selector to OFF, MONITOR, or PACER.

• Change the selected defibrillator energy.

For safety , the R Seri es unit automatically disarms if left ch arg ed for more than eith er 60 or 120 seconds (user configurable) if the SHOCK button is not pressed.

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Warnings

General

Federal (U.S.A.) law restricts this defibrillator to use by or on the order of a physician. Only appropriately trained, skilled personnel who are familiar with equipment operation should

perform emergency defibrillation. The prescribing physician should determine what training, such as Advanced Cardiac Life Support (ACLS) or Basic Life Support (BLS) certification, is appropriate.

Only skilled personnel trained in Advanced Cardiac Life Support (ACLS) and who are familiar with equipment operation should perform synchronized cardioversion. The precise cardiac arrhythmia must be determined before attempting defi bril lat io n.

These operating instructions describe the functions and proper operation of the R Series products. They are not a substitute for a formal patient care training course. Operators should obtain formal training from an appropriate authority before using this defibrillator for patient care.

Proper operation of the unit and correct electrode placement is critical to obtaining optimal results. Operators must be thoroughly familiar with proper device operation.

The use of external pacing/defibrillation electrodes or adapter devices from sources other than ZOLL is not recommended. ZOLL makes no representations or warranties regarding the performance or effectiveness of its products when used with pacing/defibrillation electrodes or adapter devices from other sources. Defibrillator failures attributable to the use of pacing/ defibrillation electrodes or adapters not manufactured by ZOLL might void ZOLL’s warranty.

Warnings

Do not disassemble the unit. A shock hazard exists. Refer all problems to authorized service personnel.

Follow all recommended maintenance instructions. If a problem occurs, obtain service immediately. Do not use the defibrillator until it has been inspected by appropriate personnel.

The R Series unit might not perform to specifications when stored at the upper or lower extreme limits of storage temperature and then immediately put into use.

A void using the R Series adjacent to, or stacked on, other equipment. If unavoidable, verify that the R Series operates normally in this configuration before clinical use.

The R Series should be installed and put into service according to the EMC information in Appendix A of this manual.

Assess the Wi-Fi performance for the possibility of RFI in your environment of use. If multiple devices are transmitting simultaneously to the same access po int, W i-Fi data transfer

will be slowed down. If the access point is too overloaded, data transmission failures can occur. The use of accessories, transducers, and cables other than those specified in this manual and

related R Series option manual inserts may result in increased emissions or decreased immunity of the R Series.

Do not use or place the unit in service if the Code Readiness indicator (at the upper right of the front panel) displays a red “X”.

Carefully route patient cabl es to avoid tri pping over the m, or inadverte ntly pulli ng the unit onto the patient.

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 1–13

CHAPTER 1GENERAL INFORMATION

Always inspect the unit for damage if it has been dropped.

ECG Analysis, Defibrillating, Pacing and CPR

Prior to attempting synchronized cardioversion, ensure the ECG signal quality is good and that sync markers are displayed above each QRS complex.

Do not use the unit in advisory mode during patient movement. A patient must be motionless during ECG rhythm analysis. Do not touch the patient during analysis. If transporting the patient, cease all movement before beginning ECG analysis.

ECG rhythm analysis does not warn of patient asystole, which is not a shockable rhythm. The ECG rhythm analysis function might not reliably identify ventricular fibrillation in the

presence of an implanted pacemaker. Inspection of the electrocardiogram and clinical evidence of cardiopulmonary arrest should be the basis for any treatment of patients with an implanted pacemaker.

Implanted pacemakers might cause the heart rate meter to count the pacemaker rate during incidents of cardiac arrest or other arrhythmias. Dedicated pacemaker detection circuitry may not detect all implanted pacemaker spikes. Check the patient's pulse; do not rely solely on heart rate meters. Patient history and physical examination are important factors in determining the presence of an implanted pacemaker. Pacemaker patients should be carefully observed.

Do not place electrodes directly over an implanted pacemaker. The R Series unit detects ECG electrical signals only. It does not detect a pulse (effective

circulatory perfusion). Always verify pulse and heart rate by physical assessment of the patient. Never assume that the display of a nonzero heart rate means that the pat ient has a pulse.

To avoid possible damage to the R Series unit, turn off pacing before defibrillating the patient with a second defibrillator.

Do not use the unit’s ECG-out signal as a synchronization pulse for another defibrillator or cardioverter.

Place the patient on a firm surface before performing CPR.

Battery

Do not operate the unit without a battery. Keep a fully charged spare battery pack with the defibrillator at all times.

Test battery packs regularly. A battery that does not pass the ZOLL charger’s capacity test might cause the R Series unit to shut down unexpectedly.

When the warning LOW BATTERY appears, plug the R Series unit into a power source or install a fully charged battery pack. When the warning REPLACE BATTERY appears, immediately replace the battery pack with a fully char ged pack or plu g the R Series unit into a power source, as unit shut down due to a low battery condition is imminent.

If mistreated, a battery pack might explode. Do not disassemble a battery pack or dispose of it in fire.

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Operator Safety

Do not use R series products in the presence of oxygen-rich atmospheres, flammable anesthetics, or other flammable agents (such as gasoline). Using the unit in such environments might cause an explosion.

Do not use the unit near or within standing water. Electrical safety might be compromised when the defibrillator is wet.

Never discharge the unit with the defibrillation electrodes or paddles shorted together or in open air.

Do not discharge the defibrillator except as indicated in the instructions. Discharge the defibrillator only when defibrillation electrodes or paddles are properly applied to the patient.

To avoid risk of electrical shock, do not touch the gelled area of the hands-free therapy electrodes during pacing or defibrillation.

T o avoid risk of electrical shock, do not allow electrolyte gel to accumulate on hands or paddle handles.

To avoid risk of electrical shock, do not allow patient connectors to contact other conductive parts, including earth.

For defibrillation using paddles, use only high-conductivi ty electrolyte gel specified for such use by the manufacturer.

Warnings

When using paddles for defibrillation, use your th umb s to operat e th e SHOCK buttons. Doing so avoids inadvertent shock to the operator and unintentional depression of an ENERGY SELECT button, which causes the defibrillator to disarm. Keep your hands and fingers away from the paddle plates.

The use of accessory equipment that does not comply with the equivalent safety requirements of the R Series defibrillator could reduce the level of safety of the combined system. When choosing accessory equipment, consider the following:

• Use of the accessory in the patient vicinity.

• Evidence that the safety certification of the accessory has been performed in accordance

with the appropriate IEC (EN) 60601-1 and/or IEC (EN) 60601-1-1 harmonized national

standards. Always check that the equipment functions properly and is in proper condition before use. Disconnect all electro-medical equipment that is not defibrillation-protected from the patient

prior to defibrillation. Before discharging the defibrillator, warn everyone to STAND CLEAR of the patient. Do not touch the bed, patient, or any equipment connected to the patient during defibrillation.

A severe shock can result. To avoid hazardous pathways for the defibrillation current, do not allow exposed portions of the patient's body to touch any metal objects, such as a bed frame.

When the R Series is performing a Code Readiness test, as indicated on the display, do not touch the connected paddles, electrodes, or OneStep cable connector.

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 1–15

CHAPTER 1GENERAL INFORMATION

Patient Safety

This equipment should be connected to only one patient at a time. Use only OneStep Pediatric electrodes to defibrillate patients under 8 years of age in Advisory

modes. Use of adult electrodes, or pediatric electrodes other than OneS tep Pediatric electrodes, can result in the delivery of excessive energy doses.

Neonatal and pediatric defibrillation energy level settings should be based on site-specific clinical protocols.

To ensure patient safety, connect the R Series only to equipment with galvanically isolated circuits.

Use only high-quality ECG electrodes. ECG electrodes are for rhythm acquisition only; you cannot use ECG electrodes for defibrillation or pacing.

Do not use therapy or ECG electrodes if the gel is dried, separated, torn or split from the foil; patient burns may result from using such electrodes. Poor adherence and/or air pockets under therapy electrodes can cause arcing and skin burns.

Check the expiration date on the electrode packaging. Do not use electrodes after their expiration date.

Excessive body hair or wet, diaphoretic skin can inhibit electro de co up lin g to th e skin. Clip excess hair and dry any moisture from the area where an electrode is to be attached.

Therapy electrodes should be replaced periodically during continuous pacing. Consult electrode directions for proper replacement instructions.

Prolonged pacing (more than 30 minutes), particularly in neonates or adults with severely restricted blood flow, may cause burns. Periodically inspect the skin under the electrodes.

Carefully route the patient cables to reduce the possibil ity of patient entanglement or strangulation.

T o avoid electrosurgery burns at monitoring sites, ensure proper connection of the electrosurgery return circuit so that a return path cannot be made through monitoring electrodes or probes.

During electrosurgery, observe the following guidelines to minimize electrosurgery unit (ESU) interference and provide maximum operator and patient safety:

• Keep all patient monitoring cables away from earth ground, ESU knives, and ESU return

wires.

• Use electrosurgical grounding pads with the largest practical contact area.

Always ensure proper application of the electrosurgical return electrode to the patient. Check electrical leakage levels before use. Leakage current might be excessive if more than one

monitor or other piece of equipment is connected to the patient.

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Cautions

If the unit is to be stored longer than 90 days, remove the battery pack. Do not sterilize the defibrillator, or its accessories unless the accessories are labelled as

sterilizable. Do not immerse any part of the defibrillator in water. Do not use ketones (such as acetone or MEK) on the defibrillator. Avoid using abrasives (including paper towels) on the display window. Grounding reliability can be achieved only when the equipment is connected to a receptacle

marked “HOSPITAL ONL Y,” “HOSPITA L GRAD E,” or equ ivalent. If the ground ing in tegrit y of the line cord or ac receptacle is questionable, operate the defibrillator using battery power only.

To protect the unit from damage during defibrillation, for accurate ECG information, and to protect against noise and other interference, use only internal current-limiting ECG cables specified or supplied by ZOLL.

For continued safety and EMI performance, use only the line cord supplied by ZOLL. Dispose of battery packs in accordance with national, regional and local regulations. Battery

packs should be shipped to a reclamation facility for recovery of metal and plastic compounds as the proper method of waste management.

Cautions

Restarting the Defibrillator

Certain events require the R Series products to be restarted after they shut off or become inoperative (for example, when the battery runs down and the unit shuts off).

In such a case, always try to restore defibrillator operation as follows:

1. Turn the Mode Selector to OFF.

2. If necessary, replace a depleted battery wi th a fully char ged pack, or connect th e defibrillator

to ac mains.

3. Turn the Mode Selector to the desired operating mode to restart the unit.

This sequence is necessary to restart the defibrillator and can also be used to clear some fault messages when immediate use of the defibrillator is required.

If restarted after a shutdown period of 10 second s or more, the unit restores all settings (such as ECG lead, ECG size, and alarm state and limits) to their power-up default values. After restoring device operation, you might need to reinstate previously selected, non-default settings.

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 1–17

CHAPTER 1GENERAL INFORMATION

FDA Tracking Requirements

U.S. Federal Law (21 CFR 821) requires the tracking of defibrilla tors. Under this law, owners of this defibrillator must notify ZOLL Medical Corporation if this product is

• received

• lost, stolen, or destroyed

• donated, resold, or otherwise distributed to a different organization

If any such event occurs, contact ZOLL Medical Corporation in writing with the following information:

1. Originator's organization – Company name, address, contact name, and contact phone

number

2. Model number, and serial number of the defibrillator

3. Disposition of the defibrillator (for example, received, lost , stolen, destroyed, distributed to

another organization), new location and/or organization (if known and different from

originator’s organization) – company name, address, contact name, and contact phone

number

4. Date when the change took effect

Please address the information to:

ZOLL Medical Corporation Attn: Tracking Coordinator 269 Mill Road Chelmsford, MA 01824-4105

Fax: (978) 421-0025 Telephone: (978) 421-9655

Notification of Adverse Events

As a health care provider, you may have responsibilities under the Safe Medical Devices Act (SMDA), for reporting to ZOLL Medical Corpora tion, and possibl y to the FDA, the occurrence of certain events.

These events, described in 21 CFR Part 803, include device-related death and serious injury or illness. In addition, as part of our Quality Assurance Program, ZOLL Medical Corporation requests to be notified of device failures or malfunctions. This information is required to ensure that ZOLL Medical Corporation provides only the highest quality products.

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Software License

Note: Read this Operator’s Guide and License agreement carefully before operating any of

the R Series products.

Software incorporated into the system is protected by copyright laws and international copyright treaties as well as other intellectual property laws and treaties. This software is licensed, not sold. By taking delivery of and using this system, the Purchaser signifies agreement to and acceptance of the following terms and conditions:

1. Grant of License: In consideration of payment of the software license fee which is part of

the price paid for this product ZOLL Medical Corporation grants the Purchaser a

non-exclusive license, without right to sublicense, to use the system so ftware in object -code

form only.

