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MRx Training with Q-CPR. ROC Refresher & EMT/ EKG monitoring parameters. System Components. Therapy/CPR Cable. Compression Sensor. MRx Defib Pads. Basic Orientation. Ready for use indicator Therapy knob Charge Button Shock Button Printer Printer button Speaker. - PowerPoint PPT Presentation
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MRx Training with Q-CPRMRx Training with Q-CPR
ROC RefresherROC Refresher
&&
EMT/ EKG monitoring parametersEMT/ EKG monitoring parameters
System ComponentsSystem Components
Therapy/CPR Cable
MRx Defib Pads
Compression Sensor
Basic OrientationBasic Orientation
Ready for use indicatorReady for use indicator
Therapy knobTherapy knob
Charge ButtonCharge Button
Shock ButtonShock Button
PrinterPrinter
Printer buttonPrinter button
SpeakerSpeaker
Basic Orientation cont.Basic Orientation cont.
Menu select buttonMenu select button
Navigation buttonsNavigation buttons
4 soft keys4 soft keys
Event summaryEvent summary
Alarm pauseAlarm pause
Lead selectLead select
Event mark buttonEvent mark button
Patient connectionsPatient connections
Monitoring on the LeftMonitoring on the Left
3-lead patient cables3-lead patient cables
Spare electrodesSpare electrodes
Defib on the RightDefib on the Right
Patient / defib cablePatient / defib cable
Q-CPR puckQ-CPR puck
Shock test load plugShock test load plug
Defib patchesDefib patches
RazorRazor
Ready For Use IndicatorReady For Use IndicatorBlinking Black Hourglass – Shock, pacing, and ECG are ready for use and sufficient battery power is available
Blinking Red X with a periodic chirp – Low battery that is not being charged
Blinking Red X without a periodic chirp – Low battery that is being charged
Solid Red X with a chirp – A failure has been detected that may prevent delivery of a shock, pacing, or ECG acquisition
X
Solid Red X without a chirp – No power or device failure
X
Compression MeasurementCompression Measurement
The sensor is…• Reusable• Easy to clean• Acts as landmark• Goes where your hands would go• Weighs 8 Ounces
What the sensor does…• Detects motion using and accelerometer
Compression Sensor
Compression MeasurementCompression Measurement
Compression Sensor
Measurements:• Compression Depth• Compression Rate• Leaning (incomplete release)• Duty Cycle (duration)• No Flow Time (inactivity timer)
Sensor Adhesive Pad
Compression MeasurementCompression Measurement
• Compression rate is moving average of last 3 compressions• Target compression depth of 1.5 - 2 inches indicated by lines• Incomplete release (“Leaning”) is indicated by “*” on waveform
Ventilation MeasurementVentilation Measurement
A new role for our multifunction pads…• Detect changes in chest impedance that correlate to ventilation volume
Min.
Max.Typical
Impedance Change (Ohms)
Volu
me (
ml per
Kg)
This is a new applicationof a proven principle
Ventilation MeasurementVentilation Measurement
• Ventilation rate is moving average of last 3 ventilations• Ventilation Volume Icon shows 0, 1/3, 2/3 or 1+ of the target volume• Inactivity timer -- “30 Seconds without ventilation”
Real-Time FeedbackReal-Time Feedback
Q-CPR Feedback is…• Corrective -- it speaks up only when you need it• Prioritized -- based on clinical importance• User Friendly -- user is given time to react (3-4 sec.)
Real-Time FeedbackReal-Time Feedback
Compressions:1. Incomplete Release2. Compression depth shallow3. Compression rate slow or fast4. Compression depth deep5. Duty Cycle Ventilations:1. Volume low2. Frequency high or low3. Inflation time fast or slow
* These priorities were set based on an evaluationof published research data.
Clinical Priorities*
Batteries and the MRXBatteries and the MRX
M3538A Lithium Ion BatteriesM3538A Lithium Ion Batteries
Batteries should be used as primary power Batteries should be used as primary power source.source.Fully charged battery will last 5-hours or 50-Fully charged battery will last 5-hours or 50-shocks.shocks.No memory build up but should not be No memory build up but should not be allowed to go dead.allowed to go dead.Fuel cell is broken up into 5 LED’s or 20%Fuel cell is broken up into 5 LED’s or 20%Full charge takes about 2-3 hoursFull charge takes about 2-3 hoursLife expectancy is 2-yearsLife expectancy is 2-years
Maintenance ActivitiesMaintenance Activities
Observe Ready for Use indicator.Observe Ready for Use indicator.
