MRx Heart Start Philips Owners Manual

User Manual: HeartStart MRx

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Introduction
Getting Acquainted
Setting Up
ECG and Arrhythmia Monitoring
AED Mode
Manual Defibrillation and Cardioversion
Noninvasive Pacing
Pulse Oximetry
Noninvasive Blood Pressure
Monitoring Carbon Dioxide
Invasive Pressures
Q-CPR and Data Capture
Networking
Supplies & Accessories
- Overview
Troubleshooting

Instructions For Use

HeartStart MRx

English

M3535A/M3536A

Notice

About This Edition

Publication number: 989803160421

Edition 1 Printed in the USA

To determine the product level version to which these

Instructions for Use are applicable, refer to the version

level appearing on the back cover of this book or on the

label of the User Documentation CD-ROM that

accompanied this device. This information is subject to

change without notice.

NOTE: To obtain Instructions for Use for previous

versions of the HeartStart MRx, visit the Philips

Documentation and Downloads web site at

http://www.philips.com/ProductDocs and search for

resuscitation.

Philips shall not be liable for errors contained herein or

for incidental or consequential damages in connection

with the furnishing, performance, or use of this material.

All rights are reserved. Permission is granted to copy and

distribute this document for your organization’s internal

educational use. Reproduction and/or distribution

outside your organization in whole or in part is

prohibited without the prior written consent of the

SMART Biphasic is a registered trademark of Philips.

Rosetta-Lt™, Rosetta-Rx™ and CAREpoint™ are

trademarks of General Devices. Microstream® and

FilterLine® are registered trademarks of Oridion Medical

Ltd. Smart CapnoLine™ is a trademark of Oridion

Medical Ltd. Q-CPR® is a registered trademark of

Laerdal Medical AS. The HeartStart MRx contains an

Ezurio PC Card with Bluetooth® wireless technology.

The Bluetooth wordmark and logos are owned by the

Bluetooth SIG, Inc. and any use of such marks by Ezurio

is under license. Coverage Plus® and Coverage Plus

NPD® are registered trademarks of Steris Corp.

CidexPlus® is a registered trademark of Advanced

Sterilization Products. Nellcor® is a registered trademark

of Nellcor Puritan Bennett, Inc. TransPac® IV is a

registered trademark of ICU Medical, Inc. TruWave® is

a registered trademark of Edwards Lifescience Corp.

DTX Plus™ is a trademark of Becton, Dickinson & Co.

RelyOn and Virkon are registered trademarks or

trademarks of E.I. du Pont de Nemours and Company or

its affiliates. Other trademarks and trade names are those

of their respective owners.

Use of supplies or accessories other than those

recommended by Philips may compromise product

performance.

THIS PRODUCT IS NOT INTENDED FOR HOME

USE. U.S. FEDERAL LAW RESTRICTS THIS

DEVICE TO SALE ON OR BY THE ORDER OF A

PHYSICIAN.

Medical Device Directive

The HeartStart MRx complies with the requirements of

the Medical Device Directive 93/42/EEC and carries the

0123 mark accordingly.

Manufacturer

Philips Medical Systems

3000 Minuteman Road

Andover, MA 01810 USA

Authorized EU-representative

Philips Medizin Systeme Böblingen GmbH

Hewlett Packard Str. 2

71034 Böblingen

Germany

Canada EMC:ICES-001

U.S. FCC and Industry Canada Radio Compliance:

Contains FCC ID: PQC-WMTS-MODULE

When using the IntelliVue networking option, operation

of this equipment requires the prior coordination with a

frequency coordinator designated by the FCC for the

Wireless Medical Telemetry Service. This device

complies with Part 15 of the FCC rules and RSS-210 of

Industry Canada. Operation is subject to the following

conditions:

• This device may not cause harmful interference.

• This device must accept any interference received,

including interference that may cause undesired

operation.

Edition Print Date

1 April 2009

Notice

Any changes or modifications to this equipment not

expressly approved by Philips Medical Systems may cause

harmful radio frequency interference and void your

authority to operate this equipment.

China:

After Sales Service: Beijing MEHECO-PHILIPS Medical

Equipment Service Center.

After Sales Service Address: No. 208, 2nd District, Wang

Jing Li Ze Zhong Yuan, Chao Yang District, Beijing.

Postal code: 100102.

Telephone: 8008100038.

Registration number: SFDA(I)20083211481.

Product Standard number: YZB/USA 1863-2008.

For the Declaration of Conformity Statement, please see

the Philips Medical web site at http://

incenter.medical.philips.com/PMSPublic. Scroll over the

Quality and Regulatory Tab located in the upper left

corner of the window. Click to select Regulatory by

Modality. Then click to select Defibrillators and select

the entry for Declaration of Conformity (DoC).

Warning

Radio frequency (RF) interference coming from devices

other than the HeartStart MRx may degrade the perfor-

mance of the MRx. Electromagnetic compatibility with

surrounding devices should be assessed prior to using the

monitor/defibrillator.

iii

These Instructions for Use contain the following conventions:

WARNING Warning statements describe conditions or actions that can result in personal injury or loss of life.

CAUTION Caution statements describe conditions or actions that can result in damage to the equipment or loss of

data.

NOTE Notes contain additional information on usage.

"Voice" represents voice prompt messages

Text represents messages that appear on the display

[Soft key] represents soft key labels that appear on the display above the

button to which they correspond.

Images of the HeartStart MRx display and menus appearing in this document are for illustration

purposes only. Menu choices on your device are driven by the options you have purchased and

selections you make in Configuration Mode.

1Table of Contents

1Introduction 1

Overview 1

Intended Use 2

Indications for Use 3

AED Therapy 3

Manual Defibrillation 3

Noninvasive External Pacing Therapy 3

Pulse Oximetry 3

Noninvasive Blood Pressure Monitoring 3

End-tidal CO23

12-Lead ECG 3

Q-CPR 4

Invasive Pressures 4

Te m p e r a t u re 4

ACI-TIPI 4

TPI 4

Safety Considerations 5

Documentation and Training 5

2Getting Acquainted 7

Basic Orientation 8

Front Panel 8

Side Panels 9

Top Pa nel 10

Back Panel 11

M3538A Lithium Ion Battery 12

Battery Capacity 12

Battery Life 12

Operating Modes 12

Password Security 13

Display Views 13

General Status 14

Wave Sectors 15

Parameter Blocks 16

Turning Parameters On/Off 16

Soft Key Labels 16

Menus 17

Message Windows 18

High Contrast Display 18

Controls 19

Therapy Knob 19

General Function Buttons 20

Defibrillation Controls 21

Soft Keys 21

Indicators 22

Audio Recording 23

Reviewing Recorded Audio 23

Alarms 24

Responding to Alarms 24

Printing on Alarms 26

Identifying Your Device 26

Entering Patient Information 27

Continued Use 27

Printing Waveforms 28

Return to Owner 29

3Setting Up 31

Attaching the Carrying Case and Accessory Pouches 31

Storing Accessories 33

Connecting the ECG Cable 35

Connecting the SpO2 Cable 36

Connecting the NBP Interconnect Tubing 37

Connecting the Invasive Pressures Cable 38

Connecting the Temperature Cable 39

Connecting the CO2 FilterLine 40

Connecting the Therapy or Pads/CPR cables 41

Installing Paper 42

50 mm paper 42

75mm Printer (optional) 43

Installing Batteries 44

Charging Batteries 44

Battery Safety 44

Installing the AC Power Module 45

Installing the Data Card 46

4ECG and Arrhythmia Monitoring 47

Overview 47

Monitoring View 48

Preparing to Monitor ECG 49

Electrode Placement 51

Lead Selection 53

Lead Choices 53

Selecting the Lead 54

Arrhythmia Monitoring 54

vii

Aberrantly-Conducted Beats 55

Intermittent Bundle Branch Block 55

Heart Rate and Arrhythmia Alarms 56

Arrhythmia Alarm Latching 56

INOP Messages 58

Setting Alarms 59

Changing Heart Rate or VTACH Alarm Limits 59

Enabling/Disabling Heart Rate and Arrhythmia Alarms 59

Responding to HR and Arrhythmia Alarms 59

Displaying an Annotated ECG 60

Arrhythmia Learning/Relearning 61

Troubleshooting 61

5AED Mode 63

Precautions for AED Therapy 63

AED View 64

Preparation 65

Using AED Mode 66

Step 1 - Turn the Therapy Knob to AED 67

Step 2 - Follow Screen and Voice Prompts 67

Step 3 - Press Shock Button, if Prompted 69

Using Q-CPR in AED Mode 69

Troubleshooting 69

6Manual Defibrillation and Cardioversion 71

Overview 71

Precautions for Manual Defibrillation Therapy 72

Synchronized Cardioversion Therapy 72

Code View 73

Preparing for Defibrillation 74

Using Multifunction Electrode Pads 74

Using External Paddles 75

Using Pediatric Paddles 76

Using Internal Paddles 76

Defibrillating (asynchronously) 77

Performing Synchronized Cardioversion 79

Preparing for Synchronized Cardioversion 79

Delivering a Synchronized Shock 80

Delivering Additional Synchronized Shocks 81

Disabling the Sync Function 81

Using Q-CPR in Manual Mode 81

Troubleshooting 81

7Noninvasive Pacing 83

Overview 83

Alarms 84

viii

Pacing View 85

Demand Mode Versus Fixed Mode 86

Preparing for Pacing 87

Demand Mode Pacing 88

Fixed Mode Pacing 89

Defibrillating During Pacing 91

Troubleshooting 91

8Pulse Oximetry 93

Overview 93

Understanding Pulse Oximetry 94

Selecting a Sensor 95

Applying the Sensor 96

Monitoring SpO297

Pleth Wave 98

SpO2 Alarms 99

Changing the SpO2 Alarm Limits 99

SpO2 Desat Alarm 100

Enabling/Disabling the SpO2 Alarms 100

Pulse Rate Alarms 100

Enabling/Disabling the Pulse Rate Alarms 101

Changing the Pulse Rate Alarm Limits 101

Disabling the SpO2 Monitoring Function 101

Caring for Sensors 102

Troubleshooting 102

9Noninvasive Blood Pressure 103

Overview 103

Preparing to Measure NBP 104

Measuring NBP 106

Changing the NBP Schedule 106

Alarms 107

Changing NBP Alarms 107

Enabling/Disabling NBP Alarms 108

Troubleshooting 108

10 Monitoring Carbon Dioxide 109

Overview 109

Preparing to Measure EtCO2110

Selecting the Accessories 110

Setting Up Microstream EtCO2 Measurements 111

Using the Nasal FilterLine 111

Using the FilterLine and Airway Adapter 111

Measuring EtCO2112

EtCO2 and AwRR Alarms 112

Changing the EtCO2 Alarm Limits 113

Enabling/Disabling the EtCO2 Alarms 113

Changing the AwRR Alarm Limits 113

Changing the Apnea Time Alarm Limit 114

Enabling/Disabling AwRR Alarms 114

Disabling the EtCO2 Monitoring Function 114

Troubleshooting 114

11 Invasive Pressures 115

Overview 115

Setting up for a Pressure Measurement 115

Selecting a Pressure to Monitor 117

Pressure Waves 118

Zeroing the Pressure Transducer 119

Zeroing Using the Menu Select Button 119

Zeroing Using a Soft Key in Monitor Mode 119

Calibration 121

Known Calibration Factor 121

Calibrating Reusable Transducer CPJ840J6 122

Calibration Confirmation 123

Last Zero/Calibration 124

Non-Physiological Artifact Suppression 124

Alarms 125

Enabling/Disabling alarms 126

Viewing/Changing/Setting Source for Alarms 126

CPP Alarms 127

Wedge 127

Pulse 128

Pulse Sources 128

Changing Pulse Source 129

Setting Pulse Alarms 129

Enabling/Disabling Pulse Alarms 129

Pulse Alarm Limits 130

Changing Default Pulse Source and Alarm Limits 130

Caring For Your Transducers and Probes 130

Troubleshooting 130

12 Temperature 131

Overview 131

Selecting a Temperature Label 131

Monitoring Temperature 132

Alarms 132

Setting Temperature Alarms 132

Changing Temperature Alarm Limits 133

Enabling/Disabling Temperature Alarms 133

Changing Degree Units 133

Disabling the Temperature Function 134

Caring For Your Temperature Cables and Probes 134

Troubleshooting 134

13 12-Lead ECG 135

Overview 135

Preparation 136

Preview Screen 137

Acquiring a 12-Lead ECG 138

Acquiring a 12-lead ECG with ACI-TIPI and/or TPI Analysis 139

Critical Values 143

Culprit Artery 145

12-Lead Report 146

Accessing Stored Reports 148

Improving Signal Quality 149

Adjusting Wave Size 149

12-Lead Filters 150

Troubleshooting 150

14 Vital Signs Trending 151

Overview 151

Reviewing Trending Data 151

About The Data Displayed 152

Vital Signs Trending Report Parameter List Order 153

Scrolling in the Vital Signs Trending Report 153

Vital Signs Trending Report Intervals 153

Adjusting Vital Signs Trending Report Interval 153

Printing the Vital Signs Trending Report 154

Exiting Vital Signs Trending Report 155

Troubleshooting 155

15 Q-CPR and Data Capture 157

Overview 157

Preparing to Use Q-CPR 159

Connecting the Pads/CPR Cable 159

Connecting the CPR Meter to the Pads/CPR Cable 160

Applying Multifunction Electrode Pads 160

CPR Meter 161

Attaching the CPR Meter Adhesive Pad 162

Placing the CPR Meter on the Patient 163

Starting CPR with the CPR Meter 164

CPR Meter Display 165

Q-CPR Feedback on the HeartStart MRx 167

Advanced View 167

Basic View 170

Using Q-CPR in Manual Defib Mode 171

Using Q-CPR in AED Mode 171

Feedback Prompts 172

Adjusting CPR Feedback Volume 173

After Each Use 174

Q-CPR Data Capture 174

Q-CPR Feedback Setting 174

Data and Events Recorded 175

Research Storage Setting 175

Reviewing Q-CPR Data 175

Troubleshooting 175

16 Networking 177

IntelliVue Networking Display 178

Connecting to the Network 179

Physical Connections 179

Wired Connection 180

Wireless Connection 180

Combined Connection 181

Configuring to Work on the Network 181

Using the Device Location Option 182

Network Settings 183

Admit, Discharge, Transfer of Patients 184

Admit 184

Discharge 185

Transfer 187

Transfer Mode 188

Sharing Information on the Network 190

Patient Information 190

Conflict Handling 192

Viewing Patient Incident Data 193

Alarms 193

Printing 193

Tu rn i n g a Ne tw o r k e d De v i c e Of f 193

Leaving a Clinical Mode 194

Events Logged 195

INOPs, Alarms and Messages at the Information Center 195

Troubleshooting 197

17 Configuration 199

Overview 199

Accessing the Configuration Menu 199

Setting the Date and Time 200

Modifying Settings 200

Saving Configuration Settings to a Data Card 201

Loading Configuration Settings from a Data Card 201

Restoring the Default Settings 201

Printing Configuration Settings 201

xii

Configurable Parameters 202

18 Working with Data 225

Overview 225

Initiating an Event Summary 226

Entering Data Management Mode 226

Copying from Internal Memory 227

Viewing and Erasing the External Data Card 228

Printing During a Patient Event 229

Event Summaries 229

Vital Signs Trending Reports 229

12-Lead ECG Reports 229

Printing Individual Events 230

Printing from Data Management Mode 231

Events Stored in Event Summary 232

Marking Events 237

19 Data Transmission 239

Overview 239

Transmitting During a Critical Care Event 240

Preparing for Transmission 241

Modifying Reference IDs 241

Setting up Bluetooth Transmissions 242

Setting up Rosetta Transmissions 245

Connecting Rosetta-Lt 246

Setting Up for RS-232 Transmissions 247

Transmitting in 12-Lead Mode 248

Transmitting to a Manually Entered Fax Number 249

Transmitting to a Personal Computer 249

Periodic Clinical Data Transmission 250

Transmitting Clinical Values 250

PCDT Contents 250

Starting a Periodic Clinical Data Transmission 252

Ending a Periodic Clinical Values Transmission 253

Transmitting Event Summaries Post Event 254

Transmitting in Data Management Mode 255

Tracking Data Transmission 257

Transmission Errors 257

Cancelling a Transmission 257

Queuing Transmissions 258

Finding Transmission Results 258

Batch LAN Data Transfer 259

Setting Up for Batch LAN Data Transfer 259

Transferring Files with BLDT 260

Troubleshooting 261

xiii

20 Maintenance 263

Overview 263

Automated Tests 264

Automated Test Summary 265

Ready For Use Indicator 266

Shift Checklist 267

Weekly Shock Test 267

HeartStart MRx Shift Checklist 268

Operational Check 270

Performing the Operational Check 271

Operational Check Report 277

Operational Check Summary 282

Battery Maintenance 283

Battery Life 283

Charging Batteries 284

Battery Calibration 284

Storing Batteries 286

Discarding Batteries 286

Cleaning Instructions 287

Monitor/Defibrillator 287

Printer Printhead 287

Paddles, Therapy Cable 288

ECG Cable 288

Carrying Case 289

NBP Cuff 289

SpO2 Sensor and Cable 289

Invasive Pressures Transducer and Cable 289

Temperature Probe and Cable 289

CPR meter 289

HeartStart MRx Disposal 290

Empty Calibration Gas Cylinders Disposal 290

CPR Meter and Adhesive Pads Disposal 290

21 Supplies & Accessories 291

Overview 291

22 Troubleshooting 297

Symptoms 298

Audio Tones and Alarm Indications 318

Calling for Service 319

23 Specifications and Safety 321

Specifications 321

General 321

Defibrillator 321

xiv

ECG and Arrhythmia Monitoring 324

Display 326

Battery 326

Thermal Array Printer 327

Noninvasive Pacing 327

SpO2 Pulse Oximetry 328

NBP 329

Invasive Pressures 330

Tem pe rat ur e 331

EtCO2 331

AwRR 332

Calibration Gas for CO2 Measurement System 332

CPR Meter 333

Patient Adhesive Pads 333

12-Lead ECG 333

Networking 333

Patient Data Storage 334

Environmental (M3535A) 334

Environmental (M3536A) 335

Bluetooth 336

Symbol Definitions 337

Units and Abbreviations 340

Clinical Performance Summary - Defibrillation 341

Methods 341

Results 341

Conclusion 341

Clinical Performance Summary - Cardioversion 342

Methods 342

Results 342

Conclusion 343

Clinical Performance Summary - Internal Defibrillation 344

Overview 344

Methods 344

Results 344

Conclusion 344

Safety Considerations 345

General 345

Defibrillation 348

Battery 349

Supplies and Accessories 350

Electromagnetic Compatibility 350

Reducing Electromagnetic Interference 350

Restrictions for Use 351

Emissions and Immunity 351

Guidance and Manufacturer’s Declaration 351

Index 359

1Introduction

Thank you for choosing the HeartStart MRx monitor/defibrillator. Philips Healthcare welcomes you

to its family of resuscitation devices.

The HeartStart MRx is designed to meet your monitoring and resuscitation needs by providing

advanced, multi-parameter monitoring functions, a full range of defibrillation therapies, industry-

leading algorithms and a suite of data transmission options. This guide provides instructions for the

safe and proper operation of the device, as well as set-up, configuration, and maintenance information.

Be sure to familiarize yourself with the features and operation of your HeartStart MRx prior to its use.

Overview

The HeartStart MRx is a lightweight, portable, monitor/defibrillator. It provides four modes of

operation: Monitor, Manual Defib, AED, and Pacer (optional).

In Monitor Mode you can monitor up to four ECG waveforms, acquired through a 3-, 5-, or 10-lead

ECG set. Optional monitoring of pulse oximetry (SpO2), noninvasive blood pressure (NBP), carbon

dioxide (EtCO2), temperature, and invasive pressures are also available. Measurements from these

parameters are presented on the display. Alarms are available to alert you to changes in the patient’s

condition. You can also display a Vital Signs Trending Report to view all key parameters and their

measurements at a glance.

Monitor Mode also provides an optional 12-Lead ECG function, enabling you to preview, acquire,

store, and print 12-lead ECG reports, with or without analysis/interpretation. In addition, there are

several STEMI decision support tools, including STEMI Culprit Artery, Critical Values and the Acute

Cardiac Ischemia Time-Insensitive Predictive Instrument (ACI-TIPI) and Thrombolytic Predictive

Instrument (TPI) algorithms. You can also transmit 12-Lead reports and Event Summaries via the 12-

Lead ECG Transmission and Event Summary Data Transfer options. Other transmission options are

available. See “Data Transmission” on page 239.

Manual Defib Mode offers simple, 3-step defibrillation. You analyze the patient’s ECG and, if

appropriate: 1) select an energy setting, 2) charge, and 3) deliver the shock. Defibrillation may be

performed using paddles or multifunction electrode pads. Manual Defib Mode also allows you to

perform synchronized cardioversion and internal defibrillation. If desired, use of Manual Defib Mode

may be password protected.

In AED Mode, the HeartStart MRx analyzes the patient’s ECG and determines whether a shock is

advised. Voice prompts guide you through the 3-step defibrillation process, providing easy-to-follow

instructions and patient information. Voice prompts are reinforced by messages on the display.

1 Introduction Intended Use

The Manual Defib and AED modes incorporate Philips’ low energy SMART Biphasic waveform for

defibrillation. Both modes also offer the Q-CPR® option. Q-CPR offers real-time measurement and

corrective feedback on the rate, depth/complete release of compressions (and lack of CPR activity) and

ventilation rate. The HeartStart MRx displays a CPR Timer and compression counter to assist with

protocol management.

The HeartStart MRx also has an optional Audio function which allows you to record audio during a

patient event.

Optional Pacer Mode offers noninvasive transcutaneous pacing therapy. Pace pulses are delivered

through multifunction electrode pads, using a monophasic waveform. If desired, use of Pacer Mode

may be password protected.

The HeartStart MRx is powered by rechargeable lithium ion batteries. Available battery power is easily

determined by viewing the convenient battery power indicators located on the device display or by

checking the gauge on the battery itself. Additionally, an external AC or DC Power Module may be

applied as a secondary power source and for continual battery charging.

The HeartStart MRx performs Automated Tests on a regular basis. The results of these tests are

reported to the Ready For Use (RFU) indicator. The prominently displayed RFU indicator

communicates the status of your device, letting you know it is operating correctly, needs attention, or is

unable to deliver therapy. In addition, performing the specified Operational Check ensures that the

HeartStart MRx is functioning properly.

The HeartStart MRx automatically stores critical event data, such as Event Summaries, 12-Lead

Reports and Vital Signs Trending, in its internal memory. The HeartStart MRx also enables you to

store data and event information on an optional data card for downloading to Philips’ data

management solution, HeartStart Event Review Pro, or you can send the data electronically via several

methods to your destination point.

The HeartStart MRx is highly configurable to better meet the needs of diverse users. Be sure to

familiarize yourself with your device’s configuration before using the HeartStart MRx. See Chapter 17

“Configuration” for more details.

Intended Use

The HeartStart MRx is intended for use in hospital and pre-hospital settings by qualified medical

personnel trained in the operation of the device and qualified by training in basic life support,

advanced cardiac life support or defibrillation.

When operating as a semi-automatic external defibrillator in AED Mode, the HeartStart MRx is

suitable for use by medical personnel trained in basic life support that includes the use of an AED.

When operating in Monitor, Manual Defib or Pacer Mode, the HeartStart MRx is suitable for use by

healthcare professionals trained in advanced cardiac life support.

The SMART Biphasic waveform utilized in the HeartStart MRx has previously undergone clinical

testing in adults. These trials support the waveform’s effectiveness for defibrillation of ventricular

tachyarrhythmias at 150J.

Indications for Use 1 Introduction

Indications for Use

The HeartStart MRx is for use for the termination of ventricular tachycardia and ventricular

fibrillation.

The device is for use by qualified medical personnel trained in the operation of the device and qualified

by training in basic life support, advanced cardiac support, or defibrillation. It must be used by or on

the order of a physician.

AED Therapy

To be used in the presence of a suspected cardiac arrest on patients of at least 8 years of age that are

unresponsive, not breathing and pulseless.

Manual Defibrillation

Asynchronous defibrillation is the initial treatment for ventricular fibrillation and ventricular

tachycardia in patients that are pulseless and unresponsive. Synchronous defibrillation is indicated for

termination of atrial fibrillation.

Noninvasive External Pacing Therapy

The pacing option is intended for treating patients with symptomatic bradycardia. It can also be

helpful in patients with asystole, if performed early.

Pulse Oximetry

The SpO2 option is intended for use when it is beneficial to assess a patient’s oxygen saturation level.

Noninvasive Blood Pressure Monitoring

The NBP option is intended for noninvasive measurement of a patient’s arterial blood pressure.

End-tidal CO2

The EtCO2 option is intended for noninvasive monitoring of a patient’s exhaled carbon dioxide and to

provide a respiration rate.

12-Lead ECG

The 12-Lead ECG function is to provide a conventional diagnostic 12-Lead ECG report, which may

include measurements and interpretative statements.

1 Introduction Indications for Use

Q-CPR

The Q-CPR option provides feedback designed to encourage rescuers to perform resuscitation in

accordance with AHA/ERC guidelines for chest compression rate, depth, and duty cycle and

ventilation rate, volume and flow rate (inflation time).

The Q-CPR option is contraindicated as follows:

• The Q-CPR option is contraindicated for use on neonatal and pediatric patients (under 8 years of

age or weighing less that 25 kg).

• The Q-CPR option is not for use when CPR is contraindicated.

Invasive Pressures

The Invasive Pressures option is indicated for measuring arterial, venous, intracranial and other

physiological pressures on patients.

Temperature

The Temperature option is indicated for measuring temperature in patients.

ACI-TIPI

This device is intended to be an aid to clinicians by focusing their attention on indicators of Acute

Cardiac Ischemia.

TPI

Indications for Use: Physiological purpose: To aid the clinician deciding whether to administer

thrombolytic therapy or to provide another avenue of treatment; Condition: Patient is a potential

candidate for thrombolytic therapy; Patient Population: adult (35 to 75 years) patients diagnosed as

having symptoms of Acute Myocardial Infarction; Body or type of tissue interacted with: No body or

tissue contact. Prescription versus over-the-counter: TPI is a prescription device.

Contraindications: NOTE: The Thrombolytic Predictive Instrument (TPI) is contraindicated for

patients with conditions which mimic acute myocardial infarction. Some of these conditions are:

Prinzmetal variant angina, acute pericarditis, acute myocarditis, cardiomyopathy, and primary and

secondary cardiac neoplasms.

The Thrombolytic Predictive Instrument (TPI) is also contraindicated for patients with conditions

whom the administration of thrombolytics is contraindicated. Some of these conditions are: aortic

dissection, acute myocardial infarction due to bacterial endocarditis, vasculitis, intracardiac thrombi,

and acute nonsuppurative and suppurative pericarditis mimicking acute myocardial infarction.

These situations, as well as Posterior Acute Myocardial Infarction, were not considered or covered in

the development of the predictive instrument calculations.

NOTE See note on page 140 for additional details on contraindications for TPI therapy.

Safety Considerations 1 Introduction

Safety Considerations

General warnings and cautions that apply to use of the HeartStart MRx are provided in “Specifications

and Safety” on page 321. Additional warnings and cautions specific to a particular feature are provided

in the appropriate section of this guide.

WARNING Electric shock hazards exist internally. Do not attempt to open the device. Refer servicing to qualified

personnel.

WARNING Use only supplies and accessories approved for use with your HeartStart MRx. Use of non-approved

supplies and accessories could affect performance and results.

WARNING Use single-use supplies and accessories only once.

Documentation and Training

Available documentation and training for the HeartStart MRx includes:

• HeartStart MRx Instructions for Use

• HeartStart MRx Quick Reference Cards

• HeartStart MRx Battery Application Note

• HeartStart MRx Improving ECG Quality Application Note

• HeartStart MRx Web-based User Training (Located at:

www.medical.philips.com/goto/mrxtraining. Enter training access password: meetMRx.)

• HeartStart MRx User Training Videotape and DVD

• To purchase additional copies of the Instructions for Use or Quick Cards, visit the Philips

Healthcare eStore at: www.philips.com/healthcarestore.

• Other Application Notes can be found on the Philips website at: www.medical.philips.com/goto/

productdocumentation.

2Getting Acquainted

The HeartStart MRx is designed with your needs in mind. Controls, indicators, and menus are

carefully organized to facilitate easy use. Display information is tailored to the current task.

This chapter acquaints you with the HeartStart MRx operational modes, display views, controls, and

indicators. It also provides general information on device use.

NOTE If your HeartStart MRx does not have some of the optional functionality listed in this chapter,

disregard these controls and the related information described throughout this manual.

2 Getting Acquainted Basic Orientation

Basic Orientation

HeartStart MRx controls, indicators, and connections are carefully organized.

Front Panel

The front panel contains operational controls and indicators, as shown below.

Figure 1 Basic Orientation (Front)

Additional controls and indicators are on the paddles (if used) and batteries.

NOTE A palette of colored decals is included with your HeartStart MRx. These colored decals may be applied

to the label recesses located on the device handle to aid in identification. Use an indelible marker to

print identification information on the decal.

Sync

Shock

Charge

Select

Energy

150

200

170

120

100

1-10

Adult

Dose

Off

AED

Monitor

Pacer

Synchronized

Cardioversion (Sync)

Ready For Use

(RFU) Indicator

Therapy Knob

Charge

button

Shock

button

Printer Door

Latch

Speaker

Menu Select button

Navigation

buttons

Soft keys

(4 total)

Mark Event

button

Display

Printer Door

External Power Indicator

Summary

button

Alarm Pause button

Label Recess

Microphone

Location of Networking icon

(if device is network enabled)

Button

Lead Select

button

Printer

(50 mm)

Basic Orientation 2 Getting Acquainted

Side Panels

The left side of the HeartStart MRx has ports for monitoring cables, including ECG, pulse oximetry

(SpO2), noninvasive blood pressure (NBP), invasive pressure (2), temperature and carbon dioxide

(CO2). The ECG port may be used to connect a 3-, 5-, or 10-lead patient cable. The ECG Out jack

may be used to connect to an external monitor.

The right side of the HeartStart MRx has a therapy port for paddles (external or internal), or therapy

cable and multifunction electrode pads. It also has a slot for a data card to transfer patient information.

Figure 2 Basic Orientation (Right/Left Sides)

ECG

™

Invasive Pressure

ports

NBP Port

ECG Port

SpO2 Port

ECG Out

(Sync) Jack

Temperature

Port

CO2 Inlet

Port

CO2

Outlet Port

Data Card slot

Therapy

Connector

2 Getting Acquainted Basic Orientation

Top Panel

The top of the HeartStart MRx has a handle and basic operating instructions. If optional external

paddles are present, they reside on the top panel as shown.

Figure 3 Basic Orientation (Top - with Optional Paddles)

Basic Orientation 2 Getting Acquainted

Back Panel

The back panel of the HeartStart MRx has two compartments for lithium ion batteries. Compartment

B may also be used to connect an AC power module. Between the battery compartments is a DC

Power Input port.

The back panel also has an RS-232 serial port for 12-lead ECG transmission or setting up a wireless

connection to the IntelliVue Network. The LAN port is for a wired connection to the IntelliVue

Network or for Batch LAN Data Transfer.

Figure 4 Basic Orientation (Back)

WARNING The HeartStart MRx LAN port is intended for connection to the IntelliVue Clinical Network or for

Batch LAN Data Transfer. It should only be used for connection to devices that comply with IEC

60950-1 and IEC 60601-1. During real-time patient monitoring, the HeartStart MRx wired LAN

connector should only be connected to the IntelliVue Network. For post-event Batch LAN Data

Transfer, the HeartStart MRx should only be connected to the facility network.

The RS-232 Serial Port is intended for connection to the IntelliVue wireless backpack. It is also for

connecting with the Rosetta-Lt and cellphones for data transmission. Improper system operation may

result if any other device is connected to this port.

AC Power Module DC Power Input

RS-232

Serial Port

LAN Port

Battery/AC

Compartment B

Battery

Compartment A

2 Getting Acquainted M3538A Lithium Ion Battery

M3538A Lithium Ion Battery

The HeartStart MRx uses the M3538A Lithium Ion Battery. The battery has a fuel gauge with 5 LED

indicators, each representing a charge of at least 20% of capacity. Press the fuel gauge button to

illuminate the fuel gauge.

CAUTION A battery should be used as the primary power source. AC/DC should be used as a secondary source, if

desired. If an AC/DC power module is used as the only power source, the HeartStart MRx takes longer

to charge to the desired energy level and, in the event of power loss, all settings reset to the default

settings and a new incident is created when power is returned. All stored data remains intact and can be

found by retrieving the previous incident. Keep your unit charged.

Battery Capacity

A new, fully-charged M3538A battery, operating at room temperature 25oC (77oF), provides at least 5

hours of monitoring, with ECG, SpO2, CO2, temperature, two invasive pressures monitored

continuously, NBP measured every 15 minutes, and 20 200J discharges. A fully charged new battery

provides approximately 3.5 hours of monitoring, with ECG, SpO2, CO2, temperature, two invasive

pressures monitored continuously, NBP measured every 15 minutes, and pacing at 180ppm at 160mA.

Battery Life

Battery life depends on the frequency and duration of use. When properly cared for, the M3538A

Lithium Ion battery has a useful life of approximately 2 years. To optimize performance, a fully (or

nearly fully) discharged battery should be charged as soon as possible.

Operating Modes

The HeartStart MRx has four clinical modes of operation, each with a customized display view. The

modes are as follows:

Table 1 Operating Modes and Views

NOTE Upon returning to a clinical mode from a non-clinical mode such as Configuration or Data

Management, all settings reset to the default settings.

Mode of Operation Display View Description

Monitor Mode Monitoring View, or

12-Lead View

Used to monitor ECG, take an optional 12-lead ECG, and monitor

optional parameters such as SpO2, EtCO2, NBP, Invasive Pressures,

Temperature and for viewing Vital Signs Trending data.

AED Mode AED View Used to analyze ECG and if necessary, perform semi-automatic external

defibrillation. Q-CPR available.

Manual Defib Mode Code View Used to perform asynchronous and synchronous defibrillation

(cardioversion). Q-CPR available.

Pacer Mode Pacing View Used to perform demand or fixed mode pacing.

Display Views 2 Getting Acquainted

Password Security

Access to Manual Defib Mode and Pacer Mode may be configured to be password protected. If the

modes are password protected, you are prompted to enter the password upon moving the Therapy

Knob to either the Pacer position or an energy selection. The password is entered by using the

Navigation buttons to select the password numbers and then selecting Done to complete the entry.

The Charge button and the [Start Pacing] soft key remain inactive until the password is

entered. AED mode is always available without a password.

WARNING Use of the Manual Therapy security password requires the clinician to know and remember the

password, as defined in Configuration. Failure to enter the correct password will prevent the delivery of

manual defibrillation or pacing therapy. Prior to selecting this Configuration option, review this

potential risk with your Risk Manager.

Display Views

The HeartStart MRx display layout is segmented as shown in Figure 5.

Figure 5 Display Layout

NOTE Pictures of the HeartStart MRx display appearing in this manual are for illustration purposes only. The

content of these areas varies with the display view, the options on your device and the function being

performed.

harge

ECG/HR alarms

Mark Event 10 Feb 2006 11:20

Patient name

Adult Non-Paced

Inops Area

HH:MM:SS

36.9 80 120/80

(95)

Pulse NBP

mmHg q120

10:40

bpm

Temp

SYS

160

Primary ECG

bpm 80

120

50 39.0

36.0

SpO2 % EtCO2

100 AwRR

mmHg rpm

PAP ABP

150

ABP

PAP

CO2

160

SYS

118/77

(95)

mmHgmmHg

24/10

(15)

DIA

0100

Softkey

#1 Softkey

#2 Softkey

#3 Softkey

Main Menu

Exit

High Contrast On

Other

Trends

Patient Info

Measurements/Alarms

Printed Waves

Displayed Waves

Volume

Parameter

Block 1

Parameter

Block 2

Menu Area

General

Status Area

Wave

Sector 1

Wave

Sector 3

Wave

Sector 2

Wave

Sector 4

Soft Keys

2 Getting Acquainted Display Views

General Status

The general status area of the display contains:

• Mark Event button label

•Date and time

• Audio recording icon. If the option is enabled, one of the audio recording icons is displayed to the

left of the battery icons in all clinical modes to indicate the status of audio recording.

• Network Connectivity icon. If the option is enabled, a network connectivity icon will appear to the

right of the Mark Event Statements. See “Networking” on page 177 for more information.

• Periodic Clinical Data Transmission (PCDT) icon. If the option is enabled, the PCDT icon will

appear to the right of the Mark Event Statement. See “PCDT Icons” on page 250 for more

information.

• Battery power indicators

Battery icons, labeled “A” and “B”, correspond with the battery compartments located at the back of

the HeartStart MRx. Each battery icon displays the current available battery power, ranging from

hollow (fully discharged) to full (fully charged), as shown in Figure 6. If the AC Power Module is

inserted in Compartment B, the no battery icon is displayed.

Figure 6 Battery Charge Level Indicators

•INOP statements

INOP statements appear in the top left of the display if equipment problems are detected.

• ECG/HR alarm status

Alarm messages communicate arrhythmia alarms, as well as overall alarm status (alarms off, alarms

paused).

•Patient Type

Some modes of operation allow for the entry of patient information via a menu choice. If no

information is entered, the patient category is defaulted to Adult, unless configured otherwise, and

the pacing status is set to Non-Paced, unless the Paced status has been previously set to paced for an

internally paced patient. In Pacer Mode, Paced status is not displayed.

• Patient Name. If entered, the patient’s name will appear above the patient type and paced status.

• Bed/Equipment Label. The HeartStart MRx equipment label is displayed when the device is not

connected to the IntelliVue Network. The Equipment label is replaced by the bed label when

connected to the IntelliVue Network.

•Event Timer

An Event Timer communicates the elapsed time for the current patient event.

AAA

No Battery Empty Battery 25% Capacity 100% Capacity75% Capacity

50% Capacity

Display Views 2 Getting Acquainted

Wave Sectors

The HeartStart MRx is configured to populate each wave sector with a predetermined waveform, when

powered on in Monitor, Manual Defib, or Pacer Mode. Figure 7 shows the default Waves

configuration choices for a device containing all monitor options. See “Configuration” on page 199 for

more information.

A dashed line in a wave sector or an empty wave sector indicates that the waveform source is invalid.

Wave sectors may contain a variety of information, as appropriate to the parameter, view, and task.

Figure 7 Default Waves Configuration

Wave Sector 1

Wave Sector 1 only contains an ECG waveform. This is the waveform used by the arrhythmia, heart

rate derivation, and AED analysis algorithms.

If Pads are configured as the primary ECG source for Wave Sector 1, the ECG patient cable must be

connected to the HeartStart MRx and to the monitoring electrodes on the patient in order to change

the ECG source to a Leads selection.

NOTE When monitoring using a 3-lead ECG set, the HeartStart MRx displays 1 ECG lead at a time.

ECG/HR alarms

Mark Event

10 Feb 2006 11:20

Patient name

Adult Non-Paced

Inops Area

HH:MM:SS

36.9 80 120/80

(95)

Pulse NBP

mmHg q120

10:40

bpm

Temp

SYS

160

Primary ECG

bpm 80

120

50 39.0

36.0

SpO2 % EtCO2

100 AwRR

mmHg rpm

PAP ABP

150

ABP rhythm status

PAP

0CO2

160

SYS

118/77

(95)

mmHgmmHg

24/10

(15)

DIA

0100

Softkey

#1 Softkey

#2 Softkey

#3 Softkey

Main Menu

Exit

High Contrast On

Other

Trends

Patient Info

Measurements/Alarms

Printed Waves

Displayed Waves

Volume

2 Getting Acquainted Display Views

Wave Sectors 2-4

Wave Sectors 2 through 4 are automatically populated when parameter sources (cables/tubing) are

connected to the HeartStart MRx. If the parameter source is the configured choice of a particular wave

sector, it is displayed in that wave sector. If you connect a parameter source that is not configured to be

displayed, it is displayed in the first empty wave sector. If you subsequently connect the configured

parameter source, it replaces the current parameter. For invasive pressures, you should label your

waveforms as they are connected to avoid possible confusion.

Changing Displayed Waveforms

Wave Sector 1 has a dedicated Lead Select button to change the displayed lead/source. Waveforms

displayed in other wave sectors may be changed for the current patient through the menu. See

“Menus” on page 17.

Parameter Blocks

Measurements for monitored parameters are provided in the parameter blocks. Parameter Block 1

always contains the heart rate and HR alarm settings. Other parameters are in fixed locations

depending upon the options which were included in your HeartStart MRx. Each measurement is

labeled and displays the current value and the high and low alarm limit settings or the (alarms off)

icon. A “-?-” is displayed until a valid measurement can be obtained.

Your parameter text colors always match their corresponding wave.

Parameter Alarm Messages are displayed in the space above each numeric value, replacing the

parameter label, except HR.

Turning Parameters On/Off

SpO2, Invasive Pressures, EtCO2 and Temperature parameters are activated when the associated

parameter cable/tubing is connected. To turn the parameter off, disconnect the cable/tubing from the

HeartStart MRx. A prompt message (see Figure 8) alerts you that the parameter has been disconnected

and requests confirmation to turn the parameter off.

Figure 8 Parameter Message

Press the Menu Select button to select Yes, confirm your action and turn off the parameter. If you

do not wish to turn the parameter off, use the Navigation Buttons to highlight No. Press the Menu

Select button to keep the parameter on and reconnect the cable/tubing. You can also ignore the

message and reconnect the cable/tubing. The HeartStart MRx will detect the connection and remove

the message.

Soft Key Labels

The four soft key labels correspond to the soft key buttons located immediately below. These labels

change, as appropriate, according to the current display view and function. Soft key labels appearing as

gray text indicate that the soft key is inactive.

Turn off SpO2?

Display Views 2 Getting Acquainted

Menus

Menus with controls and options specific to each function of the HeartStart MRx are easily accessible

using the Menu Select and Navigation buttons located on the front panel. Menus are used to adjust

volume, select waveforms for display, select waves for printed strips, set alarms, schedule

measurements, enter patient information, perform the Operational Check, generate reports, and a

variety of other tasks. Menus and submenus are organized to allow you to conveniently make selections

and enter information.

To display a menu, press the Menu Select button. Then use the up or down Navigation

buttons to scroll through the available choices until the desired selection is highlighted. The menus

have a wrap-around scrolling feature. Holding the Navigation button down accelerates scrolling

through the menu choices. Once you hit the bottom of a menu, it automatically wraps around to the

top of the menu and continues scrolling.

To activate a selection, press the Menu Select button. Select Exit to close the menu without activating a

selection. Arrows at the bottom of the list indicate additional list options are available. An indication of

which page you are on in the menu is located between the arrows. Scrolling down (or up) reveals the

remaining options. Depending upon the situation, there are times when some options on various

menus are unavailable for use. These options will appear in menus as “grayed out” and can’t be

highlighted or selected. See Figure 9.

Figure 9 Sample Menus

Value Adjustment

By using the HeartStart MRx’s Navigation buttons you can set numeric values for several parameters

by displaying a values box in the Menu area. See Figure 10. Some values are adjustable in increments

other than 1. Hold the Navigation button down to accelerate scrolling through the numeric values.

Release the Navigation button to stop the scrolling. The value initially displayed is the default value.

Figure 10 Setting Values

NOTE Accelerated scrolling is not available when setting Pacer Rate and Pacer Output.

Measurements/Alarms

HR/Arrhythmia

Press1:ABP

Press 2: PAP

CPP

NBP

EtCO2

AwRR

SpO2

Pulse

1 of 2

Highlighted selection

More menu

options available

Disabled selection

Patient Info

Discharge Patient

Name

Patient Category

Date of Birth

Sex

Paced

Chest Pain

Exit

Pacer Rate

60 ppm

2 Getting Acquainted High Contrast Display

Message Windows

Periodically, message windows appear on the display to provide additional status information, alert you

to an error or a potential problem, or direct you to take action. Remain alert to these messages. If a

response is required, use the Navigation buttons and Menu Select buttons to highlight and select the

appropriate action.

Figure 11 Sample Message Window

High Contrast Display

To optimize visibility of the HeartStart MRx display when used in bright sunlight, the device provides

a High Contrast feature which may be enabled. In this view, the MRx display appears using a yellow

background with all other screen elements appearing in black or shades of gray. High Contrast is

enabled in Manual Defib, Pacer and Monitor Modes by pressing the Menu Select button and

selecting High Contrast On from the Main Menu.

NOTE The High Contrast feature does not display colors configured as red or blue, therefore, be sure your

device is configured correctly with the appropriate parameter color settings. Refer to “Configuration”

on page 199 for more information.

Connect Pads Cable

Controls 2 Getting Acquainted

Controls

The Therapy Knob is used to turn the HeartStart MRx on in the desired mode of operation. Operating

controls are organized by function, with general function buttons located along the left and bottom

sides of the display, defibrillation controls to the right of the display, and soft keys immediately below

the display. (See Figure 1.)

Therapy Knob

The Therapy Knob serves as the power switch for the HeartStart MRx. It can be set to:

•Off

•AED - to enable AED Mode for semi-automated external defibrillation.

•Monitor - to enable Monitor Mode for 3- or 5-lead ECG monitoring, 12-lead ECG acquisition

(optional), Vital Signs Trending, or monitoring of optional parameters.

•Pacer - to enable Pacer Mode (optional) for demand or fixed mode pacing.

•Manual Defib - to enable Manual Defib Mode for asynchronous or synchronous defibrillation

(cardioversion) at the selected energy setting.

In Manual Defib Mode, without Pacing, the defibrillation energy settings are labeled as 1-9, 10, 15,

20, 30, 50, 70, 100, 120, 150, 170, and 200 Joules. If your unit is equipped with Pacing, the energy

settings are labeled as 1-10, 15, 20, 30, 50, 70, 100, 120, 150, 170, and 200 Joules.

2 Getting Acquainted Controls

General Function Buttons

The general function buttons control monitoring or non-critical resuscitation activities. They include:

Mark Event button - allows you to insert a time-stamped annotation in the Event Summary

Report to note events as they occur, including the administration of certain drugs. A Mark Event

button label appears at the top left corner of the display.

Lead Select button - changes the ECG lead in Wave Sector 1. Pressing this button cycles through

the available ECG waves, changing the displayed wave and label. The list of available ECG waves is

based on the current lead set and device configuration, and includes pads or paddles, if the

corresponding cable is connected to the device.

Alarm Pause button - The Alarm Pause button pauses all visual and audible physiological alarms

and audible inops for the configured time interval. At the end of the pause interval, each alarm returns

to its previous setting (On or Off). Pressing the Alarm Pause button during the pause interval also

returns alarms to their previous settings.

Print button - The Print button initiates a continuous print-out of the primary ECG and other

selected waveform(s) either real-time or with a 10-second delay, depending on your configuration.

Pressing the Print button while printing is in progress stops the printing.

Summary button - The Summary button displays a menu from which you can print the current

or most recent Event Summary report or Vital Signs Trending Report.

Menu Select button - Pressing the Menu Select button either brings up the current menu or

confirms a menu selection.

Navigation buttons - The Navigation buttons display the current menu just as the Menu

Select button does. Additionally, within any menu or list, these buttons move to the next or previous

item in the list. They also increase or decrease numbers or values in a sequence.

Controls 2 Getting Acquainted

Defibrillation Controls

The defibrillation controls are shown in Figure 12. They include:

Therapy Knob - Enables AED or selects an energy for Manual Defib Mode defibrillation or

cardioversion.

Charge Button - Charges the defibrillator to the selected Manual Defib energy setting. Used only in

Manual Defib Mode. In AED Mode, the defibrillator charges automatically.

Shock Button - Delivers a shock through multifunction electrode pads or switchless internal paddles.

In AED mode a 150J shock is delivered. In Manual Defib Mode, the shock is delivered at the selected

Manual Defib energy setting.

NOTE When external paddles or switched internal paddles are used, once the HeartStart MRx is fully

charged, the shock is delivered by pressing the Shock button(s) on the paddles.

Sync Button - Toggles between synchronized energy delivery used during cardioversion and

asynchronous energy delivery used during defibrillation.

Figure 12 Defibrillation Controls

Soft Keys

The soft keys perform the function displayed as a label appearing immediately above on the display.

The labels (and, therefore, the function) change appropriately for the various modes of operation and

are described in the following chapters.

150

200

170

120

100

dult

AED

onitor

acer

Therapy

Knob

Shock

Button

Charge

Button

Sync

Button

2 Getting Acquainted Controls

Indicators

The HeartStart MRx indicators provide a visual display of device status.

Ready For Use Indicator The Ready For Use (RFU) indicator is located on the upper, right corner of

the device. It indicates the status of the therapy delivery functions of the monitor/defibrillator using the

following definitions:

• A blinking black hourglass symbol indicates the shock, pacing, and ECG functions of the

device are ready for use. Sufficient battery power is available for device operation. Additionally, a

blinking black hourglass, together with the presence of external power (AC or DC), indicates that

installed battery(s) are being charged.

• A blinking red “X” and a periodic audio chirp indicate no battery is present or a low battery

condition. The device can be used, but its operation time is limited. If a battery is inserted and

charging, the audio chirp is not present.

• A solid red “X” and a periodic audio chirp indicate a failure has been detected that may

prevent the delivery of defibrillation therapy, pacing, or ECG acquisition. When turned on, the

device displays INOP messages for the failures detected.

• A solid red “X” without periodic audio chirps indicates either there is no power available, or

the device cannot power on. If, after power is supplied, the indicator reverts to the blinking black

hourglass symbol, the device is once again ready for use.

NOTE The RFU indicator may briefly display a solid red "X" when initially turning the device on, when

switching between clinical and non-clinical operating modes, and at the start of any automated test.

This does not indicate a failure of the device.

External Power Indicator The external power indicator is located above the display. It is green if

power is being provided by an external AC or DC power source. See Figure 13.

Figure 13 External Power Indicator

NOTE The external power indicator will momentarily go out when charging for defibrillation with a charged

battery installed. This is normal operation, as the device is switching its power source to the battery for

a faster charge time.

NOTE The AC Line Filter default setting of all HeartStart MRx devices is 60 Hz. You should adjust the AC

Line Filter default to the electric power frequency of your country. See “Configurable Parameters” on

page 202.

Audio Recording 2 Getting Acquainted

Audio Recording

If your device has the Audio Recording option, it is configured to “On” by default and cannot be

turned off during use, but can be turned off in Configuration Mode. If configured, audio will be

recorded in Manual, Pacing, 12-Lead, Monitor and AED modes, independent of whether Sync is on or

off. You can record up to 90 minutes of audio during an event. The audio is synchronized with clinical

event data.

One of the following icons is displayed to the left of the battery icon in all clinical modes:

Audio is not recorded if the Audio Recording configuration setting is set to Off or 90 minutes of audio

has been recorded for the current event.

NOTE You need to be within five feet of the HeartStart MRx (three feet if the printer and CO2 are running)

for a quality voice recording.

Reviewing Recorded Audio

To review recorded audio, transmit your Event Summary from the HeartStart MRx to a receiving

personal computer running Event Review Pro software. For more information about Event Review

Pro, go to www.medical.philips.com and search for data management. For more information on

HeartStart MRx transmission options see “Data Transmission” on page 239.

Table 2 Audio Recording Icon

Symbol Definition

Audio recording on.

Audio recording off.

2 Getting Acquainted Alarms

Alarms

The HeartStart MRx provides various alarm types indicating changes in patient condition or device/

cable conditions which may require attention. Table 3 details different alarm types.

Table 3 HeartStart MRx Alarm Types

NOTE The presence of multiple alarm conditions is quite possible. Announcing all of the detected alarms

would cause confusion and a less serious condition might hide a more serious condition. For this

reason, alarms are prioritized and categorized so that the most serious or highest priority alarm

condition is the one announced. If multiple same-parameter, same-priority alarms occur, all alarms will

be displayed.

NOTE Audio is suppressed for INOP alarms for the first 60 seconds after the HeartStart MRx is turned on.

INOP messages do appear on the display.

Responding to Alarms

Alarm limits are displayed with each parameter if alarms for the parameter are on. When an alarm

condition occurs and an alarm is indicated, visually and audibly, there are several ways to respond.

Initially:

1Attend to the patient.

2Identify the alarm(s) indicated.

3Silence the alarm(s). When a physiological alarm is announced, the audio pause label (see Figure

14) is displayed above the Navigation and Menu Select buttons. Pressing any of these buttons will

silence the audio for all active alarms while you are attending to the patient. If the alarming

condition continues to exist, it will re-alarm in two minutes. Silencing a specific alarm does not

prevent another alarm condition from sounding. If you also silence the second alarm, it resets the

two-minute audio pause for all active alarms.

When an INOP is announced without a concurrent physiological alarm, the audio off label is

displayed above the Navigation and Menu Select buttons. Pressing any of these buttons will silence

Type of Alarm Condition

Red High priority. Life-threatening alarm condition is present. Immediate operator response is required.

Red alarm message; alarm tone.

Yellow Medium priority. Non life-threatening alarm condition is present. Prompt operator response is

required. Yellow alarm message; alarm tone.

INOP Low priority. Most technical alarms are grouped together as INOPs and are handled as low priority

alarms indicating a problematic condition exists related to the ability of part or all of the device to

perform its intended monitoring function. Operator awareness is required. Exception: conditions

which stop or may stop the delivery of pacing therapy and invasive pressure disconnect. These are

classified as high priority technical alerts. They are potentially life-threatening conditions.

Latching Alarm is announced and remains present regardless of whether the alarm condition continues to

exist. A latching alarm is not removed until it is either acknowledged or a higher priority alarm

condition occurs.

Non-latching Alarm is automatically removed when the alarm condition no longer exists.

Alarms 2 Getting Acquainted

the audio for all active alarms while you are attending to the patient. INOPs do not reannunciate

after pressing audio off.

Figure 14 Audio Pause Label

Then:

4Address the alarm condition on the HeartStart MRx. The menu shown in Figure 15 appears.

Figure 15 Sample Alarm Response Menu

Alarms Off Turns the monitoring parameter’s alarms off and prevents future parameter alarms from

alarming. The alarm message is no longer displayed, and the icon appears next to the parameter

value.

Acknowledge For latching alarms, acknowledge clears the alarm condition when the condition no

longer exists.

New Limits Adjust the parameter alarm limits accordingly.

NOTE Alarm history can be accessed in the patient’s Event Summary. This information is maintained after

powering the device down and in the unlikely event of power loss.

WARNING Although the Alarm Pause button can be used when responding to alarms, the response procedures

described above are recommended. Alarm Pause removes audio and visual indications of active alarm

conditions as well as inhibiting indications of new alarm conditions.

A potential hazard exists if different alarm limits are used for the same or similar equipment in any

single area.

Confirm the alarm limits are appropriate for the patient each time there is a new patient incident.

Do not set alarm limits to such extreme values that render the alarm system useless.

NOTE Heart Rate and Arrhythmia Alarms function a bit differently than other alarms. For information about

responding to these alarms, see “Responding to HR and Arrhythmia Alarms” on page 59.

Audio Pause

SpO2 Alarm

Alarms Off

Acknowledge

New Limits

2 Getting Acquainted Identifying Your Device

Printing on Alarms

You can configure your HeartStart MRx to automatically print on certain alarms and not on others.

See “Printing Settings” on page 220 for more information.

Identifying Your Device

There are multiple ways to identify your HeartStart MRx and the data transmitted from it.

In Configuration Mode you can set up an Institution Name and/or Device ID. These two names are

not configurable during a patient event. You can also set up multiple Reference IDs which are

selectable during a patient event.

For example a HeartStart MRx could have the Institution Name "City Hospital" and a Reference ID

of "Emergency Department 1" or "City Fire & EMS" and "Truck 32". The Institution Name and

Reference ID are part of the data transmitted to a receiving device/institution.

For devices with the IntelliVue Network installed, Reference IDs are replaced with an Equipment

Label if the device is not on an active network and a Bed Label if it is on an active network.

Reference ID information is entered using the Reference ID menu. You can pre-configure up to 20

Reference IDs and can also manually enter one new Reference ID during a clinical event. Each

Reference ID can be up to 16 characters long and can include uppercase letters, numbers, spaces and

hyphens. See “Configuration” on page 199 and “Periodic Clinical Data Transmission” on page 250.

The HeartStart MRx maintains Reference IDs until:

• changed by the user

• changed in Configuration Mode

• a new HeartStart MRx configuration is imported

Institution ID, Device ID and Equipment/Bed Label indentifications are entered in Configuration

Mode. See “Configuration” on page 199.

NOTE Institutions should develop clear naming conventions for users to follow in order to assure accurate

post-event data review.

Entering Patient Information 2 Getting Acquainted

Entering Patient Information

Patient information may be entered for the following:

•Name

•ID

•Patient Category

• Age (Date of Birth if the IntelliVue Networking option is installed)

•Sex

• Chest Pain (if the ACI-TIPI and TPI option is installed)

• Paced (internal paced status)

Information is entered using the Patient Info menu. Patient Name is entered using 2 alphabetical lists,

one to enter the last name, followed by another to enter the first name. When each name is complete,

select Done. Select Cancel to close the patient name menu without saving.

NOTE Pediatric patients are defined on the HeartStart MRx as children under 8 years old or less than 25kg.

Adult patients are defined as 8 years old and over or 25 kg (55 lbs.) and heavier.

Continued Use

Once a patient event begins, the Continued Use feature is activated. This feature facilitates continued

treatment of the same patient by retaining the current settings and the patient record when the

HeartStart MRx is turned off for less than 10 seconds, for instance when switching between AED and

Manual Defib Modes or when the Therapy Knob is inadvertently moved to Off. When turned on

within the 10-second time period, the HeartStart MRx retains the most recent settings, including:

• Alarm settings

• Wave Sector settings

•Event Timer

• QRS, alarm tone, and voice prompt volumes

•ECG gain

• Vital Signs Trending data

• Pacing settings (The device DOES NOT automatically resume pacing.)

• Patient record in the Event Summary Report; new data is appended to the record.

The Sync feature remains active if the HeartStart MRx is turned off for less than 10 seconds. However,

Sync is disabled when AED Mode is activated, and must be turned on upon returning to Manual

Defib Mode.

NOTE The Continued Use feature will not function if all sources of power (battery and external AC/DC

power modules) are removed from the device, even briefly.

2 Getting Acquainted Printing Waveforms

Printing Waveforms

By using the Print Button on the front of the HeartStart MRx, you can obtain a continuous printout

of the primary ECG and one additional waveform if you have the 50mm printer installed; two

additional waveforms if you have the 75mm printer installed. Certain waveforms (including invasive

pressures and CO2) will include scale indications on the printout. The printouts are generated either

real-time or with a 10-second delay, depending on your configuration.

For devices with a 50mm printer, to change wave forms for the second wave printed, perform the steps

below:

1Press the Menu Select button.

2Using the Navigation buttons, select the Printed Waves option and press the Menu Select button.

3Using the Navigation buttons, select the wave form you want to print in Wave 2 and press the

Menu Select button.

For devices with a 75mm printer, to change wave forms for the second or third waves printed, perform

the steps below:

1Press the Menu Select button.

2Using the Navigation buttons, select the Printed Waves option and press the Menu Select button.

3Using the Navigation buttons, select Wave 2 or Wave 3 and press the Menu Select button.

4Using the Navigation buttons, select the wave form you want printed and press the Menu Select

button.

5Repeat Steps 2 through 4 for the other printed wave.

Return to Owner 2 Getting Acquainted

Return to Owner

The Return to Owner feature allows the owner of the HeartStart MRx to enable a specified loan

period. When the time period is up, the borrower of the HeartStart MRx will be reminded to return

the device to its owner as identified on the display. The feature is password protected in Configuration

and enabled through the Other Menu, where the owner can activate, deactivate, and specify the length

of the loan period.

NOTE Monitoring and defibrillation functions are suspended while the Return to Owner set-up screen is

displayed. Alarms Off is indicated on the display. Monitoring and defibrillation functions will return

when exiting the Return to Owner screen.

NOTE The appearance of the loan expiration message does not disable monitoring and defibrillation

functionality.

To enable the Return to Owner feature:

1Press the Menu Select button.

2Select Other from the menu and press the Menu Select button.

3Select Return To Owner and press the Menu Select button.

4Press the [Activate] soft key.

5Enter the number of days in the loan period and press the Menu Select button.

6Press the [Exit Return-To] soft key.

To disable the Return to Owner feature:

1Press the Menu Select button.

2Select Other from the menu and press the Menu Select button.

3Select Return To Owner and press the Menu Select button.

4Press the [Deactivate] soft key.

5Enter the password and press the Menu Select button.

6Press the [Exit Return-To] soft key.

3Setting Up

This chapter provides the basic set-up information you need to prepare your HeartStart MRx for

operation and to connect the optional monitoring accessories.

NOTE If your HeartStart MRx does not have some of the optional functionality or accessory pouches listed in

this chapter, disregard these features and related information.

Before using the HeartStart MRx, review the configuration settings of your device. Confirm and

update the settings as appropriate.

Attaching the Carrying Case and Accessory

Pouches

The HeartStart MRx accessory pouches are designed to hold your essential monitoring and

defibrillation accessories. Follow the procedures below for assembly and recommended accessory

placement.

1Disconnect all external power and remove all batteries.

2Lower the device into the sleeve of the carry case. The rear base of the device fits in the sleeve

socket.

Paddle Tray

a. If paddles are connected, disconnect them from the Therapy port and remove them from the

paddle tray.

b. Remove the 4 T-15 screws from the tray plates.

c. Gently lift the paddle tray up, leaving all wires connected.

Handle Only

a. Remove the handle cover by pushing in on either side of the handle cover and lifting up or by

lifting the corners of the label to expose the two T-15 screws.

b. Remove the 2 T-15 screws.

c. Remove the handle.

d. Gently lift the cap plate up.

3Setting Up Attaching the Carrying Case and Accessory Pouches

3Fold the two sleeve flaps over the top of the device, positioning them so that the screw holes are

exposed.

4Replace the paddle tray (and 4 T-15 screws) or cap plate, as appropriate, so that the molded

openings fit over the sleeve flaps.

5Replace the handle.

6If your handle cover does not have screw holes, insert the 2 T-15 screws and tighten. Then snap the

handle cover in place by pushing down on either side of the handle cover.

7If your handle cover has screw holes, replace the handle cover and then insert the 2 T-15 screws and

tighten. Smooth down the label corners to cover the screw holes.

8Secure the front and rear cinch straps using the metal rings provided.

9Perform an Operational Check as described in, “Operational Check” on page 270.

10 Attach the side pouches using the hook and loop fastener with the flaps and slots.

Figure 16 Accessory Pouch Assembly

Storing Accessories 3 Setting Up

Storing Accessories

Suggested parameter cabling and accessories storage is shown below.

Figure 17 Storing Accessories

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3Setting Up Storing Accessories

1Attach the Therapy cable and route it through cable fastener loop, securing the cable just below the

strain relief.

2Attach the rear pouch using the buckles provided.

NOTE Depressions are provided on the inside of the rear pouch should you wish to make a cut-out to

accommodate external power. Some devices may come with the cut-outs already made.

Figure 18 Connecting Cables

WARNING When using the carry bag to transport the HeartStart MRx, it is important to position it with the

display facing away from the body. If not, the Therapy Knob may be bumped and inadvertently moved

from its current position.

NOTE When packing cables into the carry bag, keep them untangled to ensure quick and easy deployment

when needed.

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Connecting the ECG Cable 3 Setting Up

Connecting the ECG Cable

To connect a 3-, 5- or 10-lead cable:

1Align the ECG cable with the white ECG port, as shown in Figure 19. The white key marker on

the ECG cable faces the top of the device.

2Push the ECG cable firmly into the ECG port, until the white portion of the cable connector is no

longer visible.

Figure 19 Connecting the ECG Patient Cable

ECG

3Setting Up Connecting the SpO2 Cable

Connecting the SpO2 Cable

To connect the SpO2 cable:

1Hold the cable connector with the flat side facing front, as shown in Figure 20.

2Insert the cable into the blue SpO2 port on the HeartStart MRx and push until the blue portion of

the cable connector is no longer visible.

Figure 20 Connecting the SpO2 Cable

ECG

Connecting the NBP Interconnect Tubing 3 Setting Up

Connecting the NBP Interconnect Tubing

To connect the NBP Interconnect Tubing:

1Insert the NBP Interconnect Tubing into the red NBP port as shown in Figure 21.

2Attach the NBP Interconnect Tubing fitting to the NBP cuff.

Figure 21 Connecting NBP Interconnect Tubing / NBP Cuff

ECG

3Setting Up Connecting the Invasive Pressures Cable

Connecting the Invasive Pressures Cable

To connect the invasive pressure cable:

1Insert the invasive pressure cable into either of the invasive pressure ports as shown in Figure 22.

2Attach the invasive pressure cable to your transducer/tubing.

3Assign a label to the connection on the HeartStart MRx. See “Selecting a Pressure to Monitor” on

page 117.

Figure 22 Connecting Invasive Pressure Cable

ECG

Connecting the Temperature Cable 3 Setting Up

Connecting the Temperature Cable

To connect the temperature cable:

1Insert the temperature cable into the temperature port as shown in Figure 23.

2If needed, attach the cable to your probe.

Figure 23 Connecting the Temperature Cable

ECG

3Setting Up Connecting the CO2 FilterLine

Connecting the CO2 FilterLine

To connect the CO2 FilterLine®:

1Using the end of the FilterLine fitting, slide the CO2 compartment door down.

2Insert the fitting into the CO2 Inlet port as shown in Figure 24.

3Turn the fitting clockwise into place.

Figure 24 Connecting the CO2 FilterLine

ECG

Connecting the Therapy or Pads/CPR cables 3 Setting Up

Connecting the Therapy or Pads/CPR cables

To connect the Therapy or Pads/CPR cable:

1Align the white pointer on the cable with the white arrow on the green Therapy port as shown in

Figure 25.

2Insert the cable into the green Therapy port. Push until you hear it click into place.

3If you are using the carry case, thread the cable through the fabric fastener at the bottom of the side

pouch to secure the cable into position.

Figure 25 Connecting the Therapy or Pads/CPR Cable

To detach the Therapy or Pads/CPR cable:

1Rotate the green knob in a clock-wise direction as indicated by the lock/unlock symbol next

to the Therapy door.

2Pull the cable away from the device.

3Setting Up Installing Paper

Installing Paper

50 mm paper

To install printer paper:

1Open the printer door by pushing on the latch as shown in Figure 26.

2If there is an empty or low paper roll in the printer, pull up on the roll to remove it.

3Examine a new roll of printer paper and remove any remaining adhesive residue from the outer

layer of paper.

4Place the new roll of printer paper into the paper well, positioning the roll so that the end of the

roll is on the bottom and the grid faces up as indicated by the symbol inside the printer

door.

5Pull the end of the paper out past the paper roller.

6Close the printer door.

Figure 26 Installing Paper (50mm)

Shock

Off

AED

Monitor

Shock

Off

AED

Monitor

Installing Paper 3 Setting Up

75mm Printer (optional)

To install printer paper:

1Open the printer door by pushing on the latch as shown in Figure 27.

2If there is an empty or low paper roll in the printer, pull up on the tab holding the paper roll to

remove it.

3Examine a new roll of printer paper and remove any remaining adhesive residue from the outer

layer of paper.

4Place a new roll of printer paper into the paper well, positioning the roll so that the end of the roll

is on the bottom and the grid faces up as indicated by the symbol inside the printer

door.

5Pull the end of the paper out past the paper roller.

6Close the printer door.

Figure 27 Installing Paper (75mm)

Shock

AED

Monitor

Off

Shock

AED

Monitor

Off

3Setting Up Installing Batteries

Installing Batteries

To install the batteries:

1Align the M3538A Lithium Ion battery in a battery compartment.

2Insert the battery, and press until you hear it click into place. Ensure that the latches located on

both sides of the battery are engaged fully.

Figure 28 Installing Batteries

Charging Batteries

Charge batteries fully upon receipt and prior to use. Be sure to familiarize yourself with the battery

maintenance procedures discussed in “Battery Maintenance” on page 283.

Battery Safety

Review the Application Note, M3538A Lithium Ion Battery - Characteristics and Care, provided with

your HeartStart MRx. Additionally, read the battery related warnings in “Specifications and Safety” on

page 321, prior to using the M3538A Lithium Ion Battery.

Installing the AC Power Module 3 Setting Up

Installing the AC Power Module

If not presently installed in your device, insert the M3539A AC power module as follows:

1Align the M3539A AC power module in Compartment B.

2Insert the AC power module, and press until you hear it click into place. Ensure that the latched

located on both sides of the AC power module are engaged fully.

3Insert the power cord into the AC power receptacle.

4Plug into an AC power outlet.

5Check that the External Power indicator on the front panel is illuminated.

Figure 29 Installing the AC Power Module

3Setting Up Installing the Data Card

Installing the Data Card

If not presently installed in your device, install the data card as follows:

1Insert the data card in the data card tray, sliding it under the tray clip. Confirm that the connector

is facing away from the pull tab.

2With the front of the tray facing forward, press the data card and tray firmly into the data card slot

located on the right side of the HeartStart MRx and marked by the data card symbol.

Figure 30 Installing the Data Card/Tray

CAUTION Even if a data card is not used, the data card tray should always be installed to protect the device from

the ingress of liquids or solids.

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4ECG and Arrhythmia

Monitoring

This chapter describes the basic ECG and arrhythmia monitoring functions of the HeartStart MRx

monitor/defibrillator. For specific information related to taking a 12-Lead ECG, refer to Chapter 13

“12-Lead ECG” on page 135.

