M In-service

survival from cardiac arrest requires quick recognition Rapid Response early defibrillation and ACLs intervention understanding the operation of yours old m-series before you encounter an emergency situation will enhance your potential to save victims of cardiac arrest this program will introduce you to the Zoll n series and its features to fully understand its operation you should read the operator’s guide and your medical control authorities protocol for use the soul n series is designed for use by health care providers trained in manual or automated defibrillation models include manual defibrillators advisory models and semi-automated bottles with manual override when using the manual mode the charging and discharging is fully controlled by the operator in advisory and semi-automated modes a sophisticated algorithm determines the need for a defibrillation shock and prompts the operator all models of the m-series have thes old uniform operating system manual only models have a charge bucket advisory and semi-automated models have a charge and/or analyze button the first section of the video standard operating controls describes the basic operation of the sole M series all operators should view this section the monitoring and recording section should also be viewed by all operators if you use the device for manual defibrillation view this section if you intend to use the advisory mode view this section to learn how to operate the device for pacing view the pacing section all operators should view the batteries and power section since many voice and visual prompts are selectable all messages referred to in this video are the default settings different messages may be displayed at the option of your medical authority check your m-series voice and visual prompts prior to use a detailed configuration guide showing all selectable operations is supplied to allow medical control authorities to select and standardize operation let’s begin by looking at the standard operating controls the selector switch enables defib monitor off and the optional pacer modes semi-automated versions of the device have a single on position which activates the monitor and defibrillator all units will be four times indicating they have passed the power-on self-test if PCMCIA cards are inserted ECG data and patient event information will be recorded m-series are now available with a choice of two defibrillation waveforms some m-series are equipped with a monophasic waveform and some offers oles new low energy rectilinear biphasic waveform the rectilinear biphasic waveform offers superior defibrillation capabilities at lower energy settings the suggested three shock VF protocol from monophasic waveforms is 200 300 and 360 joules Lee suggested biphasic 3 shock VF protocol is 120 150 and 200 joules successive low energy shocks should remain at 200 joules recommended pediatric settings should remain consistent with monophasic joule settings users should consult your medical authority to confirm pediatric settings biphasic energy levels for internal defibrillation should also remain consistent with monophasic protocol unless otherwise directed by your medical authority this video depicts the use of monophasic defibrillators other than energy levels there are no operational differences between monophasic and biphasic m-series devices the default energy levels for first second and subsequent shocks are 200 joules 300 joules and 360 joules there are two arrow buttons for changing the defibrillator energy level press and hold the up or down arrow buttons until the desired energy level is indicated on the display to charge the defibrillator press the charge button on the front panel or if using paddles the charge button on the apex paddle handle charging is shown on the display the charge indicator on the paddle lights up

when the defibrillator is charged and ready when the selected energy level is reached the message ready appears next to the energy display on the monitor each pedal has a shock button you must press and hold both buttons simultaneously to discharge the defibrillator when using paddles the front panel also has a shock button that lights up when the defibrillator is charged and ready press this button to discharge the defibrillator when using multi-function electrode or MFE pads the five soft keys are used for code marker and other functions depending on the operating mode of the device labels for the soft keys appear at the bottom of the display directly above each key to indicate its function when these features are used the default lead setting pads or paddles is selected when the device is turned on in defib or monitor modes and multi-function electrode pads or paddles are connected to the universal table lead 2 is automatically selected when the unit is turned on in pacer mode pressing the lead button changes the ECG source and sequentially selects ECG from each of the following lead configurations 1 2 3 n paddles when using a three lead cable and 1 2 3 ”and AVR AVL AVF V and paddles with a 5 lead cable the size button allows you to change the ECG size and sensitivity of the signal size options are indicated on the display the alarm suspend button activate or deactivates the heart rate alarm function a bell symbol appears when the alarms are enabled when alarms are disabled the Bell symbol has a line crossed through it alarms are set using a soft key the recorder button starts and stops the multiple application printer a second recorder button is provided on the external paddles you can change from monitoring to diagnostic bandwidth by depressing and holding the button for four seconds the unit reverts to monitoring bandwidth when the button is released the speaker button enables soft keys to adjust the QRS beeper tone from maximum to inaudible a heart rate alarm and charge ready tones are not adjustable on the back of the unit the ECG input connector for both three and five lead patient cables is located at the far right the universal cable is color-coded red and is secured with two screws a 1 volt ECG output is second from the left and the grounding terminal is located directly behind it in units equipped with AC mains the receptacle for the power cable is located at the left input for DC powered units is also located at the left when so configured external paddles are stored on either side of the unit and can be tested in this position they may also be used as handles to grab or carry the unit the paddles connect to the universal cable by inserting the end of the cable into the paddle labeled apex the cable is removed by sliding the latch and removing the end from the paddles the cable end connects directly to all Zoll multi-function electrodes internal handle assemblies and the test port pediatric paddles are located directly under the adult electrode press the latch and slide the adult electrode off when replacing it is important that the adult electrode is locked correctly into position when the m-series unit is plugged into an AC mains or a DC power source the charger on indicators show the status of the battery and charging the orange charger on indicator illuminates continuously whenever the device is off and the battery is charging or on with the battery installed the green indicator illuminates continuously when the unit is off and the battery has been fully charged the green and orange indicators illuminate alternately when no battery is installed or when a battery fault has been detected you will learn more about batteries and power later in this program the summary report shows patient ECG data control settings date/time and code marker entries to print summary information press the summary button then press the corresponding soft key press the button again or turn the unit off to stop printing reports will be