2. Ownership of Software/Firmware: Title to, ownership of and all rights and interests in the

system software and all copies thereof remain at all times vested in the manufacturer, and

Licensors to ZOLL Medical Corporation and they do not pass to purchaser.

3. Assignment: Purchaser agrees not to assign, sublicense or otherwise transfer or share its

rights under the license without the express written permission of ZOLL Medical

Corporation.

4. Use Restrictions: As the Purchaser, you may physically transfer the products from one

location to another provided that the software/firmware is not copied. You may not disclose,

publish, translate, release or distribute copies of the software/firmware to others. You may

not modify, adapt, translate, reverse engineer, decompile, crosscompile, disassemble or

create derivative works based on the software/firmware.

Software License

Service

NO IMPLIED LICENSE

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

The R Series does not require periodic recalibration or adjustment. Appropriately train ed and qualified personnel should, however, perform periodic tests of the defibrillator to verify proper operation.

If a unit requires service, contact the ZOLL Technical Service Department.

For customers In the U.S.A.

Telephone:

Fax:

1-800-348-9011 1-978-421-9655

1-978-421-0010

For customers outside the U.S.A.

Call the nearest authorized ZOLL Medical Corporation representative.

To locate an authorized service center, contact the International Sales Department at

ZOLL Medical Corporation 269 Mill Road Chelmsford, MA 01824-4105

Telephone: 1-978-421-9655

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 1–19

CHAPTER 1GENERAL INFORMATION

When requesting service, please provide the following information to the service representative:

• Unit serial number

• Description of the problem

• Department using the equipment and name of the person to contact

• Purchase order to allow tracking of loan equipment

• Purchase order for a unit with an expired warranty

• Sample ECG or other stripcharts demonstrating the problem (if available and applicable),

less any confidential patient information.

Returning a unit for service

Before sending a unit to the ZOLL Technical Service Department for repair, obtain a service request (SR) number from the service representative.

Remove the battery pack from the unit. Pack the unit with its cables and battery in the original containers (if available) or equivalent packaging. Be sure the assigned service request number appears on each package.

For customers Return the unit to

In the U.S.A. ZOLL Medical Corporation

In Canada ZOLL Medical Canada Inc.

In other locations The nearest authorized ZOLL Medical Corporation representative.

269 Mill Road Chelmsford, MA 01824-4105

Attention: Technical Service Department (SR number) Telephone: 1-800-348-9011

1750 Sismet Road, Unit #1 Mississauga, ON L4W 1R6

Attention: Technical Service Department (SR number) Telephone: 1-866-442-1011

To locate an authorized service center, contact the International Sales Department at

ZOLL Medical Corporation 269 Mill Road Chelmsford, MA 01824-4105

Telephone: 1-978-421-9655

The ZOLL Serial Number

Each ZOLL product displays a serial number that contains information about t hat product. From left to right, ZOLL serial numbers are structured as follows:

• A two-character product code

• A three-character date-of-manufacture code

• A product serial number of six or more alphanumeric characte rs

The product code for the R Series defibrillator is AF.

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The ZOLL Serial Number

The first two characters of the date-of-manufacture code give the last two digi ts of the year (for example, “06” appears for products manufactured in 2006). The last character of the date-of-manufacture code gives the mont h in wh ich the product was manufactured. The month appears in the form of a single alphanumeric character: “A” for January , “B” for February, “C” for March, and so on through “L” for December .

The product serial number is a unique set of alphanumeric c haracters that ZOLL assigns to each individual unit.

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 1–21

CHAPTER 1GENERAL INFORMATION

(This page intentionally left blank.)

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Product Overview

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Defibrillator Controls and Indicators

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9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 2–1

CHAPTER 2PRODUCT OVERVIEW

Table 2-1. R Series Unit Features

Item Description

1 Front panel Includes the display screen and primary controls. 2 Handle Integrated carrying handle.

3 External paddle well Holds paddles when not in use. Allows defib self-test when

4 Beeper Emits R-wave detection beeps, defib charge Ready tones, and

5 USB host connector

(Optional)

6 USB device connector For connecting the R Series defibrillator to a USB device. For

7 Data card slot Holds a compact flash card for copying data stored in the

8 Defibrillator test port When not using OneStep electrodes or paddles, connect the

9 Speaker Issues voice prompts.

paddles are stowed in their respective wells.

alarm tones. (Reserved for future use — do not connect to any equipment.)

details, refer to “Event Records and Reports” on page 10-1.

device’s internal memory. Accepts a CF memory card or a WiFi card.

patient end of a OneStep cable to this port to allow device checks.

10 Paper Compartment Holds the paper for the stripchart printer.

11 RELEASE button Allows access to the paper compartment.

12 Battery compartment Holds a rechargeable lithium ion battery pack. 13 Grounding post Electrical ground for biomedical test equipment.

14 AC mains connector For connecting the device to an ac power source. 15 Patient connectors For details, refer to “Patient Cables and Connectors” on

page 2-6.

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The Front Panel

The front panel of the R Series device includes the display screen, softkeys, battery indicator, ac power indicator, Code Readiness indicator, SHOCK button, and control panel. The control panel configuration varies slightly depending on the model. See Figure 2-1.

Defibrillator Controls and Indicators

Display screen

Six softkeys

Battery

indicator

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indicator

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Table 2-2 describes the controls and indicators that appear on the front panel.

Table 2-2. R Series Controls and Indicators

Control or Indicator Description

Display screen Shows therapeutic settings, physiological waveforms, and other

information for each monitored parameter, messages, time, and softkey labels.

Battery indicator Indicates battery status:

Steady yellow: Battery is charging. Steady green: Battery is charged. Alternating yellow and green: No battery is installed, or there is a

battery charging fault.

Indicator for ac power Illuminated when the unit is plugged into an alternating current (ac)

power source.

Code Readiness indicator

Shows the status of the unit, based on its most recent Readiness check:

• A green “

3“ indicates the unit is ready for therapeutic use.

• A red “X” indicates the unit’s Readiness is compromised an that it may not be ready for therapeutic use.

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 2–3

CHAPTER 2PRODUCT OVERVIEW

Table 2-2. R Series Controls and Indicators (continued)

Control or Indicator Description

Mode Selector Selects the mode of operation (available options depend on model):

ENERGY SELECT Buttons

CHARGE Button Charges the defibrillator to the selected energy. In addition to the

SHOCK Button The front panel SHOCK button is only active when using OneStep

ANALYZE Button (optional)

LEAD Button Selects the ECG source for display and printing. Pressing this button

SIZE Button Selects the amplitude scale for the displayed ECG waveform. Available

ALARM SUSPEND Button

RECORDER Button Starts or stops the stripchart recorder. You can switch the unit to

PACER OUTPUT mA (optional)

PACER RATE ppm (optional)

• OFF — Unit is powered off.

• MONITOR — Physiological monitoring (ECG and other options)

• DEFIB — Manual or advisory defibrillation

• P A C ER — No ni n v a s ive external pacing

Two sets of up-down arrow buttons control the selection of defibrillator energy, one set located on the front panel and the other located on the sternum paddle.

CHARGE button on the front panel, there is one located on the apex paddle handle.

electrodes, hands-free therapy electrodes (see “R Series Accessories” on page B-1 for a list), external autoclavable paddles, or interna l defibrillation paddles without a discharge button. The SHOCK button illuminates when the device is charged and ready.

To discharge the defibrillator when using paddles (internal or external) with discharge buttons, press and hold the SHOCK buttons on the paddles.

Initiates ECG analysis to determine whether or not a shockable rhythm is present.

sequentially selects ECG signals derived from each of the following lead configurations: I, II, III, aVR, aVL, aVF , PADDLES, or PADS, P1, P2, and P3 (when using OneStep Pacing electrodes, or OneStep Complete electrodes with OneStep Pacing cable) for display. The PADS or PADDLES lead setting is automatically selected when the defibrillator powers up in DEFIB or MONITOR mode with either hands-free therapy electrodes or paddles attached to the OneStep cable. Lead II or P3 (OneStep Pacing) is automatically selected when the R Series is powered up in PACER mode. Pads or Paddles monitoring is not available in PACER mode.

sizes are 0.5, 1, 1.5, 2, and 3 centimeters per millivolt (cm/mV). Activates, deactivates or audibly suspends all alarm functions. A bell

symbol ( alarms are either audibly or permanently disabled, an “X” appears across the bell ( ) symbol.

diagnostic ECG bandwidth (0.05 - 150Hz) by pressing and holding the

RECORDER button. Diagnostic bandwidth is maintained as long as the RECORDER button is held down. When the RECORDER button is

released, the unit reverts to standard monitoring bandwidth. When pacing is selected, this control sets the amount of current

delivered. The selected current setting is indicated on the display. When pacing is selected, this control sets the rate (pulses per minute) at

which the pacemaker will operate. The selected pace rate setting is indicated on the display.

) appears on the display when alarms are enabled. When

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Table 2-2. R Series Controls and Indicators (continued)

Control or Indicator Description

4:1 Button (optional)

Softkeys Six unlabeled buttons located directl y below the di splay contro l diff erent

Charge Indicator Light (not shown)

Display Screen

The front panel includes a color display which shows:

• The elapsed time (since the unit was turned on).

• The ECG trace, selected lead, size, heartbeat indicator, and alarm status.

• The selected energy, charging status, and delivered energy for defibrillation and

synchronized cardioversion.

• The output current and stimulus rate for pacing.

• The measured SpO

applicable), and alarm status indicators for optional SpO

• Messages and prompts.

• Labels above the softkeys (appropriate to the context).

• CPR Index™.

Defibrillator Controls and Indicators

This button is used to determine a patient’s underlying ECG rhythm. While depressed, this button causes pacing stimuli to be delivered at ¼ of the indicated ppm setting. When the button is released, normal pacing resumes.

functions depending on the operating mode of the unit. Labels for the softkeys appear at the bottom of the display directly

above each softkey to indicate its function. Located on the apex paddle, this light turns on when the defibrillator is

charged and ready.

percent saturation, signal strength, plethsymographic trace (if

monitoring.

Figure 2-2 shows the layout of parameter values, waveforms, system data, and softkey labels.

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 2–5

CHAPTER 2PRODUCT OVERVIEW

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Color coding

To differentiate information for various parameters, the unit displays each type of information in a specific user-configurable color.

Messages

During operation, a FAULT XX message is displayed when a fault is detected. If this occurs, turn the unit off and then on and recheck o peration. If the fault persist s, contact yo ur authorized ZOLL agent as described on page 1-20.

Patient Cables and Connectors

The back of the unit includes a set of connectors for patient cables.

Sync In/ Marker Out/ ECG Out

ECG

(optional)

OneStepSpO Cable

Figure 2-3. Patient Cable Connectors

2–6 www.zoll.com 9650-0912-01 Rev. A

Defibrillator Controls and Indicators

Connector Description

OneStep Cable For connecting paddles or ZOLL hands-free therapy and pacing

electrodes using either OneStep or OneStep Pacing cables.

ECG For connecting 3- or 5-lead ECG cable or OneStep Pacing cable’s

ECG cable.

Sync In / Marker Out / ECG x1000

SpO

Connector for

• An incoming defibrillator synchronization signal from an external patient monitor.

• Output of R wave marker to an external patient monitor.

• ECG signal output for use with other equipment such as patient

monitors and radio telemetry equipment (1 V/cm of displayed ECG signal).

(Optional) For connecting pulse oximeter cable.

OneStep Cables

The R Series ships with either a OneStep, or OneStep Pacing cable. The OneStep Pacing cable has an additional connector that plugs into the rear panel ECG

connector . This cable is used with OneStep Pacing electrodes or OneStep Complete electrodes for external pacing and ECG monitoring. Alternatively, you can disconnect the OneStep Pacing cable from the ECG connector and use a 3- or 5-lead ECG cable.

OneStep Cable

Figure 2-4. OneStep Cables

ECG Connector

OneStep Pacing Cable

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 2–7

CHAPTER 2PRODUCT OVERVIEW

OneStep Cable Manager (Optional)

As an option, the OneStep Cable Manager is available to store and organize cables.

Figure 2-5. The R Series with the Optional OneStep Cable Manager (Side View)

External Paddles

OneStep Cable Manager

Cable Caddy

Paddles are defibrillation-proof Type BF equipment.

The external paddles on the R Series device are used for defibrillation and synchronized cardioversion.

Caution You cannot use paddles for ECG analysis or pacing.

Defibrillation paddles can be used for ECG monitoring when it is not pr actical to apply ECG electrodes. Press the LEAD button to select PADDLES as the ECG source.