Overview

The HeartStart MRx can be used for ECG and arrhythmia monitoring, allowing you to monitor

through:

• multifunction electrode pads, or

• 3-, 5-, or 10-lead monitoring electrode ECG sets.

If both pads and monitoring electrodes are connected, monitoring allows you to select a lead from the

3-, 5- or 10-lead monitoring electrode ECG source, or to monitor through pads.

Configurable heart rate and arrhythmia alarms clearly communicate patient status, both audibly and

visually.

Waveforms may be acquired through the therapy port for pads/paddles or the monitoring port for 3-,

5-, or 10-lead monitoring electrodes. If the configured source is not connected to the HeartStart MRx

when turned on, the first valid ECG source is displayed in Wave Sector 1. Once the configured source

is available, it automatically populates Wave Sector 1. Should the configured source then become

invalid, a Leads Off condition is displayed. The HeartStart MRx does not revert to the initial source of

ECG but you can select a lead by pressing the Lead Select button.

WARNING Do not use the HeartStart MRx to monitor neonatal ECGs. Doing so could result in inaccurate

measurements and alarms.

4 ECG and Arrhythmia Monitoring Monitoring View

Monitoring View

Monitoring View appears on the display when the Therapy Knob is in the Monitor position. Figure 31

shows the information displayed in Monitoring View.

Figure 31 Monitoring View

Monitoring View can display up to four ECG waves. Numeric values for heart rate and all other

available parameters are displayed, as well as any active alarm settings.

Mark Event 10 Feb 2006 11:20

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02:4

36.9 80 120/80

(95)

120

SYS

160

120

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100

150

160

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Preparing to Monitor ECG 4 ECG and Arrhythmia Monitoring

There are two separate sources of ECG: the ECG leads connection and the Pads/Paddles connection.

Leads/pads are displayed according to your device’s configuration. Lead II is configured as the primary

ECG lead source and is displayed in Wave Sector 1. You may change this during use with the Lead

Select button. You can also configure the HeartStart MRx to display up to 3 additional leads (or pads/

paddles) when turned on (see “Configuration” on page 199). The leads displayed may be changed

during use through the Displayed Waves menu item.

Monitoring View displays the first valid source of ECG acquired in Wave Sector 1. For example, if

your HeartStart MRx has Lead II configured to display in Wave Sector 1, but pads are attached to the

patient and connected to the defibrillator before a valid ECG can be obtained from the monitoring

electrodes, then Pads will be displayed in Wave Sector 1. However, Lead II will take its place as soon as

it is acquired.

NOTE The ECG lead source appearing in Wave Sector 1 is used to determine heart rate and monitor

arrhythmia.

Preparing to Monitor ECG

To prepare for monitoring ECG, perform the following steps.

If monitoring via electrodes:

1Prepare the patient’s skin prior to applying monitoring electrodes. Skin is a poor conductor of

electricity, so skin preparation is important in achieving good electrode-to-skin contact.

– Identify the appropriate electrode sites (See Figures 33 and 34.)

– If necessary, clip hair at the electrode sites (or shave sites if needed).

– Clean and abrade the skin at the electrode site.

– Dry the electrode sites briskly to increase capillary blood flow in the tissues and to remove oil

and skin cells.

2Attach the snaps to the electrodes before placing them on the patient.

3Apply the electrodes by peeling them, one at a time, from the protective backing and sticking them

firmly to the patient’s skin. Refer to Figures 33 and 34 for proper electrode placement. Press

around the entire edge of each electrode to ensure they are secure. Make sure the lead wires do not

pull on the electrodes.

WARNING Be sure that the electrodes do not come in contact with other conductive materials, especially when

connecting or disconnecting the electrodes to/from the patient.

NOTES Use only approved lead-sets with the HeartStart MRx. Failure to do so may introduce noise and result

in intermittent leads off messages.

A signal from a TENS unit can cause ECG artifact.

4 ECG and Arrhythmia Monitoring Preparing to Monitor ECG

4If not preconnected, connect the ECG patient cable.

– Align the keyed patient cable connector with the ECG port on the Measurement module, as

shown in Figure 32.

– Push the patient cable firmly into the ECG port until the white portion is no longer visible.

Figure 32 ECG Cable Connection

If monitoring via multifunction electrode pads:

1If not preconnected, connect the pads cable to the HeartStart MRx. See Figure 41 on page 65.

2Connect the pads to the pads cable. See Figure 42 on page 65.

3Apply the pads as directed on the package.

NOTE If monitoring for extended periods of time, monitoring electrodes and multifunction electrode pads

may need to be changed periodically. Refer to the manufacturer’s documentation for how often to

replace the monitoring electrodes or pads.

ECG

Electrode Placement 4 ECG and Arrhythmia Monitoring

Electrode Placement

Figure 33 shows the typical electrode placement for a 3-lead ECG set.

Figure 33 3-lead Placement

Figure 34 shows the typical electrode placement for a 5-lead ECG set.

Figure 34 5-lead Placement

–

––

III

RA/R placement: directly below the clavicle and

near the right shoulder

LA/L placement: directly below the clavicle and

near the left shoulder

LL/F placement: on the left lower abdomen

RA/R

(White/Red)

LL/F

(Red/

Green)

LA/L

(Black/

Yellow)

–

––

III

aVR

aVL

aVF

RA/R p

acement:

irect

ow t

e c

avic

e an

near

the right shoulder

LA/L placement: directly below the clavicle and near

the left shoulder

RL/N placement: on the right lower abdomen

LL/F placement: on the left lower abdomen

V/C placement: on the chest; the position depends on

your required lead selection. See Figure 35.

LL/F

(Red/

Green)

LA/L

(Black/

Yellow)

RA/R

(White/Red)

RL/N

(Green/

Black)

V/C

(Brown/

White)

4 ECG and Arrhythmia Monitoring Electrode Placement

The V/C lead may be placed in any of the precordial electrode positions as shown in Figure 35 (V1/C1

through V6/C6).

Figure 35 V/C Electrode Placement

For accurate V/C lead placement and measurement, it is important to locate the fourth intercostal

space, as follows:

1Locate the second intercostal space by first palpating the Angle of Lewis (the small bony

protuberance where the body of the sternum joins the manubrium). This rise in the sternum is

where the second rib is attached, and the space just below this is the second intercostal space.

2Palpate and count down the chest until you locate the fourth intercostal space.

Figure 36 shows electrode placement for a 12-lead ECG set.

Figure 36 12-Lead Placement

NOTE When you do a 12-lead ECG, you should attach the limb leads to the patient’s extremities.

123456

V1/C1 p

acement:

ourt

intercosta

space at

right sternal margin.

V2/C2 placement: fourth intercostal space at

left sternal margin.

V3/C3 placement: midway between V2 and

V4.

V4/C4 placement: fifth intercostal space at

left midclavicular line.

V5/C5 placement: same level as V4 on

anterior axillary line.

V6/C6 placement: same level as V4 at left mid

axillar

line.

12-Lead ECG In a 12-Lead ECG using 10 electrodes, an

electrode is placed on the right arm, left arm, right leg, and

left leg. Six V/C electrodes are placed on the chest as shown

in Figure 36. The right leg electrode is the reference

electrode.

Lead Selection 4 ECG and Arrhythmia Monitoring

Lead Selection

It is important to select a suitable lead for monitoring so that a QRS complex can be accurately

detected. The guidelines for lead selection are as follows:

For non-paced patients:

• QRS complex should be tall and narrow (recommended amplitude > 0.5mV).

• R-wave should be above or below the baseline (but not biphasic).

• P-wave should be smaller than 1/5 R-wave height.

• T-wave should be smaller than 1/3 R-wave height.

NOTE To prevent detection of P-wave or baseline noises as QRS complexes, the minimum detection level for

QRS complexes is set at 0.15 mV, according to AAMI-EC 13 specifications. If the ECG signal is too

weak, you may get false alarms for asystole.

For paced patients with internal/transvenous pacemakers, in addition to the above, the pace pulse

should be:

• not wider than the normal QRS complex.

• large enough to be detected (half the height of the QRS complex), with no re-polarization artifact.

NOTE Adjusting the ECG wave size on the display does not affect the ECG signal which is used for

arrhythmia analysis.

Lead Choices

Available monitoring leads vary depending upon what type of ECG cable is connected to your

HeartStart MRx and its configuration. Table 4 shows the choice of leads available for 3-, 5-, and 10-

lead ECG sets.

Table 4 Lead Choices

If you are using: These leads are available:

a 3-electrode ECG set I, II, III

a 5-electrode ECG set I, II, III, aVR, aVL, aVF, V

a 10-electrode ECG set I, II, III, aVR, aVL, aVF, V1-V6

4 ECG and Arrhythmia Monitoring Arrhythmia Monitoring

Selecting the Lead

The ECG lead for Wave Sector 1 is selected through the Lead Select button or through the

Displayed Waves menu. The ECG lead for Wave Sectors 2-4 is selected through the Displayed Waves

menu, as follows:

1Press the Menu Select button.

2Using the Navigation buttons, select the Displayed Waves menu and press the Menu Select

button.

3Select the Wave Sector and press the Menu Select button.

4Select the desired lead and press the Menu Select button.

5If needed, use the Navigation buttons to adjust the ECG wave size (gain) and press the Menu

Select button.

Figure 37 Displayed Waves Menu

Arrhythmia Monitoring

The HeartStart MRx uses the ST/AR Basic Arrhythmia Algorithm. Arrhythmia analysis provides

information on your patient’s condition, including heart rate and arrhythmia alarms. The HeartStart

MRx uses the ECG lead appearing in Wave Sector 1 for single-lead arrhythmia analysis.

NOTE Because the ST/AR Basic Arrhythmia Algorithm is the HeartStart MRx’s cardiotach source and is

needed to generate heart rate and heart rate alarms, the algorithm can never be disabled. However, if

desired, arrhythmia and heart rate alarms can be turned off.

During arrhythmia analysis, the monitoring function continuously:

• optimizes ECG signal quality to facilitate arrhythmia analysis. The ECG signal is continuously

filtered to remove baseline wander, muscle artifact, and signal irregularities. Also, if the Patient Paced

status is set to Yes, pace pulses are filtered out to avoid processing them as QRS beats.

• measures signal features such as R-wave height, width and timing.

• creates beat templates and classifies beats to aid in rhythm analysis and alarm detection.

• examines the ECG signal for ventricular arrhythmias, asystole.

Displayed Waves

Wave 1

Wave 2

Wave 3

Wave 4

Exit

Wave 1

Pads

III

aVR

aVL

aVF

1 of 2

II Size

x1/2

x1/4

Auto

Main Menu

Start Data Transmit

Volume

Displayed Waves

Printed Waves

Measurements/Alarms

Patient Info

Trends

Other

High Contrast On

Exit

Arrhythmia Monitoring 4 ECG and Arrhythmia Monitoring

Aberrantly-Conducted Beats

As P-waves are not analyzed, it is difficult and sometimes impossible for the algorithm to distinguish

between an aberrantly-conducted supraventricular beat and a ventricular beat. If the aberrant beat

resembles a ventricular beat, it is classified as a ventricular beat. You should always select a lead where

the aberrantly-conducted beats have an R-wave that is as narrow as possible to minimize incorrect

classifications.

Intermittent Bundle Branch Block

Bundle branch and other fascicular blocks create a challenge for the arrhythmia algorithm. If the QRS

complex changes considerably from the learned normal due to a bundle branch block, the blocked beat

may be incorrectly identified as ventricular, and may cause false PVC alarms. You should always select

a lead where the bundle branch block beats have an R-wave that is as narrow as possible to minimize

incorrect classifications.

NOTE For more information on arrhythmia analysis, refer to the Application Note, “Arrhythmia Monitoring

Algorithm” available on the web at www.medical.philips.com/goto/productdocumentation.

4 ECG and Arrhythmia Monitoring Heart Rate and Arrhythmia Alarms

Heart Rate and Arrhythmia Alarms

The HeartStart MRx detects arrhythmia alarm conditions by comparing ECG data to a set of pre-

defined criteria. An alarm can be triggered by a rate exceeding a threshold (for example HR > XX), an

abnormal rhythm (for example, Ventricular Tachycardia), or an ectopic event (for example, PVC >

limit).

HR/Arrhythmia Alarms can be generated for the conditions shown in Tables 5 and 6. Once generated,

they appear as alarm messages in the alarm status area of the display located just above the HR

numeric. The notification of an alarm is indicated by both an audible and visual alert signal.

Arrhythmia Alarm Latching

Arrhythmia alarms are categorized as “latching” or “non-latching” alarms. Latching alarms are

announced and remain present, regardless of whether the alarm condition still exists, until they are

either acknowledged or a higher priority alarm condition occurs. Indications for non-latching alarms

are automatically removed when their alarm condition no longer exists.

Latching and non-latching alarms are categorized in Tables 5 and 6.

Table 5 HR/Arrhythmia Red Alarms

Alarm Message Condition Indicator Latching/

Non-Latching

Asystole No detectable beats for four

seconds in the absence of

Vfib

Red alarm message,

alarm tone

Latching

VFIB/VTACH A fibrillatory wave detected

for four seconds

Red alarm message,

alarm tone

Latching

VTACH Consecutive PVCs and HR

exceed configured limits

Red alarm message,

alarm tone

Latching

Extreme Brady 10 bpm below HR Low

limit, capped at 30 bpm

Red alarm message,

alarm tone

Latching

Extreme Tachy 20 bpm above HR High

limit capped at 200 bpm

(adult) or 240 bpm (pedi)

Red alarm message,

alarm tone

Latching

Heart Rate and Arrhythmia Alarms 4 ECG and Arrhythmia Monitoring

Figure 38 Alarm Chain for Basic Arrhythmia Monitoring

Table 6 HR/Arrhythmia Yellow Alarms

NOTE Pacer Alarm Messages are associated with internal/transvenous pacemakers only.

* PNC = Pacer Not Capture

PNP = Pacer Not Pacing

Asystole

V-Fib/V-Tach

V-Tach

Red Alarms

Extreme Tachy Extreme Brady

Yellow Alarms

PVC Alarms Beat Detection Alarms Rate Alarms

Frequent PVCs PNC* PNP* High HR Low HR

PVCs>xx/Min.

First level timeout period

Second level timeout period

Alarm Message Condition Indication Latching/

Non-Latching

HR High The HR exceeds the configured

HR high limit

Yellow alarm

message, alarm tone

Non-Latching

HR Low The HR is below the configured

HR low limit

Yellow alarm

message, alarm tone

Non-Latching

PVC/min High

(value > limit)

The number of detected PVCs in

a minute exceeds the limit of

15(adult/pedi.)

Yellow alarm

message, alarm tone

Non-Latching

Pacer Not Capture No QRS following a pacer pulse Yellow alarm

message, alarm tone

Latching

Pacer Not Pacing No QRS or pacer pulse detected Yellow alarm

message, alarm tone

Latching

4 ECG and Arrhythmia Monitoring Heart Rate and Arrhythmia Alarms

INOP Messages

INOP messages communicate conditions that prevent the device from monitoring or analyzing the

ECG. INOP messages are displayed just above the HR/Arrhythmia alarm status area. If multiple

INOP conditions exist, the associated INOP messages will cycle through, alternating every 2 seconds.

Table 7 ECG IN O Ps

Alarm Message Condition Indication

Cannot Analyze ECG Cannot reliably monitor the ECG in

Wave Sector 1.

INOP message, INOP tone

ECG Cable Failure During the Operational Check, a short

has been detected between a lead wire

and ground

INOP message, INOP tone

Leads Off An electrode used for Wave Sector 1

may be off or not attached securely.

INOP message, INOP tone

Pads /Paddles Off The multifunction electrode pads or

paddles used as the source for the Wave

Sector 1 may be off or not attached

securely.

INOP message, INOP tone

ECG Unplugged The primary ECG is derived from leads

and the ECG cable is not connected.

INOP message, INOP tone

ECG Equip Malfunction A malfunction has occurred in the

ECG hardware.

INOP message, INOP tone

Pads/Paddles Cable

Failure

During the Operational Check, a

failure was detected in the pads or

paddles cable during the pads/paddles

ECG test.

INOP message, INOP tone

Pads ECG Equip

Malfunction

A device hardware failure was detected. INOP message, INOP tone

Setting Alarms 4 ECG and Arrhythmia Monitoring

Setting Alarms

Alarms are automatically enabled in Monitor and Pacer modes. In Manual Defib Mode alarms are

automatically enabled if the Sync function is enabled. If the Sync function is not enabled, alarms are

enabled in Manual Defib mode using the Alarm Pause button. Alarm settings for Heart Rate (HR) and

VTACH are as configured but may be changed via the Menu Select button during operation for the

current patient incident. The setting for PVC Rate Limit may only be changed in response to a PVC

Rate alarm condition. Settings for other HR and arrhythmia alarms may not be changed.

Changing Heart Rate or VTACH Alarm Limits

To change the HR or VTACH limits:

1Press the Menu Select button.

2Using the Navigation buttons, select Measurements/Alarms from the menu and press the Menu

Select button.

3Select HR/Arrhythmia and press the Menu Select button.

4Select HR or VTACH Limits and press the Menu Select button.

5Using the Navigation buttons, select the new values and press the Menu Select button.

Enabling/Disabling Heart Rate and Arrhythmia Alarms

To enable/disable the HR and Arrhythmia alarms:

1Press the Menu Select button.

2Select Measurements/Alarms from the menu and press the Menu Select button.

3Select HR/Arrhythmia and press the Menu Select button.

4Select Alarms On/Off and press the Menu Select button.

Responding to HR and Arrhythmia Alarms

When an alarm is announced, the audio pause label is presented above the Navigation and Menu

Select buttons. Pressing any of these buttons temporarily silences the alarm audio while you are

attending to the patient. See Figure 39. Alarms will reannunciate if conditions exist for two minutes or

another alarm condition is generated.

Figure 39 Audio Pause Label

Then respond to the alarm condition on the HeartStart MRx. There are two ways to respond to an HR

or Arrhythmia alarm:

1Acknowledge the alarm condition.

2Adjust the limits using the New Limits menu.

Audio Pause

4 ECG and Arrhythmia Monitoring Displaying an Annotated ECG

Displaying an Annotated ECG

You may choose to display an annotated ECG with arrhythmia beat labels in Wave Sector 2. The same

ECG source appearing in the Wave Sector 1 is displayed with a six second delay along with white

arrhythmia beat labels. See Table 8 below for additional information on beat classification.

Table 8 Arrhythmia Beat Labels

To display an annotated ECG:

1Press the Menu Select button.

2Using the Navigation buttons, select Displayed Waves and press the Menu Select button.

3Select Wave 2 and press the Menu Select button.

4Select Annotated ECG and press the Menu Select button.

Label Description Displayed Location

NNormal Above QRS

VVentricular Ectopic Above QRS

P Paced Above QRS

' Pacer spike Above the waveform where the pacer spike is

detected. (If the patient is both atrially and

ventricularly paced, the display will show two '

marks above the waveform aligned with the

atrial and ventricular pacing.)

L Learning Patient’s ECG Above QRS

A Artifact (noisy episode) Above the waveform where the noise is

detected.

? Insufficient information to classify beats Above QRS

I Inoperative condition (e.g. LEAD OFF) Above the waveform at start of INOP, every

second of INOP, and at end of INOP.

M Pause, Missed Beat, No QRS Above the waveform where the condition is

detected.

Arrhythmia Learning/Relearning 4 ECG and Arrhythmia Monitoring

Arrhythmia Learning/Relearning

When arrhythmia monitoring starts, a “learning” process is initiated. The goal is to learn the patient's

normal complexes and/or paced complexes (if the patient with an internal/transvenous pacemaker is in

paced rhythm). The learning process involves the first 15 valid (non-noisy) beats encountered during

the learning phase.

The family selected to represent the “normal” complex includes the beat that is the most frequently

seen, narrowest, on-time beat. For this reason, learning should not be initiated when the patient's

rhythm is primarily ventricular.

Arrhythmia learning/relearning automatically occurs when the Therapy Knob is turned on to Monitor,

Pacer or Manual Defib, any time there is a change in the lead selection for Wave Sector 1, and after the

correction of a “Leads or Pads Off” INOP condition that has been active longer than 60 seconds.

Manual relearning should be initiated if the beat detection is not occurring or if beat classification is

incorrect and results in a false alarm. Remember, however, that if the same signal condition which

caused the algorithm to perform poorly still persists, relearning will not be able to correct the problem.

The problem can only be corrected by improving the quality of the signal (e.g., by selecting a different

lead.)

To initiate relearning manually,

1Press the Menu Select button.

2Using the Navigation buttons, select Measurements/Alarms from the menu and press the Menu

Select button.

3Select HR/Arrhythmia and press the Menu Select button.

4Select Relearn Rhythm and press the Menu Select button.

The messages “Learning ECG” and “Learning Rhythm” appear in the rhythm status area of the display.

WARNING If arrhythmia relearning takes place during a ventricular rhythm or during a period of poor ECG signal

quality, ectopic beats may be incorrectly learned as the normal QRS complex. This may result in

missed detection of subsequent events of V-tach and high PVC rates.

For this reason, you should:

• take care to initiate arrhythmia relearning only when the ECG signal is noise-free.

• be aware that arrhythmia relearning can happen automatically.

• respond to any INOP messages (for example, if you are prompted to reconnect electrodes).

• display an annotated wave to ensure beat labels are correct.

Troubleshooting

If your HeartStart MRx does not operate as expected during ECG and Arrhythmia monitoring, see

“Troubleshooting” on page 297.

5AED Mode

Defibrillation therapy is the definitive method for termination of a variety of potentially fatal

arrhythmias. The HeartStart MRx’s Semi-Automated External Defibrillation (AED) Mode is designed

to guide you through standard treatment algorithms for cardiac arrest. The HeartStart MRx provides

therapy through the application of a brief biphasic pulse of electricity to the cardiac muscle. This

electrical energy is transferred through disposable multifunction electrode pads applied to the patient’s

bare chest.

Configuration choices allow you to customize AED Mode to better meet the unique needs of your

organization or resuscitation team. This chapter describes how to use AED Mode. It explains the

prompts that guide you through the defibrillation process and describes how prompts vary depending

upon the condition of the patient and the configuration of your device.

For information on annotating, storing, and printing event information acquired in AED Mode, see

“Working with Data” on page 225.

For information on setting configuration choices, see “Configuration” on page 199.

Precautions for AED Therapy

WARNING The AED algorithm is not designed to handle erratic spiking problems caused by a properly or

improperly functioning pacemaker. In patients with cardiac pacemakers, the HeartStart MRx may

have reduced sensitivity and not detect all shockable rhythms.

NOTES The Philips HeartStart MRx AED mode is not intended for children under 8 years of age. For children

8 years of age and older, the American Heart Association recommends that standard operating

procedures for AEDs be followed. See the American Heart Association Guidelines 2005 for

Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Dallas, Texas; AHA; 2005.

Successful resuscitation is dependent on many variables specific to the patient’s physiological state and

the circumstances surrounding the patient incident. Failure to have a successful patient outcome is not

a reliable indicator of monitor/defibrillator performance. The presence or absence of a muscular

response to the transfer of energy during electrical therapy is not a reliable indicator of energy delivery

or device performance.

5AED Mode AED View

AED View

Once the Therapy Knob is moved to AED, AED View is displayed.

Figure 40 AED View Display

Wave Sectors 1 and 2 are combined so that a large ECG may be shown. The Event Timer is also large

for easier viewing. A Shock Counter is displayed just below the ECG and shows the total number of

shocks delivered to the patient in AED and Manual Defib Mode. Also below the ECG is a prominent

text message window which accompanies the voice prompts annunciated in AED Mode.

NOTE Only the ECG acquired through multifunction electrode pads is displayed in AED Mode.

Alarms Off

Mark Event

10 Feb 2006 11:20

154 02:4

Analyzing

Do Not Touch Patient

cks

Preparation 5AED Mode

Preparation

Confirm that the patient is:

• unresponsive

•not breathing

• pulseless

Then:

1Remove clothing from the patient’s chest. Wipe moisture from the patient’s chest and, if necessary,

clip or shave excessive chest hair.

2Make sure the multifunction electrode pads packaging is intact and within the expiration date

shown.

3Apply multifunction electrode pads to the patient as directed on the pads package. Use the

anterior-anterior electrode placement.

4If not pre-connected, insert the pads cable into the green Therapy port located on the right side of

the device. Push until you hear it click into place. See Figure 41.

Figure 41 Pads Cable Connection

5Connect the pads to the pads cable as shown in Figure 42.

Figure 42 Pads Connections

5AED Mode Using AED Mode

WARNING Do not use anterior-posterior pads placement (multifunction electrode pads placed on the patient’s

chest and back). The AED algorithm used by the HeartStart MRx has not been validated using this

placement.

WARNING Do not let the multifunction electrode pads touch each other or other monitoring electrodes, lead

wires, dressings, transdermal patches, etc. Such contact can cause electrical arcing and patient skin

burns during defibrillation and may divert defibrillation current away from the heart.

WARNING During defibrillation, air pockets between the skin and multifunction electrode pads can cause patient

skin burns. To help prevent air pockets, make sure defibrillation pads completely adhere to the skin.

Do not use dried-out multifunction electrode pads.

CAUTION Aggressive handling of multifunction electrode pads in storage or prior to use can damage the pads.

Discard the pads if they become damaged.

NOTE Impedance is the resistance between the defibrillator’s pads or paddles that the defibrillator must

overcome to deliver an effective discharge of energy. The degree of impedance differs from patient to

patient and is affected by several factors including the presence of chest hair, moisture, and lotions or

powders on the skin.

The low-energy SMART Biphasic waveform is an impedance-compensating waveform that is designed

to be effective across a wide range of patients. However, if you receive a "No Shock Delivered"

message, check that the patient’s skin has been washed and dried and that any chest hair has been

clipped. If the message persists, change the pads and/or the pads cable.

Using AED Mode

To operate the HeartStart MRx in AED Mode, follow these three basic steps:

1Turn the Therapy Knob to AED.

2Follow the voice and screen prompts.

3Press the orange Shock button, if prompted.

These steps are described more fully in the sections that follow.

While operating in AED Mode, the capabilities of the device are limited to those essential to the

performance of semi-automated external defibrillation. Only the ECG acquired through pads is

displayed. Previously set alarms and scheduled measurements are indefinitely paused and entry of

patient information is disabled. Additionally, the Sync, Lead Select, and Alarm Pause buttons are

inactive.

Using AED Mode 5AED Mode

Step 1 - Turn the Therapy Knob to AED

When the HeartStart MRx is turned on in AED Mode, it checks to see if the pads cable and

multifunction electrode pads are properly connected. If the:

• pads cable is not properly attached, you are prompted to "Connect Pads Cable".

• multifunction electrode pads are not connected to the pads cable, pads are not applied to the

patient, or pads are not making proper contact with the patient’s skin, you are prompted to "Apply

Pads" and "Plug in Connector".

Step 2 - Follow Screen and Voice Prompts

Once an ECG is detected through the multifunction electrode pads, the HeartStart MRx

automatically analyzes the patient’s heart rhythm and warns you not to touch the patient (Figure

43).

Figure 43 ECG Analysis Message in AED Mode

WARNING Handling or transporting the patient during ECG rhythm analysis can cause an incorrect or delayed

diagnosis. Under these circumstances, if the HeartStart MRx issues a "Shock Advised" prompt, keep

the patient as still as possible for at least 10 seconds so the HeartStart MRx can reconfirm the rhythm

analysis before you deliver a shock.

If artifact interferes with analysis, the message "Analyzing Interrupted, Do Not Touch the Patient" is

annunciated while the HeartStart MRx attempts to continue analyzing. If the artifact persists, the

message "Cannot Analyze" is annunciated and the message Paused. Attend To Patient is displayed. While

paused, analysis is suspended. Check that the pads are making proper contact with the patient’s skin

and minimize movement. Analysis resumes automatically after 30 seconds or when you press

[Resume Analyzing].

Always use the analyze function to determine if a rhythm is shockable.

Adjusting Voice Prompt Volume

You may adjust the volume of the voice prompts at any time by accessing the Voice Volume menu.

Press the Menu Select button.

Select the desired volume level and press the Menu Select button.

NOTE In loud environments, you can use the display prompts in lieu of voice prompts.

ANALYZING

DO NOT TOUCH PATIENT

5AED Mode Using AED Mode

Shock Advised

If a shockable rhythm is detected, the HeartStart MRx automatically charges to 150J. Charging is

accompanied by voice and screen prompts as shown in Figure 44. A steady high-pitched tone is

sounded, and the orange Shock button flashes when the device is fully charged.

Heart rhythm analysis continues while the HeartStart MRx charges. If a rhythm change is detected

before the shock is delivered and a shock is no longer appropriate, the defibrillator disarms.

Figure 44 Shock Advised, Charging Display

NOTE When the HeartStart MRx is fully charged, you can disarm it any time by turning the Therapy Knob

to the “Off” position or by pressing the [Pause for CPR] soft key. Resume monitoring the

patient by turning the Therapy Knob back to AED.

No Shock Advised (NSA)

If a shockable rhythm is not detected, the HeartStart MRx tells you, "No shock advised". If the NSA

Action Configuration Choice is set to:

Monitor - The HeartStart MRx monitors the ECG and automatically resumes analysis if a potentially

shockable rhythm is detected. You are periodically prompted to "If needed, press Pause and begin CPR."

The frequency of these prompts is defined in the Monitor Prompt Interval Configuration Choice. You

may press [Pause for CPR] to suspend monitoring and administer CPR. The pause period is

defined by the CPR Timer Configuration Choice.

Pause Time - Analysis is suspended for the specified period and you may administer CPR and attend

to the patient. A Pause status bar is displayed as shown in Figure 45. The pause period is defined by the

NSA Action Configuration Choice. At the completion of the pause period, the HeartStart MRx

resumes analyzing.

Figure 45 Paused Display

SHOCK ADVISED

CHARGING

STAND CLEAR

PAUSED,

ATTEND TO PATIENT

Troubleshooting 5AED Mode

Step 3 - Press Shock Button, if Prompted

Once charging is complete, the HeartStart MRx prompts you to "Deliver Shock Now; Press the Orange

Button Now". Make sure no one is touching the patient or anything connected to the patient. Call out

clearly and loudly, “Stay Clear.” Then press the orange Shock button to deliver a shock to the patient.

WARNING Defibrillation can cause operator or bystander injury. Do not touch the patient or equipment

connected to the patient during defibrillation.

WARNING The Shock button must be pressed to deliver a shock. The HeartStart MRx will not automatically

deliver a shock.

Delivery of the shock is confirmed by the message "Shock Delivered" and the shock counter on the

display is updated to reflect the number of shocks given. The defibrillator will announce "Paused. If

needed, begin CPR." The HeartStart MRx pauses for the configured CPR Timer period. Prompts may

be brief or detailed, as defined by the CPR Prompt Configuration Choice. Analysis begins again at the

completion of the pause period or when you press [Resume Analyzing].

If you press [Pause for CPR] after a shock is delivered in the current Shock Series, the length of

the CPR Pause is defined by the CPR Timer Configuration Choice.

NOTE You may return to analyzing the patient’s heart rhythm at any time by pressing the [Resume

Analyzing] soft key.

NOTE Once prompted to "Deliver Shock Now; Press the Orange Button Now", if you do not do so within the

configured Auto Disarm time interval, the HeartStart MRx disarms itself and provides a pause for

CPR. The device resumes analyzing at the end of the configurable pause period or when the [Resume

Analyzing] soft key is pressed.

NOTE Rhythm Monitoring is intended to provide a backup or secondary measure of potentially shockable

rhythms in various environments but is not a substitute for being attentive to the state of the patient.

Using Q-CPR in AED Mode

If your HeartStart MRx is equipped with the Q-CPR option, your default view is Basic View. For

more information, see “Basic View” on page 170. You can configure the device for Advanced View. See

“AED Settings” on page 218 for more information.

Troubleshooting

If your HeartStart MRx does not operate as expected during defibrillation, see “Troubleshooting” on

page 297.

6Manual Defibrillation

and Cardioversion

This chapter explains how to prepare for and perform asynchronous and synchronous (cardioversion)

defibrillation using multifunction electrode pads, external paddles, and internal paddles.

NOTE Defibrillation is always performed through paddles or pads. However, during defibrillation you may

choose to monitor the ECG using an alternate ECG source (3-, 5-, or 10-lead monitoring electrodes).

If an alternate ECG source is connected, any available lead may be displayed.

For information on monitoring optional measurements while in Manual Defib Mode, see the

corresponding chapters in these Instructions for Use.

Overview

Defibrillation therapy is the definitive method for termination of a variety of potentially fatal

arrhythmias. The HeartStart MRx provides this therapy through the application of a brief biphasic

pulse of electricity to the cardiac muscle. This electrical energy is transferred through attached paddles

or disposable multifunction electrode pads applied to the patient’s bare chest. Internal paddles for

open-chest intrathorasic defibrillation can also be used.

In Manual Defib Mode, you must assess the ECG, decide if defibrillation or cardioversion is indicated,

select the appropriate energy setting, charge the monitor/defibrillator, and deliver the shock. The entire

defibrillation process is under your control. Voice prompts are not present. However, text messages on

the display provide relevant information throughout the process. It is important to be attentive to these

messages when displayed.

The ECG strip and Event Summary are easily annotated with event information using the Mark Event

function button. See “Marking Events” on page 237 for more information.

Monitoring alarms are available in Manual Defib Mode, however, they are turned off once an energy is

selected for defibrillation unless Sync is active. Alarms may be turned on in Manual Defib Mode by

pressing the Alarm Pause button. Alarms are also reactivated once the Therapy Knob is moved to

Monitor or Pacer or Sync is selected.

When an energy is selected, automatic NBP measurements are discontinued. If a manual NBP

measurement is requested by pressing the [Start NBP] soft key, the NBP information, including

the current schedule, is displayed in its normal position, and scheduled NBP measurements resume.

NOTE The use of Manual Defib Mode may be password protected, as defined in Configuration. See

“Password Security” on page 13.

6 Manual Defibrillation and Cardioversion Overview

Precautions for Manual Defibrillation Therapy

Defibrillating asystole can inhibit the recovery of natural pacemakers in the heart and completely

eliminate any chance of recovery. Asystole should not be routinely shocked.

Synchronized Cardioversion Therapy

The HeartStart MRx provides synchronized cardioversion therapy by delivering a brief biphasic pulse

of electricity to the cardiac muscle immediately following an R-wave detected in the ECG

measurement. The SMART Biphasic waveform utilized in the HeartStart MRx has undergone clinical

testing demonstrating its effectiveness for cardioversion of atrial fibrillation.

NOTES Successful resuscitation is dependent on many variables specific to the patient’s physiological state and

the circumstances surrounding the patient event. Failure to have a successful patient outcome is not a

reliable indicator of monitor/defibrillator performance. The presence or absence of a muscular response

to the transfer of energy during electrical therapy is not a reliable indicator of energy delivery or device

performance.

Use only approved lead sets with the HeartStart MRx. Failure to do so may introduce noise and result

in intermittent leads off messages.

Code View 6 Manual Defibrillation and Cardioversion

Code View

In Manual Defib Mode, an energy is selected and the Code View is displayed. Code View is optimized

to clearly communicate data associated with a resuscitation event. Notice the increased prominence of

the Event Timer, as well as the enlarged ECG in Wave Sectors 1 and 2 as shown in Figure 46.

Figure 46 Code View Display

For details related to using Q-CPR in Manual Mode, see “Preparing to Use Q-CPR” on page 159.

NOTE The Shock Counter displays the number of shocks delivered while in AED and Manual Defib modes.

Mark Event

10 Feb 2006 11:20

36.9

Temp

HR 180120

50 39.0

36.0

SpO2 % EtCO2

60 AwRR

mmHg rpm

Pleth

100

90 34 50

30 18 30

Start

NBP Disarm

02:42

Alarms Off

Shocks: 0

bpm

Adult Non-Paced

Selected Energy: 150 Joules

CO2

Pulse

bpm

Event Timer

(enlarged)

Shock

Status

Area

ECG (enlarged)

Heart

Rate

6 Manual Defibrillation and Cardioversion Preparing for Defibrillation

Preparing for Defibrillation

In preparation for defibrillation:

1Connect the appropriate Therapy cable.

2Apply the paddles or pads as described below.

Using Multifunction Electrode Pads

To prepare for defibrillation using multifunction electrode pads:

1If not pre-connected, connect the pads cable to the HeartStart MRx by aligning the white pointer

on the pads cable connector with the white arrow on the green Therapy port. Then push until you

hear it click into place. See Figure 47.

Figure 47 Pads/Internal Paddles Cable Connection

2Check the expiration date that appears on the pads package.

3Inspect the packaging for any damage.

4Connect the pads connector to the pads cable. See Figure 48.

Figure 48 Pads Connectors

5Apply the pads to the patient as directed on the pads packaging or according to your organization’s

protocol.

Preparing for Defibrillation 6 Manual Defibrillation and Cardioversion

Using External Paddles

To defibrillate using external paddles:

1If not pre-connected, connect the paddles cable to the HeartStart MRx by aligning the white

pointer on the paddles cable connector with the white arrow on the green Therapy port. Then

push until you hear it click into place. See Figure 49.

Figure 49 Paddles Cable Connection

2Remove the Paddle Set from the Paddle Tray by pulling the paddles straight up and out of the

paddle tray. Verify there is no debris or residue (including dried electrode gel) on the surfaces of the

paddles. Clean if necessary.

3Apply conductive matter to the paddle electrodes.

Do not distribute conductive matter by rubbing the paddle electrodes together.

4Apply paddles to the patient’s bare chest, using the anterior-anterior placement (or in accordance

with your organization’s protocol).

The sternum paddle contains a patient contact indicator (PCI). See Figure 50. If necessary, as

indicated by the appearance of either a red or orange LED on the PCI, adjust paddle pressure and

placement to optimize patient contact. Once proper contact is made, the PCI shows a green LED.

Figure 50 Patient Contact Indicator

NOTE Reasonable effort should be made to obtain a reading of at least one green LED. Due to impedance,

this may not be possible for some patients, and orange LEDs may be the best that can be achieved.

Patient Contact

Indicator (PCI)

6 Manual Defibrillation and Cardioversion Preparing for Defibrillation

Using Pediatric Paddles

The HeartStart MRx’s external paddle set comes with pediatric paddles included. The American Heart

Association recommends using pediatric paddles on children weighing < 10 Kg (larger paddles may be

used as long as contact between the paddles is avoided).

To use the pediatric paddles set:

1Depress the latch at the front of the external paddle set while pulling forward on the adult paddle

electrode.

2Store the adult paddle electrodes in the paddle tray pockets.

3To defibrillate, see “Using External Paddles” on page 75.

NOTE Impedance is the resistance between the defibrillator’s pads or paddles that the defibrillator must

overcome to deliver an effective discharge of energy. The degree of impedance differs from patient to

patient and is affected by several factors including the presence of chest hair, moisture, and lotions or

powders on the skin.

The low-energy SMART Biphasic waveform is an impedance-compensating waveform that is designed

to be effective across a wide range of patients. However, if you receive a “No Shock Delivered”

message, check that the patient’s skin has been washed and dried and that any chest hair has been

clipped. If the message persists, change the pads and/or the pads cable.

Using Internal Paddles

To defibrillate using internal paddles:

1Select the appropriate paddle electrode size.

2If using switchless internal paddles, connect the paddles to the M4740A Paddle Adapter Cable.

3Connect the paddles cable (or the paddle adapter cable) to the HeartStart MRx by aligning the

pointer on the paddles cable (or paddle adapter cable) with the white arrow on the green Therapy

port. Then push until you hear it click into place. See Figure 47.

Defibrillating (asynchronously) 6 Manual Defibrillation and Cardioversion

Defibrillating (asynchronously)

Once you have performed the necessary preparation for defibrillation, perform the following steps:

1Select Energy - To select the energy setting, rotate the Therapy Knob to the desired energy level as

shown in Figure 51. Energy choices range from 1 to 200, with 150J the recommended level for

adult patients.

Figure 51 Energy Selection

Selecting the 1-10 (1-9) energy setting displays the Select Energy menu, with a default setting of

6J. The low energy setting can be changed using the Navigation buttons to increase or decrease the

desired setting. Complete your selection by pressing the Menu Select button. Your current

energy selection is shown in the Shock Status area of the display as shown in Figure 46.

WARNING Clinicians must select an appropriate energy level for defibrillation of pediatric patients.

WARNING The HeartStart MRx has a built-in limitation of 50 Joules when using internal paddles.

WARNING Do not leave patients unattended when the HeartStart MRx is in manual defibrillation mode with pads

applied to the patient.

150

200

170

120

100

dult

AED

onitor

acer

6 Manual Defibrillation and Cardioversion Defibrillating (asynchronously)

2Charge - Press the Charge button on the front panel. If using external paddles, the charge

button on the paddles may be used instead. As the defibrillator charges, the energy selection shown

in the Shock Status area changes to show the current charge energy. A continuous, low-pitch

charging tone sounds until the desired energy level is reached, at which point you will hear a

continuous, high-pitch charge done tone.

You may increase or decrease the selected energy at any time during charging or after charging is

complete. Simply move the Therapy Knob to the desired energy level as explained above. The

defibrillator charges to the selected energy level automatically.

To disarm the defibrillator, press [Disarm]. If the Shock button has not been pressed within the

time period specified in the Time to Auto Disarm Configuration setting, the defibrillator disarms

automatically.

3Shock - Confirm that a shock is still indicated and that the defibrillator has charged to the selected

energy level. Make sure no one is touching the patient or anything connected to the patient. Call

out loudly and clearly, “Stay Clear!”

If using:

– pads or switchless internal paddles, press the flashing Shock button to deliver a shock to

the patient.

– external paddles, simultaneously press the shock buttons located on the paddles to deliver a

shock to the patient.

– switched internal paddles, press the Shock button located on the paddles to deliver a shock to

the patient.

The number of shocks delivered is displayed in the Shock Status area of the display. This number

includes any shocks administered while in AED Mode.

WARNING Defibrillation current can cause operator or bystander injury. Do not touch the patient, or equipment

connected to the patient, during defibrillation.

CAUTION Alarms are turned off when an energy is selected for asynchronous defibrillation, and the “Alarms Off”

message is displayed. Alarms remain paused until toggled on using the Alarm Pause button, the Sync

function is enabled, or the Therapy Knob is moved to Monitor or Pacer.

harge

Performing Synchronized Cardioversion 6 Manual Defibrillation and Cardioversion

Performing Synchronized Cardioversion

Synchronized Cardioversion allows you to synchronize delivery of the shock with the R-wave of the

ECG being monitored in Wave Sector 1. You may choose to perform synchronized cardioversion

through either:

• multifunction electrode pads, or

• external paddles

When using paddles, you should monitor the ECG through monitoring electrodes connected to a 3-,

5- or 10-lead ECG cable or a Philips bedside monitor. You may choose to monitor through an

alternate source when using pads, as well. Cardioversion is still delivered through either pads or

paddles.

Preparing for Synchronized Cardioversion

In preparation for synchronized cardioversion:

1Perform the tasks as described in “Preparing for Defibrillation” on page 74

2If monitoring through a 3-, 5-, or 10-lead ECG cable, plug the ECG cable into the ECG port on

the HeartStart MRx and apply monitoring electrodes to the patient. (See “ECG and Arrhythmia

Monitoring” on page 47.)

3Use the Lead Select button to select pads, paddles or a lead from attached monitoring electrodes.

The selected ECG source should have a clear signal and a large QRS complex. (See “Lead

Selection” on page 53.)

NOTE When the patient is already connected to Philips bedside monitoring equipment, an external ‘Sync’

cable plugs into the ECG Output jack of the bedside monitor and connects to the ECG port of the

HeartStart MRx. This connects the ECG signal from the monitor into the HeartStart MRx, where it is

displayed and synchronization occurs.

If you are using a SureSigns monitor and connect it to the HeartStart MRx, you will see a square

waveform in place of the QRS.

The signal from the bedside monitor is displayed as Lead II on the HeartStart MRx, even though it is

not necessarily Lead II coming from the bedside monitor.

WARNING If you use an external monitor as the ECG source, a biomedical technician MUST verify that the

external monitor and the HeartStart MRx combination will deliver a synchronized shock within 60 ms

of the peak of the R-wave. Use a 1 mV QRS complex with a QRS width of 40 ms. This performance

cannot be guaranteed with all commercially available monitors.

WARNING When monitoring through paddles only, artifact introduced by paddle movement may resemble an R-

wave and trigger a defibrillation shock.

6 Manual Defibrillation and Cardioversion Performing Synchronized Cardioversion

Delivering a Synchronized Shock

To perform synchronized cardioversion:

1With the Therapy Knob in the Monitor position, press the Sync button located beside the

Therapy Knob (see Figure 51) to activate the Sync function. A Sync message appears in the upper

right corner of Wave Sector 1.

2Confirm that the Sync marker appears with each R-wave.

3Turn the Therapy Knob to the desired energy level setting.

4Press the Charge button on the HeartStart MRx or, if using paddles, the yellow charge

button located on the handle of the paddle with the symbol. Wait until the charge has

reached the energy level selected, and you hear a continuous charge done tone.

To disarm the defibrillator, press [Disarm]. If Shock has not been pressed within the time period

specified in the Time to Auto Disarm Configuration Choice, the defibrillator disarms

automatically.

If desired, you may increase or decrease the selected energy level after pressing the Charge button

by moving the Therapy Knob to the desired setting. The defibrillator charges to the modified

energy level automatically. Wait until the current charge reaches the selected energy level before

proceeding.

5Make sure no one is touching the patient or anything connected to the patient. Call out clearly and

loudly, “Stay Clear!”.

6Press and hold the Shock button on the HeartStart MRx or, if you are using external

paddles, press and hold the orange buttons on both paddles. The shock will be delivered when the

next R-wave is detected.

NOTE It is important to continue to hold the Shock button (or the paddle shock buttons) until the

shock is delivered. The defibrillator shocks with the next detected R-wave.

NOTE Should an ECG or pads INOP (such as Leads Off) occur while performing synchronized

cardioversion, the HeartStart MRx will not charge, or if charged, will disarm automatically.

WARNING Defibrillation current can cause operator or bystander injury. Do not touch the patient or equipment

connected to the patient during defibrillation.

harge

Troubleshooting 6 Manual Defibrillation and Cardioversion

Delivering Additional Synchronized Shocks

If additional synchronized shocks are indicated, perform the following steps:

1Make sure the Sync function is still enabled, as indicated by the presence of the Sync message in

the upper right corner of the Wave Sector 1.

2Repeat Steps 4-6 under “Delivering a Synchronized Shock”.

The Sync function of the HeartStart MRx can be configured to either be enabled or disabled after each

shock is delivered. If configured to remain enabled and the Therapy Knob is moved to either Monitor

or Pacer, the Sync function is still enabled. However, should the Therapy Knob be moved to either the

Off or AED positions, the Sync function is disabled.

Disabling the Sync Function

To turn off the Sync function of the HeartStart MRx, press the Sync button.

Using Q-CPR in Manual Mode

If your HeartStart MRx has the Q-CPR option, refer to “Q-CPR Feedback on the HeartStart MRx”

on page 167.

Troubleshooting

If your HeartStart MRx monitor/defibrillator does not operate as expected during defibrillation, see

“Troubleshooting” on page 297.

7Noninvasive Pacing

This chapter explains the noninvasive transcutaneous pacing option available with the HeartStart MRx

and describes how to perform pacing.

Overview

Noninvasive transcutaneous pacing therapy is used to deliver pace pulses to the heart. Pace pulses are

delivered through multifunction electrode pads that are applied to the patient’s bare chest.

While in Pacer Mode, the ECG strip and Event Summary are easily annotated with event information

using the Mark Event function button. See “Marking Events” on page 237 for more information.

NOTES Use only approved lead sets when pacing with the HeartStart MRx. Failure to do so may introduce

noise and result in intermittent leads off messages.

For treatment of patients with implantable devices such as permanent pacemakers or cardioverter-

defibrillators, consult a physician and the instructions for use provided by the device’s manufacturer.

Waveforms, ECG monitoring, measurements, and most alarms remain active and retain their settings

when you transition from Monitor or Manual Defib Mode to Pacer Mode. However, the waveform

displayed in Wave Sector 4 is replaced by the pacing status bar.

The use of Pacer Mode may be password protected as defined in Configuration. See “Password

Security” on page 13.

7 Noninvasive Pacing Alarms

Alarms

Arrhythmia alarms for Pacer Not Pacing and Pacer Not Capture are associated with non-

transcutaneous pacing (such as internal, transvenous or epicardial pacing), therefore, these alarms are

off when the HeartStart MRx is in Pacer Mode. All other red and yellow alarms are active if enabled,

and their limits may be changed while in Pacer Mode. Refer to the specific chapter for each

measurement for information on red and yellow alarms and changing alarm limits.

While pacing, should a Pads Off condition occur or the pads cable get disconnected, a latching, red

alarm is generated and pacing is stopped. The message, Pacing Stopped. [Pads Off] [Pads Cable Off] is

displayed in the top line of the pacing status bar. Once the condition is corrected, resume pacing by

pressing the [Resume Pacing] soft key.

While pacing, if the pacer output drops below the selected setting (sometimes caused by poor pads

contact as a result of gas bubbles underneath the pads) by 20 percent or 10 mA (whichever is greater), a

Pacer Output Low yellow alarm is displayed on the top line of the Pacer Status block. The alarm

remains on the display until pacing is stopped, the condition clears or the therapy knob is moved off

the Pacer position. A Pacer Output Low entry is logged in the Event Summary.

While pacing in demand mode, should the ECG source for Wave Sector 1 become invalid, e.g. a Leads

Off condition or the ECG cable is disconnected, a latching, red alarm is generated and pacing is

stopped. The message, Pacing Stopped. Leads Off. is displayed in the top line of the pacing status bar.

Once the condition is corrected, resume pacing by pressing the [Resume Pacing] soft key.

When pacing in demand mode using a 3-lead ECG set, if the lead in Wave Sector 1 is changed, a

latching, red alarm is generated. The message, Pacing Stopped. Leads Off. is displayed in the top line of

the pacing status bar. Resume pacing by pressing the [Resume Pacing] soft key.

NOTE The Pacing Stopped red alarm cannot be disabled.

WARNING Heart rate displays and alarms function during pacing, but they can be unreliable. Observe the patient

closely while pacing. Do not rely on the indicated heart rate or heart rate alarms as a measure of the

patient’s perfusion status.

NOTE When pacing is stopped due to a power interruption, a red Pacing Stopped. Power Interrupted alert will

appear on the HeartStart MRx display when power is eventually restored.

Pacing View 7 Noninvasive Pacing

Pacing View

Pacing View appears when the Therapy Knob is set to the Pacer position. Figure 52 shows information

displayed in Pacing View.

Figure 52 Pacing View

Pacing View includes a status block which appears in Wave Sector 4 of the display. The first line of the

status block communicates whether pacing is active or paused. If pacing is powered by batteries, this is

indicated here as well, if configured. The second line of the status block identifies the Pacer Mode

(demand or fixed), pacing rate (ppm), and pacing output (mA).

Soft keys are available for setting pacing status ([Start Pacing], [Pause Pacing],

[Resume Pacing]) and adjusting [Pacer Rate], [Pacer Output].

NOTE If pacing is interrupted for any reason, the [Resume Pacing] soft key must be pressed to

continue pacing.

Mark Event

Feb 2

006

11:2

10 Feb 2006 11:20

Jones, Samuel

Adult

02:02:42

36.9 70

120/80

(95)

Pulse NBP

mmHg q120

10:40

bpm

Temp

SYS

160

120

50 39.0

36.0

SpO2 % EtCO2

100

AwRR

mmHg rpm

Pleth

100

90 38 50

30 18 30

Start

NBP Pause

Pacing Pacer

Rate Pacer

Output

PACING ON BATTERIES

Demand Mode 70 ppm 50 mA

Pacing

Status

Area

Pacing

Markers

Pacing Soft Keys

7 Noninvasive Pacing Demand Mode Versus Fixed Mode

A white pacing marker appears on the ECG waveform in Wave Sector 1 each time a pacer pulse is

delivered to the patient. If pacing in demand mode, white R-wave markers also appear on the ECG

until capture occurs.

NOTE R-wave markers do not appear on paced beats.

Demand Mode Versus Fixed Mode

The HeartStart MRx can deliver paced pulses in either demand or fixed mode.

•In demand mode, the pacer only delivers paced pulses when the patient’s heart rate is lower than the

selected pacing rate.

•In fixed mode, the pacer delivers paced pulses at the selected rate.

WARNING Use demand mode pacing whenever possible. Use fixed mode pacing when motion artifact or other

ECG noise makes R-wave detection unreliable or when monitoring electrodes are not available.

The HeartStart MRx requires a 3-, 5-, or 10-lead ECG cable and monitoring electrodes as the source of

the ECG during demand pacing. Pace pulses are delivered through the multifunction electrode pads.

However, the pads cannot be used to monitor the ECG and deliver pace pulses simultaneously.

NOTE The ECG derived from pads does not need to be displayed in a wave sector in order to deliver pacing

therapy.

NOTE When using demand mode, pads are not an available choice for display in Wave Sector 1, through

either the Lead Select button or the Displayed Waves menu.

Preparing for Pacing 7 Noninvasive Pacing

Preparing for Pacing

To prepare f o r paci ng:

1If not pre-connected, connect the pads cable to the HeartStart MRx by aligning the white pointer

on the pads cable with the white arrow on the green Therapy port. Then push until you hear it

click into place. See Figure 53.

Figure 53 Pads Cable Connection

2Make sure the multifunction electrode pads packaging is intact and within the expiration date

shown.

3Connect the pads connector to the pads cable. See Figure 54.

Figure 54 Pads Connectors

4Apply the pads to the patient as directed on the pads packaging or according to your organization’s

protocol. Prepare the patient’s skin prior to applying the pads. Skin is a poor conductor of

electricity, so skin preparation is important in achieving good contact.

– If necessary, clip hair at the electrode sites (or shave sites if needed).

– Clean and abrade the skin at the electrode site.

– Dry the electrode sites briskly to increase capillary blood flow in the tissues and to remove oil

and skin cells.

7 Noninvasive Pacing Demand Mode Pacing

5If pacing in demand mode, apply monitoring electrodes (see “Electrode Placement” on page 51),

and connect the ECG cable to the HeartStart MRx (see “Connecting the ECG Cable” on

page 35).

NOTE If pacing for long periods of time, new monitoring electrodes and multifunction electrode pads should

be applied periodically. Refer to the manufacturer’s documentation for replacement recommendations.

NOTE The signal from a TENS unit can cause ECG artifact which may impact pacing.

Demand Mode Pacing

To pace in demand mode:

1Turn the Therapy Knob to the Pacer position.

The message, Pacing Paused, appears in the status block and indicates that the pacing function is

enabled, however, pace pulses are not being delivered. Pacing is enabled in demand mode, with the

configured lead displayed in Wave Sector 1. If the configured lead is set to Pads, Lead II or the first

available monitoring lead, that lead is displayed.

2Press the Lead Select button to select the best lead with an easily detectable R-wave. (See

“Lead Selection” on page 53).

NOTE If you are using anterior-anterior pads placement while pacing and are experiencing difficulty with

Lead II, select another lead.

3Verify that white R-wave markers appear above or on the ECG waveform. A single marker should

be associated with each R-wave. If the R-wave markers do not appear or do not coincide with the

R-wave, select another lead.

4Press [Pacer Rate] and use the Navigation and Menu Select buttons to select the desired

number of pace pulses per minute. The initial rate is configurable.

5If needed, adjust the initial pacer output. To do this, press [Pacer Output] and use the

Navigation and Menu Select buttons to select the desired output. The initial output is

configurable.

6Press [Start Pacing]. The message, Pacing, appears.

WARNING Use care when handling the multifunction electrode pads on the patient to avoid shock hazard during

pacing.

7Verify that white pacing markers appear on the ECG waveform.

8Press [Pacer Output]. Then use the Navigation and Menu Select buttons to:

a. increase the output until cardiac capture occurs. Capture is indicated by the appearance of a

QRS complex after each pacing marker.

b. decrease the output to the lowest level that still maintains capture.

9Verify the presence of a peripheral pulse.

Fixed Mode Pacing 7 Noninvasive Pacing

NOTE Spontaneous beats may be present which are not associated with the delivery of pace pulses.

Additionally, if the patient’s heart rate is above the pacer rate, pace pulses are not delivered and,

therefore, pacing markers do not appear.

To stop delivery of pace pulses, press [Pause Pacing]. Once paused, press [Resume

Pacing] to resume delivery of pace pulses.

You may also stop delivery of pace pulses by moving the Therapy Knob off the Pacer position.

WARNING When Pacing in demand mode, the ECG cable must be directly connected from the patient to the

HeartStart MRx.

WARNING If you are using the pacing function with battery power and the Low Battery Alarm is annunciated,

connect the device to external power or insert a fully charged battery.

NOTE Routinely assess the patient’s cardiac output by assessing peripheral pulses.

NOTE Pacing will not start if there is a problem with the multifunction electrode pads connection or patient

contact. Pace pulses will not be delivered if there is a problem with the ECG monitoring electrodes

connections. If either situation occurs, a system message is displayed to alert you that a lead is

disconnected or that the pads have a poor connection.

Fixed Mode Pacing

To pace in fixed mode:

1Turn the Therapy Knob to the Pacer position.

The message, Pacing Paused, appears and indicates that the pacing function is enabled, however,

pace pulses are not being delivered. Pacing is enabled in demand mode, with the configured lead

displayed in Wave Sector 1. If the configured lead is set to Pads, Lead II or the first available

monitoring lead is displayed.

2Change the pacer mode to fixed mode, using the menu selections shown below in Figure 55

Figure 55 Changing Pacer Modes

Main Menu

Pacer Mode

Start Data Transmit

Volume

Displayed Wave

Printed Waves

Measurements/Alarms

Patient Info

Trends

Other

High Contrast On

Exit

Pacer Mode

Demand

Fixed

7 Noninvasive Pacing Fixed Mode Pacing

3Use the Lead Select button to select the desired lead for viewing.

NOTE If you want to see the ECG waveform and related parameters while pacing, you must have electrodes

on the patient with pads. Using pads only will give you an incorrect heart rate and inappropriate

alarms.

4Press [Pacer Rate] and use the Navigation and Menu Select buttons to select the desired

number of paced pulses per minute. The initial rate is configurable.

5If needed, adjust the initial pacer output. To do this, press [Pacer Output] and use the

Navigation and Menu Select buttons to select the desired output. The initial output is

configurable.

6Press [Start Pacing]. The message, Pacing, appears.

WARNING Use care when handling the multifunction electrode pads on the patient to avoid shock hazard during

pacing.

7Verify that white pacing markers appear on the ECG waveform (if ECG electrodes are in place).

8Press [Pacer Output]. Then use the Navigation and Menu Select buttons to:

a. increase the output until cardiac capture occurs. Capture is indicated by the appearance of a

QRS complex after each pace pulse marker.

b. decrease the output to the lowest level that still maintains capture.

9Verify the presence of a peripheral pulse.

10 To p a us e o r st op p ac i n g :

– Press [Pause Pacing].

– A prompt message will ask you to confirm your action.

Figure 56 Pause Pacing Message

– Confirm your action. Use the Navigation buttons to highlight Yes and press the Menu Select

button.

– Move the Therapy Knob off the Pacer position.

Pause Pacing?

Yes

Defibrillating During Pacing 7 Noninvasive Pacing

Defibrillating During Pacing

Should it be necessary to defibrillate the patient during pacing, refer to the procedure for defibrillating

in Manual Defib Mode in Chapter 6, or AED Mode in Chapter 5. Once the Therapy Knob is moved

from the Pacer position to a Manual Defib Mode energy setting or AED, pacing is stopped.

To resume pacing after defibrillation, repeat the pacing procedure, as described in “Demand Mode

Pacing” on page 88 or “Fixed Mode Pacing” on page 89. When pacing is resumed, pacing settings

selected prior to defibrillation (mode, rate, and output) are retained. Be sure to confirm that cardiac

capture has been maintained.

CAUTION Pacing must be turned off before defibrillating with a second defibrillator. Failure to do so could

damage the HeartStart MRx.

Troubleshooting

If your HeartStart MRx does not operate as expected during pacing, see Chapter 22,

“Troubleshooting” on page 297.

8Pulse Oximetry

Pulse Oximetry (SpO2) monitoring is one of the tools available to assist in assessing a patient’s cardiac

and respiratory systems. This chapter explains how pulse oximetry works and describes how to use the

HeartStart MRx to monitor SpO2.

Overview

Pulse oximetry is a noninvasive method of continuously measuring functional oxygen saturation

(SpO2) in arterial blood. The resultant SpO2 reading indicates the percentage of hemoglobin

molecules in the arterial blood which are saturated with oxygen.

WARNING Do not rely solely on SpO2 readings; assess the patient at all times. Inaccurate measurements can be

caused by:

• Incorrect sensor application or use.

• Significant levels of dysfunctional hemoglobins (such as carboxyhemoglobin or methemoglobin).

• Injected dyes such as methylene blue, or intravascular dyshemoglobins such as methemoglobin or

carboxyhemoglobin.

• Exposure to excessive illumination such as surgical lamps (especially those with a xenon light

source), bilirubin lamps, fluorescent lights, infrared heating lamps, or direct sunlight.

The HeartStart MRx allows you to monitor SpO2 while in Monitor, Manual Defib, and Pacer modes.

When using the Q-CPR option, SpO2 monitoring functionality is not available.

NOTE For more information on SpO2, refer to the Application Note, Philips Pulse Oximetry.

8Pulse Oximetry Understanding Pulse Oximetry

Understanding Pulse Oximetry

A pulse oximetry sensor sends light through patient tissue to a receiver on the other side of the sensor.

As Figure 57 shows, light emitting diodes transmit red and infrared light through peripheral areas of

the body, such as a finger.

Figure 57 Pulse Oximetry Sensor

A photodetector positioned opposite the light emitting diodes compares light absorption before and

after pulsation. The amount of light getting through reflects the blood flow in the arterioles. This

measurement of light absorption during pulsation is translated into an oxygen saturation percentage

and an SpO2 value is displayed.

For accurate SpO2 measurements, the following conditions must apply:

• The patient must have perfusion in that extremity.

• The light emitter and the photodetector must be directly opposite each other.

• All of the light from the emitter must pass through the patient’s tissue.

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

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

Light

Emitting

Diodes

Photodetector

Selecting a Sensor 8Pulse Oximetry

Selecting a Sensor

See “SpO2 Sensors and Cables” on page 293 for a list of the SpO2 sensors that may be used with the

HeartStart MRx.

CAUTION • Do not use disposable sensors in high humidity environments or in the presence of fluids which may

contaminate sensor and electrical connections, causing unreliable or intermittent measurements.

• Do not use disposable sensors on patients who have allergic reactions to the adhesive.

• Do not use the ear transducer on patients with small ear lobes, as incorrect measurements may

result.

The most important factor when selecting a sensor is the position of the light emitting diodes in

relation to the photodetector. When a sensor is applied, the diodes and the photodetector must be

opposite each other. Sensors are designed for patients with a specific weight range and for specific sites.

Be sure to:

• Select a sensor appropriate for the patient’s weight.

• Select a sensor site with adequate perfusion. Improve perfusion at the site by rubbing or warming

the site.

• Avoid application to sites with edematous tissue.

Reusable Sensors may be reused on different patients after they have been cleaned and disinfected (see

the manufacturer’s instructions supplied with the sensor).

Disposable Sensors should be used only once and then discarded. They may be relocated to another

sensor site on the patient if the first location does not give the desired results. Disposable sensors must

not be reused on different patients.

NOTE A 2-meter SpO2 extension cable (M1941A) is available for use with the HeartStart MRx.

8Pulse Oximetry Applying the Sensor

Applying the Sensor

Follow the manufacturer’s directions for applying and using the sensor, making sure to observe any

warnings or cautions. For the best results:

• Make sure the sensor is dry.

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

• Make sure the transducer is not too tight. Too much pressure can cause venous pulsation or can

impede the blood flow, resulting in low readings.

• Keep power cables away from the sensor cable and connection.

• Avoid placing the sensor in an environment with bright lights. If necessary, cover the sensor with

opaque material.

• Avoid placing the sensor on an extremity with an arterial catheter, blood pressure cuff, or

intravenous infusion line.

WARNING • Failure to apply the sensor properly may reduce the accuracy of the SpO2 measurement.

• Inspect the sensor application site at least every two hours for changes in skin quality, correct optical

alignment, and proper sensor application. If skin quality is compromised, change the sensor site.

Change the application site at least every four hours. More frequent checking may be required due

to an individual patient’s condition.

•Using an SpO

2 sensor during MR imaging can cause severe burns. Minimize this risk by positioning

the cable so that no inductive loops are formed. If the sensor does not appear to be operating

properly, remove it immediately from the patient.

CAUTION Do not use more than one extension cable (M1941A).

Position the sensor cable and connector away from power cables to avoid electrical interference.

Monitoring SpO28Pulse Oximetry

Monitoring SpO2

To moni t or Sp O 2:

1Connect the appropriate sensor cable to the to the HeartStart MRx as described in “Connecting

the SpO2 Cable” on page 36.

2Apply the sensor to the patient.

3If the HeartStart MRx is not turned on, turn the Therapy Knob to Monitor.

4Check that the patient category is appropriate for the patient. If necessary, use the Patient Info

menu to access Patient Category and select the correct patient category setting (adult/pediatric).

This is used to optimize the calculation of the SpO2 and pulse values.

A -?- is displayed in Parameter Block 2 while the oxygen saturation is initially measured and a value is

calculated. In a few seconds a value appears, replacing the -?-. As the patient’s oxygen saturation

changes, the SpO2 value is updated continuously. See Figure 58.

If SpO2 alarms are turned on, alarm limits are displayed to the right of the SpO2 value. If alarms are

turned off, the symbol is displayed instead of the alarm limits. SpO2 alarms are on by default. See

“SpO2 Alarms” on page 99.

The patient’s pulse rate as derived from pulse oximetry, is displayed in Parameter Block 1 (see Figure

60). If pulse rate alarms are turned on, alarm limits are displayed to the right of the pulse rate value. If

alarms are turned off, the symbol is displayed instead of the alarm limits. Pulse alarms are off by

default. See “Pulse Rate Alarms” on page 100.

Figure 58 SpO2 Parameter Block 2

100

18/77

(95) 24/10

(15)

SYS

160

0100

8Pulse Oximetry Monitoring SpO2

Pleth Wave

When the sensor is connected to the HeartStart MRx, the pleth wave is displayed in the configured

Wave Sector or the first available empty Wave Sector. It is drawn at an approximate speed of 25 mm/

second. Grid lines are displayed to indicate signal quality.When signal quality is good, the pleth wave is

auto scaled to the grid lines. When signal quality is poor, the size of the pleth wave is proportionately

decreased.

Figure 59 Pleth Wave Size

When the Therapy Knob is moved to an energy setting, the SpO2 values and pleth wave continue to be

displayed as long as they are not located in Wave Sector 2 or you’re in Q-CPR View. When the

Therapy Knob is moved to Pacer, the pacing status bar appears in Wave Sector 4, replacing the

waveform in that sector. If the pleth wave was removed, the SpO2 and Pulse values and alarm settings

are retained. If the Therapy Knob is moved to AED, SpO2 and pulse related information is no longer

monitored.

SpO2 Alarms 8Pulse Oximetry

SpO2 Alarms

Alarms are annunciated if measurements fall outside the configured limits for high or low SpO2, or if

the measurement falls below the configured SpO2 Desat Limit. SpO2 alarms, except Desat, are all

categorized as “non-latching” alarms, meaning they are automatically removed when their alarm

condition no longer exists. Desat alarms are latching, meaning they remain present even if the alarm

condition no longer exists. Table 9 lists SpO2 alarms.

Table 9 SpO2 Red/Yellow Physiological Alarms

SpO2 alarms are on unless you turn SpO2 alarms off or alarms for the entire device are off. Once

disabled, alarms remain off until they are turned on.

WARNING Turning off alarms prevents all alarms associated with the SpO2 measurement from being annunciated.

If an alarm condition occurs, NO alarm indication will be given.

Changing the SpO2 Alarm Limits

To change the SpO2 high and low alarm limits, perform the following steps:

1Press the Menu Select button.

2Using the Navigation buttons, select the Measurements/Alarms menu and press the Menu Select

button.

3Select SpO2 and press the Menu Select button.

4Select SpO2 Limits and press the Menu Select button.

5Using the Navigation buttons, select the new high limit value and press the Menu Select button.

6Select the new low limit value and press the Menu Select button.

Alarm Message Type of A larm Indicator Condition

Desat Red Red alarm message;

alarm tone

The SpO2 value has fallen below the

desat low limit.

SpO2 High Yellow Yellow alarm message;

alarm tone

The SpO2 value exceeds the high alarm

limit.

SpO2 Low Yellow Yellow alarm message;

alarm tone

The SpO2 has dropped below the low

alarm limit.

8Pulse Oximetry Pulse Rate Alarms

100

SpO2 Desat Alarm

The HeartStart MRx also provides an alarm for SpO2 Desat Limit. The SpO2 Desat alarm provides an

additional limit setting below the low limit setting to notify you of potentially life threatening decreases

in oxygen saturation. This additional limit setting is preset through the Configuration menu.

NOTE If the SpO2 Low Limit alarm value is set below the configured SpO2 Desat Limit, the SpO2 Desat

Limit value is automatically adjusted to the SpO2 Low Limit alarm value. Should the SpO2 reading fall

below this limit, the SpO2 Desat Limit alarm is announced.

Enabling/Disabling the SpO2 Alarms

To enab le the Sp O 2 Alarms, perform the following steps:

1Press the Menu Select button.

2Using the Navigation buttons, select the Measurements/Alarms menu and press the Menu Select

button.

