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Philips HeartStart MRx Instructions For Use Manual

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M3535A/M3536A
Instructions for Use
HeartStart MRx

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  Summary of Contents for Philips HeartStart MRx

  • Page 1 M3535A/M3536A Instructions for Use HeartStart MRx...
  • Page 3: Table Of Contents

    Table of Contents 1 Introduction Overview Intended Use Indications for Use AED Therapy Manual Defibrillation Noninvasive External Pacing Therapy Pulse Oximetry Noninvasive Blood Pressure Monitoring End-tidal CO 12-Lead ECG Q-CPR Invasive Pressures Temperature Safety Considerations Documentation and Training 2 Getting Acquainted Basic Orientation Front Panel Side Panels...
  • Page 4 High Contrast Display Controls Therapy Knob General Function Buttons Defibrillation Controls Soft Keys Indicators Audio Recording Reviewing Recorded Audio Alarms Responding to Alarms Entering Patient Information Continued Use Printing Waveforms Return to Owner 3 Setting Up Attaching the Carrying Case and Accessory Pouches Storing Accessories Connecting the ECG Cable Connecting the SpO...
  • Page 5 Heart Rate and Arrhythmia Alarms Arrhythmia Alarm Latching INOP Messages Setting Alarms Changing Heart Rate or VTACH Alarm Limits Enabling/Disabling Heart Rate and Arrhythmia Alarms Responding to HR and Arrhythmia Alarms Displaying an Annotated ECG Arrhythmia Learning/Relearning Troubleshooting 5 Semi-Automated External Defibrillation Precautions for AED Therapy AED View Preparation...
  • Page 6 7 Noninvasive Pacing Overview Alarms Pacing View Demand Mode Versus Fixed Mode Preparing for Pacing Demand Mode Pacing Fixed Mode Pacing Defibrillating During Pacing Troubleshooting 8 Pulse Oximetry Overview Understanding Pulse Oximetry Selecting a Sensor Applying the Sensor Monitoring SpO Pleth Wave Alarms Changing the SpO...
  • Page 7 Using the FilterLine and Airway Adapter Measuring EtCO EtCO and AwRR Alarms Changing the EtCO Alarm Limits Enabling/Disabling the EtCO Alarms Changing the AwRR Alarm Limits Changing the Apnea Time Alarm Limit Enabling/Disabling AwRR Alarms Disabling the EtCO Monitoring Function Troubleshooting 11 Invasive Pressures Overview...
  • Page 8 14 12-Lead ECG Transmission Overview Setting Up for Bluetooth Transmission Adding a Bluetooth Device Pairing a Bluetooth Device with the HeartStart MRx Changing Bluetooth Profiles Additional Bluetooth Device Information Transmitting to a Configured Site using Bluetooth Setting Up for RS 232 Transmission...
  • Page 9 16 Q-CPR and Data Capture Overview Preparing to Use Q-CPR Connecting the Pads/CPR Cable Connecting the Compression Sensor to the Pads/CPR Cable Attaching the Compression Sensor Adhesive Pad Applying Multifunction Electrode Pads Placing the Compression Sensor on the Patient Using Q-CPR in Manual Defib Mode Compression Waveform Parameter Block 2 Soft Keys...
  • Page 10 19 Maintenance Overview Automated Tests Automated Test Summary Ready For Use Indicator Shift Checklist Weekly Shock Test HeartStart MRx Shift Checklist Operational Check Performing the Operational Check Operational Check Setup Operational Check Report User Checks Operational Check Summary Battery Maintenance...
  • Page 11 21 Specifications and Safety Specifications General Defibrillator Manual Defib Mode AED Mode ECG and Arrhythmia Monitoring Display Battery Thermal Array Printer Noninvasive Pacing SpO2 Pulse Oximetry Invasive Pressures Temperature EtCO2 AwRR Calibration Gas for CO Measurement System 12-Lead ECG Patient Data Storage Environmental (M3535A) Environmental (M3536A) Symbol Definitions...
  • Page 12 Emissions and Immunity Guidance and Manufacturer’s Declaration Recommended Separation Distances Index...
  • Page 13 Andover, MA 01810 USA defibrillation and look for part number M3535-91900. Authorized EU-representative Philips shall not be liable for errors contained herein or Philips Medizin Systeme Böblingen GmbH for incidental or consequential damages in connection Hewlett Packard Str. 2 with the furnishing, performance, or use of this material.
  • Page 14 These Instructions for Use contain the following conventions: Warning statements describe conditions or actions that can result in personal injury or loss of life. WARNING CAUTION Caution statements describe conditions or actions that can result in damage to the equipment or loss of data.
  • Page 15: Introduction

    Be sure to familiarize yourself with the features and operation of the 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).
  • Page 16: Intended Use

    HeartStart Event Review Pro or Q-CPR Review. 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”...
  • Page 17: Indications For Use

    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.
  • Page 18: Q-Cpr

    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: •...
  • Page 19: 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 273. Additional warnings and cautions specific to a particular feature are provided in the appropriate section of this guide.
  • Page 21: Getting Acquainted

    It also provides general information on use of the device. 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.
  • Page 22: Basic Orientation

    Additional controls and indicators are on the paddles (if used) and batteries. A palette of colored decals is included with your HeartStart MRx. These colored decals may be applied N O TE to the label recesses located on the device handle to aid in identification. Use an indelible marker to...
  • Page 23: Side Panels

    The right side of the HeartStart MRx has a therapy port for paddles (external or internal) or multifunction electrode pads. It also has a slot for a data card to transfer patient information.
  • Page 24: Top Panel

    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)
  • Page 25: Back Panel

    2 Getting Acquainted Back Panel The back panel of the HeartStart MRx has two compartments for lithium ion batteries. Compartment B may instead be used to connect an AC power module. Between the battery compartments is a DC Power Input port.
  • Page 26: M3538A Lithium Ion Battery

    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 approximately 20% of capacity. Press the fuel gauge button to illuminate the fuel gauge.
  • Page 27: Password Security

    Soft Keys E xit Pictures of the HeartStart MRx display appearing in this manual are for illustration purposes only. The N O TE content of these areas varies with the display view, the options on your device and the function being...
  • Page 28: General Status

    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 or the HeartStart MRx is pacing the patient. In Pacer Mode, Paced status is not displayed.
  • Page 29: Wave Sectors

    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.
  • Page 30: Wave Sectors

    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.
  • Page 31: Menus

    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.
  • Page 32: High Contrast Display

    181 for more information. 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.
  • Page 33: General Function Buttons

    Controls 2 Getting Acquainted 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.
  • Page 34: Defibrillation Controls

    In AED mode a 150J shock is delivered. In Manual Defib Mode, the shock is delivered at the selected Manual Defib energy setting. When external paddles or switched internal paddles are used, once the HeartStart MRx is fully N O TE charged, the shock is delivered by pressing the Shock button(s) on the paddles.
  • Page 35: Indicators

    This is normal operation, as the device is switching its power source to the battery for a faster charge time. The AC Line Filter default setting of all HeartStart MRx devices is 60 Hz. You should adjust the AC N O TE Line Filter default to the electric power frequency of your country.
  • Page 36: Audio Recording

    Reviewing Recorded Audio To review the recorded audio: • Copy the event data from the HeartStart MRx internal memory to an external data card. See the “Data Management” chapter on page 203 for information. • Import the data into the Q-CPR Review application. See the Q-CPR Review Directions for Use for...
  • Page 37: Alarms

    If multiple same-parameter, same-priority alarms occur, all alarms will be displayed. Audio is suppressed for INOP alarms for the first 60 seconds after the HeartStart MRx is turned on. N O TE INOP messages do appear on the display.
  • Page 38 INOPs do not reannunciate after pressing audio off. Figure 13 Audio Pause Label AUDIO PAUSE Then: Address the alarm condition on the HeartStart MRx. The menu shown in Figure 14 appears. Figure 14 Sample Alarm Response Menu SpO2 Alarm Alarms Off Acknowledge New Limits Alarms Off Turns the monitoring parameter’s alarms off and prevents future parameter alarms from...
  • Page 39: Entering Patient Information

    • 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.
  • Page 40: Printing Waveforms