erased when the summary button is pressed and held for approximately four seconds or is configurable from five to ninety minutes after the unit is turned off press down and pull open the paper tray to replace paper paper is easily replaced by unfolding one section grid side up with arrow facing outward and closing the Train the optional code marker feature activates the soft keys to record drugs and treatments and time stamps the intervention code markers correspond to a H a guidelines and can be configured to meet system protocols your operator’s guide contains more detail on code marker and summary report features of the M series the M series can be used to monitor the ECG and when available other parameters such as spo2 and etco2 the ECG may be acquired through ECG electrodes multi-function electrode pads or through external defibrillation paddles or ECG monitoring the signal is acquired using a three lead patient cable or the optional five lead cable during pacing an ECG cable is required for monitoring when using the three lead cable leads one two and three are available when using the five lead cable leads 1 2 3 AVR AVL AVF and V are available the lead button automatically adapts to the patient cable selected proper application and placement of electrodes are essential for high quality ECG monitoring markings and color codes for the different lead sets are shown in your operator’s guide plug the patient cable into the ECG input connector at the back of the unit the selector switch should be in the monitor or on position press the lead button until the desired lead is selected if the ECG lead off message appears inspect the ECG electrodes lead wires and connections if the check pads or poor pad contact message appears inspect the MFE pads cable and connections the ECG size is automatically set at turn on press the size button to adjust the waveform the QRS beeper volume can be adjusted by using the speaker Bucky and appropriate soft keys default heart rate limit alarms are 30 and 150 beats per minute with alarms enabled preset limits manually selectable and auto limits of 80% and 120% of patient heart rate can be selected from the set alarm function soft keys complete information on alarms is available in the operator’s guide the printer documents the ECG with a 6 second delay and can be programmed to automatically run when an alarm or a defibrillation event occurs press the recorder button to start and stop the death ECG time/date lead size and heart rate and any other monitored for are documented if pacing the output current will be printed and delivered energy will be printed when the defibrillator is discharged check the paper supply at the beginning of each shift a red stripe along the top of the paper indicates that the paper supply is low and should be replaced a Czech recorder message appears on the display when the printer is activated without paper consult your operators guide for more detail on ECG monitoring and recording this section is for personnel trained in manual defibrillation an advanced cardiac life support or similar protocols first let’s look at manual defibrillation with paddles for emergency defibrillation with paddles first turn the selector switch to defib the unit defaults to paddles as the ECG source when it is turned to the defib setting and paddles are connected to the universal cable observe the ECG by checking the monitor or use the paddles to quickly view the patient’s rhythm if defibrillation is required applied defibrillation gel over each electrode

uniformly verify the selected energy level and press the charge button on the apex paddle or on the front panel of the unit apply the paddles firmly to the chest rub the paddles against the skin to ensure good contact after charging to the selected energy level the charge indicator on the apex paddle will light the charge ready tone will sound and the energy display will show ready and the selected energy level verify the energy level worn all persons to stand clear prior to discharge and observe all other safety procedures Claire using your thumbs depress and hold both shock buttons simultaneously until the energy is delivered to the patient the display will show the amount of energy delivered the procedure for using multi-function electrode pads and manual mode is similar to that used with paddles attach the multifunction electrode pads to the patient according to the directions on the electrode packaging ensure that the multifunction electrode pads make good contact with the patient’s skin and that they are not covering any part of the ECG electrodes if the multifunction electrode pads are not making good contact the messages check pads and poor pad contact will be displayed alternately and energy will not be delivered pressing the pads down can correct this problem the ECG can be immediately observed if defibrillation is required press the charge button follow the same safety procedures as with the paddles when the charge ready tone sounds the shock button will light up verify the selected energy level and discharge the unit by pressing and holding the shock button when in the defib mode synchronized cardioversion is available to synchronize discharge with the ECG R wave the sync on/off is controlled by a soft key ECG should be obtained via a patient cable since it provides the best signal and lead selection after pressing the soft key labeled sync a marker will appear above each our wave to indicate where the discharge will occur verify the markers location is appropriate and consistent with each beat use the lead and size button if necessary to establish consistent synchronization select the desired energy level the word sync will appear next to the selected level using either paddles or multifunction pads charge the defibrillator to the selected level verify the ECG waveform is stable and deliver the synchronized discharge by depressing both paddles discharge buttons or if using multifunction pads the shock button on the front panel press and hold the buttons long enough for an R wave to trigger a discharge clear once energy is delivered the unit will automatically return to defib mode unless configured differently internal defibrillation is available using Zoll autoplay pible handles and electrodes autoplay pible internal handles are only for use in the manual mode they do not operate in the advisory or semi-automatic modes when using internal handles the defibrillator automatically limits its energy output to a maximum of 50 joules the defibrillator is charged by pressing the charge button on the front panel and discharged by pressing either the shock button on the front panel or the discharge button incorporated in the internal handle sets to test your internal paddles simply place both paddle surfaces together keeping your hands off of the electrodes charge the device to 30 joules press the shock button and note the test okay message that appears to indicate energy has been delivered to the assembly complete information on internal handles including procedures for cleaning and sterilization is available in your operator’s guide this section covers operation and advisory movement ECG analysis capability identifies shockable rhythms when using multi-function electrode pads verify the patient is unconscious not breathing and pulseless begin CPR request assistance and remove clothing covering the patient’s chest apply the MFE pads according to directions on the package