Once a week, perform an Operational Check Once a week, perform an Operational Check and Shock Test.and Shock Test.
Care for batteries.Care for batteries.
Clean MRx and accessories.Clean MRx and accessories.
Performing an Operational CheckPerforming an Operational Check
1.1. Insert a charged battery (Insert a charged battery (>> 20%). 20%).
2.2. Turn the Therapy Knob to Turn the Therapy Knob to MonitorMonitor..
3.3. Press the Menu Select button.Press the Menu Select button.
4.4. Using the Navigation buttons, Using the Navigation buttons, select select OtherOther..
5.5. Select Select Operational CheckOperational Check..
6.6. Respond to the prompts.Respond to the prompts.
Operational Check Report
Operational Check SummaryOperational Check Summary
Shows results of the last 60 Operational ChecksShows results of the last 60 Operational Checks
To print:To print:
1.1. Select Select OtherOther from the Main menu. from the Main menu.
2.2. Select Select Op Check SummaryOp Check Summary..
3.3. Press the Press the [Print][Print] soft key. soft key.
Data Transfer to cardData Transfer to card
Turn MRX to MonitorTurn MRX to MonitorPress the Menu ButtonPress the Menu ButtonSelect “Other” then Select “Data Select “Other” then Select “Data Management”Management”Press Menu & acknowledge the messagePress Menu & acknowledge the messageSelect appropriate “EVENT”Select appropriate “EVENT”Press “Menu” then select “Copy”Press “Menu” then select “Copy”Place Data card in Defib Envelope!Place Data card in Defib Envelope!
Questions about the MRX???Questions about the MRX???
ROC SitesROC Sites
CPR ReportingCPR Reporting
BLS & ALS MIRF’sBLS & ALS MIRF’s
BLS AED Data card & ALS card if placed prior to BLS AED Data card & ALS card if placed prior to ROSCROSC
Dispatch / RMS reportDispatch / RMS report
ROC Protocol check sheetROC Protocol check sheet
Phone call to ROC Study within 1 hourPhone call to ROC Study within 1 hour
Data transfer to County server within 24-hoursData transfer to County server within 24-hours
TopicsTopics
ROC Study ProtocolsROC Study Protocols
1.1. Purpose of an ITD ValvePurpose of an ITD Valve2.2. Analyze Early or Analyze LateAnalyze Early or Analyze Late
ITD ValveITD Valve• Impedance Threshold
Device
2
• ITD is a circulation adjunct not a ventilation adjunct.
• Increases blood flow back to the heart during the recoil phase of chest compression.
Analyze Early/Analyze LateAnalyze Early/Analyze Late• Analyze Early:
– 1 round (30 compressions) of priming before AED analysis
– Business as usual in King County
• Analyze Late:
– Longer period of priming before AED analysis
– 3 minutes of CPR before first analysis
2
Target Population: ITD and AE/ALTarget Population: ITD and AE/AL
Patients 18 years of age or greater who suffer non-traumatic cardiopulmonary arrest outside of hospital.
Enroll all NON-traumatic CPR cases, Enroll all NON-traumatic CPR cases,
EXCEPT…
Exclusion Criteria: ITD and Exclusion Criteria: ITD and AE/ALAE/AL
Known Pregnancy
DNAR orders in place
Known Prisoner / In Custody
Less than 18 years of age
Trauma cardiac arrest
Exclusion Criteria: Exclusion Criteria: Specific to ITDSpecific to ITDTracheostomy present
AE/AL use is appropriate in this case. AE/AL use is appropriate in this case.
Exclusion Criteria: Exclusion Criteria: Specific AE/ALSpecific AE/ALAnalyze early or analyze late should NOT be Analyze early or analyze late should NOT be used if:used if:
EMS-witnessed arrest
AED applied by non-ROC agency (lay person/police/private AMB)
ITD use is appropriate in both cases. ITD use is appropriate in both cases.