    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 CO ) will include scale indications on the printout.
  • Page 41: 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.
  • Page 43: Setting 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. If your HeartStart MRx does not have some of the optional functionality or accessory pouches listed in N O TE this chapter, disregard these features and related information.
  • Page 44 3 Setting Up Attaching the Carrying Case and Accessory Pouches Fold the two sleeve flaps over the top of the device, positioning them so that the screw holes are exposed. Replace the paddle tray or cap plate, as appropriate, so that the molded openings fit over the sleeve flaps.
  • Page 45: Storing Accessories

    Storing Accessories 3 Setting Up Storing Accessories Suggested parameter cabling and accessories storage is shown below. Figure 16 Storing Accessories...
  • Page 46 Some devices may come with the cut-outs already made. Figure 17 Connecting Cables When using the carry bag to transport the HeartStart MRx, it is important to position it with the WARNING display facing away from the body. If not, the Therapy Knob may be bumped and inadvertently moved...
  • Page 47: Connecting The Ecg Cable

    Connecting the ECG Cable 3 Setting Up Connecting the ECG Cable To connect a 3-, 5- or 10-lead cable: Align the ECG cable with the white ECG port, as shown in Figure 18. The white key marker on the ECG cable faces the top of the device. Push the ECG cable firmly into the ECG port, until the white portion of the cable connector is no longer visible.
  • Page 48: Connecting The Spo 2 Cable

    Hold the cable connector with the flat side facing front, as shown in Figure 19. Insert the cable into the blue SpO port on the HeartStart MRx and push until the blue portion of the cable connector is no longer visible.
  • Page 49: Connecting The Nbp Interconnect Tubing

    Connecting the NBP Interconnect Tubing 3 Setting Up Connecting the NBP Interconnect Tubing To connect the NBP Interconnect Tubing: Insert the NBP Interconnect Tubing into the red NBP port as shown in Figure 20. Attach the NBP Interconnect Tubing fitting to the NBP cuff. Figure 20 Connecting NBP Interconnect Tubing / NBP Cuff...
  • Page 50: Connecting The Invasive Pressures Cable

    Insert the invasive pressure cable into either of the invasive pressure ports as shown in Figure 21. Attach the invasive pressure cable to your transducer/tubing. Assign a label to the connection on the HeartStart MRx. Figure 21 Connecting Invasive Pressure Cable...
  • Page 51: Connecting The Temperature Cable

    Connecting the Temperature Cable 3 Setting Up Connecting the Temperature Cable To connect the temperature cable: Insert the temperature cable into the temperature port as shown in Figure 22. If needed, attach the cable to your probe. Figure 22 Connecting the Temperature Cable...
  • Page 52: Connecting The Co 2 Filterline

    3 Setting Up Connecting the CO FilterLine Connecting the CO FilterLine ® To connect the CO FilterLine Using the end of the FilterLine fitting, slide the CO compartment door down. Insert the fitting into the CO Inlet port as shown in Figure 23. Turn the fitting clockwise into place.
  • Page 53: Connecting The Therapy Or Pads/Cpr Cables

    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: Align the white pointer on the cable with the white arrow on the green Therapy port as shown in Figure 24.
  • Page 54: Installing Paper

    3 Setting Up Installing Paper Installing Paper 50mm Printer To install printer paper: Open the printer door by pushing on the latch as shown in Figure 25. If there is an empty or low paper roll in the printer, pull up on the roll to remove it. Place 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.
  • Page 55: 75Mm Printer (Optional)

    Installing Paper 3 Setting Up 75mm Printer (optional) To install printer paper: Open the printer door by pushing on the latch as shown in Figure 26. If there is an empty or low paper roll in the printer, pull up on the tab holding the paper roll to remove it.
  • Page 56: Installing Batteries

    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 273, prior to using the M3538A Lithium Ion Battery.
  • Page 57: Installing The Ac Power Module

    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: Align the M3539A AC power module in Compartment B. Insert 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.
  • Page 58: Installing The Data Card

    Insert the data card in the data card tray, sliding it under the tray clip. With the front of the tray facing forward, insert the tray fully into the data card slot located on the right side of the HeartStart MRx. Figure 29 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.
  • Page 59: Ecg And Arrhythmia Monitoring

    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.
  • Page 60: Monitoring View

    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 30 shows the information displayed in Monitoring View. Figure 30 Monitoring View 10 Feb 2006 11:20 Mark Event 02:42 I nops A rea...
  • Page 61: Preparing To Monitor Ecg

    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.
  • Page 62 Figure 31 ECG Cable Connection If monitoring via multifunction electrode pads: If not preconnected, connect the pads cable to the HeartStart MRx. See Figure 40 on page 65. Connect the pads to the pads cable. See Figure 41 on page 66.
  • Page 63: Electrode Placement

    Electrode Placement 4 ECG and Arrhythmia Monitoring Electrode Placement Figure 32 shows the typical electrode placement for a 3-lead ECG set. Figure 32 3-lead Placement RA/R placement: directly below the clavicle and RA/R near the right shoulder – LA/L – (White/ (Black/ –...
  • Page 64 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 34 (V1/C1 through V6/C6). Figure 34 V/C Electrode Placement V1/C1 placement: fourth intercostal space at right sternal margin. V2/C2 placement: fourth intercostal space at left sternal margin.
  • Page 65: Lead Selection

    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...
  • Page 66: Selecting The Lead

    The HeartStart MRx uses the ECG lead appearing in Wave Sector 1 for single-lead arrhythmia analysis. Because the ST/AR Basic Arrhythmia Algorithm is the HeartStart MRx’s cardiotach source and is N O TE needed to generate heart rate and heart rate alarms, the algorithm can never be disabled.
  • Page 67: Aberrantly-Conducted Beats

    R-wave that is as narrow as possible to minimize incorrect classifications. For more information on arrhythmia analysis, refer to the Application Note, “Arrhythmia Monitoring N O TE Algorithm” available on the web at www.medical.philips.com/goto/productdocumentation.
  • Page 68: 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 >...
  • Page 69 Heart Rate and Arrhythmia Alarms 4 ECG and Arrhythmia Monitoring Figure 37 Alarm Chain for Basic Arrhythmia Monitoring (RED ALARMS) Asystole V-Fib/V-Tach V-Tach Extreme Tachy Extreme Brady (YELLOW ALARMS) PVC Alarms Beat Detection Alarms Rate Alarms Frequent PVCs PNC* PNP* High HR Low HR First level timeout period Second level timeout period...
  • Page 70: Inop Messages

    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 INOPs Alarm Message Condition...
  • Page 71: Setting Alarms

    Figure 38 Audio Pause Label AUDIO PAUSE Then respond to the alarm condition on the HeartStart MRx. There are two ways to respond to an HR or Arrhythmia alarm: Acknowledge the alarm condition. Adjust the limits using the New Limits menu.
  • Page 72: Displaying An Annotated Ecg

    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.
  • Page 73: Arrhythmia Learning/Relearning

    • 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 249.
  • Page 75: Semi-Automated External Defibrillation

    In patients with cardiac pacemakers, the HeartStart MRx may have reduced sensitivity and not detect all shockable rhythms. The Philips HeartStart MRx AED mode is not intended for children under 8 years of age. For children N O TE S 8 years of age and older, the American Heart Association recommends that standard operating procedures for AEDs be followed.
  • Page 76: Aed View

    5 Semi-Automated External Defibrillation AED View AED View Once the Therapy Knob is moved to AED, AED View is displayed. Figure 39 AED View Display 10 Feb 2006 11:20 Mark Event Alarms Off 02:42 P ads S hocks : 0 Analyzing Do Not Touch Patient P ause...
  • Page 77: Preparation

    Preparation 5 Semi-Automated External Defibrillation Preparation Confirm that the patient is: • unresponsive • not breathing • pulseless Then: Remove clothing from the patient’s chest. Wipe moisture from the patient’s chest and, if necessary, clip or shave excessive chest hair. Make sure the multifunction electrode pads packaging is intact and within the expiration date shown.
  • Page 78 Do not use anterior-posterior pads placement (multifunction electrode pads placed on the patient’s WARNING chest and back). The AED algorithm used by the HeartStart MRx has not been validated using this placement. Do not let the multifunction electrode pads touch each other or other monitoring electrodes, lead WARNING wires, dressings, transdermal patches, etc.
  • Page 79: Using Aed 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".
  • Page 80: Step 2 - Follow The Screen And Voice Prompts

    WARNING 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.
  • Page 81: Shock Advised