pads may be applied in an anterior posterior or anterior anterior position to use the advisory feature a selector button must be turned to defib the unit will display defib 200 joules selected on the monitor press the analyze button to begin analysis of the patient’s ECG rhythm and to detect any shockable rhythm analyzing ECG will be displayed while the patient’s ECG is analysed once the analysis is completed the unit indicates whether or not a shock is advised when an on shockable rhythm is detected a no shock advised message will be displayed when a shockable rhythm is detected and the shock advised message is displayed charged the unit as indicated by the prompts if the automatic analyze and charge option is enabled the unit will automatically charge to the pre-configured or user selected energy sending the shock button will light up and a continuous tone will sound warned all persons – stand clear clear press and hold the shock button on the front panel until energy is delivered to the patient confirmation of delivered energy will appear for approximately 5 seconds review your operator’s guide for all advisory function messages and related procedures in advisory mode this section covers the use of the m-series non-invasive pacing capability apply ECG electrodes to the patient as shown previously apply the multifunction electrode pads following the directions on the pouch pacing is best accomplished with anterior posterior electrode positioning turn the selector switch to pacer the pacer output will automatically be set to zero milliamps ma and the pacer rate at 70 pace pulses per minute BPM prior settings will be retained if previously set and the unit was turned off for 10 seconds or less set pacer rate to a value 10 to 20 ppm higher than the patient’s intrinsic rate if no intrinsic rate exists use 100 ppm increase the pacer output until stimulation is effective observe the pacing stimulus marker on the display or strip chart to verify that it is well positioned in diastole it is important to recognize when pacing stimulation has produced a ventricular response capture capture must be assessed by checking both the ECG and peripheral pulse to ensure appropriate circulatory support of the patient electrical capture is determined by the presence of a widened QRS complex the loss of underlying intrinsic rhythm and the appearance of an extended and sometimes enlarged teewe mechanical capture is assessed by checking the pulse at the carotid femoral right brachial or radial arteries the ideal output current is the lowest value that will maintain capture usually about 10% above threshold typical threshold currents are between 40 and 80 milliamps location of the multifunction electrode pads will affect the current required to obtain ventricular capture standby pacing provides a pacing stimulus when the patient’s heart rate drops below a predetermined level establish effective pacing as shown and set the pacer output 10% higher lower the pacing rate below the patient’s heart rate to rate sufficient for adequate cardiac output pacing is resumed if the patient’s rate drops below the set pacing rate the m-series also incorporates an asynchronous capability that is selected using a soft key the operators guide has additional information on this feature the M series can operate from batteries AC power or DC power and uses a rapidly replaceable battery pack two types of replaceable battery packs are available one is a standard battery pack and the other is a smart battery pack with capacity indicators batteries can be charged within the unit or by using an external battery charger Zoll recommends a separate battery charger be available to charge spare batteries and perform periodic testing with an M series connected to AC or DC power and turned off the unit will fully recharge the battery within 4 hours if the unit is on continuously recharging will be complete in 24 hours if equipped with AC mains or

DC capability the unit will operate regardless of battery condition or without a battery the power cord must be connected to the device and a suitable power source for charging and operation when operating on battery power a low battery message will be displayed on the monitor and a 2 beep tone will sound once a minute when the battery is low replace the battery pack immediately or plug the unit into an AC or DC power source to ensure continuous operation all settings will be maintained for 10 seconds while the batteries are exchanged smart battery capability may be added to all zoals smart ready battery packs a smart battery displays remaining operating time when in use smart batteries have a do not use indicator that will illuminate if a smart battery has not been recalibrated after 20 discharge and cycles have occurred or if another fault exists batteries require periodic testing the SOL 4×4 with auto test capability provides for 100% automated testing with each recharge cycle batteries that test ready provide a minimum of one and one-half hours monitoring time the number of batteries used frequency of use and how they are used effect capacity because of this Zoll recommends periodic testing and that you replace batteries on a preventive scheduled basis or at least every 18 months please review your operator’s guide for other important steps in managing batteries before using the SOL M series we urge you to thoroughly examine the unit and all associated materials additionally using the M series in a simulated cardiac arrest result training electrodes and simulator will prepare you to use this equipment in emergency situations you