The paddles are stowed in wells on either side of the unit. To release the paddles, grasp the handles and then press down on the latch button above each paddle.

RELEASE

Figure 2-6. Releasing the Paddles

2–8 www.zoll.com 9650-0912-01 Rev. A

Defibrillator Controls and Indicators

Attach the OneStep cable from the R Series unit to the con necto r at the base of the apex paddle .

1. Align OneStep cable as shown. 2. Insert OneStep cable into APEX paddle.

Figure 2-7. Attaching the OneStep Cable to the APEX Paddle

OneStep cable connected to APEX paddle

Figure 2-8. OneStep Cable Connected to APEX Paddle

If you need to detach the OneStep cable from the APEX paddl es, push the RELEASE button (see Figure 2-9) in the direction of the arrow and unplug the OneStep cable.

Refer to Chapter 3, "Manual Defibrillation" before using paddles for defibril lation. The pa ddles include controls for selecting defibrillation energy, charging, delivering a shock, and turning the stripchart recorder on and off.

SHOCK

RECORDER

Button

ENERGY SELECT

Buttons

Charge Ready

Indicator

CHARGE

Button

Connector and RELEASE button for OneStep cable

Sternum Paddle

Apex Paddle

Figure 2-9. External Paddles

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 2–9

CHAPTER 2PRODUCT OVERVIEW

Pediatric-size electrodes are built into the paddle assembly beneath the standard electrode plates. The user must manually adjust energy settings to pediatric levels consistent with their institution’s protocols.

Figure 2-10. Pediatric Plate

Note: The R Series defibrillator also supports ZOLL autoclavable internal handles for use

during open chest defibrillation procedures.

PEDI button

To expose the pediatric plate, press the PEDI button at the top of the paddle, then slide the Adult plate upward.

Before replacing the Adult plate, be sure to clean the pediatric plate and surrounding area thoroughly.

Slide the Adult plate onto the paddle until it locks into place.

Working with Menus

For some functions, the screen shows a menu of options with related softkeys for navigating through the menus and making selections and entries.

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On the display, highlighting indicates the currently selected item, that is, the item or value you are working with.

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Working with Menus

The following table summarizes some of the more common softkeys.

Softkey Action Next Item

Next Field Prev Item Moves the highlighting up to the previous item in a vertical list. Next Digit Moves the highlighting to the right in a serie s of let te rs or di g i ts. Prev Digit Moves the highlighting to the left in a series of letters or digits. Inc

Inc Digit Dec

Dec Digit Newer Moves the highlighting to the adjacent item with the more recent date or time. Older Moves the highlighting to the adjacent item with the older date or time. Enter Accepts the settings with the values currently shown. Return Displays the previous menu. Next Param Moves the highlighting to the next pa rameter. Prev Param Moves the highlighting to the previous parameter. Change Value Changes the value of the selected parameter.

Moves the highlighting down to the next item in a vertical list.

Increases the highlighted value or digit. (For example, changes 2 to 3 or B to C).

Decreases the highlighted value or digit. (For example, changes 2 to 1 or B to A).

Defib Mentor Mode (Optional)

Defib Mentor™ mode is a nonclinical tutorial mode available when the Mode Selector is turned to MONITOR. When in this mode, the device displays a brief description of each front panel control’s function when that control is activated.

Note: Do not run the Defib Mentor mode with a patient connected to the R Series unit. To access Defib Mentor mode:

1. Turn the Mode Selector to MONITOR.

2. Press the Options softkey.

3. Press MORE.

Additional options appear.

4. Press Mentor.

5. Press Confirm Mentor Mode.

The unit is now in Defib Mentor Mode, a non-clinical operatin g mode .

6. Activate a front panel control (except the Mode Selector or the Exit Mentor softkey).

A brief description of that control’s function appears on the screen.

To exit Mentor mode, press the Exit Mentor softkey or turn the Mode Selector to OFF,

DEFIB, or PACER. Note: After 60 seconds of non use in the Mentor mode, the R Series returns to MONITOR

mode.

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 2–11

CHAPTER 2PRODUCT OVERVIEW

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Common Tasks

Follow the instructions in the subsequent sections for:

• “Replacing a Battery Pack” on page 2-12.

• “Adjusting Display Brightness” on page 2-13.

• “Using Code Markers” on page 2-13.

Replacing a Battery Pack

To remove a battery pack, press the tab on the end of the battery pack inward, and lift the battery pack out of the compartment.

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Figure 2-12. Removing a Battery Pack

To install a battery pack:

1. Place the end of the battery pack opposite the tab into the end of the compartment closest to the front of the unit.

2. Lower the tabbed end of the battery pack into the compartment and press down on the tabbed

end until it locks into place.

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Figure 2-13. Installing a Battery Pack

2–12 www.zoll.com 9650-0912-01 Rev. A

Adjusting Display Brightness

To adjust brightness:

1. Press the Options softkey.

2. Press the High Bright or Low Bright softkey to select high and low brightness.

Note: Brightness level affects battery run time. Selecting high bright will cause the battery

charge to be depleted at a faster rate than when selecting low bright.

Using Code Markers

Pressing the CODE MARKER softkey causes the unit to display a preconfigured list of clinical actions. Pressing the softkey associated with a particular action causes that action, and 6 seconds of ECG, to be recorded along with a date and time stamp in the Summary Report memory. You can supplement an event summary by manually adding code markers which itemize drugs or treatments administered to the patient.

Up to six Code Markers can be displayed on the screen at one time.

Common Tasks

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Figure 2-14. Code Markers

The right-most softkey is labeled MORE when there are more than six items on the code marker list. Press the MORE softkey to see the next set of Code Markers displayed above the softkeys.

Separate code marker lists are maintained for DEFIB, MONITOR, and PACER modes, thereby enabling the display of appropriate code markers for eac h part icula r protoc ol. (For informa tion on configuring these code marker lists, refer to the R Series Configuration Guide.)

The code markers are removed from the display after 10 seconds. If no Code Marker softkey has been pressed during that time, a “default” event mark is stored in Summary Report memory.

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 2–13

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Chapter 3

Manual Defibrillation

Paddles are a defibrillation-protected Type BF patient connection.

ECG leads are a defibrillation-protected Type CF patient connection.

Emergency Defibrillation Procedure with Paddles

WARNING! To avoid risk of electrical shock, do not allow electrolyte gel to accumulate on hands or

paddle handles.

When defibrillating with paddles, use your thumbs to operate the SHOCK buttons in order to avoid inadvertent operator shock. No portion of the hands should be near the paddle plates.

Determine the Patient’s Condition Following Local Medical Protocols

Verify:

• Unconsciousness.

• Absence of breathing.

• Absence of pulse.

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 3–1

CHAPTER 3MANUAL DEFIBRILLATION

Begin CPR Following Local Medical Protocols.

Request additional assistance.

1 Select DEFIB

Turn the Mode Selector to DEFIB. The unit automatically defaults to 120 joules or the preconfigured first shock energy selection.

RECORDER

MONITOR

OFF

PACER

DEFIB

Note: Defibrillator PADDLES are selected as the ECG source when the instrument is turned

to MONITOR or DEFIB with paddles connected to the OneStep cable.

Energy Select

Look at the Display and verify the energy is appropriate. Unless internal handles are connected to the OneStep cable, the default energy selections for adult patients are:

• Shock 1 - 120 joules

• Shock 2 - 150 joules

• Shock 3 - 200 joules

If medical protocol allows, you may select a different energy level using the up and down arrow buttons. One pair is located on the front panel of the unit; the other pair is located on the sternum paddle.

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Note: Neonatal and pediatric defibrillator energy levels should be selected based on site-

specific protocols.

3–2 www.zoll.com 9650-0912-01 Rev. A

Emergency Defibrillation Procedure with Paddles

The selected energy level is shown as DEFIB XXXJ SEL. on the display.

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If you have configured Shocks 1, 2, and 3 to escalating energy levels (see the R Series Configuration Guide for instructions), the R Series automatically sets the energy to the

preconfigured Energy Level: Shock 1, 2, 3 setting at power-up and after each of the first two shocks. The ENERGY INCREMENTED message will be displayed after Shocks 1 and 2 are delivered. Manually changing the energy level outside the preprogrammed sequence and delivering a shock disables the automatic escalation function.

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Prepare Paddles

Release the paddles, apply a liberal amount of electrolyte gel to the electrode surface of each paddle, and rub the electrode surfaces together to evenly distribute the applied gel. (You can substitute electrode gel patches for the gel.)

Apply Paddles to Chest

Apply the paddles firmly to the anterior wall of the chest. Place the ste rn um padd le to t he righ t of the patient’s sternum (patient’s right), just below the clavicle.

Place the apex paddle on the chest wall, just below and to the left of the patient’s left nipple, along the anterior-axillary line.

Sternum

Apex

Rub the paddles against the skin to maximize the paddle-to-patient contact.

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 3–3

CHAPTER 3MANUAL DEFIBRILLATION

WARNING! Do not permit gel to accumulate between the paddle electrodes on the chest wall (gel

bridge). This could cause burns and reduce the amount of energy delivered to the heart.

If using defibrillator gel pads, make sure that the size of the pad is large enough to cover the entire paddle electrode area.

The paddles may be used for ECG monitoring in emergency situations when time does not allow connection of standard ECG monitoring electrodes.

If an ECG cable and ECG electrodes are in use, press the LEAD button to select the desired ECG lead.

2 Charge Defibrillator

Press the CHARGE button on the apex handle or on the front panel.

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If both SHOCK buttons on the paddles are depressed when the CHARGE button is activated, the unit does not charge and a RELEASE SHOCK BUTTON message appears on the display.

To increase or decrease the selected energy after you have pressed the CHARGE button, use the defibrillator ENERGY SELECT buttons on either the sternum paddle or the defibrillator front panel.

Caution Changing the selected energy while the unit is charging or charged causes the defibrillator to

disarm itself. Press the CHARGE button again to charge the unit to the newly selected energy level.

After charging to the selected energy, the charge indicator on the apex paddle lights. A distinctive charge ready tone sounds, and the message DEFIB XXXJ READY is displayed. The defibrillator is now ready to discharge.

3–4 www.zoll.com 9650-0912-01 Rev. A

Autoclavable External Paddles

3 Deliver Shock

WARNING! Warn all persons in attendance of the patient to STAND CLEAR prior to defibrillator

discharge.

Do not touch the bed, patient, or any equipment connected to the patient during defibrillation. A severe shock can result. Do not allow exposed portions of the patient’s body to come into contact with metal objects, such as a bed frame, as unwanted pathways for defibrillation current may result.

Apply a force of 10 - 12 kilograms (22 - 26.4 pounds) to each paddle in order to minimize patient impedance and achieve optimal results.

Using your thumbs, simultaneously press and hold both SHOCK buttons (one on each paddle) until energy is delivered to the pati ent.

Caution Use only thumbs to depress the SHOCK buttons. Failure to do so could result in the inadvertent

depression of the ENERGY SELECT buttons, causing the defibrillator to disarm itself.

Once the energy is delivered, the display si multaneously shows XXXJ DE LIVERED and DEFIB XXXJ SEL. After approximately 5 seconds, the XXXJ DELIVERED message disappears, and the DEFIB XXXJ SEL. message remains to indicate the selected energy level.

Note: If the defibrillator is not discharged within 60 seconds after reaching the selected

energy level, the unit automatically disarms itself.

During the 10 seconds prior to disarming, the charge ready tone beeps intermitten tly. The charge ready tone then stops, the charge indicator light goes off, and the monitor message changes to DEFIB XXXJ SEL. Press the CHARGE button to recharge the unit.

Autoclavable External Paddles

ZOLL Autoclavable External Paddles are available for use with manually operated ZOLL defibrillators when sterile conditions must be maintained during defibrillation.

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 3–5

CHAPTER 3MANUAL DEFIBRILLATION

Emergency Defibrillation Procedure with Hands-Free Therapy Electrodes

ZOLL hands-free therapy electrodes are a defibrillation-protected Type BF patient connection.

ECG leads are a defibrillation-protected Type CF patient connection.

Determine the Patient’s Condition Following Local Medical Protocols

Verify:

• Unconsciousness.

• Absence of breathing.

• Absence of pulse.

Begin CPR Following Medical Protocols

Request additional assistance.

Prepare Patient

Remove all clothing covering the patient’s chest. Dry chest if necessary. If the patient has excessive chest hair, clip or shave it to ensure proper adhesion of the electrodes.

Attach hands-free therapy electrodes according to inst ruct io ns on the electrode packaging. Ensure that the therapy electrodes are making good contact with the patient’s skin and are not

covering any part of the ECG electrodes. Connect the hands-free therapy electrodes to the OneStep cable if not preconnected.

