Philips MP40/50 manual

Patient Mo nitor ing INST RUCT IONS FOR USE IntelliVue MP20/30, MP40/50 and MP60/70/80/90 IntelliVue Pati ent Monitor MP20/30, M P40/50, MP60/70/80/90 Release D .0 with S oftware Revi sion D.00.xx[...]

P a rt N umber M8000-9 001G Pr i n t e d i n G e r m a n y 0 2 / 0 6 4512 610 1 3551 *M8000-9001G*[...]

i 1 Table Of Contents M8000 -9001G 1 Basic Op eration 1 Intro ducing the I nt elliV ue F amily 1 IntelliV ue MP20/MP30 2 MP20/MP30 Maj or P arts and Keys 3 Intelli V ue MP40/MP50 4 MP40/MP50 Maj or P arts and Keys 4 Intelli V ue MP60/MP70 5 MP60/MP70 Maj or P arts and Keys 6 Intelli V ue MP80/MP90 6 MP80/MP90 M ajor P arts and Keys 7 D80 Intelli ge[...]

ii U nderstandin g P rofiles 24 S wapping a Complete P rofile 25 S wapping a Settings B lock 26 Default Profile 26 Locke d P rofiles 26 U nderstandin g S ettings 26 Changing Measu rement Settings 26 S witching a M easurement On and Off 27 Sw i t c h i n g Num e r i cs On a n d O f f 27 Adjust ing a Measure ment W ave 27 Changi ng W ave Speeds 27 Ch[...]

iii 3 Alarms 41 Visual Al arm Indicator s 42 Audibl e Alarm Indicato rs 42 Alarm T one Configuration 42 T raditiona l Audible Alarms (HP/ Agilen t/Phi lips/C ar enet) 43 ISO/IE C Sta ndar d 9703-2 A udible Alarms 43 Changing the Alarm T one V olume 43 Minimum V o lume for N o Central Monitoring INOP 43 Ac kno wledgin g Alarms 44 Ackno w ledging D i[...]

iv Disch argin g a P a tient 79 T r ansfe rring P atie nts 80 T ransferring a Centrally-Monitor ed P atient 80 T ransferring a P atient with an MMS (no Central S tation) 81 Data U pload fr om an MMS 81 Data Exchange Betw een Informatio n Centers 82 Res olving P atient I nformat ion M ismatch 82 Manually R esolving P atient Mismatch 82 P atient Mism[...]

v St andard 3-Lead Placement 98 St andard 5-Lead Placement 98 Chest Electrod e Placement 99 10-Lead Placement 100 Conventional 12-Lead ECG 100 Mod ified 12- Lead ECG 101 Choosing Standard or Modified Electrode Placement 101 Labelling 1 2-Lea d ECG R eports 101 Capture 12-Lead 102 EASI EC G Lead Placemen t 10 2 ECG, Arrhythmia, and ST Alarm Ov er vi[...]

vi Behavior of S ilenced Arrhyth mia Alarm s 114 Arrhythmi a Alarm Chaining 115 U nd erstanding PV C-Related Alarms 116 About ST M o nito ring 11 7 S witching ST On and Off 117 Selec ting S T Lead s for Analys is 117 U nderstandin g the ST Displ a y 118 U pdati ng ST B aseline S nippets 119 Recor ding ST Se gments 119 About t he ST M easur ement P [...]

vii Manual Detection Mo de 133 Resp Detectio n Modes and C ardiac Overlay 133 Changi ng the Siz e of the Re spiration W ave 13 3 Changi ng the S peed of the Resp irat ion W ave 134 U sing Resp Alarm s 134 Changi ng the A pnea Alarm D elay 134 Resp Safet y Informati on 134 9 Monitori ng SpO 2 13 7 SpO 2 Sens ors 137 Appl ying the S ensor 137 Connect[...]

viii 12 Monitoring Invasive Pressure 151 Set ting up t h e P res sure M easure ment 151 Selectin g a Pressure for Monitor ing 152 Extended P ressu re Label Set 15 2 Zeroing the P ressure T ransduce r 152 Zeroing ICP (or IC1/IC2) 15 3 Determ ining a Pr essure’ s Most Re cent Zero 153 Zeroing a P r essur e M e asure ment 153 Usin g th e Ze ro Ha rd[...]

ix Docum entin g C.O. M easur ements 169 C.O. I njecta te G uidelin es 17 0 Guidelines fo r Right Heart Thermod ilution C.O. Injectate 170 Guide lines f or PiCC O C.O. I njectate 170 Inj ecta te V olume, P atient W eight and ETVI V alues (P iCCO Only) 170 C.O./ CCO Cur ve Aler t Messages 171 C.O./CCO P rompt M essages 172 C.O./CCO W arning M essage[...]

x Spirometry V alues Wind ow 192 Alarms and Alarm Limits 192 Changing t he Apnea Alarm Delay 192 Au tomatic Alar m S uppr ession 193 Choosi ng M easure d A WV Components 193 Setting the Gas Compensation Mode 19 3 Changing the T ype of Balance Gas 193 Changing the Conc entration of Inspired O2 and the I nspired Agent s 193 Changing the T em perature[...]

xi Changing the Impedance Limit 20 9 Ab out E lec trode- to -S kin Imp edance 21 0 Imp edan ce Ind ica tor s 210 About Comp ressed S pectral Arrays (CSA) 211 Changing CSA Setti ngs 212 Changi ng EE G Se tting s 212 S witc hing EEG Numerics On and Off 212 Changing the Scal e of the EEG W ave s for Display 212 Changing Filter F requenci es 213 Changi[...]

xii T rend Parameter Scales 227 Graphical T rend P resentation 22 8 Docum entin g T rends 22 8 T rends Da tabases 229 Aperiodic T rends Database 22 9 T rending M ultiple-V alue Measur ements 229 Screen T rends 229 Setting the Screen T rend T ime 23 0 Changing the S election of Scr een T rends Displayed 231 Activating the Cursor for Screen T rend s [...]

xiii T riggering E vents Manually 246 The E vents Database 24 7 View ing Events 247 E vent Counter 247 Counting Combi- Ev ents 2 48 Counting N eonatal E vent Review (NER ) E vents 248 E vent S ummary Window 249 E vent Review Wind ow 24 9 Ev ent Episode Win dow 250 Annota ting E vent s 25 1 Docum enting E vents 251 Documenting Event Review 251 Docum[...]

xiv Sett ing Up Individ ual Print Jobs 27 0 Checking P rinter S ettings 270 P rinti ng a T e st Repor t 271 S witching P rinters On Or Off for Reports 271 Dashed Line s on Re ports 271 U navailable P rinter: R e-routi ng Re ports 271 Pr i n t e r St a t u s Me s s a g e s 272 Sampl e R eport P rintouts 27 2 Alarm Limits Re port 27 3 Rea ltim e Rep [...]

xv 29 Respiratory Loops 28 9 View ing L oops 289 Capturing and De leting Loops 290 Sh owin g/H iding Loop s 290 Changi ng Lo ops D isp lay S ize 29 1 U sing the Lo ops C urs or 291 Changi ng Lo ops T ype 291 Setting U p Source De vice 291 Document ing Loops 292 30 Care and Cl eaning 293 Genera l P oint s 293 Clea ning 294 Disi nfec ting 29 4 Cleani[...]

xvi 33 Accessories 309 ECG/R esp A ccessories 309 Tr u n k C a b l e s 309 3-E lec tr ode Ca ble S ets 309 5-E lec tr ode Ca ble S ets 310 10-Ele ctrode Cabl e Se ts 310 3-E lec tr ode One P iece C able s 310 5-E lec tr ode One P iece C able s 310 Set Com bine rs and Organi zers 31 1 NBP Accessorie s 311 Adult /P ediatri c M ulti-P atient C omfort [...]

xvii 802.11 Bedside A dapter (Wir eless N etwork Adapter) 335 Altit ude S etting 336 M onitor S afety S pecification s 336 Physical S pecificati ons 337 Environmental Specific ations 33 9 M4605A Batte ry Specificatio ns 34 1 M onitor P erformance S pecif ications 342 M easurement S pecifications 34 8 ECG/Ar rhyt hmia/S T 34 8 Resp irat ion 350 SpO [...]

xviii tcGas D e fault S ettings 37 9 Sv O 2 Default S e ttin gs 37 9 EEG Defa ult S ettin gs 38 0 BIS Default S e ttings 380 V ueLink Default Set tings 381[...]

1 1 1 Basic Oper ation These Inst ructions for Us e are for cl inical p rofess ionals using the Inte lliVue MP20/MP30 (M8001A/ M8002A), MP40/50 (M8003A /M8004 A) and MP60/70/80/9 0 (M8005A /M8007A/M 8008A/ M8010A) patient monito rs. Unless otherwise specified, the informatio n here is valid for all the above IntelliVue patie nt monitors. The basi c[...]

1 Bas ic O pe rat ion Introd ucing th e IntelliVue Fam ily 2 Your monitor stores data in trend, event, a nd calcula tion data bases . You can see tabul ar trends (vital signs) and document the m on a lo cal or remote pr inte r. You can view measuremen t trend graphs, with up to three measure ments combined in each graph, to help you identify change[...]

Introduc ing the Intelli Vue Family 1 Basic O peration 3 MP20/MP30 Major Parts and Keys MP20/MP 30 l eft side 1 Colo r-code d alar m lamps 2 Alarms of f lamp 3 Model indicat or 4 ECG out 5 Na vi g a ti o n P o in t 6 P art number and seria l number 7 Mou nting qui ck-relea se leve r MP20/MP 30 f ront p anel 1 On/Standby s witch 2 On/Stan dby LED 3 [...]

1 Bas ic O pe rat ion Introd ucing th e IntelliVue Fam ily 4 IntelliVue MP40/MP50 The Intelli Vue MP40/MP5 0 (M8003A/M8 004A) patient monit or has a 12-inch TFT LCD flat panel SVGA display. The standard input device s for the MP 50 are the Touchs creen and inte gr ated navigation point; the MP40 is suppli ed with an integrated n avigation point onl[...]

Introduc ing the Intelli Vue Family 1 Basic O peration 5 IntelliVue MP60/MP70 The Intelli Vue MP60/MP7 0 (M8005A/M8 007A) pati ent monitors i ntegrate the d isplay un it, with a 15” colo r LCD displa y, and the data processing unit into one . Up to eight waves can be shown on the scr eens, as we ll as the 12- Lead E CG Scre en. The MP60 use s the[...]

1 Bas ic O pe rat ion Introd ucing th e IntelliVue Fam ily 6 MP60/MP70 Major Parts and Keys IntelliVue MP80/MP90 Note: The MP80 monito r (M8008A) is not av aila ble in the USA. The Intelli Vue MP80/MP9 0 (M8008A/M8 010A) pati ent monitors have the d isplay a nd the proc essi ng uni t as sepa rat e co mp onents. They offer b oth touchscr een and the[...]

Introduc ing the Intelli Vue Family 1 Basic O peration 7 MP80/MP90 Major Parts and Keys D80 Intelligent Di splay The D80 Intelli gent Dis play can be used as a thi r d main display wi th the MP90 monit o r. You then have three displays able to be confi gured indiv idually and to be operated in dependently. Remote Alarm Device The Remote Alarm Devic[...]

1 Bas ic O pe rat ion Rela ted Pr odu cts 8 Docking Station MP20/30/ 40/50 only The docking sta tion provides q uick mou nting and co nne ctio ns in a one- step o peration. By pla cing th e monitor on the docking station and closing the l ever you can make the connection to power and to a wired netwo rk, if present. WARNING If t he do cking sta tio[...]

Related Prod ucts 1 Basic Operation 9 Measurement Modules You can u se up to eig ht mea sur emen t modu les wi th th e Flex ible Modu le Se rver (M 804 8A), t wo additional mo dules in the integrated module slots in the MP60/MP70, and up to four in the integrated slots i n the MP40/ MP50. Avail able module s are: • Inva sive b lood pressur e (M10[...]

1 Bas ic O pe rat ion Rela ted Pr odu cts 10 Multi-Measurement Server (M3001A) The Multi-Measureme nt Server (MMS) can simul taneo usl y monitor 3-, 5- or 10-lead ECG (includ ing arrhythmia and ST monitoring), respiration, SpO 2 , NBP a nd either i nvasive p ressure or temper ature. Depending on the mo nitor model, you can connect it to the monitor[...]

Related Prod ucts 1 Basic Operation 11 Measurement Server Extensions The measurement se rver extens ions connect to th e MMS a nd use the MMS setti ngs an d pow er. Tren d data and measurem ent set tings from the measurements i n the exte nsions are st ored in the m easurement server. To separate an exte nsion from the MMS, pr ess th e relea se le [...]

1 Bas ic O pe rat ion Rela ted Pr odu cts 12 WARNING The measurement server extensi ons can only func tio n when they are connected to a mea suremen t server. If the measure ment server i s removed duri ng monito ring, the measurem ents from b oth the measuremen t server and the m easure ment se rver e xtens ion are lost. M3014A, M3015 A and M3016A[...]

Related Prod ucts 1 Basic Operation 13 M3012A Hemodynamic M easurement S erver Extension The M3 012A Hemo dynamic Measureme nt Server Extensi on (HMSE) can be connected to the M3001A Mult i-Measur ement Server to provide the fo llowing add itional measuremen ts: Temp erature, Pres sure, an ad ditio nal Pr essur e or Tem perature, and C. O. an d CCO[...]

1 Bas ic O pe rat ion Operatin g and Na vigati ng 14 Operating and Navigating Everything you nee d to ope rate the moni tor is contain ed on i ts screen. Almo st every element on the screen is interactive. Screen el ements inclu de mea surement nume rics, wave forms, sc reen keys, info rmation fields , alarm s fields and me nus. The configurabili t[...]

Operat ing an d Naviga ting 1 Basic Operation 15 Selecting Screen Elements Select a screen element to tel l the monitor to carry out the actions linked to the e lement. For e xample, select the Patient I dentifica ti on element to call up the Pa tien t De mo gr ap hi cs wind ow, or select the HR numeri c to call up the Setu p ECG me nu. Select the [...]

1 Bas ic O pe rat ion Operatin g and Na vigati ng 16 Using the Speed Po int Rotate the Speed Point knob lef t or right. With e ach click, the highlight jumps to the neighboring screen eleme nt. Alternati vely, tilt the k nob to move it in the direction of a screen el ement. A cursor moves acro ss the s creen, fo llowing the d irection o f the knob [...]

Operat ing an d Naviga ting 1 Basic Operation 17 Using th e Navigation Point MP20/MP30/ MP40/MP50 Only To use the navigat ion point, rot ate it lef t or right. With e ach click, the highl ight jumps to the neighboring sc reen element. T he element und er the cu rsor is highlighted. When you reach the screen element you wa nt, press the knob to s el[...]

1 Bas ic O pe rat ion Operatin g and Na vigati ng 18 Smar tKeys A SmartKey is a configurable graphical key, located at the b ottom of the main scree n. It gives you fa st access to functions. The sele ction of SmartKe ys av ailable on your moni tor depends on you r monitor configura tion an d on t he options purch ased. enter pro file menu, or reve[...]

Operat ing an d Naviga ting 1 Basic Operation 19 Hardkeys A hardkey is a physical key on a monitoring device, such as the zero pressure ke y on the MMS or a setup key on a modu le. Pop-Up Keys Pop-up key s are task-related graphical keys that ap pear automatical ly on the mon itor screen when required. Fo r example, the confir m pop-up k ey appears[...]

1 Bas ic O pe rat ion Operatin g and Na vigati ng 20 Using the On -Screen Keyboard Use this as you would a co nvention al keyboar d. Enter the informati on by selecting o ne character a fter another. Use the Shift and capi tal Lock keys to access uppercase letters. Use the Ba ck key to d ele te single characters, or use the Clr key to delete enti r[...]

Operat ing Mode s 1 Basic Operation 21 Operating Modes When you switch the monitor on, it starts up in monitori ng mode. To chan ge to a diffe rent mode : 1 Sele ct the Main Setup menu. 2 Sele ct Ope rating Mode s an d choose the mo de you req uire. Your monitor ha s four opera ting modes . Some are passco de protect ed. • M onitor ing M ode : Th[...]

1 Bas ic O pe rat ion Understanding Screens 22 Un derstanding Screens Your monitor co mes with a set of preconfi gured Sc reens, optimized for common monitoring scenarios such as OR ad ult, or ICU neon atal. A Screen define s the overall selection, size and positio n of waves, numerics a nd SmartKeys on the moni tor screen when you sw itch on. You [...]

Using Add itional Disp lays 1 Basic O peration 23 In the Ch ange Scr een menu, the changed Screen is show n lin ked t o the ori gina l Scree n and mark ed wi th an aster is k. Up t o three m odifi ed Scr eens c an be a ccessed via the Chan ge Scree n menu. To recall Scree ns, ei ther ♦ select the name of the Scr een in the Chan ge Scree n menu or[...]

1 Bas ic O pe rat ion Understanding Profiles 24 1 Sele ct Pr ofiles in the monitor inf o line of the first di splay , 2 Sele ct Display 1 , Display 2, or Di spla y 3 then select the Sc reen you want to display on the that display f rom the list of avail able Scr eens. When two d isplays ar e mounted ne xt to each othe r or one abo ve the other, a s[...]

Understanding Prof iles 1 Basic O peration 25 You can change from one complete profile to anot her or swap in dividual settings bl ocks (display screen/moni tor set tings/mea surement settings) t o ch ange a subse t of a profile. C hanges you make to any element within the settings bl ocks are not save d when you discharge the patient, unless you s[...]

1 Bas ic O pe rat ion Und erstanding S ettings 26 Swapping a Setting s Block 1 Sele ct Pro files in the monitor info line, o r select the Pr o fil es Sm artKey . 2 In the Prof iles menu, select Displa y or Measmn t. Sett ings or Monit or Setting s to call up a list of the settings blocks in each category . 3 Choose a settings b lock from the pop-up[...]

