MRx Training with Q-CPR

MRx Training with Q-CPRMRx Training with Q-CPR

ROC RefresherROC Refresher

&&

EMT/ EKG monitoring parametersEMT/ EKG monitoring parameters

System ComponentsSystem Components

Therapy/CPR Cable

MRx Defib Pads

Compression Sensor

Basic OrientationBasic Orientation

Ready for use indicatorReady for use indicator

Therapy knobTherapy knob

Charge ButtonCharge Button

Shock ButtonShock Button

PrinterPrinter

Printer buttonPrinter button

SpeakerSpeaker

Basic Orientation cont.Basic Orientation cont.

Menu select buttonMenu select button

Navigation buttonsNavigation buttons

4 soft keys4 soft keys

Event summaryEvent summary

Alarm pauseAlarm pause

Lead selectLead select

Event mark buttonEvent mark button

Patient connectionsPatient connections

Monitoring on the LeftMonitoring on the Left

3-lead patient cables3-lead patient cables

Spare electrodesSpare electrodes

Defib on the RightDefib on the Right

Patient / defib cablePatient / defib cable

Q-CPR puckQ-CPR puck

Shock test load plugShock test load plug

Defib patchesDefib patches

RazorRazor

Ready For Use IndicatorReady For Use IndicatorBlinking Black Hourglass – Shock, pacing, and ECG are ready for use and sufficient battery power is available

Blinking Red X with a periodic chirp – Low battery that is not being charged

Blinking Red X without a periodic chirp – Low battery that is being charged

Solid Red X with a chirp – A failure has been detected that may prevent delivery of a shock, pacing, or ECG acquisition

X

Solid Red X without a chirp – No power or device failure

X

Compression MeasurementCompression Measurement

The sensor is…• Reusable• Easy to clean• Acts as landmark• Goes where your hands would go• Weighs 8 Ounces

What the sensor does…• Detects motion using and accelerometer

Compression Sensor

Compression MeasurementCompression Measurement

Compression Sensor

Measurements:• Compression Depth• Compression Rate• Leaning (incomplete release)• Duty Cycle (duration)• No Flow Time (inactivity timer)

Sensor Adhesive Pad

Compression MeasurementCompression Measurement

• Compression rate is moving average of last 3 compressions• Target compression depth of 1.5 - 2 inches indicated by lines• Incomplete release (“Leaning”) is indicated by “*” on waveform

Ventilation MeasurementVentilation Measurement

A new role for our multifunction pads…• Detect changes in chest impedance that correlate to ventilation volume

Min.

Max.Typical

Impedance Change (Ohms)

Volu

me (

ml per

Kg)

This is a new applicationof a proven principle

Ventilation MeasurementVentilation Measurement

• Ventilation rate is moving average of last 3 ventilations• Ventilation Volume Icon shows 0, 1/3, 2/3 or 1+ of the target volume• Inactivity timer -- “30 Seconds without ventilation”

Real-Time FeedbackReal-Time Feedback

Q-CPR Feedback is…• Corrective -- it speaks up only when you need it• Prioritized -- based on clinical importance• User Friendly -- user is given time to react (3-4 sec.)

Real-Time FeedbackReal-Time Feedback

Compressions:1. Incomplete Release2. Compression depth shallow3. Compression rate slow or fast4. Compression depth deep5. Duty Cycle Ventilations:1. Volume low2. Frequency high or low3. Inflation time fast or slow

* These priorities were set based on an evaluationof published research data.

Clinical Priorities*

Batteries and the MRXBatteries and the MRX

M3538A Lithium Ion BatteriesM3538A Lithium Ion Batteries

Batteries should be used as primary power Batteries should be used as primary power source.source.Fully charged battery will last 5-hours or 50-Fully charged battery will last 5-hours or 50-shocks.shocks.No memory build up but should not be No memory build up but should not be allowed to go dead.allowed to go dead.Fuel cell is broken up into 5 LED’s or 20%Fuel cell is broken up into 5 LED’s or 20%Full charge takes about 2-3 hoursFull charge takes about 2-3 hoursLife expectancy is 2-yearsLife expectancy is 2-years

Maintenance ActivitiesMaintenance Activities

Observe Ready for Use indicator.Observe Ready for Use indicator.