If defibrillation electrodes are not making good contact with the patient’s skin, the unit issues the messages CHECK P ADS and POOR PAD CONTACT and does not allow del ivery of ener gy. If a short circuit exists between the electrodes, the unit issues t he message DEFIB PAD SHORT.

Therapy Electrode Application

WARNING! Poor adherence and/or air under the therapy electrodes can lead to the possibility of

arcing and skin burns.

1. Apply one edge of the pad securely to the patient.

2. Roll the pad smoothly from the applied edge to the other, being careful not to trap any air

pockets between the gel and skin.

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Emergency Defibrillation Procedure with Hands-Free Therapy Electrodes

Pad

Skin

Note: If it is not possible to place the “BACK” electrode on the patient’s back, place the

electrodes in the standard apex-sternum positions. Effective defibrillation results, but pacing will usually be less effective.

WARNING! Application of adult electrodes to a pediatric patient will result in the automatic

selection of adult energy levels. If needed, manually adjust the energy settings based on site-specific protocols.

1 Select DEFIB

Turn the Mode Selector to DEFIB. The unit automatically defaults to 120 joules or the preconfigured first shock energy selection.

RECORDER

MONITOR

OFF

DEFIB

PACER

PADS are selected as the ECG source when the instrument is turned to MONITOR or DEFIB and paddles are not connected to the On eStep cable. You may select any of the other ECG leads by pressing the front panel LEAD button.

Energy Select

Look at the display, and verify the selected energy is appropriate. The default energy selections for adult patients are:

• Shock 1 - 120 joules

• Shock 2 - 150 joules

• Shock 3 - 200 joules

When used with OneStep Pediatric electrodes, the default energy selections are:

• Shock 1 - 50 joules

• Shock 2 - 70 joules

• Shock 3 - 85 joules

WARNING! When used with pedi•padz, defibrillator energies must be set manually based on site-

specific institutional protocols for pediatric defibrillation.

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 3–7

CHAPTER 3MANUAL DEFIBRILLATION

After the third shock, all subsequent shocks are delivered at the same energy as the third shock in both Adult and Pediatric modes.

If medical protocol allows, you may select a different energy level using the ENERGY SELECT buttons on the front panel.

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The selected energy level is shown as DEFIB XXXJ SEL. on the display.

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If you have configured Shocks 1, 2, and 3 to escalating energy levels (see the R Series Configuration Guide for instructions), the R Series automatically sets the energy to the

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3–8 www.zoll.com 9650-0912-01 Rev. A

Emergency Defibrillation Procedure with Hands-Free Therapy Electrodes

2 Charge Defibrillator

Press the CHARGE button on the front panel.

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To increase or decrease the selected energy after you have pressed the CHARGE button, use the defibrillator ENERGY SELECT buttons.

Caution Changing the selected energy while the unit is charging or charged causes the defibrillator to

disarm itself. Press the CHARGE button again to charge the unit.

After charging to the selected energy, the SHOCK button on the front panel lights. A distinctive charge ready tone sounds and the DEFIB XXXJ READY is displayed. The defibrillator is now ready to discharge.

3 Deliver Shock

WARNING! Warn all persons in attendance of the patient to STAND CLEAR prior to defibrillator

discharge.

Press and hold the SHOCK button until energy is delivered to the patient.

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9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 3–9

CHAPTER 3MANUAL DEFIBRILLATION

Note: If the defibrillator is not discharged within 60 seconds after reaching the selected

energy level, the unit automatically disarms itself.

During the 10 seconds prior to disarming, the charge ready tone beeps intermitten tly. The charge ready tone then stops, the SHOCK button light goes off, and the monitor message changes to DEFIB XXXJ SEL. Press the CHARGE button to recharge the unit.

Once the energy is delivered, the display si multaneously shows XXXJ DE LIVERED and DEFIB

XXXJ SEL. After approximately 5 seconds, the XXXJ DELIVERED message disappears and the DEFIB XXXJ SEL. message remains to indicate the selected energy level.

Autoclavable Electrodes

ZOLL Autoclavable Internal Handles are designed for use with a manually operated ZOLL defibrillator to defibrillate the heart during open chest procedures. Two types of Autoclavable Internal Handles are available:

• Molded Autoclavable Internal handles with integrated electrode spoons

• Autoclavable Internal Handles with removable internal defibrillation electrodes

When these internal handles are used, the R Series defibrillator can operate only in Manual mode even if the unit supports Advisory mode. When an interna l hand le set is co nnect ed to th e R Series, it automatically limits energy output to a maximum of 50 joules.

For step-by-step procedures for op en chest defibrillation as well as important cleaning and sterilization information, refer to the Autoclavable Internal Handle and Electrode Operator’s Guide.

3–10 www.zoll.com 9650-0912-01 Rev. A

Chapter 4

Advisory Defibrillation (Optional)

ZOLL hands-free therapy electrodes are a defibrillation-protected Type BF patient connection.

When the Mode Selector is turned to DEFIB and hands-free therapy electrodes are used, the R Series can identify shockable rhythms using its built in ECG analysis capability. You must read the advisory messages, charge the defibrillator to the preconfigured or user-selected energy level (if automatic charge is disabled), and deliver treatment to the patient when required by protocol and patient condition.

The advisory function can be activated only when:

• Hands-free therapy electrodes are connected and selected as the ECG source.

• Hands-free therapy electrodes are properly connected to the patient.

• The Mode Selector is turned to DEFIB.

WARNING! Use only pediatric electrodes to defibrillate patients under 8 years of age in Advisory

mode. Use of adult electrodes with pediatric patients can result in the delivery of excessive energy doses.

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 4–1

CHAPTER 4ADVISORY DEFIBRILLATION (OPTIONAL)

Advisory Defibrillation Procedure

Determine the Patient’s Condition Following Local Medical Protocols

Verify:

• Unconsciousness.

• Absence of breathing.

• Absence of pulse.

Begin CPR Following Local Medical Protocols

Request additional assistance.

Prepare Patient

Remove all clothing covering the patient’s chest. Dry chest if necessary. If the patient has excessive chest hair, clip or shave it to ensure proper adhesion of the electrodes.

Attach hands-free therapy electrodes according to instructions on the electrode packaging and as described in “Therapy Electrode Application” on page 3-6.

Ensure that the electrodes are making go od contact with the patient’s skin and are not covering any part of the ECG electrodes.

If therapy electrodes are not making good contact with the patient’s skin, the unit issues the messages CHECK PADS and POOR P AD CONT ACT and does not allow delivery of energy. If a short circuit exists between the electrodes, the unit issues the message DEFIB PAD SHORT.

1 Select DEFIB

Turn the Mode Selector to DEFIB. The unit displays DEFIB 120J SEL on the monitor.

RECORDER

MONITOR

OFF

PACER

Energy Select

DEFIB

The default energy selections for adult patients are:

• Shock 1 - 120 joules

• Shock 2 - 150 joules

• Shock 3 - 200 joules

4–2 www.zoll.com 9650-0912-01 Rev. A

Advisory Defibrillation Procedure

When used with OneStep Pediatric electrodes, the default energy selections for pediatric patients are:

• Shock 1 - 50 joules

• Shock 2 - 70 joules

• Shock 3 - 85 joules

WARNING! Use only OneStep Pediatric electrodes to defibrillate patients under 8 years of age in

Advisory mode. Use of adult electrodes, or pediatric electrodes other than OneStep Pediatric electrodes, can result in the delivery of excessive energy doses.

After the third shock, all subsequent shocks are delivered at the same energy as the third shock in both Adult and Pediatric modes.

If medical protocols allow, you may select a different energy level using the energy select up and down arrow buttons on the front panel. The new energy setting displays on the monitor.

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If you have configured SHOCK 1, 2, and 3 to escalating energy levels, and then you manually change the energy level outside preconfigured SHOCK 1, 2, 3 sequence and deliver a shock, it disables the automatic energy escalation. See the Energy Level: Shock 1, 2, 3 section of the R Series Configuration Guide for more details.

2 Press ANALYZE Button

WARNING! Keep patient motionless during ECG analysis. Do not touch the patient during analysis.

Cease all movement via stretcher or vehicle before analyzing the ECG.

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9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 4–3

CHAPTER 4ADVISORY DEFIBRILLATION (OPTIONAL)

Press the ANALYZE button to begin the analysis of the patient’s ECG rhythm and to determine if a shockable rhythm is present.

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An ANALYZING ECG message is displayed for 6 to 12 seconds while the patient’s ECG is analyzed. Once the analysis is completed, the unit indicates whether or not a shock is advised.

The analysis normally consists of three consecutive 3-second ECG rhythm anal yses. If at least two of the three analyses determine that the patient has a shockable rhythm, the unit automatically charges to the preconfigured energy level and prompts the operator to shock the patient. If two or more of the three 3-second ECG analyses do not detect a shockable rhythm, the unit alerts the operator that no shock is advised.

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WARNING! ECG rhythm analysis does not warn of patient asystole, which is not a shockable

rhythm.

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When a nonshockable rhythm is detected, the unit displays a NO SHOCK ADV. message. Follow the local protocols to continue CPR or other life support, and re-analyze the ECG at appropriate intervals.

Note: When a nonshockable rhythm is detected, the R Series does not prevent the user from

manually defibrillating the patient.

When a shockable rhythm is detected (ventricular fibrillation or wide-complex tachycardia with heart rate > 150), one of the following occur:

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• Units with the automatic charge option enabled automatically charge to the preco nfigured or

user selected energy setting.

4–4 www.zoll.com 9650-0912-01 Rev. A

Advisory Defibrillation Procedure

• Units with the automatic charge option disabled will alternately display the messages

SHOCK ADVISED and PRESS CHARGE. Press the CHARGE button.

Regardless of the analysis result, the user can control the defibrillator manually. For example, the user can defibrillate the patient even if the advisory function issues a NO SHOCK ADV. message.

SHOCK ADVISED

ECG

DEFIB 120J SEL.

00:01

Options AlarmsReport

Code

MarkerParam

Sync

On/Off

3 Press SHOCK

WARNING! Warn all persons in attendance of the patient to STAND CLEAR prior to defibrillator

discharge.

Do not touch the bed, patient, or any equipment connected to the patient during defibrillation. A severe shock can result. Do not allow exposed portions of the patient’s body to come in contact with metal objects, such as a bed frame, as unwanted pathways for defibrillation current may result.

Once the unit is charged to the selected energy, the SHOCK button illuminates and the PRESS SHOCK message is displayed. Simultaneously, the monitor displays the energy level to which the defibrillator is charged, DEFIB XXXJ READY.

PRESS SHOCK

ECG

DEFIB 120J READY

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Options AlarmsReport

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 4–5

Code

MarkerParam

Sync

On/Off

CHAPTER 4ADVISORY DEFIBRILLATION (OPTIONAL)

A continuous tone sounds for 50 seconds, followed by an intermittent beeping for 10 seconds.You must deliver the shock within this 60 second interval, or the defibrillator will disarm itself.

Press and hold the illuminated SHOCK button on the front panel until energy is delivered to the patient. An XXXJ DELIVERED message appears on the display for approximately 5 seconds.

Watch the patient or ECG response to verify that the shock has been delivered. After the energy has been delivered to the patient, the display returns to DEFIB XXX J SEL.

Perform CPR

Begin chest compressions and rescue breathing per local protocol.

Repeat Analysis

Press the ANALYZE button to restart an ECG analysis and determine if additional shocks are required.

Note: Reanalysis of the ECG rhythm is inhibited for 3 seconds after each shock.

Continue Patient Care

Continue patient care according to medical protocols.

Advisory Function Messages

SELECT DEFIB MODE

Displayed if the ANALYZE button is pressed, but the unit is not in the DEFIB mode. T urn the Mode Selector to DEFIB to enable the defibrillator and advisory capability.

SELECT PADS

Displayed if the ANALYZE button is pressed while the device is operating in any ECG lead other than “PADS.” Press the LEAD button until “PADS” is selected.

REMOVE SYNC

Displayed if the ANALYZE button is pressed while the device is in SYNC mode. Turn off SYNC mode by pressing the SYNC softkey. Press the ANALYZE button again to initiate ECG rhythm analysis.

W arning Messages

Wa rning messages prompt the operator to check the patient, the unit, the electrodes and/or connections.

NOISY ECG / RETRY ANALYSIS

A NOISY ECG message alternating with a RETRY ANALYSIS message is displayed for 5 seconds when the unit detects a noisy ECG signal during ECG analysis. Check and adjust electrode placement and cable connections to help eliminate the noise source. Keep patient motionless during ECG analysis. Press the ANALYZE button again to begin ECG analysis.