    CHARGING STAND CLEAR When the HeartStart MRx is fully charged, you can disarm it any time by turning the Therapy Knob N O TE 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.
  • Page 82: Step 3 - Press The Orange Shock Button, If Prompted

    Using Q-CPR in AED mode If your HeartStart MRx is equipped with the Q-CPR option, refer to “Using Q-CPR in AED Mode” on page 174.
  • Page 83: Manual Defibrillation And Cardioversion

    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.
  • Page 84: Precautions For Manual Defibrillation Therapy

    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.
  • Page 85: Code View

    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 45.
  • Page 86: Preparing For Defibrillation

    To prepare for defibrillation using multifunction electrode pads: If 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.
  • Page 87: Using External Paddles

    Using External Paddles To defibrillate using external paddles: If 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 48.
  • Page 88: Using Pediatric Paddles

    If using switchless internal paddles, connect the paddles to the M4740A Paddle Adapter Cable. Connect 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...
  • Page 89: Defibrillating (Asynchronously)

    Clinicians must select an appropriate energy level for defibrillation of pediatric patients. 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 WARNING applied to the patient.
  • Page 90 6 Manual Defibrillation and Cardioversion Defibrillating (asynchronously) harge Charge - 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.
  • Page 91: Performing Synchronized Cardioversion

    HeartStart MRx. This connects the ECG signal from the monitor into the HeartStart MRx, where it is displayed and synchronization occurs. 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.
  • Page 92: Delivering A Synchronized Shock

    Should an ECG or pads INOP (such as Leads Off) occur while performing synchronized N O TE cardioversion, the HeartStart MRx will not charge, or if charged, will disarm automatically. Defibrillation current can cause operator or bystander injury. Do not touch the patient or equipment WARNING connected to the patient during defibrillation.
  • Page 93: Delivering Additional Synchronized Shocks

    Repeat 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.
  • Page 95: Noninvasive Pacing

    Noninvasive 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.
  • Page 96: Alarms

    (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.
  • Page 97: Pacing View

    Pacing View 7 Noninvasive Pacing Pacing View Pacing View appears when the Therapy Knob is set to the Pacer position. Figure 51 shows information displayed in Pacing View. Figure 51 10 Feb 2006 11:20 Mark Event Jones, Samuel 02:02:42 A dult T emp P ulse mm H g q 120...
  • Page 98: Demand Mode Versus Fixed Mode

    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.
  • Page 99: Preparing For Pacing

    Preparing for Pacing To prepare for pacing: If 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.
  • Page 100: Demand Mode Pacing

    Demand Mode Pacing If 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). If pacing for long periods of time, new monitoring electrodes and multifunction electrode pads should N O TE be applied periodically.
  • Page 101: Fixed Mode Pacing

    You may also stop delivery of pace pulses by moving the Therapy Knob off the Pacer position. When Pacing in demand mode, the ECG cable must be directly connected from the patient to the WARNING HeartStart MRx. If you are using the pacing function with battery power and the Low Battery Alarm is annunciated, WARNING connect the device to external power or insert a fully charged battery.
  • Page 102 7 Noninvasive Pacing Fixed Mode Pacing If you want to see the ECG waveform and related parameters while pacing, you must have electrodes N O TE on the patient with pads. Using pads only will give you an incorrect heart rate and inappropriate alarms.
  • Page 103: Defibrillating During Pacing

    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 20, “Troubleshooting” on page 249.
  • Page 105: Pulse Oximetry

    • 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 SpO while in Monitor, Manual Defib, and Pacer modes.
  • Page 106: Understanding Pulse Oximetry

    8 Pulse 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 56 shows, light emitting diodes transmit red and infrared light through peripheral areas of the body, such as a finger.
  • Page 107: Selecting A Sensor

    Selecting a Sensor 8 Pulse Oximetry Selecting a Sensor Table 9 shows the SpO sensors that may be used with the HeartStart MRx. Table 9 SpO Sensors Sensor Type Patient Type Patient Size Sensor Site M1191A Reusable Adult >50 kg...
  • Page 108 Disposable sensors must not be reused on different patients. A 2-meter SpO extension cable (M1941A) is available for use with the HeartStart MRx. N O TE...
  • Page 109: Applying The Sensor

    Applying the Sensor 8 Pulse Oximetry 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. •...
  • Page 110: Monitoring Spo

    8 Pulse Oximetry Monitoring SpO Monitoring SpO To monitor SpO Connect the appropriate sensor cable to the to the HeartStart MRx as described in “Connecting the SpO Cable” on page 36. Apply the sensor to the patient. If the HeartStart MRx is not turned on, turn the Therapy Knob to Monitor.
  • Page 111: Pleth Wave

    8 Pulse Oximetry 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.
  • Page 112: Spo 2 Alarms

    8 Pulse Oximetry Alarms Alarms Alarms are annunciated if measurements fall outside the configured limits for high or low SpO , or if the measurement falls below the configured SpO Desat Limit. SpO alarms are all categorized as “non-latching” alarms, meaning they are automatically removed when their alarm condition no longer exists.
  • Page 113: Spo 2 Desat Alarm

    Pulse Rate Alarms 8 Pulse Oximetry Desat Alarm The HeartStart MRx also provides an alarm for SpO Desat Limit. The SpO Desat alarm provides an additional limit setting below the low limit setting to notify you of potentially life threatening decreases in oxygen saturation.
  • Page 114: Enabling/Disabling The Pulse Rate Alarms

    8 Pulse Oximetry Disabling the SpO Monitoring Function Enabling/Disabling the Pulse Rate Alarms To enable/disable the Pulse Rate Alarms, perform the following steps: Press the Menu Select button. Using the Navigation buttons, select the Measurements/Alarms menu and press the Menu Select button.
  • Page 115: Caring For Sensors

    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 SpO Monitoring, see Chapter 20, “Troubleshooting” on page 249.
  • Page 117: Noninvasive Blood Pressure

    Noninvasive 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.
  • Page 118: Preparing To Measure Nbp

    9 Noninvasive Blood Pressure Preparing to Measure NBP 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.
  • Page 119 • If a spill occurs and liquid appears to be inside the tubing, contact your service personnel. N O TE 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...
  • Page 120: Measuring Nbp

    9 Noninvasive Blood Pressure Measuring NBP 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.
  • Page 121: Alarms

    Alarms 9 Noninvasive Blood Pressure 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.
  • Page 122: Enabling/Disabling Nbp Alarms

    Using the Navigation buttons, select the Measurements/Alarms menu and press the Menu Select button. Select NBP and press the Menu Select button. Select Alarms On/Off and press the Menu Select button. Troubleshooting If your HeartStart MRx does not operate as expected during NBP Monitoring, see Chapter 20, “Troubleshooting” on page 249.
  • Page 123: Monitoring Carbon Dioxide

    The HeartStart MRx may be used to monitor carbon dioxide in both intubated and non-intubated patients.
  • Page 124: Preparing To Measure Etco

    Due to a measurement delay, do not use Microstream (sidestream) CO as a direct reference for WARNING determining the end expiratory point in the pressure curve. N O TE The HeartStart MRx is equipped with automatic barometric pressure compensation.
  • Page 125: Setting Up Microstream Etco 2 Measurements

    Setting Up Microstream EtCO Measurements 10 Monitoring Carbon Dioxide Setting Up Microstream EtCO Measurements WARNING • Danger - explosion hazard - sidestream measurement should not be used in the presence of flammable anesthetics such as: – flammable anesthetic mixture with air –...
  • Page 126: Measuring Etco

    Attach scavenging tube to the CO outlet port. Should the FilterLine or exhaust tubing be blocked when the HeartStart MRx is turned on, the CO2 N O TE Check Exhaust INOP message is displayed. Should the blockage occur during CO monitoring, the waveform appears as a flat line, and if alarms are on, an apnea alarm is annunciated.
  • Page 127: Changing The Etco 2 Alarm Limits

    EtCO and AwRR Alarms 10 Monitoring Carbon Dioxide Changing the EtCO Alarm Limits To change the EtCO alarm limits: Press the Menu Select button. Using the Navigation buttons, select the Measurements/Alarms menu and press the Menu Select button. Select EtCO and press the Menu Select button.
  • Page 128: Changing The Apnea Time Alarm Limit

    Select No and press the Menu Select button. Secure the connection. The CO monitoring function is once again enabled. Troubleshooting If your HeartStart MRx does not operate as expected during CO Monitoring, see Chapter 20, “Troubleshooting” on page 249.
  • Page 129: Invasive Pressures