Once a week, perform an Operational Check Once a week, perform an Operational Check and Shock Test.and Shock Test.

Care for batteries.Care for batteries.

Clean MRx and accessories.Clean MRx and accessories.

Performing an Operational CheckPerforming an Operational Check

1.1. Insert a charged battery (Insert a charged battery (>> 20%). 20%).

2.2. Turn the Therapy Knob to Turn the Therapy Knob to MonitorMonitor..

3.3. Press the Menu Select button.Press the Menu Select button.

4.4. Using the Navigation buttons, Using the Navigation buttons, select select OtherOther..

5.5. Select Select Operational CheckOperational Check..

6.6. Respond to the prompts.Respond to the prompts.

Operational Check Report

Operational Check SummaryOperational Check Summary

Shows results of the last 60 Operational ChecksShows results of the last 60 Operational Checks

To print:To print:

1.1. Select Select OtherOther from the Main menu. from the Main menu.

2.2. Select Select Op Check SummaryOp Check Summary..

3.3. Press the Press the [Print][Print] soft key. soft key.

Data Transfer to cardData Transfer to card

Turn MRX to MonitorTurn MRX to MonitorPress the Menu ButtonPress the Menu ButtonSelect “Other” then Select “Data Select “Other” then Select “Data Management”Management”Press Menu & acknowledge the messagePress Menu & acknowledge the messageSelect appropriate “EVENT”Select appropriate “EVENT”Press “Menu” then select “Copy”Press “Menu” then select “Copy”Place Data card in Defib Envelope!Place Data card in Defib Envelope!

Questions about the MRX???Questions about the MRX???

ROC SitesROC Sites

CPR ReportingCPR Reporting

BLS & ALS MIRF’sBLS & ALS MIRF’s

BLS AED Data card & ALS card if placed prior to BLS AED Data card & ALS card if placed prior to ROSCROSC

Dispatch / RMS reportDispatch / RMS report

ROC Protocol check sheetROC Protocol check sheet

Phone call to ROC Study within 1 hourPhone call to ROC Study within 1 hour

Data transfer to County server within 24-hoursData transfer to County server within 24-hours

TopicsTopics

ROC Study ProtocolsROC Study Protocols

1.1. Purpose of an ITD ValvePurpose of an ITD Valve2.2. Analyze Early or Analyze LateAnalyze Early or Analyze Late

ITD ValveITD Valve• Impedance Threshold

Device

2

• ITD is a circulation adjunct not a ventilation adjunct.

• Increases blood flow back to the heart during the recoil phase of chest compression.

Analyze Early/Analyze LateAnalyze Early/Analyze Late• Analyze Early:

– 1 round (30 compressions) of priming before AED analysis

– Business as usual in King County

• Analyze Late:

– Longer period of priming before AED analysis

– 3 minutes of CPR before first analysis

2

Target Population: ITD and AE/ALTarget Population: ITD and AE/AL

Patients 18 years of age or greater who suffer non-traumatic cardiopulmonary arrest outside of hospital.

Enroll all NON-traumatic CPR cases, Enroll all NON-traumatic CPR cases,

EXCEPT…

Exclusion Criteria: ITD and Exclusion Criteria: ITD and AE/ALAE/AL

Known Pregnancy

DNAR orders in place

Known Prisoner / In Custody

Less than 18 years of age

Trauma cardiac arrest

Exclusion Criteria: Exclusion Criteria: Specific to ITDSpecific to ITDTracheostomy present

AE/AL use is appropriate in this case. AE/AL use is appropriate in this case.

Exclusion Criteria: Exclusion Criteria: Specific AE/ALSpecific AE/ALAnalyze early or analyze late should NOT be Analyze early or analyze late should NOT be used if:used if:

EMS-witnessed arrest

AED applied by non-ROC agency (lay person/police/private AMB)

ITD use is appropriate in both cases. ITD use is appropriate in both cases.