Removal of ITDRemoval of ITD
Remove ITD immediately if:
1. Patient gets a pulse (ROSC)
2. Device fills with fluid twice, or cannot be cleared
3. Arrival at ED
4. No chest rise with patent (open) airway
1 round1 round of of CPR/Attach ITD CPR/Attach ITD
valvevalve
1 round1 round of of CPR/Attach ITD CPR/Attach ITD
valvevalveShock Shock
(if (if indicated)indicated)
Shock Shock (if (if
indicated)indicated)
CPR CPR ProtocolProtocol
CPR CPR ProtocolProtocol
Study Protocol #1—Analyze EarlyStudy Protocol #1—Analyze Early
3 minutes3 minutes of of CPR/Attach ITD valveCPR/Attach ITD valve
3 minutes3 minutes of of CPR/Attach ITD valveCPR/Attach ITD valve
CPR CPR ProtocolProtocol
CPR CPR ProtocolProtocol
Study Protocol #2—Analyze LateStudy Protocol #2—Analyze Late
Shock Shock (if (if
indicated)indicated)
Shock Shock (if (if
indicated)indicated)
EMT / EKG MONITORINGEMT / EKG MONITORING
Questions?????Questions?????
What do we need to know about EKG’s?What do we need to know about EKG’s?
What “Guidelines” should we use to place the What “Guidelines” should we use to place the monitor on someone?monitor on someone?
Electro what???Electro what???
Rate ?Rate ? Slow – Normal – FastSlow – Normal – Fast
P wave?P wave? Present or absentPresent or absent
Regular ?Regular ? Regular or irregular spacingRegular or irregular spacing
Narrow or Wide?Narrow or Wide? Width of QRS?Width of QRS?
Rhythm?Rhythm? Who cares anyways????Who cares anyways????
Basic Normal PathwaysBasic Normal Pathways
P QRS TP QRS T
Normal Sinus RhythmNormal Sinus Rhythm
OH, the boxes mean something??OH, the boxes mean something??
What’s the rate???What’s the rate???
BradycardiaBradycardia
Irregularly IrregularIrregularly Irregular
Atrial FibrillationAtrial Fibrillation
Atrial FlutterAtrial Flutter
Atrial FlutterAtrial Flutter
Supraventricular TachycardiaSupraventricular Tachycardia
Narrow Complex TachycardiaNarrow Complex Tachycardia
Ventricular TachycardiaVentricular Tachycardia
Wide Complex TachycardiaWide Complex Tachycardia
Ventricular FibrillationVentricular Fibrillation
Frequency - TachyarrhythmiaFrequency - Tachyarrhythmia Amplitude - MinimumAmplitude - Minimum Waveform - Chaotic, Varying, Wide, Waveform - Chaotic, Varying, Wide,
UnorganizedUnorganized
What is it ??What is it ??
What is it ??What is it ??
What is it ??What is it ??
What is it? What is it?
What is it?What is it?
What is it?What is it?
What is it?What is it?
What is it?What is it?
What is it?What is it?
What is it?What is it?
EMT / EKG MONITORINGEMT / EKG MONITORING
Answers!!!!Answers!!!!
1.1. What do we need to know about EKG’s?What do we need to know about EKG’s?Is there a pulse with every QRS?Is there a pulse with every QRS?
How fast or How slow is it?How fast or How slow is it?
Is it wide or narrow?Is it wide or narrow?
2.2. What “Guidelines” should we use to place What “Guidelines” should we use to place the monitor on someone?the monitor on someone?
A medical patient who you need to evaluate for a potential arrhythmia….. A medical patient who you need to evaluate for a potential arrhythmia….. Who is that?Who is that?
NEVER USE IT TO DECIDE IS THIS A HEART PROBLEM OR NOT!!!NEVER USE IT TO DECIDE IS THIS A HEART PROBLEM OR NOT!!!
When in doubt ask for assistance……… When in doubt ask for assistance………
Any Questions?Any Questions?
Thank YouThank You
& &
Good Luck!!!!!Good Luck!!!!!