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Warning Messages

CHECK PATIENT

The unit has detected a shockable rhythm during continuous background ECG analysis (i.e., Smart Alarms™). The prompt is given only when the heart rate alarms are enabled and the unit detects a shockable rhythm. The screen message persists as long as a shockable rhythm is being detected. Press the ANALYZE button to begin ECG analysis.

Note: This CHECK PATIENT analysis function operates continuously when heart rate

alarms are enabled and does not require pressing the ANALYZE button for operation.

CHECK PADS / POOR PAD CONTACT

The therapy electrodes are not properly attached to the patient, or the cable connections have become loose.

Check that the therapy electrodes are making good contact with the patient’s skin and that all cables are securely connected. This voice prompt will not sound if the therapy electrodes were not previously connected to the patient.

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CHAPTER 4ADVISORY DEFIBRILLATION (OPTIONAL)

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Chapter 5

Synchronized Cardioversion

Paddles are a defibrillation-protected Type BF patient connection.

ECG leads are a defibrillation-protected Type CF patient connection.

WARNING! Only skilled personnel trained in Advanced Cardiac Life Support and familiar with

equipment operation should perform synchronized cardioversion. The precise cardiac arrhythmia must be determined before attempting defibrillation or cardioversion.

Before attempting synchronized cardioversion, ensure that ECG signal quality is sufficient to minimize the risk of synchronizing on artifact.

Certain arrhythmias, such as ventricular tachycardia, atrial fibrillation, and atrial flutter, require synchronizing the defibrillator discharge with the ECG R-wave to avoid the induction of ventricular fibrillation.

detects the patient’s R-waves. When the SHOCK button (or buttons, if using paddles) is pressed and held, the unit discharges with the next detected R-wave, thus avoiding the vulnerable T-wave segment of the cardiac cycle.

When in the SYNC mode, the unit displays markers ( points in the cardiac cycle (R waves) where discharge can occur.

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 5–1

In this case, a synchronizing (SYNC) circuit within the defibrillator

) above the ECG trace to indicate the

CHAPTER 5SYNCHRONIZED CARDIOVERSION

Verify that markers are clearly visible on the monitor and their location is appropriate and consistent from beat to beat. If necessary, use the LEAD and SIZE buttons to establish settings that yield the most consistent sync marker pattern.

The synchronized cardioversion procedure for ZOLL hands-free therapy electrodes is identical to that for paddles with the exception of the SHOCK button location.

The R Series defibrillator supports two types of synchronized cardioversion:

• Synchronized Cardioversion — The R Series monitors the patient’s ECG and

synchronizes shock delivery with this ECG source. For instructions, refer to “Synchronized Cardioversion Procedure” below.

• Remote Synchronized Cardioversion — An external device (such as a patient monitor)

monitors the patient’s ECG and provides a synchronization pulse to the R Series’ Sync In/Marker Out connector. The R Series synchronizes shock delivery with these external pulses.

Note: When using the Remote Sync function, the procedure and displayed information are

different. Make sure to follow the instructions for Remot e Synchronized Cardio version on page 5-5.

Marker indicates each detected R wave during synchronization

Synchronized Cardioversion Procedure

Determine the Patient’s Condition and Provide Care Following Local Medical Protocols

Prepare Patient

Remove all clothing covering the patient’s chest. Dry chest if necessary. If the patient has excessive chest hair, clip or shave it to ensure proper adhesion of the electrodes.

Attach ECG electrodes as described in“Monitoring Electrodes Attachment” on page 9-3. A standard ECG cable and ECG electrodes are recommended for use during cardiove rsi on .

Hands-free therapy electrodes may be used as an ECG source. Signal quality will be equal to that of standard leads except immediately following a discharge when there may be more noise due to muscle tremors, especially if an electrode is not in complete contact with the skin.

Attach hands-free therapy electrodes according to instructions on the electrode packaging and as described in “Therapy Electrode Application” on page 3-6.

Ensure that the therapy electrodes are making good contact with the patient’s skin and are not covering any part of any other electrodes.

Connect the hands-free therapy electrodes to the OneStep cable if not preconnected.

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An ECG LEAD OFF condition prevents synchronized discharge if leads are selected as the ECG source. This condition does not prevent the use of the defibril lator; it simply preven ts use in a synchronized manner.

If paddles are being used for synchronized cardioversion, refer to “Emergency Defibrillation Procedure with Paddles” on page 3-1 for preparing paddles, applying paddles, charging the defibrillator, and delivering a shock. Note, however, that synchronized discharge with paddles as an ECG source is discouraged since the artifact induced by moving the paddles may resemble an R-wave and trigger defibrillator discharge at the wrong time.

1 Select DEFIB

Turn the Mode Sele ctor to DEFIB. Se lect the desired ener gy using the up and down arrow keys on the front panel (or sternum paddle if using paddles).

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Press the SYNC On/Off softkey

Your system will be in SYNC mode once you press the SYNC On/Off softkey if your R Series is not configured to support Remote Sync. However, if your R Series is configured to support Remote Sync, pressing the Sync On/Off softkey will cause two other softkeys to be displayed: Remote SYNC and SYNC. Press the SYNC softkey to enter Sync mode.

The selected energy level is displayed on the monitor. A sync marker (

) appears on the monitor above each detected R-wave to indicate where

discharge will occur. Verify that the markers are clearly visible on the monitor and their location is appropriate and

consistent from beat to beat. If necessary, use the LEAD and SIZE buttons to establish settings that yield the best display.

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CHAPTER 5SYNCHRONIZED CARDIOVERSION

A SYNC XXXJ SEL. message appears on the display. If DEFIB XXXJ SEL. appears, press the SYNC On/Off softkey. (If your unit supports Remote Sync, you must also press the SYNC softkey.) Two quick beeps sound.

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Unless otherwise configured, the unit automatically exits Sync mode after each shock and when the Mode Selector is moved to MONITOR, PACER or OFF.

To reactivate SYNC mode, press the SYNC On/Off softkey again. (If your unit supports Remote Sync, press the SYNC softkey again.) Changing the selected energy levels does not cause the unit to leave SYNC mode.

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Note that the unit can be configured to stay in SY NC mode after d efibrillation, if desired. Re fer to the R Series Configuration Guide for instructions.

2 Charge Defibrillator

Press the CHARGE button on the front panel or on the apex paddle handle.

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To abort charging and increase or decrease the selected energy after the CHARGE button has been pressed, use the ENERGY SELECT buttons on either the defibrillator front panel or the sternum paddle. Press the CHARGE button again to charge the unit to the newly selected energy level.

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After charging the unit to the selected energy, either the front panel SHOCK button or the APEX paddle charge indicator illuminates. A distinctive audible tone sounds and the SYNC XXXJ READY message is displayed.

The defibrillator is now ready to deliver therapy.

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Remote Synchronized Cardioversion Procedure

3 Deliver SHOCK

WARNING! Warn all persons in attendance of the patient to STAND CLEAR prior to defibrillator

discharge.

Verify that no one is in contact with the patient, monitoring cable or leads, bed rails, or any other potential current pathways.

Verify that the ECG waveform is stable and that sync markers appear over each R-wave. Press and hold the illuminated SHOCK button on the front panel, (or simultaneously press and

hold both paddle SHOCK buttons) until energy is delivered to the patient . The defibrillator will discharge with the next detected R wave.

Note: If the defibrillator is not discharged within 60 seconds after reaching the selected

energy level, the unit automatically disarms itself. During the ten seconds prior to this internal disarm, the charge ready ton e beeps intermitten tly. The charge ready tone then stops, and the defibrillator remains in SYNC mode.

Once the energy is delivered, the display si multaneously shows XXXJ DE LIVERED and DEFIB

XXXJ SEL. After approximately 5 seconds, the XXXJ DELIVERED message disappears and the DEFIB XXXJ SEL. message remains to indicate the selected energy level.

If additional countershocks are necessary, readjust the energy level as necessary, press the SYNC On/Off softkey, followed by the SYNC softkey (if your unit supports Remote Sync), and repeat. Note that SYNC XXXJ SEL must be displayed prior to pressing the CHARGE button.

If the ANALYZE button is pressed while the unit is in SYNC mode, the unit displays the REMOVE SYNC message and does not allow ECG rhythm analysis until the unit is taken out of SYNC mode.

Remote Synchronized Cardioversion Procedure

The R Series may be configured to receive defibrillation synchronizat io n pu lse s from a remote ECG monitoring device. See the R Series Configuration Manual. Be sure that the remote device is connected to the Sync In/Marker Out connector on the R Series unit. The remote device must have a sync out connector and a cable must be provided to connect the two devices. Ensure the remote device conforms with the Sync In/Marker Out specifications (described in Appendix A, “Defibrillator Specifications”).

WARNING! A lethal arrhythmia may be induced through improper synchronization. Qualified

personnel within the hospital should verify synchronization delay for the entire remote monitor and defibrillator system prior to clinical use. Synchronization delay for the system as a whole must not exceed 60 msec.

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CHAPTER 5SYNCHRONIZED CARDIOVERSION

Determine the Patient’s Condition and Provide Care Following Local Medical Protocols

Prepare Patient

Prepare the patient as described in “Prepare Patient” on page 5-2.

Follow the instructions provided with the external monitoring device to prepare the patient for ECG monitoring and synchronization with a separate defibrillator.

1 Select DEFIB

Turn the Mode Selector to DEFIB. Select the desired energy using the up and down arrow keys on the front panel (or sternum

paddle if using paddles).

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Press SYNC On/Off softkey, then press the Remote Sync Softkey

The selected energy level is displayed on the monitor. The words “REMOTE SYNC” are displayed in place of the ECG trace, and a REMOTE SYNC

XXXJ SEL. message appears on the display. The ECG heartbeat indicator will flash with each synchronization pulse received from the

remote monitoring device. Unless otherwise configured, the unit automatically exits sync mode after each shock, and if the

Mode Selector is moved to MONITOR, PACER or OFF. Press the Sync On/Off, Remote Sync softkey sequence again to reactivate Remote Sync mode.

Changing the selected energy levels does not cause the unit to leave Remote Sync mode. View the ECG trace on the remote device’s display. Verify that sync markers appear with each

R-wave. The sync markers will appear as described in the remote device’s user manual.

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Remote Synchronized Cardioversion Procedure

WARNING! Ve rify the ECG waveform is stable and that a sync marker appears only with R-waves.

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

2 Charge Defibrillator

Press the CHARGE button on the front panel or, if using paddles, on the apex paddle handle.

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After charging the unit to the selected energy, either the front panel SHOCK button or, the apex paddle charge indicator illuminates. A distinctive audible tone sounds and the energy ready REMOTE SYNC XXXJ READY message is displayed.

The defibrillator is now ready to deliver therapy.

3 Deliver SHOCK

WARNING! Warn all persons in attendance of the patient to STAND CLEAR prior to defibrillator

discharge.

Verify that no one is in contact with the patient, monitoring cable or leads, bed rails, or any other potential current pathways.

Press and hold the illuminated SHOCK button on the front panel, or simultaneously press and hold both paddle SHOCK buttons until energy is delivered. The defibrillator will discharge with the next remote synchronization pulse.

Note: If the defibrillator is not discharged within 60 seconds after reaching the selected

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 5–7

CHAPTER 5SYNCHRONIZED CARDIOVERSION

Once the energy is delivered, the display si multaneously shows XXXJ DE LIVERED and DEFIB XXXJ SEL. After approximately 5 seconds, the XXXJ DELIVERED message disappears and the DEFIB XXXJ SEL. message remains to indicate the selected energy level.

If additional countershocks are necessary, readjust the energy level as necessary, press the

SYNC On/Off, and then the Remote SYNC softkeys and repeat. Note that REMOTE SYNC XXXJ SEL must be displayed prior to pressing the CHARGE button.

If the ANALYZE button is pressed while the unit is in Remote SYNC mode, the unit displays the REMOVE SYNC message and disallows ECG rhythm analysis until the unit is taken out of SYNC mode.

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Chapter 6

Real CPR Help

Real CPR Help is defibrillation-proof Type BF equipment.

WARNING! The Real CPR Help function is not intended for use on patients under 8 years of age.

When used with OneStep CPR electrodes or OneStep Complete electrodes, the R Seri es uni t can provide rescuers with feedback about the quality of CPR they are delivering to their patients. The way in which feedback is provided varies with respect to the operational mode and user configuration, but is derived from compression rate and depth measurements.

When applied according to package instructions, ZOLL OneStep CPR and OneStep Complete electrodes provide a chest compression sensor that is located between the rescuer's hands and the patient's lower sternum. This sensor monitors the rate and depth of chest compressions and sends this information to the R Series unit for processing and display.