3Select SpO2 and press the Menu Select button.

4Select Alarms On/Off and press the Menu Select button.

NOTE While an NBP measurement is in progress, SpO2 INOP messages are suppressed for up to 60 seconds.

Pulse Rate Alarms

Pulse Rate alarms are off unless you enable them during use. The configured alarm limits may be

changed during use. Alarms are annunciated if measurements fall outside the configured limits for high

and low pulse rate. Pulse Rate alarms are all categorized as “non-latching” alarms, meaning they are

automatically removed when their alarm condition no longer exists. Table 10 details Pulse Rate alarms.

Table 10 Pulse Rate Physiological Alarms

Alarm Message Type of A larm Indicator Condition

Pulse High Yellow Yellow alarm message;

alarm tone

Pulse value exceeds the high alarm limit.

Pulse Low Yellow Yellow alarm message;

alarm tone

Pulse value has fallen below the low

alarm limit.

Disabling the SpO2 Monitoring Function 8Pulse Oximetry

101

Enabling/Disabling the Pulse Rate Alarms

To enable/disable the Pulse Rate Alarms, perform the following steps:

1Press the Menu Select button.

2Using the Navigation buttons, select the Measurements/Alarms menu and press the Menu Select

button.

3Select Pulse and press the Menu Select button.

4Select Alarms On/Off and press the Menu Select button.

Changing the Pulse Rate Alarm Limits

To change the Pulse Rate Alarm Limits, perform the following steps:

1Press the Menu Select button.

2Using the Navigation buttons, select the Measurements/Alarms menu and press the Menu Select

button.

3Select Pulse and press the Menu Select button.

4Select Pulse Limits and press the Menu Select button.

5Using the Navigation buttons, select the new high limit value and press the Menu Select button.

6Select the new low limit value and press the Menu Select button.

Disabling the SpO2 Monitoring Function

To disable the SpO2 monitoring function, disconnect the sensor cable from the SpO2 port. The

message SpO2 Unplugged. Turn off SpO2? appears. Select Yes and press the Menu Select button.

Should the sensor cable be disconnected accidentally, the message SpO2 Unplugged. Turn off SpO2?

appears to notify you of the disconnection. Select No and press the Menu Select button. Secure the

connection. The SpO2 monitoring function is once again enabled.

8Pulse Oximetry Caring for Sensors

102

Caring for Sensors

Refer to the manufacturer’s instructions for care and cleaning of sensors. To get the best results from

your reusable SpO2 sensors, always handle the sensor and cable with care and protect them from sharp

objects. The sensor sleeve houses a sensitive electronic device that can be damaged. Harsh treatment of

sensors will drastically reduce their lifetime.

WARNING Do not use a damaged sensor or one with exposed electrical circuits.

Troubleshooting

If your HeartStart MRx does not operate as expected during SpO2 Monitoring, see Chapter 22,

“Troubleshooting” on page 297.

103

9Noninvasive Blood Pressure

This chapter describes how to monitor noninvasive blood pressure (NBP) with the HeartStart MRx.

Overview

Your HeartStart MRx measures blood pressure for both adult and pediatric patients using the

oscillometric method. Systolic, diastolic, and mean measurements are provided, and alarms are

available to alert you to changes in the patient’s condition. NBP measurements may be taken while in

Monitor, Pacer, or Manual Defib modes. NBP measurements can be taken automatically on a schedule

or manually on demand.

While an NBP measurement is in progress, the current cuff pressure is displayed in Parameter Block 1.

Once the measurement is complete, the values for systolic, diastolic, and mean pressure are displayed,

along with the measurement schedule (manual or automatic intervals) and a time stamp (see Figure

60). If NBP alarms are enabled, alarm limits appear next to the NBP value and the alarm source

(systolic, diastolic, or mean) is displayed above the NBP alarm limits. If alarms are off, the alarms off

symbol replaces the limits.

Figure 60 NBP / Parameter Block 1

For more information on monitoring NBP, refer to the Application Note, About Noninvasive Blood

Pressure.

WARNING Do not perform NBP monitoring on patients whose upper arm circumference is less than 13 cm.

Doing so may result in inaccurate measurements.

36.9 80 120/80

(95)

Pulse NBP

mmHg q120

10:40

bpm

Temp

SYS

160

bpm

120

50 39.0

36.0

9 Noninvasive Blood Pressure Preparing to Measure NBP

104

The first time an NBP measurement is taken, the cuff’s initial inflation pressure is 160 mmHg (adult)

or 120 mmHg (pediatric). If the measurement is successful, the next inflation pressure is 35-40 mmHg

above the systolic measurement, with a minimum inflation pressure of 120 mmHg. If the patient’s

systolic pressure measurement is higher than the inflation pressure, the cuff inflation pressure is

automatically increased by 35-40 mmHg and another measurement is attempted. The maximum cuff

inflation pressure is 280 mmHg, while the maximum systolic value is 260 mmHg.

WARNING Initial cuff inflation pressure is based on the configured patient type, adult or pediatric. If necessary,

select the correct patient type during use by changing the Patient Category selection through the

Patient Info menu.

Preparing to Measure NBP

To prepare for NBP measurement:

1Select the appropriately sized cuff for the patient. The cuff width should be either 40% of the limb

circumference or 2/3 of the upper arm length. The inflatable part of the cuff should be long

enough to encircle 50%-80% of the limb. The wrong cuff size may give false and misleading

results. If you do not have the correct cuff size, use a larger one to minimize error.

2Attach the cuff to the NBP tubing, making sure that air can pass through the tubing and that the

tubing is not squeezed or kinked (see Figure 61).

Figure 61 Connecting the NBP Cuff/Tubing

3Insert the NBP tubing into the NBP port as described in “Connecting the NBP Interconnect

Tub i n g” o n pa ge 37 .

Preparing to Measure NBP 9 Noninvasive Blood Pressure

105

4Apply the blood pressure cuff to the patient’s arm or leg as follows:

a. Ensure that the cuff is completely deflated.

b. The cuff should not be placed on the same extremity as an SpO2 sensor. Wrap the cuff around

the arm, making sure that the artery marker is aligned over the brachial artery. Ensure that the

cuff is not wrapped too tightly around the limb. Excessive tightness may cause discoloration and

eventual ischemia of the extremities. Also ensure that the NBP tubing from the defibrillator to

the cuff is not compressed, crimped, or damaged.

c. Check that the edge of the cuff falls within the range identified by the <---> markings. If it does

not, use a larger or smaller cuff that fits better.

5Place the limb used for taking the measurement at the same level as the patient’s heart.

WARNING • Do not perform noninvasive blood pressure measurements on patients with sickle-cell disease or any

condition where skin damage has occurred or is expected.

• Do not use in a hyperbaric chamber.

• Use clinical judgement to decide whether or not to perform automatic blood pressure measurements

on patients with severe blood clotting disorders, because of the risk of hematoma in the limb

wearing the cuff.

• Do not apply the cuff to a limb that has an intravenous infusion or arterial catheter in place. This

could cause tissue damage around the catheter when the infusion is slowed or blocked during cuff

inflation.

• Use only approved cuffs and tubing in order to prevent inaccurate data, injury, or damage. All

specified cuffs are protected against the effects of the discharge of a defibrillator.

• Prolonged series of noninvasive blood pressure measurements in automatic mode may be associated

with purpura, ischemia, and neuropathy in the limb wearing the cuff. When monitoring a patient,

examine the extremities of the limb frequently for normal color, warmth, and sensitivity. If any

abnormality is observed, stop the blood pressure measurements immediately.

• Blood pressure readings may be affected by the position of the subject, his/her physiologic

condition, the presence of arrhythmia, and other factors.

• To obtain accurate blood pressure readings, the cuff must be the correct size and also be correctly

fitted to the patient. Incorrect size or incorrect fitting may result in incorrect readings.

CAUTION • Do not compress or restrict pressure tubes during an NBP measurement.

• If a spill occurs and liquid appears to be inside the tubing, contact your service personnel.

NOTE When using the HeartStart MRx aboard aircraft, NBP measurements should only be taken while on

the ground or once cruising altitude is reached. Measurements taken during ascent or descent may not

be accurate.

9 Noninvasive Blood Pressure Measuring NBP

106

Measuring NBP

To measure NBP, press the [Start NBP] soft key. The cuff pressure is displayed as the cuff inflates

and deflates. When the measurement is complete, the NBP values are displayed. Additional

measurements are taken according to the configured NBP schedule. If the schedule is configured to:

Manual - There is no schedule for additional measurements. One measurement is taken each time

you press [Start NBP]. Take additional measurements by pressing [Start NBP].

Automatic - The measurement is repeated at the configured interval of 1, 2.5, 5, 10, 15, 30, 60, or

120 minutes from the time you press the [Start NBP] soft key. Additional manual measurements

may be taken without affecting the automatic measurement schedule, by pressing [Start NBP].

The configured NBP schedule may be changed during use through the Measurements/Alarms menu.

If the automatic measurement schedule is changed, the new time interval is applied to the start time of

the last measurement. If the new time interval is less than or the same as the time since the last

measurement, a measurement begins immediately.

NOTE You may perform a manual NBP measurement at any time, even when an automatic schedule is set.

Simply press the [Start NBP] soft key. To stop an NBP reading in progress, press the [Stop

NBP] soft key.

Changing the NBP Schedule

To change the NBP schedule and/or the interval of automatic measurements for the current patient:

1Press the Menu Select button.

2Using the Navigation buttons, select the Measurements/Alarms menu and press the Menu Select

button.

3Select NBP and press the Menu Select button.

4Select NBP Schedule and press the Menu Select button.

5Using the Navigation buttons, select the desired interval and press the Menu Select button.

NOTE Interval choices are presented in the format “qx”, indicating measurements will be taken every “x”

minutes from the time you first press [Start NBP].

NOTE If no subsequent measurements are taken, NBP values will removed from the display after 60 minutes

but can still be obtained through Vital Signs Trending.

Alarms 9 Noninvasive Blood Pressure

107

Alarms

An NBP alarm is annunciated when a measurement for the configured source (systolic, diastolic, or

mean) falls outside the configured high or low limits. NBP alarms are all categorized as “non-latching”

alarms, meaning they are automatically removed when their alarm condition no longer exists. Both the

source of the alarm and the limits may be changed during use, for the current patient incident. NBP

alarms are on unless you disable them. Once disabled, alarms remain off until enabled. Table 11 lists

NBP alarms.

Table 11 NBP Red/Yellow Physiological Alarms

WARNING Turning off alarms prevents all alarms associated with the NBP measurement from being annunciated.

If an alarm condition occurs, NO alarm indication will be given.

Changing NBP Alarms

To change the NBP alarm source and/or limits for the current patient incident:

1Press the Menu Select button.

2Using the Navigation buttons, select the Measurements/Alarms menu and press the Menu Select

button.

3Select NBP and press the Menu Select button.

4Select NBP Limits and press the Menu Select button.

5Select the desired source for the alarm, Systolic, Diastolic, or Mean, and press the Menu Select

button.

6Using the Navigation buttons, increase or decrease the high limit value and press the Menu Select

button.

7Set the new low limit value and press the Menu Select button.

Alarm Message Type of A larm Indicator Condition

NBPs High Yellow Yellow alarm message;

alarm tone

The NBP systolic value exceeds the high

alarm limit.

NBPd High Yellow Yellow alarm message;

alarm tone

The NBP diastolic value exceeds the

high alarm limit.

NBPm High Yellow Yellow alarm message;

alarm tone

The NBP mean value exceeds the high

alarm limit.

NBPs Low Yellow Yellow alarm message;

alarm tone

The NBP systolic value has fallen below

the low alarm limit.

NBPd Low Yellow Yellow alarm message;

alarm tone

The NBP diastolic value has fallen below

the low alarm limit.

NBPm Low Yellow Yellow alarm message;

alarm tone

The NBP mean value has fallen below the

low alarm limit.

9 Noninvasive Blood Pressure Troubleshooting

108

Enabling/Disabling NBP Alarms

To enable/disable NBP Alarms:

1Press the Menu Select button.

2Using the Navigation buttons, select the Measurements/Alarms menu and press the Menu Select

button.

3Select NBP and press the Menu Select button.

4Select Alarms On/Off and press the Menu Select button.

Troubleshooting

If your HeartStart MRx does not operate as expected during NBP Monitoring, see Chapter 22,

“Troubleshooting” on page 297.

109

10Monitoring Carbon Dioxide

This chapter describes how to monitor carbon dioxide (CO2) and measure end-tidal carbon dioxide

(EtCO2) and Airway Respiration Rate (AwRR) with the HeartStart MRx using the Microstream®

(sidestream) method. CO2 Monitoring is available in Monitor, Pacer, and Manual Defib modes.

Overview

The carbon dioxide monitoring function of the HeartStart MRx, together with the appropriate

FilterLine® and, if necessary, airway adapter, measures the partial pressure of carbon dioxide in a

sample of the patient’s exhaled breath aspirated from the breathing circuit. The HeartStart MRx may

be used to monitor carbon dioxide in both intubated and non-intubated patients.

The partial pressure of carbon dioxide is derived by multiplying the measured carbon dioxide

concentration with the ambient pressure. From the partial pressure measurement, the end-tidal carbon

dioxide (EtCO2) is derived. EtCO2 is the peak CO2 value measured during expiration. It is used to

monitor the patient’s respiratory status. The EtCO2 measurement uses a technique based on the

absorption of infrared radiation by some gases. It indicates the change in:

• The elimination of CO2.

• The delivery of O2 to the lungs.

The CO2 monitoring function of the HeartStart MRx provides an EtCO2 value, a CO2 waveform,

and an airway respiration rate (AwRR).

WARNING The EtCO2 readings do not always correlate closely with blood gas values, especially in patients with

pulmonary disease, pulmonary embolism or inappropriate ventilation.

Do not measure CO2 in the presence of pharmaceuticals in aerosols.

NOTE For more information on capnography and EtCO2, refer to the Application Note, Uses of Capnography

and Benefits of the Microstream Method.

10 Monitoring Carbon Dioxide Preparing to Measure EtCO2

110

Preparing to Measure EtCO2

Selecting the Accessories

There are some factors to consider when selecting accessories:

• the type of patient, adult, pediatric, or neonate.

• airway status of the patient, ventilated or not ventilated.

• if a ventilated patient, whether humidified or non-humidified ventilation is used.

WARNING Do not re-use, clean, or sterilize Microstream CO2 accessories as they are intended for single-patient,

one-time use.

Table 12 shows CO2 accessories with their corresponding application areas.

Table 12 Microstream CO2 Accessories

WARNING Use only Microstream accessories (as listed above) to ensure correct functioning of the CO2 sidestream

measurement.

WARNING Due to a measurement delay, do not use Microstream (sidestream) CO2 as a direct reference for

determining the end expiratory point in the pressure curve.

NOTE The HeartStart MRx is equipped with automatic barometric pressure compensation.

Part Number Circuit Description

M1920A Intubated FilterLine Set - Adult/Pediatric

25 sets/case

M1921A Intubated FilterLine H Set - Adult/Pediatric

25 sets/case

M1923A Intubated FilterLine H Set - Infant/Neonatal

yellow, 25 sets/case

M2520A Non-Intubated

Dual Purpose

Smart CapnoLineTM- Pediatric

M2522A Non-Intubated

Dual Purpose

Smart CapnoLine - Adult

M2524A Non-Intubated

Single Purpose

Smart CapnoLine - Pediatric

M2526A Non-Intubated

Single Purpose

Smart CapnoLine - Adult

Setting Up Microstream EtCO2 Measurements 10 Monitoring Carbon Dioxide

111

Setting Up Microstream EtCO2 Measurements

WARNING • Danger - explosion hazard - sidestream measurement should not be used in the presence of

flammable anesthetics such as:

– flammable anesthetic mixture with air

– flammable anesthetic mixture with oxygen or nitrous oxide

•CO

2 should not be measured in the presence of aerosolized pharmaceuticals.

• When using the nasal FilterLine, if one or both nostrils are partially or completely blocked, or the

patient is breathing through the mouth, the displayed EtCO2 values may be significantly low.

• Reflux of gastric contents, mucus, pulmonary edema fluid or endotracheal epinephrine introduced

into the detector can increase airway resistance and affect ventilation. Discard accessory if this

occurs.

• The presence of carbonated beverage or antacids in the stomach may cause incorrect readings and

unreliable capnography in identifying esophageal intubation.

Using the Nasal FilterLine

To set u p EtC O 2 measurements using the nasal FilterLine, perform the following steps:

1Attach the FilterLine tubing to the CO2 Inlet port as described in “Connecting the CO2

FilterLine” on page 40.

2Check that both nostrils are clear and position the nasal FilterLine on the face by inserting the

FilterLine tips into the nostrils.

3Pass the FilterLine tubing over the ears, then slide the sleeve up the tubing towards the neck to a

comfortable fit under the chin. If using dual purpose FilterLine tubing, connect the green tubing

to the oxygen source. Check the positioning of the FilterLine regularly to ensure proper

monitoring function.

4Change the nasal FilterLine every 24 hours, if the CO2 Occlusion INOP message appears, or if

measurement readings become erratic.

Using the FilterLine and Airway Adapter

To set u p EtC O 2 measurements using the FilterLine and airway adapter:

1Attach the FilterLine tubing to the CO2 Inlet port as described in “Connecting the CO2

FilterLine” on page 40.

2Connect the wide end of the airway adapter to the endotracheal tube and connect the narrow end

of the airway adapter to the ventilator tubing or manual resuscitator.

Disconnect the FilterLine during suctioning and nebulizing therapies. For best results for non-

humidified use, change the FilterLine after 24 hours of continuous use. For humidified use, change the

FilterLine H after 72 hours of continuous use.

10 Monitoring Carbon Dioxide Measuring EtCO2

112

WARNING When using the Microstream EtCO2 measurement on patients who are receiving or have recently

received anesthetics, connect exhaust tubing from the CO2 Outlet port to a scavenging system or to the

anesthesia machine/ventilator to prevent exposing medical staff to anesthetics. Use an exhaust tube to

remove the sample gas to a scavenging system. Attach scavenging tube to the CO2 outlet port.

NOTE Should the FilterLine or exhaust tubing be blocked when the HeartStart MRx is turned on, the CO2

Check Exhaust INOP message is displayed. Should the blockage occur during CO2 monitoring, the

CO2 waveform appears as a flat line, and if alarms are on, an apnea alarm is annunciated.

Measuring EtCO2

The EtCO2 measurement is automatically turned on when you connect a FilterLine to the CO2 Inlet

port. The CO2 waveform is displayed in the configured Wave Sector if available. The measurement

values for EtCO2 and AwRR are displayed in Parameter Block 2 (see Figure 62).

Figure 62 EtCO2 and AwRR / Parameter Block 2

EtCO2 and AwRR Alarms

Alarms are annunciated if measurements fall outside the configured limits for high or low EtCO2, high

or low Airway Respiration Rate (AwRR) and Apnea time. EtCO2 alarms, except Apnea, are all

categorized as “non-latching” alarms, meaning they are automatically removed when their alarm

condition no longer exists. Apnea alarms are latching, meaning they remain present even if the alarm

condition no longer exists.

Tab le 13 E tCO 2 Red/Yellow Physiological Alarms

EtCO2 and AwRR alarms are on unless you turn them off or alarms for the entire device are off. Once

disabled, alarms remain off until they are turned back on.

WARNING Turning off alarms prevents all alarms associated with EtCO2 or AwRR measurements from

annunciating. If an alarm condition occurs, NO alarm indication will be given.

100

18/77

(95) 24/10

(15)

SYS

160

0100

Alarm Message Alarm Type Indicator Condition

Apnea Red Red alarm message; alarm tone No detectable breaths for the configured

number of seconds.

EtCO2 High Yellow Yellow alarm message; alarm tone The EtCO2 value exceeds the high alarm limit.

EtCO2 Low Yellow Yellow alarm message; alarm tone The EtCO2 value has fallen below the low alarm

limit

AwRR High Yellow Yellow alarm message; alarm tone The AwRR value exceeds the high alarm limit.

AwRR Low Yellow Yellow alarm message; alarm tone The AwRR value has fallen below the low alarm

limit.

EtCO2 and AwRR Alarms 10 Monitoring Carbon Dioxide

113

Changing the EtCO2 Alarm Limits

To change the EtCO2 alarm limits:

1Press the Menu Select button.

2Using the Navigation buttons, select the Measurements/Alarms menu and press the Menu Select

button.

3Select EtCO2 and press the Menu Select button.

4Select EtCO2 Limits and press the Menu Select button.

5Using the Navigation buttons, increase or decrease the high limit value and press the Menu Select

button.

6Set the new low limit value and press the Menu Select button.

Enabling/Disabling the EtCO2 Alarms

To enable or disable the EtCO2 alarms:

1Press the Menu Select button.

2Using the Navigation buttons, select the Measurements/Alarms menu and press the Menu Select

button.

3Select EtCO2 and press the Menu Select button.

4Select Alarms On/Off and press the Menu Select button.

Changing the AwRR Alarm Limits

To change the AwRR alarm limits:

1Press the Menu Select button.

2Using the Navigation buttons, select the Measurements/Alarms menu and press the Menu Select

button.

3Select AwRR and press the Menu Select button.

4Select AwRR Limits and press the Menu Select button.

5Using the Navigation Buttons, increase or decrease the high limit value and press the Menu Select

button.

6Set the new low limit value and press the Menu Select button.

10 Monitoring Carbon Dioxide Disabling the EtCO2 Monitoring Function

114

Changing the Apnea Time Alarm Limit

To change the apnea time alarm limit:

1Press the Menu Select button.

2Using the Navigation buttons, select the Measurements/Alarms menu and press the Menu Select

button.

3Select AwRR and press the Menu Select button.

4Select Apnea Time and press the Menu Select button.

5Using the Navigation buttons, increase or decrease the limit and press the Menu Select button.

Enabling/Disabling AwRR Alarms

To enable the AwRR alarms:

1Press the Menu Select button.

2Using the Navigation buttons, select the Measurements/Alarms menu and press the Menu Select

button.

3Select AwRR and press the Menu Select button.

4Select Alarms On/Off and press the Menu Select button.

WARNING • The safety and effectiveness of the respiration measurement method in the detection of apnea,

particularly the apnea of infancy, has not been established.

• The selected apnea alarm may be delayed by up to 17 seconds, if apnea occurs during the automatic

zero process.

Disabling the EtCO2 Monitoring Function

To disable the EtCO2 monitoring function, disconnect the FilterLine from the CO2 inlet port. The

message CO2 Unplugged. Turn off EtCO2? appears. Select Yes and press the Menu Select button.

Should the FilterLine be disconnected accidentally, the message CO2 Unplugged. Turn off EtCO2?

appears to notify you of the disconnection. Select No and press the Menu Select button. Secure the

connection. The CO2 monitoring function is once again enabled.

Troubleshooting

If your HeartStart MRx does not operate as expected during CO2 Monitoring, see Chapter 22,

“Troubleshooting” on page 297.

115

11Invasive Pressures

This chapter describes how to monitor invasive pressures using the HeartStart MRx.

Overview

The Invasive Pressures option on your HeartStart MRx offers two channels of real-time continuous

invasive pressure measurements and waveforms in Monitor, Manual Defib and Pacer modes. If the

pressure signal is pulsatile, numeric values are displayed for systolic, diastolic and mean pressure. If the

pressure signal is non-pulsatile, then only the mean is displayed. Alarms are provided to alert you to a

change in the patient’s condition. If alarms are enabled, alarm limits appear next to the pressure value

and the alarm source is displayed above the alarm limits. If alarms are off, the Alarms Off symbol

replaces the limits.

Setting up for a Pressure Measurement

1Turn the HeartStart MRx on.

2Connect the pressure cable to the HeartStart MRx.

NOTE The HeartStart MRx will perform a check of invasive pressure functionality when the option is turned

on.

3Connect the cable to the transducer.

4Prepare the flush solution.

5Flush the system to expel air from the tubing. Make sure the stopcocks and transducer are also free

of air bubbles.

WARNING If air bubbles appear in the tubing system, flush the system with infusion solution again. Air bubbles

may lead to an incorrect reading.

6Connect the pressure line to the patient catheter.

11 Invasive Pressures Setting up for a Pressure Measurement

116

7If you are using an infusion pressure cuff with the pressure line, attach the pressure cuff to the fluid

to be infused. Inflate it according to your hospital’s standard procedure then begin the infusion.

Position the transducer so that it is level with the heart, approximately at the level of the

midaxillary line.

WARNING If measuring intracranial pressure (ICP) with a sitting patient, level the transducer with the top of the

patient’s ear. Incorrect leveling may lead to an incorrect reading.

Selecting a Pressure to Monitor 11 Invasive Pressures

117

Selecting a Pressure to Monitor

You need to assign a label to each pressure channel as it is connected. Channels are identified as Press 1

and Press 2. You can apply labels to each pressure channel by selecting the appropriate pressure label

using the Menu Select button. Once you select a label, the HeartStart MRx will use that label’s stored

information (color, alarm source and limits, scale) as the default. You should check each pressure

channel label as the cable is connected and make changes as appropriate.

To select a pressure label, perform the following steps:

1Press the Menu Select button.

2Using the Navigation buttons, select Measurements/Alarms and press the Menu Select button.

3Select Press 1 (or Press 2) and press the Menu Select button.

4Select Label and press the Menu Select button.

5Select the appropriate label from the list provided (see Table 14 for list) and press the Menu Select

button.

6Select the size of your scale (See “Pressure Waves” on page 118).

7Select Alarm Source type (See “Alarms” on page 125).

8Set the high and low alarm limits.

Repeat the steps to label the other pressure channel.

NOTE Changing the pressure site label activates scales and alarm settings associated with the new label. You

will be presented with the controls for scale and alarm settings after selecting a label from the menu to

either confirm or adjust the value. Table 14 lists pressure labels.

Table 14 Pressure Labels

* - Cerebral Perfusion Pressure (CPP) is automatically displayed with ICP when one pressure is already

set to ABP, ART or Ao and the other pressure is set to ICP. CPP will be displayed in the same color as

ICP. Only one of the ICP or CPP alarms can be enabled at the same time. See Alarms page 125.

NOTE When selecting a pressure label for a pressure channel, the label assigned to the other pressure channel

appears in your options list only if the other channel is not connected to a transducer. If you select the

same label as the other channel, the label for the other channel changes to a non-specific label (P1 or

P2). If you decide to re-label the first channel, the other channel’s label remains non-specific (P1 or

P2).

NOTE To monitor a pressure from an arterial waveform when using an intra-aortic balloon pump, connect

your invasive pressure device directly to the balloon pump.

Label Description Label Description

ABP Arterial Blood Pressure LAP Left Atrial Pressure

ART Arterial Blood Pressure PAP Pulmonary Artery Pressure

Ao Aortic Pressure RAP Right Atrial Pressure

CVP Central Venous Pressure P1 Non-specific pressure label

(Channel 1)

ICP Intracranial Pressure* P2 Non-specific pressure label

(Channel 2)

11 Invasive Pressures Pressure Waves

118

Pressure Waves

Each pressure label has a set of scales for the pressure wave. You can adapt the displayed wave to the

offset and amplitude of the signal. The scale can be modified through the Displayed Waves menu.

To select a pressure wave and the associated scale for the display or printed strip, perform the following

steps:

1Press the Menu Select button.

2Using the Navigation buttons, highlight Displayed Waves and press the Menu Select button.

3Select Wave Position (Wave 1, Wave 2, Wave 3 or Wave 4) and press the Menu Select button.

4Select the appropriate label and press the Menu Select button.

5Select the appropriate scale and press the Menu Select button.

Available scales in mmHg:

300, 240, 180, 150, 120, 110, 100, 90, 80, 70, 60, 50, 40, 30, 20, 10, -5, -10, -15, and -20.

Available scales in kPa:

38.0, 32.0, 26.0, 24.0, 22.0, 20.0, 18.0, 16.0, 14.0, 13.0, 12.0, 11.0, 10.0, 9.0, 8.0, 7.0, 6.0, 5.0, 4.0,

3.0, 2.0, -1.0, -1.5, -2.0, -2.5.

NOTE A positive scale sets the top gridline to your selected scale and the bottom to zero. A negative scale will

set the bottom gridline to the selected negative unit and the middle gridline to zero.

Zeroing the Pressure Transducer 11 Invasive Pressures

119

Zeroing the Pressure Transducer

To avoid inaccurate pressure readings, the HeartStart MRx requires a valid zero be performed on the

pressure channel. It should be zeroed according to your hospital policy - at least once per day. Also, you

should rezero in the following circumstances:

• Every time you reconnect the transducer cable to the HeartStart MRx.

• After a patient is moved.

• During changes in altitude when using the HeartStart MRx aboard an aircraft. Re-zero when

reaching a cruising altitude.

• When you use a new transducer or tubing.

• When you think the pressure readings are not correct.

NOTE The numeric value will be invalid (displayed as -?-) when the transducer is plugged in until zeroed

successfully.

For each assigned label, the pressure channel can be zeroed through the Menu Select button menu or,

when in Monitor Mode, through the use of a soft key. You can zero the pressure channels separately or

together.

WARNING Before zeroing a pressure, make sure related pressure transducers are vented to atmospheric pressure

and the stopcock to the patient is closed.

Zeroing Using the Menu Select Button

To Zero using the Menu Select button, perform the following:

1Place the transducer at the appropriate level for the measurement site.

2Close the transducer stopcock to the patient and vent the transducer to atmospheric pressure.

3On the HeartStart MRx, press the Menu Select button.

4Using the Navigation buttons, select Measurements/Alarms and press the Menu Select button.

5Select the pressure label you wish to perform the zero procedure on.

6Press Zero and press the Menu Select button. Zeroing begins.

Zeroing Using a Soft Key in Monitor Mode

To Zero using the soft key in Monitor Mode, perform the following:

1Place the transducer at the appropriate level for the measurement site.

2Close the transducer stopcock to the patient and vent the transducer to atmospheric pressure.

3Press the button under [Zero Pressure] on the display.

4Using the Navigation buttons, select the pressure(s) you wish to zero from the Zero menu and press

the Menu Select button. Zeroing begins.

11 Invasive Pressures Zeroing the Pressure Transducer

120

WARNING Invasive pressure alarms and pulse alarms (if they are derived from invasive pressure readings) are

temporarily turned off while the transducer is zeroing. The alarms will turn back on 30 seconds after

zeroing is complete.

During the zeroing process, a message will appear on the HeartStart MRx display. If the process was

successful, the message on the screen changes to Pressure label zero done at date/time (for example: ABP

zero done at 25Jan2006, 9:26). If the process is unsuccessful, you get an Unable to zero message with a

probable cause message displayed. Table 15 lists probable cause messages.

Table 15 Unable toZero Probable Causes:

NOTE Upon successful completion of the process, close the stopcock to atmospheric pressure, which opens

the stopcock to the patient.

Probable Cause Message Corrective Action

Equipment Malfunction Hardware is faulty. Contact your service personnel.

Excessive Offset Make sure the transducer is vented to the air and try again. If this doesn’t

work, replace the transducer cable and try again. If it still doesn’t zero, replace

the transducer and try again. If it still will not zero, contact your service

personnel.

Unstable Signal

No Transducer Reconfirm that the transducer is connected and try again. If this doesn’t

work, replace the transducer.

Pulsatile Pressure Make sure that the transducer is vented to air and not the patient. Try again.

Calibration 11 Invasive Pressures

121

Calibration

The HeartStart MRx allows you to input the calibration factor (see documentation supplied by the

transducer’s manufacturer) of a new transducer plugged into the pressure line.

Known Calibration Factor

To set a known calibration factor, perform the following:

1Zero the transducer (see previous section)

2Press the Menu Select button.

3Using the Navigation buttons, select Measurements/Alarms and press the Menu Select button.

4Select the correct pressure (channel: label) and press the Menu Select button.

5Select Calibration Factor and press the Menu Select button.

6Set the calibration factor using the Navigation buttons. Values range from 180.0 to 220.0 in 0.2

increments. Press the Menu Select button.

NOTE Calibration only needs to be done on reusable transducers.

11 Invasive Pressures Calibration

122

Calibrating Reusable Transducer CPJ840J6

Perform a mercury calibration when you use a new reusable transducer and at regular intervals

according to your hospital policy. You will need:

• standard sphygmomanometer

• sterile 10cc syringe with heparinized solution

• 3-way stopcock

• approximately 25cm of tubing.

WARNING Never perform invasive pressure mercury calibration while the patient is being monitored.

To perform a mercury calibration on the CPJ840J6, perform the following:

1Zero the transducer (see previous section).

2Connect the syringe and manometer. (See Figure 63.)

a. Attach the tubing to the manometer

b. Connect the 3-way stopcock to the stopcock that is not connected to the patient catheter.

c. Attach the syringe to one port and the manometer to the other port.

d. Open the port to the manometer

Figure 63 Connecting the Syringe and Manometer

™

Calibration 11 Invasive Pressures

123

3Raise the manometer pressure to approximately 200 mmHg or 27.0 kPa.

4Press the Menu Select button.

5Using the Navigation buttons, select Measurements/Alarms and press the Menu Select button.

6Select the pressure (channel: label) you wish to calibrate and press the Menu Select button.

7Select Calibration Pressure and press the Menu Select button.

8Using the Navigation Buttons, select the Calibration Pressure you set for the manometer in Step 3

above. The default is 200 mmHg (27.0 kPa). Values range from 90 to 220 mmHg in increments of

1 (12.0 to 30.0 kPa in increments of 0.2).

9Press the Menu Select button. The HeartStart MRx will automatically set and display the

calibration factor.

NOTE Upon successful calibration, write the calibration factor on the transducer for future reference.

Calibration Confirmation

If the calibration process is successful, a brief message appears on the HeartStart MRx display with the

date and time the calibration was completed and the new calibration factor. If calibration is not

successful, an Unable to Calibrate message appears with a probable cause. See Table 16 for probable

cause messages.

Table 16 Unable to Calibrate Probable Causes

WARNING Each time you use a reusable transducer, you should confirm the calibration factor written on the

transducer is the same as the calibration factor displayed on your HeartStart MRx. Different

calibration factors may lead to an inaccurate measurement.

Message Corrective Action

Equipment Malfunction Hardware is faulty. Contact your service personnel.

Out of range Make sure you have selected a value for the calibration pressure that you are

applying to the transducer. Repeat calibration.

Unstable Signal Make sure there are no disturbances to the transducer. Repeat calibration.

No Transducer Reconfirm that the transducer is connected and try again.

Perform Zero first A valid zero does not exist. Zero the transducer.

11 Invasive Pressures Calibration

124

Last Zero/Calibration

You can view dates and times for a channel’s last zero or mercury calibration through the HeartStart

MRx menu.

To view a channel’s last zero and mercury calibration dates, perform the following steps:

1Press the Menu Select button.

2Using the Navigation buttons, select Measurements/Alarms and press the Menu Select button.

3Select the pressure label (channel: label) you want and press the Menu Select button.

4The last zero and Mercury calibration dates and times are displayed.

NOTE The information listed for the last mercury calibration is the date and time of either calibrating at a

known pressure or entering the calibration factor manually.

Figure 64 Last Zero and Mercury Calibration Dates

Non-Physiological Artifact Suppression

Various clinical procedures (i.e. taking a blood sample) may affect invasive pressure readings. Your

HeartStart MRx can be configured to suppress alarms when artifact is detected for a specific length of

time. You can configure suppression lengths in Configuration Mode. Options are 30, 60 and 90

seconds or off. The default is 60 seconds. During suppression, the HeartStart MRx shows an INOP

message and ? next to the pressure label. Pressure alarms and Pressure Label Non-Pulsatile INOPs are

inactive during the suppressed period. The CPP high alarm is not suppressed.

Label

Zero ABP

Calibration Pressure

Calibration Factor

Measurements/Alarms

Alarms Off

ABP Limits

Exit

Press 1: ABP

Last Zero 28Nov 2005 09:05

Last Mercury Cal 28 Nov 2005 9:06

Alarms 11 Invasive Pressures

125

Alarms

Alarms are provided to alert you to a change in the patient’s condition. If alarms are enabled, alarm

limits appear next to the pressure value. Invasive pressure alarms (except ABP, ART, Ao, PAP, P1 or P2

disconnect alarms) are all categorized as “non-latching” alarms, meaning they are automatically

removed when their alarm condition no longer exists. The above listed disconnect alarms are latching,

meaning they remain present even if the alarm condition no longer exists. Table 17 details invasive

pressure alarms.

Table 17 Invasive Pressure Red/Yellow Physiological Alarms

Each pressure label has its own unique set of default alarm limits which are set in Configuration mode.

See “Configuration” on page 199 for details. If the alarm is from a pulsatile source, the source is

displayed above the alarm limits. If alarms are off, the Alarms Off symbol replaces the limits.

If a wave becomes non-pulsatile, the measurement will become mean only and be compared to the

current source (which may be systolic or diastolic) and alarm limits.

WARNING Make sure you enable/disable and set alarm limits for the correct label. These settings apply to that

particular label only. Changing the label might change the alarm limits.

Alarm Message Type of A larm Indicator Condition

[ABP, ART, Ao,

PAP, P1, P2]

Disconnect

Red Red alarm message;

alarm tone

The mean pressure has fallen below 10

mmHg (1.3 kPa) and the pressure is non-

pulsatile.

[Pressure label]s

High

Yellow Yellow alarm message;

alarm tone

The systolic pressure value exceeds the

high alarm limit.

[Pressure label]d

High

Yellow Yellow alarm message;

alarm tone

The diastolic pressure value exceeds the

high alarm limit.

[Pressure label]m

High

Yellow Yellow alarm message;

alarm tone

The mean pressure value exceeds the

high alarm limit.

[Pressure label]s

Low

Yellow Yellow alarm message;

alarm tone

The systolic pressure value has fallen below

the low alarm limit.

[Pressure label]d

Low

Yellow Yellow alarm message;

alarm tone

The diastolic pressure value has fallen

below the low alarm limit.

[Pressure label]m

Low

Yellow Yellow alarm message;

alarm tone

The mean pressure value has fallen below

the low alarm limit.

11 Invasive Pressures Alarms

126

Enabling/Disabling alarms

To enable/disable alarms, perform the following steps:

1Press the Menu Select button.

2Using the Navigation buttons, select Measurements/Alarms and press the Menu Select button.

3Select the pressure label (channel: label) you wish to modify alarm status on and press the Menu

Select button.

4Select Alarms On (or Alarms Off) and press the Menu Select button.

Viewing/Changing/Setting Source for Alarms

Alarm sources and limits can be viewed or modified for a given pressure label.

To view or modify alarm settings, perform the following steps:

1Press the Menu Select button.

2Using the Navigation buttons, select Measurements/Alarms and press the Menu Select button.

3Select the pressure label (channel: label) you wish to view/modify alarms on and press the Menu

Select button.

4Select pressure label Limits and press the Menu Select button.

5If the pressure label is pulsatile, select the desired source of the alarm (Systolic, Diastolic or Mean)

and press the Menu Select button.

6Using the Navigation buttons, increase or decrease the high limit and press the Menu Select

button.

7Set the new low limit and press the Menu Select button.

Alarms 11 Invasive Pressures

127

CPP Alarms

With CPP and ICP, only one of the two parameters can have alarms enabled at one time. If CPP

alarms are turned on then ICP alarms are turned off. Both alarms can be turned off at the same time.

The parameter with alarms off will be displayed at the bottom of the ICP/CPP parameter area with the

Alarms Off symbol. ICP alarms default to on; CPP to off.

Wedge

Perform a pulmonary artery wedge procedure according to your hospital protocol. The wedge numeric

will not be stored in the Vital Signs Trending.

WARNING For Pulmonary Artery Wedge Pressure (PAWP) readings, due to a measurement delay, do not use

Microstream (sidestream) CO2 as a direct reference for determining the end expiratory point in the

pressure curve.

If the pulmonary artery flotation catheter drifts into the wedge position without inflation of the

balloon, the pulmonary artery pressure waveform will assume a wedged appearance. To correct the

situation take appropriate action in accordance with standard procedures.

11 Invasive Pressures Pulse

128

Pulse

The HeartStart MRx can provide pulse readings from either the SpO2 or Invasive Pressures options.

To understand how pulse works with SpO2 only, read Chapter 8, Pulse Oximetry. If your device has

both options, read the following section.

Pulse Sources

When both SpO2 and Invasive Pressures options are present on the HeartStart MRx, pulse can be

derived from an SpO2 pleth wave or one of the two invasive pressure waves in Monitor, Pacing and

Manual Defib modes. The pulse reading will be displayed in the color of its source (e.g. if your pleth

wave is cyan and pulse is being derived from the pleth wave, then the pulse reading will appear in

cyan.)

Pulse is on (and displayed) if one of the possible sources is activated. SpO2 is the factory default but can

be modified in Configuration Mode. If the default pulse source is not active during an event but a

secondary source is, the pulse value will appear on screen but it will be invalid and display a -?- where

the value should be. A Pulse Check Source INOP will also appear on the screen. To obtain a pulse rate,

you must modify the pulse source to an active source for this incident.

If the pulse source you are using to obtain a pulse rate is disconnected during active measuring and a

secondary pulse source is available, the pulse rate does not automatically switch to the secondary

source. The pulse value (and the value of your source measurement) remains on screen but becomes

invalid and displays a -?- where the value should be. An INOP message also appears on screen. To

reactivate a pulse reading, reconnect the original pulse source or change the pulse source to the

secondary option.

Pulse 11 Invasive Pressures

129

Changing Pulse Source

To change pulse source for the current incident, perform the following steps:

1Press the Menu Select button.

2Using the Navigation buttons, select Measurements/Alarms and press the Menu Select button.

3Select Pulse and press the Menu Select button.

4Select Pulse Source and press the Menu Select button. Pick a source with an arterial or pulmonary

waveform.

5Using the Navigation buttons, highlight the pulse source desired and press the Menu Select button.

Figure 65 Pulse Source

Setting Pulse Alarms

When on, pulse alarms annunciate if measurements fall outside of the limits for high or low pulse.

Alarms are turned off unless you turn them on during use. Once turned on, alarms remain on until

they are turned back off.

NOTE If pulse alarms are enabled, alarm limits appear next to the pulse value. If alarms are off the Alarms Off

symbol replaces the limits.

Enabling/Disabling Pulse Alarms

Pulse alarms are turned off by default. To turn the pulse alarms on for the current incident perform the

following steps:

1Press the Menu Select button.

2Using the Navigation buttons, select Measurements/Alarms and press the Menu Select button.

3Select Pulse and press the Menu Select button.

4Select Alarms On and press the Menu Select button.

The alarms will now be on. To turn alarms off, repeat the steps above except select Alarms Off in Step

Main Menu

Start Data Transmit

Volume

Displayed Waves

Printed Waves

Measurements/Alarms

Patient Info

Trends

Other

High Contrast On

Exit

Measurements/Alarms

HR/Arrhythmia

Press1:ABP

Press2:PAP

CPP

NBP

EtCO2

AwRR

SpO2

Pulse

1 of 2

Pulse

Pulse Source

Alarms On

Pulse Limits

Exit

Pulse Source

SpO2

Press 1: ABP

Press 2: PAP

11 Invasive Pressures Caring For Your Transducers and Probes

130

Pulse Alarm Limits

Pulse alarm limits can be changed for the current incident. To change alarm limits, perform the

following steps:

1Press the Menu Select button.

2Using the Navigation buttons, select Measurements/Alarms and press the Menu Select button.

3Select Pulse and press the Menu Select button.

4Select Pulse Limits and press the Menu Select button.

5Using the Navigation buttons, select the new high limit value and press the Menu Select button.

6Select the new low limit and press the Menu Select button.

Changing Default Pulse Source and Alarm Limits

You can change the default pulse source in the pulse section of Configuration Mode. See “Pulse

Settings” on page 210. Because pulse and heart rate share the same default alarm limits, default pulse

alarm limits can be changed in the ECG section of Configuration Mode.

Caring For Your Transducers and Probes

Refer to the manufacturer’s instructions for care and cleaning of your invasive pressure transducers and

cables. Inappropriate treatment of the cables will reduce their lifetime.

Troubleshooting

If your HeartStart MRx does not operate as expected during invasive pressure monitoring, see

“Troubleshooting” on page 297.

131

12Temperature

This chapter describes how to monitor temperature using the HeartStart MRx.

Overview

The HeartStart MRx offers one channel of real-time continuous temperature monitoring. The device

can monitor nasopharyngeal, esophageal, rectal, skin, arterial, venous, core and urinary bladder

temperatures. Measurements, which can be displayed in either Fahrenheit or Celsius, may be taken

while in Monitor, Pacer or Manual Defib modes.

Selecting a Temperature Label

The HeartStart MRx monitors the temperature of the area where the sensor is located. To assure

specific temperature settings are matched with the temperature reading, assign the proper temperature

label to the measurement. When modifying a temperature label, all settings (including alarm limits)

associated with that label become active. The default label is Temp.

Table 18 Temperature Labels

To select a temperature label, perform the following:

1Press the Menu Select button.

2Using the Navigation buttons, select Measurements/Alarms and press the Menu Select button.

3Select the temperature label option currently assigned to your measurement (default is Te m p ) and

press the Menu Select button.

4Select Label and press the Menu Select button.

5Select the appropriate label from the list provided and press the Menu Select button.

Label Type Label Type

Tesoph esophageal temperature Tnaso nasopharyngeal temperature

Trect rectal temperature Tvesic urinary bladder

Tskin skin temperature Tart arterial temperature

Temp non-specific temp label Tven venous temperature

Tcore core temperature

12 Temperature Monitoring Temperature

132

Monitoring Temperature

To monitor temperature, perform the following:

1Connect the temperature cable to the HeartStart MRx.

2Select the correct temperature label for your measurement.

3Check that the current device settings (including alarm settings) are appropriate for the patient.

4Apply the temperature probe to the patient.

NOTE The temperature function performs a self-test when initially turned on and also performs hourly system

tests when active.

Alarms

Setting Temperature Alarms

Temperature alarms are annunciated if measurements fall outside the configured limits for high and

low temperatures. Temperature alarms are all categorized as “non-latching” alarms, meaning they are

automatically removed when their alarm condition no longer exists. Table 19 details Temperature

alarms.

Table 19 Temperature Physiological Alarms

Alarms are on unless you turn them off during use. Once turned off, alarms remain off until they are

turned back on.

WARNING Make sure you enable/disable and set alarm limits for the correct label. These settings are stored for

that particular label only. Changing the label may change the alarm limits.

NOTE If temperature alarms are enabled, alarm limits appear next to the temperature value. If alarms are off

the Alarms Off symbol replaces the limits.

Alarm Message Type of A larm Indicator Condition

[Temperature

label] High

Yellow Yellow alarm message;

alarm tone

The temperature value exceeds the high

alarm limit.

[Temperature

label] Low

Yellow Yellow alarm message;

alarm tone

The temperature value has fallen below

the low alarm limit.

Changing Degree Units 12 Temperature

133

Changing Temperature Alarm Limits

To change the temperature alarm limits for the current incident, perform the following:

1Press the Menu Select button.

2Using the Navigation buttons, select Measurements/Alarms and press the Menu Select button.

3Select the temperature label option currently assigned to your measurement and press the Menu

Select button.

4Select Temperature Limits and press the Menu Select button.

5Using the Navigation buttons, change the high limit and press the Menu Select button.

6Using the Navigation buttons, change the low limit and press the Menu Select button.

Enabling/Disabling Temperature Alarms

Temperature alarms default to on. To disable temperature alarms, perform the following:

1Press the Menu Select button.

2Using the Navigation buttons, select the Measurements/Alarms menu and press the Menu Select

button.

3Select the temperature label option currently assigned to your measurement and press the Menu

Select button.

4Select Alarms Off and press the Menu Select button.

To turn alarms back on, repeat the steps above except select Alarms On in Step 4.

Changing Degree Units

The HeartStart MRx can display temperature in either Fahrenheit or Celsius. The default is Celsius

and can only be changed through Configuration Mode. See “Configuration” on page 199 for more

information.

12 Temperature Caring For Your Temperature Cables and Probes

134

Disabling the Temperature Function

To turn off the Temperature function, disconnect the temperature cable from the HeartStart MRx

port. The message Te m p (or the label currently activated) unplugged. Turn off Temp? appears. Select Ye s

and press the Menu Select button.

Should the temperature cable get disconnected accidentally or if the probe and cable separate, the

message Te m p unp l u g ge d. Tu r n of f Temp ? appears to notify you of the disconnection. To continue

monitoring temperature, select No and press the Menu Select button. Reconnect the temperature cable

to restart the temperature monitoring function. See “Turning Parameters On/Off” on page 16.

Caring For Your Temperature Cables and Probes

Refer to the manufacturer’s instructions for care and cleaning of your cables. Inappropriate treatment

of the cables will reduce their lifetime.

Troubleshooting

If your HeartStart MRx does not operate as expected during temperature monitoring, see Chapter 22,

“Troubleshooting”.

135

1312-Lead ECG

This chapter describes how to use the diagnostic 12-lead ECG function of the HeartStart MRx.

Overview

The optional 12-lead ECG function, using Philips’ DXL Algorithm, is available in Monitor Mode and

allows you to preview, acquire, print, copy, and store a 12-lead ECG. In addition, the 12-lead function

provides computerized ECG analysis using the DXL Algorithm. A report with measurements and

interpretive statements from the analysis is displayed, stored and printed, as configured. Certain

interpretive results generate Critical Value statements which alert you to an interpretation which may

mean your patient needs immediate attention.

The Philips DXL Algorithm provides an analysis of the amplitudes, durations, and morphologies of the

ECG waveforms and the associated rhythm. Patient age and gender are used to define normal limits for

heart rate, axis deviation, time intervals, and voltage values, for interpretation accuracy in tachycardia,

bradycardia, prolongation or shortening of PR and QT intervals, hypertrophy, early repolarization,

myocardial infarction and culprit artery detection. DXL Algorithm adult criteria apply if the patient

age is 16 years old or older. Pediatric criteria apply if the patient age is less than 16. The DXL

Algorithm also identifies paced patients automatically.

The DXL Algorithm also includes the optional Acute Cardiac Ischemia Time-Insensitive Predictive

Instrument (ACI-TIPI) and Thrombolytic Predictive Instrument (TPI) algorithms. ACI-TIPI

generates a 0-100% predicted probability score of Acute Cardiac Ischemia (ACI). TPI predicts patient

outcomes with and without thrombolytic therapy for an acute myocardial infarction.

WARNING Computerized ECG interpretation is not intended to be a substitute for interpretation by a qualified

physician.

NOTE Refer to the DXL Physician’s Guide for more information on the algorithm’s functionality.

13 12-Lead ECG Preparation

136

NOTES The Philips DXL Algorithm is capable of interpreting up to 16 leads, however the HeartStart MRx uses

the 12-lead functionality only.

ACI-TIPI and TPI are to be used as part of a suite of diagnostic tools and used in an advisory basis.

Clinical symptoms, 12-Lead ECG information and/or patient history may contradict the results of the

predictive algorithms. Institutions should establish protocols before instituting the use of the predictive

instrument algorithms.

You can configure the ACI-TIPI algorithm on your 12-lead without running the TPI algorithm.

However to use the TPI algorithm, you must first run the data through ACI-TIPI algorithm.

Preparation

Proper skin preparation and electrode placement are the most important elements in producing a high

quality 12-lead ECG. The patient should be supine and relaxed when an ECG is acquired. In

preparation for acquiring the ECG:

1Connect the 10-lead cable to the HeartStart MRx, as described in “Connecting the ECG Cable”

on page 35.

2Prepare the skin and apply electrodes, as described in “Electrode Placement” on page 51.

3Turn the Therapy Knob to Monitor.

4Enter patient information as described in “Entering Patient Information” on page 27.

5Confirm the patient’s pacing status is correct.

Preview Screen 13 12-Lead ECG

137

Preview Screen

The 12-lead function’s Preview Screen allows you to see real-time 12-lead ECG data and verify signal

quality before acquiring the ECG. As shown in Figure 66, it displays patient information and

approximately 2.5 seconds of each of the 12 leads acquired. Waveforms are presented at a rate of

25mm/sec and the configured wave size. A dashed line is displayed if a lead cannot be derived. The

message (Lead-Wire) Lead Off is displayed if an electrode is not making adequate contact with the

patient.

The Preview Screen’s patient information includes ID, age, and sex. The Event ID is displayed until

you enter the patient’s ID. Age and sex are displayed once entered (see “Entering Patient Information”

on page 27).

Although waveforms for monitored parameters such as ECG, SpO2, Invasive Pressures and CO2 are

not visible on the Preview Screen, related alarms, measurements and INOP messages remain active and

are reported in Parameter Blocks 1 and 2 and the general status area.

Figure 66 12-Lead ECG Preview Screen

Mark Event 10 Feb 2006 11:20

Jones, Samuel

Adult Non-Paced 02:42

36.9 80 120/80

(95)

Pulse NBP mmHg q120

10:40

bpm

Temp

SYS

160

bpm

80120

50 39.0

36.0

SpO2 % EtCO2

100

AwRR

mmHg rpm

100

90 38 50

30 18 30

Start

NBP Exit

12-Lead Start

Acquire .05-40 Hz

Filter MENU

ID: 12345 55 Years Male

V1V1II

V2V2IIII

V3V3III III

V4V4aVRaVR

V5V5aVLaVL

V6V6aVFaVF

Display: .05-150 Hz Report: .05-150 Hz

13 12-Lead ECG Acquiring a 12-Lead ECG

138

Acquiring a 12-Lead ECG

Once preparation is complete, to acquire a 12-lead ECG in Monitor Mode:

1Press the [12-Lead] soft key.

The Preview Screen is displayed, as shown in Figure 66.

2Check the signal quality on each lead and, if necessary, make adjustments as described in

“Improving Signal Quality” on page 149.

3Check filter settings.

4Press the [Start Acquire] soft key. The message Acquiring 12-Lead is then displayed while

the HeartStart MRx acquires ten seconds of ECG data.

5If patient age and sex were not previously entered, you are prompted to enter the information.

a. For age, use the Navigation buttons to increase or decrease the displayed value of the patient’s

age. Then press the Menu Select button . If connected to the IntelliVue Network, you enter

the patient’s date of birth.

b. For sex, use the Navigation buttons to select the patient’s sex and press the Menu Select button.

c. If your device is configured to run the ACI-TIPI and TPI algorithms, you’re asked to enter the

patient’s chest pain symptoms in the menu.

6Keep the patient still while the message Acquiring 12-Lead is displayed.

Once ECG acquisition is complete, ECG analysis begins automatically and is accompanied by the

message Analyzing 12-Lead. The patient does not need to be still during this time.

Following analysis, the 12-Lead Report is displayed, printed, and stored internally.

To acquire another 12-Lead ECG, press [New 12-Lead]. To exit the 12-lead function, press

[Exit 12-Lead].

WARNING Failure to enter correct patient age and sex can result in erroneous diagnosis.

NOTES A minimum of one chest lead and all limb leads are required to get a partial interpretation from the 12-

Lead algorithm. You must have all six chest leads to get a full interpretation. Also, wet gel electrodes

take less time to settle than hydrogel electrodes, thereby varying the amount of time you might have to

wait before acquiring a 12-Lead ECG. Pressing the [Acquire] softkey a little too soon may result in

a dashed line.

The Lead Select button is disabled when the 12-lead function is active.

Acquiring a 12-Lead ECG 13 12-Lead ECG

139

Acquiring a 12-lead ECG with ACI-TIPI and/or TPI Analysis

If configured to do so, the HeartStart MRx runs the ACI-TIPI and TPI predictive instrument

algorithms after a 12-lead ECG has been acquired.

You can configure your device to:

• Auto ACI-TIPI — Auto ACI-TIPI runs the ACI-TIPI analysis if there isn’t an Acute MI Critical

Value statement and the ECG severity is not Normal.

• ACI-TIPI — ACI-TIPI prints the standard report followed by computer generated diagnostic

statements using ACT-TIPI criteria.

• ACI-TIPI and TPI — ACI-TIPI & TPI uses the ACI-TIPI report followed by TPI inputs,

computer generated diagnostic statements using TPI criteria and the user-selected Thrombolytic

Therapy Contraindications.

To configure analysis, see Table 53 in the Configuration chapter.

CAUTION Proper lead placement must be used in order to receive proper predictive instrument algorithm

calculations. See “V/C Electrode Placement” on page 52.

To acquire a 12-lead ECG in Monitor Mode with additional ACI-TIPI and/or TPI analysis:

1Perform steps 1-5 from “Acquiring a 12-Lead ECG” on page 138.

2If you had not previously entered information on Chest Pain symptoms, you are prompted to do

so. Use the Menu Select button and Navigation buttons to select the proper value. See Table

“Required ACI-TIPI & TPI data” on page 142.

3Keep the patient still while the message Acquiring 12-Lead is displayed.

4Once ECG acquisition is complete, ECG analysis begins automatically and is accompanied by the

message Analyzing 12-Lead. The patient does not need to be still during this time.

5If you are not configured for TPI analysis, the 12-Lead Report, including the ACI-TIPI predicted

probability of Acute Ischemia percentage is displayed, printed and stored internally. If you are

configured for TPI analysis, the HeartStart MRx next performs a TPI screening test to see if the

ECG is a candidate for TPI analysis.

– If the ECG is not a candidate for TPI analysis, the 12-Lead Report is displayed, printed and

stored internally.

– If the ECG is a candidate for TPI analysis, the HeartStart MRx asks you to input more patient

information. Continue with Step 6.

6When required, the HeartStart MRx displays a list of TPI inputs which require data entry (See

Figure 67). Press the Menu Select button to view possible values for the first highlighted topic.

(You can press the [Skip TPI] softkey to bypass TPI analysis.)

7Use the Navigation buttons to highlight your answer and press the Menu Select button to select.

8Use the Navigation buttons to select the next item and repeat steps 6 and 7 to complete all TPI

inputs.

9Once you’ve completed all inputs, press the [Run TPI] softkey.

10 You are now prompted to consider contraindications for thrombolytics. See “Contraindications for

Thrombolytic Therapy” on page 140.

13 12-Lead ECG Acquiring a 12-Lead ECG

140

Figure 67 TPI Inputs

Contraindications for Thrombolytic Therapy

After entering TPI inputs, the HeartStart MRx prompts you to indicate the presence of thrombolytic

therapy contraindications from a pre-configured list. Speak with and observe the patient to answer the

contraindications.

The HeartStart MRx allows you to pre-configure up to 20 thrombolytic therapy contraindications. If

you have configured 9 or less contraindications, they appear on the HeartStart MRx on a single screen.

If you have more than 9 configured contraindications, they appear on multiple screens. Press the

[Next Page] softkey to advance to the next page of contraindications.

If you do not enter any thrombolytic indications, the resulting printed 12-Lead Report prompts you to

consider other Thrombolytic contraindications.

There are 10 default contraindications:

The default value for each contraindication is Unknown. You have the ability to change each

contraindication to Yes or No or leave it as Unknown. Once entered, the contraindications are retained

for the current patient.

Pressing the [No Other Contra.] softkey sets all contraindications on that page to No unless

they were previously set to Yes.

NOTE The Intended Use statement for the Thrombolytic Predictive Instrument provides a list of some

contraindications that were associated with thrombolytic therapy when the U.S. Food and Drug

Administration (FDA) reviewed the software in 1997. It is important to understand that the second set

of contraindications are associated with the therapy and not the TPI software. Each institution can

configure the TPI software to reflect the processes it uses to determine if thrombolytic therapy should

be administered.

Candidate for Thrombolysis

Time Since Onset of Ischemic Symptoms Unknown

Blood Pressure Unknown

History of Hypertension unknown Unknown

History of Diabetes Unknown

Patient Weight Unknown

• Right vs. left arm systolic blood pressure difference > 15 mmHg

• History of structural central nervous system disease

• Significant closed head/facial trauma within previous 3 months

• Major trauma, surgery, GI/GU bleed within 6 weeks

• Bleeding or clotting problem or on blood thinners

• CPR for longer than 10 minutes

•Pregnant female

• Serious systemic disease

• Pulmonary edema

• Signs of shock

Acquiring a 12-Lead ECG 13 12-Lead ECG

141

To change a contraindication:

1When the list of contraindications appears on the HeartStart MRx display (see Figure 68), use the

Navigation buttons to highlight one of the contraindications and press the Menu Select button.

2Use the Navigation buttons to select a new value for the contraindication and press the Menu

Select button.

3Use the Navigation buttons to select the next contraindication.

4Complete steps 2-3 for the remaining contraindications in your list.

5Press the [Done] softkey to exit contraindications to thrombolytic therapy. After analysis is

complete, all settings are logged in the Event Summary and the 12-Lead analysis is complete.

6To acquire another 12-Lead ECG, press [New 12-Lead]. To exit the 12-lead function, press

[Exit 12-Lead].

Figure 68 TPI Contraindications

Page Done MENU

Unknown

Page 1 of 2

Consider contraindications to thrombolysis

Right vs. left arm sys. BP difference > 15 mmHg

History of structural central nervous system disease

Significant closed head/facial trauma within prev. 3 mos.

Major trauma, surgery, GI/GU bleed within six wks.

Bleeding or clotting problem or on blood thinners

CPR for longer than 10 min.

Pregnant female

Serious systemic disease

Pulmonary edema

50 years Male

No Other

Contra.

Start

NBP

25 Jan 2009 12:03:37

13 12-Lead ECG Acquiring a 12-Lead ECG

142

Table 20 Required ACI-TIPI & TPI data

ST and T Changes

The ACI-TIPI’s probability value substantially depends on the primary values for ST and T changes.

However, ventricular conduction abnormalities and ventricular hypertrophy cause secondary ST and T

wave changes that, if misinterpreted as primary could cause erroneously high ACI-TIPI scores. Philips’

algorithm attempts to sort out the primary from the secondary ST and T changes when conduction

abnormalities are present. The algorithm issues a warning message if the distinction can’t be made. The

algorithm excludes the ST and/or T factors (as appropriate) from its calculations when it detects:

• Left ventricular hypertrophy (can alter T waves and the ST segment)

• Right bundle branch block (produces conduction delay)

• Left bundle branch block (produces conduction delay)

• Secondary repolarization (ST and T) abnormalities

• The presence of an artificial pacemaker

When such data is excluded from calculations, the HeartStart MRx prints a message indicating the

reason for a lower ACI-TIPI score.

Patient Data Required for

ACI-TIPI

Required

for TPI

Possible values Default

value

Chest pain symptoms - Is chest pain/

pressure or left arm pain the patient’s

most important presenting

symptom?

YES NO • Primary complaint

• Secondary complaint

•None

Primary

Complaint

Time since ischemic symptoms onset NO YES • Hour settings ranging

from 0 to 7 hours*

•8+ hours

•Unknown

unknown

Blood Pressure NO YES The HeartStart MRx auto-populates

the NBP value if there is a valid one. If

not, the initial value is unknown and

the starting values for entering an NBP

are 120/80.

Patient history of diabetes NO YES •Yes

•No

•Unknown

unknown

Patient history of hypertension NO YES •Yes

•No

•Unknown

unknown

Patient weight NO YES 50-450 Lbs

(25-225 kg)

Initial value

is unknown.

Starting

menu value

is 160 Lbs

* - If 0-7 hours is selected, a second menu appears, asking you to select the number of minutes in 15-

minute increments.

Acquiring a 12-Lead ECG 13 12-Lead ECG

143

Critical Values

Certain interpretive results generate Critical Value statements which alert you to a condition which

may need immediate attention. The Critical Value statements appear on the bottom of the HeartStart

MRx 12-Lead display in white text on a red background with directional arrows (>>> <<<) on each side

of the statement text.

Acute Myocardial Infarct

If the interpretive statement listed in Table 21 result from measurements generated by an ECG, the

Critical Value statement Acute MI appears on the 12-Lead Report.

Table 21 Acute MI Statements

Interpretive Statement Criteria

Probable anterolateral infarct, acute ST >0.15 mV, V2-V6, aVL

Anterolateral infarct, possibly acute Q >35 mS, ST >0.15 mV, V2-V6, I, aVL

Anterolateral infarct, acute ST >0.20 mV, V2-V6, I, aVL

Anterolateral infarct, acute (LAD) ST >0.20 mV, V2-V6, I, aVL

Probable anteroseptal infarct, acute ST>0.15 mV, T UPRIGHT, V1-V2

Anteroseptal infarct, possibly acute Q>35 mS, ST>0.15mV, V1-V2

Anteroseptal infarct, acute ST >0.20 mV, V1-V2

Anteroseptal infarct, acute (LAD) ST >0.25 mV, V1-V2

Probable anterior infarct, acute ST >0.15 mV, UPRIGHT T, V2-V5

Anterior infarct, acute ST >0.25 mV, V2-V5

Anterior infarct, acute (LAD) ST >0.25 mV, V2-V5

Anterior infarct, possibly acute ST >0.15 mV, UPRIGHT T, V2-V5

Extensive anterior infarct, acute ST >0.20 mV, V1-V6

Extensive anterior infarct, acute (LAD) ST >0.20 mV, V1-V6

Extensive anterior infarct, possibly acute Q>35 mS, ST >0.15 mV, V1-V6

Probable inferior infarct, acute ST>0.10 mV, II III aVF

Inferior infarct, possibly acute Q >30 mS, ST >0.10 mV, II III aVF

Inferior infarct, acute ST >0.10 mV T UPRIGHT, II III aVF

Inferior infarct, acute (RCA) ST >0.10 mV IN III > II

Inferior infarct, acute (LCX) ST >0.10 mV II III aVF, STD V1-V3

Inferoposterior infarct, acute ST >.1 INF, <-.1 V1-3 OR >.05 V7-9

Inferoposterior infarct, acute (RCA) ST >.1 INF, <-.1 ANT

Inferoposterior infarct, acute (LCX) ST >.1 INF, <-.1 V1-3 OR >.05 V7-9

Inferolateral infarct, acute ST >.10 mV, INF-LAT LEADS

Inferolateral infarct, acute (LCX) ST >.10 mV, INF-LAT LEADS

Inferolateral infarct, acute (RCA) ST >.10 mV, INF-LAT LEADS

Probable lateral infarct, acute Q >28 mS, ST>0.10 mV, V5 V6 I aVL

Lateral infarct, possibly acute Q >28 mS, ST > 0.10 mV, V5 V6 I aVL

Lateral infarct, acute ST >.10 mV, V5 V6 I aVL

13 12-Lead ECG Acquiring a 12-Lead ECG

144

Acute Ischemia

If the interpretive statement listed in Table 22 result from measurements generated by an ECG, the

Critical Value statement Acute Ischemia appears on the 12-Lead Report.

Extreme Tachycardia

If the interpretive statements listed in Table 23 result from measurements generated by an ECG, the

Critical Value statement Very High Heart Rate appears on the 12-Lead Report.

Complete Heart Block

If the interpretive statements listed in Table 24 result from measurements generated by an ECG, the

Critical Value statement Complete Heart Block appears on the 12-Lead Report.

Lateral infarct, acute (LAD) ST >.10 mV, V5 V6 I aVL

Posterior infarct, acute ST<-.01 V1-V3 or ST>.05 V7-V9

Probable posterior infarct, acute ST<-.05 V1-V3 or >.05 V7-V9

Posterior infarct, acute (LCX) ST<-.01 V1-V3 or ST>.05 V7-V9

Table 21 Acute MI Statements (Continued)

Interpretive Statement Criteria

Table 22 Acute Ischemia Statements

Interpretive Statement Criteria

Repol abnrm, severe global ischemia (LM/MVD) STe aVR, STd & Tneg, ant/lat/inf

Table 23 Extreme Tachycardia Statements

Interpretive Statements

Extreme tachycardia v-rate > (220-age)

Wide-QRS tachycardia vs-rate > ***, QRSD > ***

Extreme tachycardia with wide complex, no further rhythm analysis attempted

Table 24 Complete Heart Block Statements

Interpretive Statements

AV block, complete (third degree) v-rate < ***, AV dissociation

Complete AV block with wide QRS complex v-rate < ***, QRSD >***, AV dissoc

Atrial flutter/fibrillation with complete AV block

Acquiring a 12-Lead ECG 13 12-Lead ECG

145

Culprit Artery

If your 12-Lead interpretive statement contains an acronym in parenthesis (see Table 25), it is an

indication the analysis is identifying the probable anatomical site of a coronary artery occlusion

responsible for ischemia.

Table 25 Culprit Arteries

NOTE More information on the specificity and sensitivity of these statements can be found in the Physician’s

Reference Guide for the DXL algorithm.

Acronym Probable Anatomical Site

(RCA) Right Coronary Artery

(LAD) Left Anterior Descending

(LCx) Left Circumflex

(LMMVD) Left Main/Multi Vessel Disease

13 12-Lead ECG 12-Lead Report

146

12-Lead Report

The 12-Lead Report View is in a format similar to Monitor View, so that you may monitor the patient

while viewing the report. In this view, the 12-Lead Report replaces Monitoring View’s Wave Sectors 3

and 4, as shown in Figure 69, and includes the following information, if configured:

Measurements - The measurements component of the algorithm generates standard interval and

duration measurements, in milliseconds, limb lead axis measurements, in degrees, and heart rate, in

beats per minute.

Interpretive statements - Measurements and patient information are used by the Philips 12-Lead

DXL Algorithm to generate statements describing the patient’s cardiac rhythm and waveform

morphology. There is also culprit artery detection which locates the probable anatomical site of a

coronary artery occlusion responsible for ischemia. Statements regarding signal quality problems

encountered during ECG acquisition are also included in this section.

Critical Values Statements - The HeartStart MRx displays Critical Value statements to aid in quickly

identifying an interpretation that may mean your patient needs immediate attention. Statements

identify any of four life-threatening conditions: acute myocardial infarction, acute ischemia, complete

heart block and extreme tachycardia. The values appear as white text on a red background. For more

information on Critical Values Statements see “Critical Values” on page 143.