Chan ging W ave Sp eeds 1 Basic O peration 27 •v i a t h e Main Se tu p SmartKey - if yo u want to set up a measure ment when the measur ement is switched off , use t he Main Set up Sm a r t K e y a n d s e l ec t Measurem ents . The n select the measurement nam e from the popu p list. With this SmartKey you can access any setup menu in the monit[...]

1 Bas ic O pe rat ion Freezing Waves 28 3 Selec t a value f rom the list of availab le sp eeds. Changing Wave Speed f or a Channel To change the wa ve spee d of an indivi dual wa ve channel, 1 Enter the Wave menu for a measur ement b y selecting i ts wav e. 2 Sele ct Ch ange Speed . 3 T o set the speed to the wave gr oup speed, select Respirator yS[...]

Using Labe ls 1 Basic Operatio n 29 Changing The Wave Sp eed Lowering the wave speed co mpresses the wave and lets you view a longer time p eriod. Increasing the speed expa nds the wa veform, gi ving you a more detai led view . To change the wave spee d: 1 Select t he fro zen wa ve. 2 Sele ct Ch ange Sp eed . 3 Select a s peed f rom the list. Updat[...]

1 Bas ic O pe rat ion Using La bels 30 1 Enter the Wave menu of the measur ement. 2 Sele ct La bel . 3 Cho ose a labe l from the list. Th e mon ito r au tom ati cal ly ap pli es th e sc ale , col or, e t c. settings stored in the Profi le for the l abel yo u select. You can change scale settings in Monit oring Mode, but color can only be changed in[...]

Chan ging M onit or Set tings 1 Basic Operation 31 2 Select t he device whose labe l you want t o correct. 3 U se the mea sur ement sel ection pop-up key s to re solv e the confl ict. Select e ither: – Chan ge Lab el to assign a diff er ent label to the conflicti ng label – De-a ctivat e: to disa ble the con flicting device. I t retains its lab[...]

1 Bas ic O pe rat ion Checking Y our Monitor Revisi on 32 2 Select, in turn, the Year, Month, Day, Hour (in 24 hour format, only) and Minute as necessary . Select the corr ect values fr om the pop-up list. 3 Sele ct St or e Dat e, Time to change the date and time. Checking Your Monitor Revision 1 Sele ct Ma in Setu p -> Revi sion to open the Mon[...]

Disconne cting from Power 1 Basic O peration 33 2 Connect the requ ired modules , M easur ement Servers, or measur ement s erver extens ions. 3 Check that you have the correct patient cable s and transducers plugged in. The co nnectors are color-coded to the patie nt cables and transducers for easy ident ification. Starting Monitori ng After you sw[...]

1 Bas ic O pe rat ion Using Remote Appl ications 34 1 In the Main Set up me nu , s elec t Remote A ppli cs , or sele ct the Remot e Applic atio ns Sm ar t Ke y . 2 Sel ect th e req uire d appl icatio n fro m the pop-u p list of ava ilable appl ications. 3 Operat e the app lication w ith your pr eferred monito r input dev ice: tou chscree n, S peedP[...]

35 2 2 What’s New? This sectio n lists the most impo rtant new fea tures and improv ements to the monitor and its user interface introduced with each release. Further inform at ion is pr ovid ed in o ther se ctio ns of th is boo k. You may not have all of these features, depen ding on the mo nitor confi guration purchased by your hos pi ta l. Wha[...]

2W h a t ’ s N e w ? What’ s New in Release C.0? 36 What’s New in Release C .0? IntelliVue MP80 The MP80 patient moni tor is a new addition to the Intelli Vue patient mon itor family. The functionality is similar to that of the MP70 but with the fle xibil ity of co mponent modulari ty as in the MP90. M3014A Capnogr aphy Ext ension The M3014A [...]

What’s New in R elease B.1? 2W h a t ’ s N e w ? 37 Trends • In graphical tr end s, a segment me nu allows d ire ct adjus tment of tr end scal es, autom atic sc ale optimiz ation, expan ded view f or an indi vidual s egment. • In graphical and horizo n Screen T rends a cursor is available. • In the V ital S igns windo w , the values ca n [...]

2W h a t ’ s N e w ? What’s New in Release B.0? 38 • ST P oint can be set dire ctly by sele cting a numeric value • N ew NBP countdo wn timer shows the time r emaining unt i l the ne xt NBP measur ement in a series • N etwor ked moni tors can no w show Ot her Bed inf ormation embe dded on Scre en • Add itional l abels a vai lable f or P[...]

What’s New in R elease A.2? 2W h a t ’ s N e w ? 39 What’s New in Release A.2 ? 12-Lead ECG r ecordings: 12-Lead ECG waves and numerics can be sent to a connected recorder High -Res olut ion T ren d Rep ort : high-resolution trend report can be sent to a connected printer ST Sn ippets ST snipp ets, showing a one se cond wave se gment for ea c[...]

2W h a t ’ s N e w ? What’s New i n Release A.2? 40[...]

41 3 3 Alarms The al arm informati on here applie s to all measu rements. Mea surement-spe cific alarm i nformatio n is discu ssed in the sections on ind ividual m easuremen ts. The monitor has three a larm levels: red, yellow, and INOP. Red and yel low alar ms are patient al arms. A red alarm indicates a high priori ty patient alarm such as a pote[...]

3A l a r m s Visual Alarm Indi cator s 42 Visual Alarm Indic ators Alarm mess age: An alarm message text appe ars in the alar m status area at the top of the screen indicati ng the source of the alarm. If more than one meas urement i s in an alarm co ndition, the messa ge changes every two se conds, and has an arrow ( ) at the sid e. The backgroun [...]

Audibl e Ala rm Indi cators 3A l a r m s 43 Traditional Audible Alarms (HP/Agi lent/Philips/Carenet) • Red alarms: A high p itched sound is r epeated once a second. • T wo -star yellow alarms: A lower pitched so und is repeated ever y two seconds. • One-star yell ow alarms (arrhythmia a larms): The audible ind icator is the same as for yellow[...]

3A l a r m s Acknow ledging Alarms 44 Acknowledging Alarm s To ackno wledge all acti ve alarms and I NOPs, select th e Sile nce permanent key. This switch es o ff th e audi ble al arm indic ators an d alarm lam ps. Alter nati vely, you can ack nowle dge alarm s by pres sing the Si lence hardkey o n the MMS or on the Speed Point. The ha rdkeys fo ll[...]

Pausin g or Switch ing Off Ala rms 3A l a r m s 45 To Pause All Alarm s ♦ Sele ct the Paus e Al ar ms p ermanent key . If y our monitor is configure d to infinite pause time, the perm anent key is labe lled Al arms Off , and selecting it switch es al arms off . ♦ Or pr ess the Al arms har dkey on the S peedP oint or N avigation P oint. The hard[...]

3A l a r m s Alarm Limits 46 Restarting Paused Alarms ♦ T o manually switch on alarm i ndication agai n after a paus e, select the perma nent key Pause Alarm s (or Alarms Of f ) again. Alarm in dication starts agai n automatically after the pa use period expires. If the monitor is configured to stay pause d infinitely, you mu st select Al arms Of[...]

Alar m Limits 3A l a r m s 47 Viewing All Alarm Limits The Alarm Lim its overvi ew window lists the currently set ala rm limits fo r all measurements . If an Apnea alarm delay time is set, this is als o shown. The Alarms Off sym bol is sh own be side t he meas urement lab el of any m easurem ent whos e alarm swi tched off. To open the Alar m Limi t[...]

3A l a r m s Alarm Limits 48 These pop -up key s are not avai lable in the window f or changi ng in divid ual ala rm limi ts which you access by s electing the m easurement label in the Alarm Limi ts wi ndo w. Changing Al arm Limits To change individual me asurement al arm limits us ing the measu rement’s S etup Menu, 1 in the me asur ement ’ s[...]

Alar m Limits 3A l a r m s 49 If you set the ye llow alarm limit o utside the red alar m limi t, the moni tor will auto matically set the red alarm t o the yell ow al arm l imit. When an ST meas urement is in the Change L imits w indow there are also two pop -up keys availa ble labe led All ST Narr ow / All S T Wide . With these keys you can set Au[...]

3A l a r m s Review ing Al arms 50 Reviewing Alarms To revie w the cur rentl y act ive alarms and INOPs , se lect any of the alarm status areas on the mo nitor scre en. T he Alarm Me ssages window pops up. All alarms and INOPs are erased fro m the monitor’s a larm history when yo u discharge a pa tient, or if you change to Dem onstration Mode . A[...]

Understa nding Al arm Messa ges 3A l a r m s 51 Understanding Alarm Messages If you do not immed iately understand an INOP o r alarm message, refer to i ts help text. ♦ In the Alarm Me ssag es window , select the INOP message. This calls up a help win dow with an explana tion of the INOP mes sage and, wher e ap pro priate, a su ggested sol ution [...]

3A l a r m s Test ing A larms 52 Alarm Latching Behavi or All INOP s exce pt DISCON NECT an d UNPLUG GED INOPs fro m measurem ent servers and mo dules are non-latching. See “Y ellow Arrhythmia Ala rms” on page 113 for in formation on sho rt yellow arrhythmia alarms latching behavior. Testing Alarms When yo u switch the monitor on, a selftest is[...]

53 4 4 Patient Alarms and INOPs This chap ter lists patient alarms and technical ala r ms (INOPs) al phabeticall y, irrespective of their priority . INOPs start on page 59. For information on alarms and INOPs from the gas modules refer to your Gas Module Instructions for Use. Patient Alarm Messages The measure ment label s and abbrevi ati ons for p[...]

4 Pati ent Alarms an d INOPs Patient Alarm Mess ages 54 ***BRADY (Pulse) or ***BRADY xxx<yyy Pr ess, SpO 2 The he art rate from the P ulse signal has fallen bel ow the bradycardia limit. xxx denotes the lowe st measured va lue; yyy is the bradycardia li mit. numeric flas hes and alarm limit is highlighted, red alarm lamp, alarm tone. **CCO/CCI H[...]

Patient Alarm Messages 4 Patient Al arms and INO Ps 55 **HR HIGH ECG The heart rate high alarm limit has been exce eded. numeric flashes and high limit is highli ghted, yell ow alarm lamp, alarm tone. The sound switches off af ter 5 seconds if Arrh ythmia is On. **HR LOW ECG The he art rate has fa llen b elow the l ow alarm limit. numeric flashes a[...]

4 Pati ent Alarms an d INOPs Patient Alarm Mess ages 56 */**NON-SUSTAIN VT ECG/ Arrhythmia A run of Vs having a ve ntricular HR>V - T ach HR limit, but lasting for less than the V -T ach Run limit ha s been detected. numeric flas hes, yellow alarm lamp, short y ellow audible alarm. */**PACER NOT CAPT EC G/ Arrhythmia (paced patients only) A miss[...]

Patient Alarm Messages 4 Patient Al arms and INO Ps 57 **RR HIGH RESP The r espira tion rate h as ex ceeded the high alarm limit. numeric flashes and high limit is highli ghted, yell ow alarm lamp, alarm tone. **RR LOW RESP Th e respiration r ate has dropp ed below the low alarm limit. numeric flashes and low limit is highli ghted, yell ow alarm la[...]

4 Pati ent Alarms an d INOPs Patient Alarm Mess ages 58 **tcpO2 LOW/ **tcpCO2 LOW tcGas The tcpO 2 or tcpCO 2 value has f allen below th e low alarm limit. numeric flas hes, low alarm limit is highlighted, yellow alarm lamp, alarm tone. **<Temperature label> HIGH TEMP The temperatur e has ex ceeded the high alarm limit. numeric flashes and hi[...]

Techni cal A larm Mes sages (I NOPs) 4 Patient Alarms and INOPs 59 Technical Alarm M essages (INOPs) The measure ment label s and ab breviati ons for pres sure, temperature, SpO 2 , anes thetic agent, a nd VueLink I NOP message s are explained in the ind ividu al chapters . INOP Message, Indication Sou rce What to do ABP INOP S PRES S See < P re[...]

4 Pati ent Alarms an d INOPs Technica l Ala rm Me ssages ( INOPs ) 60 BIS CABLE INCOMPAT INOP t one . BIS The semi-reusable sensor cable connected is u nknown or not supported by your software revision. Replace it with a Philips- supported senso r cable. BIS CABLE USAGE INOP t one . BIS The semi-reusable sens or ca ble has excee ded the maximum num[...]

Techni cal A larm Mes sages (I NOPs) 4 Patient Alarms and INOPs 61 BIS ISOELECTRC EEG BIS N o discernible EEG activity is detected for l onger than one minute. Check the patient. Check that the electro des are pr operly connected. BIS LEAD OFF INOP tone may sound BIS One or more e lectrodes have no skin contact and therefor e impedanc es cannot b e[...]

4 Pati ent Alarms an d INOPs Technica l Ala rm Me ssages ( INOPs ) 62 BISx INCOMPATIBLE INOP t one BIS The BISx softw are i s not co mpatible with the BIS module or with the MP20/MP30 monitor software . A software upgrade may be requir ed. Contact your service personnel. BISx MALFUNCTION INOP t one BIS The BISx is faulty . Disconnect and reconnect [...]

Techni cal A larm Mes sages (I NOPs) 4 Patient Alarms and INOPs 63 CCO PRESS INVALID at Inform ation Cente r C.O. The a rterial pressure sele cted for pulse contour calculation for CCO is available but currently in valid. Make sure the pressure transducer is connected and the zero calibration is valid. CCO PRESS OVERRANG numeric is replaced by -?- [...]

4 Pati ent Alarms an d INOPs Technica l Ala rm Me ssages ( INOPs ) 64 Check Mouse Device INOP t one . M onitor P erform a visual and functional check of the mouse input device. Contact yo ur service personnel . Check MSL Voltage INOP t one Mon i to r / M easuremt Ser v e r There is a problem with the voltage of the Measurement Server Link (MSL). Co[...]

Techni cal A larm Mes sages (I NOPs) 4 Patient Alarms and INOPs 65 CO 2 CHECK CAL Nu meric is replaced by a - ? - INOP t one . CO 2 The CO 2 value is outs ide the me asuremen t range. P erform an accuracy check for b oth calstick cells and, if necessary , recalib rate the tr ansducer . C.O. EQUIP MALF Nu meric is replaced by a - ? - INOP t one . C.[...]

4 Pati ent Alarms an d INOPs Technica l Ala rm Me ssages ( INOPs ) 66 CO 2 ZERO FAILED Nu meric is replaced by a - ? - INOP t one . CO 2 An erro r occurred du ring the last zero calibration. Check the air way adapter and clean, if nece ssary . P er form another zero calibration. If the INOP persists, contact your service personnel. CO 2 ZERO REQUIR[...]

Techni cal A larm Mes sages (I NOPs) 4 Patient Alarms and INOPs 67 EEG<X> LEAD OFF [X = channel ] at Inform ation Cente r EEG One or more electrodes ar e not connected. Che ck in the EEG Impedance/Montage windo w on the monitor w hich electro de(s) a re affe cted and reconn ect the el ectrod es. EEG<X> LEADS OFF [X = channel ] EEG T wo [...]

4 Pati ent Alarms an d INOPs Technica l Ala rm Me ssages ( INOPs ) 68 LEADS OFF Nu meric is replaced by -?- for 10 seconds; IN OP tone. ECG Check that all of the requir ed ECG leads are attached, and that none o f the ele ctrod es have been di splac ed. LL LEAD OFF Nu meric is replaced by -?- for 10 seconds; IN OP tone. ECG The LL electrode h as be[...]

Techni cal A larm Mes sages (I NOPs) 4 Patient Alarms and INOPs 69 NBP INTERRUPTED Nu meric is replaced by -?- INOP t one . NBP Che ck the tubi ng and cuff fo r leakag es or ki nks. C heck that you are using the correct cuff size and placement, and that the correct patient catego ry is se lected. T ry restarting the measur ement. If the INOP occurs[...]

4 Pati ent Alarms an d INOPs Technica l Ala rm Me ssages ( INOPs ) 70 <Pressure label> EQUIP MALF Nu meric displayed with -?- INOP t one . PRESS Contact your service personnel. The pres sure hard ware is f au lty . <Pressure label> NO TRANSDUCER Nu meric is replaced by -?- INOP t one . PRESS Make sur e that the pre ssure transducer is c[...]

Techni cal A larm Mes sages (I NOPs) 4 Patient Alarms and INOPs 71 RESP ERRATIC Nu meric is replaced by -?- RESP The monitor has detected too many artifacts in the measured Resp s ignal. Check that the RA an d LL ele ctrodes ar e correctly attached and have not dried out. RESP LEADS OFF Nu meric is replaced by -?- INOP t one . RESP N ot all the r e[...]

4 Pati ent Alarms an d INOPs Technica l Ala rm Me ssages ( INOPs ) 72 <SpO 2 label> DEACTIVATED INOP t one Sp O 2 Y ou have conn ected a measur ement server that uses a lab el the monitor has already assigned to a differe nt source. T o activate the n ew so urce , choose a new la bel in th e Meas ure ment Selection w indow . <SpO 2 label&g[...]

Techni cal A larm Mes sages (I NOPs) 4 Patient Alarms and INOPs 73 <SpO 2 LABEL> UPGRADE Label is displ ayed with a -?-, numeric is unav ailable Sp O 2 The SpO 2 measurement is curren tly in UPGRADE mode. M onitoring i s not possibl e in this mo de. Sp - vO 2 CHK SOURCES Nu meric is replaced by -?- Sp - v O 2 N ot all measurements or values r[...]