Removal of ITDRemoval of ITD

Remove ITD immediately if:

1. Patient gets a pulse (ROSC)

2. Device fills with fluid twice, or cannot be cleared

3. Arrival at ED

4. No chest rise with patent (open) airway

1 round1 round of of CPR/Attach ITD CPR/Attach ITD

valvevalve

1 round1 round of of CPR/Attach ITD CPR/Attach ITD

valvevalveShock Shock

(if (if indicated)indicated)

Shock Shock (if (if

indicated)indicated)

CPR CPR ProtocolProtocol

CPR CPR ProtocolProtocol

Study Protocol #1—Analyze EarlyStudy Protocol #1—Analyze Early

3 minutes3 minutes of of CPR/Attach ITD valveCPR/Attach ITD valve

3 minutes3 minutes of of CPR/Attach ITD valveCPR/Attach ITD valve

CPR CPR ProtocolProtocol

CPR CPR ProtocolProtocol

Study Protocol #2—Analyze LateStudy Protocol #2—Analyze Late

Shock Shock (if (if

indicated)indicated)

Shock Shock (if (if

indicated)indicated)

EMT / EKG MONITORINGEMT / EKG MONITORING

Questions?????Questions?????

What do we need to know about EKG’s?What do we need to know about EKG’s?

What “Guidelines” should we use to place the What “Guidelines” should we use to place the monitor on someone?monitor on someone?

Electro what???Electro what???

Rate ?Rate ? Slow – Normal – FastSlow – Normal – Fast

P wave?P wave? Present or absentPresent or absent

Regular ?Regular ? Regular or irregular spacingRegular or irregular spacing

Narrow or Wide?Narrow or Wide? Width of QRS?Width of QRS?

Rhythm?Rhythm? Who cares anyways????Who cares anyways????

Basic Normal PathwaysBasic Normal Pathways

P QRS TP QRS T

Normal Sinus RhythmNormal Sinus Rhythm

OH, the boxes mean something??OH, the boxes mean something??

What’s the rate???What’s the rate???

BradycardiaBradycardia

Irregularly IrregularIrregularly Irregular

Atrial FibrillationAtrial Fibrillation

Atrial FlutterAtrial Flutter

Atrial FlutterAtrial Flutter

Supraventricular TachycardiaSupraventricular Tachycardia

Narrow Complex TachycardiaNarrow Complex Tachycardia

Ventricular TachycardiaVentricular Tachycardia

Wide Complex TachycardiaWide Complex Tachycardia

Ventricular FibrillationVentricular Fibrillation

Frequency - TachyarrhythmiaFrequency - Tachyarrhythmia Amplitude - MinimumAmplitude - Minimum Waveform - Chaotic, Varying, Wide, Waveform - Chaotic, Varying, Wide,

UnorganizedUnorganized

What is it ??What is it ??

What is it ??What is it ??

What is it ??What is it ??

What is it? What is it?

What is it?What is it?

What is it?What is it?

What is it?What is it?

What is it?What is it?

What is it?What is it?

What is it?What is it?

EMT / EKG MONITORINGEMT / EKG MONITORING

Answers!!!!Answers!!!!

1.1. What do we need to know about EKG’s?What do we need to know about EKG’s?Is there a pulse with every QRS?Is there a pulse with every QRS?

How fast or How slow is it?How fast or How slow is it?

Is it wide or narrow?Is it wide or narrow?

2.2. What “Guidelines” should we use to place What “Guidelines” should we use to place the monitor on someone?the monitor on someone?

A medical patient who you need to evaluate for a potential arrhythmia….. A medical patient who you need to evaluate for a potential arrhythmia….. Who is that?Who is that?

NEVER USE IT TO DECIDE IS THIS A HEART PROBLEM OR NOT!!!NEVER USE IT TO DECIDE IS THIS A HEART PROBLEM OR NOT!!!

When in doubt ask for assistance……… When in doubt ask for assistance………

Any Questions?Any Questions?

Thank YouThank You

& &

Good Luck!!!!!Good Luck!!!!!