ECG severity - Each interpretive statement on the report has an associated severity. The severities of

all selected interpretive statements are assessed to determine an overall severity for the ECG. The

categories of severity are "Normal ECG," "Otherwise Normal ECG," "Borderline ECG," "Abnormal ECG,"

and "Defective ECG."

Probability of Acute Ischemia - If your HeartStart MRx has the ACI-TIPI and TPI option

configured for use, your 12-Lead Report contains a predicted probability score of Acute Cardiac

Ischemia. The ACI-TIPI score does not appear if you are configured for Auto ACI-TIPI and you get an

Acute MI statement or an ECG severity of normal. If the predicted probability is greater than or equal

to the pre-configured ACI Threshold then results are displayed in white text on a red background.

Stored and printed 12-Lead Reports can be configured to include all 12 leads, measurements,

interpretive analysis statements, ACI-TIPI analysis results, TPI analysis results and TPI

contraindications.

One or two copies of the 12-Lead Report are printed at the completion of acquisition and/or analysis,

as configured. Press the [Print] soft key to print another copy. In addition to the information on

the displayed 12-Lead Report, the printed report includes a rhythm strip with up to three ECG leads.

WARNING • Do not pull on the paper while a report is being printed. This can cause distortion of the waveform

and lead to potential misdiagnosis.

NOTES Should an alarm condition occur while a 12-Lead Report is printing, an alarm strip is not printed,

however, the corresponding ECG waveform is stored and available in the Event Summary.

A 12-Lead report must finish printing before you can acquire a new 12-lead. If you can’t wait, cancel

the printing and acquire the new 12-lead.

12-Lead Report 13 12-Lead ECG

147

Figure 69 Displayed 12-Lead Report

NOTES TPI results and contraindications appear on the HeartStart MRx 12-Lead Report’s printed results and

in transmitted 12-Leads and Event Summaries. They do not appear on the 12-Lead Report displayed

on the HeartStart MRx.

Full interpretive statements appear on the printed strip but may be shortened on the HeartStart MRx

display.

Start

NBP Exit

12-Lead New

12-Lead Print MENU

HR 60

PR 168

QRSD 74

QT 360

QTc 360

--Axis--

P 52

QRS 45

T 41

12345 11-Apr-2009 11:19:00

-ABNORMAL ECG-

Unconfirmed diagnosis

55 years Male

Sinus rhythm

Consider right atrial abnormality

Inferior injury, probable early acute infarct

Ant-sept injurt, probable early acute infarct

Lateral leads are also involved

Acute MI

>>> <<<

Philips Predicted Probability of Acute Ischemia

Interpretive

Statements

ECG

Severity

Critical Value

Statement

Predicted

Probability

of Acute

Ischemia

percentage

Measurements

13 12-Lead ECG 12-Lead Report

148

Accessing Stored Reports

You may access stored reports to print additional copies or delete the report from internal storage. You

may also copy the report to a data card. The list of stored reports for the current patient event may be

accessed while a report is displayed or from either the 12-Lead Acquire Screen or the 12-Lead Preview

Screen. To do this:

1While in 12-Lead, press the Menu Select button.

2Using the Navigation buttons, select Reports.

Reports for the current patient event are listed by date, time and sequence number.

3Use the Navigation buttons to select a report and press the Menu Select button.

4Select Print, Copy, or Delete and press the Menu Select button.

5To select another report repeat steps 1 through 3, or press Exit to close the menu.

Improving Signal Quality 13 12-Lead ECG

149

Improving Signal Quality

Signal quality can impact ECG analysis. Refer to Table 26 for possible solutions to common ECG

quality problems.

Tab le 2 6 ECG S i gn al Pr o b l e m s

Adjusting Wave Size

Adjusting ECG wave size may improve signal viewability. To do this:

1While in 12-Lead, press the Menu Select button.

2Using the Navigation buttons, select ECG Size and press the Menu Select button.

3Using the Navigation buttons, select the desired size value and press the Menu Select button.

The lead size is retained when you exit and then return to 12-lead functionality, without turning

off power for more than 10 seconds.

NOTE Selecting ECG wave size of either 10mm/mV ½ V or 20 mm/mV ½ V displays V leads at half of the

selection, 5 mm/mV and 10 mm/mV, respectively.

Problem Possible Causes Possible Solutions

Tremor or muscle artifact • Poor electrode placement.

• A cold patient.

• Tense, uncomfortable patient.

•Patient tremors.

• Clean the site and reapply

electrodes. Be sure the

electrodes are placed on flat,

non-muscular areas of the

body.

• Warm the patient.

• Reassure and relax the patient.

• Attach electrodes high on the

extremities, near the trunk.

Baseline wander • Patient movement

• Electrode movement. Poor

electrode contact and skin

preparation.

• Respiratory interference.

• Reassure and relax the patient.

• Be sure lead wires are not

pulling on the electrodes.

• Move electrodes away from

areas with the greatest

respiratory motion, if possible.

Power line AC Interference • Poor electrode contact. Dry or

dirty electrodes.

• Interference from poorly

grounded instrument near

patient.

• Reapply electrodes.

• Route electrode wires along

the limbs and away from other

electrical equipment.

Intermittent or jittery waveform • Poor electrode contact.

• Dry electrodes.

• Faulty lead wires

• Clean the site and reapply

electrodes.

• Apply new electrodes.

• Repair or replace faulty leads.

13 12-Lead ECG 12-Lead Filters

150

12-Lead Filters

ECG bandwidth filters of 0.15 - 40 Hz, 0.05 - 40 Hz, or 0.05 - 150 Hz may be selected in

Configuration to apply to 12-lead ECG waveforms shown on the display. Additionally, the 12-Lead

Report may be configured to apply either the same filter choice used for the display, or a 0.05 - 150 Hz

filter. The filter setting for the 12-Lead Report is applied to both printed and stored 12-Lead Reports.

Regardless of filter settings for display or printing, the DXL Algorithm uses the full 0.05 -150 Hz

bandwidth for its analysis. The full bandwidth is also transmitted.

NOTE Although, the 0.05 -150 Hz, or "Diagnostic" bandwidth filter may be selected for the display filter,

LCD display limitations prevent the ECG from appearing in true diagnostic quality.

A filter soft key is available to switch between filter settings during use. When changing the filter

during use, the filter setting is applied to both the display and the 12-Lead Report. The display and 12-

Lead Report filter settings are returned to their configured settings whenever the [New 12-Lead]

soft key is pressed or when the Therapy Knob is moved from the Monitor position.

Troubleshooting

If your HeartStart MRx does not operate as expected during 12-Lead ECG operation, see Chapter 22,

“Troubleshooting” on page 297.

151

14Vital Signs Trending

This chapter describes how to review patient data using HeartStart MRx Vital Signs Trending.

Overview

In Monitor Mode, your HeartStart MRx provides the ability to view and print numeric vital sign

trending for the current incident. Trending data are automatically acquired if parameters are on.

When viewing trending, the Vital Sign Trending Report is displayed in the HeartStart MRx’s lower

two wave sectors and takes over the soft key functions. Trending data are presented at the selected

interval for up to the most recent 12 hours of monitoring. The newest data appear when trending is

initially displayed. The oldest measurements are deleted as needed to store the newest measurements.

Reviewing Trending Data

To review trending data:

1Place the HeartStart MRx into Monitor Mode.

2Press the Menu Select button.

3Using the Navigation buttons, select Tre n d s and press the Menu Select button.

The Vital Signs Trending Report takes over the bottom two wave sectors. See Figure 70.

14 Vital Signs Trending Reviewing Trending Data

152

Figure 70 Vital Signs Trending Report

About The Data Displayed

• When trending is initially displayed, the latest (most recent) trending data will appear in the far

right column.

• The display will auto-update as new vital sign data become available as long as the latest data are

displayed on screen. If you have scrolled left to view older data, the screen will not update to new

data when available. The latest data will be displayed when scrolling back to the most recent data.

• If a parameter has not been measured during the display period, it is not listed in the display.

• If a parameter in the display has invalid information, it is indicated by -?-. Questionable data are

indicated by a question mark just before the numeric value and unavailable data are indicated by an

empty space.

• Aperiodic measurements (e.g. NBP) are displayed with a measurement timestamp below the

readings. A ^ after the timestamp indicates multiple measurements were taken during the interval.

The most recent measurement within the interval is displayed.

• If an inactive parameter becomes active when viewing a Vital Signs Trending Report, the added

parameter will automatically appear in the report when the interval is updated and the latest data is

available.

Parameters - A list of vital signs

monitored by the MRx during the

displayed time period.

Date of report - The earliest time displayed

in the table determines the date of the report.

Trending data - In the body of the

report, vital sign units of measure are

not displayed in the table.

Time intervals - Vital Sign trends are

displayed at the selected time interval. See

“Vital Signs Trending Report Intervals” on

page 153.

120

117

120

Timestamp

indicator -

^ indicates

multiple

measurements

were taken

during interval.

Reviewing Trending Data 14 Vital Signs Trending

153

NOTE When the time interval in the Vital Signs Trending Report is one minute, data from continuous

measurements represents the average reading for that one-minute period. For all other time intervals,

the measurement shown is the one-minute average from the most recent minute in the time interval.

Vital Signs Trending Report Parameter List Order

Vital Signs Trending Reports list parameters in the following order, beginning at the top of the table:

HR, P1, P2, ABP, Ao, ART, PAP, RAP, CVP, LAP, ICP, CPP, NBP, EtCO2, AwRR, SpO2, Pulse,

Temp.

If a parameter has not been measured during the display period, it is not listed in the display.

Scrolling in the Vital Signs Trending Report

Use the [<<] or [>>] softkeys to scroll left and right (backward and forward) in the Vital Signs

Trending Report. The softkey will be displayed as inactive if there is no more data to be viewed in a

particular direction.

If there are more vital signs than can be shown on the screen, use the Navigation buttons next to the

Menu Select button to scroll up and down with the vertical scroll bar on the display. Make sure there is

not a menu active at the same time.

Vital Signs Trending Report Intervals

Vital Signs Trending data can be shown at selected intervals for up to 12 hours of monitoring. You can

adjust the display’s time interval for the current incident to 1, 5, 10, 15, 30 or 60 minutes. The default

is 5 minutes.

Adjusting Vital Signs Trending Report Interval

To adjust the intervals in the Vital Signs Trending report, perform the following steps:

1With Vital Signs Trending active on your display, press the Menu Select button.

2Using the Navigation buttons, select Tre n d I n t e r v a l and press the Menu Select button.

3Using the Navigation buttons, select the trend interval you want and press the Menu Select button.

14 Vital Signs Trending Reviewing Trending Data

154

Printing the Vital Signs Trending Report

You can print the Vital Signs Trending Report two ways:

1Press the soft key under the Print Trends label. A report for the displayed period and interval is

printed.

2Press the Summary button and select Tr e n ds and then Tre n d s I nt e r v al . A report for the entire

incident period is printed.

Figure 71 Sample Vital Signs Trending Report Printout

See “Vital Signs Trending Reports” on page 229 for more information.

NOTE If your device has a 50mm printer its report will have 11 lines of text. If the device has a 75mm printer,

the report contains 16 lines.

DD Mon YYYY HH:MM HR bpm 100 100 100 100 100 100 100

ABPd mmHg 72 72 72 72 72 72 72

P2s mmHg 25 25 25 25 25 25 25

P2sEvent ID: 0302 mmHg 10 10 10 10 10 10 10

26 Apr 10:55 10:50 10:45 10:40 10:35 10:30 10:25

AwRR rpm 12 12 12 12 12 12 12

SpO2 % 100 100 100 100 100 100 100

Temp F 99.0 99.0 99.0 99.0 99.0 99.0 99.0

NBPs mmHg 120 120 117

NBPd mmHg 70 60 64

NBPm mmHg 82 80 81

10:47 10:30 10:23

EtCO2 mmHg 39 3839 36 3935 39

Pulse bpm 95 9595 95 9595 95

P2s

LastName,First Name

mmHg 16 16 16 16 16 16 16

ABPsPatient ID:12345 mmHg 118 118 118 118 118 118 118

M3535A S/N:US00112345

SW Rev: 7.00.00 American English

ABPm mmHg 95 95 95 95 95 95 95

Trend Report 26 Apr

10:55 10:50 10:45 10:40 10:35 10:30 10:25

"page"

Troubleshooting 14 Vital Signs Trending

155

Exiting Vital Signs Trending Report

To exit the Vital Signs Trending Report and return to a waveform display, press the soft key under the

[Close Trends] label in the Vital Signs Trending Report display. You will be returned to

Monitor Mode.

Troubleshooting

If your HeartStart MRx does not operate as expected during Vital Signs Trending, see Chapter 22,

“Troubleshooting.”

157

15Q-CPR and Data Capture

Overview

The Q-CPR option offers real-time measurement and corrective feedback on the rate, depth, and

complete release of compressions, ventilation rate, and lack of CPR activity in accordance with current

CPR guidelines. The feedback can appear on the HeartStart MRx display and on the CPR meter

display (compression feedback only).

Compressions are measured by the CPR meter connected to the HeartStart MRx using a Pads/CPR

meter cable. Ventilation data is acquired through Philips multifunction defib electrode pads applied to

the patient and connected to the HeartStart MRx using the same Pads/CPR cable.

Q-CPR is available in both Manual Defib Mode and AED Mode. In both modes, easy-to-follow visual

indicators and audio prompts provide feedback to the rescuer when CPR performance deviates outside

of target ranges. Feedback from the HeartStart MRx is configurable. Manual Defib Mode provides

advanced feedback while AED Mode can be configured to provide either advanced or basic feedback.

(See the Q-CPR Application Note for more information on Q-CPR.)

The Q-CPR Data Capture option enables you to capture data on CPR quality from the HeartStart

MRx using the Q-CPR option. The option enables the storage of CPR-related data for retrospective

review and analysis in Event Review Pro.

NOTE Q-CPR is not available in 12-Lead Mode and is deactivated when entering Sync Mode.

15 Q-CPR and Data Capture Overview

158

WARNING The Q-CPR option is not intended for use in a moving environment, such as an ambulance.

Additional movement introduced during patient transport may reduce the accuracy of the compression

and ventilation measurements. If Q-CPR must be used in a moving environment, do not rely on the

Q-CPR feedback during such conditions. It is not necessary to remove the CPR meter from the

patient.

Q-CPR is not to be used on patients under 8 years of age or less than 25 kg (55 lbs.).

The Q-CPR option should not be used to verify placement of airway adjuncts, such as endotracheal

tubes and laryngeal masks.

Ventilation feedback accuracy may be decreased when the patient is handled or moved, or when the Q-

CPR option is used on patients with certain conditions such as trauma, seizures, reduced lung volume,

or high cardiac ejections.

CPR is best performed when the patient is lying on a firm surface. If the patient is on a surface that

yields, such as a mattress, compression depth feedback from the CPR meter is inaccurate. Either move

the patient to a rigid surface or slide a backboard under the patient and compensate for mattress

compliance by ensuring that each compression exceeds the minimum depth target shown on the CPR

meter or exceeds the lower line of the depth target zone on the MRx display.

Do not reply on CPR meter feedback during aircraft ascent and descent as its accuracy is reduced in

such conditions.

Do not practice with the CPR meter on a person. The CPR meter can be used with a training manikin

or on a compliant surface for practice.

CAUTION The CPR meter and its Pads/CPR cable can only be used on HeartStart MRx devices with Software

Version F.01 installed. Earlier versions of the Compression Sensor and Pads/CPR cable can’t be used

on a HeartStart MRx with Version F.01 installed. See Figure 72. Institutions with mixed fleets should

develop a way for end users to identify which CPR devices go with which HeartStart MRx units.

The Q-CPR option is not intended for use with any other CPR compression devices.

Figure 72 CPR meter and Sensor Differences

This Pads/CPR meter

connection

must be used with

this CPR meter

on HeartStart MRx

devices with

software version F.01

installed

This Pads/Compression

Sensor connection

must be used

with this

Compression

Sensor

on HeartStart MRx

devices with

software version

9.xx or lower

installed

Preparing to Use Q-CPR 15 Q-CPR and Data Capture

159

Preparing to Use Q-CPR

A Pads/CPR cable connects the CPR meter to the HeartStart MRx. To set up the Q-CPR option on

the HeartStart MRx and prepare the patient for use, follow the steps described on the following pages.

Connecting the Pads/CPR Cable

To connect the Pads/CPR cable:

1Align the white pointer on the cable with the white arrow on the green Therapy port as shown in

Figure 73.

2Insert the cable into the green Therapy port. Push until you hear it click into place. As a time

saving measure, you may choose to always keep your Pads/CPR cable pre-connected to the MRx.

Figure 73 Connecting the Pads/CPR Cable

NOTE The Q-CPR option is operational only when the Pads/CPR cable is connected to the HeartStart MRx.

CPR feedback is not available if the standard pads or paddles cable is connected.

15 Q-CPR and Data Capture Preparing to Use Q-CPR

160

Connecting the CPR Meter to the Pads/CPR Cable

To connect the CPR meter to the Pads/CPR cable:

1Align the arrow on the CPR meter cable with the arrow on the receptacle end of the Pads/CPR

cable as shown in Figure 74. As a time saving measure, you may choose to always keep your CPR

meter cable pre-connected to the Pads/CPR cable.

2Push until you feel it snap into place. There should be no gap between the two connectors.

Figure 74 Attaching the CPR meter to the Pads/CPR Cable

Applying Multifunction Electrode Pads

To apply pads to the patient:

1Check the expiration date that appears on the pads package.

2Inspect the packaging for any damage, then open.

3Connect the pads connector to the Pads/CPR cable. See Figure 75.

Figure 75 Pads Connections

4Apply the pads to the patient in the anterior/anterior position as shown on the pads package.

WARNING Anterior-posterior pad placement should not be used with the Q-CPR option.

CAUTION Philips multifunction defib electrode pads are required to measure ventilation activity, as well as

acquire an ECG signal and deliver a shock, as appropriate.

Pads/CPR

cable

CPR meter

cable

Preparing to Use Q-CPR 15 Q-CPR and Data Capture

161

CPR Meter

The CPR meter is a small, lightweight device that provides CPR feedback in a display area in the line

of sight of the caregiver performing compressions. See Figure 76.

Figure 76 CPR Meter

NOTES Remove the protective film from the CPR meter’s display screen before first use.

To prolong the life of the display, avoid storing the CPR meter where it is exposed to direct sunlight

when not in use.

Status Light

The CPR meter’s status light will be off when the meter is attached to a HeartStart MRx that is turned

off. When the HeartStart MRx is turned on, the CPR meter’s status light turns green to indicate that it

has passed its self test. If the status light is orange or does not light during start-up, see Table 97 to

troubleshoot. The status light turns off once the CPR meter display turns on. The status light turns on

and remains on for 10 seconds after the HeartStart MRx is turned off.

< 8

Manuf ac tured for

PHILIPS MEDICAL SYSTEMS

Andover, MA 01810, USA

by LAERDAL MEDICAL AS, Norway

CPR

meter

REF

453564145481

3.9 - 10 V

max 170mA

FRONT

This surface faces up

Status Light

Display Area

Compression

Area

Placement Guide

Patient Adhesive

Mount Area

BACK

This surface placed on patient

Vent membrane*

* The vent membrane allows internal and

external pressures to equalize.

15 Q-CPR and Data Capture Preparing to Use Q-CPR

162

Attaching the CPR Meter Adhesive Pad

You need to attach an adhesive pad to the back of the CPR meter before using. To attach the CPR

meter Adhesive Pad to the CPR meter:

1Open the package of CPR meter Adhesive Pads and peel one from the liner strip to expose the

adhesive surface on the underside.

2Align the bottom of the patient adhesive with the yellow patient adhesive mount area on the back

of the CPR meter. Make sure the channel on the adhesive (indicated by a dotted line on the front

of the pad) is directly over the visible groove in the plastic. Press into place. See Figure 77. Do not

peel off the green liner from the front of the pad until you are ready to apply the CPR meter to a

patient.

WARNING Check the label on the outside packing to confirm the adhesive pads are within their expiration date.

Do not use pads beyond their expiration date.

Figure 77 CPR Meter Adhesive Pad

WARNING The CPR meter Adhesive Pad is intended for single-patient use only. It should be replaced after each

use.

CAUTION The CPR meter should always be stored with the CPR meter Adhesive Pad in place as described above.

Use of the adhesive pad assists in protecting the vent membrane from getting dirty or damaged.

Preparing to Use Q-CPR 15 Q-CPR and Data Capture

163

Placing the CPR Meter on the Patient

To place the CPR meter on the patient:

1Ensure the patient’s skin is clean and dry. If necessary, clip or shave the hair from the sternum area.

2Peel off the green liner from the CPR meter Adhesive Pad to expose the adhesive surface.

3Position the CPR meter so the compression area is centered between the nipples and on the

centerline of the bare chest as illustrated on the front of the CPR meter and in Figure 78. It is

acceptable if the CPR meter overlaps the defibrillator pad.

Figure 78 CPR Meter Placement

If difficulty is encountered in applying the CPR meter, do not delay CPR. Remove the CPR meter and

begin compressions. If the CPR meter moves during use, reposition it correctly in the center of the

chest.

WARNING Do not apply the CPR meter to an open wound or recent incision site.

Do not use the CPR meter in conjunction with any mechanical or automated compression device.

If the CPR meter stops working, isn’t working as expected or you are uncertain about the patient’s age

or the device fitting properly on the patient, remove the CPR meter from the patient and continue

CPR according to your organization’s protocol.

15 Q-CPR and Data Capture Preparing to Use Q-CPR

164

Starting CPR with the CPR Meter

Using standard CPR technique, place the heel of one hand directly over the compression area of the

attached CPR meter. Place your other hand on top of the first, interlocking your fingers. You should be

able to see the display area of the CPR meter to look for feedback (see Figure 79). Provide chest

compressions according to your organization’s CPR protocol.

Figure 79 CPR and Positioning

When the CPR meter first detects compressions, the display changes to enlarged compression

indicators. See Figure 80. For a list of all feedback displays, see “Feedback Prompts” on page 172.

Figure 80 Beginning Compressions on CPR Meter

Preparing to Use Q-CPR 15 Q-CPR and Data Capture

165

CPR Meter Display

The CPR meter provides real-time graphical feedback as a coaching tool once CPR compressions

begin. See Figure 81.

Figure 81 CPR Meter Indicators

Compression Depth

As you perform CPR on the patient, the CPR meter display tells you what your compression depth is

and if you are not completely releasing pressure after a compression. See Figure 82.

Figure 82 Compression Depth Indicator

Compression Rate Target

Compression

Rate Indicator

Compression

Release Target

Compression

Depth Indicator

Compression

Depth Target

Each compression performed is represented on the

CPR meter display by a moving white compression

depth indicator bar. When the correct compression

depth is achieved, the bottom target lights up. When

the pressure is completely released, the top target

lights up.

If your compression exceeds the compression depth

target (50mm/2 inches), the CPR meter will show the

depth indicator bar below the target area.

If you do not fully release pressure between four

consecutive compressions, the CPR meter display

shows a yellow arrow pointing up to the compression

release target zone. You should allow the chest to

completely recoil between compressions.

If your compression fails to meet the target depth

(40mm/1.5 inches), the compression depth target

zone does not light up. If four consecutive

compressions fail to meet the depth target, a yellow

arrow appears on the display, pointing to the depth

target zone. If the compression depth is not

corrected the HeartStart MRx provides corrective

voice prompts (if configured).

15 Q-CPR and Data Capture Preparing to Use Q-CPR

166

Compression Rate

The CPR meter also provides feedback on your rate of compressions and uses a speedometer to tell you

to speed up or slow down your compression rate. See Figure 83.

Figure 83 Compression Rate Indicator

Table 27 Other Icons Appearing on the CPR Meter Display

If the CPR meter detects the rate of compression is

within the target area, the speedometer needle on the

compression rate indicator points to the green target

zone, which lights up.

If the CPR meter detects your compression rate is

faster than the target rate (120 compressions per

minute), the needle on the compression rate

indicator points to the right of the green target zone.

If the compression rate is not corrected the

HeartStart MRx provides corrective voice prompts (if

configured).

If the CPR meter detects your compression rate is

slower than the target rate (90 cpm), the needle on

the compression rate indicator points to the left of

the green target zone. If the compression rate is not

corrected the HeartStart MRx provides corrective

voice prompts (if configured).

Icon on Display Definition

The CPR meter displays the Do Not Touch The Patient Icon when the

HeartStart MRx provides prompts to stop CPR for analyze of the patient’s heart

rhythm, the HeartStart MRx is charging or advises a shock is required. Stay

clear of the patient when the icon is displayed.

NOTE: Do not remove the CPR meter during rhythm analysis or shock

delivery. Leave the CPR meter on the patient’s chest.

If compressions are stopped for 10 seconds the CPR meter display changes to a

flashing white image to indicate that CPR should be resumed. If compressions

are not resumed, the HeartStart MRx provides voice prompts (if configured)

that no compressions are detected.

The customer service indicator appears only at shutdown when the number of

compressions performed on the CPR meter reaches the device’s service limit.

Take the CPR meter out of service and contact your local response center for

more information.

Q-CPR Feedback on the HeartStart MRx 15 Q-CPR and Data Capture

167

Q-CPR Feedback on the HeartStart MRx

Depending upon how you configure your HeartStart MRx, you can receive a variety of information on

the HeartStart MRx display. Feedback is also displayed on the CPR meter.

On the HeartStart MRx display, Advanced View can be displayed in both Manual Defibrillation Mode

and in AED Mode while Basic View is available in AED Mode only. You can only configure which

view is displayed in Configuration Mode, not during a patient event. See “Configuration” on page 199

for more information.

Advanced View

When configured for Advanced View, the HeartStart MRx can display the following parameters,

depending upon your configuration (See Figure 84 “Advanced Q-CPR View” on page 168):

Compression Waveform

If you do not have an invasive pressure waveform (ABP, ART, Ao or PAP) displayed, the compression

waveform appears in Wave Sector 3 and is labeled Comp. The waveform is drawn at a speed of 12.5

mm/second. As the chest is compressed, the compression is shown as a downward stroke of the wave,

rebounding up to a baseline as compression pressure is released. The wave sector contains lines drawn

at minus 38 mm and minus 51 mm (minus 1.5 inches and minus 2 inches) that define a target zone to

help you achieve good compression depth. Good compression depth is achieved when the peak, or

minimum value, of the waveform appears between the lines. When pressure is not released between

compressions, an asterisk (*) will annotate the baseline segment between compressions. This is also

referred to as “leaning”. If the signal from the CPR meter becomes invalid (e.g., the meter is

disconnected), the waveform appears as a dashed line.

In Manual Defib Mode, if you do have an arterial or pulmonary arterial invasive pressure waveform

displayed, it displays in Wave Sector 3. The compression waveform remains in AED Mode.

•Compression rate

• No flow time

•EtCO

2 numeric (if available)

• Ventilation Rate.

• Ventilation detected icon

•CPR Timer

•Compression Counter

• Compression Wave (if an IBP arterial or pulmonary arterial pressure wave is available it

replaces the Compression Wave)

•CO

2 wave (if available)

15 Q-CPR and Data Capture Q-CPR Feedback on the HeartStart MRx

168

Figure 84 Advanced Q-CPR View

Parameter Block 2

In Advanced View, Parameter Block 2 contains the numeric values for compression rate, as well as

ventilation rate. Both rates are a moving average rate, measured per minute. Based on the Q-CPR

algorithm, the target compression rate is 100 compressions per minute within an acceptable range of

90-120 compressions per minute. The acceptable range for ventilation rate while CPR is being

administered is 4-16 ventilations per minute (to reflect 2005 AHA/ERC resuscitation guidelines).

The acceptable range for ventilation rate following 60 seconds without compressions (such as while

rescue breathing is being administered) is 9-16 ventilations per minute.

11 Feb 2006 22:32

Adult Non- Paced

Alarms Off

HRHR

145 14:02

120120

5050

Start

NBP

Disarm MENU

Stop

CPR

bpm

Mark Event

107

cpm

CO2

Vent rpm

Comp

Compressions: 31

No Flow sec

EtC02 mmHg

Selected Energy: 150 Joules

CPR: 02:30

Shocks: 0

1.5 inches

2.0 inches

Compression

Target Zone

CPR Timer Compression

Counter

Compression

Waveform

Q-CPR Feedback on the HeartStart MRx 15 Q-CPR and Data Capture

169

If your device does not have invasive pressure active, the ventilation detection icon is displayed in

Parameter Block 2 and depicts the level of ventilation volume. A set of lungs graphically shows the

three states of volume: full, empty and questionable (if ventilation cannot be measured, lungs marked

with a “- ? -” appear). A filled ventilation icon indicates a ventilation was detected.

Figure 85 Ventilation Detection Icons

WARNING The graphical display of a set of lungs does not signify the actual filling (ventilation) or presence of

both lungs in the patient. The actual ventilation volume associated with filling of the lung icon will

vary from patient to patient. Actual tidal volumes should be determined based on chest rise.

The HeartStart MRx does not provide feedback on hyperventilation if the transthorasic impedance

signal is too noisy. Proceed doing ventilations according to your organization’s protocol.

Parameter Block 2 also contains a numeric value for No Flow Time. If no compressions are detected,

the No Flow Timer starts. The No Flow Time value is displayed, beginning at 3 seconds and

incremented with each additional second. A voice prompt is given every 15 seconds that compression

activity is not detected. The No Flow Time value is reset when a compression occurs or when the

Shock button on the HeartStart MRx is pressed. If the No Flow Time value exceeds 1 minute, it

is assumed that CPR compression activity has stopped intentionally and the value is reset to two dashes

(- -).

If monitoring CO2, the EtCO2 numeric value is displayed in Parameter Block 2, along with its alarm

limits. Annunciation of alarms is suspended in AED Mode.

Soft Keys

In Advanced View, to stop CPR, press the soft key labeled [Stop CPR].If you want to return to the

Advanced View, press the [Start CPR] soft key.

NOTE Pressing the [Start CPR] soft key turns off the Sync function. Conversely, pressing the Sync

button turns off Q-CPR.

NOTE The [Start CPR] soft key is disabled if patient category is Pedi or patient age is less than 8 years

old.

15 Q-CPR and Data Capture Q-CPR Feedback on the HeartStart MRx

170

Basic View

When selecting Basic View, the HeartStart MRx displays the following parameters, depending upon

your configuration (See Figure 86):

•CPR Timer

• AED and Q-CPR prompt commands. See “Feedback Prompts” on page 172.

Figure 86 Basic Q-CPR View

11 Feb 2006 22:25

Alarms Off

180

02:09

bpm

Mark Event

Shocks: 0

Pads

Resume

Analyzing

COMPRESS FASTER

CPR Timer

Status Bar

AED and

Q-CPR

prompt

area

Using Q-CPR in Manual Defib Mode 15 Q-CPR and Data Capture

171

Using Q-CPR in Manual Defib Mode

When the Therapy Knob is moved to the 150J Manual Defib setting, the Advanced CPR View is

automatically displayed only if the Sync function is disabled, patient category is Adult, and patient age

is equal to or greater than 8 years old. Advanced View is automatically displayed after the Manual

Therapy Security password is entered, only if Manual Defib Mode is password protected.

When the Therapy Knob is located on any other Manual Defib setting, a compression on the CPR

meter turns on Advanced CPR View. Advanced View may also be manually displayed by pressing the

[Start CPR] soft key. Also, the patient category must be Adult and the patient age must be equal

to or greater than 8 years old to display the view for either action.

Wave forms for ECG, invasive pressure (ABP, ART Ao or PAP) and CO2 parameters can be viewed

during the use of Q-CPR. If an ABP, ART Ao or PAP pressure measurement is active, the waveform

always appears in Wave Sector 3 and the pressure value displays in Parameter Block 2. If two pressures

labeled ABP, ART, Ao or PAP are available, the label assigned to Pressure 1 is displayed. If no pressure

is active, then the compression waveform appears in Wave Sector 3. Parameter Block 2 displays

compression and ventilation measurement information. The EtCO2 waveform will appear in Wave

Sector 4 if present. AwRR numeric values are not displayed.

NOTES If the Pads/CPR cable is not connected when you turn the Therapy Knob to Manual Defib Mode, the

message Connect Pads/CPR Cable displays.

When using Q-CPR, SpO2 monitoring functionality is not available.

Compression and ventilation measurement values are printed in the annotation area of the ECG

printed strip.

Using Q-CPR in AED Mode

In AED Mode, CPR feedback is provided automatically during the CPR Pause period of the AED

protocol or manually when the [Pause for CPR] soft key is pressed. If your No Shock Advised

(NSA) Action configuration item is set to provide a CPR Pause interval, Q-CPR can be activated by

delivering a compression with the CPR meter.

As in Manual Defib Mode, voice prompts are issued to guide you if necessary, however, in AED Mode

they are accompanied by a momentary text message appearing on the HeartStart MRx display. A

configurable CPR Timer status bar is also displayed. The time period of the CPR Timer is determined

by the Configuration setting for CPR Pause Time. See Figure 86.

NOTES Basic CPR View in AED Mode displays the ECG waveform only, Q-CPR prompts appear as text on

the display and the compression waveform is not displayed while performing CPR in AED Mode.

If the Pads/CPR cable is not connected when you turn the Therapy Knob to AED Mode, the message

Connect Pads Cable is displayed.

Compression and ventilation measurement values are printed in the annotation area of the ECG

printed strip.

15 Q-CPR and Data Capture Using Q-CPR in AED Mode

172

Feedback Prompts

Table 28 lists the feedback prompts that may be issued during the use of Q-CPR.

Table 28 CPR Feedback Prompts

CPR Component Problem HeartStart MRx

Voice Prompt

Accompanying HeartStart MRx

Text Prompt (Basic View only)

Compression Depth Too shallow Compress deeper Compress deeper

Compression Rate Too slow Compress faster Compress faster

Too fast Compress slower Compress slower

Residual Pressure on the

Patient’s Chest

Incomplete release of

compression (Leaning)

Release pressure between

compressions

Release pressure between

compressions

Ventilation Rate Too high Ventilate less often Ventilate less often

No Compression Activity

15 seconds without sign of

compressions

Fifteen seconds without sign

of compressions

15 seconds without sign of

compressions

30 seconds without sign of

compressions

Thirty seconds without sign

of compressions

30 seconds without sign of

compressions

45 seconds without sign of

compressions

Forty-five seconds without

sign of compressions

45 seconds without sign of

compressions

60 seconds without sign of

compressions

Sixty seconds without sign of

compressions

60 seconds without sign of

compressions

Poor pad/patient contact Pads are on the patient but

impedance is greater than

200 ohms or less than 25

ohms.

Press pads firmly to patient’s

bare chest

Press pads firmly to patient’s bare

chest

Using Q-CPR in AED Mode 15 Q-CPR and Data Capture

173

Adjusting CPR Feedback Volume

To adjust the volume of CPR feedback voice prompts:

1Press the Menu Select button.

2Using the Navigation buttons, select Volume from the menu and press the Menu Select button.

3Select Voice and press the Menu Select button.

4Select the desired volume level and press the Menu Select button.

A sample voice prompt is annunciated to confirm your selection.

NOTE In AED Mode, steps 2 and 3 are not applicable unless Q-CPR is active.

If desired, CPR feedback voice prompts may also be muted. When muted, a CPR Voice Muted text

message displays in the middle of the wave sector containing the compression waveform during

Manual Defib Mode or below the text prompt in AED Mode. CPR inactivity time is indicated by an

audible tone.

To mute the CPR feedback voice prompts:

1Press the Menu Select button.

2Press the Menu Select button again to select Mute CPR Voice.

To resume voice prompts set at the previously selected volume:

1Press the Menu Select button.

2Press the Menu Select button again to select Resume CPR Voice.

NOTE Mute is only available when Q-CPR is active.

15 Q-CPR and Data Capture After Each Use

174

After Each Use

The CPR meter, vent membrane and horizontal groove on the rear of the meter should be inspected

after each use and cleaned if necessary. Remove the CPR meter Adhesive Pad from the CPR meter and

follow the cleaning directions listed in the Maintenance chapter section entitled “CPR meter” on

page 289.

Q-CPR Data Capture

This section describes how to configure Q-CPR Data Capture settings, lists the data and events

recorded, and provides information on reviewing Q-CPR data.

Q-CPR Feedback Setting

You can enable or suppress Q-CPR feedback, while still capturing CPR data. When Q-CPR feedback

is enabled, the MRx displays the CPR view, with accompanying voice and/or text prompts.

When Q-CPR feedback is suppressed, the HeartStart MRx behaves in the following way:

Manual Defib Mode

• The CPR sub view (chest compression waves, compression rate and ventilation rate numerics, and

no-flow time) is not displayed.

•There is no Q-CPR voice or text prompt feedback or storage.

• INOPs regarding ventilation are not displayed.

AED Mode

• For Advanced View, chest compression waves, compression rate and ventilation rate numerics, and

no-flow time are not displayed. (They are never shown in Basic View.)

•There is no Q-CPR voice or text prompt feedback or storage.

• INOPs regarding ventilation are not displayed.

Troubleshooting 15 Q-CPR and Data Capture

175

Data and Events Recorded

With the Data Capture option, the HeartStart MRx records CPR data in all clinical modes when data

recording is active. It will start recording when a CPR meter is detected and stop when the CPR meter

is removed from the HeartStart MRx or the HeartStart MRx leaves a clinical mode. In addition to the

standard HeartStart MRx defibrillation and monitoring events and ECG waveform, the following data

and events related to Q-CPR are captured. Q-CPR feedback prompts are captured if the Q-CPR

Feedback configuration option is set to On. However, these Q-CPR related events are not included in

the Event Summary report printed by the HeartStart MRx.

Table 29 Q-C PR Ca pt ured Da ta

Research Storage Setting

When you enable Research Storage, in addition to the data and events listed in Table 29 the following

data is captured:

• CPR meter acceleration data

• CPR meter force data

• Patient Contact Impedance (PCI) from multifunction electrode pads

Reviewing Q-CPR Data

To review Q-CPR data:

• Copy the event data from the HeartStart MRx internal memory to an external data card. See the

“Data Management” chapter for information.

• Import the data into the Event Review Pro application.

Troubleshooting

If your HeartStart MRx does not operate as expected during Q-CPR, see Chapter 22,

“Troubleshooting.”

Captured Data Description

Compression Waveform Waveform showing compression depth versus time.

Ventilation Waveform Waveform showing change in chest impedance versus time.

Compression event Compression occurs

Ventilation event Ventilation occurs

Compression rate Rate of compressions

Ventilation rate Rate of ventilation

Level 2 feedback Visual feedback on the CPR meter is displayed if some aspect of the CPR

performed does not conform to CPR guidelines.

Level 3 feedback Verbal feedback announced if some aspect of the CPR performed continues to

fall outside CPR guidelines after Level 2 feedback is given.

177

16Networking

The IntelliVue Networking Option allows the HeartStart MRx monitor/defibrillator to connect and

communicate with the Philips IntelliVue M3185 Clinical Network (System J or later) via a wired

network connection or wirelessly. When on the network, the HeartStart MRx performs in a fashion

similar to a bedside monitor - sending waveforms (ECG, Pleth, invasive pressure and CO2) and patient

parameters along with alarm and INOP messages to the Philips IntelliVue Information Center for

monitoring.

Connection to the Information Center allows you to silence certain alarms and send patient

demographic data to the HeartStart MRx from a remote location. Monitoring data can also be sent

from the HeartStart MRx to the patient’s electronic medical record through the IntelliVue HL 7

connection. Defibrillation and pacing capabilities can only be initiated at the HeartStart MRx.

The IntelliVue Networking Option is available in most countries; wireless functionality is available in

the U.S. only.

HeartStart MRx devices that have the IntelliVue Networking Option have an identifying icon placed

on the device’s handle. See Figure 87.

Figure 87 HeartStart MRx with IntelliVue Networking Option

WARNING Before using the HeartStart MRx with IntelliVue Networking Option, you should familiarize yourself

with the operation of the IntelliVue Information Center. Refer to the IntelliVue M3150 Information

Center Instructions for Use.

150

200

170

120

100

dult

AED

onitor

acer

16 Networking IntelliVue Networking Display

178

IntelliVue Networking Display

When in a clinical mode, the status area of the HeartStart MRx with IntelliVue Networking Option

provides network-related data (see Figure 88) including:

Network Connectivity Icon An icon indicating a wired or wireless Local Area Network (LAN)

connection is displayed. It is located on the display’s top line, to the left of the bed/equipment label.

See Table 30.

Table 30 Icon Definitions

Bed/Equipment Label The HeartStart MRx equipment label is displayed when the device is not

connected to the network. The equipment label will be replaced by a bed label when connected to the

network.

Figure 88 HeartStart MRx With IntelliVue Networking Option Status Area

NOTE For a description of other information in the status area, refer to “Getting Acquainted” on page 7.

Symbol Definition

No symbol No connection/association with the Information Center is established.

Connected. A wired connection is established. The HeartStart MRx is

assigned to a sector and is being monitored by the Information

Center.

Connected. A wireless connection is established. The HeartStart MRx

is assigned to a sector and is being monitored by the Information

Center.

Extreme Tachy

Mark Event Bed5678901

ECG Unplugged

Network Connectivity Icon Bed/Equipment Label

Connecting to the Network 16 Networking

179

Connecting to the Network

There are two aspects to getting your HeartStart MRx up and active on the IntelliVue Network. Both

need to be in working order before your HeartStart MRx can be used on the IntelliVue Network.

1Configure the device and the IntelliVue Network to “talk” with each other. See "Configuring to

Work on the Network" on page 181.

2Physically connect your device to the IntelliVue network. See "Physical Connections" below.

Physical Connections

You can physically connect your HeartStart MRx to the network in three different configurations:

1“Wired.” An IntelliVue Network LAN cable is plugged into the RJ 45 connector (labeled “LAN”)

on the back of the HeartStart MRx. See "Wired Connection" on page 180.

2“Wireless.” Philips’ Instrument Telemetry 1.4 GHz radio and A/C module (radio/AC power module

backpack) is mounted on the HeartStart MRx and plugged into the RS-232 connector. See

"Wireless Connection" on page 180.

3A combination of wired and wireless. The wired LAN and wireless radio/AC power module are

physically connected to the device at the same time. See "Combined Connection" on page 181.

CAUTION The radio module operating in the Wireless Medical Telemetry Service 1.4 GHz frequency is limited

by US FCC 47 CFR Part 95 to operation and use in healthcare facilities only. Use in ambulances or

other vehicles is prohibited.

If a HeartStart MRx M3535A leaves the healthcare facility, disconnect the radio module from the

device.

Do not place the radio module on the HeartStart MRx M3536A.

NOTE The IntelliVue Networking option is not available with the Batch LAN Data Transfer option.

16 Networking Connecting to the Network

180

Wired Connection

To connect your HeartStart MRx to the network using a wired connection, plug an active IntelliVue

Network cable into the LAN port on the back of the device. See Figure 89.

Figure 89 Wired Connection Physical Setup

Wireless Connection

The radio/AC power module snaps into the back of the HeartStart MRx and connects to the device

using an RS-232/DB 9 connection. See Figure 90. Your institution must have a 1.4 GHz frequency

wireless network to use this function. To connect your HeartStart MRx to the network using a wireless

connection, make sure the device is off then insert the radio/AC power module into Compartment B

and press in until you hear it click. Then plug the RS-232 connector into the RS-232 port on the

HeartStart MRx and tighten the screwlocks. Do not wiggle the connections. Turn the device on.

Figure 90 Wireless Connection Physical Setup

NOTE Be sure to fully connect the wireless radio/AC module to the HeartStart MRx before turning the device

on. Failure to do so will prevent the HeartStart MRx from detecting the module. If you connect the

wireless radio/AC module to the device after it has been turned on, turn the power off for 10 seconds.

When you restart the HeartStart MRx, it finds the wireless module and starts a new patient incident.

On the display:

The wired icon appears on your display in

all clinical views indicating a wired connection to

the network. Data can be exchanged with and

viewed at the Information Center.

On the display:

The wireless icon appears on your

display in all clinical views indicating a

wireless connection to the network. Data can

be exchanged with and viewed at the

Information Center.

Connecting to the Network 16 Networking

181

Combined Connection

In instances when you have both wired and wireless connections available (See Figure 91), the wired

connection takes priority.

NOTE If you lose the wired connection, the device automatically attempts to connect to the network via the

wireless radio/AC module. If the radio/AC module is not connected to the device when you lose your

wired connection, you will not automatically switch over to wireless operation. You must plug the

module in and restart the device (turn it off for 10 seconds) before obtaining a wireless connection.

Figure 91 Simultaneous Wired and Wireless Physical Network Connections

WARNING The HeartStart MRx LAN port is intended for connection to the IntelliVue Clinical Network or for

Batch LAN Data Transfer. It should only be used for connection to devices that comply with IEC

60950-1 and IEC 60601-1. During real-time patient monitoring, the HeartStart MRx wired LAN

connector should only be connected to the IntelliVue Network. For post-event Batch LAN Data

Transfer, the HeartStart MRx should only be connected to the facility network.

The RS-232 Serial Port is intended for connection to the IntelliVue wireless backpack. It is also for

connecting with the Rosetta-Lt and cellphones for data transmission. Improper system operation may

result if any other device is connected to this port.

NOTE Regardless of a wired or wireless connection, the HeartStart MRx provides the same level of network

functionality. The device sends up to four waveforms (except Q-CPR) and a maximum of seven alarms

to the Information Center. All arrhythmia processing and controls reside with the HeartStart MRx.

Configuring to Work on the Network

Before you can use the HeartStart MRx on the IntelliVue Network, it needs to be correctly configured

AND the IntelliVue Information Center needs to be properly set up to accept the HeartStart MRx. For

HeartStart MRx configuration instructions, see the HeartStart MRx Service Manual. To access

configuration options on the HeartStart MRx, see “Troubleshooting” on page 197. For instructions on

how to set up the IntelliVue Information Center, see the IntelliVue Information Center System

Installation and Service Manual.

On the display:

When both wired and wireless connections

are available, the wired connection takes

priority. Only the wired icon appears on your

display (in all clinical views). The icon

indicates data can be exchanged with and

viewed at the Information Center.

16 Networking Connecting to the Network

182

Using the Device Location Option

A HeartStart MRx that is powered on and has an active wireless connection to the IntelliVue Clinical

Network can be located by using the Information Center’s Device Location option. The Device

Location option allows you to identify the general location of your HeartStart MRx by associating the

device with network access points installed in the healthcare facility. These access points provide

communication pathways between the HeartStart MRx and the Information Center.

WARNING Because the coverage range of access points can sometimes overlap, including floor levels, the Device

Location feature is not intended for use when attempting to locate a patient.

There are device prerequisites for the Device Location function to work. See Table 31. For further

Device Location information, see the IntelliVue M3150 Information Center Instructions for Use.

Table 31 Device Location prerequisites

NOTE The HeartStart MRx does not verify the above mentioned firmwares are at the correct levels. To

confirm firmware versions on the HeartStart MRx, enter Service Mode and highlight Instrument

Telemetry. Press the Menu Select button and wait for the version numbers to appear.

At the ... Prerequisite

HeartStart MRx

The device must have software Version 9.xx or Version F.xx installed

The device’s radio module must have Instrument Telemetry

Subsystem firmware revision A.00.17 or greater.

The device’s radio module must have Instrument Telemetry

Subsystem radio firmware revision A.00.52 or greater.

IntelliVue Network

The Information Center needs to be configured for the Device

Locator functionality.

Access Point firmware must be A.00.54 or greater.

Connecting to the Network 16 Networking

183

Network Settings

You can view your current network settings in Monitor, Pacer and Manual Defib modes. To view

current network settings, perform the following:

1Press the Menu Select button.

2Using the Navigation buttons ( and ), select Other and press the Menu Select button.

3Select Network Settings and press the Menu Select button. See Figure 92 and Table 32.

Figure 92 Network Settings Display

Table 32 Network Settings Parameters

Network Settings

onn

ion

ess

0009

B03

A015

MAC Instr. Tele. : 0009 FB16 0035

ccess

ess

172

ubn

ask

255

240

SSI

Field Description

Connection Displays current connection status: Wired, Wireless, or Inactive

MAC Address HeartStart MRx MAC address (wired)

MAC Instr. Tele. Instrument Telemetry Radio Module MAC address

RF Access Code Used to identify which RF (radio frequency) channel the HeartStart MRx-Information

Center wireless communications use (Set in Configuration Mode.)

IP Address Current IP address - HeartStart MRx (wired) or Radio Module (wireless)

Server IP Information Center IP address

Subnet Mask Subnet mask of wired or wireless network

RSSI Instrument Telemetry Radio’s Received Signal Strength Indicator (Value updates while

window is open)

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Admit, Discharge, Transfer of Patients

A HeartStart MRx with the IntelliVue Networking Option synchronizes and maintains common

patient demographic data with the Information Center. The HeartStart MRx can admit, discharge and

transfer (ADT) patients to or from the Information Center and update or modify patient information.

The HeartStart MRx will also accept certain patient admission data entered at the Information Center

including name, medical record number (patient ID), patient type (category), date of birth, gender

(sex) and paced status. It does not display height or weight from the Information Center.

Admit

The HeartStart MRx displays physiological data and stores it as soon as a patient is connected. This

allows you to monitor a patient who is not yet admitted. You need to admit patients properly so you

can correctly identify your patient on recordings, reports and network devices.

The HeartStart MRx admits patients by entering one or more of the following: patient name, patient

ID, date of birth or sex. You can’t admit a patient by changing patient type (category) or paced status.

To admit a patient from the HeartStart MRx, perform the following steps:

1Press the Menu Select button.

2Using the Navigation buttons, select Patient Info and press the Menu Select button (See Figure 93).

3Select Name, ID, Date Of Birth or Sex and press the Menu Select button.

4Enter the appropriate information and press the Menu Select button.

5A Patient Admitted momentary message displays on the device when a patient is admitted.

Figure 93 Admitting a Patient

NOTE When admitting a patient from the HeartStart MRx, if you enter a Patient ID but do not enter a last

name, the last name is set to “---”. If you enter a first name, date of birth or sex and not a last name or

ID, the last name is set to “---”, the Patient ID is set to the HeartStart MRx Event ID and the Patient

ID is sent to the Information Center. If you enter only a last name, no other patient information fields

are affected. Patient ID is left blank. Once admitted, the last name field can not be cleared. If the field

is cleared, (“---” in the field is acceptable and not considered cleared), the device will retain the previous

last name and display a momentary message “Last name must not be blank.”

Main Menu

Volume

Displayed Waves

Printed Waves

Measurements/Alarms

Patient Info

Trends

Other

High Contrast On

Exit

Patient Info

Discharge Patient

Name

Patient Category

Date of Birth

Sex

Paced

Exit

Last Name

Backspace

Cancel

Done

Page 1 of 4

Last Name

Jones _

Patient Admitted

Admit, Discharge, Transfer of Patients 16 Networking

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WARNING Patient Type and Paced status will always have a value, regardless if the patient is admitted or not. If

you do not specify settings for these two fields, the HeartStart MRx uses the default settings, which

may not be correct for your patient. Changing a patient’s type may change algorithms and alarm limits.

For internally paced patients, you must set Paced to Yes. If incorrectly set to No, the device may

identify a pace pulse as a QRS and not alarm during asystole.

Discharge

Discharge Patient is used to:

• Clear patient information

• Close a patient data record

• Reset patient type, paced status, alarm settings and all other MRx settings to default values

• Discharge a patient from the Information Center, if connected

CAUTION Discharging from the HeartStart MRx clears all data from the Information Center. To save event data

at the Information Center, use the Information Center to discharge the patient.

Discharge Patient is an option whether a patient is admitted or not, whether the device is connected to

the Information Center or not, or if in Transfer Mode. Discharge Patient is not available in Pacer,

Manual Defib, 12-Lead or AED modes. At the Information Center, Discharge Patient - except for the

Discharge for Transport function - is not available when the HeartStart MRx is in Pacer, Manual Defib

or AED modes.

NOTE You should always perform a discharge, even if your previous patient was not admitted, to clear out

patient data and reset all settings at the HeartStart MRx and Information Center.

To access Discharge Patient, perform the following steps:

1Press the Menu Select button.

2Using the Navigation buttons, select Patient Info and press the Menu Select button.

3Select Discharge Patient and press the Menu Select button.

4Your screen will display one of two Discharge Patient messages (see Table 33) and prompt you with

a Discharge Patient? question.

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Table 33 Discharge Patient Messages

5Select Yes to discharge the patient, No to cancel discharge. See Figure 94.

Figure 94 Discharge Patient Confirmation

Network Status Discharge Patient Message

Connected to network The patient demographics and all patient data will be closed in the

MRx and erased in Central and settings reset to defaults.

Not connected to network All trends, events and patient identification of the current patient

will be closed and settings reset to defaults.

Discharge Patient?

Discharge Patient

The patient demographics and all patient data

will be closed in the MRx and erased in Central

and settings reset to defaults.

Admit, Discharge, Transfer of Patients 16 Networking

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If a patient discharge is confirmed:

1The current patient incident is closed.

2The HeartStart MRx sends the discharge command to the Information Center (if connected) then

automatically shuts down and restarts. While shutting down, the display will go black. You can

turn the device off at this point. If you do not turn the device off, a Patient Discharged message

will appear on the screen until the HeartStart MRx restarts. Upon restart, the patient name is

displayed as “Not Admitted”. Patient type, paced status, and alarm limits are all reset to default

values. Other patient information is cleared.

NOTE Data related to previous patient incidents must be accessed through Data Management. Refer to the

HeartStart MRx Instructions for Use.

Transfer

The Transfer option is used to transfer the current patient’s data to another location on the IntelliVue

Network by moving the patient to the transfer list at the Information Center.

To access Transfer, perform the following steps:

1Confirm that the HeartStart MRx is on the network, not already in Transfer Mode and the patient

has been admitted. (The patient’s name or “---” is displayed.)

2Press the Menu Select button.

3Using the Navigation buttons, select Patient Info and press the Menu Select button.

4Select Transfer and press the Menu Select button.

5The Transfer Patient message (see Figure 95) prompts you with a Transfer Patient? question.

Figure 95 Transfer Patient Confirmation

6Select Yes to transfer the patient, No to cancel transfer.

When a patient transfer is confirmed, the patient is discharged to the transfer list at the Information

Center and the HeartStart MRx enters Transfer Mode. “Prepared for transfer” is displayed above the

patient name. The HeartStart MRx continues to store data that can be accessed through the Data

Management feature.

Transfer Patient?

Transfer Patient

The patient will be discharged to the transfer

list in the Central and the MRx will enter

transfer mode.

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Transfer Mode

Transfer Mode is used to hand off patient data from one monitoring location to another. While in

Transfer Mode patient information can’t be modified. The HeartStart MRx continues to send data to

the Information Center without an associated patient name. The data is not associated with the patient

now on the transfer list. Patient data can be identified by a unique bed label common to both the

HeartStart MRx and the specific data sector being monitored at the Information Center.

Re-admit Patient

If you need to re-admit a patient, the Re-admit function restores patient data. It moves the patient off

the Information Center’s transfer list back into the corresponding Information Center sector, when

connected to the network.

To select Re-admit perform the following steps:

1Press the Menu Select button.

2Using the Navigation buttons, select Patient Info and press the Menu Select button.

3Select Re-admit and press the Menu Select button.

When Re-admit is selected, your screen displays the Re-admit Patient message (see Figure 96) and

prompts you with a Re-admit Patient? question. Select Yes to re-admit the patient, No to cancel re-

admission.

Figure 96 Re-admit Patient Confirmation

Re-admit Patient?

Re-admit Patient

This patient will be re-admitted to the MRx

and transfer mode will be exited.

Admit, Discharge, Transfer of Patients 16 Networking

189

Clear Transfer

Clear Transfer exits the HeartStart MRx’s Transfer Mode after losing connection to the network.

Demographic or patient data remain in the Information Center’s transfer list and are maintained at the

HeartStart MRx.

To select Clear Transfer perform the following steps:

1While in Transfer Mode, press the Menu Select button.

2Using the Navigation buttons, select Patient Info and press the Menu Select button.

3Select Clear Transfer and press the Menu Select button.

When Clear Transfer is selected, the message “Transfer mode will be exited.” is displayed (see Figure

97). The display prompts you with a Clear Transfer? question. Select Yes to clear transfer, No to

remain in transfer mode.

Figure 97 Clear Transfer Confirmation

Automatic Re-Admit

If a lost network connection between the HeartStart MRx and Information Center is restored while in

Transfer Mode, the patient is automatically re-admitted from the transfer list. The HeartStart MRx

exits Transfer Mode.

Turning the HeartStart MRx Off

When the HeartStart MRx is turned off or enters a non-clinical mode (i.e. Data Management,

Operational Check, Battery Calibration, Configuration or Service modes) while in Transfer Mode the

current patient incident is closed and the HeartStart MRx exits Transfer Mode. The patient remains

on the Information Center’s transfer list. When the HeartStart MRx is turned back on or you re-enter

a clinical mode, patient information is reset to device defaults and the patient state is Not Admitted.

Clear Transfer?

Clear Transfer

Transfer mode will be exited.

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Sharing Information on the Network

Once connected to the IntelliVue Network, the HeartStart MRx shares information and data with the

Information Center. You can also silence and reset most alarms remotely from the Information Center.

Patient Information

Updates

After the HeartStart MRx makes a network connection with the Information Center, all patient

information (except height, weight, screen notes and care group which are not available on the

HeartStart MRx) entered at one location is automatically reflected at the other.

Date Of Birth

The HeartStart MRx with IntelliVue Networking Option allows you to enter a patient’s date of birth.

Without the IntelliVue Option, you enter the patient’s age. The valid range for date of birth is the

current date to 150 years ago.

The patient’s date of birth is unpopulated until entered. To enter the date of birth for a patient,

perform the following:

1Press the Menu Select button.

2Using the Navigation buttons, select Patient Info and press the Menu Select button.

3Select Date Of Birth and press the Menu Select button.

– If the patient type is adult, the default menu option will be the current month and day, 50 years

ago.

– If the patient type is pediatric, the default menu option will be the current month and day, 7 years

ago.

4Using the Navigation buttons enter the date of birth and press the Menu Select button.

The date of birth will automatically be converted to an age for 12-Lead reports. Only the age will be

displayed in the 12-Lead screen, printed on and stored with 12-Lead reports.

NOTE The HeartStart MRx supports adult and pediatric patient categories only. If the Information Center

sends a neonatal patient type to the HeartStart MRx (this possibility exists only if a neonatal patient is

admitted by a networked patient monitor which allows a neonatal status and then the monitor is

replaced on the network by the HeartStart MRx), the HeartStart MRx modifies the setting to pediatric

and sends it back to the Information Center.

Sharing Information on the Network 16 Networking

191

Date and Time

In instances where the HeartStart MRx’s date and time are not in agreement with the Information

Center, the HeartStart MRx automatically synchronizes its date and time to match the Information

Center’s. The date and time displayed in the HeartStart MRx’s status area reflect the new time.

When a time change occurs:

• Event Summary Report start times are adjusted and a “?” is placed in front to indicate the time

change.

• The date and time printed in the waveform header prior to the time change are updated based on

the new time and a “?” placed in front.

• Timestamps related to events prior to the time change are updated based on the new time and a “?”

placed in front.

• When a time change occurs while you are printing a Trends Report, the printing stops because the

printed time frame no longer matches the displayed timeframe.

• In the Trends Display and printed Trends reports, the interval times prior to and including a time

change event and NBP timestamps will be updated based on the new time and a “?” placed in front.

• While a strip is printing, the change is reflected in the next header.

• For 12-Lead reports:

– If you do not have any 12-Lead reports saved for the current incident, the next 12-Lead report is

updated with the new date and time.

– If you have one or more 12-Lead reports saved for the current incident, the date and time for new

12-Lead reports during the same incident are not updated to reflect the time change. The new

reports retains the same time sequence as the saved 12-Lead reports to preserve the report order.

• Timestamps for the last invasive pressure zero and calibration along with a displayed NBP

measurement occurring prior to a date/time change are not updated on your display. However, both

are updated in the Event Summary. All timestamps of non-clinical events (events that occur outside

of a patient incident such as NBP and CO2 calibration, Operational Check, and Automated Tests)

indicate the HeartStart MRx’s time when the event occurred.

Apnea time is based on elapsed time and is not affected by a time change.

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Conflict Handling

Conflicting patient information between the Information Center and the HeartStart MRx is

automatically resolved (using the Information Center’s “Same Patient” Conflict Resolution) when the

HeartStart MRx associates with the Information Center.

If patient information on the HeartStart MRx has changed as a result of the resolution, the message

“Patient information from the MRx and Central has been merged” and a menu to confirm or edit patient

info appear in all modes, except AED (see Figure 98). When in AED Mode, only the “Patient

information from the MRx and Central has been merged.” message appears on the display for 10 seconds.

Figure 98 Patient Information

Press the Menu Select button to confirm the information.

If you wish to edit the information, use the Navigation buttons to highlight Edit Patient Info and press

the Menu Select button. The Edit Patient Info menu is displayed. See Figure 99.

Figure 99 Edit Patient Info

Any selection from the Edit Patient Info menu brings up a screen for modifying the selection. After

modifying the information and closing the screen, the Patient Information merged menu will reappear

with the new patient information included. The Information Center is also updated with the modified

information.

NOTE The Patient Merged and Edit Patient Info menus are removed from the screen when you change

displayed views.

Edit Patient Info

Confirm

Last Name: Jones

First Name: Samuel

ID: 1234567890123456

Patient Category: Adult

DOB: 25 Jan 1977

Sex: Male

Paced: No

Patient information from the MRx

and the Central has been merged

Edit Patient Info

Name

Patient Category

Date of Birth

Sex

Paced

Sharing Information on the Network 16 Networking

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Viewing Patient Incident Data

While at the Information Center, you can view patient incident data sent from the HeartStart MRx.

Refer to the IntelliVue Clinical Information Center Instructions for Use for details. Up to 30 single-

valued and/or tripled-valued parameters, up to four waveforms (except for Q-CPR) and seven alarms

are viewable at the Information Center. The waveforms that appear at the Information Center are

determined by the Information Center’s wave wishlist.

Alarms

If configured, you can silence/reset HeartStart MRx alarms and INOPs from the Information Center.

Refer to the IntelliVue Information Center Instructions for Use for details. As they do on the HeartStart

MRx, alarms will re-sound after two minutes if the condition is not cleared.

NOTE Pacing Stopped, Batteries Low and Defib Shutdown alarms result in Red INOPs that can’t be silenced at

the Information Center. Pacer Output Low alarm results in a Yellow INOP that can’t be silenced at the

Information Center. All four alarms must be silenced at the HeartStart MRx.

Printing

When the HeartStart MRx prints data and information, it prints to the 50 mm or 75 mm printer

installed in the device, not a printer located on the institution’s network. Alarm recordings are

configured at the HeartStart MRx and sent to the Information Center central recorder (if present).

Once alarm recordings are configured at the HeartStart MRx they can be controlled at the Information

Center from the Record/Store tab under All Controls. Vital Signs Trending Reports generated by the

HeartStart MRx can only be printed at the device.

Turning a Networked Device Off

If a networked HeartStart MRx is turned off, wave and alarm data may be displayed at the Information

Center for 10 more seconds. After 10 seconds, a No data from bed INOP statement appears on the

Information Center display. The current patient incident is closed at the HeartStart MRx. The patient

is not discharged from the Information Center.

If the HeartStart MRx is turned back on, the ADT state is initially set to Not Admitted. Patient type,

paced status and alarm limits are reset to their default settings. If the patient is still admitted at the

Information Center, the HeartStart MRx is updated with patient information from the Information

Center. The ADT state is reset to “admitted.”

In the event the HeartStart MRx loses its network connection with the Information Center, and both

devices are still powered on, the devices retain the patient’s status and other settings when a network

connection is restored.

NOTE Prior to monitoring a new patient with the HeartStart MRx, you should discharge the old patient to

ensure that all old data at the Information Center are removed.

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Leaving a Clinical Mode

If a networked HeartStart MRx is changed to a non-clinical mode (i.e. Data Management, Operational

Check, Battery Calibration, Configuration or Service modes) a “No data from bed” INOP statement

appears on the Information Center display. The current patient incident is closed at the HeartStart

MRx. The patient will not be discharged from the Information Center. If you re-enter a clinical mode,

the ADT state is initially set to Not Admitted and patient type (category), paced status and alarm limits

are reset to their default settings. If the patient is still admitted at the Information Center, the

HeartStart MRx is updated with patient information from the Information Center. The ADT state is

reset to “admitted.”

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Events Logged

The HeartStart MRx automatically creates an Event Summary for each patient incident. Each Event

Summary is assigned a unique event identification number and is date/time stamped.

Table 34 lists IntelliVue Networking-related events and information stored in the Event Summary.

Refer to the "Working with Data" chapter of the HeartStart MRx Instructions for Use for a complete

listing of all events stored.

Table 34 IntelliVue Networking Events Logged

* See Table 99for causes and possible solutions to these logged events.

INOPs, Alarms and Messages at the Information Center

Most HeartStart MRx alarms, INOPs and messages display at the Information Center in their entirety

or in an abbreviated form. Table 35 lists alarms, INOPs and messages that appear differently at the

Information Center. Refer to “Troubleshooting” on page 297 for a full list of alarms, INOPs and

messages.

Logged Event Frequency

Audio Paused by Central Logged when alerts are silenced/reset from the Information Center.

Time changed from (with

original device time)

Logged when the HeartStart MRx time and date are synchronized to

the Information Center time.

Date of Birth (day, month,

year)

Logged when the Date of Birth is set or changed.

Central Monitoring Active Logged when the HeartStart MRx associates with the Information

Center.

Patient Discharged Logged when the patient is discharged.

No Central Monitoring* Logged when event occurs depending upon configuration - “Central

Monitoring Mandatory”

Radio Malfunction* Logged when event occurs. (INOP detected)

Radio Unplugged* Logged when event occurs. (INOP detected)

Radio Weak Signal* Logged when event occurs. (INOP detected)

All ECG Alarms Off* Logged when event occurs. (INOP detected)

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Table 35 HeartStart MRx Messages at the Information Center

HeartStart MRx Information Center

Defibrillation/Pacing

Alarm/INOP Type Alarm/INOP Type

Charge Button Failure Hard INOP Defib Malf Hard INOP

Shock Button Failure Hard INOP Defib Malf Hard INOP

Shock Equip Malfunction Hard INOP Defib Malf Hard INOP

Pacer Equip Malfunction Hard INOP Defib Malf Hard INOP

Therapy Knob Failure Hard INOP Defib Malf Hard INOP

Therapy Cable Failure Hard INOP Defib Malf Hard INOP

Pacing Stopped. Pads Off. Red Alarm ! ! ! Pacing Stopped Red INOP

Pacing Stopped. Device Error. Red Alarm ! ! ! Pacing Stopped Red INOP

Pacing Stopped. Pads Cable Off. Red Alarm ! ! ! Pacing Stopped Red INOP

Pacing Stopped. Leads Off. Red Alarm ! ! ! Pacing Stopped Red INOP

Pacing Stopped. Power Interrupted. Red Alarm ! ! ! Pacing Stopped Red INOP

Other INOPs

Batteries Low Hard INOP Batteries Low Hard INOP

Batteries Low (while Pacing on batteries) Red Alarm ! ! ! Batteries Low Red INOP

Bluetooth Malfunction Hard INOP Check Device Hard INOP

Event Storage Full Soft INOP Check Device Soft INOP

Fan Failure Hard INOP Check Device Hard INOP

Internal Memory Failure Hard INOP Check Device Hard INOP

Radio Malfunction Hard INOP Check Device Hard INOP

Radio Unplugged Hard INOP Check Device Hard INOP

Power Supply Failure Hard INOP Defib Malf Hard INOP

Replace Clock Battery Hard INOP Check Device Hard INOP

Printer INOPs

Incompatible Printer Hard INOP Check Device Hard INOP

Check Printer Hard INOP Check Device Hard INOP

Printer Temperature High Hard INOP Check Device Hard INOP

Printer Malfunction Hard INOP Check Device Hard INOP

Printer Not Ready Soft INOP None NA

Other HeartStart MRx Messages

Pacing on Batteries Message only Pace on Batteries Soft INOP

Shutting Down 1 Min Message only ! ! ! Defib Shutdown Red INOP

Shutting Down Now Message only ! ! ! Defib Shutdown Red INOP

Power Interrupted. All settings have

been reset to default values.

Message only Check Settings Hard INOP

Device Restarted. All settings have

been reset to default values.

Message only Check Settings Hard INOP

Troubleshooting 16 Networking

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Troubleshooting

If your HeartStart MRx does not operate as expected while trying to communicate with the IntelliVue

Network, see “” on page 314 and “Network Connection Rejection Messages” on page 317.

199

17Configuration

This chapter describes the configurable parameters of the HeartStart MRx and the procedures for

modifying configuration.

Overview

Configuration settings allow you to customize the HeartStart MRx to best meet your needs.

Configuration is performed through the Configuration menu of the device and may be saved to a data

card for replication on multiple devices. At any time, configuration settings may be viewed and

exported to a data card, and the date and time may be changed. However, a password is required to

change the configuration of the device.

Accessing the Configuration Menu

To access the Configuration Main menu:

1Turn the Therapy Knob to Monitor.

2Press the Menu Select button.

3Using the Navigation buttons, select Other and press the Menu Select button.

4Using the Navigation buttons, select Configuration and press the Menu Select button.

To return to normal operating mode, press the [Exit Config] soft key.

The Configuration Main menu is displayed, listing sub-menus for each category of configurable

parameters. You may use this menu to view or print your device’s configuration, as well as to modify

the date and time settings. To modify any other settings, you must enter the configuration password

printed on the front of the HeartStart MRx User Documentation CD-ROM.