4 Pati ent Alarms an d INOPs Technica l Ala rm Me ssages ( INOPs ) 74 SvO 2 UNABL TO MEAS Sv O 2 numeric is re placed by -?-. INOP t one Sv O 2 The signa l is out of the n ormal r ange, a nd no Sv O 2 value can be derived. P er form an in-vivo cal ibration. If the INOP persists, try another Optical M o dule and catheter . SvO 2 UNPLUGGED Sv O 2 num[...]

Techni cal A larm Mes sages (I NOPs) 4 Patient Alarms and INOPs 75 tcpO 2 (or tcpCO 2 or tcGas) EQUIP MALF Nu meric is replaced by -?- INOP t one . tcGas T here is a malfunction in the transducer or module. Connect another transducer . If this INOP persists, contact your service personnel. tcpO 2 (or tcpCO 2 or tcGas) NO TRANSDUC Nu meric is replac[...]

4 Pati ent Alarms an d INOPs Technica l Ala rm Me ssages ( INOPs ) 76 Ttymp INOPS TEMP See <T emp label> INOP s (under T emp) Tven INOPS TEMP See <T emp label> INOPs (under T emp). Tvesic INOPS TEMP See <T emp label> INOPs (under T emp) UAP INOP S PRES S See < P ressure l abel> I NOPS (under P ressur e). Unsupported LAN INOP[...]

77 5 5 Managing Patients Use the Pati ent De mograp hics windo w and its as soci ated pop-up keys to admit, discharge, and transfer (ADT) patients. All patient demographic and ADT inf ormation is shared betwe en the patient monitor and the Information Ce nter, for examp le, pati ents admitted to the monitor are auto matically admit ted to a connect[...]

5 Managi ng Patients Q uick Admitt ing a Pat ient 78 – First na me : Enter the patient ’ s first name, for example Joseph. – MRN : E nter the patient ’ s medical reco rd number (MRN), for e xample 12345678. – Patien t Cat : Choose the pati ent category , either A dult, P e diatric, or N eonatal. – Paced : Cho ose Yes or No (Y ou mu st u[...]

Editing Patient In formation 5 Managin g Patients 79 3 Sele ct En ter . 4 In the conf irma tion win dow , sel ect C onfirm to discharge the previous pati ent (if conf irmation is configured). 5 Check that patient category and paced status are corr ect for the new patient. If the monitor i s connected to an Info rmation Cent er and o nly the MRN is [...]

5 Managi ng Patients Transferring Patients 80 Transferring Patients To save you from having to ente r the same pat ient data multiple times and en able patient transfer without loss of data, info rmation can be shared be t ween meas urem ent servers, pa tient moni tors, and Information Centers. – patient demographic inf ormation is shar ed betwe [...]

Data Upload f rom an MMS 5 Man aging Patients 81 4 At the new lo cation, conn ect the MMS to the moni tor . If the monitor dete cts a patient conflict, the patient selection wi ndow wil l be displayed. 5 Sele ct Co ntinue MM S and Confirm your se lection. This re -admits the patient from the transfer list to the new mo nitor , completing the transf[...]

5 Managi ng Patients Data Exchang e Between Information Cente rs 82 Data Exchange Between Information Centers You can tr ansfe r demog raphic data a nd tren d data fr om one II C to another by se lecti ng Transfer on the patient moni tor. Trend data is no t sh ared between Info rmation Cent ers and monitors. Resolving Patient Inform ation Mismatch [...]

Resol ving Pa tient Infor matio n Mism atch 5 Man aging Patients 83 Patient Mism atch - I f One Set of Patient Data is Co rrect ♦ If ther e is a m ismatch bet ween an Informati on Center and a monitor , choose the data set you want to continue us ing for this patient , either: Continue Central : to continue with the patient demographics f rom the[...]

5 Managi ng Patients Care Group s 84 Patient Mismatch - If Both Patien t Data Sets Ar e Corr ect A patient mismatch where both sets of patient data are correct mi ght occur if you admi t a new patient at the monitor (or Information Center) before the pa tient arrives at you r unit and then connect the MMS that was used during the patient transport [...]

Care Group s 5 Man aging Patients 85 Monitors must be assigned to the s e Care Group s at the Information Center. There is a third care group which can be assigned locall y at the bedside . This is the My Ce ntral care group which includ es all beds (up to 16) from the Inform ation Center your be d is connected to. This care gro up setting is typic[...]

5 Managi ng Patients Care Group s 86 Viewing the My Care Group Window This wind ow shows the alarm status, b ed name, and pati ent name fo r every bed in the Ca re Gro up. The wind ow for the U nit group (s hown here) shows first the beds of the Information Cent er this bed is connected to. By selecting the Information Center name you can display a[...]

Care Group s 5 Man aging Patients 87 Viewing the Other Bed Window T he O th e r Be d w in d ow l et s yo u v ie w a su bs e t o f the wav eform and n umeric inf ormation f rom another bed on t he same net work. Wave s and nume ric informat ion fr om anot her bed a re del ayed. If configured, Other Bed information is displayed in color, using the co[...]

5 Managi ng Patients Care Group s 88 Note that changing the Screen may automati cally change the bed shown in the othe r bed window. If you switch to a different Screen , you should check if the correct other bed is displayed. Other Bed P op-Up Keys Select the Othe r Pati ents Sma rtKey or the Other Bed wind ow or em bedded screen element to access[...]

Care Group s 5 Man aging Patients 89 Automatic alarm notification can be switched off permanently in the monitor’s Conf iguration Mod e or at the Informatio n Center. To tempo rarily disabl e and re-enable autom atic alarm notificati on at the bedside monitor, for example if you want to carry out a procedure, in Monitoring Mode: 1 Select t he net[...]

5 Managi ng Patients Care Group s 90 Telemetry Data Overview Screen Element WARNING Waves and numeric information on the telemetry screen element ar e delayed for severa l seconds. I f you need realtime data, for example for defibri llation , always use the mo nitor ECG instead of telemetry. Silencing Telemetry Alarms from the Bedside When a teleme[...]

91 6 6 ECG, Arrhythmia, and ST Monitoring The electroca rdiogram (ECG) mea sur es the electrical activit y of the heart and displays it o n the monitor as a w aveform and a n umeric. This se ction also tells y ou about arrhythmi a monitoring (se e page 107) and ST monito ring (see page 117 ). Skin Preparation for Electrode Placement Good electrode-[...]

6 ECG, Arrh ythmia, an d ST Mo nitor ing Selecti ng th e Primary and Second ary ECG Le ads 92 CAUTION To protect the mon itor from damage duri ng defi brillation, for accurate ECG information and to protect agains t noise and othe r interference , use only ECG el ectrodes and cables specif ied by Philip s. Selecting the Primary and Secondary ECG Le[...]

Understandin g the ECG Disp lay 6 EC G, Arr hythmi a, and ST Mo nitori ng 93 Understanding the ECG Display You r disp lay may b e confi gure d to lo ok sli ghtly differe nt. ECG numeric : This is deri ved from the monitored ECG. Pace puls e marker s : These a re show n if the Paced statu s has been set to Yes and the patient has a paced signal. Def[...]

6 ECG, Arrh ythmia, an d ST Mo nitor ing Changing the Size of th e ECG Wave 94 Setting the Paced Status (Pace Pulse Rejection) Avoiding Pace Pulse Repolarization Tails Some un ipolar pacem akers di splay pace pu lses with repolarization tails. These tai ls may be counte d as QRSs in the event of cardiac arrest or other arrhythmias. If you note a vi[...]

Chan ging t he Volu me of t he QRS T one 6 ECG, Ar rhyt hmia, a nd ST M onito ring 95 To Change the S ize of all the ECG Waves To change the size of all the ECG waves on the screen by a f ixed adjustment factor, 1 In the Setup ECG Lead menu, select Adjust Size . 2 Select th e requir ed adjustment factor fro m the line o f pop-up keys. – Size x 0.[...]

6 ECG, Arrh ythmia, an d ST Mo nitor ing Choosing EASI or Standard Lead Placement 96 – Diag (Diagnos tic): U se when diagnostic quality is req uired. The unf iltere d ECG wave is displayed so that changes such as R-wa ve notching or discrete elevation or depression of the ST segments a re vi sible. The setting Diag selects t he highest av ailab l[...]

ECG Lead Fallbac k 6 EC G, Arr hythm ia, and ST Mo nitori ng 97 will iss ue a Lead Off INOP m essage. Select New Lead Setup and the I NOP me ssage will disap pear . ECG Lead Fallback If fallback is configured on and ther e is a lead s of f INO P in t he pr imary lead (an d in th e se condar y lead, if yo u are using m ulti-lead monitoring) for lo n[...]

6 ECG, Arrh ythmia, an d ST Mo nitor ing ECG Lead Pl acement s 98 Standard 3-Lead Placement Standard 5-Lead Placement RA placemen t: directly below the cl avicl e and near the right shoul der LA placement: dire ctly below the clav icle and near the left shou lder LL placement: on th e left lo wer a bdom en RA LA LL RA placement: directly below t he[...]

ECG Lead Pl acements 6 EC G, Arrhy thmi a, and ST Mo nitori ng 99 Chest Electrode Placement For accurate chest electrode placeme nt and measur e ment, it i s important to l ocate the fou rth intercostal space. 1 Locate the second i ntercostal space by first palpating the An gle of L ewis (the li ttle bo ny prot uberance where t he body of the s ter[...]

6 ECG, Arrh ythmia, an d ST Mo nitor ing ECG Lead Pl acement s 100 10-Lead Placement When monitoring 12-leads of ECG, usin g a 10-Electro de Lead Placement , it is important to correct ly place e lectrodes and to label al l 12-lead ECG reports with the correct lead pl acement. Conventional 12-Lead ECG In conventi onal 1 2-Lead ECG usin g 10 elec tr[...]

ECG Lead Pl acements 6 EC G, Arrhy thmi a, and ST Mo nitori ng 101 Modified 12- Lead ECG Choosing Standard or Modified Electrode Placement If your i nstitu tion uses modi fied 10 L ead ECG e lectrod e placeme nt (the Maso n-Likar Lea d Syste m), you must sw itch Mod. Lea d Plac ment to On in the monitor. To d o this, ♦ in the Setu p ECG menu, sel[...]

6 ECG, Arrh ythmia, an d ST Mo nitor ing Captu re 12- Lea d 102 – 12 Lead ECG R e ports wil l be labelled 12 Lead EC G Re por t (Mason -Lik ar ) . – Captur ed 12-lea d ECGs will be la belled M ason-L ika r to the ri ght of the bandwidth annotation at the Info rmation Cent er . When M od. Le adPl acem ent is s et to Off , – 12 Lead ECG R e por[...]

EASI ECG Le ad Pl acement 6 ECG, A rrhyt hmia, a nd ST M onito ring 103 EASI Electrode Placement 1 E (V) on the low er sternum a t the level o f the fifth i ntercostal space 2 A (LL) on the lef t midaxi llary li ne at the same leve l as the E e lectrode 3 S (LA) on the up per sternum 4 I (RA) on the right midaxillary li ne at the same leve l as the[...]

6 ECG, Arrh ythmia, an d ST Mo nitor ing ECG, Arrhyth mia, and ST Ala rm Overview 104 ECG, Arrhythmia, and ST Alarm Overview The ECG, arrhy thmia, and ST alarms available d epend on w hich measure ments are sw itched on, an d the arrhythmia option enabled for your monitor. • Cardiotach al arms are availabl e when HR i s on and the active alarm so[...]

Using ECG Alarms 6 EC G, Arr hythm ia, a nd ST Mo nito ring 105 Using ECG Alarms ECG al arms can be switched on and off an d the high and low alarm limits chan ged just like othe r measur ement alarm s , as des cribe d in t he Al arms secti on. Sp ecial alarm fe atur es which ap ply on ly t o ECG are describe d here. Extreme Al arm Limits The extre[...]

6 ECG, Arrh ythmia, an d ST Mo nitor ing ECG Safety Information 106 WARNING Defibril lation and El ectrosurger y: Do not touch th e patient, or tabl e, or instruments, d uring defibr illatio n. After defibrill ation, the screen display recovers within 10 seconds if the correct e lectrodes are used and applied in accordance with the manufacturers in[...]

About Arrhythmia Monitoring 6 EC G, Arr hythmi a, and ST Mo nitori ng 107 About Arrhythmia Mo nitoring Arrhyt hmia anal ysis provid es info rmatio n on yo ur pat ient’s c onditio n, includ ing he art rate , PVC rate, rhythm, and ectopi cs. The moni tor uses the user -select ed primary a nd seconda ry ECG leads for single- lead or mu lti-lead arrh[...]

6 ECG, Arrh ythmia, an d ST Mo nitor ing Switch ing Arrhyt hmia An alysi s On and Off 108 Switching Arrhythmia Analysis On an d Off 1 In the Setu p Ar rh ythmi a menu, select Arrhyt hmia to to ggle betwe en On and Off . 2 Sele ct the Confi rm pop-up key whi ch appears at the bo ttom of the screen. Be aware that when arrhythm ia analysi s is switche[...]

Understanding the Arrhyth mia Display 6 ECG, Ar rhyt hmia, a nd ST M onito ring 109 Intermittent Bundle Branch Block Bundle branch and the other fascicu lar blocks create a chal lenge for the arrhythmia al gorithm. If the QRS during the blo ck changes considerabl y from the lea rned normal, the blocked be at may be incorrectly classified as ventric[...]

6 ECG, Arrh ythmia, an d ST Mo nitor ing Understanding the Arrhyth mia Displa y 110 Arrhythmia Status Messages The moni tor displays two type s of status messa ges: • Rhythm S tatus Me ssages -- to indicate the patient ’ s rhy thm. • Ectopic S tatus M essages -- to indicate the presence of ectopic beats. These status messa ges are s hown on t[...]

Arrhyt hmia Re lear ning 6 ECG, Arrhy thmi a, and ST Mo nitori ng 111 Ectopic S tat us Mes sages The label B or E i ndicates basic (B) or enhanced (E) arrhythmi a capabil ity. Arrhythmia Relearning During a learning phase: • Alarm timeout periods are cleared • St ored arrhythmia templates are cleared • Asystole, Vfib, and HR alarms (when ther[...]

6 ECG, Arrh ythmia, an d ST Mo nitor ing Arrhyt hmia Al arms 112 Automatic Arrhythm ia Relearn Arrhyt hmia rel earning is ini tiated a utomatic ally whenever : • ECG monitoring is switche d on • The ECG Lead or Lead Label is chan ged manually , o r when fallback occurs •A Leads Of f INO P condit ion (that has been activ e for > 60 second s[...]

Arrhythmia Alarms 6 EC G, Arr hythm ia, and ST Mo nitori ng 113 Yellow Arrhythmia A larms Yellow arrhythmia alarms a re short yell ow alarms sp e cific t o arrhyt hmia- related pa tien t condit ions. Depending on yo ur monitor and I nformation Cent er revision, the y may be shown with o ne or two star s. WARNING When arrhythmia analysis is on, all [...]

6 ECG, Arrh ythmia, an d ST Mo nitor ing Arrhyt hmia Al arms 114 What is a Timeout Period? Timeout p eriods are automa tically started wh en a ye llow arrhyt hmia alarm is de tected. During this period, the same al arm condition will not gen erate another al arm. Alarm cond itions further down the same arrhythmi a alarm chain will al so not generat[...]

Arrhythmia Alarms 6 EC G, Arr hythm ia, and ST Mo nitori ng 115 Arrhythmia Alarm Chaining When arrhythm ia analysis is switche d on, multiple alarm cond itions may be present. Announci ng all of the detected alarm co nditions would be confusing, and might hide a more serious condition. Fo r this reas on, ar rhy thmia alarm s are priori tize d in th[...]

6 ECG, Arrh ythmia, an d ST Mo nitor ing Arrhyt hmia Al arms 116 Understanding PVC-Related Alarms PVC-related alarms are de tected on the basis of the current ventricul ar heart rate and the number of consecutive PVCs counted (re ferred to as PVC Runs ). Changing one alarm limit automatically changes link ed alarm li mits. Example: This diagram ill[...]

About ST Monitori ng 6 ECG, Arr hyt hmia, a nd ST M onito ring 117 About ST Monitoring The mon itor perform s ST segment an alysis on nor mal and atrially paced beats and calculates ST segmen t elevations a nd depressi ons. This in formatio n can be disp layed in the form of S T numeri cs and snippets on the monitor. All availabl e leads can be m o[...]

6 ECG, Arrh ythmia, an d ST Mo nitor ing Unde rstanding the ST Di splay 118 Understanding the ST Display Your monitor sc reen may be configured to lo ok slight ly different f rom the illustrati ons. ST N ume ri cs Up to 12 ST numerics plus the ST index can b e displayed on the monitor screen. They can be configured to show be side the measure ment [...]

Upda ting ST Bas eline S nipp ets 6 ECG, Ar rhyt hmia, a nd ST M onito ring 119 Up dating ST Baseline Snippets ST anal ysis requi res va lid sampl es to measu re and store a sn ippet. ST Sn ippets and ST values ar e updated eve ry minute. If the re is artifact in the signal, it may take longer for an ST snippe t and an ST value to appear. The fi rs[...]

6 ECG, Arrh ythmia, an d ST Mo nitor ing About the ST Mea surement Points 120 Ab out the ST Measurement Points The ST va lue for ea ch be at co mple x is th e ve rtical diff eren ce be twee n the I SO p oint a nd t he ST poi nt, as s hown in th e diagr am b elow. The i soel ectric (ISO ) point provides the baseline, the ST point is at the midpoint [...]

About the ST Measurement Points 6 ECG, Arrhy thmi a, and ST Mo nitori ng 121 3 Use t h e S elect Point pop-up key to scro ll through the points and activ ate the point you need to adjust, then use the left and right a rrow keys to move the measure ment point. Each point is highlighted while activ e. The ISO-poin t cursor positions the i soe lectric[...]

