ZOLL R Series, Operator'S Manual

Page 1: ...R Series ALS Operator s Guide PPI CPR 9650 0912 06 Rev G...

Page 2: ...larms CPR Index Defib Mentor Rectilinear Biphasic and ZOLL are trademarks or registered trademarks of ZOLL Medical Corporation in the United States and or other countries Masimo is a registered tradem...

Page 3: ...efibrillator Output Energy 1 7 External Pacemaker Optional 1 8 Intended Use Pacemaker 1 8 Pacemaker Complications 1 9 Pediatric Pacing 1 10 Intended Use SpO2 Monitoring 1 10 Intended Use EtCO2 Monitor...

Page 4: ...cal Medical Protocols 3 2 1 Select DEFIB 3 2 2 Charge Defibrillator 3 4 3 Deliver Shock 3 5 Autoclavable External Paddles 3 5 Emergency Defibrillation Procedure with Hands Free Therapy Electrodes 3 6...

Page 5: ...6 Real CPR Help Real CPR Help Field 6 2 CPR Index Optional 6 2 CPR Idle Time Display 6 2 CPR Rate and Depth Display 6 2 Compression Release Bar Adult only 6 2 CPR Metronome 6 3 Fully Release prompt 6...

Page 6: ...Diagnostic Bandwidth 9 8 Alarms 9 8 Setting Alarm Limits 9 8 Heart Rate Alarm Limits 9 9 Vital Sign Alarms 9 10 Suspending and Silencing Alarms 9 10 Smart Alarms 9 11 Chapter 10 Event Records and Rep...

Page 7: ...5 Recorder Check 12 6 Code Readiness Log 12 6 Setting Time and Date 12 8 Cleaning the R Series Unit 12 8 Loading Stripchart Paper 12 9 Cleaning the Print Head 12 10 Operator s Checklist for R Series P...

Page 8: ...or Defibrillation of Ventricular Fibrillation VF and Ventricular Tachycardia VT A 25 Randomized Multi Center Clinical trial for Cardioversion of Atrial Fibrillation AF A 26 Synchronized Cardioversion...

Page 9: ...Series is a versatile manual advisory external defibrillator When operating in the manual configuration the device operates as a conventional defibrillator where the device s charging and discharging...

Page 10: ...cm diagonal display which provides high contrast and visibility under virtually all lighting conditions Operating and warning messages are displayed on the monitor and the unit can also be configured...

Page 11: ...mage If the shipping container or cushion material is damaged keep it until the contents have been checked for completeness and the instrument has been checked for mechanical and electrical integrity...

Page 12: ...t connection Defibrillator proof type CF patient connection Fusible link Equipotentiality Alternating current AC Direct current DC Contains lithium Recycle or dispose of properly Keep away from open f...

Page 13: ...equipment WEEE Do not dispose of in unsorted trash Date of manufacture Use by Latex free Do not reuse Do not fold Not sterile Nonionizing electromagnetic radiation from Wi Fi during data transfer Manu...

Page 14: ...Series product contains a direct current DC defibrillator capable of delivering up to 200 joules It may be used in synchronized mode to perform synchronized cardioversion using the patient s R wave a...

Page 15: ...minute Voice and visual prompts encourage a compression depth in accordance with AHA and or ERC recommendations of 2 inches 5 cm minimum for adult patients Defibrillator Complications Inappropriate d...

Page 16: ...with these operating instructions Intended Use Pacemaker This product can be used for temporary external cardiac pacing in conscious or unconscious patients as an alternative to endocardial stimulati...

Page 17: ...ve responses tachycardia or fibrillation in the presence of generalized hypoxia myocardial ischemia cardiac drug toxicity electrolyte imbalance or other cardiac diseases Pacing by any method tends to...

Page 18: ...the CAPNOSTAT 5 Mainstream CO2 sensor attached to an airway adapter that connects to an endotracheal tube mask or disposable mouthpiece The R Series EtCO2 option is designed to monitor adult pediatri...

Page 19: ...ived from electrodes within particular OneStep electrodes While ECG signals acquired from these leads are appropriate for rhythm assessment and determining electrical capture during pacing they should...

Page 20: ...ays check the expiration date on the electrode packaging Do not use expired electrodes which might result in false patient impedance readings and affect the level of delivered energy or cause burns Th...

Page 21: ...provide an interface that communicates the electrode s expiration date and condition to the defibrillator The Defib Test Log stores the results for as many as 1000 defibrillator tests in internal memo...