WARNING The HeartStart MRx should never be connected to a patient while performing configuration activities.

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200

Setting the Date and Time

To modify the date and time setting from the Configuration menu:

1Press the Menu Select button.

2Using the Navigation buttons, select Date and Time. Then press the Menu Select button.

3Using the Navigation buttons, adjust the value for the year. Then press the Menu Select button.

4Select the appropriate month. Then press the Menu Select button.

5Adjust the value for the day. Then press the Menu Select button.

6Adjust the value for the hour. Then press the Menu Select button.

If the device is configured to use a 12-hour clock format, am or pm is displayed next to the hour.

For a 24-hour format only the hour is shown, with choices from 0 to 23.

7Press the [Exit Config] soft key if finished with configuration.

Date and time should be changed to correspond with local clock changes for Daylight Savings Time

and Summer Time.

Modifying Settings

When modifying configuration settings, the device should be connected to external power and have a

battery with at least 20% capacity installed. To modify configuration settings, from the Configuration

Main menu:

1Press the [Change Config] soft key.

2When prompted, enter the configuration password.

3Press the Menu Select button. Use the Navigation buttons to select the sub-menu for the

category of parameters to be changed. Then press the Menu Select button.

4Use the [Prev Item] and [Next Item] soft keys to select a parameter.

5Use the Navigation buttons to highlight the desired choices. Press the Menu Select button to select

the highlighted choice.

6Repeat steps 3, 4 and 5 to select another sub-menu and modify additional settings.

7Once the desired setting changes have been made, from the Configuration Main screen, press the

[Save Changes] soft key.

You may press the [Cancel Changes] soft key to return to the previous settings.

8Press the [Exit Config] soft key to return to normal operating mode.

If you press [Exit Config] before saving the changes, you are prompted with the message

Configuration Not Saved - Exit Anyway? Select No and press the Menu Select button. Then press

the [Save Changes] soft key.

NOTE This chapter lists configuration parameters for all HeartStart MRx options. Your specific device may

not have all options installed or data specific to an option programed in, therefore all related

configuration parameters are not available for modification.

Saving Configuration Settings to a Data Card 17 Configuration

201

Saving Configuration Settings to a Data Card

To save configuration settings to a data card:

1Make sure a data card is in the HeartStart MRx.

2Press the [Export] soft key.

The HeartStart MRx copies the configuration settings to the data card.

Loading Configuration Settings from a Data Card

To load configuration settings from a data card:

1Insert the data card with the saved configuration in the HeartStart MRx.

2Press the Change Config soft key and enter the configuration password.

3Press the Import soft key.

4Make any device specific configuration changes, such as 12-Lead location code.

5Press the [Save Changes] soft key.

Restoring the Default Settings

To return to using the configuration settings initially entered during manufacture:

1Press the [Change Config] soft key.

2Enter the Configuration password.

3Press the [Factory Defaults] soft key.

4Press the [Save Changes] soft key.

Printing Configuration Settings

To print the configuration settings, select Print Configuration from the Configuration Main menu

and press the Menu Select button. The configuration report is printed on the printer.

NOTE Upon exiting Configuration and returning to a clinical mode (Monitor, Pacer, Manual Defib or AED),

all settings will be reset to the device’s configured values.

17 Configuration Configurable Parameters

202

Configurable Parameters

The following tables list configurable parameters for each of the sub-menus on the Configuration Main

menu. A description of each parameter is provided, along with the possible choices for settings. Default

settings are in bold type.

Table 36 Ge n e r a l Setti n g s

NOTE The Return to Owner Password should be documented in a secure manner. Should it need to be reset,

all configuration settings must be reset to factory default values, and the device must then be

re-configured.

NOTE Do not set alarm volumes so low that you can’t hear them in loud environments.

Parameter Description Setting Choices

Institution Name Enters your organization’s name in the 12-Lead

ECG Report. (If you are sending data to the

TraceMasterVue database then this field must

match a valid entry in the TraceMasterVue

database.)

32 characters, blank

Voice Volum e Vo ice prompt vol um e level. Ver y Sof t, Soft, Medium, Loud, Very Loud

Alarm Volume Audible alarm volume level. Very Soft, Soft, Medium, Loud, Very Loud

Minimum Alarm Volume Minimum audible alarm level available during

use.

Very Soft, Soft, Medium, Loud, Very Loud

QRS Volume Volume of audible beep with each QRS

complex detected.

Off, Very Soft, Soft, Medium, Loud, Very Loud

Time Format Selects time format to display. 12-hour, 24-hour

Pacing on Batteries

Warning

Displays the warning message Pacing on

Batteries if pacing using only battery power.

Yes, No

Unit Display Defines if parameter values are displayed with

or without corresponding measurement units.

On, Off

Patient Category Selects the default patient category. Adult, Pedi

Device Owner Identification for Return to Owner feature. 20 characters

Return to Owner

Password

Password required in order to deactivate the

loan period setting.

4 characters

Audio Recording Turns audio recording on or off. On, Off

Configurable Parameters 17 Configuration

203

Table 37 Heart Rate and ECG Settings

Parameter Description Setting Choices

Auto Gain Determines whether ECG size is automatically

adjusted to the standard maximum wave size

without clipping the wave sector. If auto-gain is

off, the gain is set to 1 (10mm/mV).

On, Off

AC Line Filter Selects the setting used to filter out AC line

noise. Adjust this setting to the power

frequency of your country.

60 Hz, 50 Hz

ECG Bandwidth for

Display

Selects the display filter frequency for the

attached therapy cable or 3-/5-lead ECG cable.

(This setting does not affect 12-Lead View.)

.15-40 Hz Monitor, 1-30 Hz EMS

ECG Bandwidth for

Printer

Selects the printer filter frequency for the

attached therapy cable or 3-/5-lead ECG cable.

(This setting does not affect 12-Lead Reports.)

If Diagnostic is selected, pads ECG is set to

Monitor.

0.05-150 Hz Diagnostic, .15-40 Hz Monitor,

1-30 Hz EMS

ECG Electrode Labels Selects electrode label format. AAMI: RA, LA,

LL, RL, V.

IEC: R, L, F, N, C.

AAMI, IEC

HR/Pulse High Limit Selects the default High Alarm Limit for the

HR derived from the ECG and the pulse

derived from SpO2 or Invasive Pressures.

Adult: 35-200, 120, (bpm)

Pediatric: 35-240, 160

adjusted in increments of 5

HR/Pulse Low Limit Selects default Low Alarm Limit for the HR

derived from the ECG and the pulse derived

from SpO2 or Invasive Pressures.

Adult: 30-195, 50 (bpm)

Pediatric: 30- 235, 80

adjusted in increments of 5

VTACH Detection of ventricular tachycardia based on

heart rate limit and PVC run limit.

Heart Rate Limit:

Adult: 95-150, 100 (bpm)

Pediatric: 95-150, 120

adjusted in increments of 5

PVC run limit:

Adult: 3-20, 5

Pediatric: 3-20, 5

adjusted in increments of 1

Color Selects the HR/ECG color. Red, Yellow, Blue, Green, Cyan, Magenta,

White (Note: Red and blue text and numerics

are not visible in high contrast mode.)

17 Configuration Configurable Parameters

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Table 38 Invasive Pressure Settings - Default Labels

Table 39 Invasive Pressure Settings - P1

Parameter Description Values / Default

Unit and Default

Labels

Selects measurement units for all invasive

pressures

mmHg, kPa

Press 1 Label Selects default label for pressure channel 1 P1, ABP, ART, Ao, CVP, ICP, LAP, PAP, RAP

Press 2 Label Selects default label for pressure channel 2 P2, ABP, ART, Ao, CVP, ICP, LAP, PAP, RAP,

Parameter Description Value/Defaults

Alarm Source Selects the type of alarm

source.

Systolic, Diastolic, Mean

Systolic High Limit Selects the systolic high limit

value.

Adult: -35 - 360, 160 (mmHg)

Ped: -35 - 360, 120

Adjusted in increments of 5 mmHg or 1kPa

Systolic Low Limit Selects the systolic low limit

value.

Adult: -40 - 355, 90 (mmHg)

Ped: -40 - 355, 70

Adjusted in increments of 5 mmHg or 1 kPa

Diastolic High Limit Selects the diastolic high limit

value.

Adult: -35 - 360, 90 (mmHg)

Ped: -35 - 360, 70

Adjusted in increments of 5 mmHg or 1 kPa

Diastolic Low Limit Selects the diastolic low limit

value.

Adult: -40 - 355, 50 (mmHg)

Ped: -40 - 355, 40

Adjusted in increments of 5 mmHg or 1 kPa

Mean High Limit Selects the mean high limit

value.

Adult: -35 - 360, 110 (mmHg)

Ped: -35 - 360, 90

Adjusted in increments of 5 mmHg or 1 kPa

Mean Low Limit Selects the mean low limit

value.

Adult: -40 - 355, 70 (mmHg)

Ped: -40 - 355, 50

Adjusted in increments of 5 mmHg or 1 kPa

Scale Selects the default wave form

scale.

Adult: 300, 240, 180, 150, 120, 110, 100, 90, 80, 70, 60,

50, 40, 30, 20, 10, -5, -10, -15, -20

Pedi: 300, 240, 180, 150, 120, 110, 100, 90, 80, 70, 60, 50,

40, 30, 20, 10, -5, -10, -15, -20

Artifact Suppression Specifies the duration for

suppressing pressure alarms

due to non-physiological

artifacts. An INOP is

displayed.

30 sec., 60 sec., 90 sec., Off

Filter Selects the filter setting. 12 Hz, 40 Hz

Color Selects the P1 color. Red, Yellow, Blue, Green, Cyan, Magenta, White. (Note:

The High Contrast feature does not display the colors red or

blue, therefore, be sure your device is configured correctly

with appropriate parameter color settings.)

Configurable Parameters 17 Configuration

205

Table 40 Invasive Pressure Settings - P2

All setting options are exactly the same as P1 in Table 39 except for:

Table 41 Invasive Pressure Settings - ABP, ART, Ao

All setting options are exactly the same as P1 in Table 39

Table 42 Invasive Pressure Settings - CVP, RAP, LAP

Parameter Description Value/Defaults

Color Selects the P2 color. Red, Yellow, Blue, Green, Cyan, Magenta, White

Parameter Description Values / Default

Alarm Source Source is always Mean and not

configurable.

High Limit Selects the high limit value. Adult: -39 - 360, 10 (mmHg)

Ped: -39 - 360, 4

Adjusted in increments of 1 mmHg or

0.1 kPa

Low Limit Selects the low limit value. Adult: -40 - 359, 0 (mmHg)

Ped: -40 - 359, 0

Adjusted in increments of 1 mmHg or

0.1 kPa

Scale Selects the default waveform scale Adult: 300, 240, 180, 150, 120, 110,

100, 90, 80, 70, 60, 50, 40, 30, 20, 10,

-5, -10, -15, -20

Ped: 300, 240, 180, 150, 120, 110, 100,

90, 80, 70, 60, 50, 40, 30, 20, 10, -5, -

10, -15, -20

Artifact Suppression Selects the default artifact suppression

timeframe.

30 sec., 60 sec., 90 sec., Off

Filter Selects the filter setting. 12 Hz, 40 Hz

Color Selects the parameter color. Red, Yellow, Blue, Green, Cyan,

Magenta, White

17 Configuration Configurable Parameters

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Table 43 Invasive Pressure Settings - PAP

Parameter Description Values / Default

Alarm Source Selects the type of alarm source. Systolic, Diastolic, Mean

Systolic High Limit Selects the systolic high limit value. Adult: -39 - 360, 35 (mmHg)

Ped: -39 - 360, 60

Adjusted in increments of 1 mmHg or

0.1 kPa

Systolic Low Limit Selects the systolic low limit value. Adult: -40 - 359, 10 (mmHg)

Ped: -40 - 359, 24

Adjusted in increments of 1 mmHg or

0.1 kPa

Diastolic High Limit Selects the diastolic high limit value. Adult: -39 - 360, 16 (mmHg)

Ped: -39 - 360, 4

Adjusted in increments of 1 mmHg or

0.1 kPa

Diastolic Low Limit Selects the diastolic low limit value. Adult: -40 - 359, 0 (mmHg)

Ped: -40 - 359, -4

Adjusted in increments of 1 mmHg or

0.1 kPa

Mean High Limit Selects the mean high limit value. Adult: -39 - 360, 20 (mmHg)

Ped: -39 - 360, 26

Adjusted in increments of 1 mmHg or

0.1 kPa

Mean Low Limit Selects the mean low limit value. Adult: -40 - 359, 0 (mmHg)

Ped: -40 - 359, 12

Adjusted in increments of 1 mmHg or

0.1 kPa

Scale Default waveform scale Adult: 300, 240, 180, 150, 120, 110,

100, 90, 80, 70, 60, 50, 40, 30, 20, 10,

-5, -10, -15, -20

Ped: 300, 240, 180, 150, 120, 110, 100,

90, 80, 70, 60, 50, 40, 30, 20, 10, -5, -

10, -15, -20

Artifact Suppression Selects the default artifact suppression

timeframe.

30 sec., 60 sec., 90 sec., Off

Filter Selects the filter setting. 12 Hz, 40 Hz

Color Selects the parameter color. Red, Yellow, Blue, Green, Cyan,

Magenta, White

Configurable Parameters 17 Configuration

207

Table 44 Invasive Pressure Settings - ICP

Table 45 Invasive Pressure Settings - CPP

Parameter Description Values / Default

Alarm Source Source is always Mean and not

configurable.

High Limit Selects the high limit value. Adult: -39 - 360, 10 (mmHg)

Ped: -39 - 360, 4

Adjusted in increments of 1 mmHg or

0.1 kPa

Low Limit Selects the low limit value. Adult: -40 - 359, 0 (mmHg)

Ped: -40 - 359, 0

Adjusted in increments of 1 mmHg or

0.1 kPa

Scale Selects the default waveform scale Adult: 300, 240, 180, 150, 120, 110,

100, 90, 80, 70, 60, 50, 40, 30, 20, 10,

-5, -10, -15, -20

Ped: 300, 240, 180, 150, 120, 110, 100,

90, 80, 70, 60, 50, 40, 30, 20, 10, -5, -

10, -15, -20

Artifact Suppression Selects the default artifact suppression

timeframe.

30 sec., 60 sec., 90 sec., Off

Filter Selects the filter setting. 12 Hz, 40 Hz

Color Selects the parameter color. (Also applies

to CPP.)

Red, Yellow, Blue, Green, Cyan,

Magenta, White

Parameter Description Values / Default

Alarm Source Source is always Mean and not

configurable.

High Limit Selects the high limit value. Adult: -35 - 360, 130 (mmHg)

Ped: -35 - 360, 100

Adjusted in increments of 5 mmHg or 1

kPa

Low Limit Selects the low limit value. Adult: -40 - 355, 50 (mmHg)

Ped: -40 - 355, 40

Adjusted in increments of 5 mmHg or 1

kPa

17 Configuration Configurable Parameters

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Table 46 Noninvasive Blood Pressure Settings

Parameter Description Setting Choices

NBP Schedule Selects the schedule for NBP measurements,

manual, or automatic at the selected frequency.

Manual, q1, q2.5, q5, q10, q15, q30, q60,

q120

NBP Alarm Source Selects the alarm source. Systolic, Diastolic, Mean

Unit Selects the measurement units. mmHg, kPa

Systolic High Limit Selects the high limit alarm value used when

systolic is the selected alarm source.

Adult: 35-270, 160 (mmHg)

Pediatric: 35-180, 120

adjusted in increments of 5 mmHg or 1 kPa

Systolic Low Limit Selects the low limit alarm value when systolic

is the selected alarm source.

Adult: 30-265, 90 (mmHg)

Pediatric: 30-175, 70

adjusted in increments of 5 mmHg or 1 kPa

Diastolic High Limit Selects the high limit alarm value when

diastolic is the selected alarm source.

Adult: 15-245, 90 (mmHg)

Pediatric: 15-150, 70

adjusted in increments of 5 mmHg or 1 kPa

Diastolic Low Limit Selects the low limit alarm value when diastolic

is the selected alarm source.

Adult: 10-240, 50 (mmHg)

Pediatric: 10-145, 40

adjusted in increments of 5 mmHg or 1 kPa

Mean High Limit Selects the high limit alarm value when mean is

the selected alarm source.

Adult: 25-255, 110 (mmHg)

Pediatric: 25-160, 90

adjusted in increments of 5 mmHg or 1 kPa

Mean Low Limit Selects the low limit alarm value when mean is

the selected alarm source.

Adult: 20-250, 60 (mmHg)

Pediatric: 20-155, 50

adjusted in increments of 5 mmHg or 1 kPa

Color Selects the NBP color. Red, Yellow, Blue, Green, Cyan, Magenta,

White

Configurable Parameters 17 Configuration

209

Table 47 End-Tidal Carbon Dioxide Settings

Parameter Description Setting Choices

Unit Selects the unit of measure mmHg, kPa

EtCO2 High Limit Selects the high limit alarm value. Adult: 20-95, 50 (mmHg)

Pediatric: 20-95, 50

adjusted in increments of 1mmHg or 0.1 kPa

EtCO2 Low Limit Selects the low limit alarm value. Adult: 10-94, 30 (mmHg)

Pediatric: 10-94, 30

adjusted in increments of 1mmHg or 0.1 kPa

AwRR High Limit Selects the high limit alarm value. Adult: 10-100, 30 (rpm)

Pediatric: 10-100, 60

adjusted in increments of 1

AwRR Low Limit Selects the low limit alarm value. Adult: 0-99, 8 (rpm)

Pediatric: 0-99, 12

adjusted in increments of 1

Apnea Time Length of time without respiration required to

trigger an apnea alarm.

Adult: 10-40, 20 (seconds)

Pediatric: 10-40, 20

adjusted in increments of 5

Color Selects the EtCO2 and AwRR color. Red, Yellow, Blue, Green, Cyan, Magenta,

White

17 Configuration Configurable Parameters

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Table 48 SpO 2 Settings

Table 49 Pu l se Settings

NOTE Pulse is only included in the Configuration menu if your device has the Invasive Pressures option.

Parameter Description Setting Choices

SpO2 High Limit Selects high limit alarm value. Adult: 51-100, 100 (%)

Pediatric: 51-100, 100

adjusted in increments of 1

SpO2 Low Limit Selects low limit alarm value. Adult: 50-99, 90 (%)

Pediatric: 50-99, 90

adjusted in increments of 1

SpO2 Desat Limit Selects extreme low limit alarm value. Adult: 50-low limit, 80 (%)

Pediatric: 30-low limit, 80

adjusted in increments of 1

Color Selects the SpO2 color. Red, Yellow, Blue, Green, Cyan, Magenta,

White

Parameter Description Values / Default

Pulse Source Sets default pulse source SpO2, Press 1: label, Press 2: label

Default: SpO2 if device has SpO2

option, otherwise Press 1

Configurable Parameters 17 Configuration

211

Table 50 Temperature Settings

Table 51 Wave Sector Settings

Table 52 Alarm Settings

Parameter Description Values / Default

Unit Selects measurement units °C, °F

Label Selects the default temperature label Te m p, Tskin, Trect, Tnaso, Tesoph,

Tart, Tven, Tvesic, Tcore

High Limit Selects the high limit value. Adult: 0.1 to 45.0, 39.0 °C

(32.2 to 113 °F)

Ped: 0.1 to 45.0, 39.0 °C

Adjusted in increments of 0.1 °C or 0.2

°F.

Low Limit Selects the low limit value. Adult: 0.0 to 44.9, 36.0 °C

(32.0 to 112.8 °F)

Ped: 0.0 to 44.9, 36.0 °C

Adjusted in increments of 0.1 °C or 0.2

°F.

Color Selects the temperature color. Red, Yellow, Blue, Green, Cyan,

Magenta, White

Parameter Description Setting Choices

Wave 1 Selects the waveform displayed in Wave Sector 1. Pads, I, II, III, aVR, aVL, aVF, V

Wave 2 Selects the waveform displayed in Wave Sector 2. Pads, I, II, III, aVR, aVL, aVF, V, CO2, Pleth,

Press 1, Press 2, Cascade, Annotated ECG,

None

Default: Press 1 if you have the Invasive

Pressures option, Cascade otherwise.

Wave 3 Selects the waveform displayed in Wave Sector 3. Pads, I, II, III, aVR, aVL, aVF, V, CO2, Pleth,

Press 1, Press 2, None

Default: Press 2 if you have the Invasive

Pressures option, Pleth if you have SpO2, none

otherwise.

Wave 4 Selects the waveform displayed in Wave Sector 4. Pads, I, II, III, aVR, aVL, aVF, V, CO2, Pleth,

Press 1, Press 2, Cascade, None

Default: CO2 if you have the CO2 option,

none otherwise.

Parameter Description Setting Choices

Alarm Tone Selects either traditional Philips or IEC Standard

alarm tones.

Philips, IEC

Alarm Pause Time Selects the interval of time during which alarms

are paused, after the Alarm Pause button is

pressed.

1, 2, 3, 5, 10, indefinite

(minutes)

17 Configuration Configurable Parameters

212

Table 53 12-Lead Settings

Parameter Description Setting Choices

Institution Name Enters your organization’s name in the 12-Lead

ECG Report. (If you are sending data to the

TraceMasterVue database then this field must

match a valid entry in the TraceMasterVue

database.)

32 characters, blank

Facility ID Enters the Facility ID in the 12-Lead ECG

Report.

5 alpha-numeric characters, blank

Department ID Enters the Department ID in the 12-Lead ECG

Report.

10 alpha-numeric characters, blank

Device ID Enters a device identification number. 4 digits

Analysis Defines the analysis information included on the

12-Lead Report.

• None prints waveforms, Event/patient ID,

date and time.

• Measurements Only adds HR, interval and

axis measurements Standard adds severity,

interpretive statements and reasons.

• Standard prints waveform, ID, basic

measurements and standard diagnostic

statements.

• Auto ACI-TIPI runs the ACI-TIPI analysis if

there is no Acute MI Critical Value statement

and the ECG severity is not Normal.

• ACI-TIPI prints the standard report followed

by computer generated diagnostic statements

using ACT-TIPI criteria.

• ACI-TIPI & TPI uses the ACI-TIPI report

followed by TPI inputs, computer generated

diagnostic statements using TPI criteria and

the user-selected Thrombolytic Therapy

Contraindications.

None, Measurements Only, Standard, Auto

ACI-TIPI, ACI-TIPI, ACI-TIPI and TPI

Critical Values Statements Enables or disables the printing and exporting of

Critical Value Statements.

Yes, No

ACI Threshold Set the threshold above which the predicted

probability of Acute Cardiac Ischemia is

highlighted on the 12-Lead Report screen.

0-100 percent, 75%

Patient Weight Units To set the units of weight measurement for TPI

analysis. Weight is only used for TPI analysis

lbs., kg.

ECG Bandwidth for 12-

Lead Display

Defines the default ECG bandwidth for the 12-

Lead preview display.

.15-40 Hz, .05-40 Hz, .05-150 Hz

ECG Bandwidth for 12-

Lead Report

Defines the default ECG bandwidth for printed

and stored 12-Lead Reports.

Same as Display, .05-150 Hz

Configurable Parameters 17 Configuration

213

NOTE If the same configuration file is used to configure multiple devices, be sure to assign a unique device ID

number to each device.

NOTE The 3x4 3R Printer Format Setting is not for use with the 12-Lead Transmission option.

ECG Report Specifies how the 12-lead ECG segments are

displayed for the 12-Lead Report. The segments

are displayed in three rows, four columns for

each row.

• Sequential reports: Each column represents a

sequential 2.5-second period of time for a

total of 10 seconds.

• Simultaneous reports: Each column represents

the same 2.5 seconds of time.

Sequential, Simultaneous

Number of Automatic

Printouts

Selects the number of 12-Lead ECG Reports

printed at the completion of analysis.

0, 1, 2

Printer Format Selects the number of rhythm strips to be printed

with the 12-Lead Report, 0, 1, or 3.

3x4, 3x4 1R, 3x4 3R

Rhythm Strip #1 Selects the first rhythm strip printed in the 3x4

1R or 3x4 3R format.

I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5,

Rhythm Strip #2 Selects the second rhythm strip printed for

reports in the 3x4 3R format.

I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5,

Rhythm Strip #3 Selects the third rhythm strip printed for reports

in the 3x4 3R format.

I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5,

12-Lead Export Format Indicates which version of the 12-Lead XML

schema the 12-Lead Reports are to conform to.

1.03, 1.04

Parameter Description Setting Choices

17 Configuration Configurable Parameters

214

Table 54 Data Transmission - Serial Phone Profile Settings

Parameter Description Setting Choices

Profile Name Name of the profile. (This field is fixed) Serial Phone Profile

Configuration String Available from your cell phone service provider. 45 characters, blank

Dial String Available from your cell phone service provider. 40 characters, blank

Wait for Dial Tone Available from your cell phone service provider. Yes, No

PPP User Name Typically not needed but may be required by some

cell phone service providers.

30 characters, blank

PPP Password Typically not needed but may be required by some

cell phone service providers.

40 characters, blank

Static IP Address Typically not needed but may be required by some

cell phone service providers.

15 characters (nnn.nnn.nnn.nnn), blank

Primary DNS Typically not needed but may be required by some

cell phone service providers.

nnn.nnn.nnn.nnn, blank

Secondary DNS Typically not needed but may be required by some

cell phone service providers.

nnn.nnn.nnn.nnn, blank

http Proxy Address Typically not needed but may be required by some

cell phone service providers.

15 characters, blank

http Proxy Port Typically not needed but may be required by some

cell phone service providers.

15 characters, blank

Baud Rate Available from your cell phone documentation. If

your phone transmits “high speed” data, set to

115200.

9600, 19200, 38400, 57600, 115200

Flow Control Available from your cell phone documentation. None, Hardware

Configurable Parameters 17 Configuration

215

Table 55 Dat a Tr ans mi s sion - Ph o n e /Modem Se tt i n gs

Parameter Description Setting Choices

Profile Name Name of the profile. Serial Phone Profile

Configuration String Available from your cell phone service provider. 45 characters, blank

Landline Set to Yes if you are using a modem. Yes, No

Dial Prefix Only configurable if Landline is set to Yes. The

dial prefix is the number or numbers you dial

before the phone number. For example, you may

need to dial 9 for an outside line or an area code in

addition to a number.

10 charaters, blank

Dial String Available from your cell phone service provider. 40 characters, blank

User Name/Password Sets how the user name/password pairs are

configured. Per profile means a single user name/

password is configurable for this profile; per device

means a different user name/password is

configurable for each device which uses this

profile.

Per Profile, Per Device

PPP User Name Typically not needed but may be required by

some cell phone service providers.

30 characters, blank

PPP Password Typically not needed but may be required by

some cell phone service providers.

40 characters, blank

Static IP Address Typically not needed but may be required by

some cell phone service providers.

15 characters (nnn.nnn.nnn.nnn), blank

Primary DNS Typically not needed but may be required by

some cell phone service providers.

nnn.nnn.nnn.nnn, blank

Secondary DNS Typically not needed but may be required by

some cell phone service providers.

nnn.nnn.nnn.nnn, blank

http Proxy Address Typically not needed but may be required by

some cell phone service providers.

15 characters, blank

http Proxy Port Typically not needed but may be required by

some cell phone service providers.

15 characters, blank

17 Configuration Configurable Parameters

216

Table 56 Data Transmission - 12-Lead Settings (Hub)

Table 57 Data Transmission - 12-Lead Settings (Sites)

Table 58 Dat a Tr ans mi s sion

Parameter Description Setting Choices

Server URL Hub server address. Available from your ISP. 40 characters, blank

User Name http user name. Use your web server

documentation to create user accounts on the hub.

30 characters, blank

Password http password. Use your web server

documentation to create user accounts on the hub.

40 characters, blank

Parameter Description Setting Choices

Site Name This label appears in the Send To menu when

intitiaing a transmission. The label should be an

easy to recognize name.

12-20 characters, blank

Site Type Indicates the type of device receiving the

transmission.

Fax, Printer, TraceMaster, 12LTS, Hub,

Telemedicine

Phone Number Phone number for fax site type, otherwise N/A.

Note: It is important that the you know the

dialing rules from the 12-Lead Transfer Station.

For example, does the 12-Lead Transfer Station

need to dial a 1 or an area code in addition to the

number? If it does, the number sent by the MRx

must include these digits.

20 characters, blank

URL URL for PC site type (i.e., TraceMaster or another

12-Lead Transfer Station), otherwise N/A

40 characters, blank

Use Hub’s Routing Indicates whether or not to use hub routing.

(Note: This field is not used by the 12-Lead

Transfer Station 2.0.).

Yes, No

Default Site If yes, this will be the highlighted site when the

Send to menu is displayed. When set to yes, this

field will automatically be set to no for all other

sites.

Yes, No

User Name Sets the http user name for the data viewing

software server.

30 characters, blank

Password Sets the http password for the data viewing

software server.

40 characters, blank

Parameter Description Setting Choices

Transmit Interval Sets the interval between Periodic Clinical Data

Transmissions when connected to the data viewing

software server.

1, 2, 3, 4, 5 minutes

Configurable Parameters 17 Configuration

217

Table 59 Ref ere nc e ID

Table 60 Manual Therapy Settings

WARNING Use of the Manual Therapy Security password requires the clinician to know and remember the

password, as defined in Configuration. Failure to enter the correct password will prevent the delivery of

manual defibrillation or pacing therapy. Prior to selecting this Configuration option, review this

potential risk with your Risk Manager.

Parameter Description Setting Choices

Reference ID Defines a maximum of 20 preconfigured

Reference IDs. Each Reference ID has a

maximum of 16 characters limited to uppercase

letters, numbers, spaces and hyphens.

Up to 20 user-defined settings

Parameter Description Setting Choices

Remain In Sync Mode

After Shock

Defines whether the device remains in Sync

Mode after a synchronized shock is delivered.

Yes, No

Time To Auto Disarm Determines the amount of time the device will

remain charged if a shock has not been delivered.

Applies to both Manual Defib and AED Modes.

30, 60, 90 (seconds)

Pacing Rate Upon entering the selected Pacer Mode

(Demand or Fixed), defines the default rate of

delivery of paced pulses.

30-180, 70 (ppm)

adjusted in increments of 10

Pacing Output Upon entering the selected Pacer Mode

(Demand or Fixed), defines the default current

setting at which paced pulses are delivered.

10-160, 30 (mA)

adjusted in increments of 5

Manual Therapy Security Defines whether Manual Defib and Pacer Modes

are password protected.

A password entry screen is displayed when the

setting is changed to On. Using the Menu, enter

a 4-character password. Selecting Cancel during

password entry resets the setting to Off. Once

the password is set, changing the setting to Off

clears the password from the device memory.

Off, On (See Warning below.)

CPR Timer Defines whether the CPR Timer is displayed in

Manual Defib mode (This does not affect the

display of the timer in AED Mode.)

Off, On

17 Configuration Configurable Parameters

218

Table 61 AED Settings

Parameter Description Setting Choices

Shock Series Sets the number of shocks that must be delivered to activate an

automatic CPR Pause. The length of the CPR pause is determined by

the CPR Timer Setting. A new Shock Series begins when a shock is

delivered:

• after the device is turned on,

• after the automatic CPR pause,

• after the [Pause for CPR] soft key has been pressed, or

• if the time since the previous shock exceeds the Protocol Timeout

setting.

1, 2, 3, 4

Protocol Timeout Sets the time interval used to determine if a delivered shock should be

counted as part of the shock series (see Shock Series above.)

30, 60, 90, 120, 150,

180, 210, Off (seconds)

No Shock Advised (NSA)

Action

Defines how the device behaves following a No Shock Advised (NSA)

decision:

• Monitor - directs the device to monitor the patient’s ECG

following an NSA decision and prompts the user to periodically

perform CPR. The CPR prompt interval is defined by the Monitor

Prompt interval.

• Time Setting - directs the device to provide a CPR Pause interval

following a NSA decision. If a shock has been delivered in the

current Shock Series, the length of the CPR Pause interval is

defined by the CPR Timer setting. Otherwise, the length of the

CPR Pause interval is defined by the NSA Action time setting.

Monitor, 30, 60, 90,

120, 150, 180 (seconds)

CPR Prompt Defines the level of detail provided in the CPR reminder voice

prompts provided at the completion of a Shock Series.

• Long - provides detailed instruction to check airway, breathing

and pulse/circulation before beginning CPR.

• Short - provides instruction to begin CPR, if needed, only.

Long, Short

Monitor Prompt Interval Sets the interval for patient care prompts provided during AED

monitoring of the patient’s ECG following an NSA decision. Off

means there are no prompts during AED monitoring.

30, 60, 90, 120, 150,

180, Off (seconds)

CPR Display If Q-CPR is installed and configured on, sets the look of Q-CPR data

in the AED display. Basic display shows the CPR Progress Indicator

and any prompt text. The Advanced view shows Compression Rate,

No Flow Time, EtCO2 numeric (if available), Ventilation Rate (if

configured), ventilation detected icon (if configured), CPR Timer,

Compression Counter, Compression Wave, CO2 wave (if available).

Basic, Advanced

Configurable Parameters 17 Configuration

219

Table 62 Ne tw o r k Settings

* - Change the default RF Access Code. The default 0 is not valid for clinical use

NOTE Network settings are not copied to a data card when exporting configurations and must be set

individually on each device.

Parameter Description Setting Choices

Equipment Label A user-entered name that uniquely identifies the device;

used to associate the HeartStart MRx with an

Information Center monitoring sector.

up to 16 Unicode characters, blank

Central Monitoring Controls whether the No Central Monitoring INOP

appears at startup.

“Mandatory” means when the HeartStart MRx is not

connected to the Information Center and is turned on,

or a connection is lost during monitoring, the No

Central Monitoring INOP message appears.

“Optional” means the INOP message only appears

when a connection is lost during monitoring, not at

startup.

Mandatory, Optional

Remote Controls Sets or defines the ability of the Information Center to

remotely control the HeartStart MRx. Silence/reset

alarms can be controlled from the Information Center.

Set controls to “Disabled” if you do not want operators

to control this function from the Information Center.

Enabled, Disabled

RF Access Code* Identifies which RF channel the HeartStart MRx-

Information Center wireless communications are on.

0-255, 0

17 Configuration Configurable Parameters

220

Table 63 Printing Settings

NOTE Red arrhythmia alarms can’t be turned off.

Parameter Description Setting Choices

Print on Alarm Prints a 15 second strip (10 seconds of pre-alarm

data and 5 seconds of post alarm data) when

selected alarm type occurs.

Red Arrhythmia: An alarm recording strip is

printed for Asystole, VFIB/VTACH, VTACH,

Extreme Tachy, Extreme Brady.

Red: An alarm recording strip is printed for the

Red Arrhythmia alarms plus IBP Disconnect,

Apnea, SpO2 Desat.

Red/Yellow: An alarm recording strip is printed

for the Red alarms plus High and Low alarms for

HR, NBP, SpO2, Pulse Rate, EtCO2, AwRR,

IBP, CPP, and Temp; Also, Pacer Not Captured,

Pacer Not Pacing, PVC, Pacer Output Low.

Red/Yellow, Red, Red Arrhythmia

Print on Charge Prints a continuous strip during charging.

Printing continues until a shock is delivered, the

device is disarmed, or the Print button is pressed.

Yes, No

Print on Shock Prints a 12 second strip when a shock is delivered

or when a shock is attempted but unable to be

delivered.

Yes, No

Print on Mark Prints a strip when the Mark Event button is

pressed. The strip includes the printer delay (if

configured) and extends 6 seconds from the start

of the annotation text or from the time the

Events menu is removed from the display.

Yes, No

Printer Delay Defines whether printed strips, including those

requested manually and those generated by an

event (mark, charge, or shock), include an

additional 10 seconds of information - the 10

seconds occurring just prior to printing being

initiated.

No Delay, 10 sec.

Event Summary Report Selects the Event Summary Report format. Short

includes a log of events and vitals. Medium adds

waveforms. Long adds 12-Lead Reports.

Short, Medium, Long

Strip Print Speed Selects the ECG strip print speed. 25, 50 (mm/sec)

12-Lead Print Speed Selects the 12-Lead ECG Report print speed. 25, 50 (mm/sec)

Configurable Parameters 17 Configuration

221

Table 64 Mark Event Settings

Parameter Description Setting Choices

Mark Event 1 Defines menu choice #1 on the Mark Events

menu.

20 characters, ET Access

Mark Event 2 Defines menu choice #2 on the Mark Events

menu.

20 characters, IV Access

Mark Event 3 Defines menu choice #3 on the Mark Events

menu.

20 characters, Adrenaline (for Europe),

Epinephrine (for the rest of the world)

Mark Event 4 Defines menu choice #4 on the Mark Events

menu.

20 characters, Lidocaine

Mark Event 5 Defines menu choice #5 on the Mark Events

menu.

20 characters, Atropine

Mark Event 6 Defines menu choice #6 on the Mark Events

menu.

20 characters, Morphine

Mark Event 7 Defines menu choice #7 on the Mark Events

menu.

20 characters, Nitroglycerin

Mark Event 8 Defines menu choice #8 on the Mark Events

menu.

20 characters, Aspirin

17 Configuration Configurable Parameters

222

Table 65 CPR Set t i n g s

Parameter Description Setting Choices

Q-CPR In devices with the Q-CPR option, this

setting defines whether Q-CPR is configured

off or on.

On, Off

CPR Timer Sets the length of the pause interval that

automatically starts when:

• a Shock series is completed

•The [Pause for CPR Timer]

softkey is pressed.

• A No Shock Advised (NSA) decision is

made, the NSA CPR pause is enabled,

and the conditions for using the CPR

Timer setting for NSA CPR pause

period are met (see NSA entry in Table

61.)

• The Shock Button is not pressed for the

configured “Time to Auto Disarm”

setting after the device is armed in AED

Mode

• Continuous artifact is detected during

rhythm analysis.

30, 60, 90, 120, 150, 180, 240, 300

Q-CPR Voice Sets default setting for Q-CPR voice

prompts.

Audible, Muted

Compression only CPR Enables/disables ventilation feedback and

measurements.

On, Off

Comp Color Selects the color of the compression

waveform and values for compression rate

and no flow time.

Red, Yellow, Blue, Green, Cyan,

Magenta White

Q-CPR Feedback Enables or suppresses Q-CPR feedback.

Suppressing Q-CPR feedback will prevent

Q-CPR View in Manual Mode, voice prompt

feedback and storage of prompts in Manual

and AED modes and Q-CPR text prompt

feedback in AED Mode. (This configuration

item is only displayed and printed if the

Q-CPR Data Storage option is enabled.)

On, Off

Research Storage If on, enables the storage of specific research

data, including: acceleration and force data

from the CPR Meter and PCI data from

pads.

On, Off

Configurable Parameters 17 Configuration

223

Table 66 Thrombolytic Therapy Contraindications Settings

Parameter Description Setting Choices

Prompt for

Contraindications

Enables/disables the prompt for

Thrombolytic Therapy

Contraindications.

Yes, No

Contraindication 1

Listing of contraindications to

Thrombolytic Therapy for you to

consider before treatment.

Right vs. left arm sys. BP difference > 15 mmHg

Contraindication 2 History of structural central nervous system disease

Contraindication 3 Significant closed head/facial trauma within prev. 3 mos.

Contraindication 4 Major trauma, surgery, GI/GU bleed within 6 wks

Contraindication 5 Bleeding or clotting problem or on blood thinners

Contraindication 6 CPR for longer than 10 min.

Contraindication 7 Pregnant female

Contraindication 8 Serious systemic disease

Contraindication 9 Pulmonary edema

Contraindication 10 Signs of shock

Contraindications 11-20 Blank (editable for you to list more contraindications)

225

18Working with Data

This chapter describes the data management features of the HeartStart MRx. See “Data Transmission”

on page 239 for instructions on how to send data from the HeartStart MRx.

Overview

The two most common uses of data coming from the HeartStart MRx are:

• Transmission of vital signs and related data.

• Post event data management.

The HeartStart MRx automatically creates a complete Event Summary for each patient event. Each

Event Summary is assigned a unique event identification number and is date/time stamped.

Measurements are stored for viewing, reporting and printing in the Vital Signs Trending Report. Event

Summaries, including any trending and associated 12-Lead reports, are automatically stored in internal

memory. When internal memory reaches capacity, each addition of an Event Summary to internal

memory causes one or more of the oldest Event Summaries to be overwritten. The current or most

recent Event Summary or Vital Signs Trending report may be printed by pressing the button.

Event Summaries stored in internal memory may be individually selected and:

•Printed.

• Copied to a data card using the Data Management menu.

• Transmitted to a remote computer via Bluetooth or LAN for viewing in a data management

application like Event Review Pro.

18 Working with Data Initiating an Event Summary

226

Initiating an Event Summary

New Event Summaries are initiated each time one of the following activities occurs:

• The arrival of a valid ECG signal.

• The arrival of valid SpO2 data.

• The arrival of valid CO2 data.

• The arrival of valid invasive pressure data.

• The arrival of valid temperature data.

• The arrival of a valid CPR meter compression.

• An NBP measurement is requested.

• The Charge button is pressed.

• The Mark Event button is pressed.

Patient data collected includes two ECG waveforms, two invasive pressure waveforms and one CO2

waveform, and other clinical events. The number of incidents stored in memory at any given time is

determined by the length of each incident and the amount of data collected. There is 12-hour data

limit per incident with a maximum capacity of 55 patient incidents, regardless of card capacity or size

of incidents. When deleting, records are erased oldest first.

NOTE Monitoring and defibrillation functions are disabled while using the data management features of the

HeartStart MRx. An active patient event is closed upon entering Data Management.

Entering Data Management Mode

To enter Data Management Mode:

1Turn the Therapy Knob to either Monitor, Pacer or Manual Defib.

2Press the Menu Select button.

3Using the Navigation buttons, select the Other menu and press the Menu Select button.

4Select Data Management and press the Menu Select button.

5Press the Menu Select button to acknowledge the message, Leaving Normal Operational Mode.

6Press the Menu Select button to display the Data Management menu.

harge

Copying from Internal Memory 18 Working with Data

227

Copying from Internal Memory

You can copy Event Summaries and 12-Lead ECG Reports stored in internal memory to a data card

from Data Management Mode:

1Insert a data card, see “Installing the Data Card” on page 46.

2Enter Data Management Mode. See “Entering Data Management Mode” on page 226.

3Use the [Prev Item] and [Next Item] soft keys to select an Event Summary.

4Press the Menu Select button to display the Data Management menu.

5Highlight Copy and press the Menu Select button.

6Select the data option listed that you want to copy (see Figure 100) and press the Menu Select

button to copy to the external data card.

Figure 100 Copying in Data Management Mode

NOTES If you print an event in Clinical Mode and switch to Data Management Mode, the printing must be

complete before the event can be copied or sent. Failure to do so results in either a Cannot copy this

event while printing or a Cannot send this event while printing message. If you get either message, wait

for the printing to finish or cancel the printing before proceeding.

Do not remove the external data card from the HeartStart MRx while the device is copying data.

Highlight All Event Data to copy the selected Event Summary.

Highlight the specific 12-Lead Report listed to copy the selected

12-Lead Report.

Highlight Exit to exit the Copy menu.

Copy

All Events Data

1-25 Apr 2007 11:15

2-25 Apr 2007 11:30

Exit

18 Working with Data Viewing and Erasing the External Data Card

228

Viewing and Erasing the External Data Card

The contents and status of your data card are conveniently available for viewing. To display data card

information:

1Enter Data Management Mode. See “Entering Data Management Mode” on page 226.

2Press the Menu Select button to display the Data Management menu.

3Select View Data Card and press the Menu Select button.

[Prev Page] and [Next Page] soft keys appear to navigate to additional display pages.

Use the Erase Card menu entry to delete the contents of the data card.

CAUTION If you format a Philips data card in a PC card reader, you must use a FAT16 file system to format the

data card. Using a FAT32 format makes the card incompatible with the HeartStart MRx.

Do not use the data card as a long term storage device. Follow your organization’s protocol for backing

up electronic data.

Printing During a Patient Event 18 Working with Data

229

Printing During a Patient Event

The HeartStart MRx allows you to print data reports during a patient event. The device also allows you

to go back and print data reports after the fact from Data Management Mode, see “Printing from Data

Management Mode” on page 231.

Event Summaries

You can print the current Event Summary at any time during a patient event by pressing the Summary

button and selecting Event Summary from the menu. If an event is not in progress, pressing the

Summary button and selecting Event Summary prints the most recent Event Summary. The printed

format of the Event Summary is defined in Configuration.

WARNING Should an alarm condition occur while an Event Summary is printing, an alarm strip is not printed.

However, the corresponding ECG waveform is stored and available in the Event Summary.

Vital Signs Trending Reports

You can print the current Vital Signs Trending Report at any time during a patient event by pressing

the Summary button and selecting Trends and then a Trends Interval from the menu or by hitting the

soft key under the [Print Trends] label.

If an event is not in progress, pressing the Summary button and selecting Trends and then a Trends

Interval prints the most recent Vital Signs Trending Report.

12-Lead ECG Reports

You can print individual 12-Lead ECG Reports for the current or most recent patient event through

the 12-Lead Report View menu. You can print the current 12-Lead ECG report by hitting the

[Print] softkey in 12-Lead View. To print a recent 12-Lead ECG Report:

1Press the Menu Select button and highlight Reports

2Use the Navigation buttons to highlight the report you want to print.

3Press the Menu Select button and highlight Print

4Press the Menu Select button to print the report.

18 Working with Data Printing During a Patient Event

230

Printing Individual Events

The HeartStart MRx can be configured to print automatically when certain events occur. Table 67 lists

these events and the length of the strip printed, depending on whether the printer is configured to

print real-time or with a 10-second delay.

Table 67 Printed Strip Lengths

Event Real-Time

Strip Length

Delayed Strip Length

HeartStart MRx charges to

deliver a shock.

Continuous 10 seconds just prior to charging, plus

continuous printing through the charge

duration.

Shock delivered 12 seconds 10 seconds just prior to shock, plus 12

seconds after shock.

Shock failed 12 seconds 10 seconds just prior to the message No

Shock Delivered, plus 12 seconds after

the message.

Alarm condition 15 seconds (10 seconds of pre-

alarm data and 5 seconds of

post alarm data when specified

alarm type occurs.

Same as real-time strip.

Mark Event button

pressed (For more

information on this

feature see “Marking

Events” on page 237.)

6 seconds from the start of the

annotation text or from the

time the Events menu is

removed from the display.

10 seconds prior to the Mark Event

plus 6 seconds from the start of the

annotation text or from the time the

Events menu is removed from the

display.

Printing from Data Management Mode 18 Working with Data

231

Printing from Data Management Mode

To print a historical Event Summary, Vital Sign Trends Report or 12-Lead Report:

1Enter Data Management Mode. See “Entering Data Management Mode” on page 226.

2Use the soft keys labeled [Prev Item] and [Next Item] to select the Event Summary you

want to print.

3Press the Menu Select button to display the Data Management menu.

4Highlight Print and press the Menu Select button.

5Select the data option listed that you want to print (see Figure 101) and press the Menu Select

button to print.

Figure 101 Printing in Data Management Mode

NOTE To print an Event Summary stored on the removable data card, the information must first be

downloaded to the HeartStart Event Review Pro data management system. Refer to the HeartStart

Event Review Pro Instructions for Use for download instructions.

Highlight Event Summary to print the selected Event Summary.

Highlight Trends to bring up the Trends Interval screen and print the

current Trends Report according to the configured format.

Highlight the specific 12-Lead Report you want to print.

Highlight Exit to exit the Print menu.

All Events Data

Trends

1-25 Apr 2007 11:15

2-25 Apr 2007 11:30

Exit

18 Working with Data Events Stored in Event Summary

232

Events Stored in Event Summary

Table 68 lists events and related information stored in an Event Summary, if they occur. Not all are

possible based on your device options. Italicized text is replaced by an appropriate value.

Table 68 Event Information

Logged Event Frequency

Power On/Off

Device On Logged when device first turns on.

Device Off Logged when Therapy Knob is turned to Off position.

Continued Use Logged when device is turned on after being turned off for less than 10 seconds.

Mode

AED Mode Logged at start of incident and when mode or selected energy changes.

Monitor Mode

Pacer Mode

Selected Energy xx J

Return To Owner

Display

Logged when Return To Owner screen is displayed.

Patient Info

Adult Patient/

Pediatric Patient

Logged at start of incident and when changed.

Paced Patient/

Non-Paced Patient

Logged at start of incident and when changed.

Age xx unit Logged when set.

Male/Female Logged when set.

Patient ID Logged when set.

Battery Status

Battery Low Logged when batteries are low and external power is not available.

***Batteries Low Logged when batteries are low and device is pacing.

Shutting Down in 1

Minute

Logged when warning issued.

Shutting Down Now

Pads/Paddles/Leads

Pads On Logged when pads are applied to patient.

Pads Off Logged after a Pads On event if adult/pediatric multifunction electrode pads are

removed from the patient or the pads cable is disconnected.

External Paddles On Logged when external paddles make contact with the patient.

External Paddles Off Logged after an External Paddles On event if paddles lose contact with patient.

Internal Paddles On Logged when internal paddles make contact with the patient.

Internal Paddles Off Logged after an Internal Paddles On event if paddles lose contact with patient.

Leads On Logged when monitoring electrodes for primary ECG are attached to the patient.

Leads Off Logged after a Leads On event if a monitoring electrode for the primary wave

loses contact with the patient.

Events Stored in Event Summary 18 Working with Data

233

Measurements

PVC/min Limit Logged when device is turned on if ECG alarms are on, when settings are

changed, or when ECG alarms are turned on.

VTACH Limits HR

value Run value

ECG Alarms Off Logged when ECG alarms are turned off.

Primary ECG label Logged for initial or change in primary ECG source.

Gain xY Logged for initial or change in ECG gain.

Learning Rhythm Logged when ST/AR algorithm learns ECG rhythm.

SpO2 On/Off

EtCO2 On/Off

Pressure Label On/Off

Temperature Label On/

Off

Logged when device is turned on if measurement is connected and subsequently

when measurement is disconnected/connected.

HR Limits low high

SpO2 Limits low high

EtCO2 Limits low high

Pressure Label Limits

source low high

Temperature Label

Limits low high

AwRR Limits low high

Pulse Limits low high

Logged with measurement on event if measurement alarms are on, when settings

are changed, or when measurement alarms are turned on.

SpO2 Alarms Off

EtCO2 Alarms Off

Pressure Label Alarms

Off

Temperature Label

Alarms Off

AwRR Alarms Off

Logged when measurement alarms are turned off.

Apnea Time limit sec. Logged when AwRR alarms are turned on and EtCO2 when settings are changed.

Pulse Alarms Off Logged when Pulse alarms are turned off.

[Press 1 - Press 2]

Label: Pressure Label

Logged when a pressure label is set or changed.

Pressure Label zeroed Logged when pressure label is zeroed.

Pressure Label cal factor

value

Logged when cal factor for pressure label is entered or a mercury calibration is

completed.

Pulse Source source Logged when the pulse source is initially determined and when changed.

NBP Schedule

[Manual, q1, ...]

Logged when schedule is changed.

NBP On Logged when Start NBP is initially pressed manually, or configured schedule.

NBP Limits source low

high

Logged when Start NBP soft key pressed and when settings are changed.

NBP Alarms Off Logged when NBP alarms are turned off.

Table 68 Event Information (Continued)

Logged Event Frequency

18 Working with Data Events Stored in Event Summary

234

[Temperature] Label:

Temperature Label

Logged when a temperature label is set or changed.

Alarms

**yellow or***red alarm Logged when alarm condition occurs.

Alarms Paused Logged when action occurs.

Alarms Resumed Logged when action occurs.

Alarms Off Logged when action occurs.

Audio Paused Logged when action occurs.

Audio Resumed Logged when action occurs.

Audio

Audio Recording

Started

Logged when audio recording starts or resumes after being stopped.

Audio Recording

Stopped

Logged when audio recording stops because of MRx mode change.

Audio Recording Full Logged when audio recording stops because 90 minutes of audio has been

recorded for the current event.

Q-CPR

NOTE: Q-CPR events are logged to the patient incident record but are not included in the Event

Summary report printed by the HeartStart MRx. Events and waveforms related to Q-CPR can be viewed

through Event Review Pro. For more Q-CPR feedback messages see Table 28 in the Q-CPR and Data

Capture chapter.

Q-CPR feedback On Logged at the beginning of an event if the Q-CPR Feedback configuration setting

is On.

Q-CPR feedback Off Logged at the beginning of an event if the Q-CPR Feedback configuration setting

is Off.

Cannot Analyze Vent Caused by ventilation events (either spontaneous respiration or noise) with an

impedance change > 3 ohms.

Pads Off Pads are off the patient while Q-CPR is active (ventilation invalid).

Poor Pads Contact Pads are on the patient but the impedance is >140 ohms while Q-CPR is active.

CPR meter

Malfunction

CPR meter responds with an error.

CPR meter Unplugged Device cannot communicate with the CPR meter.

Compression Event A CPR chest compression was detected.

Ventilation Event A ventilation event was detected.

Table 68 Event Information (Continued)

Logged Event Frequency

Events Stored in Event Summary 18 Working with Data

235

INOPs See "Troubleshooting" chapter for information regarding INOP statements.

Defibrillation

Charging to xx J Logged when device starts charging to selected energy setting.

Disarm [Manual, Auto] Logged when device disarmed by user or automatically after time-out period.

Shock # xLogged when discharge to patient (energy delivered, impedance and peak current

are stored with the waveform).

No Shock Delivered Logged when discharge to patient fails.

Sync On Logged when Sync function turned on by user.

Sync Off Logged when Sync function turned off by user.

AED Mode

Pause/Resume Logged when the [Pause for CPR] or [Resume Analyzing] soft keys

are pressed.

Analyzing Logged when advisory algorithm begins analysis.

Artifact Detected Logged when advisory algorithm detects noise or motion artifact.

Cannot Analyze ECG Logged when advisory algorithm cannot complete analysis sequence.

No Shock Advised Logged when a non-shockable rhythm is detected.

Shock Advised Logged when a shockable rhythm is detected.

Pacer

Pacer Mode [Demand,

Fixed]

Logged when pacing is started and when mode is changed.

Pacer [Start or Resume]

xx ppm xx mA

Logged when pacing is started and when pacing is resumed.

Pacer Rate ppm Logged when rate or output is changed and maintained for 2 seconds while

pacing. The logged time will be the time the setting took effect. If this event is

logged out of order, a * will be appended to the time stamp.

Pacer Output xx mA

Pacer Pause/Stop Logged when the Therapy Knob is moved off the Pacer position while pacing.

Pacer Output Low xx

in mA

Logged when the pacer output is less than the selected setting by 20 percent or 10

mA (whichever is greater)

12-Lead

12-Lead Acquired Logged when action occurs.

12-Lead Printed date/

time

Logged when action occurs.

12-Lead Deleted date/

time

Logged when action occurs.

12-Lead Transmitted

date/time

Logged when 12-Lead Report is successfully transmitted from the MRx.

Mark Event

Mark Event Logged when Mark Event button is pressed.

Mark event/drug Logged when user selects an entry from the Mark Event menu.

Table 68 Event Information (Continued)

Logged Event Frequency

18 Working with Data Events Stored in Event Summary

236

Print Strip Logged when Print button is pressed

Periodic Clinical Data Transfer

Start Data Transmit to

(site)

Logged when the HeartStart MRx begins a periodic clinical data transfer session

End Data Transmit Logged when the HeartStart MRx ends a periodic clinical data transfer session

Network

Audio Paused by

Central

Logged when alerts are silenced/reset from the Information Center.

Time changed from

(with original device

time)

Logged when the HeartStart MRx time and date are synchronized to the

Information Center time.

Date of Birth (day,

month, year)

Logged when the Date of Birth is set or changed.

Central Monitoring

Active

Logged when the HeartStart MRx associates with the Information Center.

Patient Discharged Logged when the patient is discharged.

No Central

Monitoring*

Logged when event occurs depending upon configuration - “Central Monitoring

Mandatory”

Radio Malfunction* Logged when event occurs. (INOP detected)

Radio Unplugged* Logged when event occurs. (INOP detected)

Radio Weak Signal* Logged when event occurs. (INOP detected)

All ECG Alarms Off* Logged when event occurs. (INOP detected)

* See Table 99 for causes and possible solutions to these logged events.

Table 68 Event Information (Continued)

Logged Event Frequency

Marking Events 18 Working with Data

237

Marking Events

The Mark Event button allows you to annotate the Event Summary and the ECG strip at the

point in time the button is pressed. If configured, pressing the Mark Event button prints a 6-second

ECG strip. Depending on configuration, the ECG strip is either printed real time, or prepended with

the previous 10 seconds of data leading up to the marked event.

Once pressed, the Mark Event label in the upper left corner of the display changes to Select Event and

the Mark Events menu is displayed (see Figure 102).

Figure 102 Mark Events Menu

Use the Navigation buttons to select the desired event and press the Menu Select button.

The ECG strip is annotated with the mark event symbol and the selected annotation. If an

annotation item is not selected within five seconds after the Mark Event button is pressed, only the

generic mark event symbol will appear on the ECG strip.

The marked event is stored in the Event Summary.

NOTE Entries on the Mark Events menu are as configured. Changes are made using the Configuration menu.

Mark Events

ET Access

IV Access

Epinephrine

Lidocaine

Atropine

Morphine

Nitroglycerin

Aspirin

Other

239

19Data Transmission

This chapter provides instructions on how to transmit data from the HeartStart MRx to various

external devices using the suite of data transmission options available in the monitor/defibrillator.

Overview

There are two applicable scenarios for transmitting HeartStart MRx data:

• During a critical care event: Transmission of vital signs and related data (12-lead waveforms and vital

signs) ahead of a critical care patient (cardiac, stroke, trauma, respiratory, pediatric, etc.) to alert a

healthcare facility of an incoming critical care patient so the facility can prepare for the next level of

care before the patient arrives. See “Transmitting During a Critical Care Event” on page 240.

• Post event: Transmission of complete event data after an event has occurred for quality review,

billing and eventual archiving. “Transmitting Event Summaries Post Event” on page 254.

Depending upon what you are trying to do, the HeartStart MRx can send 12-Lead Reports, Event

Summaries and/or Periodic Clinical Data to a remote location. See Figure 103.

Figure 103 MRx Data Transmission Options During An Event

HeartStart MRx

Cell/Radio Tower

Personal Computer/

Laptop/Tablet/Mobile

Device

onBoard™ Mobile Gateway

(from InMotion Technology)

Cellphone

Radio Tower

CAREPoint™ station

at healthcare facility

(from General Devices)

2-Way Radio

Rosetta-LT™

(from General Devices)

US Only

Internet

Server running

data review

software

Fax

LAN Printer

TraceMasterVue

ECG Management System

Another server with

data review software

GE MUSE®

(Or other ECG Management System

through the Data Med Format Translator

by Engineering Solutions, Inc.)

19 Data Transmission Transmitting During a Critical Care Event

240

Transmitting During a Critical Care Event

The HeartStart MRx provides multiple options to transmit data during a critical care event. See Table

69.

Table 69 Critical Care Transmission Use Cases

I want to transmit: The HeartStart MRx uses: What transmission options does my

HeartStart MRx need to make it

work?

Where do I find

instructions?

Clinical data to a

destination point

periodically during

transport using Bluetooth

wireless.

Dial Up Networking

(DUN) and a Bluetooth

wireless card to transmit a

12-Lead ECG through a

cell phone, land line

modem or other gateway to

a destination point.

The Periodic Clinical Data Transfer

options (B18) and 989803153411

(Internal Bluetooth Card).

See “Periodic Clinical Data

Transmission” on page 250

and “Transmitting Clinical

Values” on page 250.

A 12-Lead ECG using

Bluetooth wireless

technology via a cell phone,

land line modem or other

cellular broadband gateway

to the Internet.

The 12-Lead Transmission -

Bluetooth wireless technology

option (B06) OR product upgrades

M3801 (12-Lead BT Transmit) and

989803153411 (Internal Bluetooth

Card).

See “Transmitting During

a Critical Care Event” on

page 240.

A 12-Lead ECG using my

portable computer to

forward to the Internet.

Bluetooth File Transfer and

a Bluetooth wireless card to

transmit the 12-Lead ECG

to the PC. Data Messenger

software will forward to the

12-Lead Transfer Station.

The 12-Lead Transmission -

Bluetooth wireless technology

option (B06) and either Event

Summary Bluetooth option (B10) or

Periodic Clinical Data Transmission

options (B18). HeartStart Data

Messenger software (861453).

See “Transmitting to a

Personal Computer” on

page 249.

A 12-Lead ECG using

electronic PCR software in

my portable computer1.

Bluetooth File Transfer and

a Bluetooth wireless card to

transmit the 12-Lead ECG

to the PC.

The Event Summary Bluetooth

option (B10) AND one of the 12-

Lead Transmission options (Serial,

Bluetooth or Rosetta-Lt) installed.

See “Transmitting to a

Personal Computer” on

page 249.

A 12-Lead ECG using a 2-

way radio and the Rosetta-

Lt2 to a CAREpoint™ or

Rosetta-Rx™ device at a

healthcare facility.

An RS-232 cable3 to

connect the HeartStart

MRx to the Rosetta-Lt,

which then transmits to a

destination point.

The 12-Lead Transmission, Rosetta-

Lt interface option (B11) OR

product upgrade 861326 (12-Lead

transmission, Rosetta-Lt Interface).

See “Setting up Rosetta

Transmissions” on

page 245.

A 12-Lead ECG using the

RS-232 port, a cell phone

and the Internet to a

destination point.4

The RS-232 port to

transmit data through a cell

phone to a selected

destination.

The 12-Lead Transmission - RS-232

and Bluetooth option (B07) OR

product upgrades M3802 (12-Lead

BT/RS-232 Transmit) and

989803153411 (Internal Bluetooth

Card).

See “Setting Up for RS-232

Transmissions” on

page 247.

1 – Patient Care Report (PCR) software must be able to deliver the file to the healthcare facility. The destination site set at the HeartStart MRx is contained

in the file information transmitted. If you use a Philips product to deliver the file to the healthcare facility, it reads the destination site from the file sent. For

more information on the set-up of your ePCR software, see the software’s Instructions for Use.

2 – Available in the U.S. only

3 – Cable provided by General Devices.

4 – There are a limited number of carriers and cellphones which support this feature. Consult your cellular handset sales representative for more

information.

Preparing for Transmission 19 Data Transmission

241

Preparing for Transmission

Before transmitting data, the HeartStart MRx needs to be set up properly based on the type of

transmission option selected. If you are using Bluetooth wireless technology, your wireless devices need

to be set up as well. If you are using Batch LAN Data transfer, set up your HeartStart Data Messenger

Server ahead of time and configure both devices. See the instructions which came with the Data

Messenger Server for more information. Regardless of the solution selected, test the transmission before

using in a clinical situation.

If you are using a cell phone, data transmission can sometimes be unreliable. A strong signal and

stationary transmission will improve the transmittal success rate. Follow instructions provided with

your cell phone.

CAUTION Many institutions prohibit the use of cell phones on their premises. Please abide by local rules and

regulations.

NOTES If transmitting in a clinical mode, waveforms for all monitored parameters can be viewed during the

transmission process. However, the waveform appearing in Wave Sector 4 is partially obscured when

the transmission status bar is displayed. Related alarms, measurements and INOP messages remain

active and are reported in Parameter Blocks 1 and 2 and the general status area.

The HeartStart MRx transmits data from internal memory only. Data contained on the external data

card only is not transmittable.

Modifying Reference IDs

You can change the Reference ID of your HeartStart MRx during an event by performing the

following (for more information on Reference IDs, see “Identifying Your Device” on page 26.

1Press the Menu Select button.

2Use the Navigation buttons to highlight Other and press the Menu Select button to select.

3Highlight Reference IDs and press the Menu Select button to select.

4Select the Reference ID you want to use or Other to add an additional Reference ID.

If you selected a reference ID from the list in Step 4, it becomes the Reference ID for the current event

and subsequent events. If you selected Other, the HeartStart MRx prompts you to create a new

Reference ID. Use the Menu Select button and the Navigation buttons to create the new entry.

Selecting Done saves your edits as the current Reference ID. Selecting Cancel closes the menu and does

not change the Reference ID.

19 Data Transmission Preparing for Transmission

242

Setting up Bluetooth Transmissions

To use Bluetooth technology to wirelessly transfer data from the HeartStart MRx, including Clinical

Values Data Transmission, you must configure both the monitor/defibrillator and the receiving

Bluetooth device.

Adding a Bluetooth Device

The HeartStart MRx can have up to 20 Bluetooth devices configured at one time. Adding a 21st device

replaces the device used least recently.

NOTE Bluetooth devices may not be added or modified during transmission and transmission is not allowed

during Bluetooth device configuration.

To add a Bluetooth device to the list of Transmission Devices:

1Once in 12-Lead mode, press the Menu Select button.

2Using the Navigation buttons, select Bluetooth Devices and press the Menu Select button. A list of

previously discovered Bluetooth devices is displayed.

3Select Add Device and press the Menu Select button. The message Searching for Bluetooth Devices

is displayed. The search lasts for 30 seconds.

4From the Add Device menu, select the desired device and press the Menu Select button.

The selected device must now go through the “Pairing” process described below.

NOTE All Bluetooth devices within the specified range are discovered by the HeartStart MRx and are

displayed on the Add Device menu, even if you have already paired with the device.

You can also add a Bluetooth device in Data Management Mode, during Periodic Clinical Data

Transmission and from the Other option from the Main menu. The process is the same beginning with

Step 2 above.

Pairing a Bluetooth Device with the HeartStart MRx

Once a Bluetooth device is selected from the Add Devices menu, a passkey sequence must be

performed in order to communicate or “pair” the wireless device with the HeartStart MRx. The

passkey is a user-defined character sequence, such as 000 or 1234, etc.

Some Bluetooth devices only allow pairing for 30 seconds, so be ready to enter the passkey.

1Use the Navigation buttons to enter the passkey on the MRx and select Done.

The Bluetooth device prompts you for a passkey.

2Enter the same passkey on your Bluetooth device. See the documentation that came with your

Bluetooth device for instructions.

3You are prompted to select a Bluetooth Service. Highlight File Transfer or Dial-Up Networking and

press the Menu Select button. Generally, phones and gateways are Dial-Up Networking and

personal computers are File Transfer. If you are unsure of which service to select, contact your

Philips installation manager for more information.

4If you selected dial-up networking, select the designated profile from the Phone/Modem Profiles

menu. If you selected file transfer, proceed to the next step. (You will not be prompted to select a

profile when adding a Bluetooth device as part of the Event Summary, Bluetooth option.)

Preparing for Transmission 19 Data Transmission

243

5Once the Bluetooth device is paired with the HeartStart MRx and the profile selected, the

HeartStart MRx performs a transmission test. After successfully connecting, the message

Transmission Test Passed is displayed. Press the Menu Select button to acknowledge the message.

Should the transmission test fail, the message Transmission Test Failed is displayed, along with

additional information about where the failure occurred. See “Transmission Problems (Bluetooth)”

on page 304 for troubleshooting information.

NOTES The profile contains specific information about the Bluetooth device that enables it to communicate

with the 12-Lead Transfer Station, personal computers and devices running data viewing software.

Your administrator sets up the profiles and can tell you which one to choose.

There may be exceptions to the pairing process, particularly for devices that do not have a user

interface. Please refer to the documentation for your Bluetooth device. Additionally, pairing may

sometimes be referred to by other names, such as “bonding”.

Pairing information is not retained when importing a configuration file from the data card. The

devices must be paired again using the process above.

CAUTION The HeartStart MRx is capable of communicating via Bluetooth with nearby devices such as

computers, laptops, tablets and mobile devices. Each of these devices has a unique set of features and

configuration options. In order to ensure reliable transmissions, familiarize yourself with the Bluetooth

configuration choices of each. Some choices (either default or chosen by the user) could prevent receipt

of data from the HeartStart MRx. For example, it is recommended that you disable features such as

“Start discovery every 10 minutes”. Enabling this option could interfere with transmissions from the

HeartStart MRx.

19 Data Transmission Preparing for Transmission

244

Changing Bluetooth Profiles

Once you have added and paired a Bluetooth device, you can change its profile using the following

steps:

1In 12-Lead Mode, press the Menu Select button.

2From the 12-Lead Main Menu, select Bluetooth Devices and press the Menu Select button. A list

of paired Bluetooth devices is displayed.

3Using the Navigation buttons, select a device and press the Menu Select button.

4To change a profile, select Change Profile and press the Menu Select button. A menu of configured

profiles for that device is displayed, with the currently associated profile highlighted.

5Select the profile you want to associate with the device.

The MRx tests the profile to determine if the Bluetooth device can communicate with the 12-Lead

Transfer Station. Progress messages are displayed during the test. If the test is successful, the

message Transmission Test Passed is displayed. Press the Menu Select button to acknowledge the

message. Should the transmission test fail, the message Transmission Test Failed is displayed, along

with additional information about where the failure occurred. See “Transmission Problems

(Bluetooth)” on page 304.

Additional Bluetooth Device Information

Keep the following points in mind when working with Bluetooth devices:

• Many Bluetooth devices are not discoverable by default. Check your device’s documentation to see if

you need to enable discovery.

• As a general security practice, you should not leave your Bluetooth device in discoverable mode.

• Some devices require that you turn on the Bluetooth functionality.

• Some devices may prompt you to authenticate each time. Check your device’s documentation to see

if you can configure it to always communicate with the HeartStart MRx.

• Give your Bluetooth device an easily recognizable name as this is the name that appears on the MRx

menus. The name should be no more than 15 characters in order for it to display properly on the

HeartStart MRx.