The R Series defibrillator uses this information to provide feedback to the rescuer in one or more of the following forms:

• CPR Index

• CPR Idle Time Display

• CPR Rate Metronome

• Voice prompts

• Chest Compressions Waveform display

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 6–1

CHAPTER 6REAL CPR HELP

Real CPR Help Field

Whenever OneStep CPR, or OneStep Complete electrodes are connected to the R Series defibrillator, the unit illuminates the Real CPR Help field in the upper center portion of the display. This field includes the indicators described in the next sections.

CPR Index (Optional)

This hexagon shaped figure provides a quick, overall indicator of how well the rescuer's combined rate and depth of chest compressions match the AHA/ERC recommendations for adult CPR.

Before chest compressions begin (and after each shock), the CPR Index is displayed as a hollow outline. This index starts to fill from the center out as compressions b egin, and be comes fully filled when consistent chest compression depth exceeding 1.75 inch es and rate exceeding 90 compressions per minute (cpm) are simultaneously achieved. Should the chest compression rate or depth begin to fall below the AHA/ERC recommended levels, the Index will only partially fill to indicate the need for more vigorous efforts. Following the cessation of compressions, the Index’s fill level gradually decreases until a hollow outline is displayed afte r a short period of time.

When complete filling of the CPR Index has not been achieved due to diminished compression rate or depth, the R Series will display the words RATE and/or DEPTH to assist the rescuer in determining whether chest compression rate or depth should be increased. When an appropriate rate or depth has been achieved, 80 cpm and 1.5 i nches, respectively, one or both of these words will disappear from the display.

CPR Idle Time Display

This display indicates the elapsed time in minutes and seconds since the last detected chest compression. When compressions are being delivered, this time display will be blanked. Ten seconds following the cessation of compressions, the display will illuminate and show the elapsed time since the last detected compression. If no compressions have been delivered for more than 20 minutes, dashes (---) will be displayed in this time field.

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CPR Metronome

The R Series unit includes a CPR metronome feature that can be used to encourage rescuers to perform chest compressions at the AHA/ERC recommended rate of 100 compressions per minute. This feature can be configured On or Off.

When activated, the metronome beeps at the AHA/ERC recommended rate to provide a compression rhythm for rescuers to follow. The metronome is silent when no chest compressions are being detected by CPR-equipped hands-free therapy electrodes.

In Manual and Advisory modes, the metronome only beeps when chest compressions are detected and their rate falls below th e AHA/ERC recommended levels. When comp ressions are being performed at 80 compressions per minute or higher, the metronome is silent. Should the detected compression rate fall below this level, the metronome will begin beeping until recommended compression rates are consistently achieved over several compression cycles. The metronome stops beeping approximately 2 seconds after the last chest compression is detected.

CPR Voice Prompts

The R Series can be configured to issue voice prompts related to the depth of chest compressions as feedback to rescuers performing CPR. Two voice prompts are available for this purpose:

CPR Voice Prompts

• Push Harder

• Good Compressions

When chest compressions are detected but their depth is consistently less than 1.5 inches (3.8 cm), the defibrillator will periodically issue the prompt “Push Harder”. If the rescuer responds by increasing compression depth to more than 1.5 inches (3.8 cm) on a consistent basis, the unit will issue a “Good Compressions” prompt.

See the R Series Configuration Guide for information on enabling/disabling CPR voice prompts.

Chest Compressions Waveform

The R Series can display the chest displacement waveform computed from the CPR sensor signals. Displacement waveforms are displayed at the same sweep speed as ECG resulting in a 5 second CPR display.

Displaying the CPR Waveform

To display the CPR displacement waveform in the Trace 2 or 3 position:

1. Press the Options softkey, then press Traces.

2. Press either the Trace 2 or Trace 3 softkey.

3. Press CPR.

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CHAPTER 6REAL CPR HELP

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Chapter 7

See-Thru CPR (Optional)

WARNING! The See-Thru CPR filter works only when the R Series defibrillator is monitoring CPR.

The See-Thru CPR filter stops if:

— The unit is in pace mode. — Patient impedance is invalid. — OneStep CPR electrodes or OneStep Complete electrodes are no longer detected.

The See-Thru CPR filter will not remove all CPR artifact. Always stop CPR to verify the patient’s ECG rhythm before making treatment decisions.

The See-Thru CPR filter does not operate during ECG rhythm analysis. Always stop chest compressions durin g ECG rhyth m anal ys is to avoid incorrect results caused by the presence of CPR artifact.

Diagnostic bandwidth is never applied to the See-Thru CPR waveform.

See-Thru CPR enables the rescuer to see a close approximation of the patient’s underlying ECG rhythm while performing CPR. See-Thru CPR is available if the R Series is monitoring CPR.

Chest compressions introduce CPR artifact into the ECG signal. See-Thru CPR uses a filter that relies on the correlation between CPR compressions, as detected by the ZOLL Onestep CPR or OneStep Complete electrodes, and the CPR artifact to remove much, but not all, of the artifact from the ECG signal. Under some conditions, residual noise after filtering can obscure the ECG rhythm, requiring the rescuer to stop CPR to assess the ECG. For example, in the case of asystole or low amplitude PEA, the residual artifact seen after filtering may look like fine ventricular fibrillation.

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CHAPTER 7SEE-THRU CPR (OPTIONAL)

Because the filtered ECG signal may contain residual chest compression and/or filtering artifacts, a rescuer should always follow the standard procedure of stopping CPR to assess the patient’s ECG rhythm before determining treatment.

Using See-Thru CPR

To use See-Thru CPR

• The R Series unit must be monitoring CPR.

• OneStep CPR or OneStep Complete electrodes must be attached to the unit.

When chest compressions begin, the R Series unit automatically starts filtering the CPR artifact after detecting the first 3 to 6 compressions. The filtered ECG, with the label “FIL,” may be displayed on the second or third trace (by selecting FILT ECG in the Trace2 or Trace3 menu).

See-Thru CPR filtering continues as long as the OneStep CPR or OneS tep Compl ete electrodes detect compressions and patient impedance is valid. When no compressions are detected or one of the conditions noted above occurs, See-Thru CPR filtering stops, and unfiltered ECG signals are displayed. When compressions resume, filtering automatically restarts after 3 to 6 chest compressions.

Note: There is a delay of approximately 1/16 second between the See-Thru CPR waveform

and the Trace 1 ECG waveform.

Examples

The following examples show the effects of See-Thru CPR filtering on ECG signals contaminated with CPR artifacts.

Each example includes:

• ECG signal with CPR artifact.

• ECG signal after the See-Thru CPR filter has removed CPR artifact.

• Indication of the period during which See-Thru CPR is active.

• CPR signal to show when CPR activity occurred.

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Using See-Thru CPR

The following figure shows a patient in Fine VF. It is difficult for a rescuer to discern this rhythm during CPR compressions. When the CPR filter turns on, the Fine VF rhythm becomes more obvious.

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CHAPTER 7SEE-THRU CPR (OPTIONAL)

The following figure shows a patient in VF, which, during compressions, is slightly more difficult to discern. When viewing this ECG, it is possible to view the underlying rhythm as the filter is able to reject all of the CPR artifact.

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Using See-Thru CPR

The following figure shows a patient in PEA, which could easily be mistaken for Fine VF because enough of the compression artifact leaks through to distort this signal. When the CPR filter turns on, the PEA is still not obvious beca use of the l eft over ripples from the C PR signal. About 14 seconds into this chart, the rhythm changes to asystole, which could easily be mistaken for coarse VF. When the CPR filter turns on, the CPR compression ripples are still obvious, making the rhythm look like Fine VF.

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CHAPTER 7SEE-THRU CPR (OPTIONAL)

The following figure shows a patient with an organized rhythm where See-Thru CPR effectively filters out artifact created by CPR.

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Chapter 8

Noninvasive Temporary Pacing

(Optional)

When ZOLL hands-free therapy electrodes are used, the patient connection is considered to be defibrillation-protected Type BF.

ECG leads are a defibrillation-protected Type CF patient connection.

WARNING! To avoid risk of electrical shock, do not touch the gelled area of the hands-free therapy

electrodes while pacing.

Therapy electrodes shoul d be replaced periodically. Consult electrode directions for specific recommendations.

Prolonged pacing (in excess of 30 minutes), particularly in neonates or adults with severely restricted blood flow, may cause burns. Periodic inspection of the underlying skin is recommended.

If the unit was NOT turned off and less than 10 minutes have elapsed since the pacing mode was last used, reactivating the pacer mode causes pacing to resume immediately at the previously selected mA and ppm settings.

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CHAPTER 8NONINVASIVE TEMPORARY PACING (OPTIONAL)

Noninvasive Temporary Pacing

R Series defibrillators with the pacer option contain a VVI demand pacemaker – a safe and effective design for Noninvasive Temporary Pacemakers.

Proper demand pacing requires a reliable, high quality surface ECG signal. For best results:

• Apply both standard ECG monitoring electrodes and hands-free pacing therapy electrodes

(such as, OneStep electrodes or stat•padz) to the patient, or

• Use OneStep Pacing electrodes, or OneStep Complete electrodes. These hands-free therapy

pads include both ECG monitoring and pacing/defibrillation ele ctro des in a sing le pad assembly. They provide reliable ECG monitoring without the need to use separate ECG leads. With these electrodes you must also use the OneStep Pacing cable.

Determine Patient Condition and Provide Care Following Local Medical Protocols.

Prepare the Patient

Remove all clothing covering the patient’s chest. Dry chest if necessary. If the patient has excessive chest hair, clip it to ensure proper adhesion of the electrodes.

1 Apply ECG Electrodes/Hands-Free Therapy Electrodes

The R Series supports two electrode configurations for pacing:

• OneStep Pacing Configuration

Simultaneous ECG monitoring and pacing can be performed with a single set of therapy electrodes when using OneStep Pacing electrodes or OneStep Complete electrodes along with a OneStep Pacing cable. The OneStep Pac ing cable must be connected t o both the MFC and ECG connectors of the R Series unit. Attach OneStep electrodes according to instructions on the electrode packaging. Then connect the electrodes to the OneStep Pacing cable.

• Separate ECG Electrodes and Hands-free Therapy Electrodes Configuration

Apply ECG electrodes, attach lead wires, and connect the ECG cable to the R Series rear panel (see page 9-3 for instructions on attaching ECG electrodes to the patient). Attach hands-free therapy electrodes according to instructions on the electrod e packaging . Connect these therapy electrodes to the OneStep cable.

Therapy Electrode Application

WARNING! Poor adherence and/or air under the therapy electrodes can lead to the possibility of

arcing and skin burns.

1. Apply one edge of the pad securely to the patient.

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Noninvasive Temporary Pacing

2. Roll the pad smoothly from the applied edge to the other, being careful not to trap any air

pockets between the gel and skin.

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3. Ensure that hands-free therapy electrodes are making good contact with the patient’s skin and

Skin

are not covering any part of any other ECG electrodes.

4. If using OneStep Pacing electrodes or OneStep Complete electrodes, selec t ECG lead P1, P2,

or P3; otherwise, select an appropriate ECG lead. Adjust ECG size for a clean, well-defined ECG signal.

5. Verify proper R-wave detection. The heart-shaped symbol flashes with each R-wave when

proper detection is taking place. Adjust ECG size for a clean, well-defined ECG signal.

Note: When the OneStep Pacing electrode configuration is used and the unit is switched to

PACER mode, P3 is automatically selected as the ECG source. When separate ECG

electrodes and hands-free therapy electrodes are used, Lead II is automaticall y selected as the ECG source.

While ECG signals acquired from P1, P2 or P3 are appropriate for ECG rhythm assessment and determining electrical capture during pacing, they should not be used for diagnostic purposes. Conventional ECG electrodes and cable should be used for this purpose.

2 Turn Selector Switch to PACER

RECORDER

MONITOR

OFF

PACER

Set the Pacer Output to 0 mA

If the unit has just been turned on, the PACER OUTPUT is automatically set to 0 mA.

3 Set Pacer Rate

Set the PACER RATE to a value 10-20 ppm higher than the patient’s intrinsic heart rate. If no intrinsic rate exists, use 100 ppm.

DEFIB

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 8–3

CHAPTER 8NONINVASIVE TEMPORARY PACING (OPTIONAL)

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The pacer rate increments or decrements by a value of 2 ppm on the display when the knob is turned.

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Observe the pacing stimulus marker on the display or stripchart well-positioned in diastole.

4 Set Pacer Output

Increase PACER OUTOUT until stimulation is effective (capture); the output mA value is displayed. The pacer output increments and decrements by a value of 2 mA on the display when the knob is turned.

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Note: When the unit is switched out of PACER mode into DEFIB or MONITOR mode and

then switched back to PACER mode, within 10 minutes the pacer settings remain unchanged.