Page 22: ...sources Defibrillator failures attributable to the use of pacing defibrillation electrodes or adapters not manufactured by ZOLL might void ZOLL s warranty Do not disassemble the unit A shock hazard ex...

Page 23: ...electrodes directly over an implanted pacemaker The R Series unit detects ECG electrical signals only It does not detect a pulse effective circulatory perfusion Always verify pulse and heart rate by p...

Page 24: ...of the R Series defibrillator could reduce the level of safety of the combined system When choosing accessory equipment consider the following Use of the accessory in the patient vicinity Evidence th...

Page 25: ...30 minutes particularly in neonates or adults with severely restricted blood flow may cause burns Periodically inspect the skin under the electrodes Carefully route the patient cables to reduce the p...

Page 26: ...line cord supplied by ZOLL Dispose of battery packs in accordance with national regional and local regulations Battery packs should be shipped to a reclamation facility for recovery of metal and plast...

Page 27: ...tion new location and or organization if known and different from originator s organization company name address contact name and contact phone number 4 Date when the change took effect Please address...

Page 28: ...the express written permission of ZOLL Medical Corporation 4 Use Restrictions As the Purchaser you may physically transfer the products from one location to another provided that the software firmware...

Page 29: ...Be sure the assigned service request number appears on each package The ZOLL Serial Number Each ZOLL product displays a serial number that contains information about that product From left to right ZO...

Page 30: ...e last character of the date of manufacture code gives the month in which the product was manufactured The month appears in the form of a single alphanumeric character A for January B for February C f...

Page 31: ...1 Chapter 2 Product Overview Defibrillator Controls and Indicators LEAD SIZE ANALYZE CHARGE SHOCK ENERGY SELECT RECORDER ALARM SUSPEND OUTPUT mA RATE ppm 4 1 PACER OFF MONITOR DEFIB SpO2 Front Left R...

Page 32: ...details refer to Event Records and Reports on page 10 1 7 Data card slot Holds a compact flash card for copying data stored in the device s internal memory Accepts a CF memory card or a WiFi card 8 De...

Page 33: ...me and softkey labels Battery indicator Indicates battery status Steady yellow Battery is charging Steady green Battery is charged Alternating yellow and green No battery is installed or there is a ba...

Page 34: ...2 and P3 when using OneStep Pacing electrodes or OneStep Complete electrodes with OneStep Pacing cable for display The PADS or PADDLES lead setting is automatically selected when the defibrillator pow...

Page 35: ...0915 01 Messages and prompts Labels above the softkeys appropriate to the context CPR Index and Release Bar CPR Rate and Depth Figure 2 2 shows the layout of parameter values waveforms system data an...

Page 36: ...then on and recheck operation If the fault persists contact your authorized ZOLL agent as described on page 1 21 Options Param Code Marker Report Data Alarms 11 24 72 ECG I x1 SpO2 0 00 IDLE Depth Ra...

Page 37: ...se a 3 or 5 lead ECG cable Connector Description OneStep Cable For connecting paddles or ZOLL hands free therapy and pacing electrodes using either OneStep or OneStep Pacing cables ECG For connecting...

Page 38: ...ep Cables OneStep Cable Manager Optional As an option the OneStep Cable Manager is available to store and organize cables Figure 2 5 The R Series with the Optional OneStep Cable Manager Side View OneS...

Page 39: ...ternal paddles on the R Series device are used for defibrillation and synchronized cardioversion Caution You cannot use paddles for ECG analysis or pacing Defibrillation paddles can be used for ECG mo...

Page 40: ...direction of the arrow and unplug the OneStep cable Refer to Chapter 3 Manual Defibrillation before using paddles for defibrillation The paddles include controls for selecting defibrillation energy c...

Page 41: ...or navigating through the menus and making selections and entries Figure 2 11 Example Display Screen On the display highlighting indicates the currently selected item that is the item or value you are...

Page 42: ...Mentor softkey or turn the Mode Selector to OFF DEFIB or PACER Note After 60 seconds of non use in the Mentor mode the R Series returns to MONITOR mode Softkey Action Next Item Next Field Moves the h...

Page 43: ...d of the battery pack inward and lift the battery pack out of the compartment Figure 2 12 Removing a Battery Pack To install a battery pack 1 Place the end of the battery pack opposite the tab into th...