• Bluetooth modems and fax machines use analog lines to transmit data. If you are transmitting using

a Bluetooth modem, plug it into the analog line used by the fax machine.

Transmitting Using Bluetooth

For instructions on transmitting with Bluetooth from 12-Lead Mode, see “Post Event Transmission

Use Cases” on page 254.

Setting up Rosetta Transmissions 19 Data Transmission

245

Setting up Rosetta Transmissions

Using an easy cable connection, the HeartStart MRx enables you to transmit a 12-Lead Report to a

Rosetta-Lt for two-way radio transmission to a healthcare facility running CAREpoint or Rosetta-Rx.

See Figure 104. (Available in the United States only.)

Figure 104 Rosetta-Lt Transmissions

WARNING Do not connect the HeartStart MRx to the Rosetta-Lt when the Rosetta-Lt is connected to a telephone

line. This combination is prohibited. Before connecting the Rosetta-Lt to a telephone line, disconnect

it from the HeartStart MRx.

The 12-Lead Report sent to the Rosetta-Lt includes:

• Patient identification information

• Device identification information

• Event ID number

•Waveform data

Optional information in the 12-Lead Report includes:

• Measurements. The 12-Lead Report can also contain numerics for vital signs (SpO2, EtCO2,

AwRR, Pulse, Temp, Invasive Pressure, NBP) if available. The vitals sent with the report are the

values recorded at the beginning of the 12-Lead acquisition. If a vital numeric is unavailable or its

source is off, then the vital numeric is not included in the report. NBP numerics are valid for 60

minutes. If no measurement has been taken in the last 60 minutes, NBP numerics are considered

unavailable. NBP numerics include the measurement time.

• Interpretive Statements

• Acute MI Critical Values Statements

•Rhythm strips

NOTE The HeartStart MRx sends the above data to the Rosetta-Lt. Information displayed on the 12-Lead

Report produced by the Rosetta-Lt is determined by Rosetta-Lt software.

GENERA

x/Rx

OWER

ART

ta Tr

nslator

ett

LACE MIC ON PAD

University Hospital

Children's Hospital

Rosetta-Lt Receiving device at a

healthcare facility

Radio Tower

2-Way Radio

HeartStart MRx

19 Data Transmission Setting up Rosetta Transmissions

246

CAUTION A 12-Lead Report sent to the Rosetta-Lt will overwrite any 12-Lead Report which currently exists on

the Rosetta-Lt. It is your responsibility to forward the 12-Lead Report from the Rosetta-Lt to its

destination. See the Rosetta-Lt User’s Guide for more information.

NOTEs If your HeartStart MRx is transmitting a 12-Lead Report via means other than the Rosetta-Lt, the

Rosetta-Lt option is disabled in the Send to menu until the transmission is complete.

Rosetta-LT is available in the United States only.

Connecting Rosetta-Lt

To connect the Rosetta-Lt to the HeartStart MRx, insert the Rosetta-Lt cable into the HeartStart

MRx’s RS-232 Serial port and tighten the screws. See Figure 105.

Figure 105 Attaching the Rosetta-Lt to the HeartStart MRx

NOTE For questions about the Rosetta-Lt and connector cable or to purchase a connector cable/additional

items, contact General Devices. See the Rosetta-Lt Data Translator User’s Manual for more

information.

Transmitting Using Rosetta-Lt

For instructions on transmitting with Rosetta-Lt from12-Lead Mode, see “Post Event Transmission

Use Cases” on page 254. To transmit from Data Management Mode, see “” on page 254.

NERAL

ICES

x/Rx

POWER

TART

TOP

DataTranslator

osetta - Lt

LACEMICONPAD

Setting Up for RS-232 Transmissions 19 Data Transmission

247

Setting Up for RS-232 Transmissions

12-Lead ECG Transmission using RS-232 requires a 9-pin serial cable connected to the RS-232 Serial

Port located on the back panel of the HeartStart MRx. Attach the cable to the device and secure the

screws into place. Then connect the cell phone to the other end of the cable. See Figure 106.

Figure 106 RS-232 Cable Connections

NOTE For further information concerning the setup and configuration of transmission devices and the

HeartStart MRx, refer to the Transmission Implementation Guide. For further information concerning

the 12-Lead Transfer Station, refer to the 12-Lead Transfer Station Instructions for Use.

Transmitting using RS-232

For instructions on transmitting with RS-232 in 12-Lead Mode, see “Post Event Transmission Use

Cases” on page 254.

19 Data Transmission Transmitting in 12-Lead Mode

248

Transmitting in 12-Lead Mode

You can transmit a 12-Lead Report while monitoring a patient in 12-Lead Mode. Reports can be

transmitted to printers, fax machines, PDAs, Philips TraceMaster ECG Management System or other

servers running Philips data viewing server software.

Reports are sent from the HeartStart MRx to the hub (a web server running Philips 12-Lead Transfer

Station software).

Using Bluetooth transmission, they are transmitted to the hub using configured wireless devices such as

cell phones, handheld devices and other external devices like computers, laptops and other mobile

devices.

Using the Rosetta-Lt (available in the U.S. only), 12-Lead Reports are transmitted via two-way radio

transmission to a healthcare facility running CAREpoint or Rosetta-Rx.

Using RS-232 Transmission, the reports are transmitted via a cell phone with internet capability

connected to the MRx’s RS-232 Serial Port. The 12-Lead Transfer Station then forwards the report to

the selected destination site. Additionally, reports can be sent to a wireless modem connected to an

analog line for areas where cell transmission is unavailable.

To send the current 12-Lead Report:

1From the 12-Lead Report screen, press the Menu Select button.

2Select Send and press the Menu Select button.

3Select the destination of the 12-Lead from the Send To menu and press the Menu Select button.

4If your device is configured with just one option to transmit the 12-Lead Report or you selected

the Rosetta-Lt, transmission begins when you press the Menu Select button. If your device has

more than one configured transmission device, highlight the device you want to use and press the

Menu Select button. Transmission begins. See Figure 107.

Figure 107 Steps to Sending 12-Leads

NOTES Patient Name and ID must be entered prior to 12-Lead acquisition in order for it to appear on the 12-

Lead Report.

The HeartStart MRx transmits data from internal memory only. Data contained on the external data

card only is not transmittable.

The .05 - 40 Hz 12-Lead filter setting is supported by TraceMasterVue version A.02.01 or higher.

Send To

Rosetta

St. Mary's ED

St. Joseph's Cath Lab

Dr. Smith

Dr. Jones

EMS Station

Fax Number

Exit

Transmission Devices

1st Configured Device

2nd Configured Device

nth Configured Device

20th Configured Device

Exit

Transmitting in 12-Lead Mode 19 Data Transmission

249

NOTES For further information concerning the setup and configuration of transmission devices and the

HeartStart MRx, refer to the Transmission Implementation Guide. For further information concerning

the data viewing server, refer to the software’s instructions for use.

Subsequent 12-Lead Reports can be placed in queue for transmittal while transmission is in progress,

or the originally selected 12-Lead Report can be chosen for transmission to multiple sites.

Transmitting to a Manually Entered Fax Number

Upon acquisition of the 12-Lead ECG, the 12-Lead Report is displayed.

To manually enter a fax number destination:

1Press the Menu Select button.

2Using the Navigation buttons, select Send from the 12-Lead Main Menu and press the Menu

Select button.

3Using the Navigation buttons, select Fax Number from the Send To Menu.

4Enter the fax number from the numeric list using the Navigation buttons. Include any extra digits

necessary, such as 9 for an outside line or 1 plus the area code for long distance.

5Select Done and press the Menu Select button.

NOTE If you are transmitting to a manually entered fax number using a Bluetooth device, the device and

landline prefix, if applicable, must be entered.

Transmitting to a Personal Computer

By using Bluetooth FTP either during an event/transport or post event, the HeartStart MRx can send

its data to your personal computer. See Figure 108. You can:

• Transfer 12-Lead, Periodic Clinical Data or Event Summary data to a personal computer.

• Transfer data to be used by an ePCR, or Event Review Pro on the receiving personal computer or

forwarded on to a remote destination using Data Messenger software.

Figure 108 Transmitting to a PC

HeartStart MRx Personal Computer

19 Data Transmission Periodic Clinical Data Transmission

250

Periodic Clinical Data Transmission

Periodic Clinical Data Transmission (PCDT) provides the ability to transmit clinical data from the

point of care for a critical care patient to the receiving hospital to facilitate the next level of care. The

PCDT option uses Bluetooth technology to automatically transmit periodic vitals and transmit 12-

leads and waveform data upon a set of trigger events from a clinical mode to remote data viewing

software. See Table 71 for details on the type of data sent.

Transmitting Clinical Values

With the Periodic Clinical Data Transmission (PCDT) option, the HeartStart MRx uses Bluetooth

technology to transmit “live” clinical patient information from a HeartStart MRx in a clinical mode to

a remote data viewing server for consultation and decision making assistance. When the option is

turned on, the HeartStart MRx displays an icon indicating connectivity status. See Figure 109 and

Table 70.

Figure 109 PCDT icon location

Table 70 PCDT Icons

PCDT Contents

When a PCDT is initiated, the HeartStart MRx transmits patient vital signs trending data

automatically at pre-configured intervals. You can configure your HeartStart MRx to automatically

transmit clinical values every 1, 2, 3, 4 or 5 minutes. See “Configuration” on page 199 for details on

how to configure this setting. The type of information sent in a PCDT depends on the event which

triggers the transmission. See Table 71.

Symbol Definition

No symbol No connection/association with the data viewing server is established.

PCDT is not activated.

A PCDT session has been established and is working properly.

(Blue icon with white Bluetooth symbol)

A PCDT session is currently transmitting data.

(Blue icon with green Bluetooth symbol)

A PCDT session has been started but the connection to the data

viewing server has failed.

(Blue icon with white Bluetooth symbol crossed out)

Extreme Tachy

Mark Event

ECG Unplugged

PCDT icon

Periodic Clinical Data Transmission 19 Data Transmission

251

Table 71 Dat a Tr ans mi t ted Dur i n g PC D T

NOTE All transmitted personal patient-identifiable data is encrypted to insure patient confidentiality. Please

handle in accordance with HIPAA or your local patient privacy requirements. To de-identify patient

data, you must delete the event summary.

Event When What data is sent

Vital signs updated every 1 to 5 minutes

(based on configuration)

• Patient vital data for pulse, heart and AwRR rates, NBP, EtCO2,

SpO2, Invasive Pressures and temperature for the parameters that

are turned on; timestamp of vitals

• HeartStart MRx device ID

•HeartStart MRx incident ID

12-lead acquired When obtained • 12-lead ECG (may include ACI-TIPI and TPI information)

Marking an event When Mark Event

button is pressed

• All data with Vital signs update

• Event label and time

• Mark event description

(NOTE: If a label is not selected within five seconds of pressing the Mark

Event button, the event is labeled as generic and sent.)

•A segment consisting of the 10 seconds prior to and the five

seconds following the Mark Event, inclusive, for each of the

waveforms configured to be printed

Delivering a shock After shock is

delivered or aborted

due to impedance or

other issues

• All data with Vital signs update

• Event label and time

•Shock number*

•Number of Joules*

• Data on impedance and peak current*

• A segment consisting of the 10 seconds prior to and the five

seconds following the shock, inclusive, for each of the

waveforms configured to be printed

* - not sent with an aborted shock PCDT

Physiological alarm

including: Asystol, VFIB/

VTACH, VTACH, Extreme

Tachy, Extreme Brady, Apnea,

Extreme Desat, Invasive Pressure

Disconnect, PVC/min high,

Pacer Not Captured, Pacer Not

Pacing, Pacer Output Low and

alarm limits for HR, NBP,

EtCO2, SpO2, Pulse rate,

AwRR, Invasive Pressure, CPP,

and Temperature

When trigger event

occurs

• All data with Vital signs update

• Event label and time

• A segment consisting of the 10 seconds prior to and the five

seconds following the event trigger, inclusive, for each of the

waveforms configured to be printed

* End PCDT does not send vitals or waveform data

Print button is pressed

Start/End PCDT*

19 Data Transmission Periodic Clinical Data Transmission

252

Configuring a receiving site

Before sending a Periodic Clinical Data Transmission, you need to have a receiving site destination

configured, unless you are sending to an electronic Patient Care Record (ePCR) application. See

“Modifying Settings” on page 200 in the Configuration chapter to modify the Site options in the Data

Transmission configuration section.

Starting a Periodic Clinical Data Transmission

You can configure your HeartStart MRx to automatically transmit clinical values every, 1, 2, 3, 4 or 5

minutes. See “Configuration” on page 199 for details on how to configure this setting.

To begin PCD Transmission:

1Confirm the HeartStart MRx is in a clinical mode and that your device has a properly configured

data viewing software destination and Bluetooth FTP or DUN device. If it is not properly

configured, see “Adding a Bluetooth Device” on page 242.

2Press the Menu Select button.

3Using the Navigation buttons, select Start Data Transmit and press the Menu Select button.

4From the Send To menu, use the Navigation buttons to select a pre-configured data viewing server

location to send the data to and press the Menu Select button to select.

5From the Transmission Devices menu, use the Navigation buttons to select the transmission device

option you want to use and press the Menu Select button to select. The PCDT icon appears on the

display and transmission begins. If your device does not have a a transmission device, the

HeartStart MRx prompts you to add a device. See “Adding a Bluetooth Device” on page 242.

NOTES If the connection between the HeartStart MRx and the destination server fails, the HeartStart MRx

automatically tries to reconnect and sends the transmission when a connection is established.

If you start a PCDT within 10 seconds of turning the HeartStart MRx on, the first transmission

contains no wave data.

Periodic Clinical Data Transmission is not available when the HeartStart MRx is connected to the

IntelliVue network.

Periodic Clinical Data Transmission 19 Data Transmission

253

Priorities For Sending Data

In low bandwidth or poor signal quality areas, the HeartStart MRx has the ability to queue periodic

data transmissions. See “Periodic Clinical Data Transmission” on page 250 for details on data

transmitted. When you have more than one transmission in queue, the HeartStart MRx sends data

according to a preset priority:

• If there are multiple transmissions, all patient vital signs transmissions are sent first, event

transmissions second and 12-Lead Report transmissions third.

• If there are multiple transmissions of the same type, they will be sent in chronological order.

• If a pending vital signs transmission is greater than 15 minutes old, the message is not sent.

• If there is a pending 12-Lead report transmission and a new 12-Lead report is acquired, only the

newest 12-Lead Report is sent.

• If there is a pending event message that’s greater than a minute old, it is not sent.

NOTE The most recent 500 transmission events are logged in the Periodic Clinical Data Transmission log,

available in Service Mode. See the HeartStart MRx Service Manual for more information.

Ending a Periodic Clinical Values Transmission

To end an on-going periodic clinical data transmission:

1Press the Menu Select button.

2Using the Navigation buttons, select End Data Transmit and press the Menu Select button.

3Confirm you want to end the transmission by highlighting Yes and press the Menu Select button.

(Selecting No continues the transmission.)

4The transmission stops and all pending transmissions are deleted.

NOTE Exiting a clinical mode cancels a data transmission session and all transmissions in queue.

19 Data Transmission Transmitting Event Summaries Post Event

254

Transmitting Event Summaries Post Event

The HeartStart MRx provides options (see Figure 110 and Table 72 ) to transmit data after an event

for quality review, billing and archiving. You can:

• Save data to the data card for personal transport to another device. See “Copying from Internal

Memory” on page 227.

• Send data via Bluetooth to a receiving device. See “Setting up Bluetooth Transmissions” on

page 242.

• Send data via Batch LAN Data Transfer. See “Batch LAN Data Transfer” on page 259.

Figure 110 Post Event Transmission

Table 72 Post Event Transmission Use Cases

I want to transmit: The HeartStart MRx

uses:

What transmission options does my

HeartStart MRx need to make it work?

Where do I find

instructions?

An Event Summary to an

external computer wirelessly1.

Bluetooth wireless

technology to

transmit data to a

Bluetooth-enabled

computer.

The Event Summary Bluetooth option

(B10) OR product upgrades 861325 (Event

Summary, Bluetooth) and 989803153411

(Internal Bluetooth Card).

See “Transmitting

Event Summaries

Post Event” on

page 254.

A single Event Summary or

group of Event Summaries to a

local computer after an event

or shift is finished.

A LAN cable

connecting the device

to your computer.

The Batch LAN Data Transfer (BLDT)

option (B12) or product upgrades 861447

(Batch LAN Data transfer), 989803153411

(Internal Bluetooth Card). HeartStart Data

Messenger software (861453).

See “Transmitting

Event Summaries

Post Event” on

page 254.

1 – Windows-based personal computer/laptop/tablet/mobile device with a Bluetooth stack installed that supports File Transfer Profile Server. See

“Specifications” on page 321 for more information.

ePCR

Event Review Pro

HeartStart MRx

Data Messenger

PC locally

ePCR database

Event Review Pro

PC at central

location

Transmitting in Data Management Mode 19 Data Transmission

255

Transmitting in Data Management Mode

The HeartStart MRx Event Summary, Bluetooth option uses Bluetooth wireless technology to send an

Event Summary (complete or partial) or a 12-Lead Report to a receiving Bluetooth device from Data

Management Mode. The Rosetta-Lt transmission device uses two-way radio to transmit 12-Lead

Reports from Data Management Mode. The Batch Data Transfer option uses a LAN cable to

download a single Event Summary or all Event Summaries on your internal data card.

Transmitted Event Summaries include all stored waves, trending data, 12-Lead Reports and event files,

including vital signs such as heart rate, pulse, SpO2, EtCO2, AwRR, NBP, invasive pressure and

temperature numerics. If your HeartStart MRx has the Audio and/or Q-CPR Data options, you can

include these parts of the Event Summary.

NOTE Event Summaries can only be transferred via Bluetooth to devices that support the Bluetooth File

Transfer Profile Server.

To transmit an Event Summary or 12-Lead Report from the HeartStart MRx’s internal memory to a

receiving device, perform the following:

1After you have finished monitoring the patient and removed them from the HeartStart MRx, place

the device into Data Management Mode. The display reads Data Management - Internal Memory

across the top.

2Using the [Prev Item] and [Next Item] softkeys, highlight the Event Summary you

want to transmit (or the Event Summary which contains the 12-Lead Report you want to transmit)

and press the Menu Select button.

3Highlight Send and press the Menu Select button.

4Highlight the type of data you want to transmit (see Figure 111) and press the Menu Select button.

Figure 111 Send Functions

Highlight All Event Data to send an entire event, including 12-Lead Reports.

Text in this menu line varies depending upon the HeartStart MRx options installed:

Exclude Audio & Q-CPR is displayed if your device has the Audio Recording, Q-

CPR Data and Event Summary, Bluetooth options.

Exclude Audio is displayed if your device has the Audio Recording and Event

Summary, Bluetooth options and does not have the Q-CPR Data option.

Exclude Q-CPR is displayed if your device has the Q-CPR Data and Event

Summary, Bluetooth options and does not have the Audio Recording option.

Highlight the specific data to exclude it from the Event Summary transmission.

If you only want to transmit a specific 12-Lead Report, highlight it to transmit. (Not

available with Batch LAN Data Transfer.)

Highlight Exit to exit the Send menu without transmitting any data.

Send

All Events Data

Exclude Audio & Q-CPR

1-25 Apr 2007 11:15

2-25 Apr 2007 11:30

Exit

19 Data Transmission Transmitting in Data Management Mode

256

5Depending upon which option you selected in Step 4, you are presented with different menus.

If you selected a 12-Lead Report:

1Select a destination for the 12-Lead Report from the Send To menu. Highlight the destination

and press the Menu Select button. If your device is configured with just one transmission device

or you selected the Rosetta-Lt, transmission begins.

2If your device has more than one configured transmission device, highlight the transmission

device you want to use and press the Menu Select button. Transmission begins. See Figure 112.

Figure 112 Sending 12-Leads from Data Management

If you selected an Event Summary:

If your device is configured with just one transmission device, transmission begins. If your device

has more than one configured transmission device, highlight the option you want to use and press

the Menu Select button. Transmission begins. See Figure 113.

Figure 113 Event Summary Transmission

NOTES If you press the Exit Data Management softkey while a transmission is ongoing, you need to confirm

your selection. Selecting Yes exits Data Management, cancels your current transmission and any

queued transmissions. Selecting No continues the current transmission.

If you print an event in Clinical Mode and switch to Data Management Mode, the printing must be

complete before the event can be copied or sent. Failure to do so results in either a Cannot copy this

event while printing or a Cannot send this event while printing message. If you get either message, wait

for the printing to finish or cancel the printing before proceeding.

Send

All Events Data

Exclude Audio & Q-CPR

1-25 Apr 2007 11:15

2-25 Apr 2007 11:30

Exit

Send To

Rosetta

St. Mary's ED

St. Joseph's Cath Lab

Dr. Smith

Dr. Jones

EMS Station

Fax Number

Exit

Transmission Devices

Medic Phone 1

OMG Gateway

Data Mess. PC

20th Configured Device

Exit

Transmission Devices

Medic Phone 1

OMG Gateway

Data Mess. PC

20th Configured Device

Exit

Transmitting in Data Management Mode 19 Data Transmission

257

Tracking Data Transmission

After initiating a data transmission from the HeartStart MRx, you can track transmission progress on

the device display. For events, the Event ID along with the date and time of the event data being sent

are displayed while for 12-Lead reports, the date and time of the report are displayed. The phase

(Connecting to Device and Sending) are also shown. If the HeartStart MRx is in the process of sending

data, a percentage complete is also displayed. See Figure 114.

Figure 114 Transmission Status Bar

Once transmission is complete, a brief Confirming. Stand by ... message appears on the display followed

by a Disconnecting message. Then the transmission progress message is removed.

NOTE If a 12-Lead transmission occurs during a patient event, an event indicating the time of transmission is

logged into the current Event Summary using the format, "12-Lead (hh:mm:ss) Transmitted to site

name".

If you exit the Data Management screen or leave a clinical mode causing a reboot of the device during

transmission, the transmission is aborted. Changing between clinical views (AED, Monitoring, Pacing,

Manual Defibrillation) does not terminate a transmission. The status bar is displayed in all clinical

modes.

Transmission Errors

If there is an error in transmission, a message is displayed on the HeartStart MRx screen, accompanied

by an audio beep. Press the Menu Select button to acknowledge the error. See Figure 115. The error is

logged into the Device Status Log.

Figure 115 Transmission Failure

Cancelling a Transmission

To cancel a transmission in progress, perform the following:

1From either 12-Lead Mode or Data Management Mode, press the Menu Select button.

2Highlight Cancel Transmission and press the Menu Select button.

3Confirm the Cancel Transmission action. Highlight Yes and press the Menu Select button to

cancel; highlight No and press the Menu Select button to continue the transmission.

After confirming a transmission cancellation, the HeartStart MRx displays a Disconnecting message

until the cancel process is completed. Some disconnections may occur so quickly that the Disconnecting

message may not be visible.

11 Aug 2004 10:52

Sending, 40% complete

Transmission Failed

Connection Failed

19 Data Transmission Transmitting in Data Management Mode

258

Queuing Transmissions

You can queue more than one HeartStart MRx 12-Lead Report or Event Summary for a non-BLDT

transmission using the same transmission device (except the Rosetta-Lt). 12-Lead Reports can be

queued to the same or different locations. If you are using the Rosetta-Lt, you must complete the

transmission from the HeartStart MRx to the Rosetta-Lt AND from the Rosetta-Lt to its

communication device before beginning another transmission. Failure to do so results in overwriting

the first transmission to the Rosetta-Lt with the second transmission.

To queue another transmission while a transmission is in progress, follow the same steps you used to

send the first transmission except you are not asked to select a transmission device. Your data is sent

following completion of the transmission in progress.

When you attempt to queue a transmission, items listed in the Send Menu which are incompatible

with the current connection are unavailable and grayed out.

To transmit using different transmission devices, you must complete the first transmission before

initiating the next one.

NOTE When a transmission fails or you cancel a transmission, any queued transmissions are cancelled and no

events are logged.

Finding Transmission Results

When data is transmitted from the HeartStart MRx via Bluetooth File Transfer to a receiving device, it

is placed in the default folder (typically located at: My Documents/Bluetooth Exchange Folder) set-up

during Bluetooth configuration of the receiving device. The HeartStart MRx creates a “philipsMRx”

folder and, depending on the data sent, a sub-folder: “12-Leads” or “events”. The “events” folder

contains all event data sent, including any 12-Leads sent as part of the event. Independently sent 12-

Leads are contained in the “12-Leads” folder.

NOTES If you press the [Exit Data Mgt] softkey to exit Data Management Mode while a batch

download is processing, the HeartStart MRx displays an “Exiting Data Management will cancel the

current transfer.” message and asks you to confirm the exit.

After all cases are successfully transferred and the internal data card is erased, the HeartStart MRx

adjusts its system time based on the time provided by the Data Messenger computer’s response.

Batch Data Transfer is not available on devices with the IntelliVue Networking Option.

Event Summaries and 12-Lead Reports could contain information which could be considered Patient

Healthcare Information (PHI) or patient identifiable data. This information can be printed or

transferred from the HeartStart MRx. Please handle in accordance with HIPAA or your local patient

privacy requirements.

Batch LAN Data Transfer 19 Data Transmission

259

Batch LAN Data Transfer

By using Batch LAN Data Transfer (BLDT) you can download either a single Event Summary or all

Event Summaries on the Internal Data Card to an external personal computer running Data

Messenger software for further review and archiving.

Data Messenger software 4.0, formerly Review Express Connect, is software that communicates with

the HeartStart MRx to download Event Summaries. It monitors an inbox and forwards files as Event

Review Pro files to a remote Event Review Pro computer. The Event Review Pro software 4.1 can then

automatically import the cases into the Event Review Pro database.

Data Management Part Numbers:

– Data Messenger: 861453

– Event Review Pro (single license): 861431 Option A01

– Event Review Pro (sitewide license): 861431 Option A03

Setting Up for Batch LAN Data Transfer

Batch LAN Data Transfer requires the LAN cable to be plugged into the LAN port on the back of the

HeartStart MRx. See Figure 116. The LAN cable connects to either a router or Network Interface

Card (NIC) on a local personal computer.

Figure 116 Batch LAN Data Transfer Connections

CAUTION After successfully sending all Event Summaries at once via Batch LAN Data Transfer, the HeartStart

MRx adjusts its system time based on the time provided by the Data Messenger personal computer and

the internal memory card is erased. If you want to keep other copies of the data, copy the files to an

external data card (see “Entering Data Management Mode” on page 226) before doing a BLDT or

transfer each of the Event Summaries independently.

19 Data Transmission Batch LAN Data Transfer

260

Transferring Files with BLDT

To transfer data using the BLDT option:

1Confirm the HeartStart MRx is in Data Management Mode, Data Messenger is running on the

receiving personal computer and the LAN cable is securely connected. See “Setting Up for Batch

LAN Data Transfer” on page 259.

2Once the LAN cable is connected, the HeartStart MRx automatically communicates with the Data

Messenger personal computer and prompts you to send data. See Figure 117. If you are not

prompted to send data within a short period of time, see “Transmission Problems (Batch LAN

Data Transfer)” on page 308.

Figure 117 Transferring files with BLDT

Tracking Transfer

Once the transfer begins, the HeartStart MRx tracks transmission progress indicating the number of

files sent and the percent complete. See Figure 118.

Figure 118 BLDT Transmission Message

When the transmission is complete the HeartStart MRx displays a Transmission Complete message.

Press the Menu Select button to acknowledge the message. The transmitted file appears in the

destination folder which was set up on the Data Messenger Server.

NOTES You must wait for a BLDT to complete before starting to send the next set of information.

If you want to transfer a single event:

3Use the [Prev Item] and [Next item]

softkeys to highlight the correct Event

Summary to download.

4Use the Navigation buttons to highlight Send

Selected and press the Menu Select button.

5Use the Navigation buttons to highlight the

type of data you wish to download. See Figure

111. Press the Menu Select button to select and

send your data.

If you want to transfer all events:

3Use the Navigation buttons to highlight

Send All and press the Menu Select button

to select and send your data.

Name of the host - received when IP address is obtained.

Downloads the single Event Summary highlighted in Data

Management Mode.

Downloads all Event Summaries from Data Management Mode.

Select Exit to exit the menu.

computer network name

Send Selected

Send All

Exit

Processing 1 of 1, Sending 32% Complete

Troubleshooting 19 Data Transmission

261

Cancelling BLDT

To cancel a BLDT currently being sent, press the Menu Select button, use the Navigation buttons to

highlight Cancel Transmission and press the Menu Select button. The transfer stops and the HeartStart

MRx is placed back in the Data Management screen.

Troubleshooting

If your HeartStart MRx does not operate as expected during transmission, see “Troubleshooting” on

page 297.

263

20Maintenance

This chapter describes how to care for your HeartStart MRx and its accessories.

Overview

Proper maintenance of the HeartStart MRx is a very simple, yet important factor in dependability. It

involves:

• Providing power so automated tests can be run

• Observing the Ready For Use (RFU) indicator

• Performing the Operational Check

• Caring for batteries

• Cleaning the device and accessories

• Ordering replacement supplies and accessories

WARNING Electric shock hazards exist internally. Do not remove assembly screws. HeartStart MRx service should

only be performed by qualified service personnel, in accordance with the HeartStart MRx Service

Manual.

NOTE Calibration of the optional end-tidal CO2 and noninvasive blood pressure modules of the HeartStart

MRx needs to be performed yearly by a qualified service provider, as described in the HeartStart MRx

Service Manual.

20 Maintenance Automated Tests

264

Automated Tests

The HeartStart MRx independently performs many maintenance activities, including three tests that

run automatically at regularly scheduled intervals while the device is off to assess operational

performance and alert you if a problem exists. Results of tests associated with critical functionality of

the device are reported through the Ready For Use indicator and the Automated Test Summary report.

Results are also reported through INOP statements on the display when the HeartStart MRx is turned

on. Table 73 provides a brief explanation of the tests and lists the frequency with which each is

performed.

Table 73 Automated Tests

NOTE Automated tests do not test therapy cables, paddles, buttons, audio, or the display. An ECG cable is

tested, if connected at the time of the test.

Tes t Na m e Description Frequency

Hourly Tests batteries, internal power supplies and internal

memory.

Hourly

Daily Tests batteries, internal power supplies, internal memory,

internal clock battery, defibrillation, pacing, ECG, SpO2,

EtCO2, NBP, Invasive Pressure, Temperature, Bluetooth

and printer. The defibrillation test includes low energy

internal discharges. If a 3-, 5-, or 10-lead ECG cable is

attached, the cable is tested as well.

Daily, between 11 pm

and 1 am

Weekly Performs the Daily Test described above, plus delivers a

high energy internal discharge to further exercise the

defibrillation circuitry.

Weekly, between

11PM Sunday and

1 AM Monday

Automated Tests 20 Maintenance

265

Automated Test Summary

An Automated Test Summary (ATS), showing the results of recent tests, may be printed as evidence

that the HeartStart MRx is tested regularly. To display the ATS and print its results:

1Turn the Therapy knob to Monitor.

2Press the Menu Select button.

3Using the Navigation buttons, select Other and press the Menu Select button.

4Select Operational Check and press the Menu Select button.

5Using the Navigation buttons, select Automated Test Summary and press the Menu Select button.

The Automated Test Summary is displayed.

The message, Leaving Normal Operating Mode, appears to let you know that you are exiting from

clinical functionality of the monitor/defibrillator.

6Press the [Print] soft key to print the report.

The report shows the results of the most recent Hourly Test, the Daily Tests that have run since the

last Weekly Test, and the last 53 Weekly Tests. Test results are reported, as described in Table 74.

Table 74 Automated Test Summary Results

Result RFU Indicator Definition Required Action

Pass Hourglass All tests passed None

Fail/

Solid red X, chirp A problem has been detected

that may prevent the delivery of

a shock, pacing, or ECG

acquisition.

Turn the Therapy Knob to Monitor. An

inop indicating a problem has occurred is

displayed. Refer to Chapter 22,

Troubleshooting, for the action to take.

Fail/BF Blinking X The total battery capacity

(combination of both batteries)

is less than 20%.

Charge the battery as soon as possible and/

or replace the battery with a charged

battery. Charging may be done in the

HeartStart MRx or by connecting to AC/

DC power, or in a Philips-approved battery

support system.

Fail/D Hourglass A problem has been detected

with a component that does not

affect therapy delivery.

Turn the Therapy Knob to Monitor. An

inop indicating the failed component is

displayed. Refer to Chapter 22,

Troubleshooting, for the action to take.

20 Maintenance Ready For Use Indicator

266

Ready For Use Indicator

The results from Automated Tests are reported through the Ready For Use (RFU) indicator. Be sure to

observe the RFU indicator periodically and take the appropriate action, as described in Table 75.

Table 75 RFU Indicator Status

NOTE The RFU indicator may briefly display a solid red “X” when initially turning on the device, switching

between clinical and non-clinical operating modes, and at the start of any Automated test. This does

not indicate a failure of the device.

RFU Status Meaning Required Action

Blinking black hourglass Shock, pacing, and ECG

functions are ready for use and

sufficient battery power is

available.

None

Blinking red “X” with or

without a periodic chirp

Low battery. The device can be

used but run time is limited.

Chirping indicates the battery

is not being charged. No

chirping indicates the battery is

being charged.

Charge the battery as soon as possible

and/or replace the battery with a charged

battery. Charging may be done in the

HeartStart MRx by connecting to AC/

DC power, or in a Philips-approved

battery support system

Solid red “X” and a

periodic chirp

A failure has been detected that

may prevent the delivery of a

shock, pacing, or ECG

acquisition.

Turn the Therapy Knob to Monitor. An

inop message describing the failure is

displayed. See Chapter 22,

Troubleshooting, for the corrective

action. If needed, run an Operational

Check for further information. If the

condition persists, take the device out of

use and call for service.

Solid red “X” without a

periodic chirp

No power, or device failure

(cannot turn on).

Insert a charged battery or connect to

AC/DC power. If the condition persists,

take the device out of use and call for

service.

Shift Checklist 20 Maintenance

267

Shift Checklist

In order to ensure defibrillators are ready when needed, the American Heart Association (AHA)

recommends that users complete a checklist, often referred to as a shift check, at the beginning of each

change in personnel. The activities on this check list include verifying that the appropriate supplies and

accessories are present, the device is plugged in and has sufficient battery power, and the device is ready

for use. Philips Healthcare supports the AHA checklist recommendations and has provided a Shift

Checklist document with the device and published a copy in this book. See the “HeartStart MRx Shift

Checklist” on page 268.

Weekly Shock Test

In addition to the shift check, you must verify the ability to deliver defibrillation therapy once a week

by performing one of the following:

•Operational Check

• Weekly Shock Test (See following instructions.)

NOTE Test reusable sterilizable paddles (internal or external) prior to each use. See the Sterilizable

Defibrillator Paddles Instructions for Use for more information.

To perform the Weekly Shock test:

1If you are using paddles, make sure the paddles and the paddle tray are thoroughly clean and there

is no debris or residue (including all conductive material) on the electrode surfaces of the paddles

and tray. Secure the paddles in the paddle tray and confirm the Patient Contact Indicator (PCI)

LEDs located on the sternum paddle are not lit. If the LEDs light, adjust the paddles in their

pockets. If the LEDs continue to light, clean both the adult and pediatric paddle electrode surfaces.

If you are using multifunction electrode pads, attach a test load to the end of the patient Therapy

cable.

2Turn the Therapy knob to 150J.

3Press the Charge button.

NOTE If it becomes necessary to disarm the defibrillator, press [Disarm].

4The strip prints if configured to do so. If the strip does not print immediately, press the Print

button.

5If using:

– Pads, press the Shock button on the MRx to deliver a shock into the test load.

– External paddles, simultaneously press the shock buttons located on the paddles to deliver a shock

into the pockets.

6Confirm on the printed strip that the energy delivered to the test load is 150J + 23J (127J to 173J).

If not, take the device out of use and begin troubleshooting.

NOTE Detach the test load from the patient Therapy cable after performing the Shift Check. So your device is

ready for use when needed, do not leave the test load attached after performing an Operational Check.

20 Maintenance Shift Checklist

268

HeartStart MRx Shift Checklist

Inspect the MRx, accessories, and supplies at the change of every shift, per AHA guidelines. Place a

check mark in the box as you check each item in the list below or place a dash (-) or N/A if not

applicable. Then, initial the list to indicate the check was performed for that shift.

Device Name or Serial Number:______________Unit or Department:_________

Date:

Shift: 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3

RFU Indicator - Hourglass

If blinking red X - Plug into

AC/DC power or insert

charged battery

If solid red X - Insert charged

battery or AC/DC power. If

condition persists, call for

service

Cables/connectors - present

and inspected

Paddles/Therapy cable -

present and inspected

Pads Present, sufficient

supply ___________

CPR meter and Adhesive

Pads_________

Monitoring Electrodes -

present, sufficient supply

___________

Charged Batteries - one in

device, spares __________

AC/DC Power Cord -

plugged in, green light on

Printer Paper - present,

sufficient supply________

Data Card present,

sufficient supply ________

SpO2 Sensors - present,

sufficient supply________

NBP cuffs/tubing - present,

sufficient supply

___________

CO2 FilterLine - present,

sufficient supply________

Invasive Pressure

Tranducers - present and

inspected

Temperature Sensors -

present and inspected

Initials

Shift Checklist 20 Maintenance

269

Shift Checklist (page 2)

HeartStart MRx Weekly Shock Test

Do one of the following at least once a week to verify the ability to deliver defibrillation therapy:

Operational check (See Instructions for Use for details)

Signature:________________________________ Date: _________________

Deliver a 150J shock into a test load (See instructions below)

Signature:________________________________ Date: _________________

Note: If the HeartStart MRx has Software Release B.05 or greater with the Pacing option, you cannot

test external paddles through Operational Check. Perform the Weekly Shock Test to test the external

paddles. Additionally, test reusable sterilizable paddles (internal or external) prior to each use. See the

Sterilizable Defibrillator Paddles Instructions for Use.

How to Perform the Weekly Shock Test:

Test each type of patient therapy cable used (pads cable or paddles).

1If you are using paddles, make sure the paddles and the paddle tray are thoroughly clean and there

is no debris or residue (including all conductive material) on the electrode surfaces of the paddles

and tray. Secure the paddles in the paddle tray and confirm the Patient Contact Indicator (PCI)

LEDs located on the sternum paddle are not lit. If the LEDs are lit, adjust the paddles in the tray.

If the LEDs continue to light, clean both the adult and pediatric paddle electrode surfaces.

2If you are using multifunction electrode pads, attach a test load to the end of the patient Therapy

cable. If your pads are preconnected, you need to detach them first before attaching the test load.

3Turn the Therapy Knob to 150J.

4Press the Charge button. NOTE: If it becomes necessary to disarm the defibrillator, press

[Disarm].

5The strip prints if configured to do so. If the strip does not print immediately, press the Print

button.

6If using:

— Pads/Cable, press the Shock button on the HeartStart MRx to deliver a shock into the test load.

— External paddles, simultaneously press the shock buttons located on the paddles to deliver a

shock into the test load.

7Confirm on the printed strip that the energy delivered to the test load is 150J + 23J (127J to 173J).

If not, take the device out of use and call for service.

8Detach the test load from the Therapy cable after performing the Shift Check and reattach your

preconnected pads if you use them.

What Gets Tested in an Operational Check

Operational Checks supplement the Automated Tests by verifying therapy cables, the ECG cable,

paddles, audio, charge and shock buttons and the ability to deliver defibrillation and pacing therapy.

Operational Checks also notify you if the battery, NBP module, or CO2 module needs calibration and

checks the SpO2 module, printer, and CPR meter. If you choose to perform the weekly shock test in

lieu of the Operational Check, you need to ensure the ECG cable, pacing functions, audio, battery

calibration, NBP and CO2 calibration, CO2 and SpO2 modules, temperature, Bluetooth, invasive

pressures, printer, and CPR meter are checked periodically. The best way to do this is through an

Operational Check. It is recommended that you establish a schedule for conducting periodic

Operational Checks.

20 Maintenance Operational Check

270

Operational Check

Operational Checks should be performed at regular intervals to supplement the hourly, daily, and

weekly Automated Tests executed by the HeartStart MRx. Automated Tests provide adequate

assurance that the device is in a functional state of readiness. Operational Checks supplement the

Automated Tests by verifying therapy cables, the ECG cable, paddles, audio, the Charge and Shock

buttons, Therapy Knob, and CPR meter, along with replicating the Weekly test. Operational Checks

also notify you if the battery, NBP module, or CO2 module need calibration.

WARNING Be sure the HeartStart MRx is not connected to the patient when performing an Operational Check.

NOTE It is important to establish a schedule for conducting Operational Checks, as well as for checking

supplies and accessories associated with the HeartStart MRx. This will ensure that the device is ready to

monitor and deliver therapy. The Operational Check is run with a battery installed to reflect optimal

operating conditions for defibrillation. The device automatically disconnects AC/DC power.

NOTE If you have the Pacing option, test external paddles using the Weekly Shock test. You must run

Operational Check with a pads cable in order to pass the Pacer test.

Prior to performing the Operational Check, ensure that the paddles (if tested) and the paddle tray are

thoroughly clean and there is no debris or residue (including all conductive material) on the electrode

surfaces of the paddles and tray. Make sure the paddles are secure in their pockets and that the PCI

LEDs are not lit. Should the LEDs light, adjust the paddles in their pockets. If the LEDs continue to

light, clean both the adult and pediatric paddle electrode surfaces.

At completion of the Operational Check, the message Operational Check Passed is displayed if all of the

tests pass.

If any test fails the message Operational Check failed is displayed along with one (or more) of the

following messages, depending upon the severity of the failed functionality:

• Service device.

• Replace battery.

•Replace CPR meter.

• Replace Pads cable.

• Replace Paddles cable.

• Replace Therapy cable.

• Replace ECG cable

You must fix the problem and successfully run the Operational Check to clear the failure.

NOTE If the HeartStart MRx is equipped with multifunction defib pads only and does not have a paddle tray,

you cannot test paddles during an Operational Check. To test paddles, you must have a test load. Run

the Weekly Shock Test, delivering the shock into the test load. See “Weekly Shock Test” on page 267.

Operational Check 20 Maintenance

271

Performing the Operational Check

To perform the Operational Check:

1Insert a charged battery (capacity of 20% or greater).

2Turn the Therapy Knob to Monitor.

3Press the Menu Select button

4Using the Navigation buttons, select Other and press the Menu Select button.

5Select Operational Check and press the Menu Select button.

6Select Run Operational Check and press the Menu Select button.

The message window, Leaving Normal Operating Mode, appears to let you know that you are exiting

from clinical functionality and entering a test mode of the monitor/defibrillator.

7Press the Menu Select button to acknowledge the message.

Operational Check Setup

Carefully read the setup instructions on the screen. Once the HeartStart MRx is set up properly, you

can proceed with the Operational Check. If the device has the Q-CPR option, you should run the

Operational Check with the Pads/CPR cable and the CPR meter, keeping the CPR meter still during

the test. If the HeartStart MRx has the Pacing option, you must run the Operational Check with a

Pads cable.

WARNING Be sure to safely discharge internal and external paddles tested during the Operational Check.

NOTE If you choose to proceed without setting up properly, the Operational Check may fail.

When a response is required, use the Navigation buttons to select your answer and the Menu Select

button to confirm your choice. Table 76 shows the tests, in the order in which they are performed,

explains the prompts that may appear, and describes the actions you should take (if any).

As each test is run, the name of the test appears on the display with the message In Progress, as shown

in Figure 120.

Once you have answered the last prompt (Audio test), you can leave the HeartStart MRx unattended

and the Operational Check will complete. If you cancel the Operational Check before it completes,

there is no record of it in the Operational Check Summary.

20 Maintenance Operational Check

272

Figure 119 Operational Check Setup Screen

02 Mar 2006 10:52

Operational Check

Model Number: M3535A

Serial Number: US00108360

Last Operational Check: 01 Mar 2006 9:35 Pass

Exit

Op Check

Setup

1. Connect pads/CPR cable, CPR meter and test load

Connect pads cable and test load

2. Turn knob to 150J (Required)

3. Connect ECG cable

Proceed As Is

Operational Check 20 Maintenance

273

Figure 120 Operational Check Screen

02 Mar 2006 10:53

Exit

Op Check

Model Number: M3535A

Serial Number: US00108360

Last Operational Check: 04 May 2005 9:35 Pass

General System Test: Pass

Therapy Knob: Pass

Charge Button: Pass

Shock Button: Pass

Audio Test: Pass

Defib Test: Pass/Pads

Pacer Test: Pass

CPR Meter Test: Pass

Leads ECG Test: Pass/ECG Cable

Pads/Paddles ECG Test: Pass

Battery Compartment A Test: Pass/Cal Recommended

Battery Compartment B Test: Pass

SpO2 Test: In Progress

NBP Test:

CO2 Test:

Invasive Pressure Test:

Temperature Test:

Bluetooth Test:

Printer Test:

Operational Check

20 Maintenance Operational Check

274

Table 76 Operational Checks Test

Te s t Description Prompts Action

General System Tests internal clock battery,

power supply, and internal

memory card.

None. None.

Therapy Knob Tests if the Therapy Knob is set

to 150J.

None. None.

Charge Button Tests the Charge button. Depending on the cable

connected, as follows:

• If the Pads cable is attached,

you are prompted to, Verify

Test Load is Attached and

Press the Charge Button.

• If external paddles are

attached, you are prompted to,

Verify Paddles are in Holders

and Press the Charge Button.

• If no cable is attached, the test

is marked Not Tested.

If the MRx does not detect a press

of the Charge button within 10

seconds the message If the Charge

button does not work, select

Charge from the menu below is

displayed.

Respond to the prompt, as

follows:

• Check the test load is

attached and press the

Charge button.

• Make sure the paddles are

seated in their pockets and

press the Charge button.

If the Charge button is not

working, press Charge from the

No Button Response menu. The

Charge button test is marked

Fail and the Operational Check

fails.

Shock Button Tests the Shock button. • Once charged the Shock

button lights and you are

prompted to, Press Shock or

Press Shock buttons on

paddles.

• If the MRx does not detect a

press of the Shock button

within 10 seconds the message

If the Shock button does not

work, select Shock from the

menu below is displayed.

Note: The device automatically

disarms after the time specified in

the configuration is reached.

• The message Defib Disarmed is

displayed.

• Press the Shock button.

• If the Shock button is not

working, press Shock from

the No Button Response

menu. The Shock button test

is marked Fail.

• Select Shock from the menu

to continue the Operational

Check or press Exit Op

Check. The Shock button

test is marked Fail.

Operational Check 20 Maintenance

275

Audio If a shock was delivered during

the Shock test, the voice

prompt, Shock Delivered is

annunciated.

If no shock was delivered

during the Shock test, the voice

prompt No Shock Delivered is

annunciated.

Did you hear Shock/No Shock

Delivered?

Use the navigation buttons to

respond Yes or No. Then press

the Menu Select button.

Defib Tests defibrillation circuitry and

delivers a shock through:

• pads, into a test load,

and/or

• external paddles, into the

MRx

Note: The Defib test has two

components: a high energy

internal discharge and a low

energy (5J) external discharge.

The results of the device’s

ability to charge and shock are

reported in the Defib test.

None. None.

Pacer Tests pacing functionality and

delivers a paced pulse into a 50

ohm test load.

None. None.

CPR meter Checks the basic

communication circuity of the

meter.

None. None.

Leads ECG Tests leads ECG acquisition

and the ECG cable.

None, if test passes. If test fails the

following prompt is displayed at

the end of all remaining tests:

Leads ECG Test failed with cable.

Disconnect ECG cable to rerun

test without cable.

If the ECG test fails with the

cable and passes without the

cable, the ECG cable is bad.

Replace the ECG cable and

rerun Operational Check.

If the ECG test fails with and

without the cable, see

“Troubleshooting” on page 297.

Table 76 Operational Checks Test (Continued)

Te s t Description Prompts Action

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276

Pads/Paddles ECG Checks ECG acquisition

through pad/paddles.

None, if test passes. If test fails the

following prompt is displayed at

the end of all remaining tests:

Pads/Paddles ECG Test failed

with cable. Disconnect therapy

cable to rerun test without cable.

If the Pads/Paddles test fails with

the cable and passes without the

cable, the cable is bad. Replace

the Therapy cable and rerun

Operational Check.

If the Pads/Paddles test fails with

and without the cable, see

“Troubleshooting” on page 297.

Battery A

Battery B

Checks the total battery

capacity (combination of both

batteries) and calibration status

of the batteries in

Compartments A and B.

None. None.

SpO2Checks the internal SpO2 PCA.

The SpO2 cable is not tested.

None. None.

NBP Checks to see if the NBP

module is functioning;

determines if it is due for

calibration.

None. None.

CO2Checks to see if the CO2

module is functioning;

determines if it is due for

calibration.

None. None.

Invasive Pressures Checks to see if the invasive

pressure hardware is working

properly.

None. None.

Temperature Checks to see if the temperature

hardware is working properly.

None. None.

Bluetooth Checks for the presence of the

Bluetooth card and database

integrity.

None. None.

Printer Runs a printer self test. None. None.

Table 76 Operational Checks Test (Continued)

Te s t Description Prompts Action

Operational Check 20 Maintenance

277

Operational Check Report

The Operational Check takes only a short time to complete. When it is done, a report is printed, as

shown in Figure 121. The first part of the report lists test results. The second part lists checks to be

performed by the user.

Figure 121 Operational Check Report

Press the [Print] soft key when the Operational Check is complete to print an additional copy of

the report.

Operational Check Report

Model Number: M3535A

Serial Number: USD0123456

Ver.: F.00.00

Current Operational Check:

DD Mon YYYY HH:MM:SS Pass

Last Operational Check:

DD Mon YYYY HH:MM:SS Pass

Current Test Results:

General System Test: Pass Battery Compartment A Test: Pass

Therapy Knob: Pass Battery Compartment B Test: Pass

Charge Button: Pass

Shock Button: Pass

Audio Test: Pass

Defib Test: Pass/Pads

Pacer Test: Pass

CPR Meter Test: Pass

Leads ECG Test: Pass/ECG Cable

Pads/Paddles ECG Test: Pass/Pads

SpO2 Test: Pass

NBP Test: Pass

CO2 Test: Pass

Invasive Pressure Test: Pass

Temperature Test: Pass

Bluetooth Test: Pass

Printer Test: Pass

Qty/Check List:

___ Defibrillator Inspection ___ SpO2 Sensor

___ Cables/Connectors ___ NBP Cuffs & Tubing

___ Paddles/Pads ___ CO2 FilterLine

___ CPR meter Inspection ___ Invasive Pressure Cables

___ CPR meter Pads ___ Temperature Probes

___ Monitoring Electrodes

___ Charged Batteries

___ AC/DC Power & Cord

___ Printer Paper

___ Data Card

Comments:

Inspected by:_________________

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User Checks

The guidelines for completing user checks are as follows:

Defibrillator Inspection Make sure the HeartStart MRx is clean (including the surfaces of the paddles

and paddle tray), clear of objects, and has no visible signs of damage.

Cables/Connectors/Paddles/Pads/Monitoring Electrodes Make sure there are no cracks, broken

wires, or other visible signs of damage. Make sure the connections are secure. Check expiration date

and quantity of pads and monitoring electrodes

CPR meter Inspect the CPR meter and cable for visible signs of damage. If damaged, remove from

use. Check the meter’s status light to confirm it is green.

CPR meter Adhesive Pads Make sure there is a CPR meter Adhesive Pad applied to the CPR meter

and there is an adequate supply available. Replace the pads at least every 2 years if it has not been used.

Batteries Make sure a charged battery is in the HeartStart MRx. Another charged battery should be

available or should be charging. Ensure the batteries have no visible signs of damage.

AC/DC Power Check the AC/DC power source (and power cord available):

1Connect the AC/DC power module to the HeartStart MRx and plug it into a power outlet.

2Verify that the external power indicator on the front panel is lit.

Printer Paper Make sure the printer has sufficient paper and is printing properly.

Data Card If applicable, make sure a data card is inserted and has sufficient space available.

SpO2 Sensor Inspect the sensor and cable for visible signs of damage.

NBP Cuffs and Tubing Inspect the pressure cuffs and tubing for visible signs of damage.

CO2 FilterLine Confirm that at least one un-opened, sterile package is available.

Invasive Pressure Cables Inspect the cable for visible signs of damage.

Temperature Probes Inspect the probe and cable for visible signs of damage.

NOTES Upon completing the Operational Check and returning to a clinical mode (Monitor, Pacer, Manual

Defib or AED), all settings will be reset to the device’s configured values.

If your institution’s protocol requires periodic alarm verification, and you wish to perform an alarm

verification test (in a non-clinical environment) outside of the Operational Check testing, you can

connect the HeartStart MRx up to a simulator, manually change the alarm limits to a setting which

should cause an alarm to annunciate. Look at the display and listen for the alarm. Be sure to reset the

alarm limits to the appropriate settings before returning the device to a clinical environment.

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Table 77 Operational Check Test Results

Tes t Results Action if Test Does Not Pass

General System • Pass - The clock battery, power supplies, and internal

memory are functioning.

• Fail - The clock battery, power supplies, and/or

internal memory are not functioning. A failure may

abort the remaining tests.

If the test fails with the AC/DC power

module present, remove the module and

repeat the test. If the test continues to fail, call

for service. If the test passes, replace the power

module.

Therapy Knob • Pass - The Therapy Knob is set to 150J.

• Fail - The Therapy Knob is not set to 150J.

• Fail - The Therapy Knob is not functioning.

If the test fails, confirm that the Therapy

Knob is set to 150J and repeat the test. If the

test continues to fail, call for service.

Charge Button • Pass - The Charge Button passed its self-test.

• Fail - Proceed was selected from the No Button

Response Menu.

• Fail - The Charge Button is not functioning.

Repeat the test. If the test continues to fail

because there is no response from the Charge

Button, call for service.

Shock Button • Pass - The Shock Button passed its self-test.

• Fail - Proceed was selected from the No Button

Response Menu.

• Fail - The Shock Button was not pressed before the

configured Auto Disarm time period ended.

Repeat the test being sure to press the Shock

Button before reaching the Auto Disarm time.

If the test continues to fail, call for service.

Audio • Pass - You responded Yes, that you were able to hear

the test voice prompt.

•Fail - You responded No, to hearing the voice prompt.

Take the device out of use and call for service.

Defib • Pass/cable type - The defib test passed with the

specified cable type (pads, external paddles) attached.

• Fail/cable type - The test failed with the specified

cable type connected.

If the test fails, repeat it using a different

therapy cable. A passing result with a different

cable indicates the previous cable is defective

and should be replaced. If the test continues

to fail, take the device out of use and call for

service.

Pacer • Pass - Pacing is functioning.

• Fail - Pacing is not functioning.

If the pacer fails, attach a different pads cable

and test load and repeat the test.

If the pacer fails again, take the device out of

use and call for service.

CPR meter • Pass - The CPR meter passed its self test.

• Fail - The CPR meter failed its self test.

If the test fails, call for service. If Q-CPR is

essential to patient care, take the device out of

use.

Leads ECG • Pass/ECG Cable - leads ECG acquisition and the

ECG cable connected are both functioning.

• Pass/No Cable - leads ECG acquisition is

functioning.

• Fail/ECG Cable- leads ECG acquisition and/or the

ECG cable connected are not functioning.

• Fail/No Cable - leads ECG acquisition is not

functioning.

If the test fails without an ECG cable

connected, take the device out of use and call

for service. If the test fails with a cable, repeat

the test without an ECG cable attached. A

passing result without a cable attached

indicates the cable is defective and should be

replaced. If the test continues to fail, take the

device out of use and call for service.

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Pads/Paddles ECG Pass/cable type - ECG acquisition and the cable are both

functioning.

Pass/No cable - ECG acquisition is functioning; a cable

was not tested.

Fail/cable type- ECG acquisition and/or the cable

specified are not functioning.

If the test fails with a cable connected, remove

the cable and repeat the test. If the test passes

without the cable, replace the cable. If the test

continues to fail, take the device out of use

and call for service.

Battery A

Battery B

• None - There is no battery in the slot.

• Pass - The battery has 20% or greater capacity.

• Fail - The battery has 20% or less capacity.

• Cal Recommended - The battery requires calibration.

Charge the battery.

Calibrate the battery.

SpO2• Pass - SpO2 passed its self-test.

•Fail - SpO

2 is not functioning.

If the test fails, call for service to repair the

SpO2 module. If SpO2 monitoring is essential

to patient care, take the device out of use.

NBP • Pass - NBP passed its self-test.

• Fail - NBP is not functioning.

• Pass (Cal Due) - NBP passed its self-test and is due to

be calibrated.

• Fail (Cal Overdue) - NBP passed its self-test but is

overdue for calibration. Measurements may be

inaccurate.

• Fail (Replacement Recommended) - NBP passed its

self-test but has exceeded 50,000 cycles.

If the test fails, call for service to repair the

NBP module. If NBP monitoring is essential

to patient care, take the device out of use.

If calibration is due or overdue, arrange for a

qualified service provider to perform the

calibration.

If replacement is recommended, call for

service.

CO2• Pass - CO2 passed its self-test.

•Fail - CO

2 is not functioning.

• Pass (Cal Due) - CO2 is passed its self-test and is due

for calibration.

• Fail (Cal Overdue) - CO2 passed its self-test and is

overdue for calibration. Measurements may be

inaccurate.

• Fail (Replacement Recommended) - CO2 passed its

self-test but has exceeded 15,000 operating hours.

If the test fails, call for service to repair the

CO2 module. If CO2 monitoring is essential

to patient care, take the device out of use.

If calibration is due or overdue, arrange for a

qualified service provider to perform the

calibration.

If replacement is recommended, call for

service.

Table 77 Operational Check Test Results (Continued)

Tes t Results Action if Test Does Not Pass

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281

Invasive Pressures • Pass - Invasive Pressures passed its self-test.

• Fail - Invasive Pressures is not functioning.

If the test fails, call for service (to replace the

Invasive Pressures/Temperature board.) If

invasive pressure monitoring is essential to

patient care, take the device out of use.

Temperature • Pass - Temperature passed its self-test.

• Fail - Temperature failed its self-test.

If the test fails, call for service (to replace the

Invasive Pressure/Temperature board.) If

temperature monitoring is essential to patient

care, take the device out of use.

Bluetooth • Pass - A Bluetooth card is detected and

communicating.

• Fail - A Bluetooth card is not installed or is not

functioning.

If the test fails, call for service.

Printer • Pass - The printer passed its self-test.

• Fail - The printer needs repair.

If the test fails, call for service.

Table 77 Operational Check Test Results (Continued)

Tes t Results Action if Test Does Not Pass

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Operational Check Summary

The Operational Check Summary lists the results from the last 60 Operational Checks. Test results are

reported as described in Table 77.

To view the Operational Check Summary:

1Turn the Therapy Knob to Monitor.

2Press the Menu Select button.

3Using the Navigation buttons, select Other and press the Menu Select button.

4Select Operational Check and press the Menu Select button.

5Using the Navigation buttons, select Op Check Summary and press the Menu Select button.

6Press the Menu Select button to acknowledge the message, Leaving Normal Operational Mode.

The Operational Check Summary screen is displayed.

7Press the [Print] soft key to print the report.

Table 78 Operational Check Summary Results

Result RFU Indicator Definition Required Action

Pass Hourglass All tests passed None

Fail/DX Solid red X, chirp A problem has been detected

that may prevent the delivery

of a shock, pacing, or ECG

acquisition.

Turn the Therapy Knob to Monitor. An

inop indicating the problem is displayed.

See Chapter 22, Troubleshooting, for the

corrective action.

Fail/CX Solid red X, chirp. A problem has been detected

with a cable.

Turn the Therapy Knob to Monitor. An

inop indicating the failed cable is

displayed. Replace the failed cable.

Fail/BF N/A1

1..The Automated Tests continually check for a low battery condition and set the RFU Indicator appropriately.

A battery failure was detected. Replace the battery.

Fail/D Hourglass A problem has been detected

with a component that does

not affect therapy delivery.

Turn the Therapy Knob to Monitor. An

inop indicating the failed component is

displayed. See Chapter 22,

Troubleshooting, for the corrective

action.

Fail/S Hourglass CPR meter failure. Check the CPR meter and cable

connections. If necessary, replace the

CPR meter.

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Battery Maintenance

Battery maintenance is essential to ensure that the battery’s state of charge is accurately reported, there

is sufficient charge and capacity to operate your HeartStart MRx, and battery life is optimized. Remove

faulty batteries from service immediately.

Battery maintenance begins upon receipt of a new battery, and continues throughout the life of the

battery. Detailed information on battery care is available in the Application Note, “M3538A Lithium

Ion Battery Characteristics and Care”, which was provided with your HeartStart MRx.

Table 79 lists battery maintenance activities and when they should be performed.

Table 79 Battery Maintenance Procedures

Battery Life

Battery life depends on the frequency and duration of use. When properly cared for, the M3538A

Lithium Ion battery has a useful life of approximately 2 years. To optimize performance, a fully (or

nearly fully) discharged battery should be charged as soon as possible.

Activity When to Perform

Perform a visual inspection. As part of the Operational Check.

Charge the battery. Upon receipt, after use, or if the message Batteries Low is

displayed.

Perform a calibration. When the Operational Check test results state Calibration

Recommended, or every 6 months, whichever comes first.

Store batteries in a state of charge in the

range of 20% - 40%

When not in use for an extended period of time.

Discard the battery. When there are visual signs of damage or calibration

reports less than 80% capacity.

20 Maintenance Battery Maintenance

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Charging Batteries

The M3538A Lithium Ion Battery should be charged in either the HeartStart MRx or in a Philips-

approved battery support system. The two methods of charging in the HeartStart MRx are as follows:

Using AC power - Insert the battery to be charged into Battery Compartment A. Insert the AC

Power Module into Battery Compartment B and connect to an AC power source.

Using DC power - Insert a battery to be charged into Battery Compartment A. If a second battery is

in need of charging, insert it in Battery Compartment B. Connect the DC Power Module to the

HeartStart MRx and the DC power source.

Once AC or DC power is applied, the External Power Indicator turns green and batteries in the

HeartStart MRx charge. Batteries are charged one at a time. With the HeartStart MRx turned off and

at a temperature of 25oC (77oF), a fully discharged battery typically charges to 80% of its capacity in 2

hours, and to 100% of its capacity in 3 hours. Batteries charge at a slower rate with the device turned

on.

Batteries should be charged at temperatures between 0oC (32oF) and 45oC(113oF).

Charge Status

You can check the battery’s state of charge by:

• periodically pushing the fuel gauge button on the battery to illuminate the fuel gauge. Each LED

represents a charge of approximately 20% of capacity.

• turning the Therapy Knob to any mode of operation and observing the battery power indicators

displayed in the General Status area (see “General Status” on page 14).

Battery Calibration

Battery capacity diminishes with use and age. Battery calibration checks to see if the battery is nearing

the end of its useful life and should be discarded. Battery calibration also ensures that the fuel gauge

provides accurate estimates of the battery’s state of charge, based on the total available capacity.

Calibrate a battery when the Cal Recommended message appears during an Operational Check, or every

6 months, whichever comes first. Battery calibration may be performed in the HeartStart MRx or in a

Philips-approved battery support system. To calibrate a battery in the HeartStart MRx:

1Connect the HeartStart MRx to AC or DC power.

2Insert the battery to be calibrated into Battery Compartment A or B.

3Turn the Therapy Knob to Monitor.

4Press the Menu Select button.

5Using the Navigation buttons, select Other and press the Menu Select button.

6Select Battery Calibration and press the Menu Select button.

7Press the Menu Select button to acknowledge the message, Leaving Normal Operational Mode.

The Calibration view is displayed. If external power is not detected, you are prompted to Apply

External Power. If there is no battery in either battery compartment, you are prompted to Insert

Battery. If there are batteries in both battery compartments, you must select which battery to

calibrate.

Battery Maintenance 20 Maintenance

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8Press the [Start] soft key to begin calibrating.

The calibration procedure charges the battery to full capacity, drains the battery in preparation for

calibration, calibrates the battery, and then charges it again following calibration. Once you see the

message, Calibration Complete. The battery charges faster when the device is turned off, you may

turn the Therapy Knob to Off to allow the battery to charge more quickly.

Calibration takes approximately 11 hours to complete in the HeartStart MRx. Progress is shown on the

display. It takes significantly less time to calibrate in a Philips-approved battery support system.

Monitoring/therapy functions are not available during battery calibration in the MRx. If it is necessary

to terminate calibration to resume clinical use, press the [Cancel] soft key.

WARNING Battery calibration is terminated if external power or the battery being calibrated is removed before the

calibration process is completed. If calibration is terminated, the battery will not be calibrated and its

capacity may be very low.

Calibration Results

When a battery is calibrated in the HeartStart MRx, a Pass or Fail is reported to indicate whether

calibration completed successfully. In addition, an estimate of battery capacity is provided so you can

determine if the battery is fit for use.

When a battery is calibrated in a Philips-approved battery support system the estimated battery

capacity is not displayed. To view the capacity:

1Insert the calibrated battery into a HeartStart MRx that is not connected to a patient

2Turn the Therapy Knob to Monitor

3Press the Menu Select button, highlight Other and press the Menu Select button again

4Highlight Battery Calibration and press the Menu Select button

5Press the Menu Select button to acknowledge leaving normal operating mode

6Press the [Start] softkey and wait until any information appears in the first Charging: line

7Press the [Cancel] softkey

8The battery capacity is displayed at the top of the screen

In either instance, if the capacity is:

•>

80% continue to use the battery

• < 80% discard the battery

NOTE After successfully calibrating your batteries, perform an Operational Check. You may be prompted to

recalibrate depending upon the condition of your battery.

20 Maintenance Battery Maintenance

286

Storing Batteries

Batteries should be rotated regularly to ensure even usage. When storing batteries, make sure that the

battery terminals do not come in contact with metallic objects.

If batteries are stored for an extended period of time, they should be stored in a cool place, with a

partial charge of 20% (1 LED illuminated) to 40% (2 LED’s illuminated) capacity. Storing batteries in

a cool place slows the aging process. The ideal storage temperature is 15oC (60oF). Batteries should not

be stored at temperatures outside the range of -20oC (-4oF) to 60oC (140oF).

CAUTION • Do not store batteries in the HeartStart MRx if it is out of service for an extended period of time.

• Storing batteries at temperatures above 38oC (100oF) for extended periods of time significantly

reduces a battery’s life expectancy.

Stored batteries should be charged every 2 months to 20% - 40% of their full capacity. They should be

charged to full capacity prior to use.

Discarding Batteries

Batteries should be discarded if there are visual signs of damage or if they fail calibration. Batteries

should be discarded in an environmentally safe manner. Properly dispose of batteries according to local

regulations.

WARNING Do not disassemble, puncture, or incinerate batteries. Be careful not to short the battery terminals

because this could result in a fire hazard.

CAUTION Use caution when handling, using, and testing the batteries. Do not short circuit, crush, drop,

mutilate, puncture, apply reverse polarity, expose to high temperatures, or disassemble. Misuse or

abuse could cause physical injury.

NOTE Wash skin with large amounts of water in the event of electrolyte leakage to prevent skin irritation and

inflammation.

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Cleaning Instructions

Listed below are recommendations for cleaning the HeartStart MRx and its associated accessories.

CAUTION • The HeartStart MRx, along with its accessories and supplies, may not be autoclaved, steam

sterilized, ultrasonically cleaned, or immersed unless otherwise indicated in the Instructions for Use

that accompany the accessories and supplies.

• Do not use abrasive cleaners or strong solvents such as acetone or acetone-based cleaners.

• Do not mix disinfecting solutions (such as bleach and ammonia) as hazardous gases may result.

• Do not clean electrical contacts or connectors with bleach.

• Disinfect the device as determined by your institution’s policy to avoid long-term damage to the

device.

Monitor/Defibrillator

The following cleaning products may be used to clean the exterior surfaces of the monitor/defibrillator,

as well as the batteries and data card:

• Isopropyl alcohol (70% solution in water).

• Mild soap and water.

• Sodium hypochlorite (chlorine bleach) (3% solution in water).

• Quaternary ammonium compounds (21% quaternary ammonium content) (such as Steris Coverage

Plus NPD®) (.5 oz. per gallon water - one part Coverage Plus NPD® to 255 parts water).

Before cleaning, remove all adherent soil (tissue, fluids, etc.) and wipe thoroughly with a cloth

dampened with water before applying the cleaning solution.

When cleaning, do not immerse. Wring any excess moisture from the cloth before cleaning. Be sure to

avoid pouring fluids on the device, and do not allow fluids to penetrate the exterior surfaces of the

device. To prevent scratching the display, the use of a soft cloth is recommended.

CAUTION Do not use quaternary ammonium compounds like Steris Coverage Plus NPD to clean the CPR meter.

Printer Printhead

If the printout has light or varying print density, clean the printhead to remove any buildup of paper

residue.

To clean the printhead:

1Push the printer door latch to open the door.

2Remove the roll of paper.

3Clean the printhead surface (above the brush) with a cotton swab dipped in isopropyl alcohol.

4Replace the roll of paper.

20 Maintenance Cleaning Instructions

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Paddles, Therapy Cable

If external non-sterilizable paddles were used during defibrillation, make sure you thoroughly clean the

paddles and paddle tray after each patient event and before performing an Operational Check or

Weekly Shock Test. Verify that there is no debris or residue (including all conductive material) on the

electrode surfaces of the paddles and paddle tray. External non-sterilizable paddles and the Therapy

cables may be cleaned with a soft cloth moistened with:

• Mild soap and water.

• 3.4% gluteraldehyde content such as CidexPlus®

• Sodium hypochlorite (chlorine bleach) (3% solution in water).