6 ECG, Arrh ythmia, an d ST Mo nitor ing ST Alarms 122 5 T o update the ST snippet sho wn in the Adjust ST Points window , select the Upd ate pop-up key . ST Alarms ST alar ms ar e yello w ala rms. E ach ST lead has it s own alar m li mit. ST al arms are t rig gered wh en a n ST value excee d s its alarm limit for more tha n one mi nute. Swi tching[...]

Viewing ST Maps 6 ECG, Arrhy thmi a, and ST Mo nitori ng 123 If an ST l ead i s switch ed off , its ax is is not shown in t he map. If a lead is in INOP (the valu e is being mea sured bu t is inv alid or unava ilable becaus e, for example, the corresponding ECG electro de is unplugged), the ar ea fo rmed b y the rema ining ST lea ds is left o pen. [...]

6 ECG, Arrh ythmia, an d ST Mo nitor ing Viewing ST Maps 124 If a lead is turne d off, its axis is no lo nger show n. This has no impact o n the present ation of trended v a l u e s t h a t w e r e r e c o r d e d w h i l e t h e l e a d w a s s t i l l o n . I n t h e d i a g r a m b e l o w , l e a d V 4 w a s s w i t c h e d o f f 2 0 seconds ag[...]

Viewing ST Maps 6 EC G, Arr hythm ia, and ST Mo nito ring 125 Displaying an ST Referen ce Baseline You can display an ST reference baseline for the curre nt vi ew, or for the trended view. T he baseline is s ho w n in y el l ow . H o we v er , if t he E C G c o lo r is y el l o w , t h e b a s el in e i s s h o wn i n g r ee n . Us e th i s ba s el[...]

6 ECG, Arrh ythmia, an d ST Mo nitor ing Viewing ST Maps 126[...]

127 7 7 Monitoring Pulse Rate The pu lse numeri c counts the arterial pu lsations that result from the mechani cal activity of the heart in beats p er minute (bpm). You can display a pulse from an y measure d SpO 2 signal (pleth wave) or any arterial pressure (ABP, ART, Ao, BAP, FAP, PAP, UA P, P: see t he pressu re section fo r an expla natio n of[...]

7 Monit oring P ulse Rate Switching Pu lse On and O ff 128 Switching Pulse On and Off To sw itch a pa rticul ar pulse numeric on or o ff, e nter the Setu p Puls e menu v ia the mea suremen t setup menu or wave menu of the pulse source. For example, to switch an SpO 2 pulse numeric on o r off, 1 Enter the Setup Pulse menu by selec ting the P ulse nu[...]

Using Pulse A larms 7 Monitorin g Pul se Rate 129 WARNING Selecting Pulse as the active alarm source for HR/Pulse switches off the arrhythm ia alarms listed in the section “ECG, Arrhythmia, and ST Alarm Overview” on page 104, and the heart rate alarm s. This is indi cated b y the me ssage All ECG Alar ms Off (unles s this has been configured o [...]

7 Monit oring P ulse Rate Using Pulse Alarms 130[...]

131 8 8 Monitoring Respiration Rate (Resp) For the respir atory mea surement (R esp), the mo nito r measu res th e thor acic im pedance betw een tw o ECG elec trodes o n th e patie nt’s ch est. C hange s in the impedance du e to thoracic move ment pro duce the Resp waveform on the monitor screen. The moni tor cou nts the waveform cycles to calcul[...]

8 Monitor ing Resp iratio n Rate ( Resp) Understanding the Resp Di splay 132 Lateral Chest Expansion Abdominal Breathing Some patients with re stricted chest movement b rea the ma inly abdo minall y. In thes e case s, you may need to plac e the left leg ele ctrode on the left ab domen at t he point of ma ximum abdo minal expansio n to optimize the [...]

Chan ging t he Siz e of th e Resp iratio n Wave 8 M onitor ing R espir ation R ate (Re sp) 133 • the algorithm ex pects a heart rate and ther efore needs at least 3 elec trodes attached to the patient. If you ar e monitoring respirati on with only two elect rodes, the detecti on algorithm be comes less sensit ive w hich may r esult in reduc ed br[...]

8 Monitor ing Resp iratio n Rate ( Resp) Changing the Spe ed of the Respiration Wa ve 134 Changing the Speed of the Respiration W ave Resp wavef orms are usual ly viewe d at a s lower sp eed than ot her wavefo rms. For this reaso n, the Re sp measuremen t has its own spee d control a nd is not affected by the wa ve speed s ettings of the other meas[...]

Resp Safety Information 8 Monit oring Resp iratio n Rate (Resp) 135 Rate adaptiv e pacemak ers: Impl anted pa cemak ers whi ch can adap t t o the Minut e Volume may occasiona lly rea ct on the I mpedance m easurement us ed by patient monitors f or the determi nation of the Resp value and execute pa cing with the ma ximum progra mmed rate. Switching[...]

8 Monitor ing Resp iratio n Rate ( Resp) Resp Safety Information 136[...]

137 9 9 Monitoring SpO 2 Phil ips puls e oxi metry uses a motio n-toler ant s ignal pro cessi ng algo rithm , based o n Fou rier art efact suppression technology (FAST). It provid es four measurements: • Oxygen saturation of arterial bloo d (S pO 2 ) - percentage of oxyge nated hemoglobin in r elation to the sum of oxyhemo globin and deoxy hemog [...]

9 Monit orin g SpO 2 Connecti ng SpO 2 Cab les 138 select a fin ger or toe with a diam eter of between 7 and 8 mm (0.2 7” and 0.31 ”). When applyi ng a M1193A neonata l sensor do not o vertighten the strap . 4 Check that the light emitte r and the photod etector ar e dir ectly opposite each ot her . All light from the emitter must pass throu gh[...]

Assessing a Susp icious SpO 2 Readin g 9M o n i t o r i n g S p O 2 139 – has not changed in its thickness (for example, due to edema), causing an impro per fit of the senso r . WARNING Inspect the application site every two to three ho urs to en sure skin quality and correct optical alignment. If the skin q uality changes, move the sens or to an[...]

9 Monit orin g SpO 2 Understa nding SpO 2 Alarms 140 Understanding SpO 2 Alarms This refers to SpO 2 specific al arms. See the Al arms section for general ala rm inform ation. SpO 2 offers high and lo w limit alarm s, and a high prio rity de sat alarm. You cannot set the low alarm limit bel ow the desat alarm limit. CAUTION If you me asure Sp O 2 o[...]

Perfusi on (Ple th) Indica tor 9M o n i t o r i n g S p O 2 141 Perfu sion (Pleth) Indicator The perfus ion ind icator give s a nume rical va lue for t he pul satile po rtion of the meas ured signal caused by the pulsating arte rial blood fl ow. As puls e oximet ry is base d on the p ulsatil e nature of the signal, yo u can also use the perf usion [...]

9 Monit orin g SpO 2 Calculat ing SpO 2 Difference 142 1 Fr o m t h e Main S etup menu, select Measurem ents . 2 Fr o m t h e ∆ SpO 2 Se tu p menu, select First SpO 2 . 3 Choose the first mea sureme nt sour ce. 4 Sele ct Sec ond S pO 2 . 5 Choose the second meas ureme nt source.[...]

143 10 10 Monitoring NBP This monitor uses the os cillometric metho d for measuring NB P. In adult and pedi atric mode, the blood pressure measureme nts determined with th is devi ce comply with the Ameri can National Standard for Electronic or Auto mated Sphygmoman omete rs (ANS I/AA MI SP10-1992) i n relation to mean error a nd standard de viatio[...]

10 Monitoring NBP Pr epari ng to M easure NBP 144 CAUTION If you s pill li quid onto the eq uipment or a ccessories , particularly if there is a chance that it can get inside the tubing o r the MMS, contact your service p ersonnel. Measurement Limitations Measurements are impossible wi th heart rate extremes of less than 40 b pm or greate r than 30[...]

Preparin g to Measure NBP 10 Monitoring NBP 145 3 Make sure that you are using a Philip s-approved correct sized cuff and that the bladder insid e the cove r is not folded or twisted. A wrong cuff size, and a folded or twisted bladde r , can cause inaccurate measurements. The width o f t h e c u f f s ho u ld b e i n t h e r a n ge f ro m 37 % t o [...]

10 Monitoring NBP S tarting and Stopp ing Measurements 146 – Meas T ime : t h e time o f the most recent NBP measur ement, or – Next M eas : the ti me until the next measur ement i n an automati c series, displayed with a gra phic repre sentation of the remaining time , as shown her e. Duri ng measur ements the cuff pressure is d isplaye d inst[...]

Choosing the NBP Alarm Source 10 Monitoring NBP 147 Choosing the NBP Alarm Source You can monitor fo r alarm conditi ons in systolic, diasto lic and mean press ure, either singly or in parallel. Only one alarm is given, wit h the priority of mean, systolic, diastolic. In the Setup NBP menu, select Alarms from an d cho ose fr om: Assisting Venous Pu[...]

10 Monitoring NBP Calib ratin g NBP 148[...]

149 11 11 Monitoring Temperature You can measure temperature using the Multi-Meas urement Serve r (MMS), one of the mea surement server extens ions, or the te mperature p lug-in modu le. Temp measure ment automa tically switches on when you connect a probe. You can switch the measurement off manually. Making a Temp Measurement 1 Select t he correc [...]

11 Monitoring Temperature Calculating Temp Differenc e 150 Extended Temperat ure Label Set The fo llowin g additional l abels are avai lable if La bel Set is se t to Full . This settin g can only be changed in Configuration Mode. Note that if your monitor is conne cted to an Information Center, the additional labe ls in the extended label set may n[...]

151 12 12 Monitoring Invasive Pressure You can measure pressure using the Mul ti-Measur ement Server (MMS), one of the measuremen t server extensions or the pressure plug-i n module. Setting up the Pressure Measurement 1 Plug in the pr essure cabl e. 2 Prepare the f lush so lution . 3 Flush the syst em to exhaust all air f rom the tubing. En s ure [...]

12 M onito ring In vasive Pressure Zeroing the Pressure Transducer 152 WARNING If me asuring intracran ial pressure (ICP) with a s itting patient, lev el the transducer wi th the top of the patient’s ear. Incorrect l eveling may give i ncorrect values. Selecting a Pressure f or Monitoring Tell the monitor which pressure you want to monitor by sel[...]

Zeroing the Pressure Transducer 12 Monitoring In vasive Pressure 153 Zeroing ICP (or IC1/IC2) Your hospital guidel ines may require you to zero the ICP transducer l ess frequently than other transducers, d ue to the need for aseptic co nditions. When you zero an ICP tr ansducer, the zero values are autom atically stored and you will not be pro mpte[...]

12 M onito ring In vasive Pressure Adjusting t he Calibrat ion Factor 154 If you are me asuring p ressures with more tha n one meas uring dev ice, using t he Zero SmartKey to initiate the ze roing cal ls up a list of all acti ve pres su res. Select the pressure you want t o zero or select All Pres s to zero a ll pressures sim ultaneously. Troublesh[...]

Optimizing th e Waveform 12 Monitoring Invasive Pressu re 155 3 Select a value f rom the pop-up list: – a positive valu e sets the top gridline . The bottom gridli ne is set at z ero. – a negative v alue sets the b ottom gridline. The middle grid line is set at zero . Optimizing the Waveform ♦ In the Setu p <P re ss> menu, select Optimu[...]

12 M onito ring In vasive Pressure Calibr ating R eusa ble Tran sduce r CPJ8 40J6 156 Calibrating Reusable Transducer CPJ840J6 Depending on yo ur monitor’s config uration, you may be able to perform a calibration in mo nitoring mode. Perfo rm a m ercury calibra tion when you use a new transducer, and at re gular intervals according to your hospit[...]

Calcul atin g Cerebral Perfu sion 12 Monitoring Invasive Pressu re 157 5 Select t he calibratio n pre ssure from the lis t, for exam ple 200 mmHg. 6 Sele ct Con firm to recalculate the calibration factor using the applied pressure. 7 When the m onitor displa ys < Pres s> cal ibratio n do ne at < date a nd ti me> , remo ve the manometer [...]

12 M onito ring In vasive Pressure Measurin g Pulmo nary Art ery W edge Pressur e 158 • Th e clin ical val ue of the derive d PPV info rmatio n mu st be d eterm ined by a ph ysici an. Accord ing to rece nt scientif ic lit eratur e, the cli nical rele vance of PPV informati on is r estricte d to sed ated pa tients receiving contro lled mechanical [...]

Editing th e Wedge 12 Monitoring Invasive Pressure 159 not be dis play ed or r ecorded properly . T o avoi d this , swi tch out of opti mum sca le bef ore per form ing a we dge p roced ure. 3 Use t h e R efere nc e Wa ve 1 and 2 popu p ke ys t o s elec t an y EC G or re spir at ory wav e as refe ren ce w aves . 4 Sele ct Wav e Speed if you want to [...]

12 M onito ring In vasive Pressure Identifying the Pressu re Analog Outpu t Connector 160 Identifying the Pressure Analog Output Connector analog ou tput (module M100 6B, option C01 on ly)[...]

161 13 13 Monitoring Cardiac Output The Cardiac Output (C.O.) measur ement invas ively me asures cardi ac output a nd other hemod ynamic parameters using a technique calle d thermodiluti on. Th is can be used t o determ ine the flow rate of a syste m by in tro ducing a cold s olu tion i nto the syste m and m easu ring th e res ulting d rop in temp [...]

13 Mon itoring Cardi ac Output Hemodynamic Parameters 162 Hemodynamic P arameters This table illu strates the hemo dy namic pa rameters availab le with each method, whether they are measured continuously , and whe ther they can be s h own on the m onitor’s resting disp lay or in the HemoCalc Window. * currently no t available in the U.S.A or in c[...]

Using the C.O. Procedure Window 13 M onitori ng Card iac Ou tput 163 Using the C.O. Procedure Window The C .O. procedu re window displa ys up to six tria ls (measurement curves) with the trial number and the C.O. value und er the thermodi lution curve. Wh en you open the window, a line of pop-up ke ys automatically appears to let you carry o ut C.O[...]

13 Mon itoring Cardi ac Output Accessing the Setup C.O. and Setup CCO Menus 164 Accessing the Setup C.O. and Setup CCO Menus C.O. settings can be changed in the Se tup C.O. menu. To access this menu , ♦ press t he C.O . hard key on t he C.O. modul e ♦ select any of the discon tinuous C.O. numerics (for e xample, C.O., C.I.) o n the scree n. CCO[...]

Measuring C. O. Using the PiCCO Method 13 Mon itoring C ardia c Outpu t 165 Setting Up the PiCCO C.O. Measurement 1 Set up the ar terial line using the ar terial catheter (t ranspulmona ry catheter) and the transdu cer kit fr om Pul sion M edical Syst ems. I t must be plac ed in one o f the bigger systemic arteries, for example, the femora l or the[...]

13 Mon itoring Cardi ac Output Measuring C. O. Using the PiCCO Method 166 8 Check that the correct arterial catheter constant is sel ected. If the cathete r is r ecogniz ed by t he monitor , th e catheter cons tant is au toma ticall y displa ye d and cannot be changed manually . If it is not recognized, in the C.O. procedur e windo w , select Ca th[...]

Measuring C. O. Using the PiCCO Method 13 Mon itoring C ardia c Outpu t 167 you can accept or reject tri als directly by t ippin g on the trial curve. Discard conspicuously different values. The background of r ejected trials is red an d the background of accepted trials is gre en. The monitor recalcul ates the average values aft er you reject or a[...]

13 Mon itoring Cardi ac Output M easurin g C.O. Using t he Rig ht Hear t Ther modilu tion M ethod 168 Measuring C.O. Using the Right Heart Thermodilution Method In the right heart thermodiluti on method, a flui d of known volume and temperature is inj ected into the right atrium through the proximal port of a pulmonary artery (PA) (Swan-Ganz) cathe[...]

Documenting C.O. Meas urements 13 Monit oring C ardiac O utput 169 If you are usi ng the ice -bath setup, the injectate te mperatu re probe and the inje ctate are bot h pla ced in an ic e-ba th and t he pro be m easu res th e temp era ture o f the co nten ts of the ic e buck et. Setting the Com putation Constant Check that the co rrect Computa tion[...]

13 Mon itoring Cardi ac Output C.O. I njectate Gu idelines 170 2 F rom th e po p-u p lis t, choos e: – Print Re sults to print the contents of the C .O. proced ure wind ow – Record Result s to r ecor d the contents of the C.O . procedu re wi ndow – Record Trial to send an ind ividual trial cu rve to the recor der . C.O. Injectate Gu idelines [...]

C.O./CCO Curve Alert Messages 13 Mon itoring C ardia c Outpu t 171 C.O./CCO Cur ve Alert Me ssages After each measurement trial, the mo nitor analyzes the the rmodilution curv e. If the curve appears abnormal, a curve al ert message ap pear s in the C. O. pro cedu re win dow. A que stion mark symb ol (“ ? ”) may appear next to the cardiac out p[...]

13 Mon itoring Cardi ac Output C.O./CCO Prompt Messages 172 If you ha ve follo wed all of these guideli nes, yo ur measureme nt values shoul d be vali d, even if you st ill see a curve a lert message. Ensur e that at least thre e subseq uent meas urements wi thin the curre nt series do no dif fer by more tha n 15%. If the diff erence exceed s 15%, [...]

C.O./CCO Warning Messages 13 Mon itoring C ardia c Outpu t 173 C.O./CCO Warning M essages Warning messages contain important info rmatio n about the C .O. measu rement. C.O./CCO Safety Information WARNING Catheter constant: Make sure that the arterial catheter co nstant for the measureme nt is appropriate to the catheter used. Computati on Constan [...]