Page 44: ...manually adding code markers which itemize drugs or treatments administered to the patient Up to six Code Markers can be displayed on the screen at one time Figure 2 14 Code Markers The right most sof...

Page 45: ...s When defibrillating with paddles use your thumbs to operate the SHOCK buttons in order to avoid inadvertent operator shock No portion of the hands should be near the paddle plates Determine the Pati...

Page 46: ...ook at the Display and verify the energy is appropriate Unless internal handles are connected to the OneStep cable the default energy selections for adult patients are Shock 1 120 joules Shock 2 150 j...

Page 47: ...d delivering a shock disables the automatic escalation function Prepare Paddles Release the paddles apply a liberal amount of electrolyte gel to the electrode surface of each paddle and rub the electr...

Page 48: ...ront panel If both SHOCK buttons on the paddles are depressed when the CHARGE button is activated the unit does not charge and a RELEASE SHOCK BUTTON message appears on the display To increase or decr...

Page 49: ...ress the SHOCK buttons Failure to do so could result in the inadvertent depression of the ENERGY SELECT buttons causing the defibrillator to disarm itself Once the energy is delivered the display simu...

Page 50: ...n and are not covering any part of the ECG electrodes Connect the hands free therapy electrodes to the OneStep cable if not preconnected If defibrillation electrodes are not making good contact with t...

Page 51: ...defaults to 120 joules or the preconfigured first shock energy selection PADS are selected as the ECG source when the instrument is turned to MONITOR or DEFIB and paddles are not connected to the OneS...

Page 52: ...Shocks 1 2 and 3 to escalating energy levels see the R Series Configuration Guide for instructions the R Series automatically sets the energy to the preconfigured Energy Level Shock 1 2 3 setting at...

Page 53: ...ights A distinctive charge ready tone sounds and the DEFIB XXXJ READY is displayed The defibrillator is now ready to discharge 3 Deliver Shock WARNING Warn all persons in attendance of the patient to...

Page 54: ...cate the selected energy level Autoclavable Electrodes ZOLL Autoclavable Internal Handles are designed for use with a manually operated ZOLL defibrillator to defibrillate the heart during open chest p...

Page 55: ...d deliver treatment to the patient when required by protocol and patient condition The advisory function can be activated only when Hands free therapy electrodes are connected and selected as the ECG...

Page 56: ...nstructions on the electrode packaging and as described in Therapy Electrode Application on page 3 6 Ensure that the electrodes are making good contact with the patient s skin and are not covering any...

Page 57: ...oth Adult and Pediatric modes If medical protocols allow you may select a different energy level using the energy select up and down arrow buttons on the front panel The new energy setting displays on...

Page 58: ...a shockable rhythm the unit alerts the operator that no shock is advised WARNING ECG rhythm analysis does not warn of patient asystole which is not a shockable rhythm When a nonshockable rhythm is det...

Page 59: ...even if the advisory function issues a NO SHOCK ADV message 3 Press SHOCK WARNING Warn all persons in attendance of the patient to STAND CLEAR prior to defibrillator discharge Do not touch the bed pa...

Page 60: ...deliver the shock within this 60 second interval or the defibrillator will disarm itself Press and hold the illuminated SHOCK button on the front panel until energy is delivered to the patient An XXXJ...

Page 61: ...detects a noisy ECG signal during ECG analysis Check and adjust electrode placement and cable connections to help eliminate the noise source Keep patient motionless during ECG analysis Press the ANALY...

Page 62: ...CHAPTER 4 ADVISORY DEFIBRILLATION 4 8 www zoll com 9650 0912 06 Rev G This page intentionally left blank...

Page 63: ...cardia atrial fibrillation and atrial flutter require synchronizing the defibrillator discharge with the ECG R wave to avoid the induction of ventricular fibrillation In this case a synchronizing Sync...

Page 64: ...fferent Make sure to follow the instructions for Remote Synchronized Cardioversion on page 5 5 Synchronized Cardioversion Procedure Determine the Patient s Condition and Provide Care Following Local M...

Page 65: ...duced by moving the paddles may resemble an R wave and trigger defibrillator discharge at the wrong time 1 Select DEFIB Turn the Mode Selector to DEFIB Select the desired energy using the up and down...

Page 66: ...ion if desired Refer to the R Series Configuration Guide for instructions 2 Charge Defibrillator Press the CHARGE button on the front panel or on the apex paddle handle To abort charging and increase...