• Quaternary ammonium compounds (21% quaternary ammonium content, such as Steris Coverage

Plus NPD), (.5 oz. per gallon water - one part Coverage Plus NPD to 255 parts water).

• Isopropyl alcohol (70% solution in water).

CAUTION The paddles and Therapy cables may not be ultrasonically cleaned or immersed. Nor may they be

autoclaved or ETO sterilized.

NOTE For information about cleaning and sterilizing internal and external sterilizable paddles, see the

Sterilizable Defibrillator Paddles Instructions for Use.

Philips’ disposable sterile internal defibrillation paddles, multifunction electrode pads and monitoring

electrodes are single use items and do not require cleaning.

ECG Cable

For M3525A, M3526A, M3527A, M3528A, M3529A and 989803147691 ECG cables:

• Wipe clean with any of the following:

– Isopropyl alcohol (70% solution in water).

– Mild soap and water.

– Gluteraldehyde solution (3.4% gluteraldehyde content such as CidexPlus).

– Quaternary ammonium compounds (21% quaternary ammonium content such as Steris

Coverage Plus NPD). Dilution: .5 oz. per gallon water - one part Coverage Plus NPD to 255

parts water.

– Chlorine bleach (6% sodium hypochlorite), 3% solution in water. This solution may discolor the

cable.

For any other approved ECG cable:

• Clean according to the manufacturer’s instructions.

CAUTION Do not ultrasonically clean, immerse, autoclave, or steam sterilize the ECG cable. Do not clean

electrical contacts or connectors with chlorine bleach.

Cleaning Instructions 20 Maintenance

289

Carrying Case

The carrying case may be cleaned by hand with mild soap and water. Fabric stain removers may be

used to remove stubborn stains. Air dry the carrying case. Do not wash or dry by machine.

NBP Cuff

The cuff can be disinfected by immersion in a decontamination solution of 70-85% isopropyl alcohol,

but remember to remove the rubber bag if you use this method. The cuff should not be dry cleaned.

The cuff can also be machine-washed or hand-washed as recommended by the manufacturer; the latter

method will prolong the service life of the cuff. Before washing, remove the latex rubber bag and, for

machine-washing, close the hook and loop fastening. Allow the cuff to dry thoroughly after washing,

then reinsert the rubber bag.

SpO2 Sensor and Cable

To clean the SpO2 sensor and cable, follow the instructions provided with the accessory.

Invasive Pressures Transducer and Cable

To clean the invasive pressure cable, follow the instructions provided with the accessory.

Temperature Probe and Cable

To clean the temperature probe and cable, follow the instructions provided with the accessory.

CPR meter

You should examine the CPR meter vent membrane in the center of the rear cover after each use. If

needed, use a soft cloth or toothbrush to gently clean the vent membrane. If damaged or still soiled

after cleaning, replace the rear cover. Keep sharp objects away from the vent membrane. See the

HeartStart MRx Service Manual Addendum for instructions.

If the CPR meter has been used in a training situation it can be cleaned using an alcohol wipe (70%

ethanol solution).

If the CPR meter has been used in a clinical situation, clean it as follows:

1Clean and scrub the exterior using a mild detergent and either a soft cloth or toothbrush until the

surfaces are visually clean. Wipe the exterior with a soft cloth dampened with lukewarm tap water.

2Clean the exterior using a 3% solution of RelyOn™ or Virkon®. Spray the solution on all exterior

surfaces and wait at least five minutes. Alternative cleaning agents include isopropyl alcohol (70%

solution in water).

3Wipe the exterior with a clean soft cloth dipped in distilled water. Allow to dry completely.

CAUTION Do not immerse the CPR meter in water, hold it under running water or allow moisture to penetrate

in. Do not sterilize.

Do not use quaternary ammonium compounds like Steris Coverage Plus NPD to clean the CPR meter.

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HeartStart MRx Disposal

Prior to disposal, remove the batteries. Then dispose of the device and accessories in accordance with

your country’s regulations for equipment containing electronic parts.

WARNING Disposal of the device with the battery inserted presents a potential shock hazard.

To avoid contaminating or infecting personnel, the environment, or other equipment, make sure you

disinfect and decontaminate the monitor/defibrillator and any appropriate device accessories

appropriately prior to disposal.

NOTE This product consists of devices that may contain mercury, which must be recycled or disposed of in

accordance with local, state or federal laws. Within this system, the backlight lamps in the monitor

display contain mercury.

Empty Calibration Gas Cylinders Disposal

To dispose of empty calibration gas cylinders:

1Empty the cylinder completely by pushing the pin of the regulator valve or by pulling out the pin

of the fill valve using a tire valve stem wrench or a pair of needle nose pliers.

2Write “Empty” on the cylinder and dispose of it appropriately for scrap metal.

CPR Meter and Adhesive Pads Disposal

The CPR meter contains electronic components. Dispose of it at an appropriate recycling facility in

accordance with local regulations. A used patient adhesive pad may be contaminated with body tissue,

fluid or blood. Dispose of it as infectious waste.

291

21Supplies & Accessories

This chapter lists the various supplies and accessories for the HeartStart MRx.

Overview

Approved supplies and accessories for your HeartStart MRx are listed in the following tables. To order:

In the USA, call 1-800-225-0230 (pads, electrodes, cables, paper, etc.).

Outside the USA, contact your local Philips Healthcare Sales Office, your authorized Philips

Healthcare Dealer or Distributor, or visit our website at: http://philips.com/healthcarestore and follow

the Medical Supplies link.

WARNING Use only supplies and accessories approved for use with your HeartStart MRx. Use of non-approved

supplies and accessories could affect performance and results.

WARNING Use single-use supplies and accessories only once.

Table 80 Supplies and Accessories

External Paddles

M3542A Standard External Paddles

M3543A Water Resistant External Paddles

M4745A Sterilizable External Paddles

Internal Paddles

M1741A 7.5 cm Switchless

M1742A 6.0 cm Switchless

M1743A 4.5 cm Switchless

M1744A 2.8 cm Switchless

M4741A 7.5 cm Switched

M4742A 6.0 cm Switched

21 Supplies & Accessories Overview

292

M4743A 4.5 cm Switched

M4744A 2.8 cm Switched

M4740A Internal Paddles Adapter Cable

Multifunction Electrode Pads

M3713A Adult Plus

M3716A Adult Radiolucent

M3717A Pediatric Plus

M3718A Adult Radiotransparent/Reduced Skin

M3719A Pediatric Radiotransparent/Reduced Skin

M3501A Defib Adult, AAMI

M3502A Defib Adult, IEC

M3503A Defib Pediatric, IEC

M3504A Defib Pediatric, AAMI

Pads Cables

M3507A Defib Hands-free Pads Cable, barrel style - 2.2m (7 ft.)

M3508A Hands-free Pads Cable, plug style - 2.2m (7 ft.)

05-10200 Pads Adapter (use with M3507A)

989803158661 Defibrillator Pads Hands Free Cable; CPR meter cable and connector

ECG Monitoring Electrodes

M2202A High-Tack Foam ECG Electrodes, 5 electrodes/pack (60 packs/case)

M4612A Solid Gel ECG Electrodes, 5 electrodes/pack (60 packs/case)

M4613A Solid Gel ECG Electrodes, 30 electrodes/pack (10 packs/case)

12-Lead ECG Cable Set

M3525A 2.7 meter 10-lead ECG Trunk Cable, 12-pin Connector (for 3-Lead, 5-Lead and 12-Lead

use)

989803147691 1.3 meter 10-lead ECG Trunk Cable, 12-pin Connector (for 3-Lead, 5-Lead and 12-Lead

use)

M3526A 3-wire Lead Set with Snap (AAMI)

M3527A Add 7-wire Lead Set for 12-Lead use (AAMI)

M3528A 3-wire Lead Set with Snap (IEC)

M3529A Add 7-wire Lead Set for 12-Lead use (IEC)

M5530A Combiner Plug for 3-wire Lead Set for use with M3526A/M3528A

M1663A 10-lead ECG Patient Trunk Cable, 12-pin ECG Input Connector (for 5-Lead and 12-

Lead use) (AAMI)

M1949A 10-lead ECG Patient Trunk Cable, 12-pin ECG Input Connector (for 5-Lead and 12-

Lead use) (IEC)

M1968A 10-electrode Cable Set, Extremities, Grabber (use with M1976A) (AAMI)

M1976A 10-electrode Cable Set, Chest, Grabber (use with M1968A) (AAMI)

M1971A 10-electrode Cable Set, Extremities, Grabber (use with M1978A) (IEC)

M1978A 10-electrode Cable Set, Chest, Grabber (use with M1971A) (IEC)

3-Lead ECG Cable Set

M1500A 3-lead ECG Trunk Cable (AAMI)

Table 80 Supplies and Accessories (Continued)

Overview 21 Supplies & Accessories

293

M1510A 3-lead ECG Trunk Cable (IEC)

M1605A 3-lead ECG Lead Set with Snaps (AAMI)

M1615A 3-lead ECG Lead Set with Snaps (IEC)

M1669A 3-Lead Trunk Cable

M1671A 3-Lead ICU Grabber (AAMI)

M1672A 3-Lead ICU Grabber (IEC)

M1673A 3-Lead ICU Snaps (AAMI)

M1674A 3-Lead ICU Snaps (IEC)

M1675A 3-Lead OR Grabber (AAMI)

M1678A 3-Lead OR Grabber (IEC)

5-Lead ECG Cable Set

M1520A 5-lead ECG Trunk Cable (AAMI)

M1530A 5-lead ECG Trunk Cable (IEC)

M1602A 5-Lead Chest ICU Snaps (AAMI)

M1604A 5-Lead Chest ICU Snaps (IEC)

M1625A 5-lead ECG Lead Set with Snaps (AAMI)

M1635A 5-lead ECG Lead Set with Snaps (IEC)

M1644A 5-Lead ICU Snaps (AAMI)

M1645A 5-Lead ICU Snaps (IEC)

M1668A 5-Lead Trunk Cable

M1968A 5-Lead ICU Grabber (AAMI)

M1971A 5-Lead ICU Grabber (IEC)

M1973A 5-Lead OR Grabber (AAMI)

M1974A 5-Lead OR Grabber (IEC)

M1976A 5-Lead Chest ICU Grabber (AAMI)

M1978A 5-Lead Chest ICU Grabber (IEC)

M1979A 5-Lead Chest OR Grabber (AAMI)

M1984A 5-Lead Chest OR Grabber (IEC)

989803158061 5-Lead ECG Lead Set; Limb Leads; Snaps; Shielded Electrode (AAMI)

989803158071 5-Lead ECG Lead Set; Chest Leads; Snaps; Shielded Electrode (AAMI)

989803158081 5-Lead ECG Lead Set; Limb Leads; Snaps; Shielded Electrode (IEC)

989803158091 5-Lead ECG Lead Set; Chest Leads; Snaps; Shielded Electrode (IEC)

Sync Cables

M1783A Sync Cable (8 ft.)

M5526A Sync Cable (25 ft.)

SpO2 Sensors and Cables

M1191A Reusable SpO2 Sensor - Adult Finger (2 meters)

M1191AL Reusable SpO2 Sensor - Adult Finger (3 meters)

M1191B Reusable SpO2 Sensor - Adult Finger (2 meters)

M1191BL Reusable SpO2 Sensor - Adult Finger (3 meters)

M1191T Reusable Adult Finger Sensor (Nellcor® 9-pin D-sub connector)

Table 80 Supplies and Accessories (Continued)

21 Supplies & Accessories Overview

294

M1192A Reusable SpO2 Sensor - Pediatric/Small Adult Finger

M1192T Reusable Pediatric Sensor (Nellcor 9-pin D-sub connector)

M1194A Reusable SpO2 Sensor - Adult/Pediatric Ear Clip

M1195A Reusable SpO2 Sensor - Infant

M1196A Reusable Clip Adult Sensor

M1196T Reusable Clip Adult Sensor (Nellcor 9-pin D-sub connector)

M1941A SpO2 Extension Cable, 2 m

M1943A 1m Nellcor adapter

M1131A Disposable SpO2 Sensor - Pediatric/Adult Finger

NBP

Interconnect Tubing

M1598B Adult Pressure Interconnect Cable (1.5 m)

M1599B Adult Pressure Interconnect Cable (3 m)

Reusable Blood Pressure Cuffs

40400A Reusable NBP Cuff Kit, 3 sizes (pediatric, adult, large adult)

40400B Reusable NBP Cuff Kit, 5 sizes

(infant, pediatric, adult, large adult, thigh)

40401A Traditional Reusable NBP Cuff - Infant

40401B Traditional Reusable NBP Cuff - Pediatric

40401C Traditional Reusable NBP Cuff - Adult

40401D Traditional Reusable NBP Cuff - Large Adult

40401E Traditional Reusable NBP Cuff - Thigh

M4552B Easy Care NBP Cuff - Infant

M4553B Easy Care Reusable NBP Cuff - Pediatric

M4554B Easy Care Reusable NBP Cuff - Small Adult

M4555B Easy Care Reusable NBP Cuff - Adult

M4557B Easy Care Reusable NBP Cuff - Large Adult

M4559B Easy Care Reusable NBP Cuff - Thigh

M1572A Multi-Patient Comfort Cuffs - Pediatric

M1573A Multi-Patient Comfort Cuffs - Small Adult

M1574A Multi-Patient Comfort Cuffs - Adult

M1575A Multi-Patient Comfort Cuffs - Large Adult

Disposable Blood Pressure Cuffs

M4572B Soft Single-Patient Disposable Cuff - Infant

M4573B Soft Single-Patient Disposable Cuff - Pediatric

M4574B Soft Single-Patient Disposable Cuff - Small Adult

M4575B Soft Single-Patient Disposable Cuff - Adult

M4576B Soft Single-Patient Disposable Cuff - Adult X-Long

M4577B Soft Single-Patient Disposable Cuff - Large Adult

M4578B Soft Single-Patient Disposable Cuff - Large Adult X-Long

M4579B Soft Single-Patient Disposable Cuff - Thigh

Table 80 Supplies and Accessories (Continued)

Overview 21 Supplies & Accessories

295

EtCO2

Intubated Circuits

M1920A FilterLine Set - Adult/Pediatric (25 sets/case)

M1921A Filter H Set - Adult/Pediatric (25 sets/case)

M1923A Filter H Set - Infant/Neonatal (yellow, 25 sets/case)

Non-Intubated Dual Purpose Circuits (CO2 + O2)

M2520A Smart CapnoLine - Pediatric

M2522A Smart CapnoLine - Adult

Non-Intubated Single Purpose Circuits (CO2)

M2524A Smart CapnoLine - Pediatric

M2526A Smart CapnoLine - Adult

Invasive Pressures

CPJ840J6 Reusable pressure transducer

CPJ84022 Sterile disposable pressure dome for use with CPJ840J6

CPJ84046 Transducer holder for CPJ840J6

M1567A Single channel disposable blood pressure kit (available in Europe and Asia only)

M1568A Dual Line blood pressure kit for measuring CVP, ABP and other pressure measurements.

(available in Europe and Asia only)

M1634A Reusable adapter cable (available in Europe and Asia only)

TransPac® IV Disposable transducer*

Tr u Wa v e ® PX212 Disposable transducer*

DTX Plus™ DT-4812 Disposable transducer*

* - Contact the individual manufacturers for purchasing and service information.

Temperature

Disposable Temperature Probes

21090A Esophageal/rectal

21091A Skin surface

21093A Esophageal stethoscope

21094A Esophageal stethoscope

21095A Esophageal stethoscope

21096A Foley catheter

21097A Foley catheter

M1837A Esophageal/rectal

M2255A Foley catheter

Reusable Temperature Probes

21075A Esophageal/rectal - adult

21076A Esophageal/rectal - pediatric

21078A Skin surface

Reusable Temperature Probe Extension Cables

21082A 3.0m 2-pin plug extension cable for mini phone plug

21082B 1.5m 2-pin plug extension cable for mini phone plug

Table 80 Supplies and Accessories (Continued)

21 Supplies & Accessories Overview

296

Power

M3538A Lithium Ion Battery

M3539A AC Power Module

M5529A DC Power Module

M5528A DC Power Module Mounting Bracket

989803135301 2-Bay Battery Support System for Lithium Ion Batteries

989803135331 4-Bay Battery Support System for Lithium Ion Batteries

989803135341 4-Bay Battery Support System for Sealed Lead Acid and Lithium Ion Batteries

Q-CPR

M4761A Compression Sensor

M4762A Compression Sensor Adhesive Pads (Package of 10)

M4763A Pads/CPR Cable for use with Compression Sensor

989803158661 Pads/CPR Cable for use with CPR meter

989803162401 CPR meter (for Q-CPR option with HeartStart MRx software Rev. F or higher)

989803163291 CPR meter Adhesive Pads (10)

Networking

989803148551 Instrument Telemetry 1.4 GHz radio and A/C module

M4842-61300 1.4 GHz replacement antenna

Paper

40457C 50 mm Chemical Thermal Paper, Gray Grid (10 rolls)

40457D 50 mm Chemical Thermal Paper, Gray Grid (80 rolls)

989803138171 75 mm Chemical Thermal Paper, Red Grid (10 rolls)

989803138181 75 mm Chemical Thermal Paper, Red Grid (80 rolls)

Color Handle

M5521A Green

M5522A Blue

M5523A Yellow

M5524A Rose

M5525A Gray

Miscellaneous

M1781A Test Load for use with M3507A Pad Cable

M3725A Test Load for use with M3508A Pad Cable

M3541A Carrying Case

989803146981 Data Card and Tray

M3544A Data Card Tray

M3853A Data Card Tray (also used with HeartStart FR2)

M3854A Data Card and Tray (also used with HeartStart FR2)

M4737A Display Cover

M3549A Wide bedrail hook

989803153411 Internal Bluetooth Card

Table 80 Supplies and Accessories (Continued)

297

22Troubleshooting

If the HeartStart MRx detects an error or potential problem during use, it displays an INOP statement

or a message window with text to guide you. INOP statements and messages are often accompanied by

a voice prompt or an audible beeping tone. This chapter describes the INOP statements and messages

that you may see, along with other symptoms, and provides suggestions for what to do. In addition,

this chapter provides an explanation of audible tones and information on contacting your service

representative.

If you are unable to resolve a problem using the suggestions in this chapter:

• Run an Operational Check to determine if there is a malfunction requiring service.

• If a malfunction is identified, call for service.

• Take the HeartStart MRx out of use if there is a malfunction affecting ECG monitoring,

defibrillation, or pacing. For malfunctions related to SpO2, NBP, Invasive Pressures, Temperature,

CO2 monitoring, or 12-Lead functionality, take the device out of service if the function is essential

to patient care in your organization.

Results of Automated Tests associated with critical functionality of the device are reported through the

Ready For Use indicator and the Automated Test Summary report. For information on responding to

these results, see “Ready For Use Indicator” on page 266. To respond to errors reported through

Operational Check see “Operational Check Test Results” on page 279.

For further technical and repair information, refer to the HeartStart MRx Service Manual.

WARNING Product servicing and repair should only be performed by qualified service personnel.

22 Troubleshooting Symptoms

298

Symptoms

The following tables list symptoms, INOP statements, and messages that you may encounter, along

with possible causes of the problem, and potential solutions. Symptoms are characterized by

functionality.

Table 81 Ge n e r a l Prob le m s

Symptom Possible Cause Possible Solution

The HeartStart MRx does not

turn on.

There is no power. Insert a fully charged battery.

Connect to AC/DC power.

Audio is too low or absent. The QRS, Voi ce , or Alarm volume

is configured to a Ver y Soft or Off

setting.

Use the Volume menu to adjust the volume of the

QRS beeper, voice prompts, and/or alarms.

Low battery life (appears to

deplete quickly).

The battery may be nearing its end

of life.

Replace the battery.

Battery charge indicators

inaccurate.

The battery may need calibration. Calibrate the battery.

All Settings Have Been Reset

To Default Values message.

A power failure or critical software

error has occurred.

Reset alarms, waveforms, volumes, and other settings

previously defined for the current patient.

All Settings Have Been Set To

Factory Default Values

message, accompanied by a

Power Interrupted or Device

Restarted message.

Corrupt or incomplete

configuration file.

Reload device configuration file.

Batteries Low message. The batteries may not have enough

remaining charge to provide 10

minutes of monitoring time or six

200J shocks.

Insert a fully charged battery.

Connect to AC/DC power.

Battery A Low - Switching to

Battery B (or vice-versa)

message.

The specified battery needs

charging.

Charge the low battery.

Device Error. Service

Required. message

Failure detected during start-up. Take the device out of use and call for service.

External Power Interrupted

message.

AC/DC power was removed; now

operating from battery power.

Connect to AC/DC power, if appropriate.

Fan Failure message. The internal fan should be running

but it is not.

Call for service.

Internal Memory Failure

message.

INOP message appears every

time the device is turned on.

The internal memory card has been

reformatted after failing an

automated test.

Although all previous data stored on the card has been

erased, it is now ready once again to record data.

Patient data cannot be stored in

internal memory because the

internal memory card is not

recognized.

Call for service.

An attempt to print an Event

Summary or trending report was

requested during power up.

Data Card was not available. Cycle the power. Wait at

least 16 seconds after power up before attempting to

print an Event Summary or trending report.

Symptoms 22 Troubleshooting

299

Event Storage Full message. Event Summary data for the

current patient case exceeds the

storage capacity of internal memory

or you’ve reached the 12-hour limit.

Copy or print Event Summary to retain data and then

begin a new patient case.

Print the Event Summary Report. Begin a new patient

case.

Power Supply Failure INOP. There is a problem with the

internal power supply.

Remove the device from use and call for service.

Replace Clock Battery

message.

The battery on the internal clock

needs to be replaced.

Call for service.

Shock Equip Malfunction

INOP.

A shock can not be delivered due to

a hardware failure.

Remove the device from use and call for service.

Shutting Down in 1 Minute

message.

Very low battery and the device is

not connected to AC/DC power.

Insert a charged battery and/or connect to AC/DC

power.

Shutting Down Now message. Battery charge is depleted and the

device is not connected to AC/DC

power.

Insert a charged battery and/or connect to AC/DC

power. Settings for the current patient may need to be

reset.

Arching or sparking during

paddles-in-pocket test therapy

discharge (Weekly Shock Test).

Debris or residue, such as

electrolytic gel, on the surfaces of

the paddles and/or paddles tray.

Clean paddles and paddles tray.

Table 82 ECG Monitoring Problems

Symptom Possible Cause Possible Solution

QRS beeper inaudible or beeps

do not occur with each QRS

complex.

The QRS volume is configured to

Off or the setting is too low.

Configure the QRS beeper volume.

The QRS volume was turned Off

or set too low through the Volume

menu.

Adjust the volume through the Volume menu.

The amplitude of the QRS

complex is too small to detect.

Select a different lead.

Poor ECG signal quality (noisy

trace, wandering baseline, etc.)

from signal acquired through

monitoring electrodes.

The monitoring electrodes are not

making proper contact with the

patient.

Check that the monitoring electrodes are properly

applied. If necessary, prepare the patient’s skin and

apply new electrodes.

Check the date code on the electrodes. Do not open

the electrode package until immediately prior to use.

The monitoring electrodes are

outdated or dried-out.

Check the date code on the electrodes. Do not open

the electrode package until immediately prior to use

Radio frequency interference (RFI)

is causing artifact.

Relocate or turn off equipment that may be causing

RFI. Try repositioning cables/leads.

The ECG cable may be faulty. Run the Operational Check with the ECG cable. If

the test fails, run it without the ECG cable. If the test

passes, replace the cable. If not, remove the device

from use and call for service.

Table 81 General Problems (Continued)

Symptom Possible Cause Possible Solution

22 Troubleshooting Symptoms

300

Poor ECG signal quality (noisy

trace, wandering baseline, etc.)

from signal acquired through

paddles/pads.

The paddles/pads are not making

proper contact with the patient.

Ensure proper skin preparation and correction

application. If necessary, apply new pads.

The pads are outdated or dried-

out.

Check the date code on the pads. Do not open the

pads package until immediately prior to use.

Radio frequency interference (RFI)

is causing artifact.

Relocate or turn off equipment that may be causing

RFI. Try repositioning the pads cable.

The paddles/pads cable may be

faulty.

Run the Operational Check with the pads cable. If the

test fails, run it without the pads cable. If the test

passes, replace the cable. If not, remove the device

from use and call for service.

ECG Unplugged INOP. No ECG cable is connected and

the configured/selected ECG in

Wave Sector 1 is from leads

Check that the ECG cable is firmly connected.

Connect an ECG cable or a pads therapy cable.

Leads Off INOP.

Electrode(s) for the configured/

selected ECG in Wave Sector 1

may be off or insecurely attached.

Apply electrodes/pads to the patient.

Electrode(s) are not making proper

contact with the patient.

Check that monitoring electrodes are properly applied.

If necessary, prepare the patient’s skin and apply new

electrodes.

Solid flat line - no waveform,

no Leads Off INOP.

Short in patient cable or leads. Run the Operational Check with the ECG cable. If

the test fails, run it without the ECG cable. If the test

passes, replace the cable. If not, remove the device

from use and call for service.

Pads/Paddles Off INOP Pads/Paddles for Wave Sector 1 are

off or insecurely attached.

Check that pads/paddles are properly applied. If

necessary, replace the pads.

Change the ECG in Wave Sector 1 to a lead derived

from monitoring electrodes.

There is a dashed line (----) on

the display instead of an ECG.

ECG data is not being acquired. Check the pads, paddles or ECG cable is connected.

Check the pads, paddles, or monitoring electrodes are

properly applied.

Check that the desired lead is selected.

“Lead-wire” Off message

displayed in wave sector.

The specified monitoring electrode

is off or not making proper contact

with the patient.

Check that monitoring electrodes are properly applied.

If necessary, prepare the patient’s skin and apply new

electrodes.

Check Limb Leads message

displayed in wave sector.

2 or more limb lead electrodes are

off or not making proper contact

with the patient.

Check that the limb lead electrodes are properly

applied.

Pads Off message displayed in a

wave sector.

Pads are not making proper

contact with the patient.

Make sure the pads therapy cable is connected and

pads are properly applied. If necessary, prepare the

patient’s skin and apply new pads.

Cannot Analyze ECG INOP. The arrhythmia or 12-Lead

algorithm cannot reliably analyze

the ECG data.

Check ECG signal quality. If necessary, improve lead

position or reduce patient motion.

Table 82 ECG Monitoring Problems (Continued)

Symptom Possible Cause Possible Solution

Symptoms 22 Troubleshooting

301

Pads ECG Cable Failure INOP. A short was detected between a

lead wire and ground.

Replace the pads cable and perform an Operational

Check.

ECG Cable Failure INOP. A short has been detected between

a lead wire and ground.

Replace the ECG cable.

Pads ECG Equip Malfunction

INOP.

A device hardware failure was

detected.

Perform an Operational Check. If the Pads/Paddles

ECG Test fails with Therapy cable, disconnect the

Therapy cable from the device when prompted in

order for the Pads/Paddles ECG Test to run without

the cabled connected. If the Pads/Paddles ECG test

passes without the cable connected, replace the

Therapy cable.

ECG Equip Malfunction INOP. A device hardware failure was

detected.

Disconnect the ECG cable and perform an

Operational Check. If the Leads ECG Test fails,

remove the device from use and call for service. If the

Leads ECG Test passes, replace the ECG cable and

perform an Operational Check.

Lead Select button does not

respond.

The 12-lead function is active. Exit the 12-lead function.

Device is in AED Mode. None.

Lead Select button does not

display a pads choice.

The pads therapy cable is not

connected.

Connect the pads therapy cable.

Demand mode pacing is active. Exit pacing or choose fixed mode pacing.

One or more controls do not

respond (e.g., select lead or soft

keys).

Faulty control or connection. Remove the device from use and call for service.

Therapy Cable Failure INOP Performing an Operational Check

without a therapy cable attached.

Connect a therapy cable and rerun Operational

Check.

Table 82 ECG Monitoring Problems (Continued)

Symptom Possible Cause Possible Solution

22 Troubleshooting Symptoms

302

Table 83 NBP Monitoring Problems

Symptom Possible Cause Possible Solution

NBP Cuff Not Deflated INOP.

The NBP numeric value is

replaced with a -?-.

The NBP cuff pressure has been

greater than 5mmHg (0.67kPa) for

more than 3 minutes.

Remove cuff from patient.

Release pressure in the cuff (disconnect cuff from

tubing).

Replace the cuff. If the problem persists, call for

service.

NBP Cuff Overpressure INOP.

The NBP numeric value is

replaced with a -?-.

The NBP cuff pressure has

exceeded the overpressure safety

limit of 300 mmHg.

No action is required, the cuff should deflate

automatically. If not, remove cuff from patient and

deflate.

NBP Interrupted INOP.

The NBP numeric value is

replaced with a -?-/-?-(-?).

The measurement needed longer

than the maximum time provided

for inflation, deflation, or the total

measurement.

Check that the cuff size is appropriate.

Check cuff placement.

NBP Measurement Failed

INOP.

The NBP numeric value is

replaced with a -?-/-?-(-?-).

A measurement value could not be

obtained.

Check cuff size and placement.

NBP Calibration Overdue

INOP.

NBP module needs calibration.

Calibration should be performed

once a year or every 10,000 cycles,

whichever comes first.

Call for service of the NBP module. Do not use the

NBP monitoring capabilities until the calibration has

been performed. If NBP monitoring is essential to

patient care, take the device out of use.

NBP Equip Malfunction INOP. NBP hardware failure. Call for service of the NBP module. Do not use the

NBP monitoring capabilities. If NBP monitoring is

essential to patient care, take the device out of use.

NBP Service Required INOP. The NBP module has reached its

end of life, defined as 50,000

cycles.

Call for service of the NBP module. Do not use the

NBP monitoring capabilities. If NBP monitoring is

essential to patient care, take the device out of use.

Measurement cycle doesn’t

automatically start.

NBP is not configured for

automatic measurements.

Check/modify the configuration as needed.

Automatic measurements are not

scheduled for the current patient.

Use the Measurements/Alarms menu to define an

automatic schedule of measurements for the current

patient.

The [Start NBP] soft key has

not been pressed.

Press the [Start NBP] soft key.

The pump operates, but the

cuff does not inflate or fails to

inflate fully.

Defective cuff. Replace the cuff.

Poor connection between the cuff

and the HeartStart MRx.

Check connections and replace tubing, if needed.

NBP measurements appear

high/low.

The cuff size is too small/large for

the patient.

Use the correct cuff size.

Symptoms 22 Troubleshooting

303

Table 84 SpO 2 Monitoring Problems

Symptom Possible Cause Possible Solution

The SpO2 waveform is not

displayed.

The sensor is not properly

connected or the sensor cable is

damaged.

Check the sensor connection and cable.

Try another sensor.

The SpO2 waveform is not

configured to be displayed and

there is not an unused wave sector.

Use the Displayed Waves menu to select a wave sector

for display of the SpO2 waveform.

SpO2 Non Pulsatile INOP. The patient’s pulse is absent or too

weak to be detected.

The sensor has come off.

Check perfusion at the measurement site.

Check that the sensor is applied properly.

Make sure the sensor site has a pulse.

Relocate the sensor to another site with improved

circulation.

If the message occurs due to NBP measurement on the

same limb, wait until the NBP measurement is

finished.

Try another sensor.

SpO2 Erratic INOP.

The SpO2 numeric value is

replaced with a -?-.

SpO2 measurement readings are

erratic.

Check that the sensor is applied properly.

Make sure the sensor site has a pulse.

Relocate the sensor to another site with improved

circulation.

Try another sensor.

SpO2 Noisy Signal INOP. Excessive patient movement or

electrical interference.

Minimize patient movement.

Make sure the sensor cable is not positioned too close

to power cables.

SpO2 Interference INOP.

The SpO2 numeric value is

replaced with a -?-.

Ambient light is too high. Cover the sensor with an opaque material to minimize

ambient light.

Make sure the sensor cable is not positioned too close

to power cables.

Make sure that the sensor cable is not damaged.

SpO2 Unplugged INOP.

The SpO2 sensor is not connected.

Check the SpO2 connection.There is too much interference.

The sensor is damaged.

SpO2 Unplugged. Turn off

SpO2? message appears when

the device is turned on and the

SpO2 sensor is not connected.

The SpO2 sensor is not connected. Check that the sensor connection is secure. Try

another sensor.

The software was not upgraded

after an SpO2 repair or upgrade.

was performed.

Call for service.

22 Troubleshooting Symptoms

304

SpO2 Sensor Malfunction

INOP.

The SpO2 numeric value is

replaced with a -?-.

The SpO2 sensor or cable is faulty. Try another sensor.

If the problem persists, call for service of the SpO2

module. If SpO2 monitoring is essential to patient

care, take the device out of use.

SpO2 Equip Malfunction

message.

Faulty SpO2 hardware. Call for service of the SpO2 module. If SpO2

monitoring is essential to patient care, take the device

out of use.

SpO2 Extended Update INOP.

The SpO2 numeric value is

replaced with a -?-.

An NBP measurement or an

excessively noisy signal is delaying

display/update of the SpO2

measurement for more than 60

seconds.

Wait until the NBP measurement is complete.

Try another sensor site.

Move sensor to a different limb from the NBP cuff.

SpO2 Low Perfusion INOP.

The SpO2 numeric value is

replaced with a -?-.

The SpO2 signal is too low to give

an accurate reading.

Check the sensor is applied properly.

Try another sensor type.

Table 85 Transmission Problems (Bluetooth)

Symptom Possible Cause Possible Solution

Bluetooth Malfunction

INOP.

The MRx does not have a

Bluetooth card.

Call for service.

The Bluetooth card is

incompatible.

The Bluetooth card is

corrupt.

No Bluetooth Devices

Detected message.

The MRx could not discover

the Bluetooth device.

Try searching again for Bluetooth devices.

The Bluetooth device is not

turned on.

Make sure the Bluetooth device is turned on.

The Bluetooth device is not

authorized to pair with the

MRx.

See the Bluetooth device’s documentation to set authorization.

The Bluetooth device is not

within range.

Move the Bluetooth device closer to the MRx, within the

transmitting range. (See the Transmission Implementation Guide

for information on transmission ranges.)

The Bluetooth card is

corrupt.

Call for service.

No Bluetooth Profiles

Configured message.

There are no profiles

configured for the Bluetooth

device.

Create a profile for the Bluetooth device. See the Transmission

Implementation Guide for more information.

Transmission Settings Have

Not Been Configured

message.

The Hub information

settings are not correct.

Modify the Hub Configuration settings on the MRx as needed.

Table 84 SpO 2 Monitoring Problems (Continued)

Symptom Possible Cause Possible Solution

Symptoms 22 Troubleshooting

305

Bluetooth Connection Lost

message.

The Bluetooth device is not

within range.

Move the Bluetooth device closer to the MRx, within the

transmitting range. (See the Transmission Implementation Guide

for information on transmission ranges.)

Bluetooth device pairing

failed message.

The wrong pass code was

entered on the Bluetooth

device

Check the pass code. Select the device from the MRx Add

Devices list and pair again.

The pairing process timed

out.

Try pairing again.

The Bluetooth card is

corrupt.

Call for service.

No Bluetooth Devices

Configured message.

The Bluetooth device has

not been paired with the

MRx.

Pair the Bluetooth device with the MRx.

No transmission devices

detected message.

The Bluetooth device is not

turned on.

Make sure the Bluetooth device is turned on.

The Bluetooth device is not

within range.

Move the Bluetooth device closer to the MRx, within the

transmitting range. See the Transmission Implementation Guide

for more information.

The Bluetooth pairing

information has been lost.

Pair the Bluetooth device with the MRx.

The Bluetooth card is

corrupt.

Replace the Bluetooth card.

Transmission Failed. No Dial

Tone. message.

Cell phone service is

unavailable.

Check that the cellular signal strength is sufficient.

The Bluetooth modem

connection is not secure.

Check that the connection between the Bluetooth modem and

the analog line is secure.

The connection you are

using does not provide dial

tones.

Set the “Wait for Dial Tone” configuration parameter to No.

See the Transmission Implementation Guide for more

information.

Transmission Failed. Error

configuring transmission

device. message.

The wrong Bluetooth Profile

was selected.

Check the profile to ensure it is the correct one for that

Bluetooth device.

The Configuration String

under the Bluetooth Profile

settings is not correct.

Work with your cell phone provider to ensure that the

Configuration String is correct.

Transmission Failed. Cannot

reach server. message.

No server or the connection

has been lost.

Resend the 12-Lead Report.

Table 85 Transmission Problems (Bluetooth) (Continued)

Symptom Possible Cause Possible Solution

22 Troubleshooting Symptoms

306

Transmission Failed.

Connection Interrupted.

An error occurred during

transmission of one of the

files.

Check that the cellular signal strength is sufficient.

Move the Bluetooth device closer to the MRx, within the

transmitting range. See the Transmission Implementation Guide

for more information.

Check permissions on FTP device configurations. permissions

must allow for reading and writing. Reset receiving device and

re-transmit.

Receiving device is full. Check available space on receiving device.

User settings in the

Bluetooth device do not

allow transmission

Set Bluetooth device to allow all operations for the HeartStart

MRx and re-transmit.

Transmission Failed. Server

Unknown. message.

The DNS has timed out or

there has been a failure in the

DNS.

Work with your ISP to ensure the Bluetooth Profile and Hub

settings are correct.

Transmission Failed.

Settings Configured

Incorrectly. message.

There is a problem with the

Server URL, Proxy user

name, Proxy password

Work with your ISP to ensure the Bluetooth Profile and Hub

settings are correct.

Transmission Failed.

Connection Failed. message.

A Bluetooth Card

malfunction occurred.

Retry Transmission

The wrong Bluetooth Profile

was selected.

Check the profile to ensure it is the correct one for that

Bluetooth device.

The Dial String under the

Phone Profile settings is

incorrect.

Work with your cell phone provider to ensure that the Dial

string is correct.

Data transfer service is

unavailable on the phone.

Work with your cell phone provider to ensure that your cell

phone plan has data transfer capability.

Wrong number. Check the number and re-send.

Invalid Password message.

The wrong Bluetooth Profile

was selected.

Check the profile to ensure it is the correct one for that

Bluetooth device.

The PPP User Name or PPP

Password under the Profile

Phone settings is incorrect.

Modify the Bluetooth Profile setting as needed.

The server User Name or

Password is incorrect.

Modify the Hub settings as needed.

Transmission Failed

message.

The network is down. Check with your ISP to see if your service is down.

The server connection has

timed out.

Re-send the 12-lead report.

TCP/IP Failure Re-send the 12-lead report. If still unsuccessful, check the MRx

configuration settings.

The web server has rejected

the data.

Check the MRx and the12-Lead Transfer Station to ensure that

the correct product versions are installed.

Table 85 Transmission Problems (Bluetooth) (Continued)

Symptom Possible Cause Possible Solution

Symptoms 22 Troubleshooting

307

Table 86 12-Lead Transmission Problems (RS-232)

First, attempt to solve the problem by disconnecting the serial cable from the cell phone, reconnecting it, and resending the

12-Lead Report.

Symptom Possible Cause Possible Solution

Transmission Settings Have

Not Been Configured

message.

Hub information has not

been entered or is entered

incorrectly in Configuration.

Modify the Hub configuration settings as needed.

No Transmission Devices

Detected message.

The cell phone is not an

approved model for 12-Lead

Transmission.

Use an approved cell phone model. See the requirements listed

in the Transmission Implementation Guide.

The cell phone’s RS-232

port has not been

configured.

Check the cell phone configuration settings.

The cell phone is not

connected properly.

Check that the cell phone is turned on and the connection is

secure.

Disconnect and reconnect the serial cable.

The serial cable is defective

or incompatible.

Work with your cell phone provider to obtain a serial cable that

connects to your phone with a 9-pin D serial cable connection.

No Dial Tone message. There is no dial tone.

Cell phone service is

unavailable.

Check that the connections are secure.

Check that the cellular signal strength is sufficient.

Transmission Failed

message, accompanied by an

Error Configuring

Transmission Device

message

The phone configuration

settings are invalid/incorrect.

Modify the Serial Phone Profile configuration settings as

needed. For more information refer to the Transmission

Implementation Guide.

Wrong number. Check the number and re-send.

Invalid Password message. The Internet Service

Provider (ISP) or Hub user

name or password is

incorrect.

Modify the Serial Phone Profile or Hub configuration settings

as needed. For more information refer to the Transmission

Implementation Guide.

Transmission Failed

message, accompanied by a

Connection Failed message.

The connection with the ISP

cannot be made.

Modify the Serial Phone Profile configuration settings as

needed. For more information refer to the Transmission

Implementation Guide.

Transmission Failed

message, accompanied by a

Cannot Reach Server

message.

The network server is

unavailable.

Contact the network administrator.

Transmission Failed

message, accompanied by a

Server Unknown message

Server Name or address is

not recognized.

Modify the Server configuration settings as needed. For more

information refer to the Transmission Implementation Guide.

22 Troubleshooting Symptoms

308

Transmission Failed

message, accompanied by a

Connection Interrupted

message.

The connection with the

network server has

terminated.

Choose the destination site again and re-connect.

Transmission Failed

message, accompanied by a

Settings Configured

Incorrectly message

The URL or Proxy

configuration settings are

incorrect.

Modify the Serial Phone Profile, Hub or Site configuration

settings as needed. For more information refer to the

Transmission Implementation Guide.

Transmission Failed

message.

The 12-Lead Report did not

transmit correctly.

Choose the destination site again and re-connect.

Check the cell phone connection to the HeartStart MRx.

The network is down. Check with your internet provider to see if your service is

unavailable.

Table 87 Tra ns m ission Pro bl e m s (Ro s e tt a )

Symptom Possible Cause Possible Solution

No transmission device

detected

The HeartStart MRx failed to

connect to the selected

transmission device.

Check cables and connections.

Replace Rosetta-Lt battery.

Transmission Failed The 12-Lead Report was not

transmitted to the Rosetta-Lt.

Transmission Failed

Timeout

The transfer did not complete

within the

1-minute timeout period.

Table 86 12-Lead Transmission Problems (RS-232) (Continued)

First, attempt to solve the problem by disconnecting the serial cable from the cell phone, reconnecting it, and resending the

12-Lead Report.

Symptom Possible Cause Possible Solution

Table 88 Transmission Problems (Periodic Clinical Data Transmission)

Symptom Possible Cause Possible Solution

My vitals aren’t being

transferred as often as I want

The device is configured to a

longer transmission interval.

In Configuration Mode, change the Transmit Interval to a

shorter period of time.

Connection lost icon

The connection has timed

out.

Connection will automatically be re-established with next

PCDT

Connection lost see “Transmission Problems (Bluetooth)” on page 304

Table 89 Tra ns m ission Pro bl e m s (Bat ch LAN Data Tr ans fe r)

Symptom Possible Cause Possible Solution

Device does not

automatically display BLDT

menu.

LAN cable is not properly

connected to HeartStart

MRx and external server

Unplug and re-plug in the LAN cable from both devices,

assuring a solid connection.

Confirm that HeartStart MRx is in Data Management Mode

and Data Messenger is active on the receiving server.

Contact your IT professional for assistance.

Connection lost message Successful connection to the

Data Messenger server was

lost

Symptoms 22 Troubleshooting

309

Table 90 CO 2 Monitoring Problems

Symptom Possible Cause Possible Solution

The CO2 waveform does not

appear on the display.

The FilterLine is not properly

connected.

Check the FilterLine connection.

Check tubing for knots, kinks or pinches.

The CO2 waveform is not

configured to be displayed and

there is not an unused wave sector.

Use the Displayed Waves menu to select a wave sector

for display of the CO2 waveform.

CO2 Unplugged INOP. The FilterLine is disconnected. Check the FilterLine connection and tubing.

Check the tubing for knots, kinks, or pinches.

CO2 Purging INOP. A blockage in the FilterLine or

airway adapter has been detected. If

it is not successful, a CO2

Occlusion condition will occur.

The HeartStart MRx automatically attempts to purge

the blockage.

CO2 Occlusion INOP. Attempts to purge the FilterLine

and exhaust tube were unsuccessful.

A sample cannot be taken because

of the blockage.

Make sure the FilterLine and exhaust tubing (if

connected) are not kinked and are free of blockages.

Then disconnect and reconnect the FilterLine to retry.

If necessary, replace the FilterLine and/or exhaust

tubing.

CO2 Overrange INOP. The CO2 value is higher than the

measurement range.

If you suspect a false high value, do not use the CO2

monitoring capabilities and call for service of the CO2

module. If CO2 monitoring is essential to patient

care, take the device out of use.

CO2 Auto Zero INOP. The automatic zero process is

running. It takes from 10 to 30

seconds and CO2 values are invalid

at this time.

No action required. The module automatically resets

itself.

CO2 Calibration Overdue

INOP.

The CO2 module should be

calibrated once a year or after 4,000

operating hours.

Do not use the CO2 monitoring capabilities and call

for service to calibrate the CO2 module. If CO2

monitoring is essential to patient care, take the device

out of use.

CO2 Check Exhaust INOP. When CO2 is turned on, the

exhaust tube is blocked to the

extent that a measurement sample

cannot be taken.

Make sure the exhaust tubing is not kinked and is free

of blockages. If necessary, replace the tubing.

CO2 Equip Malfunction INOP CO2 hardware failure. Do not use the CO2 monitoring capabilities and call

for service of the CO2 module. If CO2 monitoring is

essential to patient care, take the device out of use.

CO2 Service Required INOP. The CO2 module has reached its

end of life, defined as 15,000

operating hours.

Do not use the CO2 monitoring capabilities and call

for service of the CO2 module. If CO2 monitoring is

essential to patient care, take the device out of use.

22 Troubleshooting Symptoms

310

Table 91 Defibrillation and Pacing Problems

Symptom Possible Cause Possible Solution

Analyzing Stopped, or

Cannot Analyze ECG message

in AED Mode.

Excessive patient movement. Minimize patient movement. If the patient is being

transported, stop if necessary.

Radio or electrical sources are

interfering with ECG analysis.

Remove possible sources of interference from the area

Charge Button Failure INOP During an Operational Check,

when the Charge button was

pressed, there was no response.

Remove the device from use and call for service.

Defib Disarmed message.

The Shock button was not pressed

within the time period specified in

the Time to Auto Disarm

Configuration setting.

No action required. If desired, charge the device and

press the Shock button.

Therapy cable not attached. Pads/

paddles connection compromised.

Make sure the therapy cable is connected and the

pads/paddles are making proper contact with the

patient.

Maximum Energy 50J message. Attempted delivery of greater than

50J using internal paddles.

Only energies up to 50J are available for internal

defibrillation. Select a lower energy.

No Shock Delivered, Replace

Pads Now message.

Faulty pads or poor pads

application to patient. (Low

impedance.)

Make sure pads are applied properly. If the problem

persists, replace the pads.

No Shock Delivered, Press

Pads Firmly message.

Poor pads contact with the patient.

(High impedance.)

Make sure pads are applied properly. Firmly press pads

on the patient’s chest.

No Shock Delivered, Low/High

Impedance message.

Poor paddles contact with patient

skin.

Make sure paddles are making adequate contact with

the patient’s skin. If the problem persists, replace the

paddles.

Paddles failure.

Pacer Equip Malfunction

INOP.

Pacing hardware failure. Call for service. If pacing functionality is essential to

patient care, take the device out of use.

Press Charge Before Shock

message.

The device is not charged to the

selected energy.

Make sure the desired energy is selected. Then press

the Charge button.

Press Shock Buttons on

Paddles message.

The Shock button on the device is

disabled because external paddles or

switched internal paddles are

connected.

Press the Shock button(s) on the paddles to deliver a

shock.

R-Wave Not Detected message. During synchronized cardioversion,

the r-wave was not detectable.

Choose a lead with a clearly define QRS complex.

Pacing Stopped. [Leads Off]

message.

Pacing has stopped because the

ECG source for Wave Sector 1 has

become invalid because of a Leads

Off condition or an ECG cable

disconnection.

Check that the monitoring electrodes are applied

properly to the patient. Check cable connections.

Press the [Resume Pacing] soft key to continue

pacing.

Pacing Stopped. [Pads Off]

[Pads Cable Off] message.

Pacing has stopped because of poor

pads/patient contact or a pads cable

disconnection.

Check that the pads are applied correctly to the

patient. Check cable connections. Press the

[Resume Pacing] soft key to continue pacing.

Symptoms 22 Troubleshooting

311

Shock Button Failure INOP During an Operational Check,

when the Shock button was

pressed, there was no response.

Remove the device from use and call for service.

Therapy Knob Failure INOP During an Operational Check, the

Therapy Knob test failed.

Remove the device from use and call for service.

Time to charge to selected

energy is slow.

The device is being operated with

only AC/DC power (no battery) or

the battery power is low.

Install a fully charged battery.

Device displays a No Shock

Delivered message but you see

a physiological response from

the patient

Poor skin contact; pads are not

properly connected to the patient.

Minimal patient movement is

possible in this situation as the

defibrillator may deliver a small

amount of energy. The shock

counter will remain at zero.

Make sure the pads are applied properly.

Replace pads in necessary

Table 92 Printer Problems

Symptom Possible Cause Possible Solution

Paper won’t move. Paper improperly loaded or

jammed, or paper is wet.

Reload paper or clear jam. If paper is wet, replace with

fresh, dry roll.

Paper moves then stops.

Door improperly latched. Check door latch.

Paper improperly loaded or

jammed.

Reload paper or clear jam.

Paper moves but printing is

faint or absent.

Paper roll improperly installed.

Incorrect paper type.

Printhead temperature approaching

maximum recommended operating

temperature.

Check that the paper is installed correctly.

Incorrect paper type. Use only recommended paper type.

Printhead temperature approaching

maximum recommended operating

temperature.

Wait until the printer cools down and restart printing.

Paper moves but print quality

poor or some dots missing.

Dirty printhead. Clean the printhead.

Loud buzzing or grinding

noise.

Door improperly latched. Check door latch.

White line running along

paper.

Dirt on printhead. Clean the printhead.

Table 91 Defibrillation and Pacing Problems (Continued)

Symptom Possible Cause Possible Solution

22 Troubleshooting Symptoms

312

Incompatible Printer message. The installed printer does not

support the fonts required. Asian

fonts require the 75 mm printer.

Install the 75 mm printer.

Check Printer message. The printer is out of paper or the

door is open.

Load/reload the printer paper.

Make sure the printer door is closed.

Printer Malfunction message. The printer is faulty or there is a

problem communicating with the

printer.

Turn the HeartStart MRx off for 15 seconds and then

turn it on again. If the problem persists, call for

service. If printing is essential to patient care, take the

device out of use.

Printer Temperature High

message.

The temperature of the print head

exceeds the recommended

operating temperature.

Wait until the printer cools down and restart printing.

Table 92 Printer Problems (Continued)

Symptom Possible Cause Possible Solution

Table 93 Dat a Card Problem s

Symptom Possible Cause Possible Solution

Incompatible Data Card

message.

Data card is not compatible with

the HeartStart MRx.

Use only compatible Data Cards. For a listing of

compatible Data Cards see Maintenance chapter.

Data Card Full message. The data card has reached capacity. Insert new data card or erase data from card.

No Data Card Present message.

A data card is not inserted in the

device.

Insert data card. Once inserted, wait 5 seconds before

trying to access the data card.

Sufficient time not allowed for data

card recognition.

Re-insert data card and wait 5 seconds before trying to

access the data card.

Table 94 Invasive Pressure Monitoring Problems

Symptom Possible Cause Possible Solution

Invasive Pressure wave not

displayed

The sensor is not properly

connected or the sensor cable is

damaged.

Check the sensor connection and cable.

Tr y a n o t h e r s e n s o r.

The pressure waveform is not

configured to be displayed and

there is not an unused wave sector.

Use the Displayed Waves menu to select a wave sector

for display of the pressure waveform.

CPP Check Sources INOP The ICP and/or arterial pressure

used to derive CPP is invalid.

Make sure ICP and arterial pressure cables are

connected to the device and zeroed.

Invasive Pressure Label

Artifact INOP

The device has detected a pressure

change. A resulting alarm, most

likely a high limit alarm, will be

suppressed.

In the event you do not think you created a non-

physiological event, check cable and tubing. Rezero

and try again.

Invasive Pressure Label Equip

Malfunction INOP

There has been a malfunction in

the Invasive Pressure hardware.

Contact Service.

Symptoms 22 Troubleshooting

313

Invasive Pressure Label Noisy

Signal INOP

This can only occur when pulse is

determined from a pressure wave.

The pulse rate is higher than 350

bpm. May be caused by movement

artifact or electrical interference.

Stop movement.

Minimize possible electrical interference.

Invasive Pressure Label Non-

pulsatile INOP

This can only occur when pulse is

determined from a pressure wave.

The pulse rate is less than 25 bpm

or the amplitude of the pressure

wave is less than 3 mmHg.

Check the catheter and connections to the patient.

Invasive Pressure Label

Overrange INOP

The pressure wave is outside the

measurement range.

Make sure the measurement has been properly

prepared and zeroed and that the transducer is level

with the heart. If the INOP message persists, try

another transducer. Make sure the transducer is on the

supported accessories list.

Invasive Pressure Label

Unplugged INOP

The pressure transducer has been

disconnected from the device or is

faulty.

Try unplugging and then replugging the transducer. If

the symptom does not go away, use a different

transducer.

Invasive Pressure Label Zero

+ Check Cal INOP

Occurs when a new transducer is

attached to the monitor.

Zero the transducer.

Check the calibration factor, if applicable.

Check Scale displayed with

pressure waveform

The wave is clipped in the

displayed wave area.

Change the scale.

Unable to Zero message The cause is displayed with the

message.

Depends on the cause.

Unable to Calibrate message The cause is displayed with the

message.

Depends on the cause.

Invasive Pressure Label = one of the labels which can be applied to an Invasive Pressure pressure channel.

Table 95 Temperature Monitoring Problems

Symptom Possible Cause Possible Solution

Temperature Label Equip

Malfunction INOP

There has been a malfunction in

the temperature hardware.

Contact Service.

Temperature Label Overrange

INOP

The temperature value is outside

the measurement range of the

device (<0oC or > 45oC).

Check that the temperature probe is on the list of

supported accessories.

Try changing the application site.

Temperature Label Unplugged

INOP

The temperature transducer is

faulty or has been disconnected

from the device.

Try unplugging and then replugging the temperature

transducer. If the symptom does not go away, use a

different transducer.

Te m p e ra t u re L a b e l = one of the labels which can be applied to a temperature measurement.

Table 94 Invasive Pressure Monitoring Problems (Continued)

Symptom Possible Cause Possible Solution

22 Troubleshooting Symptoms

314

Table 96 Pulse Problems

Symptom Possible Cause Possible Solution

Pulse Check Source INOP The currently selected pulse source

is not available but another possible

pulse source is on.

Switch to the secondary pulse source.

See “SpO2 Monitoring Problems” on page 303 and “Invasive Pressure Monitoring Problems” on page 312 for further

troubleshooting information.

Table 97 Q-C PR Pro b lems

Symptom Possible Cause Possible Solution

The CPR meter display is dark

and the status light is not on.

The CPR meter is not connected to

the HeartStart MRx

Confirm all CPR meter and cable connections are in

place and the HeartStart MRx is turned on.

CPR meter status light is

orange and the display is dark.

Malfunction in the meter. Remove the CPR meter from service and contact

Philips for technical support.

CPR meter does not adhere to

the patient’s chest.

Adhesive pad not sticking to the

chest.

If there is no other responder present to help, provide

CPR using the meter even though it does not adhere

to the patient. Be sure to keep the meter properly

positioned.

If there is another responder present to perform CPR,

remove the CPR meter and replace the patient

adhesive pad and restart CPR with the CPR meter in

place.

Patient has a wet chest

If there is another responder present to perform CPR,

remove the CPR meter, dry the patient’s chest off

(with minimal interruption to CPR), reapply a new

patient adhesive pad and restart CPR with the CPR

meter in place.

CPR meter Malfunction INOP. The CPR meter power-on self-test

has failed.

Check the CPR meter and cable connections. If

necessary, replace the CPR meter.

Symptoms 22 Troubleshooting

315

CPR meter Unplugged INOP.

The CPR meter is unplugged. Check the CPR meter and cable connections.

The device cannot communicate

with the CPR meter.

Confirm your HeartStart MRx is running

Version F.01 software and you are using the CPR

meter not the CPR sensor. See See "CPR meter and

Sensor Differences" on page 158.

Replace the CPR meter.

Poor Pads Contact INOP. Thoracic impedance measured at

25-200 Ohms, therefore, the signal

is not valid for ventilation

detection.

Make sure the Pads/CPR cable is connected and pads

are properly applied in an anterior/anterior position. If

necessary, prepare the patient’s skin and apply new

pads.

Pads Off INOP. Pads are not making proper contact

with the patient.

Make sure the Pads/CPR cable is connected and pads

are properly applied in an anterior/anterior position. If

necessary, prepare the patient’s skin and apply new

pads.

Cannot Analyze Vent INOP. Excessive noise on the impedance

signal.

Make sure the Pads/CPR cable is connected and pads

are properly applied. If necessary, prepare the patient’s

skin and apply new pads.

Table 98 IntelliVue Networking Problems

Symptom Possible Cause Possible Solution

Data from the HeartStart

MRx are not on the

Information Center display

and you have no INOPs on

your HeartStart MRx display.

The HeartStart MRx may not

have the IntelliVue option

installed.

Print Device Info to see if the IntelliVue Networking option

is installed on the device. If not, the device can not be used

on the network.

The HeartStart MRx may

have the No Central

Monitoring INOP configured

to optional.

If your institution’s policy allows, configure the INOP to

mandatory and troubleshoot No Central Monitoring INOP.

The Information Center may

have a different monitor

assigned to the sector you are

reviewing.

Confirm that the equipment label assigned to the sector you

are reviewing matches the device.

Table 97 Q-CPR Problems (Continued)

Symptom Possible Cause Possible Solution

22 Troubleshooting Symptoms

316

No Central Monitoring INOP

on HeartStart MRx

(appears within 30 seconds of

the interruption)

The device may not have a

compatible therapy board.

Print Device Info report and verify therapy hardware revision

is at least 14. If not, call for service to upgrade therapy board.

No network connection. At the HeartStart MRx, verify the equipment label is correct.

At the Information Center, verify that the equipment label is

assigned to the correct sector.

Attend to any momentary connection rejection message (See

Table 99).

Verify that the IntelliVue Network is correctly configured to

“see” the HeartStart MRx.

Verify wired connec ti on.

Verify wireless radio module is connected prior to turning

device on and within range of an access point.

Check signal strength by reviewing the RSSI number. If the

RSSI number:

- is any value other than -128. The radio is communicating

with the device and the device is communicating with the

network. Check to see if the Information Center is

configured correctly; check to see if the equipment label and

RF Code are correct.

- remains steady at -128. The radio is talking to the device

but not to the network. Move the device closer to an access

point and confirm the proper RF code is entered.

- is blank. Call for service.

(See “Network Connection Rejection Messages” on page 317 for other possible causes.)

Radio Unplugged INOP on

HeartStart MRx

The wireless radio module is

unplugged from the device.

Confirm wireless radio module is solidly plugged into the

device then turn the device on.

Wireless radio module

malfunction.

Replace wireless radio module.

Radio Malfunction INOP on

HeartStart MRx

Wireless radio module

malfunction.

Replace wireless radio module.

Radio Weak Signal INOP on

HeartStart MRx

Radio signal strength is below

an acceptable level.

Attempt to improve signal strength by moving device closer

to access point.

All ECG Alarms Off HR and arrhythmia alarms

are turned off.

Turn HR and arrhythmia alarms on.

If you have the wireless radio

module connected only,

power is on, no connection to

the Information Center and

no INOP messages.

No Central Monitoring INOP

is configured to optional.

If your institution’s policy allows, configure INOP to

mandatory and troubleshoot No Central Monitoring INOP.

Table 98 IntelliVue Networking Problems (Continued)

Symptom Possible Cause Possible Solution

Symptoms 22 Troubleshooting

317

Table 99 Network Connection Rejection Messages

When the Information Center rejects a connection attempt from the HeartStart MRx, a momentary

message accompanied by an audio beep is displayed in the middle of the HeartStart MRx display.

Messages, possible causes and possible solutions:

Message Possible Cause Possible Solution

No Central assigned to

this bed

No Information Center is configured to

monitor the HeartStart MRx with the assigned

equipment/monitor label.

Confirm the HeartStart MRx equipment label

is correct.

Assign the HeartStart MRx equipment label to

the appropriate sector in the Information

Center.

No Central - duplicate

monitor label

Another bedside with the same equipment/

monitor label as the HeartStart MRx has

already been connected to the Information

Center.

Change the HeartStart MRx equipment label

to be unique and assign it to the Information

Center or turn the other device off.

Assigned Central is not

available

The Information Center assigned to monitor

the HeartStart MRx is not functional.

Start the Information Center by powering on

the PC.

No Central - check

software revision

Software revisions on the HeartStart MRx and

the Information Center are not compatible.

Verify that the Information Center revision is at

Release J or beyond.

Central cannot identify

this bed

The Information Center can not identify this

bed because of unexpected errors.

Verify the Information Center is configured to

monitor the HeartStart MRx.

22 Troubleshooting Audio Tones and Alarm Indications

318

Audio Tones and Alarm Indications

The following table describes the audio tones and alarm indications, when they occur, and their

meaning.

NOTE Alarm tone volume levels exceed 60 dB. See the HeartStart MRx Service Manual for alarm signal

pressure ranges.

Table 100 Audio Tones

Tone/Indication Definition

Single beep. Message tone. Accompanies a new message on the display. Informational

such as switching to the other battery.

Continuous tone, lower pitch than charged tone. Charging tone. Generated when the Charge button is pressed and

continues until the device is fully charged.

Continuous tone. Charged tone. Generated when the selected defibrillation energy is

reached and continues until the Shock button is pressed, the [Disarm]

soft key is pressed, or the device disarmed automatically after the

configured time had elapsed since pressing the Charge button.

Periodic chirp. Low battery or RFU failure. Repeated periodically while the condition

exists.

Continuous tone, alternating pitch. Device will shut down in one minute.

Tone repeated once a second.

Red alarm indicator message for applicable HR/

arrhythmia, apnea, extreme desat and pressure

disconnect alarms.

Philips’ Red Alarm Tone:

Generated while at least one red alarm is occurring.

High pitched tone repeated five times followed

by a pause.

Red alarm indicator message for applicable HR/

arrhythmia, apnea, extreme desat and pressure

disconnect alarms.

IEC Red Alarm Tone:

Generated while at least one red alarm is occurring.

Tone repeated every two seconds, lower pitch

than red alarm tone.

Yellow alarm indicator message for applicable

HR/arrhythmia, SpO2, NBP, Invasive Pressures,

Temperature, Pulse and EtCO2 alarms.

Philips’ Yellow Alarm Tone:

Generated while at least one yellow alarm is occurring.

Lower pitched tone is repeated three times,

followed by a pause.

Yellow alarm indicator message for applicable

HR/arrhythmia, SpO2, NBP, Invasive Pressures,

Tem p , Pul s e an d Et C O 2 alarms.

IEC Yellow Alarm Tone:

Generated while at least one yellow alarm is occurring

Tone repeated every two seconds, lower pitch

then yellow alarm tone.

Cyan indicator message.

Philips’ INOP Tone:

Generated while at least one INOP condition is occurring.

Lower pitched tone is repeated twice, followed by

a pause.

Cyan indicator message.

IEC INOP Tone:

Generated while at least one INOP condition is occurring.

Tone occurring synchronously with each heart

beat.

QRS tone.

Calling for Service 22 Troubleshooting

319

Calling for Service

For telephone assistance, call the Response Center nearest to you, or visit our website at:

www.medical.philips.com/cms and click on “Support”.

Table 101Response Center Phone Numbers

North America

Canada 800-323-2280

United States of America 800-722-9377

Europe

European International Sales 41 22 354 6464

Austria 01 25125 333

Belgium 02 778 3531

Finland 010 855 2455

France 0803 35 34 33

Germany 0180 5 47 50 00

Italy 800 825087

Netherlands 040 278 7630

Sweden 08 5064 8830

Switzerland 0800 80 10 23

United Kingdom 0870 532 9741

Asia/Asia Pacific

Australia 1800 251 400

China (Beijing) 800 810 0038

Hong Kong

Macau

852 2876 7578

0800 923

India

New Delhi

Mumbai

Calcutta

Chennai

Bangalore

Hyderabad

011 6295 9734

022 5691 2463/2431

033 485 3718

044 823 2461

080 5091 911

040 5578 7974

Indonesia 021 794 7542

Japan 0120 381 557

Korea 080 372 7777

02 3445 9010

Malaysia 1800 886 188

New Zealand 0800 251 400

Philippines 02 845 7875

Singapore 1800 PHILIPS

Thailand 02 614 3569

Taiwan 0800 005 616

321

23Specifications and Safety

This chapter describes the specifications and safety features of the HeartStart MRx monitor/

defibrillator.

Specifications

General

Dimensions with pads: 31.5 cm (W) x 21.0 cm (D) x 29.5 cm (H); (12.4 in. x 8.3 in. x 11.7 in.)

Dimensions with paddles: 34.0 cm (W) x 21.0 cm (D) x 34.5 cm (H); (13.4 in. x 8.3 in. x 13.6 in.)

Weight: Less than 13.2 lbs. including pads, pads cable, battery, and full roll of paper. Incremental

weight of external standard paddles and paddle tray is less than 2.5 lbs. Additional battery weighs less

than 1.8 lbs.

Standard Operator Position: Within one meter of device.

Defibrillator

Waveform: Biphasic Truncated Exponential. Waveform parameters adjusted as a function of patient

impedance.

Shock Delivery: Via multifunction electrode pads or paddles.

23 Specifications and Safety Specifications

322

Delivered Energy Accuracy

Charge Time:

• Less than 5 seconds to 200 Joules with a new, fully charged Lithium Ion battery pack at 25oC.

• Less than 15 seconds when operating without a battery, using the M3539A AC power module alone

at 90-100% rated mains voltage.

• Less than 15 seconds with a new, fully charged Lithium Ion battery pack at 25oC, depleted by up to

15 200 Joule discharges.

• Less than 25 seconds from initial power on, with a new, fully charged Lithium Ion battery pack at

25oC, depleted by up to 15 200 Joule discharges.

• Less than 25 seconds from initial power on when operating without a battery, using the M3539A

AC power module alone at 90-100% rated mains voltage.

• Less than 30 seconds from initiation of rhythm analysis (AED Mode) with a new, fully charged

Lithium Ion battery pack at 25oC, depleted by up to 15 200 Joule discharges.

• Less than 30 seconds from initiation of rhythm analysis (AED Mode) when operating without a

battery, using the M3539A AC power module alone at 90-100% rated mains voltage.

Selected

Energy Nominal Delivered Energy vs. Patient Impedance Accuracy

Load Impedance (ohms)

25 50 75 100 125 150 175

1J 1.2 1.3 1.2 1.1 1.0 0.9 0.8 ±2J

2J 1.8 2.0 2.0 1.9 1.7 1.6 1.5 ±2J

3J 2.8 3.0 3.0 3.1 3.0 2.9 2.7 ±2J

4J 3.7 4.0 4.0 4.1 4.2 4.2 4.0 ±2J

5J 4.6 5.0 5.1 5.1 5.2 5.2 5.0 ±2J

6J 5.5 6.0 6.1 6.2 6.3 6.3 6.1 ±2J

7J 6.4 7.0 7.1 7.2 7.3 7.3 7.1 ±2J

8J 7.4 8.0 8.1 8.2 8.4 8.3 8.1 ±2J

9J 8.3 9.0 9.1 9.3 9.4 9.4 9.1 ±2J

10J 9.2 10 10 10 10 10 10 ±2J

15J 14151515161615±15%

20J 18202021212120±15%

30J 28303031313130±15%

50J 46505151525250±15%

70J 64707172737371±15%

100J 92 100 101 103 104 104 101 ±15%

120J 110 120 121 123 125 125 121 ±15%

150J 138 150 152 154 157 156 151 ±15%

170J 156 170 172 175 177 177 172 ±15%

200J 184 200 202 206 209 209 202 ±15%

Specifications 23 Specifications and Safety

323

• Less than 40 seconds from initial power on (AED Mode) with a new, fully charged Lithium Ion

battery pack at 25oC, depleted by up to 15 200 Joule discharges.

• Less than 40 seconds from initial power on (AED Mode) when operating without a battery, using

the 3539A AC power module alone at 90-100% rated mains voltage.

Patient Impedance Range: Minimum: 25 Ohm (external defibrillation); 15 Ohm (internal

defibrillation); Maximum: 180 Ohm

Note: Actual functional range may exceed the above values.

Manual Defib Mode

Manual Output Energy (Selected): 1-10, 15, 20, 30, 50, 70, 100, 120, 150, 170, 200 Joules;

maximum energy limited to 50J with internal paddles

Controls: On/Off Therapy Knob, Charge, Shock, Sync, ECG Lead Select, Disarm, Print, Mark

Event, Alarm Pause, Event Review

Energy Selection: Front panel Therapy Knob

Charge Control: Front panel button, button on external paddles

Shock Control: Front panel button, buttons on external or switched internal paddles

Synchronized Control: Front panel SYNC button

Indicators: Text Prompts, Audio Alerts, QRS Beeper, Battery Status, Ready For Use, External Power,

Sync Mode

Armed Indicators: Charging/charged tones, flashing shock button, energy level indicated on display

AED Mode

AED Energy Profile: 150 Joules nominal into a 50 ohm test load

AED Controls: On/Off, shock

Tex t an d Voice Pr o m pts : Extensive text/audible messages guide user through configured protocol.