    Turn the HeartStart MRx on. Connect the pressure cable to the HeartStart MRx. N O TE The HeartStart MRx will perform a check of invasive pressure functionality when the option is turned Connect the cable to the transducer. Prepare the flush solution.
  • Page 130 11 Invasive Pressures Setting up for a Pressure Measurement If 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.
  • Page 131: Selecting A Pressure To Monitor

    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.
  • Page 132: Pressure Waves

    11 Invasive Pressures Pressure Waves 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: Press the Menu Select...
  • Page 133: Zeroing The Pressure Transducer

    11 Invasive Pressures 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: •...
  • Page 134 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).
  • Page 135: Calibration

    Calibration 11 Invasive Pressures 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:...
  • Page 136: Calibrating Reusable Transducer Cpj840J6

    11 Invasive Pressures Calibration 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 •...
  • Page 137: Calibration Confirmation

    N O TE 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 17 for probable cause messages.
  • Page 138: Last Zero/Calibration

    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.
  • Page 139: Alarms

    Alarms 11 Invasive Pressures 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 are all categorized as “non-latching” alarms, meaning they are automatically removed when their alarm condition no longer exists. Table 18 details invasive pressure alarms.
  • Page 140: Enabling/Disabling Alarms

    11 Invasive Pressures Alarms Enabling/Disabling alarms To enable/disable alarms, perform the following steps: Press the Menu Select button. Using the Navigation buttons, select Measurements/Alarms and press the Menu Select button. Select the pressure label (channel: label) you wish to modify alarm status on and press the Menu Select button.
  • Page 141: Cpp Alarms

    Alarms 11 Invasive Pressures 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.
  • Page 142: Pulse

    Pulse Sources When both SpO and Invasive Pressures options are present on the HeartStart MRx, pulse can be derived from an SpO pleth wave or one of the two invasive pressure waves in Monitor, Pacing and Manual Defib modes.
  • Page 143: Changing Pulse Source

    Pulse 11 Invasive Pressures Changing Pulse Source To change pulse source for the current incident, perform the following steps: Press the Menu Select button. Using the Navigation buttons, select Measurements/Alarms and press the Menu Select button. Select Pulse and press the Menu Select button. Select Pulse Source and press the Menu Select button.
  • Page 144: Pulse Alarm Limits

    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 Chapter 20 “Troubleshooting”.
  • Page 145: Temperature

    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.
  • Page 146: Monitoring Temperature

    Monitoring Temperature Monitoring Temperature To monitor temperature, perform the following: Connect the temperature cable to the HeartStart MRx. Select the correct temperature label for your measurement. Check that the current device settings (including alarm settings) are appropriate for the patient.
  • Page 147: Changing Temperature Alarm Limits

    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 Chapter 17 for more information.
  • Page 148: Disabling The Temperature Function

    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 20, “Troubleshooting”.
  • Page 149: 12-Lead Ecg

    12-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 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 Philips 12-Lead Algorithm.
  • Page 150: Preview Screen

    12-lead ECG. The patient should be supine and relaxed when an ECG is acquired. In preparation for acquiring the ECG: Connect the 10-lead cable to the HeartStart MRx, as described in “Connecting the ECG Cable” on page 35.
  • Page 151 Preparation 13 12-Lead ECG Figure 65 12-Lead ECG Preview Screen 10 Feb 2006 11:20 Mark Event 02:42 Jones, Samuel A dult N on -P aced P ulse T emp mm H g q 120 120/80 36.9 39.0 10:40 (95) 36.0 mm H g mm H g A w RR...
  • Page 152: Acquiring The 12-Lead Ecg

    Check filter settings. Press the [Start Acquire] soft key. The message Acquiring 12-Lead is then displayed while the HeartStart MRx acquires ten seconds of ECG data. If patient age and sex were not previously entered, you are prompted to enter the information.
  • Page 153: 12-Lead Report

    Interpretive statements - Measurements and patient information (age, gender, paced status) are used by the Philips 12-Lead Algorithm to generate statements describing the patient’s cardiac rhythm and waveform morphology. Statements regarding signal quality problems encountered during ECG acquisition are also included in this section.
  • Page 154 13 12-Lead ECG 12-Lead Report Figure 66 Displayed Report 10 Feb 2006 11:20 Mark Event 02:42 Jones, Samuel A dult N on -P aced T emp P ulse mm H g q 120 120/80 36.9 39.0 10:40 (95) 36.0 mm H g mm H g S p O2 % E t CO2 A w RR...
  • Page 155: Improving Signal Quality

    Improving Signal Quality 13 12-Lead ECG Improving Signal Quality Signal quality can impact ECG analysis. Refer to Table 21 for possible solutions to common ECG quality problems. Table 21 ECG Signal Problems Problem Possible Causes Possible Solutions Tremor or muscle artifact •...
  • Page 156: 12-Lead Filters

    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 20, “Troubleshooting” on page 249.
  • Page 157: 12-Lead Ecg Transmission

    System or other servers running Philips 12-Lead Transfer Station 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 and handheld devices.
  • Page 158 14 12-Lead ECG Transmission Overview Waveforms for all monitored parameters can be viewed during the 12-Lead Report 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.
  • Page 159: Setting Up For Bluetooth Transmission

    From 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. All Bluetooth devices within the specified range are discovered by the HeartStart MRx and are N O TE displayed on the Add Device menu, even if you have already paired with the device.
  • Page 160: Changing Bluetooth Profiles

    14 12-Lead ECG Transmission Setting Up for Bluetooth Transmission Once the Bluetooth device is paired with the HeartStart MRx and the profile selected, the HeartStart MRx performs a transmission test. After successfully connecting to the device and network, the message Transmission Test Passed is displayed. Press the Menu Select button to acknowledge the message.
  • Page 161: Transmitting To A Configured Site Using Bluetooth

    Transmitting to a Configured Site using Bluetooth 14 12-Lead ECG Transmission Transmitting to a Configured Site using Bluetooth Upon acquisition of the 12-Lead ECG, the 12-Lead Report View is displayed. To transmit the displayed 12-Lead Report to a previously configured destination: Press the Menu Select button.
  • Page 162: Setting Up For Rs 232 Transmission

    12-Lead ECG Transmission using RS 232 requires a serial cable connected to the RS 232 Serial Port located on the back panel of the HeartStart MRx. See Figure 68. The cell phone is connected to the serial cable as shown in Figure 69.
  • Page 163 Setting Up for RS 232 Transmission 14 12-Lead ECG Transmission Figure 69 RS 232 Serial Cable Connection...
  • Page 164: Transmitting To A Configured Site Using Rs 232

    14 12-Lead ECG Transmission Transmitting to a Configured Site Using RS 232 Transmitting to a Configured Site Using RS 232 Upon acquisition of the 12-Lead ECG, the 12-Lead Report View is displayed. To transmit the displayed 12-Lead Report to a previously configured destination: Press the Menu Select button.
  • Page 165: Transmitting To A Manually Entered Fax Number

    Transmitting to a Manually Entered Fax Number 14 12-Lead ECG Transmission Transmitting to a Manually Entered Fax Number Upon acquisition of the 12-Lead ECG, the 12-Lead Report View is displayed. To manually enter a fax number destination: Press the Menu Select button.
  • Page 166: Transmission Status

    14 12-Lead ECG Transmission Transmission Status Transmission Status During 12-Lead Report transmittal, a status bar is displayed to show the progress of the connection and report transmission. Once the connection is made, the status bar contains the date and time stamp of the 12-Lead Report being sent.
  • Page 167: Transmitting Stored 12-Lead Reports

    Select Cancel Transmission from the 12-Lead Main Menu and press the Menu Select button. Confirm the cancellation by pressing the Menu Select button. The transmission of any pending 12-Lead Reports is also canceled. Troubleshooting If your HeartStart MRx does not operate as expected during 12-lead transmission, see "Troubleshooting" on page 249...
  • Page 169: Vital 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.
  • Page 170: About The Data Displayed

    15 Vital Signs Trending Reviewing Trending Data Figure 72 Vital Signs Trending Report Time intervals - Vital Sign trends are displayed at the selected time interval. See Date of report - The earliest time displayed “Vital Signs Trending Report Intervals” on in the table determines the date of the report.
  • Page 171: Vital Signs Trending Report Parameter List Order