If the unit is turned off for more than 10 seconds, the pacer’s power up default settings are restored.

8–4 www.zoll.com 9650-0912-01 Rev. A

Noninvasive Temporary Pacing

5 Determine Capture

It is important to recognize when pacing stimulation has produced a ventricular response (capture). Determination of capture must be assessed both electrically and mechanically in order to ensure appropriate circulatory support of the patient.

Electrical capture is determined by the presence of a widened QRS complex, the loss of any underlying intrinsic rhythm, and the app earance of an extended, and sometimes enlarged, T-wave.

Ventricular response is normally characterized by suppression of the intrinsic QRS complex.

WARNING! Determination of electrical capture should only be performed by viewing the ECG trace

on the R Series display with its ECG connection directly attached to the patient. Use of other ECG monitoring devices might provide misleading information due to the presence of pacer artifacts.

Mechanical capture is assessed by palpation of the periph eral pulse. To avoid mistaking muscular response to pacing stimu li for arterial pulsations, use ONLY the

following locations for palpating pulse during pacing:

• femoral artery

• right brachial or radial artery

Effective pacing

The following ECG traces illustrate typical examples of effective pacing.

Large T wave

Negative R wave

Pacer Markers

Widened, positive QRS

(which looks like an

ectopic beat).

Pacer Markers

Inverted T wave/ absence of P waves

Changing ECG leads and size can sometimes be helpful in determining capture. Note: The shape and size of the paced ECG waveforms can vary depending on the ECG lead

configuration chosen; variation from patient to patient can be expected.

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 8–5

CHAPTER 8NONINVASIVE TEMPORARY PACING (OPTIONAL)

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6 Determine Optimum Threshold

The ideal pacer current is the lowest value that maintains capture — usually about 10% above threshold. Typical threshold currents range from 40 to 80 mA. Location of the hands-free therapy or OneStep therapy electrodes affects the current required to obta in ventricular capture. T ypically t he lowest threshol d is obtained whe n the position of the electrod es provides th e most direct current pathway through the heart while avoi ding lar ge chest muscles. Lower st imulation currents produce less skeletal muscle contraction and are better tolerat ed.

4:1 Mode

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Pressing and holding the 4:1 button temp orarily withholds pac ing stimuli, thereb y allowing you to observe the patient’s underlying ECG rhythm and morphology.

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When depressed, this button causes pacing stimuli to be delivered at ¼ of the indicat ed ppm setting.

Pace Fault

If the unit is attempting to deliver paci ng therapy an d one of the followi ng conditions occur , th e messages CHECK PADS and POOR PAD CONTACT are alternately displayed on the screen and an audible alarm sounds:

• The OneStep cable is not connected to the device.

• The cable is defective.

• Therapy pads are not connected to the OneStep cable.

• The therapy pads are not making good skin contact.

The alarm will continue to sound until proper connections between the patient and pacer are achieved and the leftmost softkey (Clear Pace Alarm) is pressed.

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Special Pacing Applications

Noninvasive Temporary Pacing can be performed in the Cardiac Catheterization Lab either for emergency pacing or standby pacing. For pacing in X-ray and fluoroscopic ap plications, ZOLL pro•padz® radiolucent hands-free therapy electrodes may be used.

Noninvasive Temporary Pacing can be performed in the Operating Room using ZOLL pro•padz sterile hands-free therapy electrodes.

Caution Under certain conditions, it might not be possible to properly monitor or pace while

electrosurgical apparatus is operating. Observe the device carefully for evidence of proper operation.

Standby Pacing

For certain patients at risk of developing symptomatic bradycardia, it may be advisable to use the unit in standby mode. When used in standby mode, the unit automatically provides pacing stimuli whenever the patient’s heart rate drops below the pacer rate setting. Patient’ s ECG must be monitored using one of the two electrode configurations described on page 8-2. To use the device in standby mode:

1. Establish effective pacing (see instructions on previous pages). Note the mA output at capture and run an ECG stripchart to document ECG morphology during capture.

2. Set the mA output 10% higher than the minimum mA output necessary to effect consistent

ventricular capture.

3. Turn the pacing rate (ppm) below the patient’s heart rate. This suppresses pacing unless the

patient’ s own rate drops b elow the pacer rate se tting. The pa cing rate should be set a t a level sufficient to ensure adequate cardiac output.

4. Check the threshold periodically.

Asynchronous Pacing

If ECG electrodes are not available or there is some circumstance that prevents or interferes with the surface ECG, the R Series delivers pacemaker pulses asynchronously.

Asynchronous pacing should be performed only in an emergency when no alternative is available. To pace asynchronously:

Turn the Mode Selector to PACER.

Press the Async Pacing On/Off softkey.

Note: If the pacer outp ut is set to 8 mA or h igher, pacing stimuli begin immediately at the set

rate.

The display shows “ASYNC PACE” to indicate that asynchronous pacing has been activated. The annotation “ASYNC PACE” is also printed on the stripchart when activated by the

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 8–7

CHAPTER 8NONINVASIVE TEMPORARY PACING (OPTIONAL)

RECORDER button, and printed on the corresponding summary report. To return to demand pacing, press the ASYNC Pacing On/Off softkey again. The display returns to “PACE.”

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Pace stimuli are also delivered asynchronously whenever there is an ECG LEAD OFF condition. Due to the lead off c on dit io n, no ECG wave fo rms will be displayed when pacing by this method. Use other means to determine capture such as checking the patient’s pulse

When asynchronously pacing with an ECG LEAD OFF condition, the rate and mA should be set at the known capture level or high enough (100mA) to presume capture.

Pediatric Pacing

Noninvasive pacing of pediatric patients is performed in an identical manner to adult pacing. Smaller size pediatric therapy electrodes (OneStep pediatric electrodes) are available for patients weighing less than 33 lbs/15 kg. Continuous pacing of neonates can cause skin burns. If it is necessary to pace for more than 30 minutes, p eriodic inspec tion of th e underlying skin is strongly advised. Carefully follow all instructions on electrode packaging.

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8–8 www.zoll.com 9650-0912-01 Rev. A

Chapter 9

ECG Monitoring

ECG leads are a defibrillation-protected Type CF patient connection.

The R Series products can be used for either short- or long-term ECG monitoring. R Series products have built-in circuitry to prevent damage to their ECG monitoring circuits

during defibrillation. Monitoring electro des, how ev er, can become polarized during defibrillator discharge, causing the ECG trace to briefly disappear from the screen. High-quality silver/silver chloride (Ag/AgCl) electrodes minimize this effect. Circuitry in the unit returns the ECG trace to the display within a few seconds.

You can monitor a patient’s ECG using an ECG patient cable, hands-free therapy electrodes, or through standard defibrillation paddles.

During ECG monitoring, the R Series displays the following information:

• Five seconds of ECG waveforms

• Heart Rate

• Heartbeat indicator

• ECG source lead (I, II, III, aVR, aVL, aVF, or V with ECG cable; PADS, or PADDLES)

• ECG size (0.5, 1, 1.5, 2.0 or 3 cm/mV)

• Alarm indicator

Whenever more than one waveform is displayed, the selected ECG lead appears as the uppermost trace.

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 9–1

CHAPTER 9ECG MONITORING

Caution ECG electrodes embedded in OneStep Pacing and Complete resuscitation pads produce

non-standard ECG monitoring lead vectors, designated P1, P2 and P3. While ECG signals acquired from these leads ar e appropriate for ECG rhythm assessment and determining electrical capture during pacing, they should not be used for ECG morphological evaluations. Attach conventional ECG electrodes for diagnostic purposes.

Preparations

Proper application and placement of electrodes is essential for high quality ECG monitoring. Good contact between the electrode and skin minimizes motion a rtifact and signal interferenc e. Remove all clothing covering the patient’s chest. Dry chest if necessary. If the patient has excessive chest hair, clip or shave it to ensure proper adhesion of the electrodes.

Electrode Placement

Depending upon local usage, th e ECG leads are marked either RA, LA, LL, RL, and V or R, L, F, N and C. The following table shows the mark ings and color codes for the different lead sets.

IEC Color Coding

R/Red Electrode RA/White

L/Yellow Electrode

F/Green Electrode

N/Black* Electrode

C/White* Electrode

* Not used for 3-lead monitoring

AHA Color Coding

Electrode LA/Black

Electrode LL/Red

Electrode RL/Green*

Electrode V/Brown*

Electrode

Placement of Electrodes

Place near patient’s right mid-clavicular line, directly below clavicle.

Place near patient’s left mid-clavicular line, directly below clavicle.

Place between 6th and 7th intercostal space on patient’s left mid-clavicular line.

Place between 6th and 7th intercostal space on patient’s right mid-clavicular line.

Single movable chest electrode.

9–2 www.zoll.com 9650-0912-01 Rev. A

Monitoring Electrodes Attachment

3-lead configuration 5-lead wire configuration

RA LA

3-lead set 5-lead cable

3-lead cable

Note: Lead sets and lead cables are different accessories and are not interchangeable. For

5-lead monitoring, use a 5-lead cable.

Monitoring Electrodes Attachment

RA LA

Attach snap-on leads to electrodes and check for good contact between the electrode and the lead termination.

If you are using a 3-lead set, connect the end of the 3-lead set to a OneStep Pacing cable.

OneStep Pacing cable

connection complete

3-lead set

Peel the protective backing from the ECG electrode. Be careful to keep adhesive surfac e free of electrolyte gel.

Caution Only use electrodes that are well within the expiration date indicated on the package.

Apply the ECG electrodes firmly to the patient’s skin, pressing around the entire perimeter of the electrodes.

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 9–3

CHAPTER 9ECG MONITORING

Plug the patient cable connector into the black ECG input connector (located on the rear panel of the instrument).

Note: If you are using a 3-lead set that is connected to a OneStep Pacing cable, plug the red

connector into the red OneStep cable input connector on the device, and plug the connector (that is black inside) into the black ECG input connector on the device.

OneStep Pacing cable (connected to a 3-lead set)

3-lead or 5-lead cable

Caution T o avoid electrosurgery burns at monitori ng sites, ensure proper connection of the electrosurgery

return circuit so that the return paths cannot be made through monitoring electrodes or probes.

During electrosurgery, observe the following guidelines to minimize ESU interference and provide maximum user and patient safety:

• Keep all patient monitoring cables away from earth ground, ESU knives, and ESU return

wires.

• Use electrosurgical grounding pads with the largest practical contact area.

Always assure proper application of the electrosurgical return electrode to the patient.

9–4 www.zoll.com 9650-0912-01 Rev. A

Monitoring the Patient’ s ECG

Set the Controls

Set the Mode Selector to MONITOR, then press the LEAD button until the desired lead configuration is selected. The selected lead is indicated at upper right of the display.

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Monitoring the Patient’s ECG

If the unit displays the ECG LEAD OFF, POOR LEAD CONTACT, or CHECK PADS message, inspect the ECG electrodes or therapy electrodes, lead wires, and cables for proper conn ections.

If heart rate alarms are enabled with paddles selected, the unit displays the messages SELECT LIMB LEADS and VF ALARMS OFF. If you see these messages, select limb or precordial leads.

If you want to change the size of the displaye d ECG wav eform, press the SIZE butto n until the desired waveform size is displayed. Options are 0.5, 1, 1.5, 2, and 3 times the normal size (1 cm/mv).

If you want to shut off the heart rate beeper, press the Options, then the QRS VOL OFF softkeys. To turn it back on, press the QRS VOL ON softkey.

WARNING! Implanted pacemakers may cause the heart rate meter to count pacemaker pulses

during incidents of cardiac arrest or other arrhythmias. Pacemaker patients should be carefully observed. Check the patient's pulse; do not rely solely on heart rate meters. Dedicated pacemaker detection circuitry may not detect all implant ed pacemaker spikes; patient history and physica l exa m are important in determining the presence of an implanted pacemaker.

Implanted Pacemakers

The R Series device can be configured to detect pacemaker signals from a patient with an implanted pacemaker and indicate their presence on the display. When pacer pulses are detected, the device displays a 5mm, vertical, solid line on the ECG trace.

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 9–5

CHAPTER 9ECG MONITORING

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To disable detection of pacemaker spikes:

1. Press the Param softkey.

2. Press ECG.

3. Press Disable Pacer Detect.

To re-enable detection of pacemaker spikes:

1. Press the Param softkey.

2. Press ECG.

3. Press Enable Pacer Detect.

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5-Lead Monitoring

You can perform 5-lead ECG monitoring with the appropriate ECG patient cable. The 5-lead cable allows you to monitor the following ECG leads:

• I, II, III

• aVR, aVL, aVF

• V1

Changing from 3-Lead Monitoring

To change from 3-lead to 5-lead monitoring, simply disconnect the 3-Lead ECG patient cable (or OneStep Pacing cable ECG connector) and connect the 5-lead ECG cable. Refer to the beginning of this section for appropriate preparations (i.e., placing electrodes, attaching electrodes, setting the controls, etc.).