13 Mon itoring Cardi ac Output C.O./CCO Safety Information 174 CAUTION During the cardiac output measurement proce dure th e blo od tempera ture al arms are i nactiv e. This is indicate d by a crossed-ou t alarm symbol n ext to the temperature numeric. Making al arms inactive during thi s procedu re preve nts false alarm s. The alarms are autom ati[...]

175 14 14 Monitoring Carbon Dioxide Use the CO 2 measurement t o monitor the patient’ s respiratory status and to control patient ven tilatio n. There are two methods f or measuring ca rb on dioxi de in t he patient’ s air way: • Main stre am measur ement uses a CO 2 sensor attached to an airway a d apter dir ectly inserted into the patient ?[...]

14 Mon itoring Carbon Dioxide Using the Cap nography Ex tension (M3014A) 176 WARNING Correlation : The etCO 2 readings do not always correlate closely with paCO 2 , especially in neonatal patients an d patients w ith pulmo nary diseas e, pulmon ary embolis m or inappro priate vent ilation. Pharmaceuti cals in aerosol s : Do not measure CO 2 in the [...]

Using the C apno grap hy Exte nsion (M30 14A) 14 Monitoring Carbon Dioxide 177 3 Choose the appropriate air way ad apter and conne ct it to the sensor he ad. The air way adap ter clicks into pl ace when seated corr ectly . 4 To z e r o t h e s e n s o r : – expose t he sensor to roo m air and keep it away f rom a ll sour ces of C O 2 including th[...]

14 Mon itoring Carbon Dioxide Using the Cap nography Ex tension (M3014A) 178 – expose the sensor to room air and keep it away fro m all sources of CO 2 includ ing the v entilator , the patient ’ s breath an d your own. – In the setup menu f or the CO 2 , select Star t Zer o Ca l . – When you se e the message Zero done a t <d ate and tim [...]

Using the Mainstream CO 2 Extens ion (M3016 A) 14 Monitoring Ca rbon Dioxide 179 1 P ush the sensor i nto the holder unti l it cl icks into pos ition . 2 Clamp the holder onto an IV pole , a shelf or anoth er ap prop ri ate loc ation . To remove the sensor from t he holder, release the cl ip and pull the senso r out of the holder. Removing Exha ust[...]

14 Mon itoring Carbon Dioxide Using the Mainstream CO 2 Extension (M301 6A) 180 4 Place the transducer on the high cell of the calsti ck . T he re a di n g o n t he s c ree n s ho u ld b e w it hi n ± 1 mmHg of th e value on th e ca lstick wit hin one mi nute. 5 If both readi ngs are in r ange, you ca n leave calib r ation mode and begi n monitori[...]

Using the Microstream CO 2 Extens ion (M3015A ) 14 Monitoring Carbon Dioxide 181 2 T o remov e the transducer fr om the air way adapter , ope n the latch and pull ou t the air way adapter . WARNING To prevent stress on the endotrachial tub e, support the tran sducer and airway adap ter. To avoid infection , use only sterili zed ai rway adap ters. U[...]

14 Mon itoring Carbon Dioxide Using the Microstream CO 2 Exten sion ( M3015A) 182 For intubated patient with non-hum idified ventil atio n, you can use a Microstream FilterLine set. For hum idifi ed ven tilati on, us e a Fil terLin e H Set. For non-intubated patients, t he gas sample is take n thr ough a N asal F ilte rLine, or a Smar t C apnoLi ne[...]

Sett ing up Mainstre am and Sidest ream C O 2 14 Monitoring Ca rbon Dioxide 183 Suppressing Zero Calibration To prevent an automat ic zero calibration f rom being started i n the next fiv e minutes, ♦ in the Setu p CO 2 menu, select N o Zero fo r 5 Min , or select the Suppre ss CO2 Zero Sma rtKey , if configured. Selecting No Ze ro fo r 5 Min or [...]

14 Mon itoring Carbon Dioxide Setting up Mainstrea m and S idestre am CO 2 184 Suppressing Sampling (not Mainstream CO 2 ) To temp oraril y stop samp ling , ♦ in the Setu p CO 2 menu, select Pump 15M in Off or use the CO2 Pum p Off Sm a r t K e y i f ava ilab le. Selecting Pump 15M in Off again before fi fteen mi nutes have passed re sets the tim[...]

Sett ing up Mainstre am and Sidest ream C O 2 14 Monitoring Ca rbon Dioxide 185 2 Sele ct Hig h Limit to set the upper alarm limit. Sele ct Low Limit to set the l ower alarm limi t. 3 Select the ap propriate settin g.[...]

14 Mon itoring Carbon Dioxide Setting up Mainstrea m and S idestre am CO 2 186[...]

187 15 15 Monitoring Airway Flow, Volume and Pressure The M1014A Sp iromet ry Module is desi gned to be used i n combinati on with Philips-b randed ai rway flow senso rs a nd combi ned CO 2 /a i r w a y f l o w s e n s o r s . I t p r o d u c e s a r e a l t i m e w a v e f o r f l o w , v o l u m e a n d pressure of respiratory gases togethe r wit[...]

15 Mon itoring Air way Flow, Volume and Pres sure Attaching th e Flow Sensor 188 Attaching the Flow Sensor CAUTION Use the M1 014A Spiro metry Modu le wi th Phil ips ap proved acce ssories o nly . Refe r to the instru ction s for u se pro vided with th e acce ssory. 1 Select the appropri ate flow sensor . Make su re that you ar e using the corr ect[...]

Attaching the Flow Sensor 15 Mo nitoring Airway Flow, Volum e and Pr essure 189 WARNING To prevent stress on the e ndotrachial tu be, support the sensor an d airway adapte r. Position sensor cables and tubing carefully to avoid entangle ment or pote ntial strangul ation. Do not apply excessive te nsion to any cable or tubing. Repl ace the sensor, i[...]

15 Mon itoring Air way Flow, Volume and Pres sure Zero Cali bration 190 • A volume wav eform as displayed bel ow on the lef t may be an indicator of an air leak: In general, if MV exp or TV exp are significantly smaller than MVin or TVin, the tubing should be checked for leaks. Zero Calibration The zero calibration maintains th e a ccuracy of the[...]

Manual Purging 15 Mo nitoring Airway Flow, Volum e and Pr essure 191 Adult Mode The system automaticall y purges the sensor tubi ng every ten minute s or less, depend ing on system conditions. In adult mode, the system will purge bo th sides of the line, o ne at a time, during each purge cycle. T he higher the pressure, the more f reque nt the purg[...]

15 Mon itoring Air way Flow, Volume and Pres sure Setting up Spirometry 192 T able 2 Incorrect Agent P ercentage Setting Setting up Spirom etry The following settings can be accessed through the Setup Sp iromet ry menu. Optimizing Scale Settings In the Setup Sp iromet ry menu, select Opti mi ze Sc ales .The scale settings for all three spirometry w[...]

Setting up Spirometry 15 Moni toring Air way Flo w, Volume an d Press ure 193 WARNING Safety and eff ectiveness of the respiration measurement me thod in the detection o f apnea, particul arly the apnea of prematuri ty and apne a of infanc y, has not been estab lished. WARNING If a n apnea occurs du ring a zero cali bration, the time delay betwe en[...]

15 Mon itoring Air way Flow, Volume and Pres sure Setting up Spirometry 194 3 Select the ap propriate settin g. Changing the Temperature o f the Inspired Gas Depending on the type o f ventilator e nvironment (e .g. if you are using a Heat Moisture Exchanger) you may wa nt to change the te mperature set ting of the inspired gas : 1 In the Setup Sp i[...]

195 16 16 Monitoring tcGas The tcGas module m easures the parti al pr essure of th e oxygen and ca rbon dioxid e that diff uses t hrough the skin, thereby prov idin g a measure of these gases i n the capil lary blo od. The mon itor ’s se tti ngs fo r al titu de an d baro metr ic pressure i nfluenc e the meas urement. The tcpO 2 / tcpCO 2 measure [...]

16 Mon ito ring tc Gas Setting th e tcGas Sensor Temperature 196 Setting the tcGas Sensor T emperature 1 In the Setu p tc Ga s menu, select Tr ansducer Te mp . 2 Choose a te mperature value appropriate for your pa tie nt’ s ag e, weigh t and ph ysical c onditi on in accordance with your hospital policy . U suall y , a higher trans ducer t empe ra[...]

Setting the tcGas Baromet ric Pressure 16 M oni tori ng tcG as 197 Restarting the tcGas SiteTimer To restart th e site timer wi thout recalibration (f or example, after the site time has elapsed): 1 In the Setu p tc Ga s menu, select Si te Time . 2 Enter and confirm you r desired time. Disabling the t cGas Site Timer Depending on yo ur monitor’s [...]

16 Mon ito ring tc Gas Remembraning the tcGas Transducer 198 5 Remo ve any surplus ele ctrolyte soluti on on the ou tside of the membranes with a soft tissue. 6 Make sure that the new m embranes are secured by two O-rings on the transducer . If any air bubbles a re v isible u nder the membra nes, r epeat thi s proce dure - air bubble s wil l cause [...]

Calibrati ng the tcGa s Transdu cer 16 M oni tori ng tcG as 199 Calibratin g the tcGas Transducer You can use either a Philips (15210B) or a Radiomet er TCC3 cali bration un it and a gas cylinde r whos e pressure indicator is above the ‘out-of-gas’ zone (black on 15210B, red on TCC3). To maintain accuracy, it is recommended to calib rate the tr[...]

16 Mon ito ring tc Gas Calibrating the tc Gas Transducer 200 4 P ress CAL on the modul e until the light abo ve the key comes on and wait (thr ee - 20 minute s) for the “ calibration complete ” message to appear on the monitor . Alternatively , in the Setu p tcGas menu, select Start Calibra tion . T o s a ve g as o n 1 52 1 0B , if t he t i me [...]

Applying the tcGas Transducer 16 Mo nito ring tcGa s 201 Applying the tcGas Transducer 1 P eel p rot ection film from fixa tion r ing. U sing a fi ng er , press the sti cky side of the ring on to clean, dry skin. Pr ess around the o utside to en sure a goo d seal. Apply three to fiv e drops of contact fluid in the ring ’ s center . Remo ve transd[...]

16 Mon ito ring tc Gas Finishing tcG as Monitoring 202 Selecting the tcG as HeatPowerDisplay Mode The heat po wer disp lay give s an i ndicat ion of the skin’s perfusion bel ow the transducer and of the transducer’s contact with the skin. If the transd ucer loses co ntact, the hea t powe r value drop s sign ifica ntly . When perf usion is poor [...]

203 17 17 Monitoring Sv O 2 MP60/70/ 80/90 monitor s only The Sv O 2 modu le measures the percentage of mi xed venous oxygen saturation continuo usly and invasively usin g the Hosp ira, Inc. (formerl y Abbott Laboratories) O ptiCath family of cathet ers routed via the right side o f the heart into the pulmonary artery. Can be used only with the MP6[...]

17 Monitoring SvO 2 Prep aring to Monitor S vO 2 204 Preparing to Monitor Sv O 2 In addition to an Sv O 2 module, y ou need a Hospira OptiCath catheter, and 50131 O ptical Module. Use only the Hospira accessories liste d in the Accessories section. Connect the optical module ( Hospi ra 50131) to the Sv O 2 mod ule. Allow the opt ical modul e to war[...]

Inserting the Cat heter 17 Monitoring SvO 2 205 3 Place the op tical connector i nto the optical mo dule (with the label “ TO P ” fac ing u pwa rds ) and close the lid . 4 In the Set up SvO2 menu, select Start Pr e-InsCa l . Ensur e that the tip of the catheter i s still in the optical r e fer ence. 5 Insert the ca theter when yo u see the me s[...]

17 Monitoring SvO 2 Performing In -Vivo Calibrat ion 206 Performing In-Vivo Calibration Perform an in-vivo calibration: • if you place the cathete r in a patient wi thou t perform i ng a pr e-inse r tion cali bratio n. • if the catheter was disconnect e d from the optical module . • when the cathet er has been in the p atient fo r 24 hours. ?[...]

207 18 18 Monitoring EEG The Electroencep halograph (EEG) modu le monitors th e patient’ s cerebral function by measurin g the electrical activity of the brain. It pro vide s th e m oni tor w ith two ch anne ls of re alti me E EG wav es, EEG trend information in the form of Compressed Sp ectral Arrays (CSA), and up to eight of the fo llowing nume[...]

18 Monitoring EEG EEG Monitoring Setup 208 EEG Monitoring Setup 1 Plug the trunk cable i nto the EEG module in the F lexibl e Mo dule S er ver. 2 Pr epare the patient ’ s skin prior to placing the electr odes. Good ele ctrode-to-s kin contact is impor tant for a good EEG signal, as the skin is a poor con ductor of electricity . – Shave hair fro[...]

Using the EE G Impedance/ Montage Window 18 Monitoring EEG 209 Choosing an EEG Electro de Montage 1 T o activate one of the five pre-conf igured e lectrode mo ntages, select the arr ow besi de the label i n the EEG Impe da nc e/Mo nta ge window and choose a montage fr om the list. 2 Attach the electro des as illus trated in the EEG Impeda nc e/ Mo [...]

18 Monitoring EEG Using the EEG Impeda nce/Mont age Window 210 About Electrode-to-Skin Impedance Electrode-to-skin impedance is the main q uality indicator for the measured EEG signal. During normal EEG monitoring, electrode-to -skin impedanc e i s meas ured contin uously an d disconnected electrodes are dete cted. The i mpedance value for e ach si[...]

About Compresse d Spectral Ar rays (CSA) 18 Monitoring EEG 211 About Compressed Spectral Arrays (CSA) The contin uous EEG signal i s samp led per iodic ally a nd this va lue i s stored in a f rame. Ea ch fr ame is proc esse d usi ng Fa st F ourie r Tra nsfo rmati on (F FT) t o pr ovide a freque ncy spectr um di splayed a s a compressed spectral arr[...]

18 Monitoring EEG Changing EEG Set ting s 212 Changing CSA Set tings When CSAs are show n embedded on the Main Sc reen , select the CSA to show the pop-up keys. Wh en the CSA is shown in a window ove r the current screen, the pop-up keys are alw ays displayed. Changing EEG Set tings Be aware that any changes made to EEG settings apply to both EEG c[...]

EEG Reports 18 Monitoring EEG 213 Changing Filter Frequencies The low and high pass f ilters s creen out undesirabl e inte rference from the raw EEG wa ve disp lay. The current EEG filter freque ncy settings are shown in the header of the CSA. Changing f ilter settings affects the EEG wave and a ll the EEG numerics . Whenever the filter setting is [...]

18 Monitoring EEG EEG Safety In formation 214 EEG Safety Information EEG Configur ation and M onitor U pgrades The A.2 monitor release (software revision A.20.xx) introdu ced a new feature that lets you rename EEG montages. It is not possible to clon e EEG settings between montages with dif ferent name s, therefore a ll EEG settings are re set to f[...]

215 19 19 Monitoring BIS Bispectral Index moni toring helps t o monitor the lev el of consciousness of a patient under general anesthesia or seda tion in the O R and ICU. The BI S sensor is placed on the patient’s f orehead to capture electroencephalographic (EEG) signals from which seve ral numerics are derived, including a single BIS value repr[...]

19 Monitoring BIS BIS Monitoring Setup 216 BIS Monitoring Setup There are two BIS so lutions a vailab le fo r use with the M1034A BIS module : using t he DSC and BIS engine or using the BISx . Monitoring BIS Usi ng the DSC and BIS Engine 1 If you are moni toring BIS wi th the DSC and BIS engine, a. Connect the BIS engine to the BIS module using the[...]

BIS Monitoring S etup 19 Monitori ng BIS 217 Monitoring BIS usi ng the BISx 1 If you are moni toring BIS using t he BISx, a. Connect the BISx devi ce to the BIS m odule or BI S Interface bo ard connector (M P20/MP30) b. U s e the clip o n the re ar of the BISx d evice to affix it i n a position conv enient for yo ur patient, not abo ve the patient [...]

19 Monitoring BIS BIS Continuous Im pedance Check 218 Manufacturer’s Information BISx, the BIS Engine, the DSC, the Patient Inte rfac e Cable and the BIS Se nsors are manufactu red by Aspect Medical Systems. BIS Continuous Impedance Check This checks: • the comb ined impe dance of the signal el ectro des pl us the r efere nce electr ode. This i[...]

BIS Window 19 Monitor ing BIS 219 ♦ select Stop Cyc lic Che ck in the BIS I mpedance Check Windo w . If you s top a Cycli c Impe dance Chec k before the ground electrod e has pas sed, a gro und ele ctrode impedance check will be started automatically. This cannot be swi tched off. BIS Window ♦ T o open the BIS window , in the Setup B IS menu, s[...]

19 Monitoring BIS Chan gin g the B IS Smoo thing Rate 220 Changing the BIS Smoothing Rate The smoothing rate defines ho w the monito r averages the BIS valu e. ♦ T o change the smoothing rate, in the Setup BIS menu, select BIS Smoot hing Rate then choose ei ther: – 15 seconds: this provide s increas ed respon siveness to changes in the p atient[...]

BIS Safety Informati on 19 Monitori ng BIS 221 BIS Safety Information For informa tion on the use of BI S in specific m onitoring situations a nd on pharmaco logical resp onses to the anesthetic agents Nitrous Oxide (when used as the sole anesthetic agent), Ketamine, and Etomid ate, please contact A spect Medical Systems to re quest a cop y of thei[...]

19 Monitoring BIS BIS Safety Information 222[...]

223 20 20 Trends Trends are patient d ata collected over time a nd di splayed i n graphi c or tab ular form to give y ou a picture of how your pati ent’s cond ition is develo pin g. Trend i nformat ion is sto red in the trends databa se for continu ously-monitore d measure ments, such as ECG, as w ell as for ap eriodi cally- measured parameters, [...]