    Reviewing Trending Data 15 Vital Signs Trending When the time interval in the Vital Signs Trending Report is one minute, data from continuous N O TE 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.
  • Page 172: Printing The Vital Signs Trending Report

    15 Vital Signs Trending Reviewing Trending Data Printing the Vital Signs Trending Report You can print the Vital Signs Trending Report two ways: Press the soft key under the Print Trends label. A report for the displayed period and interval is printed.
  • Page 173: 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 20, “Troubleshooting.”...
  • Page 175: Cpr And Data Capture

    M4763A Pads/CPR 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 audio prompts and visual indicators are provided as feedback to the rescuer when CPR performance deviates outside of target ranges.
  • Page 176 Overview WARNING Q-CPR is available for use with the HeartStart MRx only. 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.
  • Page 177: Preparing To Use Q-Cpr

    Pads/CPR cable pre-connected to the MRx. Figure 74 Connecting the Pads/CPR Cable N O TE 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.
  • Page 178: Connecting The Compression Sensor To The Pads/Cpr Cable

    16 Q-CPR and Data Capture Preparing to Use Q-CPR Connecting the Compression Sensor to the Pads/CPR Cable To connect the Compression Sensor to the Pads/CPR cable: Align the key marker on the Compression Sensor cable with the key marker on the receptacle end of the Pads/CPR cable as shown in Figure 75.
  • Page 179: Attaching The Compression Sensor Adhesive Pad

    Preparing to Use Q-CPR 16 Q-CPR and Data Capture Attaching the Compression Sensor Adhesive Pad To attach the Compression Sensor Adhesive Pad to the Compression Sensor: Peel the rear liner from the bottom of the Compression Sensor Adhesive Pad. (The rear liner is blank and does not contain any graphics.) Figure 76 illustrates the pad.
  • Page 180: Applying Multifunction Electrode Pads

    Apply the pads to the patient in the anterior/anterior position as shown on the pads package. 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.
  • Page 181: Placing The Compression Sensor On The Patient

    Preparing to Use Q-CPR 16 Q-CPR and Data Capture Placing the Compression Sensor on the Patient To place the Compression Sensor on the patient: Ensure the patient’s skin is clean and dry. If necessary, clip or shave the hair from the sternum area. Using the yellow pull tab on the top liner, peel the green liner away from the Compression Sensor Adhesive Pad.
  • Page 182: Using Q-Cpr In Manual Defib Mode

    16 Q-CPR and Data Capture Using Q-CPR in Manual Defib Mode Using Q-CPR in Manual Defib Mode When the Therapy Knob is moved to the 150J Manual Defib setting, the CPR sub 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.
  • Page 183: Compression Waveform

    Using Q-CPR in Manual Defib Mode 16 Q-CPR and Data Capture Figure 80 Display View in Manual Mode with Q-CPR 11 Feb 2006 22:32 Mark Event Alarms Off Adult Non- Paced 14:02 Shocks: 0 Selected Energy:150 Joules Comp No Flow sec EtC02 mmHg Vent Com p...
  • Page 184: Parameter Block 2

    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 (- -).
  • Page 185: Soft Keys

    Using Q-CPR in Manual Defib Mode 16 Q-CPR and Data Capture Soft Keys From Code View in Manual Defib Mode, press the [Start CPR] soft key to display the CPR sub view shown in Figure 80. This soft key is then labeled [Stop CPR] and may be used to switch between the CPR sub view and the standard Code View of Manual Defib Mode.
  • Page 186: Using Q-Cpr In Aed Mode

    16 Q-CPR and Data Capture Using Q-CPR in AED Mode Using Q-CPR in AED Mode In AED Mode, Q-CPR provides CPR feedback 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 Compression Sensor.
  • Page 187 Using Q-CPR in AED Mode 16 Q-CPR and Data Capture Figure 82 Display View in AED Mode with Q-CPR 11 Feb 2006 22:25 Mark Event Alarms Off 02:09 Pads Shocks: 0 CPR Timer Status COMPRESS FASTER Intubate Resume MENU Analyzing...
  • Page 188: Cpr Feedback

    16 Q-CPR and Data Capture CPR Feedback CPR Feedback Adjusting CPR Feedback Volume To adjust the volume of CPR feedback voice prompts: Press the Menu Select button. Using the Navigation buttons, select Volume from the menu and press the Menu Select button. Select Voice and press the Menu Select button.
  • Page 189: Feedback Prompts

    CPR Feedback 16 Q-CPR and Data Capture Feedback Prompts Table 22 lists the feedback prompts that may be issued during the use of Q-CPR. Table 22 CPR Feedback Prompts CPR Component Problem Voice Prompt Accompanying Text Prompt (AED Mode only) Compression Depth Too shallow Compress deeper...
  • Page 190 16 Q-CPR and Data Capture CPR Feedback Table 22 CPR Feedback Prompts (Continued) CPR Component Problem Voice Prompt Accompanying Text Prompt (AED Mode only) CPR Activity 15 seconds without signs of Fifteen seconds without 15 seconds without signs of CPR (compressions or signs of CPR ventilations)
  • Page 191: Q-Cpr Data Capture

    You can enable or suppress Q-CPR feedback, while still capturing CPR data. When Q-CPR feedback is enabled, the MRx displays the CPR sub 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 •...
  • Page 192: Data And Events Recorded

    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 Q-CPR Review application. See the Q-CPR Review Directions for Use for more information.
  • Page 193: Configuration

    Configuration 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.
  • Page 194: Setting The Date And Time

    17 Configuration Setting the Date and Time Setting the Date and Time To modify the date and time setting from the Configuration menu: Press the Menu Select button. Using the Navigation buttons, select Date and Time. Then press the Menu Select button. Using the Navigation buttons, adjust the value for the year.
  • Page 195: Saving Configuration Settings To A Data Card

    Loading Configuration Settings from a Data Card To load configuration settings from a data card: Insert the data card with the saved configuration in the HeartStart MRx. Press the Change Config soft key and enter the configuration password. Press the Import soft key.
  • Page 196: Configurable Parameters