If any ECG lead becomes disconnected during monitoring, an ECG LEAD OFF message appears on the display.

9–6 www.zoll.com 9650-0912-01 Rev. A

Changing from 5-Lead ECG Monitoring

T o change from 5-lead monitoring to 3-lead monitoring, you must power off the unit for at least 10 seconds, remove the 5-lead cable, connect the 3-lead cable, then power on the unit again. If you fail to shut the unit off for at least 10 seconds, the unit displays the ECG LEAD OFF message after you disconnect the 5-lead wire cable, even if leads from a 3 lead ECG cable are properly attached to the patient.

Simultaneous 3-Lead Printing

The R Series unit can display and print three simultaneous ECG leads when using a 5 lead cable and an ECG lead is selected as the signal source (not PADS or PADDLES).

Note: This feature does not work with a 3 lead cable. To display and print 3 simultaneous leads:

1. Press the Options softkey, then press the Traces softkey.

2. Press 3 Leads.

Leads belong to two groups: limb leads (I, II and III) and augmented leads (aVR, aVL, and aVF). The selected lead is always displayed and printed in the Trace 1 uppermost position. The other two leads are displayed in the Trace 2 and 3 positions. For example, if aVL is the selected Trace 1 lead, the Trace 2 and 3 positions display aVR, and aVF respectively.

5-Lead Monitoring

3 ECG leads will also be printed (when an ECG lead is selected) if the “Print 3 Leads When Leads are Sel.” configuration option is set to YES. Refer to the R Series Configuration Guide for instructions.

See-Thru CPR Filter (Optional)

When OneStep CPR electrodes or OneStep Complete electrodes are in use, the R Series unit allows simultaneous display and printin g of the selected EC G lead and the same ECG lead with CPR filtering applied. The CPR filter uses signals from the electrode’s CPR sensor to help reduce artifact in the ECG signal caused by mechanical compressions of the chest, thereby providing a clearer view of the ECG during periods of CPR. For more detailed information on this feature, see Chapter 7, "See-Thru CPR (Optional)".

To apply the See-Thru CPR Filter to the selected ECG lead and display it:

1. Press the Options softkey, then press the Traces softkey.

2. Press the Trace 2 or Trace 3 softkey.

3. Press Filt ECG.

Adding Traces to Be Displayed

The screen can display up to three traces simultaneously. The trace for the selected ECG lead always appears in the Trace 1 uppermost position.

If optional physiological monitoring paramet ers are i nstalled in the unit, t he operator can select applicable traces to appear in the second or third position.

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 9–7

CHAPTER 9ECG MONITORING

To select the display for the second or third trace:

1. Press the Options softkey, then press Traces.

2. Press Trace 2 or Trace 3 to select the position.

3. Press the softkey for the parameter or other waveform to display in the selected position (or

Off to clear that position).

Printing the ECG on a Stripchart

The stripchart recorder documents the ECG trace with a 6 second delay at all times. To start the stripchart recorder, press the RECORDER button. The stripchart recorder runs continuously until you press the button again.

Each time the strip chart recorder is started, the time, date, ECG lead, size, and heart rate are printed on the top part of the paper. If the unit is pacing, the output current is also printed.

Note: Check the paper supply at the beginning of each shift and after each use to ensure

adequate recording capability. A colored stripe on the paper means that the paper supply is low.

A CHECK RECORDER message appears on the display wh en the stripchart recorder is activated without paper. The stripchart recorder automatically shuts off when there is no paper.

After loading new paper, press the RECORDER button to start the strip chart recorder.

Diagnostic Bandwidth

When using an ECG cable for monitoring, you can switch the unit to diagnostic bandwidth (0.05-150 Hz) by pressing and holding the RECORDER button depr essed. Diagnostic bandwidth is maintained and printing continues as long as the RECORDER button is held down. The unit reverts to standard monitoring bandwidth w hen you release the RECORDER button.

Alarms

Setting Alarm Limits

Unless configured otherwise, heart rate alarms are preset at 30 bpm (bradycard ia) and 150 bpm (tachycardia). Refer to the R Series Configuration Guide for details on setting power-up alarm limits.

9–8 www.zoll.com 9650-0912-01 Rev. A

To set alarm parameters:

1. Press the Alarms softkey to view the Alarm Set screen and softkeys.

Alarms

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Each setting includes the alarm state (ENABLE, DISABLE, or AUTO) and the low and high limit of the acceptable range of values.

2. Press the Next Param or Prev Param softkey.

This scrolls the highlighted area among the different available vital signs. If you want to change the state of the highlighted vital sign:

a. Press the Change Value softkey. b. Press the Inc > or Dec < softkey to change the state value. c. Press the Enter softkey.

The State field can be set to three possible values, Enable, Disable, or Auto.

• Disable permanently turns off alarm processing for the selected physiological parameter.

• Enable causes alarm processing to operate whenever alarms are activated via the front

panel ALARM key.

• Selecting AUTO sets the lower and upper alarm limits to 80% and 120% of the patient’s

currently measured heart rat e, if valid measurements are present for the vital sign when the Enter softkey is pressed. (Refer to appropriate Operator’s Guide parameter insert(s) for percentages associated with other parameters).

3. Press the Next Field softkey to move to the Low or High field for the highlighted vital sign;

repeat steps 2a through 2c to change the Low or High value.

Note: To recalculate the Low and High limits for any parameter when these limits have

previously been set using the AUTO State, follow the procedure above to select AUTO again, and then press the Enter softkey. The unit automatically resets the Low and High limits based upon the currently measured value of the selected physiological parameter.

4. Press the Return softkey to set all values and return to nor mal operating mode.

Heart Rate Alarm Limits

The heart rate is displayed in the upper right-hand corner of the screen. Unless configured otherwise, heart rate alarms are preset at 30 bpm (bradycard ia) and 150 bpm

(tachycardia). The low heart rate alarm limit range is 20 bpm to 100 bpm.

9650-0912-01 Rev. A ZOLL R Series Operator’s Guide 9–9

CHAPTER 9ECG MONITORING

When the unit is monitoring a patient’s heart rate via ECG, the range for the high heart rate alarm limit is 60 to 280 bpm with a default setting of 150 bpm. When the unit is monitoring a patient’ s pulse rate via pulse oximetry (SpO limit for the high heart rate alarm to 235 bpm. The unit restores the original high heart rate alarm limit when ECG monitoring resumes.

Vital Sign Alarms

Each vital sign has associated high and low alarm limits. You can set alarm limits for patient heart rate and other optional monitoring parameters such as pulse oximetry (SpO

The R Series unit has three levels of alarms:

• High Priority — Reflects physiological parameters that are out of bounds. When these

alerts occur, the unit emits a continuous audio tone, highlights the alarming parameter, and flashes the associated alarm bell.

• Medium Priority — Reflects equipment- related, user correctable faults such as LEAD

OFF. The unit emits a two beep audio tone and displays a message for a timed period.

• Low Priority — Informational message only; the unit emits a two beep audio tone and

displays a message for a timed period.

), however, the unit automatically lowers the upper

), if available.

Suspending and Silencing Alarms

When a high priority alarm occurs, th e u ni t e m its a co n tin uo us alarm tone, highlights the value of the alarming parameter on the display, and flashes the bell icon associated with that parameter.

You can either suspend the alarm tone for 90 seconds or you can silence the alarm tone.

Suspending Alarm Tones

To suspend an alarm tone for 90 seconds, press and release the ALARM SUSPEND button in less than 1 second. The alarms tone stops, the unit displays an “X” across the alarm’s flashing bell icon, and the value for the alarming parameter remains highlighted. (If you press the ALARM SUSPEND button again, alarm processing is reactivated.)

After 90 seconds, if the physiological parameter remains at a value that triggers the alarm, the unit sounds the alarm tone ag ain.

If the alarm condition clears (the physiological parameter returns to a value within range) after you suspend the alarm tone, the unit resets the alarm and displays the bell icon (no flashing, no “X”). The alarm parameter displays normally (no highlighting).

If a second, different alarm occurs after you suspend an alarm tone, you can suspend the alarm tone for that second parameter by pressing and releasing the ALARM SUSPEND button again. The unit behaves the same as described above for the first alarm. Suspending a second alarm does not alter the timing or processing of the previously suspended alarm.

9–10 www.zoll.com 9650-0912-01 Rev. A

Alarms

Silencing Alarm Tones

To silence the alarm tone, press and hold down the ALARM SUSPEND button for between 1 and 3 seconds. The alarm tone stops, the unit displays the alarm’s bell icon

in inverse video with an “X” across it, and the value of the alarm parameter remains highlighted. (If you press the ALARM SUSPEND button again, alarm processing is reactivated.)

The alarm tone will not sound again as long as the physiologic al parameter’s value remains out of range.

If the alarm condition clears (the physiological parameter returns to a value within range) after you silence the alarm tone, the unit resets the alarm and displays the bell icon (no inverse video, no “X”). The alarm parameter value displays normally (no

highlighting). After the unit resets an alarm, should the physiological parameter again go out of range, it will

trigger the alarm.

Activating and Deactivating Alarm Processing

To deactivate all alarms on the R Series unit, press and hold down the ALARM SUSPEND button for 3 seconds or longer. The bell icons for all alarms will have an

“X” through them to indicate that the alarms are deactivated. Alarm paramete r values display normally (no highlighting).

To reactivate the alarms, press and release the ALARM SUSPEND button in less than 1 second.

Smart Alarms

In DEFIB or MONITOR mode, ECG/heart rate alarm capabilities are enhanced with the defibrillation advisory feature called Smart Alarms. When alarms are operating, this feature triggers an audible alarm and displays the message CHECK PATIENT whenever the unit detects ventricular fibrillation or wide complex ventricular tachycardias. This message ap pears on the display and the stripchart recorder print out.

If alarms are operating in PACER mode, the unit displays VF ALARMS OFF, indicating that the Smart Alarms feature has been disabled.

The Smart Alarms feature is always disabled when augmented leads (aVR, aVL, aVF), V-leads, or PADDLES are selected for ECG monitoring. The messages VF ALARMS OFF and SELECT LIMB LEADS are alternately displayed when alarms are activated and augmented leads or V-leads are selected. These messages are displayed only the first time you select the augmented or V-leads. They are not redisplayed as you cycle through the lead selection.

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CHAPTER 9ECG MONITORING

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Zoll R User guide

Specifications and Main Features

Frequently Asked Questions

User Manual

Table of Contents

Product Description

General Information

How to Use This Manual

Operator’s Guide Updates

Unpacking

Symbols Used on the Equipment

Conventions

Defibrillator Function

Defibrillator Complications

Defibrillator Output Energy

External Pacemaker (Optional)

Pacemaker Complications

Pediatric Pacing

ECG Monitoring

Recorder Function

Paddles and Electrodes

Batteries

Code-Ready System

Safety Considerations

Warnings

Operator Safety

Patient Safety

Cautions

Restarting the Defibrillator

FDA Tracking Requirements

Notification of Adverse Events

Software License

Service

The ZOLL Serial Number

Product Overview

Defibrillator Controls and Indicators

The Front Panel

Display Screen

Patient Cables and Connectors

External Paddles

Working with Menus

Defib Mentor Mode (Optional)

Common Tasks

Replacing a Battery Pack

Adjusting Display Brightness

Using Code Markers

Manual Defibrillation

Emergency Defibrillation Procedure with Paddles

Determine the Patient’s Condition Following Local Medical Protocols

Begin CPR Following Local Medical Protocols.

1 Select DEFIB

2 Charge Defibrillator

Autoclavable External Paddles

3 Deliver Shock

Emergency Defibrillation Procedure with Hands-Free Therapy Electrodes

Determine the Patient’s Condition Following Local Medical Protocols

Begin CPR Following Medical Protocols

Prepare Patient

1 Select DEFIB

2 Charge Defibrillator

3 Deliver Shock

Autoclavable Electrodes

Advisory Defibrillation (Optional)

Advisory Defibrillation Procedure

Determine the Patient’s Condition Following Local Medical Protocols

Begin CPR Following Local Medical Protocols

Prepare Patient

1 Select DEFIB

2 Press ANALYZE Button

3 Press SHOCK

Advisory Function Messages

W arning Messages

Synchronized Cardioversion

Synchronized Cardioversion Procedure

Determine the Patient’s Condition and Provide Care Following Local Medical Protocols

Prepare Patient

1 Select DEFIB

2 Charge Defibrillator

Remote Synchronized Cardioversion Procedure

3 Deliver SHOCK