20 Trends Viewing Trends 224 Viewing Graphic Trends A cursor sp anning al l meas urements i n the trend gro up helps you to navigat e through the trends databa se and shows you your cu rrent position in th e database. Whe n the cursor is moved acr oss the time line, t he value s measured at the cursor time are shown in the right hand column. In gra[...]

Setting Up Trend s 20 Trends 225 The currently-selected column is highlighted . The va lues can be configured to di splay in the same colors as the waves and numeri cs on the realtime d isplay. Any values availabl e for d isplay before the next sc heduled u pdate are shown in the right hand column, with a timestamp in brackets If more th an one v a[...]

20 Trends Setting Up T rends 226 Making Segment S ettings The Graphical Tre nds window is divided into measurem ent segments, each of which has its own settings. To enter the se gment men u, ♦ select the l eft hand co lumn of the segment, where the measurement l abel is displaye d. Expanded View To expand the segment t o fill the Graphica l Tr en[...]

Setting Up Trend s 20 Trends 227 1 In the Segm ent menu, select No. of Segmen ts 2 Sele ct 1 , 2 , or 3 segments. Trend Grou ps The measurements groupe d in trend groups def ine th e tr ends disp layed t o gether in the Vital Signs or Graphics Trends windows and printed i n trends rep orts and recordings. Th e sequence of the measurements in the gr[...]

20 Trends Document ing Trend s 228 1 In the Main Setup me nu, sel ec t Trends . 2 Sele ct Par ameter Scal es . 3 Select t he measur ement or paramete r you want to change fr om the list. 4 Select the po p-up key Change to call u p the Scale menu. 5 In the Scal e menu, sele ct the parameter label you wa nt to define settings for . Select Adult , Ped[...]

Trends Databases 20 Trends 229 Trends Databases Depending on the purchase d options and the mo nito r ’s co nfig ura tion, the trend s da taba ses stor e information for up t o 32 measureme nts for up to 72 hours. The values in the trends databas e are sto red as mea s ured by the monitor, they are no t averaged values. The trend resolution defin[...]

20 Trends Screen Trends 230 Screen Trend inf ormation is taken fr om the Trends databas e. If you do not see a Screen Tr end for a particular measurement on the S creen, check the trend priori ty list to ensure that this measurement is bein g tren ded. Setting the Screen T rend Time To set the ScreenT rend Time for all graphical and hor izon screen[...]

Sc reen Tr end s 20 Trends 231 Changing the Selection of Screen Trends Displayed 1 Select t he scr een trend. 2 Sele ct Cha nge Tren d and select the r equire d tre nd from the list of avail able tr ends. Sele ct Bla nk to remo ve th e selected tr end fro m the Scre en. If you do not see Ch ange T rend in the screen t rend m e nu, the tr end is ali[...]

20 Trends Screen Trends 232 Horiz on Vi ew The horizo n view pres ents trend i nformatio n superi mposed over a defi ned base line. This helps y ou visualize change s in your patie nt’s condition since the baseline w as set. The horizon view i s made up of : • a horizon, drawn in w hite, as a ref erence point or ba seline to help you visual ize[...]

233 21 21 Calculations Calcul ations are patient data that i s not directly measured but calcu l ated by the monitor w hen you prov ide it w ith the a ppropri ate info rmatio n. Your monitor can perfor m the followi ng hemodynami c, oxygenation, and ventilation calculati ons. The hemodynami c calculati ons avail able depend on the Cardiac Output me[...]

21 Cal cula tions V iewing Calcula tions 234 Calculations Windows This e xampl e calcul atio ns wi ndow sh ows t he hemo dynami c calculati ons window. The ventilati on and oxygen ation window s are simila r. Calculations Pop-Up Keys Depending on the calculations group you choose, a selecti on of pop-up keys will appear to let you navigate through [...]

Reviewing Ca lculations 21 Calcul atio ns 235 Reviewing Calculations ♦ T o enter the calculations review w indow , select the Oxy Revi ew , Ve ntil Review , or Hemo Revie w po p-up key as required. The review wind ow li sts all the i nput a nd out put v alues for eac h me asurem ent in the c alcul ation s group. The timeli ne in the revi ew windo[...]

21 Cal cula tions Entering V alues for Calcula tions 236 Entering Values for C alculations The m onitor autom atically en ters any av ailable val ues for ca lculations. For a periodi cally-me asured values such as C.O., the m onitor will re-use the mo st recent value in the ca lcul ation da tabase until a new val ue bec omes av ailable. ♦ T o ent[...]

Document ing Calcu lations 21 Calcul atio ns 237 ♦ T o check the current setti ng, select the patient name to e nter the P atient Demographi cs menu. BSA(B ) indicates that the Boyd formula is used ; BSA( D) indica tes tha t the Dubo is form ula is used. Documenting Calcul ations ♦ T o s end a Calculations r ecordi ng to a connected record er ,[...]

21 Cal cula tions Document ing Calcula tions 238[...]

239 22 22 High Resolution Trend Wave s High reso lution (hi-res) tren d waves prov ide info rmation for fast-changi ng parameters at a glance . They can help you to recognize trend patterns and to find in terrelation ships between measurements, by comparing changes in your patient’s condition across different hi-re s trend waves. This can aid in [...]

22 High Resolutio n Trend Waves Printing Hi-Res Trend Wave Reports 240 Printing Hi-Res Trend Wave Reports To print hi-res trend waves on reports, you can choo se to print either • all Visi bleWaves - print s all wav es and h i-res tr end wa ves cu rrently di spla yed • All Wave s - prints realtime wave s and hi-res tr end waves f or all current[...]

241 23 23 Event Surveillance Events are ele ctronic records of ep isodes in your pa tient’s condition. You can trigger them manuall y, or set them to trigger auto matically du ring pre-defined clinical situations. Depending on the level of event surveilla nce avai lable on y our mon itor, the informa tion sto red fo r each event epi sode can incl[...]

23 Event Surveillance Event Group s 242 Event Groups The event group • monitors the patient ’ s s ignals to det ect event triggers • defines w hich wav eforms ar e reco rde d in the ev ent data. In basic event surveillance on ly one e vent group can be active at a time, with Advanced Event Surveill anc e all s ix groups can be a ctiv e si mul[...]

Events Pop-Up Keys 23 Event Surveillance 243 The episod e typ e defin es the l evel of deta il capt ured in an even t episode. The higher the da ta resolution, the shorter the period that the monitor can store in its memo ry. H igh-re solu tion da ta is suited fo r neonatal applic ations, where the clinical situation m ay change very quic kly. In a[...]

23 Event Surveillance Event Tri ggers 244 Event Triggers You can trigger event capture manually, for example, if you want to record a patient’s conditi on before a procedure. You can also set events to trigger automatically, when the patient’s values cross a predefin ed th reshold va lue, or when a pa rticular mea suremen t or procedu re is car[...]

Event T riggers 23 Event Surveillance 245 If you use al arm li mits as even t triggers , the event capture is triggered automatically when your patient’ s values v iolate set al arm limits, or wh en a speci fied alarm co ndition, such as apnea, occurs . No events of this kind are triggered if al arms are sw itched off. Changing alarm limits chang[...]

23 Event Surveillance Event Tri ggers 246 2 Sele ct the name of the current ep isode type to set the episo de pr e/po st time. 3 Set the event trigger for ea ch measur ement. Select each trigger name and select, if avail able, ei ther an alarm trigger , or a user-defined trigger fro m the pop-up tri gger list . If you select a user-define d trigger[...]

The Events Databa se 23 Event Surveillance 247 For manually-triggered events. patient information fo r the time leading up to the trigger mome nt is stored usi ng the settings of the assi gned event group. The Events Database The maximum nu mber of eve nts that can be stored in the event database depend s on the database configurati on and the l ev[...]

23 Event Surveillance Viewing Events 248 Counting Combi-Eve nts If one or mo re events o ccur during th e same Ep isode Time , the monitor co mbines them and displ ays them as dis tinct event s in one e vent episod e, called a combi-eve nt. The f irst event is the trigger event, and the others are fol low-up events . For examp le, if an apnea ev en[...]

Viewing Events 23 Event Surveillance 249 Event Summary Window (Advanced Ev ent Survei llance onl y). The Event Sum m ary win dow show s the nu mber of stored e vents in ea ch ev ent gro up and the t otal n umb er of ev ent s in the da tabase. Vertical bars m ark events o n a timeline sho wing the positi on of the stored events in t he event databa [...]

23 Event Surveillance Viewing Events 250 Eve nt ba r s: Each event bar repr esents one e vent. The height i ndicates the even t severity. Bars that ext end ov er more than one chan nel rep res ent com bi- events. Manually -captured events are m arked with a bar above t he timel ine instea d of in the measure ment channe ls. Ev ent values: Event inf[...]

Annotati ng Even ts 23 Event Surveillance 251 The event val ues to the l eft of the mea surement channels show the trigger threshold set and the maximum amo unt by whi ch this l imit was ex ceeded. In this example , Brady 10 4< 110 tells you that 104 was the lo west HR val ue measured d uring the event time and tha t the low HR trigger thresho l[...]

23 Event Surveillance Document ing Ev ents 252 2 F or a graphic Even t Revi ew recording, select the Reco rd G rap hic pop-up k ey . Fo r a t a b u l a r Event Re v iew recor ding, select the Reco rd Tabu lar pop-up key . T o print an Ev ent Report, select the Print Revi ew pop-up key . Documenting an Event Episode 1 In the Even t Ep is ode window [...]

Docu mentin g Eve nts 23 Event Surveillance 253 Event Episod e Recordings 3 The third section shows the most imp ortant vital signs information, including numerics, active alarms, and any annotatio ns made on the event epis ode. 4 The four th section shows the numerics for all th e currently mo nitored vital signs an d any alarm conditions or INOP [...]

23 Event Surveillance Document ing Ev ents 254 Event Review Report s The event revi ew report do cuments al l the eve nts stored in the event databas e for a select ed group.[...]

Docu mentin g Eve nts 23 Event Surveillance 255 Event Episod e Reports The event ep isode re port docume nts the patie nt info rmation f rom the currently -selec ted eve nt. See the section on event recordings for an explanation of the report elements. Event Summary Report s (Advanced Ev ent Survei llance onl y). The event s ummary repo rt shows a [...]

23 Event Surveillance Document ing Ev ents 256[...]

257 24 24 Recording MP40/MP50/ MP60/MP70/ MP90 The M1116B pl ug-in record er reco rds numeri cs for al l acti ve me asurements and up to three wave forms. You can use it fo r local recording mounted e ither in the monitor’s FMS or in the integrat ed module sl ots (MP40/M P50, MP60/M P70). Continue LED Flashes if a continuous r ecording is ongoing[...]

24 Recording S tarti ng an d Stoppin g Recordi ngs 258 MP20/MP30 The integrated recorder records numerics for all active measurements and up to three waveforms. Central Recor ding For central recording from the bedside, your monitor must be connected via a network to an Information Ce nter. You can use e ither the M1116 B recorder or the stand alon[...]

Overview of Rec ording Types 24 Reco rding 259 To q uicks tart a de layed rec ording , ♦ Sele ct the Smar tKey Delaye d Re co rd to imm edia tely sta rt a dela yed recordi ng. M1116B only ♦ Y o u can also start a d elayed recording by pressing the RUN/CONT key on the recorder mo dule. Extending Recordings Timed (non- conti nuous) r ecor dings s[...]

24 Recording A ll ECG Wav es Recordings 260 All ECG W aves Recordings An All ECG Waves recording show s a 4 second recording of each lead with a calibration bar preceding ea ch ECG lead . All avail able lea ds are re corded se quenti ally in t he sta ndardized lead ord er. The recording is realtime, that i s, the information recorded is not simul t[...]

Chan ging E CG Wave Gain 24 Recording 261 3 Select t he name of the te mplate you want t o create or change. Each r ecording name is linked to a recording type, delayed, alarm , realtime, and high re s trends. R ecording name s can be changed in the monitor ’ s Configuration M ode. 4 Design the template b y selecting each menu item and entering t[...]

24 Recording Recording Priori ties 262 Recording Priorities Manually-started recor dings have priority over automatically-started r ecor dings. If an automatically-triggered alarm recording is running, and a realti me or d elayed recording is ma nually started, the alarm recording is stopped and the manual ly-requested recordin g is star ted. More [...]

Sample Reco rding Strip 24 Recording 263 Recorded Waveforms A selection of up to three waveforms is recorded, ma rked wit h wave labe ls and wa ve scal e info rmation. Wave scal e informa tion can be i n the f orm of a ca librat ion bar, like the 1 mV cali bration ba r for ECG, or calibration steps before the waveform starts. Maintaining Recording [...]

24 Recording Relo ading P aper 264 Reloading Paper M1116B 1 U se the latch on the ri ght side of the recor der door t o pull the door op en. 2 Remo ve the empty cor e. 3 Insert a new roll so that it f its snugly into its housing and the paper end is feeding fr om the top . 4 P ull out so me paper and fold along the f ront edge at a 45 ° angle. Thi[...]

Recorder Status Messages 24 Recording 265 Recorder Status Messages Recor der Statu s Mess ages Explanation <Recording name> running The named r ecor ding i s curr ently runni ng. No <recorder name> alarm recording available N o alarm reco rding can be made on the selected recorder . If avai labl e, try selecting a nother r ecor d er . I[...]

24 Recording Recorder Stat us Message s 266[...]

267 25 25 Printing Patient Reports Starting Reports Printouts Most patient re ports can be printed b y selecting Main Set up - > Re ports (or the Re ports SmartKey) and then selecting t he report name in the to p half of the Reports me nu. Report names are shown only for reports that have been correctly set up. Data from the time of the print re[...]

25 Printing P atient Reports Stopping Re ports Printouts 268 Stopping Reports Printouts ♦ T o stop Reports printing, in the Re ports menu, select – Stop Re port to stop the current pri nt job – Stop Al l Repor ts to cancel all q ueued report p rintout s – Schedu led Rep. to toggle t o Off and switch off sched uled reports. Setting Up Report[...]

Setting Up Report s 25 Printing Patient Reports 269 Setting Up Vital Signs and G raphic Trend Report s The settings yo u choose in the Setup Vi ta l Signs Rep or t and Gra phical Trend Repo rt menu s apply fo r all Vital Sig ns and Gr aphic Trend reports prin ted. To set up Vital Signs and Graphic T rend reports, 1 Selec t Main Set up -> Repo rt[...]

25 Printing P atient Reports Setting Up Indivi dual Print Job s 270 Setting Up Individual Print Jobs To adjus t the appearance of individ ual print jobs , in the Repo rts menu, 1 Sele ct Ma in Setup -> Report s -> Setup Re por ts to enter the Setup Re ports menu . 2 Sele ct Re port and then select the r eport you want to set up . 3 Sele ct Re[...]

Prin ting a Test Repo rt 25 Printing Patient Reports 271 Printing a Test Report A test report can be printed in Configuratio n mode, refer to the Service Guide for details. Switching Printers On Or Off for Reports You can ena ble or disabl e print er status to switch in dividual printers on or of f for report printouts. 1 In th e Setup Printer s me[...]

25 Printing P atient Reports Print er Stat us Messages 272 Printer Status Message s Sample Report Printouts Ea ch r epor t he ader co ntain s th e pa tie nt’ s bed lab el, last name and f irst name , the patie nt ID, the date and time, and the name of the re port. The report fo oter contains the hospital label an d page number, and the last page [...]

Sample Report Printouts 25 Printing Patient Reports 273 Alarm Limits Report Graphic view of current alarm limits in relation to currently monitored measuremen t value Measur ement labels , wi th alarms off symbol where al arms ar e switched off Pati ent N ame[...]

25 Printing P atient Reports Sa mple Rep ort Pr int out s 274 Realtime Report Pa t i e n t demographic infor mati on, time stamp Act iv e A la rm s and INO P s, follo wed by vit al sig ns Mea su rem e nt waves section, including HiR es waves[...]

Sample Report Printouts 25 Printing Patient Reports 275 Cardiac Output Report Nu m b er e d t ri a l curves T rial i nforma tion in tabular form Pa t i e n t inform ation[...]

25 Printing P atient Reports Sa mple Rep ort Pr int out s 276 ECG Reports Bel ow the he ader on ECG Repo rts, t he numer ic bl o ck shows the current HR, PVC, and ST values. The wave ar ea sho ws the pr inted wa ves for a ll avai labl e ECG leads. A 1 mV calib ration bar is pr inte d at the beginning of each w ave. With the 3X4, 6X2, and 2X4 f orma[...]

277 26 26 Using the Drug Calculator Drug mixtures for intrav enous (IV) drug infusions combine information on drug d ose, rate, amount, volume, concentration , and standardized rate. The Drug Calcul ator helps you to manage infusions by calculatin g one of these val ues at a ti me. *Be aw are t hat your h ospit al may use eith er ‘ µ g’ or ‘[...]

26 Using the Drug Calculator Performing Drug Cal culatio ns 278 Performing Drug Calculati ons Using the service Support Tool, a list of drugs can be confi gured for the moni tor containing pre- defined dosag e recomme ndati ons and u nit setting s. Sele cting the arr ow besid e the dru g name in the Drug Calcula tor win dow opens a list of confi gu[...]

Performin g Drug Ca lculat ions 26 Using the Drug Calculator 279 3 When you hav e enter ed thr ee valu es, the D rug Calculato r automati cally calcul ates the u nknown four th value and shows it in the hi ghlighted fiel d. Standardized rate and conce ntration are also calculated. Performing Calculations for a Specific Drug 1 Select th e arrow besi[...]