    17 Configuration Configurable Parameters 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 24 General Settings Parameter Description...
  • Page 197 Configurable Parameters 17 Configuration Table 25 Heart Rate and ECG Settings Parameter Description Setting Choices Auto Gain Determines whether ECG size is automatically On, Off 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).
  • Page 198 17 Configuration Configurable Parameters Table 26 Invasive Pressure Settings - Default Labels Parameter Description Values / Default Unit and Default Selects measurement units for all invasive mmHg, kPa Labels pressures 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...
  • Page 199 Configurable Parameters 17 Configuration Table 28 Invasive Pressure Settings - P2 All setting options are exactly the same as P1 in Table 27 except for: Parameter Description Value/Defaults Color Selects the P2 color. Red, Yellow, Blue, Green, Cyan, Magenta, White Table 29 Invasive Pressure Settings - ABP, ART, Ao All setting options are exactly the same as P1 in Table 27 Table 30 Invasive Pressure Settings - CVP, RAP, LAP...
  • Page 200 17 Configuration Configurable Parameters Table 31 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...
  • Page 201 Configurable Parameters 17 Configuration Table 32 Invasive Pressure Settings - ICP 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...
  • Page 202 17 Configuration Configurable Parameters Table 34 Noninvasive Blood Pressure Settings Parameter Description Setting Choices NBP Schedule Selects the schedule for NBP measurements, Manual, q1, q2.5, q5, q10, q15, q30, q60, manual, or automatic at the selected frequency. q120 NBP Alarm Source Selects the alarm source.
  • Page 203 Configurable Parameters 17 Configuration Table 35 End-Tidal Carbon Dioxide Settings Parameter Description Setting Choices Unit Selects the unit of measure mmHg, kPa EtCO 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 EtCO Low Limit Selects the low limit alarm value.
  • Page 204 17 Configuration Configurable Parameters Table 36 SpO Settings Parameter Description Setting Choices High Limit Selects high limit alarm value. Adult: 51-100, 100 (%) Pediatric: 51-100, 100 adjusted in increments of 1 Low Limit Selects low limit alarm value. Adult: 50-99, 90 (%) Pediatric: 50-99, 90 adjusted in increments of 1 Desat Limit...
  • Page 205 Table 40 Alarm Settings Parameter Description Setting Choices Alarm Tone Selects either traditional Philips or IEC Standard Philips, IEC alarm tones. Alarm Pause Time Selects the interval of time during which alarms 1, 2, 3, 5, 10, indefinite...
  • Page 206 17 Configuration Configurable Parameters Table 41 12-Lead Settings Parameter Description Setting Choices Institution Name Enters your organization’s name for printing on 32 characters, blank the 12-Lead ECG Report. Location Code Enters an institution number and a department 3 digits, blank (institution number) number for printing on the 12-Lead Report.
  • Page 207 Configurable Parameters 17 Configuration Table 42 12-Lead Transmission Settings (Bluetooth and Modem Profile) Parameter Description Setting Choices Profile Name Name of the profile. 20 characters, blank 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.
  • Page 208 17 Configuration Configurable Parameters Table 43 12-Lead Transmission Settings (Serial Phone Profile) 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 Dial String Available from your cell phone service provider. 40 characters, blank Wait for Dial Tone Available from your cell phone service provider.
  • Page 209 Configurable Parameters 17 Configuration Table 44 12-Lead Transmission Settings (Hub) 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 30 characters, blank documentation to create user accounts on the hub. Password http password.
  • Page 210 17 Configuration Configurable Parameters Table 46 Manual Therapy Settings Parameter Description Setting Choices Remain In Sync Mode Defines whether the device remains in Sync Yes, No After Shock Mode after a synchronized shock is delivered. Time To Auto Disarm Determines the amount of time the device will 30, 60, 90 (seconds) remain charged if a shock has not been delivered.
  • Page 211 Configurable Parameters 17 Configuration Table 47 AED Settings Parameter Description Setting Choices Shock Series Sets the number of shocks that must be delivered to activate an 1, 2, 3, 4 automatic CPR Pause. The length of the CPR pause is determined by the CPR Timer Setting.
  • Page 212 17 Configuration Configurable Parameters Table 48 Q-CPR Settings Parameter Description Setting Choices Deep Compression Prompt Selects whether the prompts regarding On, Off compressions that are too deep are issued. This setting is provided to prevent unwanted voice prompts from being issued when chest compressions are performed on a patient lying on a compliant surface.
  • Page 213 Configurable Parameters 17 Configuration Table 51 Mark Event Settings Parameter Description Setting Choices Mark Event 1 Defines menu choice #1 on the Mark Events 20 characters, ET Access menu. Mark Event 2 Defines menu choice #2 on the Mark Events 20 characters, IV Access menu.
  • Page 215: Data Management

    This chapter describes the data management features of the HeartStart MRx. Overview 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. 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.
  • Page 216: Copying From Internal Memory

    Select Copy and press the Menu Select button. The message, Copying Patient Data, is displayed while the Event Summary and any 12-Lead Reports are copied to the data card. Do not remove the external data card from the HeartStart MRx while the device is copying 12-lead N O TE reports.
  • Page 217: Printing The Event Summary

    Printing the Event Summary 18 Data Management Printing the Event Summary You can print the current Event Summary at any time during the 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.
  • Page 218: Printing The Vital Signs Trending Report

    18 Data Management Printing the Vital Signs Trending Report Printing the Vital Signs Trending Report You can print the current Vital Signs Trending Report at any time during the 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.
  • Page 219: Events Recorded

    Events Recorded 18 Data Management Events Recorded The following events and related information are stored in the Event Summary. Italicized text in logged events is replaced by an appropriate value or selected option. Table 52 Event Information Logged Event Frequency Power On/Off Device On Logged when device first turns on.
  • Page 220 18 Data Management Events Recorded Table 52 Event Information Logged Event Frequency 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.
  • Page 221 Events Recorded 18 Data Management Table 52 Event Information Logged Event Frequency [Temperature] Label: Logged when a temperature label is set or changed. Temperature Label Alarms **yellow or***red alarm Logged when alarm condition occurs. Alarms Paused Logged when action occurs. Alarms Resumed Logged when action occurs.
  • Page 222 Logged when advisory algorithm begins analysis. Artifact Detected Logged when advisory algorithm detects noise or motion artifact. Auto Disarm Logged when HeartStart MRx is automatically disarmed. Cannot Analyze ECG Logged when advisory algorithm cannot complete analysis sequence. No Shock Advised Logged when a non-shockable rhythm is detected.
  • Page 223 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 Q-CPR Review. Q-CPR feedback On Logged at the beginning of an event if the Q-CPR Feedback configuration setting is On.
  • Page 224: Marking Events

    18 Data Management Marking Events 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.
  • Page 225: Printing Events

    18 Data Management Printing Events The HeartStart MRx can be configured to print automatically when certain events occur. Table 53 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.
  • Page 227: Maintenance

    HeartStart MRx Service Manual. Calibration of the optional end-tidal CO and noninvasive blood pressure modules of the HeartStart N O TE MRx needs to be performed yearly by a qualified service provider, as described in the HeartStart MRx Service Manual.
  • Page 228: Automated Tests

    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 54 provides a brief explanation of the tests and lists the frequency with which each is performed.
  • Page 229: Automated Test Summary

    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: Turn the Therapy knob to Monitor.
  • Page 230: Ready For Use Indicator

    Chirping indicates the battery battery. Charging may be done in the is not being charged. No HeartStart MRx by connecting to AC/ chirping indicates the battery is DC power, or in a Philips-approved being charged.
  • Page 231: Shift Checklist

    Philips Medical Systems 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 220.
  • Page 232: Heartstart Mrx Shift Checklist

    19 Maintenance Shift Checklist 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.
  • Page 233 If using: — Pads, 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.
  • Page 234: Operational Check

    • Replace ECG cable You must fix the problem and successfully run the Operational Check to clear the failure. If the HeartStart MRx is equipped with multifunction defib pads only and does not have a paddle tray, N O TE you cannot test paddles during an Operational Check.
  • Page 235: Performing The Operational Check

    Operational Check. If the device has the Q-CPR option, you should run the Operational Check with the Pads/CPR cable and the Compression Sensor, keeping the Compression Sensor still during the test. If the HeartStart MRx has the Pacing option, you must run the Operational Check with a Pads cable.
  • Page 236 19 Maintenance Operational Check Figure 84 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 Setup 1. Connect pads/CPR cable, compression sensor, and test load Connect pads cable and test load 2.
  • Page 237 Operational Check 19 Maintenance Figure 85 Operational Check Screen 02 M ar 2006 10:53 Operational Check M odel N umber : M3535A S erial N umber : US00108360 L ast O perational C heck : 04 M ay 2005 9:35 P ass General System Test: Pass Therapy Knob:...
  • Page 238 19 Maintenance Operational Check Table 57 Operational Checks Test Test Description Prompts Action General System Tests internal clock battery, None. None. power supply, and internal memory card. Therapy Knob Tests if the Therapy Knob is set None. None. to 150J. Charge Button Tests the Charge button.
  • Page 239 Operational Check 19 Maintenance Table 57 Operational Checks Test (Continued) Test Description Prompts Action Did you hear Shock/No Shock Audio If a shock was delivered during Use the navigation buttons to Delivered? the Shock test, the voice respond Yes or No. Then press prompt, Shock Delivered is the Menu Select button.
  • Page 240 19 Maintenance Operational Check Table 57 Operational Checks Test (Continued) Test Description Prompts Action Pads/Paddles ECG Checks ECG acquisition None, if test passes. If test fails the If the Pads/Paddles test fails with through pad/paddles. following prompt is displayed at the cable and passes without the the end of all remaining tests: cable, the cable is bad.
  • Page 241: Operational Check Report

    Operational Check 19 Maintenance 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 86. The first part of the report lists test results. The second part lists checks to be performed by the user.
  • Page 242: User Checks

    (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...
  • Page 243 Operational Check 19 Maintenance Table 58 Operational Check Test Results Test Results Action if Test Does Not Pass General System • Pass - The clock battery, power supplies, and internal If the test fails with the AC/DC power memory are functioning. module present, remove the module and repeat the test.
  • Page 244 19 Maintenance Operational Check Table 58 Operational Check Test Results (Continued) Test Results Action if Test Does Not Pass Pads/Paddles ECG Pass/cable type - ECG acquisition and the cable are both If the test fails with a cable connected, remove functioning.
  • Page 245 Operational Check 19 Maintenance Table 58 Operational Check Test Results (Continued) Test Results Action if Test Does Not Pass Invasive Pressures • Pass - Invasive Pressures passed its self-test. If the test fails, call for service (to replace the Invasive Pressures/Temperature board.) If •...
  • Page 246: Operational Check Summary