Indicators: Monitor display messages and prompts, voice prompts, battery status, Ready For Use,

external power

Armed Indicators: Charging/charged tones, flashing shock button, energy level indicated on display

ECG Analysis: Evaluates patient ECG and signal quality to determine if a shock is appropriate and

evaluates connection impedance for proper defibrillation pad contact

Shockable Rhythms: Ventricular Fibrillation with amplitude >100 µV and shockable wide-complex

tachycardias. Shockable tachycardias include wide-complex rhythms of ventricular or unknown origin

with heart rate greater than 150 bpm and polymorphic ventricular tachycardia at any heart rate.

Shock Advisory Algorithm Sensitivity and Specificity: Meets AAMI DF-39

23 Specifications and Safety Specifications

324

Table 102 AED ECG Analysis Performance

a. From Philips Medical Systems ECG rhythm databases.

b. American Heart Association (AHA) AED Task Force, Subcommittee on AED Safety & Efficacy.

Automatic External Defibrillators for Public Access Use: Recommendations for Specifying and

Reporting Arrhythmia Analysis Algorithm Performance, Incorporation of New Waveforms, and

Enhancing Safety. American Heart Association (AHA) AED Task Force, Subcommittee on

AED Safety & Efficacy. Circulation 1997;95:1677-1682.

ECG and Arrhythmia Monitoring

Inputs: Up to four (4) ECG waves may be viewed on display and up to two (2) waves printed

simultaneously. Lead I, II, or III is obtained through the 3-wire ECG cable and separate monitoring

electrodes. With a 5-lead ECG cable, leads aVR, aVL, aVF, and V can also be obtained. Pads ECG is

obtained through 2 multifunction electrode pads.

Lead Fault: LEAD OFF message and dashed line appear on the display if an electrode or lead becomes

disconnected.

Pad Fault: Dashed line appears on the display if a pad becomes disconnected.

Heart Rate Display: Digital readout on display from 15 to 300 bpm, with an accuracy of + 10%

Heart Rate/Arrhythmia Alarms: HR, Asystole, VFIB/VTACH, VTACH, Extreme Tachy, Extreme

Brady, PVC rate, Pacer Not Capture, Pacer Not Pacing

Common Mode Rejection: Greater than 90 dB measured per AAMI standard for cardiac monitors

(EC 13)

ECG Size: 2.5, 5, 10, 20, 40 mm/mV, autogain

Maximum T wave amplitude: Meets recommended minimum 1.2mV T-wave amplitude rejection.

Rhythm Class ECG Test

Sample SizeaNominal Specifications

Shockable Rhythm

Ventricular Fibrillation

600 Meets AAMI DF39 requirement and AHA

recommendationb (sensitivity > 90%) for adult defibrillation

Shockable Rhythm

Ventricular Tachycardia

300 Meets AAMI DF39 requirement and AHA

recommendationb (sensitivity > 75%) for adult defibrillation

Non-shockable Rhythm

Normal Sinus Rhythm

250 Meets AAMI DF39 requirement (specificity > 95%) and

AHA recommendationb (specificity > 99%) for adult

defibrillation

Non-shockable Rhythm

Asystole

500 Meets AAMI DF39 requirements and AHA

recommendationb (specificity > 95%) for adult defibrillation

Non-shockable Rhythm

All other non-shockable

rhythms

600 Meets AAMI DF39 requirements and AHA

recommendationb (specificity > 95%) for adult defibrillation

Specifications 23 Specifications and Safety

325

Frequency Response:

• AC Line Filter - 60 Hz or 50 Hz

• Pads ECG for Display: Monitor - (.15-40 Hz) or EMS (1-30 Hz)

• Pads ECG for Printer - Monitor (.15-40 Hz) or EMS (1-30 Hz)

• Leads ECG for Display - Monitor (.15-40 Hz) or EMS (1-30 Hz)

• Leads ECG for Printer - Diagnostic (.05-150 Hz) or Monitor (.15-40 Hz) or EMS (1-30 Hz)

Heart rate accuracy and response to irregular rhythm: Meets AAMI standard for ventricular

bigeminy (HR=80 bpm); slow alternating ventricular bigeminy (HR=60 bpm); rapid alternating

ventricular bigeminy (HR=120 bpm); bidirectional systoles (HR=90 bpm)

Heart rate averaging: For heart rates > 50 bpm, heart rate is determined by averaging the 12 most

recent R-R intervals. Beats N, P and V are included. When heart rate drops below 50 bpm, the 4 most

recent R-R intervals are used in the average. Note: For ventricular tachycardia alarms, which have a

user-definable PVC run length limit, the heart rate is based on the user selected PVC length up to 9

PVCs maximum.

Heart Rate Response Time:

• 80 to 120 bpm: 7 seconds

• 80 to 40 bpm: 6 seconds

Time to Alarm for Tachycardia:

• 206 bpm (1 mV): 3 seconds

• 206 bpm (halved amplitude): 3 seconds

• 206 bpm (doubled amplitude): 3 seconds

• 195 bpm (2 mV): 3 seconds

• 195 bpm (halved amplitude): 3 seconds

• 195 bpm (doubled amplitude): 3 seconds

Patient Isolation (defibrillation proof):

• ECG: Type CF

•SpO

2: Type CF

•EtCO

2: Type CF

•NBP: Type CF

• Invasive Pressures: Type CF

• Temperature: Type CF

•External Defib: Type BF

• Internal Defib: Type CF

• CPR meter: Type BF

Other Considerations: The HeartStart MRx is suitable for use in the presence of electrosurgery. Burn

hazard protection is provided via a 1K current limiting resistor contained in each ECG lead wire.

23 Specifications and Safety Specifications

326

Display

Size: 128 mm x 171 mm

Type: TFT Color LCD

Resolution: 640 x 480 pixels (VGA)

Sweep Speed: 25mm/s nominal (stationary trace; sweeping erase bar) for ECG, Invasive Pressure and

SpO2; 6.25 mm/sec for CO2

Wave Viewing Time: 5 seconds (ECG)

Battery

Type: Rechargeable, Lithium Ion; See battery label for capacity information.

Dimensions: 165 mm (H) x 95 mm (W) x 42 mm (D); (6.5 in. x 3.8 in. x 1.6 in)

Weight: Less than 1.8 lb. (0.82 kg)

Charge Time with instrument off: Approximately 3 hours to 100%. Approximately 2 hours to 80%,

indicated by indicator. Charging the battery at temperatures above 45ºC may degrade battery life.

Capacity: At least 5 hours of monitoring with ECG, SpO2, CO2, temperature and two invasive

pressures monitored continuously, NBP measured every 15 minutes, and 20 200J discharges (with a

new, fully charged battery, operating at room temperature, 25oC).

At least 3.5 hours of monitoring with ECG, SpO2, CO2, temperature and two invasive pressures

monitored continuously, NBP measured every 15 minutes, and pacing at 180ppm at 160mA.

Battery Indicators: Battery gauge on battery, capacity indicator on display; flashing RFU indicator,

chirp, and LOW BATTERY message appears on display for low battery condition*

*When LOW BATTERY message first appears, there is still enough energy remaining for at least 10

minutes of monitoring time and six maximum energy discharges (with a new battery at room

temperature, 25oC).

Battery Storage: Storing the battery for extended periods at temperatures above 40ºC will reduce

battery capacity and degrade battery life.

Specifications 23 Specifications and Safety

327

Thermal Array Printer

Continuous ECG Strip: The Print key starts and stops the strip. The printer can be configured to run

real time or with a 10-second delay. The strip prints the primary ECG lead and a second or third wave

(75mm printer only) with event annotations and measurements.

Auto Printing: The printer can be configured to automatically print on Mark Events, Charge, Shock,

and Alarm. When an alarm condition occurs, the unit prints the Primary ECG wave, the alarming

wave, if configured, and a third wave (75mm printer only).

Reports: The following can be printed:

• Event Summary (short, medium, and long)

•Vital Sign Trends

•12-Lead

•Operational Check

• Configuration

•Status Log

• Device Information

Speed: 25 or 50 mm/s with an accuracy of +5%

Amplitude Accuracy: +5% or + 40 uV, whichever is greater

Paper Size:

• 50 mm (W) x 30 m (100 ft.) (L)

• 75 mm (W) x 30 m (100 ft.) (L)

Noninvasive Pacing

Waveform: Monophasic Truncated Exponential

Current Pulse Amplitude: 10 mA to 175 mA (5 mA resolution); accuracy 10% or 5 mA, whichever is

greater

Pulse Width: 40 ms with +10% accuracy

Rate: 30 ppm to 180 ppm (10 ppm increments); accuracy + 1.5%

Modes: Demand or Fixed Rate

Refractory Period: 340 msec (30 to 80 ppm); 240 msec (90 to 180 ppm)

23 Specifications and Safety Specifications

328

SpO2 Pulse Oximetry

SpO2 Measurement Range 0-100%

SpO2 Resolution: 1%

SpO2 Update Period: 1-2 sec typical; maximum: <60 sec

SpO2 Accuracy with:

• M1191A sensor - 1 standard deviation 70% to 100%, ± 2.0%

• M1191AL sensor - 1 standard deviation 70% to 100%, ± 2.0%

• M1191B sensor - 1 standard deviation 70% to 100%, ± 2.0%

• M1191BL sensor - 1 standard deviation 70% to 100%, ± 2.0%

• M1191T sensor - 1 standard deviation 70% to 100%, ± 3.0%

• M1192A sensor - 1 standard deviation 70% to 100%, ± 2.0%

• M1192T sensor - 1 standard deviation 70% to 100%, ± 3.0%

• M1194A sensor - 1 standard deviation 70% to 100%, ± 3.0%

• M1196A sensor - 1 standard deviation 70% to 100%, ± 3.0%

• M1196T sensor - 1 standard deviation 70% to 100%, ± 3.0%

• M1195A sensor - 1 standard deviation 70% to 100%, ± 3.0%

• M1131A sensor - 1 standard deviation 70% to 100%, ± 3.0%

NOTE Accuracy outside the range indicated for each sensor is not specified. The above referenced sensors were

validated for use with the HeartStart MRx using the Philips picoSAT II SpO2 module with Fourier

Artifact Suppression Technology (FAST). This module is not available as a stand-alone device.

NOTE Pulse oximeter equipment measurements are statistically distributed, therefore only two-thirds of pulse

oximeter equipment measurements can be expected to fall within +Arms of the value measured by a

CO-oximeter. The HeartStart MRx is calibrated to display functional oxygen saturation.

Ambient Light Sensitivity Interference from fluorescent light is <2% SpO2 perfusion between 0.3%

and 1% typical transmission (50nA/mA), 10 to 1000 1x light intensity, 50Hz +/- 0.5Hz as well as

60Hz +/-0.5Hz line frequency.

SpO2 Alarm Range:

Low Limit: 50 to 99% (Adult/Pediatric)

High Limit: 51 to 100% (Adult/Pediatric)

SpO2 and Pulse High/Low Alarm Signal Generation Delay: 10 seconds

SpO2 Response Time (90 to 80%): average 18.9 seconds, standard deviation 0.88 seconds

SpO2 Averaging Time: 20 seconds

Maximum Power Output: <15mW

Specifications 23 Specifications and Safety

329

Wavelength Range: 500-1000nm (Information about wavelength range can be useful to clinicians,

especially those performing photodynamic therapy.)

average 18.9 seconds; standard deviation 0.88 seconds

Desat Alarm Signal Generation Delay: 20 seconds

Pulse Rate Measurement Range 30-300 bpm

Pulse Rate Resolution 1bpm

Pulse Rate Accuracy: 2% or 1 bpm (whichever is greater) over the measurement range

Pulse Alarm Range:

Low Limit: 30 to 195 (Adult); 30 to 235 (Pediatric)

High Limit: 35 to 200 (Adult); 35-240 (Pediatric)

Pulse Response Time (90 to 120 bpm): average 18.0 seconds; standard deviation 0.86 seconds

NBP

Pressure Range:

• Systolic: 40-260 mmHg

• Diastolic: 20-200 mmHg

Pulse Rate Range: 30 to 220 bpm

Initial Pressure: 160 mmHg Adult; 120 mmHg Pediatric

Maximum Pressure: 280 mmHg

Overpressure Safety Limits: Maximum of 300 mmHg

Cuff Inflation Time: 75 second maximum (pediatric or adult)

Pressure Transducer Accuracy: ±3mmHg

Alarm Range:

• Systolic high limit: 35-270 (Adult), 35-180 (Pediatric)

• Systolic low limit: 30-265 (Adult), 30-175 (Pediatric)

• Diastolic high limit: 15-245 (Adult), 15-150 (Pediatric)

• Diastolic low limit: 10-240 (Adult), 10-145 (Pediatric)

• Mean high limit: 25-255 (Adult), 25-160 (Pediatric)

• Mean low limit: 20-250 (Adult), 20-155 (Pediatric)

Rated Life: 50,000 measurement cycles (36/day for 2.3 years)

Auto Mode Repetition Time: 1, 2.5, 5, 10, 15, 30, 60, or 120 minutes

23 Specifications and Safety Specifications

330

Maximum Measurement Time: 120 sec.

Interconnect Tube Length:

• M1598B Connect tubing 1.5 m

• M1599B Connect tubing 3.0 m

Recommended frequency of pressure transducer calibration: yearly

Invasive Pressures

Transducer Sensitivity: 5uV/V mmHg (37.5uV/V/kPa)

Sensitivity Adjustment Range: +10%

Transducer Load Resistance: 195 to 2200 Ohms

Transducer Output Resistance: 0 to 3000 Ohms

Frequency Response: 0-12Hz or 0-40Hz

Zero Adjustment Range: +200mmHg (+26.7kPa)

Zero Adjustment Accuracy: +1.0mmHg (+0.1kPa)

Zero Setting Drift: <0.1mmHg/oC (0.013kPa/oC)

Gain accuracy (excluding transducers): +1% of reading or 1mmHg (0.1kPa) whichever is greater

Gain Drift: less than 0.05%/oC

Overall Accuracy (included listed transducers): +4% of reading or 4mmHg (0.5kPa) whichever is

greater

Measurement Range: -40 to 361mmHg (-5.3 to 48.1kPa)

Measurement Resolution: 1mmHg (0.1kPa)

Noise: <1mmHg (0.1kPa)

Alarm Response Time (60 bpm - transition from 120/0 to 25/0): 11.1 seconds; standard deviation

0.001 seconds

Alarm Signal Generation Delay: < 14 seconds after an INOP condition for that pressure channel

clears or 8 seconds in the absence of an INOP for that pressure channel.

Transducer/Dome Volume Displacement: Refer to the specific device’s specifications.

Additional Noise from EMI if operating under conditions according to EMC standard EN60601-1-

2 (Radiated Immunity 3 V/m or Conducted Immunity 3 VRMS): <3mmHg

Pulse Rate Range: 25-350 bpm

Pulse Rate Accuracy: 1% of full range

Specifications 23 Specifications and Safety

331

Pulse Rate Resolution: 1 bpm

Temperature

Measurement Range: 0o- 45oC (32 - 113oF)

Measurement Resolution: 0.1oC (0.2oF)

Measurement Accuracy (excluding any adapter cable): +0.1oC from 25oC to 45oC; +0.3oC from

0oC to 24.9oC (temperature probe adds an additional +0.1oC)

Settling Time Constant: <10 seconds

Alarm Signal Generation Delay: 5 seconds

Averaging Time: 1 second

Minimum measurement time: See the probe’s Instructions for Use to obtain minimum measurement

times for accurate readings. The HeartStart MRx does not add any clinically significant time to obtain

accurate readings.

EtCO2

Range: 0 to 99 mmHg at sea level

Resolution: 1 mmHg (0.1kPa)

Accuracy: For values between 0 and 38 mmHg: +2 mmHg. For values between 39 and 99 mmHg:

+5% of reading + 0.08% for every 1 mmHg above 38 mmHg. Values read at sea level. For breath rates

above 80 and EtCO2 values > 18 mmHg, accuracy is 4mmHg or +12% of reading, whichever is

greater.

Drift of Measurement Accuracy: Over any 24-hour period, the accuracy claims listed above are

maintained.

The accuracy specification is maintained to within 4% for the following gas mixtures (all values are in

Vol. %).

Rise Time: 190 ms maximum @ 10ml/min

System Response Time (with a standard length FilterLine): 2.9 seconds typical - includes the delay

time and rise time (10% to 90%) in response to a step change in the CO2 concentration

Alarm Delay Time: 5.2 seconds, standard deviation 0.08 seconds (includes the 2.9 second FilterLine

delay).

Sample Flow Rate: Nominally 50 ml/min; - 7.5 to + 15 ml/min

CO2N2O2N2O H2OAnesthetic Agents

0 to 13 0 to 97.5 0 to 100 0 to 80 dry to saturated According to EN21647

23 Specifications and Safety Specifications

332

Microstream CO2 Humidity Correction Factor:

BTPS (Body Temperature and Pressure, Saturated - 37oC, 750mmHg, 100% humidity or 47mmHg)

is the humidity correction factor for the Microstream CO2 readings. Correction calculation formula:

PBTPS= FCO2 x (Pb-47)

~ FCO2 x 0.94

Where FCO2 = fractional concentration of CO2 in dry gas.

FCO2 = %CO2/100; Pb = ambient pressure

Alarm Range:

• Low Limit: 10 to 94 mmHg (Adult/Pediatric)

• High Limit: 20 to 95 mmHg (Adult/Pediatric)

AwRR

Range: 0 to 150 rpm

Resolution: 1 rpm

Accuracy:

• 0 to 40 rpm ±1 rpm

• 41 to 70 rpm ±2 rpm

• 71 to 100 rpm ±3 rpm

• 101 to 150 rpm ± 5 rpm

Alarm Range:

• Low Limit: 0 to 95 rpm (Adult/Pediatric)

• High Limit: 10 to 100 rpm (Adult/Pediatric)

Apnea Alarm Delay: 10-40 seconds, in increments of 5

Calibration Gas for CO2 Measurement System

Ingredients: 5% Carbon Dioxide, 21% Oxygen, 74% Nitrogen

Cylinder Size: BD

Method of Preparation: Gravimetric

Blend Tolerance: 0.03%

Accuracy: 0.03% absolute

Moisture: 10 PPM Maximum

Expiration Period: 2 years

Pressure: 144 PSIG, Volume: 10L

Specifications 23 Specifications and Safety

333

CPR Meter

Dimensions: 154mm x 64mm x 28mm with a .91m integrated cable.

Weight: 6 oz. (170 g)

Input voltage: 4.0-6.0V at 170mA. The CPR meter is electrically and galvanically isolated from the

defibrillator power and communication sources.

Temperature: Storage: -20oC to 60oC (-4oF to 140oF); Operating: 0oC to 50oC (32oF to 122oF)

Relative Humidity: Storage: 0% to 75%; Operating: 0% to 95%

Solids/Water Resistance: IP55. Meets ISO/IEC 60529

EMC: Meets IEC 60601-1-2 and RTCA/DO-160E

Patient Adhesive Pads

Dimensions: 39mm x 90 mm

Temperature: Storage: -20oC to 60oC (-4oF to 140oF); Operating: 0oC to 50oC (32oF to 122oF)

Relative Humidity: Storage: 0% to 75%; Operating: 0% to 95%

Material: Foam pad with biocompatible adhesive on both sides

Shelf life: 2 years when applied to the CPR meter or 4 years in an unopened package.

12-Lead ECG

Inputs: With a 10-lead cable, leads I, II, III, aVR, aVL, aVF, V/C1-V/C6 can be obtained. All 12-

Lead ECG waves can be viewed on the display simultaneously. All 12 leads can be printed on the strip

chart printer in 3x4 format.

Networking

Delay time from alarm signal generation at the HeartStart MRx to presence of alarm representation

at the device’s network output port: < 4 seconds

Time of alarm representation at HeartStart MRx network output port to appearance at Information

Center: Dependent on inherent network delay. Check with your network administrator for further

details.

Telemetry channels: The maximum number of telemetry channels may be limited in some

geographies. The spacing between channel 4a and channels 5 and 6 is less than 1.6 MHz; therefore

transmission on channel 4a may not be used simultaneously with transmissions on channels 5 or 6.

The device meets the U.S. FCC 47 CFR Part 15 and Part 95 for WMTS transmission.

23 Specifications and Safety Specifications

334

Patient Data Storage

Internal Event Summary: The internal Event Summary stores up to 12 hours of 2 continuous ECG

waves, 1 CO2 and 2 invasive pressure waves, events and trending per Event Summary. There is a

maximum capacity of 55 Event Summaries or 240 megabytes (62 megabytes for those devices with a

64 megabyte card) of patient data, whichever comes first.

Data Card Event Summary: The Data Card has a maximum capacity of 60 Event Summaries or 240

megabytes (62 megabytes for those devices with a 64 megabyte card) of patient data, whichever comes

first.

Environmental (M3535A)

Temperature: 0ºC to 45ºC operating; -20º to 70ºC storage

• Charging the battery at temperatures above 45ºC may degrade battery life

• Storing the battery for extended periods at temperatures above 40ºC will reduce battery capacity and

degrade battery life

Humidity: Up to 95% Relative Humidity

• Printer paper may jam if paper is wet

• Thermal Printer may be damaged if wet paper is allowed to dry while in contact with printer

elements

Atmospheric Pressure Range:

• Operating: 1014 hPa to 572 hPa (0 to 15,000 ft; 0 to 4,500 m)

• Storage: 1014 hPa to 572 hPa (0 to 15,000 ft; 0 to 4,500 m)

Shock:

• Operating: Half-sine waveform, duration < 3 ms, acceleration > 145 g, 1 time on all six faces

• Non-operating: Trapezoidal waveform, acceleration > 30 g, velocity change=742 cm/s ±10% on all

six faces

Vibration:

• Operating: Random vibration, 0.30 Grms, 5-500 Hz for >10 minutes/axis PSD=0.0002 g2/Hz from

5 to 350 Hz, -6 dB/octave slope from 350 to 500 Hz

• Non-operating: Random vibration, 2.41 Grms, 5-500 Hz for >10 minutes/axis PSD=0.02 g2/Hz

from 5 to 100 Hz, -6 dB/octave slope from 100 to 137 Hz, 0 dB/octave slope from 137 to 350 Hz,

-6 dB/octave slope from 350 to 500 Hz.

Swept sine vibration, (0.75 g [0 to peak] 5 to 500 Hz) resonant search, 1 octave/minute sweep rate,

5 minute resonant dwell at 4 resonances per axis.

Water/Solids Resistance: IP24 if used with water-resistant paddles (M3543A) or pads only. IP20 if

used with other paddles.

EMC: Complies with the requirements of standard EN 60601-1-2:2001.

Safety: Meets UL 2601-1, CSA C22.2 No. 601-1, EN 60601-1 and 60601-2-4 standards.

Specifications 23 Specifications and Safety

335

Other Considerations:

• The HeartStart MRx is not suitable for use in the presence of concentrated oxygen or a flammable

anesthetic mixture with air, oxygen, or nitrous oxide.

• Hazards arising from software errors were minimized by the product’s compliance with the software

requirements contained in EN 60601-1-4:1996.

Mode of Operation: Continuous

AC Line Powered: 100 - 240 VAC, 50 - 60 Hz, 1 - 0.46 A (Class 1)

Battery Powered: Minimum 14.4 V Rechargeable, Lithium Ion

DC Powered:

• Input: 11-32 VDC, 11 A

• Output: 18 V, 5 A, 90 W

Environmental (M3536A)

Temperature: 0ºC to 45ºC operating; -20º to 70ºC storage

• Charging the battery at temperatures above 45ºC may degrade battery life

• Storing the battery for extended periods at temperatures above 40ºC will reduce battery capacity and

degrade battery life

Humidity: Up to 95% Relative Humidity

• Printer paper may jam if paper is wet

• Thermal Printer may be damaged if wet paper is allowed to dry while in contact with printer

elements

Atmospheric Pressure Range:

• Operating: 1014 hPa to 572 hPa (0 to 15,000 ft; 0 to 4,500 m)

• Storage: 1014 hPa to 572 hPa (0 to 15,000 ft; 0 to 4,500 m)

Shock:

• Operating: Half-sine waveform, duration < 3 ms, acceleration > 145 g, 1 time on all six faces

• Non-operating: Trapezoidal waveform, acceleration > 30 g, velocity change=742 cm/s ±10% on all

six faces

• Bump: EN60068-2-29 Bump (Half-sine, 40 g peak, 6 msec duration, 1,000 bumps x 3 axes)

• Free Fall: IEC 68-2-32 Free Fall. Drops on all faces onto a steel surface (excluding bed rail hook)

- 30 in. (76.2 cm) with carrying case

- 16 in. (40.6 cm) without carrying case

Vibration:

• Operating: MIL STD 810E 514.4 Category 6 Helicopter, General Storage, UH60

23 Specifications and Safety Specifications

336

•Non-Operating:

- IEC 68-2-6 Vibration (sinusoidal) (10-57 Hz+ 0.15mm; 58-150 Hz, 2g; 20 sweeps x 3 axes)

- IEC 68-2-64 Vibration, broad-band random (10-20 Hz, 0.05 g2/Hz; 20-150 Hz, -3 dB/octave;

150 Hz, 0.0065 g2/Hz; 1.5 hours x 3 axes)

Solids/Water Resistance: IP24. Water testing performed with cables connected to the device.

EMC: Complies with the requirements of standard EN 60601-1-2:2001.

Safety: Meets UL 2601-1, CSA C22.2 No. 601-1, EN 60601-1 and 60601-2-4 standards.

Other Considerations:

• The HeartStart MRx is not suitable for use in the presence of concentrated oxygen or a flammable

anesthetic mixture with air, oxygen, or nitrous oxide.

• Hazards arising from software errors were minimized by the product’s compliance with the software

requirements contained in EN 60601-1-4:1996.

Mode of Operation: Continuous

AC Line Powered: 100 - 240 VAC, 50 - 60 Hz, 1 - 0.46 A (Class 1)

Battery Powered: Minimum 14.4 V Rechargeable, Lithium Ion

DC Powered:

• Input: 11-32 VDC, 11 A

• Output: 18 V, 5 A, 90 W

Bluetooth

The HeartStart MRx supports File Transfer Profile Server 1.1 and was tested with the following

Bluetooth stacks: Toshiba™ 4.20.01, IVT™ 2.1.2.0(Product)/05.04.11.20060301 (stack) and

Widcomm™ 4.0.1.2400. For other Bluetooth stacks, review your user documentation to see if File

Transfer Profile Server 1.1 is supported. If not, it is recommended that you install drivers that support

File Transfer Profile Server 1.1.

Specifications 23 Specifications and Safety

337

Symbol Definitions

Table 103 lists the meaning of each symbol shown on the HeartStart MRx and the M3538A battery.

Table 103 Monitor/Defibrillator, Battery and CPR Meter Symbols

Symbol Definition

Dangerous voltage Dispose of in accordance to your

country’s requirements.

Attention - See operating instructions in

Instructions for Use.

IP24 Protected against ingress of solid foreign

objects >12.5mm in diameter.

Protected against access to hazardous

parts with a finger.

Protected against splashing water.

Input. IP2X Protected against ingress of solid foreign

objects >12.5mm in diameter.

Protected against access to hazardous

parts with a finger.

Output. Data In/Out

Gas Sample Input. Electrostic sensitive device

Gas Exhaust Output. Invasive Pressure Port (Number indicates

Port 1 or Port 2)

Meets IEC type BF leakage current

requirements and is defibrillator

protected. (Patient Applied Part is

isolated and defib-proof suitable for

direct patient contact except the heart or

major arteries.)

NBP port

Meets IEC type CF leakage current

requirements and is defibrillator

protected. (Patient Applied Part is

isolated and defib-proof suitable for

direct patient contact including the

heart or major arteries.)

SpO2 port

Alarm Pause button Temperature port

23 Specifications and Safety Specifications

338

Device is Network-enabled. Reference order number

Non-Ionizing Radiation. Device

contains a radio frequency transmitter.

The CPR meter meets IEC 60529 class

IP55

Device complies with the requirements

of Medical Device Directive 93/42/EEC

Expiration date

This product has passed relevant safety

tests by the CSA, a nationally recognized

test lab.

Does not contain natural rubber latex

Single patient use only Contains number of CPR meter patient

adhesive pads shown after equals sign

Manufacturer Not for use on children under 8 years old

RoHS exempt. Environmentally

friendly for a use period of 50 years.

Device meets Directive 95/54/EC

This device can be run off a battery. This device can be run off AC power

DC current AC current

Table 103 Monitor/Defibrillator, Battery and CPR Meter Symbols (Continued)

Symbol Definition

Specifications 23 Specifications and Safety

339

Table 104 lists the meaning of the symbols that may appear on the shipping carton.

Table 104 HeartStart MRx Shipping Carton Symbols

Symbol Definition Symbol Definition

Atmospheric pressure range. Recyclable paper product.

Temperature range Fragile.

Relative humidity range. Do not get wet.

Right side up. Refer to operating

instructions

23 Specifications and Safety Units and Abbreviations

340

Units and Abbreviations

Table 105 lists units and abbreviations used with the HeartStart MRx.

Table 105 Ab brevia t i o n s

Unit Definition Unit Definition

bpm beats per minute cpm compressions per minute

oC degrees Celsius sec seconds

oF degrees Fahrenheit min minutes

mmHg millimeters of mercury mm/mV millimeter per millivolt

kPa kilo Pascal Hz Hertz

% percent ppm pulses per minute

rpm respirations per minute mA milliAmpere

mm millimeter J Joule

Clinical Performance Summary - Defibrillation 23 Specifications and Safety

341

Clinical Performance Summary - Defibrillation

An international, multicenter, prospective, randomized, clinical study was conducted to assess the

effectiveness of the SMART Biphasic waveform in out-of-hospital sudden cardiac arrests (SCAs), as

compared to monophasic waveforms. The primary objective of the study was to compare the percent of

patients with ventricular fibrillation (VF) as the initial monitored rhythm that were defibrillated in the

first series of three shocks or less.

This section summarizes the methods and results of this study.

Methods

Victims of out-of-hospital SCA were prospectively enrolled in four emergency medical service (EMS)

systems. Responders used either 150J SMART Biphasic AEDs or 200-360J monophasic waveform

AEDs. A sequence of up to three defibrillation shocks were delivered. For the biphasic AEDs, there was

a single energy output of 150J for all shocks. For monophasic AEDs, the shock sequence was 200, 200,

360J. Defibrillation was defined as termination of VF for at least five seconds, without regard to

hemodynamic factors.

Results

Randomization to the use of monophasic or SMART Biphasic automatic external defibrillators (AEDs)

was done in 338 SCAs from four emergency medical service systems. VF was observed as the first

monitored rhythm in 115 patients. The biphasic and monophasic groups for these 115 patients were

similar in terms of age, sex, weight, primary structural heart disease, cause or location of arrest, and

bystanders witnessing the arrest or performing CPR.

The 150J SMART Biphasic waveform defibrillated 98% of VF patients in the first series of three

shocks or less, compared with 69% of patients treated with monophasic waveform shocks. Outcomes

are summarized in Table 106.

Table 106 Clinical Summary - Defibrillation

Conclusion

The 150J SMART Biphasic waveform defibrillated at higher rates than 200-360J monophasic

waveforms, resulting in more patients achieving return of spontaneous circulation (ROSC) (p=0.01).

EMS system outcomes of survival discharge were not significantly different statistically. However,

patients resuscitated with the lower energy SMART Biphasic waveform were more likely to have good

cerebral performance (CPC, cerebral performance category) (p=0.04).

Biphasic Patients

Number (%)

Monophasic Patients

Number (%)

P Value

(chi-square)

Defibrillation Efficacy

- Single shock only

- <2 shocks

- <3 shocks

52/54 (96%)

53/54 (98%)

36/61 (59%)

39/61 (64%)

42/61 (69%)

<0.0001

Patients Defibrillated 54/54 (100%) 49/58 (84%) 0.003

Return of Spontaneous Circulation 41/54 (76%) 33/61 (54%) 0.01

Survival to Hospital Admission 33/54 (61%) 31/61 (51%) 0.27

Survival to Hospital Discharge 15/54 (28%) 19/61 (31%) 0.69

CPC = 1 (Good) 13/15 (87%) 10/19 (53%) 0.04

23 Specifications and Safety Clinical Performance Summary - Cardioversion

342

Clinical Performance Summary - Cardioversion

An international, multicenter, prospective, double-blinded, randomized, clinical trial was conducted to

assess the effectiveness of the SMART Biphasic waveform in treatment of atrial fibrillation (AF), as

compared to monophasic waveforms. The primary objective of the study was to determine the required

energy for cardioversion of AF using the SMART Biphasic waveform, as compared with a monophasic

damped sine waveform.

This section summarizes the methods and results of this study.

Methods

Patients enrolled for this study were adults scheduled for elective cardioversion of AF at one of 11

clinical sites. Clinicians used both a defibrillator delivering the SMART Biphasic waveform, and one

delivering a monophasic waveform. A sequence of up to five shocks was administered: four with the

initial defibrillator, and a fifth cross-over shock was delivered with the other defibrillator if necessary.

The sequence of energy settings was 100J, 150J, 200J through the first three shocks on either type of

defibrillator. A fourth shock, if necessary, was delivered at 200J if the initial defibrillator was biphasic,

and at 360J if the initial defibrillator was monophasic. The cross-over shock was 360J monophasic if

the initial defibrillator was biphasic, and 200J biphasic if the initial defibrillator was monophasic.

Successful cardioversion was defined as the occurrence of two P waves uninterrupted by atrial

fibrillation within 30 seconds of the shock.

Results

Randomization to the use of monophasic or SMART Biphasic defibrillators was done in 212 elective

cardioversions involving 210 patients at eleven clinical sites in the United States and Europe. Of these,

203 results met the protocol criteria for inclusion in this analysis. The biphasic and monophasic groups

were similar in terms of age, sex, weight, current medical history, cause of heart disease, and estimated

ejection fraction.

The 150J SMART Biphasic waveform successfully converted far more patients with an initial 100J

shock (60% compared with 22% for the monophasic waveform), and successfully converted patients at

least as well with a maximum energy of 200J as the monophasic did with its maximum energy of 360J

(91% compared to 85% for the monophasic waveform). Overall, the biphasic waveform required fewer

shocks (1.7, compared to 2.8 for the monophasic waveform) and lower delivered energy (217J,

compared to 548J for the monophasic waveform). Outcomes are summarized in Table 107.

Clinical Performance Summary - Cardioversion 23 Specifications and Safety

343

Table 107 Clinical Summary - Cardioversion

Conclusion

The SMART Biphasic waveform cardioverted at higher rates than the monophasic damped sine

waveform at each step of the protocol, although the cumulative biphasic rate after 4 shocks was not

significantly different from the monophasic rate. Tissue damage was more pronounced in the

monophasic population.

Biphasic Patients

Number (%)

Monophasic Patients

Number (%)

P Value

Cumulative Cardioversion Efficacy

- Single shock only

- <2 shocks

- <3 shocks

- <4 shocks

58/96 (60%)

74/96 (77%)

86/96 (90%)

87/96 (91%)

24/107 (22%)

47/107 (44%)

56/107 (53%)

91/107 (85%)

<0.0001

0.29

Skin “burn”

None

Mild

Moderate

Severe

25/90 (28%)

50/90 (56%)

15/90 (17%)

0/90 (0%)

15/105 (14%)

47/105 (45%)

41/105 (39%)

2/105 (2%)

0.0001

Number of shocks 1.7 + 1.0 2.8 + 1.2 <0.0001

Cumulative delivered energy 217 + 176J 548 + 331J <0.0001

Skin reaction definitions: (evaluated 24 - 48 hours after procedure)

Mild - erythema, no tenderness

Moderate - erythema, tenderness

Severe - blistering or necrosis, tenderness

23 Specifications and Safety Clinical Performance Summary - Internal Defibrillation

344

Clinical Performance Summary - Internal

Defibrillation

Overview

A study was conducted during the first half of 2002 to assess the effectiveness of the HeartStart MRx

(biphasic) for use in intra-thoracic application, as compared to a control biphasic waveform. This

appendix summarizes the methods and results of the study.

Methods

Twelve swine, each weighing approximately 30 kg, were anesthetized and intubated. A sternotomy was

performed to expose the heart. VF was induced electrically by 60 Hz current via a pacemaker catheter

in the right ventricle. After 15 seconds of VF, a defibrillating shock was applied, using hand-held (2-

inch diameter) "surgical" electrode paddles applied directly to the epicardium. Shock energies of 2, 5,

10, 20, and 30 J were used in random order. At least 4 shocks at each energy level were administered

for 4 separate VF episodes to derive a "% success" data point at that energy. Success was defined as

conversion of fibrillating rhythm to non-fibrillating rhythm five seconds after the shock.

Results

The results showed that the average impedance was about 40 ohms in this study, which is similar to the

human impedance data encountered in direct heart defibrillation. The efficacy results of the HeartStart

MRx are shown in Table 108, along with historical efficacy results of a standard monophasic damped

sine (MDS) waveform.1

Table 108 Clinical Performance Summary - Internal Defibrillation

Conclusion

Overall, the intra-thoracic defibrillation success rate for the HeartStart MRx (Biphasic) versus a control

biphasic waveform had no significant difference (p<0.05) except at 10J.

1. Zhang, Y., Davies R., Coddington W., Jones J., Kerber RE., Open Chest Defibrillation: Biphasic

versus Monophasic Waveform Shocks, JACC 2001;37;320A.

Energy

2J 5J 10J 20J 30J

HeartStart MRx (biphasic) Mean Success 4% 47% 77% 86% 88%

Sample Size 48 53 53 51 41

Control Biphasic Mean Success 10% 60% 93% 92% 92%

Sample Size 49 48 54 49 40

p-value Fisher’s Exact (p<0.050) 0.436 0.232 0.032 0.526 0.712

Historical MDS Mean Success 3% 25% 34% 57% 76%

Safety Considerations 23 Specifications and Safety

345

Safety Considerations

The following general warnings and cautions apply to use of the HeartStart MRx. Additional warning

and cautions specific to a particular feature are provided in the appropriate section.

General

WARNING The HeartStart MRx is not intended to be deployed in settings or situations that promote use by

untrained personnel. Operation by untrained personnel can result in injury or death.

WARNING HeartStart MRx service should only be performed by qualified service personnel, in accordance with

the HeartStart MRx Service Manual.

WARNING Use of the HeartStart MRx is restricted to a single patient at a time.

WARNING When transporting the HeartStart MRx, it is important to position it with the display facing away

from the body. If not, the Therapy Knob may be bumped and inadvertently moved from its current

position.

WARNING Remain attentive to the patient during the delivery of therapy. Delay in delivering a shock may result

in a rhythm that was analyzed as shockable converting spontaneously to non-shockable and could

result in inappropriate delivery of a shock.

WARNING Use only 3-wire AC power cords with 3-pronged grounded plugs.

WARNING Never operate the HeartStart MRx in standing water. Do not immerse, or pour fluids on, any portion

of the HeartStart MRx. If the device does get wet, dry the device with a towel.

WARNING Do not use the HeartStart MRx in the presence of a flammable anesthetic mixture or oxygen

concentrations greater than 25% (or partial pressures greater than 27.5 kPa/206.27 mmHg). This can

cause an explosion hazard.

WARNING Avoid connecting the patient to several devices at once. Leakage current limits may be exceeded. Do

not use a second defibrillator on the patient while pacing with the HeartStart MRx.

23 Specifications and Safety Safety Considerations

346

WARNING Electric shock hazards exist internally. Do not remove assembly screws except as described in the carry

bag assembly procedure. Refer servicing to qualified personnel.

WARNING Operating the HeartStart MRx or its accessories in conditions outside the environmental specifications

can result in device or accessory malfunction. The HeartStart MRx should be allowed to stabilize

within the operating temperature range for 30 minutes prior to operation.

WARNING The HeartStart MRx should not be used adjacent to or stacked with other equipment. If adjacent or

stacked use is necessary, the HeartStart MRx should be observed to verify normal operation in the

configuration used.

WARNING Avoid touching monitoring electrodes and other measuring devices when they are applied to the

patient. Doing so can degrade safety and may affect results.

WARNING Do not touch communication ports and a patient simultaneously.

CAUTION Do not discharge the defibrillator with the paddles shorted together.

CAUTION Conductive parts of electrodes and associated connectors for applied parts, including the neutral

electrode, should not contact other conductive parts including earth.

CAUTION This device is suitable for use in the presence of high-frequency surgical equipment. Following

electrosurgery interference, the equipment returns to the previous operating mode within 10 seconds

without loss of stored data. Measurement accuracy may be temporarily decreased while performing

electrosurgery or defibrillation. This does not affect patient or equipment safety. See the electrosurgery

device’s Instructions for Use for information on reducing hazards of burns in the event of a defect in its

equipment. Do not expose the equipment to x-ray or strong magnetic fields (MRI).

Safety Considerations 23 Specifications and Safety

347

CAUTION Be aware of patient cables, including ECG monitoring equipment when used with high frequency

surgical equipment.

NOTE This device and its accessories are not intended for home use.

NOTE The HeartStart MRx can be operated with only AC/DC power, only 14V M3538A Lithium Ion

Battery, or AC/DC power and M3538A battery simultaneously.

NOTE For operation in the U.S., the AC power cord must have the proper NEMA type plug.

NOTE The HeartStart MRx does not require the practice of any special ElectroStatic Discharge (ESD)

precautionary procedures.

23 Specifications and Safety Safety Considerations

348

Defibrillation

WARNING Keep hands and feet clear of paddle electrode edges. Use your thumbs to depress the shock buttons on

the paddle handle.

WARNING Do not allow multifunction electrode pads to touch each other or to touch other ECG monitoring

electrodes, lead wires, dressings, etc. Contact with metal objects may cause electrical arcing and

patient skin burns during defibrillation and may divert current away from the heart.

WARNING During defibrillation, air pockets between the skin and multifunction electrode pads may cause

patient skin burns. To help prevent air pockets, make sure the pads completely adhere to the skin. Do

not use dried out pads; do not open pads package until just prior to use.

WARNING Never touch the patient or any equipment connected to the patient (including the bed or gurney)

during defibrillation.

WARNING Avoid contact between the patient and conductive fluids and/or metal objects, such as the gurney.

Contact with metal objects could cause unintentional current pathways.

WARNING Medical electrical equipment which does not incorporate defibrillator protection should be

disconnected during defibrillation.

WARNING In AED Mode, the multifunction electrode pads must be in the anterior-anterior position as shown

on the packaging. The HeartStart MRx was not designed to assess data acquired from pads in an

anterior-posterior position.

Safety Considerations 23 Specifications and Safety

349

Battery

WARNING Properly dispose of or recycle depleted batteries according to local regulations. Do not puncture,

disassemble, or incinerate batteries.

WARNING Built in safety circuits can not protect against handling abuse. Adhere to all warnings and cautions in

handing and using lithium ion batteries.

WARNING Do not expose batteries to temperatures greater than 60oC (140oF). Excess temperatures may result in

battery damage.

WARNING Keep batteries away from flame and other heat sources.

WARNING Do not short circuit the battery. Avoid placing batteries around metal objects that may short circuit the

battery.

WARNING Avoid getting batteries wet or using batteries in high humidity environments.

WARNING Do not crush, dent or allow any deformation of the batteries.

WARNING Do not disassemble or open batteries. Do no attempt to alter or bypass the safety circuit.

WARNING Avoid extreme shock and vibration to the battery.

WARNING Do not use or connect the battery to batteries of other chemistries.

23 Specifications and Safety Electromagnetic Compatibility

350

Supplies and Accessories

WARNING Use only the multifunction electrode pads, battery, and accessories as listed in this guide. Substitutions

may cause the HeartStart MRx to function improperly.

WARNING Use multifunction electrode pads prior to their expiration date. Discard pads after use. Do not reuse

pads. Do not use for more than 8 hours of continuous pacing.

Electromagnetic Compatibility

When using the HeartStart MRx, electromagnetic compatibility with surrounding devices should be

assessed.

A medical device can either generate or receive electromagnetic interference. Testing for

electromagnetic compatibility EMC with and without the appropriate accessories has been performed

according to the international standard for EMC for medical devices (IEC 60601-1-2). This IEC

standard has been adopted in Europe as the European Norm (EN 60601-1-2).

The EMC standards describe tests for both emitted and received interference. Emission tests deal with

interference generated by the device being tested.

WARNING Radio frequency (RF) interference from devices other than the HeartStart MRx may degrade

performance of the HeartStart MRx. Electromagnetic compatibility with surrounding devices should

be assessed prior to using the defibrillator.

Fixed, portable, and mobile radio frequency communications equipment can affect the performance of

medical equipment. See Table 113 for the minimum recommended separation distance between RF

communications equipment and the HeartStart MRx.

Reducing Electromagnetic Interference

The HeartStart MRx and associated accessories may be susceptible to interference from other RF

energy sources and continuous, repetitive, power line bursts. Examples of other sources of RF

interference are medical devices, cellular products, information technology equipment and radio/

television transmission. Should interference be encountered, as demonstrated by artifact on the ECG

or dramatic variations in parameter measurement values, attempt to locate the source. Assess:

• Is the interference intermittent or constant?

• Does the interference occur only in certain locations?

• Does the interference occur only when in close proximity to certain medical devices?

• Do parameter measurement values change dramatically when the AC line cord is unplugged?

Once the source is located, attempt to attenuate the EMC coupling path by distancing the monitor/

defibrillator from the source as much as possible. If assistance is needed, call your local service

representative.

Electromagnetic Compatibility 23 Specifications and Safety

351

Restrictions for Use

Artifact on the ECG and parameter waveforms caused by electromagnetic interference should be

evaluated by a physician or physician authorized personnel to determine if it will negatively impact

patient diagnosis or treatment.

Emissions and Immunity

The HeartStart MRx is designed and tested to comply with the radiated and conducted emissions

requirement of international and national standards IEC 60601-1-2:2001 and EN 60601-1-2:2002.

See Tables 109 through 113 for detailed information regarding declaration and guidance.

WARNING The use of accessories, transducers and cables other than those specified may result in increased

emissions or decreased immunity of the HeartStart MRx.

The list of cables, transducers, and other accessories with which Philips claims compliance with the

emissions and immunity requirements of IEC standard 60601-1-2 are listed in “Supplies &

Accessories” on page 291.

The local area network (LAN) connector of the HeartStart MRx is marked with the label. The

pins of connectors marked with this warning symbol should not be touched or connections made to

until the following precaution is taken:

Discharge yourself to a conductive metal surface which is connected to earth ground before making

connections or touching the marked connector.

All staff using the HeartStart MRx should be instructed on these precautionary measures in order to

avoid damage to this sensitive medical equipment.

The EMC standards state that manufacturers of patient-coupled equipment must specify immunity

levels for their systems. See Tables 109 through 112 for this detailed immunity information. See Table

113 for recommended minimum separation distances between portable and mobile communications

equipment and the HeartStart MRx.

Immunity is defined in the standard as the ability of a system to perform without degradation in the

presence of an electromagnetic disturbance. Degradation in ECG quality is a qualitative assessment

which can be subjective.

Caution should, therefore, be taken in comparing immunity levels of different devices. The criteria

used for degradation is not specified by the standard and may vary with the manufacturer.

Guidance and Manufacturer’s Declaration

The HeartStart MRx is intended for use in the electromagnetic environment specified in the tables

below. The customer or the user of the HeartStart MRx should assure that it is used in such an

environment.

23 Specifications and Safety Electromagnetic Compatibility

352

Table 109 Electromagnetic Emissions

Emissions Test Compliance Electromagnetic Environment - Guidance

RF emissions

CISPR 11

Group 1 The HeartStart MRx uses RF energy only for its

internal function. Therefore, its RF emissions are

very low and not likely to cause interference in

nearby electronic equipment.

RF emissions

CISPR 11

Class B

Harmonic

emissions

IEC 61000-3-2

Class A The HeartStart MRx is suitable for use in all

establishments, including domestic establishments or

those directly connected to the public low-voltage

power supply network that supplies buildings used

for domestic purposes.

Volta ge

fluctuations/flicker

emissions

IEC 61000-3-3

Complies

Electromagnetic Compatibility 23 Specifications and Safety

353

Table 110 Electromagnetic Immunity - General

Immunity Test IEC 60601

Tes t L e vel

Compliance

Level

Electromagnetic Environment -

Guidance

Electrostatic

discharge (ESD)

IEC 61000-4-2

+ 6 kV contact

+ 8 kV air

+ 6 kV contact

+ 8 kV air

Floors should be wood, concrete, or

ceramic tile. If floors are covered

with synthetic material, the relative

humidity should be at least 30%.

Electrical fast

transient/burst

IEC 61000-4-4

+ 2 kV for power

supply lines

+1 kV for input/

output lines

+ 2 kV for power

supply lines

+1 kV for input/

output lines

Mains power quality should be that

of a typical commercial or hospital

environment.

Surge

IEC 61000-4-5

+ 1 kV differential

mode

+ 2 kV common

mode

+ 1 kV differential

mode

+ 2 kV common

mode

Mains power quality should be that

of a typical commercial or hospital

environment.

Volta ge dips, short

interruptions, and

voltage variations on

power supply input

lines

IEC 61000-4-11

< 5% UT

(> 95% dip in UT)

for 0,5 cycle

40% UT

(60% dip in UT)

for 5 cycles

70% UT

(30% dip in UT)

for 25 cycles

< 5% UT

(> 95% dip in UT)

for 5 sec

< 5% UT

(> 95% dip in UT)

for 0,5 cycle

40% UT

(60% dip in UT)

for 5 cycles

70% UT

(30% dip in UT)

for 25 cycles

< 5% UT

(> 95% dip in UT)

for 5 sec

Mains power quality should be that

of a typical commercial or hospital

environment.

Power frequency

(50/60 Hz)

magnetic field

IEC 61000-4-8

3 A/m 3 A/m Power frequency magnetic fields

should be at levels characteristic of a

typical location in a typical

commercial or hospital

environment.

UT is the AC mains voltage prior to application of the test level.

23 Specifications and Safety Electromagnetic Compatibility

354

Table 111Electromagnetic Immunity - Life Supporting Functions

Immunity Test IEC 60601

Tes t L e ve l

Compliance

Level

Electromagnetic Environment - Guidance

Portable and mobile RF communications

equipment should be used no closer to any part

of the HeartStart MRx, including cables, than

the recommended separation distance

calculated from the equation applicable to the

frequency of the transmitter.

Conducted RF

IEC 61000-4-6

3 Vrms

150 kHz to 80 MHz

outside ISM bandsa3 Vrms

Recommended Separation Distance

10 Vrms

150 kHz to 80 MHz

in ISM bandsa10 Vrms

Recommended Separation Distance

Electromagnetic Compatibility 23 Specifications and Safety

355

Radiated RF

IEC 61000-4-3

10 V/m

80 MHz to 2.5 GHz

10 V/m

where P is the maximum output power rating

of the transmitter in watts (W) according to

the transmitter’s specified output power and d

is the recommended separation distance in

meters (m).b

Field strengths from fixed RF transmitters, as

determined by an electromagnetic site survey,c

should be less than the compliance level in each

frequency range.d

Interference may occur in the vicinity of

equipment marked with the following symbol:

At 80 MHz and 800 MHz, the higher frequency range applies.

These guidelines my not apply in all situations. Electromagnetic propagation is affected by absorption and

reflection from structures, objects and people.

a The ISM (industrial, scientific, and medical) bands between 150 kHz and 80 MHz are 6.765 MHz to 6.795

MHz; 13.553 MHz to 13.567 MHz and 26.957 MHz to 27.283 MHz; and 40.66 MHz to 40.70 MHz.

b The compliance levels in the ISM frequency bands between 150 kHz and 80 MHz and in the frequency range 80

MHz to 2.5 GHz are intended to decrease the likelihood that mobile/portable communications equipment could

cause interference if it is inadvertently brought into patient areas. For this reason, an additional factor of 10/3 is

used in calculating the recommended separation distance for transmitters in these frequency ranges.

c Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones and land

mobile radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be predicted theoretically

with accuracy. To assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site

survey should be considered. If the measured field strength in the location in which the HeartStart MRx is used

exceeds the applicable RF compliance level above, the HeartStart MRx should be observed to verify normal

operation. If abnormal performance is observed, additional measures may be necessary, such as re-orienting or

relocating the HeartStart MRx.

d Over the frequency range 150 kHz to 80 MHz, field strengths should be less than 3 V/m.

Table 111Electromagnetic Immunity - Life Supporting Functions (Continued)

Immunity Test IEC 60601

Tes t L e ve l

Compliance

Level

Electromagnetic Environment - Guidance

80 MHz to 800 MHz

800 MHz to 2.5 GHz

23 Specifications and Safety Electromagnetic Compatibility

356

Table 112Electromagnetic Immunity - Nonlife Supporting Functions

Immunity Test IEC 60601

Tes t L e ve l

Compliance

Level

Electromagnetic Environment - Guidance

Portable and mobile RF communications

equipment should be used no closer to any part

of the HeartStart MRx, including cables, than

the recommended separation distance

calculated from the equation applicable to the

frequency of the transmitter.

Conducted RF

IEC 61000-4-6

3 Vrms

150 kHz to 80 MHz

3 Vrms

Recommended Separation Distance

Radiated RF

IEC 61000-4-3

3 V/m

80 MHz to 2.5 GHz

3 V/m

where P is the maximum output power rating

of the transmitter in watts (W) according to

the transmitter’s specified output power and d

is the recommended separation distance in

meters (m).

Field strengths from fixed RF transmitters, as

determined by an electromagnetic site survey,a

should be less than the compliance level in each

frequency range.b

Interference may occur in the vicinity of

equipment marked with the following symbol:

At 80 MHz and 800 MHz, the higher frequency range applies.

These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and

reflection from structures, objects and people.

a Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones and land

mobile radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be predicted theoretically

with accuracy. To assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site

survey should be considered. If the measured field strength in the location in which the HeartStart MRx is used

exceeds the applicable RF compliance level above, the HeartStart MRx should be observed to verify normal

operation. If abnormal performance is observed, additional measures may be necessary, such as re-orienting or

relocating the HeartStart MRx.

b Over the frequency range 150 kHz to 80 MHz, field strengths should be less than 3 V/m.

80 MHz to 800 MH

800 MHz to 2.5 GHz

Electromagnetic Compatibility 23 Specifications and Safety

357

Recommended Separation Distances

The HeartStart MRx is intended for use in an electromagnetic environment in which radiated RF

disturbances are controlled. The customer or the user of the HeartStart MRx can help prevent

electromagnetic interference by maintaining a minimum distance between portable and mobile RF

communications equipment (transmitters) and the HeartStart MRx as recommended below, according

to the maximum output power of the communications equipment.

Table 113Recommended Separation Distances

Separation Distance According to Frequency of Transmitter (m)

Rated Maximum Output

Power of Transmitter (W)

150 kHZ to 800 MHz 800 MHz to 2.5 GHz

0.01 0.1 m 0.2 m

0.1 0.4 m 0.7 m

1 1.2 m 2.3 m

10 4 m 7 m

100 12 m 23 m

For transmitters rated at a maximum output power not listed above, the recommended separation distance d in

meters (m) can be determined using the equation applicable to the frequency of the transmitter, where P is the

maximum output power rating of the transmitter in watts (W) according to the transmitter’s manufacturer.

At 80 MHz and 800 MHz, the higher frequency range applies.

These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and

reflection from structures, objects and people.

359

1Index

12-Lead ECG 135

ACI-TIPI 135, 139

acquiring 138

adjusting wave sizes 149

algorithm 135, 136

configurable parameters 212

Critical Values 143

Acute ischemia statements 144

Acute MI statements 143

Complete Heart Block

statements 144

Extreme Tachycardia statements 144

Culprit Artery 145

acronyms 145

entering patient info 138

filters 150

indications 3

Leads off 137

preparation 137

preview screen 137

report 146

accessing stored reports 148

contents 146

copy to data card 148

display 147

printing 229

set up 136

signal problems 149

specifications 333

TPI 135, 139

warnings 146

abbreviations, units 340

AC Line Filter 22

AC power module, installing 45

accessories 291

connecting pouches 31

ACI-TIPI 135

analysis 139

display 147

indications 4

patient info required 142

predicted probability 139

ST and T changes 142

AED Mode 63

and children 63

artifact 67

configurable parameters 218

ECG analysis 324

impedance 66

indications 3

no shock advised 68

patient status 65

prepping the patient 65

set up 65

specifications 323

therapy precautions 63

using 66

using Q-CPR 171

voice volume 67

alarms 24

apnea time limit 114

AwRR

changing 113

enabling/disabling 114

chain for basic arrhythmia 57

configurable parameters 211

CPP 127

EtCO2

changing 113

enabling/disabling 113

EtCO2 and AwRR 112

heart rate and arrhythmia 56

changing 59

enabling/disabling 59

latching 56

HR and arrhythmia

yellow 57

IntelliVue Networking 193

invasive pressures 125

changing 126

enabling/disabling 126

Noninvasive Blood Pressure (NBP) 107

changing 107

enabling/disabling 108

noninvasive pacing 84

pulse 129

enabling/disabling 129

setting limits 130

pulse rate from SpO2100

responding 59

responding to 24

SpO2 monitoring 99

changing 99

desat 100

enabling/disabling 100

temperature 132

changing limits 133

enabling/disabling 133

types 24

annotated ECG 60

Apnea Time Alarm 114

arrhythmia

alarms chain 57

learning/relearning 61

monitoring 54

artifact

AED Mode 67

TENS unit 49

audio 27

pause label 25

recording 23

reviewing recorded 23

tones 318

automated tests 264

summary results 265

AwRR

Alarms 112

changing 113

alarms

enabling/disabling 114

warnings 114

basic orientation 8

back panel 11

display

menus 17

front panel 8

general status area 14

message window 18

side panels 9

top panel 10

value adjustment 17

batteries

calibration 284

calibration recommended 284

calibration results 285

capacity 12, 326

charge level indicators 14

charge status 284

charge time 326

charging 284

discarding 286

installing 44

1Index

Index

360

life expectancy 12, 283

low battery warning 326

M3538A Lithium Ion Battery 12

maintenance 283

process 283

specifications 326

storage 286, 326

warnings 349

beat labels 60

Bluetooth

adding a device 242

changing a profile 244

general security practice 244

pairing a device 242

setup 242

specifications 336

troubleshooting 304

working with 244

Calibrating invasive pressures

confirmation 123

calibrating invasive pressures 121

calibration gas

disposal 290

calling for service 319

cardioversion 71

therapy 72

carry case 31

pouches 32

setting up 31

storing accessories 33

cautions 345

charge time 322

cleaning 287

carrying case 289

CPR meter 289

ECG cable 288

invasive pressure transducer 289

monitor/defibrillator 287

NBP cuff 289

paddles 288

printer printhead 287

SpO2 sensor 289

temperature probe/cable 289

therapy cable 288

clinical performance summary

cardioversion 342

defibrillation 341

internal defibrillation 344

configuration 199

accessing menu 199, 201

configurable parameters 202

loading configuration from a data

card 201

modifying settings 200

printing configuration settings 201

restoring default settings 201

saving configuration to a data card 201

setting date/time 200

continued use 27

and pacing 27

controls 18

therapy knob 19, 21

CPR feedback 172

CPR meter 160

adhesive pads

disposal 290

specifications 333

cleaning 289

disposal 290

specifications 333

Critical Values 143

data card

installing 46

loading configuration 201

troubleshooting 312

viewing and erasing 228

data management 225

copying from internal memory 227

Data Management Mode

entering 226

printing 231

Event Summary 225

events recorded 232

external data card 228

Rosetta

troubleshooting 308

specifications 334

uses 225

data transmission 239

12-Lead Mode 248

set up 248

Batch LAN Data Transfer 259

erasing the memory card 259

set up 259

transferring a single file 260

transferring all events 260

troubleshooting 308

Bluetooth 242

configurable 214

configurable parameters 215, 216

Event Summaries 255

in Data Management Mode 255

options

critical care use cases 240

during an event 239

post event 254

post event use cases 254

Periodic Clinical Data

Transmission 250

data sent 250, 251

icons 250

transmission intervals 252

transmit interval 216

troubleshooting 308

Rosetta

connecting devices 246

contents of report 245

set up 245

RS-232

set up 247

scenarios 239

set up 241

to a personal computer 249

to fax number 249

transmission

cancelling BLDT transmission 261

cancelling transmission 257

errors 257

finding results 258

queueing multiple

transmissions 258

tracking 257

tracking BLDT 260

troubleshooting 304

data, storing 2

Defibrillating 91

defibrillation

charge button 21

charge time 322

clinical performance summary 341

delivered energy accuracy 322

manual 71

asynchronous 77

code view 73

external paddles 75

Manual Defib Mode 73

overview 71

precautions 72

preparation 74

select energy 77

multifunction electrode pads 74

Q-CPR 171

shock button 21

shock counter 73

Sync button 21

Therapy knob 21

troubleshooting 310

using internal paddles 76

using pediatric paddles 76

warnings 348

delivered energy accuracy 322

Device ID

usage 26

display

high contrast 18

displayed waves 49

Index

361

ECG and arrhythmia monitoring 47–61

bundle branch 55

configurable parameters 203

ECG wave size 54

electrode placement 51

12-lead 52

3-lead 51

5-lead 51

V/C 52

INOP messages 58

lead choices 53

lead selection 53

monitoring view 48

overview 47

preparation 49

specifications 324

troubleshooting 299

via electrodes 49

via multifunction electrode pads 50

ECG cable 35

connecting 35

electrode pads 160

electrode placement 51

electromagnetic compatibility 350

emissions and immunity 351

EtCO2

alarms 112

changing 113

enabling/disabling 113

configurable parameters 209

disabling 114

indications 3

specifications 331

troubleshooting 309

EtCO2 monitoring 109

connecting filter line 40

measured levels 109

measuring EtCO2112

overview 109

selecting accessories 110

setting up 111

using Nasal FilterLine 111

warnings 109, 110, 111

Event Summary 225, 229

button 20

events stored 232

initiating events 226

IntelliVue Networking

events logged 195

external paddles 75

patient contact indicator 75

external power indicator 22

HeartStart MRx

AED Mode set up 65

calling for service 319

identifying your device 26

indications for use 3

intended use 2

on the IntelliVue Network 177, 190

symbol definitions 337

warnings 345

icons

audio 14, 23

controls

alarm pause button 20

charge button 21

event summary button 20

lead select button 20

mark event button 20

menu select button 20

navigation buttons 20

print button 20

shock button 21

IntelliVue Networking 177, 178

network connectivity 14

Periodic Clinical Data

Transmission 14, 250

INOP

alarm types 24

statements 14

troubleshooting 297

IntelliVue Networking 177

admitting a patient 184

bed/equipment label

bed/equipment label 178

clearing a transfer 189

configurable parameters 219

configuration 181

connecting 179

connection icons 178

date and time 191

device icon 177

discharging a patient 185

messages 186

display 178

frequency 179

handling conflicting info 192

locating a device on the network 182

prerequisites 182

messages at the information center 196

network connection

rejection messages 317

network setting parameters 183

patient information 190

viewing 193

printing 193

radio/AC power module 180

re-admitting a patient 188

specifications 333

transfer patient confirmation 187

transferring a patient 187

troubleshooting 315

turning device off 193

wired and wireless connections 181

wired connection 180

wireless connection 180

Invasive Pressures 115

air bubbles 115

alarms 125

changing 126

enabling/disabling 126

cable, connecting 38

calibration 121

confirmation 123

Cerebral Perfusion Pressure 117

changing altitude 119

configurable parameters 204, 205, 206,

207

CPP alarms 127

ICP warning 116

indications 4

last zero 124

non-physiological artifact

suppression 124

overview 115

pressure labels 117

pressure waves 118

available scales 118

reusable transducers 122

selecting a pressure 117

setting up 115

specifications 330

troubleshooting 312

unable to calibrate 123

warnings 122, 127

wedge 127

zeroing 119

Maintenance 263

automated tests 264

batteries 283

procedure 283

calibration gas disposal 290

cleaning instructions 287

disposing the HeartStart MRx 290

Operational Check 270

Performing an Operational Check 271

Ready For Use (RFU) Indicator 266

Shift Checklist 267

User Checks 278

weekly shock test

performing 267

manual defibrillation

Index

362

configurable parameters 217

indications 3

specifications 323

Mark Event 237

configurable parameters 221

patient info 27

monitoring view 48

multifunction electrode pads 74

Noninvasive Blood Pressure (NBP) 103

alarms 107

changing 107

enabling/disabling 108

automatic 106

configurable parameters 208

connecting tubing 37

indications 3

initial inflation 104

manual 106

measuring 104

changing schedule 106

overview 103

pressure displayed 103

specifications 329

troubleshooting 302

warnings 105

Noninvasive Pacing 83

alarms 84

changing modes 89

continued use 27

defibrillating 91

Demand Mode 86

demand mode 88

Fixed Mode 86

fixed mode 89

indications 3

overview 83

pacer output 84

pacing view 85

pads off 84

power interruption 84

preparation 87

R-wave markers 88

shielded leadsets 83

soft keys 85

specifications 327

troubleshooting 310

operating modes 12

Operational Check 270

performing 271

report 277

summary 282

results 282

test results 279

tests 274

User Checks 278

Pacing

see Noninvasive Pacing 83

paddles

using internal 76

using pediatric 76

parameter blocks 16

parameters

turning on and off 16

password security 13

patient

category 14

entering data 27

name 14

pediatric patients

age 27

Periodic Clinical Data Transmission 250

pleth wave 98

printing

12-Lead ECG Reports 229

cleaning printhead 287

configurable parameters 220

configuration settings 201

Event Summary 229

from Data Management Mode 231

from the IntelliVue Network 193

installing paper

50mm 42

75mm 43

printer specifications 327

strip lengths 230

troubleshooting 311

Vital Signs Trending Report 154, 229

waveforms 28

pulse

configurable parameters 210

pulse rate alarms 100

changing 101

enabling/disabling 101

source 128

changing 129

troubleshooting 314

Pulse Oximetry

see SpO2 monitoring 93

Q-CPR 157

compression waveform 167

configurable parameters 222

connecting CPR cable 41

contraindications 4

CPR feedback 172

adjusting volume 173

CPR meter 160

adhesive pad 162

after each use 174

back 161

Basic View details 170

compression depth indicator 165

feedback 164

compression depth indicator 165

compression rate indicator 165,

166

front 161

icons 166

performing CPR 164

placement 163

preparation 163

status light colors 161

warnings 163

data capture 157, 174

data/events recorded 175

reviewing data 175

electrode pads 160

feedback

Advanced View details 167

on HeartStart MRx display 167

ventilation icons 169

in manual defib mode 171

indications 4

on a mattress 158

overview 157

preparing to use 159

research data storage 175

senor and meter differences 158

troubleshooting 314

using in AED Mode 171

warnings 158

QRS beeper 299

Ready For Use (RFU) Indicator 2, 22, 266

blinking black hourglass 22

blinking red "x" 22

solid red "x" 22

Reference ID 241

configurable parameters 217

modifying during an event 241

usage 26

Return to Owner 29

safety considerations 5, 345

separation distances 357

service numbers 319

setting alarms 59

setting date/time 200

Shift Checklist 267

copy of 268

Index

363

SMART Biphasic

impedance 66

soft key labels 16

specifications 321

12-Lead ECG 333

AED Mode 323

batteries 326

Bluetooth 336

CPR meter 333

adhesive pads 333

data management 334

display 326

ECG and arrhythmia monitoring 324

environmental

M3535A 334

M3536A 335

EtCO2331

general 321

IntelliVue Networking 333

Invasive Pressures 330

manual defibrillation 323

Noninvasive Blood Pressure

(NBP) 329

Nonivasive Pacing 327

SpO2328

Temperature 331

SpO2 monitoring 93

accuracy 328

alarms 99

changing 99

enabling/disabling 100

applying a sensor 96

care and cleaning 102

configurable parameters 210

connecting the cable 36

desat alarm 100

disabling 101

indications 3

overview 93

parameters 97

pleth wave 98

selecting a sensor 95

set up 36

specifications 328

troubleshooting 303

understanding 94

warnings 93, 96

successful resuscitation 72

supplies 291

warning 291

supplies and accessories

warnings 350

symbol definitions 337

shipping carton 339

Synchronized Cardioversion 79

disabling 81

preparing 79

shock delivery 80

using an external monitor 79

Temperature 131

alarms 132

changing 133

enabling/disabling 133

changing degree units 133

configurable parameters 211

connecting the cable 39

disabling 134

indications 4

monitoring 132

selecting a label 131

self tests 132

specifications 331

troubleshooting 313

therapy cable, connecting 41

TPI 135

analysis 139

contraindications 4

configurable parameters 223

default 140

display 141

modify 141

contraindications for

thrombolytics 139

indications 4

inputs 139, 140

patient info required 142

skipping 139

training 5

troubleshooting 297

Batch LAN Data Transfer 308

Bluetooth 304

CO2309

data card 312

data transmission 304

defibrillation 310

ECG problems 299

general problems 298

IntelliVue Networking 315

Invasive Pressures 312

NBP problems 302

Noninvasive Pacing 310

Periodic Clinical Data Transfer 308

printing 311

pulse 314

Q-CPR 314

Rosetta 308

RS-232 307

service numbers 319

SpO2 problems 303

Temperature 313

User Checks 278

Vital Signs Trending 151

adjusting interval 153

data 152

exiting report 155

printing report 154, 229

report format 152

reviewing data 151

scrolling 153

warnings 345

batteries 349

defibrillation 348

general 345

supplies 291

supplies and accessories 350

wave sectors 15

changing 16

waveforms

acquiring 47

printing 28

Waves

configurable parameters 211

weekly shock test

performing 267

Zeroing invasive pressures 119

last zero 124

unable to zero, causes 120

989803160421

Edition 1

Philips Medical Systems

Printed in the U.S.A. April 2009

*989803160421*

*1* F

MRx Heart Start Philips Owners Manual

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