26 Using the Drug Calculator Charti ng Infusion P rogress 280 Charting Infusion Progress The D rip Tabl e shows yo u at a glance how much of the infusio n has been administered to your pati ent and how mu ch time is l eft. ♦ T o see the D rip T able, in the Drug Calcu lator window , sel ect the Drip Table po p-up key . If the Drip Time exceed s 2[...]

281 27 27 VueLink Modules A VueL ink module trans mits informati on from a conne cted external dev ice to your mon itor. Each module can be connected to up to three e xternal devi ces, and suppo rts alarms from the external device. Although the external device may tran smit more in formatio n, the numbe r of wave s and numerics you can view simulta[...]

27 VueLink Modules Co nnec ting a n Ex terna l Dev ice 282 Connecting an External D evice 1 Insert the mod ule into the FMS or integrated module slot. 2 Check that the device selection LED (c) lights t o sh ow that it has correctly id entified the external device. If not, select Ma in S etup -> Measur ements -> < Vu eL in k Devi ce Nam e &[...]

Using VueLink Screens 27 VueLink Modules 283 Using VueLink Screens Your monitor ma y be configured to show VueLi nk device data permanently on the Screens. Select the device data window to display the VueLink po p-up keys that let you access the setup menu and carry out VueLin k tasks. Switching VueLink On an d Off ♦ T o switch V ueLink me asur e[...]

27 VueLink Modules Languag e Confli ct with Ext ernal D evice Drivers 284 Language Conflict with Ex ternal Device Drivers You should a void la nguage conflict s between the VueLi nk module device dri ver and the mo nitor. Be aware that if you c onnec t a Vue L ink modul e with a differe nt operating language t o the monitor, the monitor will show: [...]

285 28 28 Using Timers With the Timers functi on you can set ti mers to noti fy you when a spec ific time perio d has expire d. CAUTION Do not use the tim ers to schedule critical patie nt-related tasks. Viewing Timers You can view currently active timers in the Time rs w indow or directly on the Main Screen (if a timer has been substituted for a n[...]

28 Using Timers Timer Setup P op-up Keys 286 Timer Types There are fo ur types of timer: Basic , En hanced , Cycli c and No Li mit . A Basi c timer has a single, define d run time and progress is show n in the progress bar. An Enha nced timer is like a Basi c timer but the progress bar show s progre ss beyond t he end o f the run time. A Cyclic tim[...]

Displaying Timers O n The Main Sc reen 28 Using Timers 287 Run Time The run time ca n be set betwee n 1 minute and 96 hours. N o Limi t timers have no ru n time. To set the run time, in the Timers window: 1 Sele ct the requ ired time r to displ ay the Se tup window . 2 Sele ct Ru n Ti me . 3 Select a run time f rom the li st. Timer Counting Directi[...]

28 Using Timers Displaying A Clock On The Main Screen 288 Main Screen Timer Pop-up Keys When you select a timer dis played on th e Main Scree n, additional pop-up keys become avail able: Displaying A Clock On The Main Screen In the same way that you can substit ute a timer for a numeric, you can also su bstitu te a larger clock displa y fo r a nume[...]

289 29 29 Respiratory Loops Using a VueLink module connected to a ventilator, you can measure and store graphic representations of rea lti me resp ir ator y loo ps. Re spira tor y loo ps ca n hel p you r ecog nize chan ges in yo ur pat ient ’s lung functi on , and they can als o indicate a fault in the ai rway tubing (fo r example, if the respira[...]

29 R espir atory Lo ops Captu ring and D eleting L oops 290 To open the Loop s window, and i ts associated pop-up keys, ♦ select Main Set up -> Loop s , or select the Loop s Sma rtKey , if configured. In the Lo ops window , in addition to the stored loops, three realtime airway waves and six avail able n umer ics f rom the source device can be[...]

Chan ging L oops Dis play Size 29 R espir atory Lo ops 291 Changing Loops Di splay Size To change the loo ps display size, in the Loops window, select the pop-up key Sele ct S ize then select • Size x 0.5 to display lo ops at half the us ual size • Size x 1 to d isplay loop s at the usual si ze • Size x 2 to d isplay loop s at twice the u sua[...]

29 R espir atory Lo ops Documenting Loop s 292 Documenting Lo ops 1 In the Loops window , select the pop-up key Print Loop 2 F rom the list of avail able loop s, se lect an ind ividual lo op, or sele ct P rint All to print a report of all For each loop, the report prints • the curr ently-dis played loop , with t he loop ca ptur e timesta mp • u[...]

293 30 30 Care and Cleaning Use only the Philips -appro ved substa nces and m ethods list ed in thi s chapter to cl ean or disinfec t your equipment. Warranty does not cover d amage caused by usin g unapprov ed substance s or me thods. Philips makes no claims regarding the efficacy of the listed chemicals or m ethods as a means for controlling infe[...]

30 Care an d Cleaning Cleaning 294 Cleaning Clean with a li nt-free cloth, mois tened with wa rm water (40° C/104°F ma ximum) and s oap, a di luted non-caustic det ergent, tenside, a mmonia- or a lcohol- based cle aning agent. Do not use strong solve nts suc h as aceton e or tri chloroet hylene . Take extra ca re when clean ing the screen of the [...]

Sterilizing 30 C are and Cleaning 295 Sterilizing Ste riliza tio n is not reco mme nded f or th is mon itor , related pro ducts, accessori es or supplies unless otherwise indicated in the In structions for Use that accompany the accessories and supplies. Cleaning the Recorder Printhead (M1116B only) If you run recordings at low speed (1 or 2cm/min)[...]

30 Care an d Cleaning Cleaning the Batt eries and Battery Compa rtment 296[...]

297 31 31 Using the Batteries IntelliVue MP20/MP30/ MP40/MP50 only MP20/MP 30 : one OR two Phil ips M4605A recharge able Li thium Io n batteries m ust be inserted into the battery comp artment at the re ar of the monitor to use the MP20/MP30 monitor with batt ery power. MP40/MP 50 : two Philips M4605A rechargeable Lithiu m Ion batterie s must be in[...]

31 Using the Batteries Batt ery P ower Indi cators 298 The MP60/M P70/MP80/M P90 monitors cannot be p owered by ba ttery. You can switch between battery-p owered a nd mains -power ed (AC) o perat ion wi thout inte rrupt ing monitoring. The batteries recharge automati cally whenever the mo nitor is connect ed to mains power . Battery o peration may [...]

Battery Power Indicators 31 Using the Batteries 299 Batter y status symbols : Thes e sym bols t ell you the s tatus of the batt eries (see t able b elo w) an d which battery comp artment they are i n, either 1 or 2. Batter y power ga uge: Thi s shows the remaining battery power in the combined batteries. It is divi ded into sections, each repre sen[...]

31 Using the Batteries Checking Batt ery Charge 300 Battery Status Window ♦ T o access the Battery Stat us windo w and its assoc ia ted po p-up ke ys, select the batte ry status informati on on the Screen, or select Ma in Setu p -> Batt ery . Capacit y, Rem aini ng tells you how much power is left in each battery. Capacit y, Full Charg e tells[...]

Replaci ng Batteries 31 Using the Batteries 301 charge. If all LEDs ar e lit, the batte ry is fully charged, if only one LED is lit, 25% o r less charge is left. Replacing Batteries MP40/MP50 You can rep lace bat teries wit hout switching off the monit or, if you rep lace them one at a time and if the rema ining battery ha s sufficie nt power. The [...]

31 Using the Batteries O ptim izing B atte ry Per form ance 302 Display Brig htness Setting ♦ In the Main S etup menu, select U ser In terf ace -> Brig htne ss - > Optimu m . This sel ects a level of brightness su itable f or most monito ring locati ons that uses less battery power than brighter settings. Satisfy yoursel f that this level o[...]

Battery Safety Informa tion 31 U sing t he Batteries 303 Battery Safety Infor mation WARNING U se only Philips batteries part number M4605A. Use of a different battery may present a risk of fire or explosion. Do no t open ba tteries , or dispose of t hem in fire, or cause them to shor t circuit. They may igni te, explod e, leak or heat up, causi ng[...]

31 Using the Batteries Battery Safety In formation 304[...]

305 32 32 Maintenance and Troubleshooting WARNING Sche du le : Fai lure on the part of th e respo nsibl e indi vid ual hosp ita l or i nstitu tion emp loying the u se o f this equi pment to im plement a sa tisfa ctory maint enance sc hedule ma y cause u ndue equip ment f ailure and possible health hazards. Contact : If you discov er a prob lem wi t[...]

32 Maintena nce an d Tro ublesh ootin g Maintenance Task and Test Schedule 306 4 Inspect the patient cables, leads and their strain re liefs for genera l conditi on. Make sur e there are no br eaks in the insulation. Make sure tha t the connectors are p roperly engaged at each end to prevent r otation or other st rain. 5 Apply the transducer or ele[...]

Troubleshooting 32 Maint enanc e an d Trou bleshootin g 307 Troubleshooting If you su spect a proble m with an ind ividual mea surement, read the Instructions for Use and doublecheck that you have set up the mea surement correctly . If you suspect an i ntermittent, system-wide p roblem call your service personnel. You may be asked for information f[...]

32 Maintena nce an d Tro ublesh ootin g Disposing of Empty Ca libration Gas Cylinders 308[...]

309 33 33 Accessories You ca n order part s and acces sorie s fr om Phil ips s upp li es at ww w.medical .phili ps.com or c o nsult your local Philips repre sentative for details. WARNING Reuse : Never reuse disposab le transducers, sensor s, acce ssorie s and so forth that are inte nded fo r sin gle use, or s ingle patient use on ly. Reuse may com[...]

33 Accessories ECG/Resp Ac cessories 310 5-Electrode Cable Sets 10-Electrode Cable Sets 3-Electrode One Piece Cables 5-Electrode One Piece Cables ICU Gr abber shi elded 1.0m M1603A M1613A ICU snap shield ed 1.0m M1605A M1615A ICU Clip no n-sh ielde d 0.45 m M1608A M1618A ICU Clip no n-sh ielde d 0 .7m M1609A M1619A Description Length AAMI P art N o[...]

NBP Acce ssories 33 Accessories 311 Set Combiners and Organizers NBP Accessories These cuf fs and tubings are de signed to have special p rotectio n agai nst electri c shocks (particularly regarding allowable leakage curre nts), a nd ar e defi bril lator proof. You can use them duri ng el ectro sur ger y. Adult/Pediatr ic Multi-Patient Co mfort Cuf[...]

33 Accessories NBP Ac cessori es 312 Adult/Pediatric Antimicrobial Coat ed Reusable cuffs Adult/Pediatric Soft Sing le Patient Single-Hose Disposable Cuffs Neonatal/Infant Cuffs (Disposable, non-sterile) P a tient Category (color) Limb Cir cum fe ren ce (cm) Bladder W idth Pa r t N o . Tu b i n g Adult Thigh ( grey) 45 - 56.5 21.0 cm M4559A M1 598B[...]

Invasive Pressur e Accessorie s 33 Accessories 313 Invasive Pressure Accessories These tran sduce rs and accesso ries are desi gned to have special protection against electri c shocks (particularly regarding allowable le akage currents), and are defibrillator proof. If you are using the M3012A He modynami c Meas urement Serve r Extensi on, and yo u[...]

33 Accessories SpO 2 Acce ssories 314 The M1020 B SpO 2 module with Option A02 may not be avai lable i n all countrie s. Some se nsors may not be av ailable in al l countries. Al ways use the MA X-FAST forehe ad sensor with the foam he adband provi ded by N ellcor. Make sure that yo u use on ly the accessorie s that are spec ified f or use with thi[...]

SpO 2 Accessories 33 Accesso ries 315 M1 191AN L Special E ditio n (SE ) Adult sensor (3m cab le), fo r patients over 50 k g. Any fi nger , except th umb. yes yes No adapter cabl e requ ire d. M1192AN Special Ed ition (SE) Small adult, pediatric sen sor (1.5m cable) for patients betw een 15 kg and 50 kg. Any finger except th umb. yes yes M1193AN Sp[...]

33 Accessories SpO 2 Acce ssories 316 NELLC OR disposable sensors (mu st be order ed from Nellcor) OxiM ax MAX-A Adult finger sen s or (patient size >30 kg) yes yes Opti on A01 : Use adap ter ca ble M1943A o r M1943AL. Opti on A02 : Must use adapter cable M1943N L. OxiM ax MAX-A L OxiMax MAX-A with long cable yes yes OxiM ax MAX-P P ediatric fo [...]

SpO 2 Accessories 33 Accesso ries 317 Oxiba nd OX I -A / N Adult / neonatal senso r no yes M ust use M194 3NL adap ter cable Oxiba nd OX I -P / I P ediatric / infant sensor no yes Dur ase ns or DS100A Adult finger clip sensor no yes Dura-Y D-YS Y -sensor no yes Extension / Adapter Cable s for Philips and Nellcor Senso rs M1941A Ex tension ca ble (2[...]

33 Accessories Temperature Accessories 318 The Phil ips M300 1A option A 01 M ulti-M easur ement s erver and the M1020B op tion A01 S pO2 Modul e use Masi mo certif ied pu lse o ximetry for r educed noise a nd lo w perfusion performance with M asimo S ens ors under the Masimo NR&LP protocol availab le from Mas imo. Sensors for use with the Masi[...]

Cardia c Output (C. O.) Accessor ies 33 Accessories 319 Cardiac Output (C.O.) Acces sories See Pressure accessories for PULSION co ntinuous cardiac output accessories. F o ley Cathet er P robe (16 F rench) 21096A 180 sec F o ley Cathet er P robe (18 F rench) 21097A 180 sec Adapt er cable 1 .5m 21082B Adapt er cable 3 .0m 21082A T emperatur e Pr obe[...]

33 Accessories Mainstrea m CO 2 Accessories (for M3014A) 320 Mainstream CO 2 Accessories (for M3014A) Sidestream CO 2 Accessories (for M3014A) Mainstream CO 2 Accessories (for M3016A) Descrip tion Par t No . CO 2 Senso r M2501A Adult/ P edia tric Airwa y Adap ter ( reusa ble) M2513A Infant Airway A dapt er (r eusable) M2516A Adul t Air way Ada pter[...]

Microstream CO 2 Ac cessories 33 Accessories 321 Micros tream CO 2 Accessories • “F ilterLin e Set” is a combination of a F ilterLine with an Air way Adapter . • “H” in the acces sory name indica tes sui tabil ity for hu midified vent ilation and long er usage d ue to the activ e remo val o f humidity fr om the sample li ne. • “Smar[...]

33 Accessories tcGas Accessori es 322 tcGas Accessories This s ymbol indicate s that th e specif ied tran sduc er (but not its membran es) is d esigne d to have special protecti on against elec tric shocks (particularly regarding allowable leakage currents), and is defibrill ator proof. EEG Accessories BIS Accessories Use only Aspe ct BIS sensors w[...]

SvO 2 Ac cess ori es 33 Accesso ries 323 BIS Senso rs To re-order sensors outside North America, contac t you r nearest Philip s sales offi ce and quote the Phil ips ord ering num ber. In North Am erica , contac t Aspect M edica l System s. Other BIS Accessories Order the foll owing parts from your ne arest Philips sa les office a nd quote the Phil[...]

33 Accessories Record er Accesso ries 324 Recorder Accessories Descrip tion Par t No . F or M1 116B re corder: 10 roll s of pa per 40477A 80 roll s of pa per 40477B F or i ntegr ated re corder ( MP20 /MP30 ): 10 roll s of pa per M4816A 80 roll s of pa per M4817A[...]

325 34 34 Installation and Specifications The specif icati ons in thi s section a pply to th e MP20, MP30, MP40 , MP50, MP60, MP70, MP80 and MP90 patient monitors, unle ss otherwise stated. The monitor s are not user in stall able. T hey mu st be install ed by qu alifie d service perso nnel. Intended Use The monitor s are in tended to be used f or [...]

34 In stallation and Speci fications Manufacture r’s Information 326 Manufact urer’s Inf ormat ion You c an wri te to Philip s at this addres s Philips M edizin Systeme B oebli ngen GmbH Hewlet t-Packa rd- Str. 2 71034 Boebli ngen Germ any Visit our we bsite a t: www.phili ps.com. © Copyrig ht 2002 - 2 005. Koni nklijk e Phil ips El ectronics [...]

Manu fact urer’s Infor mati on 34 Installa tion an d Specif icatio ns 327 Trademark Acknowledgement PiCCO ΤΜ is a tradem ark of Pulsio n Medical S ystems AG . Bispec tral Index and BIS are trademar ks of Aspe ct Me d ical Systems Inc, and are registered in the USA, EU a nd oth e r c oun tri es. Oxisen sor ΤΜ II , Oxi-Cl iq ΤΜ , and OxiMax ?[...]

34 In stallation and Speci fications Sym bols 328 Symbols These sym bols appear o n the monitor and its as sociated equi pment. Symbols Ref er to accomp anyi ng docu ment s Pr otective earth RS232 co nnect or Sta n db y Equi potenti al gro und ing I dentifies yea r and mo nth o f manufact ure Connection dir ection indi cato r Alter natin g cur rent[...]

Installation Sa fety Informati on 34 Installati on and S pecific ations 329 Installation Safety Information WARNING If multiple instrume nts are connected to a patient, the sum o f the leakage curre nts may exceed the limits given i n IEC/EN6 0601-1. Consult y our servi ce personnel. Connectors The actual placement of board s and configuratio n of [...]

34 In stallation and Speci fications Installati on Safety Information 330 MP20/ MP3 0 MP20/MP30 Left si de of mo nitor 1 MMS and one extension 2 ECG analo g ou tput/marker input c o nnec tor MP20/MP30 Rear of moni tor 1 Measur ement S erver Link connector 2A C p o w e r i n l e t 3 Remote alarm connect or 4 Analo g video ou t connect or 5W i r e d [...]