    19 Maintenance Operational Check Operational Check Summary The Operational Check Summary lists the results from the last 60 Operational Checks. Test results are reported as described in Table 58. To view the Operational Check Summary: Turn the Therapy Knob to Monitor. Press the Menu Select button.
  • Page 247: Battery Maintenance

    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.
  • Page 248: Charging Batteries

    Battery Maintenance 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.
  • Page 249: Calibration Results

    C (-4 F) to 60 C (140 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 38 C (100 F) for extended periods of time significantly reduces a battery’s life expectancy.
  • Page 250: Discarding Batteries

    19 Maintenance Battery Maintenance 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. Do not disassemble, puncture, or incinerate batteries. Be careful not to short the battery terminals WARNING because this could result in a fire hazard.
  • Page 251: 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.
  • Page 252: Paddles, Therapy Cable

    For information about cleaning and sterilizing internal and external sterilizable paddles, see the N O TE 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: •...
  • Page 253: Carrying Case

    Cleaning Instructions 19 Maintenance 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.
  • Page 254: Disposing The Heartstart Mrx

    19 Maintenance Disposing the HeartStart MRx Disposing the HeartStart MRx 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. Disposal of the device with the battery inserted presents a potential shock hazard.
  • Page 255: Supplies And Accessories

    Use single-use supplies and accessories only once. WARNING 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 Medical Systems Sales Office, your authorized Philips Medical Systems Dealer or Distributor, or visit our website at: http://shop.medical.philips.com and...
  • Page 256 19 Maintenance Supplies and Accessories 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.)
  • Page 257 Supplies and Accessories 19 Maintenance 5-Lead ECG Cable Set M1520A 5-lead ECG Trunk Cable (AAMI) M1625A 5-lead ECG Lead Set with Snaps (AAMI) M1530A 5-lead ECG Trunk Cable (IEC) M1635A 5-lead ECG Lead Set with Snaps (IEC) Sync Cables M1783A Sync Cable (8 ft.) M5526A Sync Cable (25 ft.)
  • Page 258 19 Maintenance Supplies and Accessories 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...
  • Page 259 Supplies and Accessories 19 Maintenance EtCO 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 (CO M2520A Smart CapnoLine - Pediatric M2522A Smart CapnoLine - Adult Non-Intubated Single Purpose Circuits (CO...
  • Page 260 19 Maintenance Supplies and Accessories 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...
  • Page 261: Troubleshooting

    Troubleshooting 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.
  • Page 262: Symptoms

    Symptoms are characterized by functionality. Table 62 General Problems Symptom Possible Cause Possible Solution The HeartStart MRx does not There is no power. • Insert a fully charged battery. turn on. • Connect to AC/DC power. Audio is too low or absent.
  • Page 263 Symptoms 20 Troubleshooting Table 62 General Problems (Continued) Symptom Possible Cause Possible Solution Event Storage Full message. Event Summary data for the • Copy or print Event Summary to retain data and current patient case exceeds the then begin a new patient case. storage capacity of internal memory •...
  • Page 264 20 Troubleshooting Symptoms Table 63 ECG Monitoring Problems Symptom Possible Cause Possible Solution QRS beeper inaudible or beeps The QRS volume is configured to Configure the QRS beeper volume. do not occur with each QRS Off or the setting is too low. complex.
  • Page 265 Symptoms 20 Troubleshooting Table 63 ECG Monitoring Problems (Continued) Symptom Possible Cause Possible Solution Pads/Paddles Off INOP Pads/Paddles for Wave Sector 1 are • Check that pads/paddles are properly applied. If off or insecurely attached. necessary, replace the pads. • Change the ECG in Wave Sector 1 to a lead derived from monitoring electrodes.
  • Page 266 20 Troubleshooting Symptoms Table 63 ECG Monitoring Problems (Continued) Symptom Possible Cause Possible Solution Lead Select button does not The 12-lead function is active. Exit the 12-lead function. respond. Device is in AED Mode. None. Lead Select button does not The pads therapy cable is not Connect the pads therapy cable.
  • Page 267 Poor connection between the cuff Check connections and replace tubing, if needed. inflate fully. and the HeartStart MRx. NBP measurements appear The cuff size is too small/large for Use the correct cuff size.
  • Page 268 20 Troubleshooting Symptoms Table 65 SpO Monitoring Problems Symptom Possible Cause Possible Solution The SpO waveform is not The sensor is not properly • Check the sensor connection and cable. displayed. connected or the sensor cable is • Try another sensor. damaged.
  • Page 269 Symptoms 20 Troubleshooting Table 65 SpO Monitoring Problems (Continued) Symptom Possible Cause Possible Solution Sensor Malfunction The SpO sensor or cable is faulty. • Try another sensor. INOP. • If the problem persists, call for service of the SpO module. If SpO monitoring is essential to patient The SpO numeric value is...
  • Page 270 20 Troubleshooting Symptoms Table 66 12-Lead Transmission Problems (Bluetooth) Symptom Possible Cause Possible Solution Bluetooth Malfunction INOP. • The MRx does not • Call for service. have a Bluetooth card. • The Bluetooth card is • Call for service. incompatible. •...
  • Page 271 Symptoms 20 Troubleshooting Table 66 12-Lead Transmission Problems (Bluetooth) (Continued) Symptom Possible Cause Possible Solution No transmission devices detected message. • The Bluetooth device • Make sure the Bluetooth device is turned on. is not turned on. • The Bluetooth device •...
  • Page 272 20 Troubleshooting Symptoms Table 66 12-Lead Transmission Problems (Bluetooth) (Continued) Symptom Possible Cause Possible Solution Transmission Failed. Settings Configured • There is a problem • Work with your ISP to ensure the Bluetooth Incorrectly. message. with the Server URL, Profile and Hub settings are correct. Proxy user name, Proxy password Transmission Failed.
  • Page 273 Symptoms 20 Troubleshooting Table 67 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 Hub information has not been Modify the Hub configuration settings as needed.
  • Page 274 • Check the FilterLine connection and tubing. • Check the tubing for knots, kinks, or pinches. Purging INOP. A blockage in the FilterLine or The HeartStart MRx automatically attempts to purge airway adapter has been detected. If the blockage. it is not successful, a CO Occlusion condition will occur.
  • Page 275 Symptoms 20 Troubleshooting Table 68 CO Monitoring Problems (Continued) Symptom Possible Cause Possible Solution Calibration Overdue The CO module should be Do not use the CO monitoring capabilities and call INOP. calibrated once a year or after 4,000 for service to calibrate the CO module.
  • Page 276 20 Troubleshooting Symptoms Table 69 Defibrillation and Pacing Problems (Continued) Symptom Possible Cause Possible Solution Press Charge Before Shock The device is not charged to the Make sure the desired energy is selected. Then press message. selected energy. the Charge button. Press Shock Buttons on The Shock button on the device is Press the Shock button(s) on the paddles to deliver a...
  • Page 277 • Make sure the printer door is closed. Printer Malfunction message. The printer is faulty or there is a Turn the HeartStart MRx off for 15 seconds and then problem communicating with the turn it on again. If the problem persists, call for printer.
  • Page 278 20 Troubleshooting Symptoms Table 72 Invasive Pressure Monitoring Problems Symptom Possible Cause Possible Solution Invasive Pressure wave not The sensor is not properly • Check the sensor connection and cable. connected or the sensor cable is displayed • Try another sensor. damaged.
  • Page 279 Symptoms 20 Troubleshooting Table 73 Temperature Monitoring Problems Symptom Possible Cause Possible Solution Temperature Label Equip There has been a malfunction in Contact Service. Malfunction INOP the temperature hardware. Temperature Label Overrange The temperature value is outside Check that the temperature probe is on the list of INOP the measurement range of the supported accessories.
  • Page 280 20 Troubleshooting Symptoms Table 75 Q-CPR Problems Symptom Possible Cause Possible Solution CPR Sensor Malfunction The Compression Sensor power-on Check the Compression Sensor and cable INOP. self-test has failed. connections. If necessary, replace the Compression Sensor. CPR Sensor Unplugged INOP. 1. The Compression Sensor is 1.
  • Page 281: Audio Tones And Alarm Indications