Page 67: ...XXJ SEL message remains to indicate the selected energy level If additional countershocks are necessary readjust the energy level as necessary press the Sync On Off softkey followed by the Sync softke...

Page 68: ...evel is displayed on the monitor The words REMOTE SYNC are displayed in place of the ECG trace and a REMOTE SYNC XXXJ SEL message appears on the display The ECG heartbeat indicator will flash with eac...

Page 69: ...tes A distinctive audible tone sounds and the energy ready REMOTE SYNC XXXJ READY message is displayed The defibrillator is now ready to deliver therapy 3 Deliver SHOCK WARNING Warn all persons in att...

Page 70: ...remains to indicate the selected energy level If additional countershocks are necessary readjust the energy level as necessary press the Sync On Off and then the Remote Sync softkeys and repeat Note...

Page 71: ...s the R Series unit can provide rescuers with feedback about the quality of CPR they are delivering to their patients The way in which feedback is provided varies with respect to the operational mode...

Page 72: ...efforts Following the cessation of compressions the Index s fill level gradually decreases until a hollow outline is displayed after a short period of time When complete filling of the CPR Index has n...

Page 73: ...chest compressions are detected and their rate falls below the AHA ERC recommended levels When compressions are being performed at 80 compressions per minute or higher the metronome is silent Should...

Page 74: ...istent basis the unit will issue a Good Compressions prompt See the R Series Configuration Guide for information on enabling disabling CPR voice prompts CPR Voice prompts are unavailable while using P...

Page 75: ...he presence of CPR artifact Diagnostic bandwidth is never applied to the See Thru CPR waveform See Thru CPR enables the rescuer to see a close approximation of the patient s underlying ECG rhythm whil...

Page 76: ...conditions noted above occurs See Thru CPR filtering stops and unfiltered ECG signals are displayed When compressions resume filtering automatically restarts after 3 to 6 chest compressions Note There...

Page 77: ...s rhythm during CPR compressions When the CPR filter turns on the Fine VF rhythm becomes more obvious FineVF 0 00 0 12 Raw ECG Raw ECG Filtered ECG Filtered ECG CPR CPR Filter ON FineVF 0 12 0 24 Raw...

Page 78: ...n When viewing this ECG it is possible to view the underlying rhythm as the filter is able to reject all of the CPR artifact CoarseVF 0 00 0 12 Raw ECG Raw ECG Filtered ECG Filtered ECG CPR CPR Coarse...

Page 79: ...er ripples from the CPR signal About 14 seconds into this chart the rhythm changes to asystole which could easily be mistaken for coarse VF When the CPR filter turns on the CPR compression ripples are...

Page 80: ...ee Thru CPR effectively filters out artifact created by CPR SinusRhythm 0 00 0 12 Raw ECG Raw ECG Filtered ECG Filtered ECG CPR CPR Filter ON SinusRhythm 0 12 0 24 Raw ECG Raw ECG Filtered ECG Filtere...

Page 81: ...0 minutes particularly in neonates or adults with severely restricted blood flow may cause burns Periodic inspection of the underlying skin is recommended If the unit was NOT turned off and less than...

Page 82: ...hest hair clip it to ensure proper adhesion of the electrodes 1 Apply ECG Electrodes Hands Free Therapy Electrodes The R Series supports two electrode configurations for pacing OneStep Pacing Configur...

Page 83: ...a clean well defined ECG signal Note When the OneStep Pacing electrode configuration is used and the unit is switched to PACER mode P3 is automatically selected as the ECG source When separate ECG el...

Page 84: ...lation is effective capture the output mA value is displayed The pacer output increments and decrements by a value of 2 mA on the display when the knob is turned Note When the unit is switched out of...

Page 85: ...R Series display with its ECG connection directly attached to the patient Use of other ECG monitoring devices might provide misleading information due to the presence of pacer artifacts Mechanical ca...

Page 86: ...cing stimuli thereby allowing you to observe the patient s underlying ECG rhythm and morphology When depressed this button causes pacing stimuli to be delivered at of the indicated ppm setting Pace Fa...

Page 87: ...cribed on page 8 2 To use the device in standby mode 1 Establish effective pacing see instructions on previous pages Note the mA output at capture and run an ECG stripchart to document ECG morphology...

Page 88: ...asynchronously pacing with an ECG LEAD OFF condition the rate and mA should be set at the known capture level or high enough 100mA to presume capture Pediatric Pacing Noninvasive pacing of pediatric...