    The following table describes the audio tones and alarm indications, when they occur, and their meaning. N O TE Alarm tone volume levels exceed 60 dB. See the HeartStart MRx Service Manual for alarm signal pressure ranges. Table 76 Audio Tones...
  • Page 282 , NBP, Invasive Pressures, Temp, Pulse and EtCO alarms. Tone repeated every two seconds, lower pitch Philips’ INOP Tone: then yellow alarm tone. Generated while at least one INOP condition is occurring. Cyan indicator message. Lower pitched tone is repeated twice, IEC INOP Tone: followed by a pause.
  • Page 283: Calling For Service

    Calling for Service 20 Troubleshooting Calling for Service For telephone assistance, call the Response Center nearest to you, or visit our website at: www.medical.philips.com/cms and follow the links for “CMS Response Center.” Table 77 Response Center Phone Numbers North America Canada...
  • Page 285: Specifications And Safety

    Specifications 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);...
  • Page 286 21 Specifications and Safety Specifications Delivered Energy Accuracy Nominal Delivered Energy vs. Patient Impedance Selected Accuracy Energy Load Impedance (ohms) 100 125 150 175 ±2J ±2J ±2J ±2J ±2J ±2J ±2J ±2J ±2J ±2J ±15% ±15% ±15% ±15% ±15% 100J 100 101 103 104 104 101 ±15% 120J 110 120 121 123 125 125 121 ±15%...
  • Page 287: Manual Defib Mode

    Specifications 21 Specifications and Safety • Less than 40 seconds from initial power on (AED Mode) with a new, fully charged Lithium Ion battery pack at 25 C, 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.
  • Page 288: Ecg And Arrhythmia Monitoring

    (specificity > 95%) for adult defibrillation rhythms 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.
  • Page 289 • External Defib: Type BF • Internal Defib: Type CF 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.
  • Page 290: Display

    21 Specifications and Safety Specifications 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 ; 6.25 mm/sec for CO Wave Viewing Time: 5 seconds (ECG) Battery Type: 6.0 Ah, 14.8 V, rechargeable, Lithium Ion...
  • Page 291: Thermal Array Printer

    Specifications 21 Specifications and Safety 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.
  • Page 292: Spo2 Pulse Oximetry

    Accuracy outside the range indicated for each sensor is not specified. The above referenced sensors were N O TE validated for use with the HeartStart MRx using the Philips picoSAT II SpO module with Fourier Artifact Suppression Technology (FAST). This module is not available as a stand-alone device.
  • Page 293: Nbp

    Specifications 21 Specifications and Safety 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;...
  • Page 294: Invasive Pressures

    21 Specifications and Safety Specifications 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/ C (0.013kPa/...
  • Page 295: Temperature

    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. EtCO Range: 0 to 99 mmHg at sea level Resolution: 1 mmHg (0.1kPa)
  • Page 296: Awrr

    21 Specifications and Safety Specifications Microstream CO Humidity Correction Factor: BTPS (Body Temperature and Pressure, Saturated - 37 C, 750mmHg, 100% humidity or 47mmHg) is the humidity correction factor for the Microstream CO readings. Correction calculation formula: x (Pb-47) BTPS ~ FCO x 0.94 Where FCO2 = fractional concentration of CO...
  • Page 297: 12-Lead Ecg

    Specifications 21 Specifications and Safety 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.
  • Page 298 Safety: Complies with the requirements of applicable safety 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.
  • Page 299: Environmental (M3536A)

    Safety: Complies with the requirements of applicable safety 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...
  • Page 300 21 Specifications and Safety Specifications Mode of Operation: Continuous AC Line Powered: 100 - 240 VAC, 50 - 60 Hz, 1 - 0.46 A (Class 1) Battery Powered: 14.8 V Rechargeable, Lithium Ion DC Powered: • Input: 11-32 VDC, 11 A •...
  • Page 301: Symbol Definitions

    Specifications 21 Specifications and Safety Symbol Definitions Table 79 lists the meaning of each symbol shown on the HeartStart MRx and the M3538A battery. Table 79 Monitor/Defibrillator and Battery Symbols Symbol Definition Defibrillation Shock. Attention - See operating instructions in Instructions for Use.
  • Page 302 21 Specifications and Safety Specifications Table 79 Monitor/Defibrillator and Battery Symbols (Continued) Symbol Definition 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. IP2X Protected against ingress of solid foreign objects >12.5mm in diameter. Protected against access to hazardous parts with a finger.
  • Page 303 Specifications 21 Specifications and Safety Table 80 lists the meaning of the symbols that may appear on the shipping carton. Table 80 HeartStart MRx Shipping Carton Symbols Atmospheric pressure range. Temperature range Relative humidity range. Recyclable paper product. Fragile. Right side up.
  • Page 304: Units And Abbreviations

    21 Specifications and Safety Units and Abbreviations Units and Abbreviations Table 81 lists units and abbreviations used with the HeartStart MRx. Table 81 Abbreviations Unit Definition Unit Definition beats per minute compressions per minute degrees Celsius seconds degrees Fahrenheit minutes...
  • Page 305: Clinical Performance Summary - Defibrillation

    Clinical Performance Summary - Defibrillation 21 Specifications and Safety 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.
  • Page 306: Clinical Performance Summary - Cardioversion

    21 Specifications and Safety Clinical Performance Summary - Cardioversion 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.
  • Page 307: Conclusion

    Clinical Performance Summary - Cardioversion 21 Specifications and Safety Table 83 Clinical Summary - Cardioversion Biphasic Patients Monophasic Patients P Value Number (%) Number (%) Cumulative Cardioversion Efficacy - Single shock only 58/96 (60%) 24/107 (22%) <0.0001 - <2 shocks 74/96 (77%) 47/107 (44%) <0.0001...
  • Page 308: Clinical Performance Summary - Internal Defibrillation

    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.
  • Page 309: Safety Considerations

    General The HeartStart MRx is not intended to be deployed in settings or situations that promote use by WARNING untrained personnel. Operation by untrained personnel can result in injury or death.
  • Page 310 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.
  • Page 311: Defibrillation

    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.
  • Page 312: Battery

    21 Specifications and Safety Safety Considerations Battery WARNING Properly dispose of or recycle depleted batteries according to local regulations. Do not puncture, disassemble, or incinerate batteries. Built in safety circuits can not protect against handling abuse. Adhere to all warnings and cautions in WARNING handing and using lithium ion batteries.
  • Page 313: Supplies And Accessories

    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.
  • Page 314: Restrictions For Use

    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.
  • Page 315 Emissions Test Compliance Electromagnetic Environment - Guidance RF emissions Group 1 The HeartStart MRx uses RF energy only for its internal function. Therefore, its RF emissions are CISPR 11 very low and not likely to cause interference in nearby electronic equipment.
  • Page 316 21 Specifications and Safety Electromagnetic Compatibility Table 86 Electromagnetic Immunity - General Immunity Test IEC 60601 Compliance Electromagnetic Environment - Test Level Level Guidance Electrostatic + 6 kV contact + 6 kV contact Floors should be wood, concrete, or discharge (ESD) ceramic tile.
  • Page 317 Test Level Level 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. 3 Vrms...
  • Page 318 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.
  • Page 319 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.
  • Page 320: Recommended Separation Distances

    Electromagnetic Compatibility 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.
  • Page 321: Index

    Index Index changing charging enabling/disabling discarding 12-Lead ECG Noninvasive Blood Pressure (NBP) installing acquiring changing life expectancy adjusting wave sizes enabling/disabling M3538A Lithium Ion Battery algorithm noninvasive pacing maintenance configurable parameters pulse specifications filters enabling/disabling storing indications setting limits warnings preparation pulse rate from SpO beat labels...
  • Page 322 HeartStart MRx alarm pause button emissions and immunity Operational Check charge button EtCO Performing an Operational Check event summary button alarms...
  • Page 323 Index summary overview test results preparing to use Temperature tests troubleshooting alarms User Checks using in AED Mode changing QRS beeper enabling/disabling changing degree units Pacing configurable parameters see Noninvasive Pacing Ready For Use (RFU) Indicator connecting the cable paddles Return to Owner indications using external...
  • Page 325 453564041991 Edition 1 Philips Medical Systems Printed in the U.S.A. September 2006 *453564041991*...

This manual is also suitable for:

M3535aM3536a