Installation Sa fety Informati on 34 Installati on and S pecific ations 331 MP40/ MP5 0 MP40/MP50 Rear of moni tor 1 S pace fo r opti onal inter fac e boards, e.g. serial/ MIB (RS232) connector s, or option al para llel printer con nectio n 2E q u i p o t e n t i a l grounding 3 Pro tective earth 4A C p o w e r i n l e t 5 Wireless net work connect[...]

34 In stallation and Speci fications Installati on Safety Information 332 MP60/ MP7 0 MP40/MP50 Left si de of mo nitor 1 MMS and one extension 2 Plu g-in mo dule sl ots 3 ECG analo g output /mark er input c o nnec tor 1 2 3 Rig ht sid e of mo nitor (MP6 0/70 ) 1 Se rial/ MIB (RS 232) conne ctors (opt iona l), type RJ4 5 2 Parall el prin ter co nnec[...]

Installation Sa fety Informati on 34 Installati on and S pecific ations 333 Le ft side of mon itor (M P60/ 70) 1 MMS patient cable connectors 2 Sl ot f or in tegra ted re corder mod ule or measurem ent module 3 Additional m easuremen t server link (MSL) ca ble (al ternat ive or additional t o MSL on rig ht of m onitor) 4 ECG analog o utput/ marker [...]

34 In stallation and Speci fications Installati on Safety Information 334 MP80/ MP9 0 MP80/MP90 (rear of processing u nit) - MP80 does not have t he top row o f connectors 1 Seri al/MIB (RS232) c onnecto rs, type RJ45 12 ECG analog ou tput/ marker inpu t 2 Seri al/MIB (RS 232) connectors, type RJ45 13 Wired net work c onnecto r 3 Independent displa[...]

Installation Sa fety Informati on 34 Installati on and S pecific ations 335 802.11 Bedside Adapt er (Wireless Network Adapter) MP80/MP 90 (f ront of pro cessing u nit) 1 A C Po w e r L E D 5 Po w e r s u p p l y 2 Error LED 6 AC power input 3 P ower on LED 7 P rotecti ve earth screw ho le 4 P o wer on swit ch 8 Equipot ential gr oundi ng po int 38 [...]

34 In stallation and Speci fications A lti tud e Sett ing 336 Al titude Setting Altitude affects tcGas and CO 2 me asurements . The mon itor must be confi gured at installati on to the correct altitude. Monitor Safety Specifications The monit ors, together w ith the Mult i-Measur ement Server (M30 01A), and the Flexib le Module Server (M804 8A), al[...]

Monitor Safety Specification s 34 Installati on and S pecific ations 337 The OEM rad io dev ice use d in this produ ct is in co mpliance with the essential requirem ents and other rel evant provis ion s of Dir ectiv e 199 9/5/E C. Th is pro d uct is intende d to be conne cted to the Pub licly Availa ble Interface s (PAI) and us ed througho ut the E[...]

34 In stallation and Speci fications Monitor Safet y Specifications 338 M301 6A Meas uremen t Server E xtension - Mainstream CO 2 < 450 g < 0.99 lb < 190 x 98 x 40 m m < 7.5 x 4 x 1. 6 in M804 8A Flexible Module Serve r (FMS) < 3500g < 7.7lb < 320 x 12 0 x 35 mm 12.6 x 4.7 x 5. 3 in without plug-in modules M804 5A Docking Stati[...]

Monitor Safety Specification s 34 Installati on and S pecific ations 339 Environmental Specifications The monitor ma y not meet the performa nce speci ficat io ns given here if stored or used out side the spe cifie d temp eratu re and h umidi ty rang es. Wh en the monito r and relate d prod ucts have di fferin g env ironm ental speci ficatio ns, t [...]

34 In stallation and Speci fications Monitor Safet y Specifications 340 Mea sur ement S er v er M3001A, M easur ement Serv er Extensions M3016A M 3015A, M3014A, M3012A, M easur ement M odules, and Flexible M o dule S er v er M8048A Ite m Condition Range T emperatur e Range Operating 0 to 45 °C ( 32 to 113 °F) No n - o p e r a t i n g -40 to 70 °[...]

M4605A Ba ttery Specificat ions 34 Ins tallati on and Spec ificat ions 341 M4605A Battery Specifications MP20/MP30/ MP40/MP50 Only Two batteri es are req uired t o operate the MP 40/MP50 moni tors. The MP20/MP30 monitors ca n operate with o ne battery . Humidity Range Operating 95% Relative H u midity (RH) max @ 40°C (1 04°F) (non cond ensi ng) N[...]

34 In stallation and Speci fications Monitor Performance Spec ifications 342 Monitor Performance Specification s T emperatur e R ange Discharge 0 to 5 0 ° C (32 to 122 ° F) Charg e 0 to 45 ° C ( 32 to 11 3 ° F) Sto rage -20 to 60 ° C (-4 to 140 ° F) Humidity Range 40% to 95% Relative H umidity (RH) Battery T ype Smart Battery 10.8V , 6000mAh,[...]

Monitor Performanc e Specification s 34 Insta llation and Specif icatio ns 343 Battery Specifications MP20/MP30 Operatin g T ime (with 2 new , fully charged batteries) Basic monitoring configuratio n: 5 hours ( Brightness set to Opt imum , MMS conn ected, NBP measurement ev ery 15 minutes) Extended monitoring configuration: 4 hours ( Brightness set[...]

34 In stallation and Speci fications Monitor Performance Spec ifications 344 Even ts Inf ormation trigger condition and time, event classificati on and associated detailed view o f episode d ata Episod e data con figurable (ex cept MP20/30), either: 4 minutes of high resolution trend o r 20 minutes of numerics trend @ 12 sec. r esolution or 15 seco[...]

Monitor Performanc e Specification s 34 Insta llation and Specif icatio ns 345 Monitor Interf ace Specifi cati ons Net wo rk St an da rd IEEE 802.3 10-B ase-T Connector RJ 45 (8 pin) Isol a tio n 1.5 kV P a rallel Printer P ort Sta nd a rd IEEE 1284-I Connector D B-25 Signals L evel 1 and Level 2 (switchab le) Isol a tio n 1.5 kV Communication Mo d[...]

34 In stallation and Speci fications Monitor Performance Spec ifications 346 Wirele ss Network Device I nterface Connector 8 pin Mini -D IN Signals RD +/-, T D+/-: IEEE 802.3 10Base- T , PW R, GN D 12.5 V ±20% , 3.5 W con tinuo us Remote A pplication Su pport T echnology Citrix ® and ICA ® (Independent Computing Architectur e) client, T unne lin[...]

Monitor Performanc e Specification s 34 Insta llation and Specif icatio ns 347 Video Interface MP60/ MP70/MP80/MP90 SXGA ( MP80, MP90, D80 only), X GA Hor iz on ta l Freq u en cy 48.4 k Hz o r 60.0 k Hz or 64.0 k Hz Vi deo S igna ls 0.7 Vpp @ 75 Ohm, HSYNC /VSYNC Signa ls TTL DDC Sig nals I2C compliant, 5V , 100 mA (max) (M8010 only) Connector 15 p[...]

34 In stallation and Speci fications Measurement Specifications 348 Measurement Specifications See the Append ix on Defa ult Settings for a lis t of the setti ngs the monito r is initiall y shipped with. ECG/A rrhythmia/S T Complies with IEC 60601-2- 25:1993 + A1: 1999 /EN60601-2 -25:1995 + A1: 1999, IEC 60601-2-27/ EN60601-2-27:19 94, I EC 60601-2[...]

Measurement Sp ecifications 34 Installati on and Spec ificat ions 349 ECG/Arrh ythmia/ ST Alarm Specificat ions Range Adjustme nt HR 15 to 30 0 bpm maximum delay: 10 seconds according to AAM I EC 13-1 992 stand ard Adult:1 bpm steps (15 to 40 bpm) 5 bpm steps (40 to 300 bpm) P edi/Neo:1 b pm steps (15 to 50 b pm) 5 bpm steps (50 to 300 bpm) Extr em[...]

34 In stallation and Speci fications Measurement Specifications 350 Respiration SpO 2 Unle ss oth erwise specif ied, th is info rmatio n is val id for S pO 2 measured using t h e M3001A measuremen t server and the M1020B mea surement mo dule. Complies wi th EN ISO 9919:2005 (except a larm syst em; alar m system comp lies wi th IEC 60601-2- 49:2001)[...]

Measurement Sp ecifications 34 Installati on and Spec ificat ions 351 Measureme nt Valid ation: The SpO 2 accuracy has been validated in human stud ies against arterial blood samp le reference measured with a CO-oximete r. Pulse oximeter measuremen ts are stat istically distributed, only about two-thi rds of the m easur ement s can be expec t ed to[...]

34 In stallation and Speci fications Measurement Specifications 352 NBP Complies wi th IEC 6060 1-2- 30:199 9/EN60601-2-30 :2000. Pu l se Range 30 to 300 bpm Accuracy ±2 % or 1 bp m, whi chev er is gr eater Resolutio n 1 bpm Sens ors W avel ength r ange : 500 to 100 0 nm Emitted Light Energy: ≤ 15mW Information about the wavelength range can be [...]

Measurement Sp ecifications 34 Installati on and Spec ificat ions 353 Measurement Validati on: In adult a nd ped iatric mo de, th e bloo d pressur e measu rement s determ ined with this devi ce comply with t he Americ an Na tional Standard for Ele ctronic or Automated Sphygmom anometers (A NSI/AAMI SP10 - 1992) in rel ation to mean err or and stand[...]

34 In stallation and Speci fications Measurement Specifications 354 Invasive Pressure and Pulse Complies wi th IEC 6060 1-2- 34:200 0/EN60601-2-34 :2000. NBP Ove rpressur e Settings Adul t > 30 0 mmHg (4 0 kP a) > 2 sec not user adjustable P edi > 3 00 mm Hg ( 40 kP a) > 2 sec N eo > 150 m mHg (20 k P a) > 2 s ec Invasiv e P ressu[...]

Measurement Sp ecifications 34 Installati on and Spec ificat ions 355 Temp Invasive P ressure Alar m S pecificatio ns Range Adju stm ent Delay Pre ss u re –40 to 360 mmHg (–5.0 t o 48 kP a) -40 to 30 mmHg 2 mmHg (0.5 kP a) > 30 mmHg 5 mmHg (1 kP a) max. 12 seconds Pu l se 25 to 30 0 bpm Adult : 1 bpm step s (25 t o 4 0 bpm) 5 bpm step s (40 [...]

34 In stallation and Speci fications Measurement Specifications 356 CO 2 The CO 2 mea surement in M 3014A an d M3015A co mplie s with EN ISO 216 47 (excep t alarm sys tem; alarm system complies wi th IEC 60601-2-49: 2001) Microstream CO 2 Humidity Correction Factor Either BTPS or STPD can be selected as the humidity correction factor for the Micros[...]

Measurement Sp ecifications 34 Installati on and Spec ificat ions 357 M3014A Mai nstr eam and S ides tr eam CO 2 Hu midity Correction Factor Either BTPS or STPD can be selected as the humidity correction factor for the Mainstream CO 2 readings. The formula for the correction calculation is: M3014A Mainstr eam CO 2 P erformance S pecifications CO 2 [...]

34 In stallation and Speci fications Measurement Specifications 358 Where p = partial pressu re, P abs = absolute p ressure, and P H2 O = 42 mmHg @3 5 ° C and 100% RH. Mainstr eam C O 2 H um idity Correction F actor Either BTPS or STPD can be selected as the humidity correction factor for the Mainstream CO 2 readings. The formula for the correctio[...]

Measurement Sp ecifications 34 Installati on and Spec ificat ions 359 Interfering Gas and Vapo r Effects On CO 2 Measurement Values The specifi ed dev iations for M3014A are vali d when the appr opriate co rrections are s witched on and set correctly. Spirometry The follo wing speci ficat ions ap ply for 76 0 mmHg ambi ent pressure and patient gas:[...]

34 In stallation and Speci fications Measurement Specifications 360 V olume W ave (A W V) Range 0 t o 100 ml ( neona tal 0 to 400 ml (pediatric) 0 to 3000 m l (a dult) Accuracy ± 5% or ± 3 ml (neonatal) ± 12 ml (pediatric) ± 90 ml (adult), whichever is greater Scales 50, 100, 2 00, 600, 800, 100 0, 2000 , 3000 ml Scale Def ault 50 ml (neonatal [...]

Measurement Sp ecifications 34 Installati on and Spec ificat ions 361 Cardiac Output / Continu ous Cardiac Output Negative In spirat or y Pre ss u re n u me r ic Range -2 0 to 0 cmH 2 O Resolutio n 1 cmH 2 O Mean Ai r way Pressu re Ran ge -20 to +1 20 cmH 2 O Resolutio n 1 cmH 2 O Plateau P ressur e numeric Range 0 to +120 cm H 2 O Resolutio n 1 cm[...]

34 In stallation and Speci fications Measurement Specifications 362 tcGas Complies wi th IEC 6060 1-2- 23:199 9/EN60601-2-23 :2000. ITB V Range 50 to 6000 ml Accuracy + 10 % or 3 0 ml Repeatability + 5% or 20 ml CCO Range 0 .1 to 25.0 l/min Standard Deviation 10% or 0.3 l/min Display Update 2 seconds nomi nal Blood T e mperatur e Range 1 7,0 to 43?[...]

Measurement Sp ecifications 34 Installati on and Spec ificat ions 363 SvO 2 EEG Complies wi th IEC 6060 1-2- 26:199 4/EN60601-2-26 :1994. tcp CO 2 response time, including transducer < 50 s W arm-up T ime < 3 minutes Site T ime r 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 6, 7, or 8 hou rs. C hange Sit e al arm when site time is expired and configurable a[...]

34 In stallation and Speci fications Measurement Specifications 364 BIS EEG P erformance S pecifications Leakage C urrent <=1 0 µ A @ 1 1 0V ac Inpu t Signa l Ra nge 1 mV p-p Differ ential Input I mpedance >15 M Ω @ 10 Hz Max. DC Input Offset V oltage ± 320 mV Input P rotection Against defibrillation (5 kV) and electrosurgery Common M ode[...]

Safety and Performance Tests 34 Inst allati on and Spec ificat ions 365 Safety and Performance Tests You mu st observe any natio nal regulatio ns on the qu al ificati on of th e testing pers onnel and suitab le measuring a nd testi ng facil ities. S ee th e maintena nce section for a li st of required te sts. Safet y and performance tests, and what[...]

34 In stallation and Speci fications Safety and Performance Tests 366 Electromagnetic I mmunity The monitor i s suitable for use in the spe cified e lectromagneti c environment. T he user must ensure tha t it is use d in th e appro priate e nviro nmen t as des cribed b elow. In this table, U T is the a.c . mains v oltage prior to application of the[...]

Safety and Performance Tests 34 Inst allati on and Spec ificat ions 367 Interfere nce may occu r in the vi cinity of equipme nt marked wit h this sy mbol: Field strengths from fi xed transmitters, such as base stations for radio (cellular, cordless) telephones and land mobile rad ios, amate ur radio, AM and FM radio broa dcast and TV broa dcast can[...]

34 In stallation and Speci fications Safety and Performance Tests 368 Electrosurgery Inte rference/Defibrillation/Electrostatic Discharge The equipment re turns to the previou s operating mode within 10 seco nds without lo ss of any stored data. Measurement accuracy may b e tempo rarily d ecrea sed w hile p erform ing el ectro -surg ery or defib ri[...]

369 35 35 Default Settings Appendix This a ppend ix do cumen ts th e most impo rtant defa ult setti ngs of your monit or a s it i s de liver ed f rom the factory. Fo r a comprehen sive list and expl anatio n of default setti ngs, see the Co nfiguration Guid e suppli ed with you r moni tor. The mon ito r’s de f ault setti ngs can be permanently ch[...]

35 Default Sett ings Appen dix Alarm De faul t Se ttings 370 Alarm Default Settings ECG, Arrhythmia, and ST Default Settings Alarm Settings Factory Default H10 / H20 / H40 H30 (deviations from H 10/20/40) Alarm V olume 5 Alarms Off 3 min. Pa u s e A l . 5 m i n En a b l e d P ause Al. 10min Enab led Auto A lar ms Of f Of f Alarm Of f Remin der Off [...]

ECG, Arrhythm ia, an d ST Defaul t Settings 35 Default Settings Ap pendix 371 P ri mary Lead II Secondar y Lead V Analysis Mode Multi-lead Lead Placement Standard Mod . Le a d Pl a cme nt Of f Fi l te r M on it o r Filter Sp eed 25mm/s Auto Filt er Of f Default EC G Size x 1 Col or G reen Asystol e Thr esh 4. 0 sec 3.0 sec ∆ ExtrT ac hy 20 bp m T[...]

35 Default Sett ings Appen dix ECG , Arrhy thmi a, and ST Defa ult S ettin gs 372 Arrhythmia S ettings F actory defaults H10 / H20 / H40 H30 (deviations from H10/20/40) Adult Pe d i Neo Adult Pe d i Neo Arrhythmia On Off Off P ause T hr esh old 2.0 sec 1.5 sec VT ach HR 1 00 120 150 VT ach Run 5 V ent Rh ythm 14 SVT HR 180 2 00 210 SVT R un 5 PV Cs[...]

Pulse D efault Settings 35 Default Settings Appen dix 373 Pulse Default Settings Pulse alarms use th e settings of the currentl y selecte d Pulse a larm sou rce. Lead I, I I, III, V , aVR, aVL, aVF , V 1-6, MCL Settings Fac t or y Ad u lt Fa c to r y Ped i Fac t o r y Neo ST (Label ) On Off For A la r m Mo d e = Si n g le - S T ST (Label ) High +2.[...]

35 Default Sett ings Appen dix Respirat ion De faul t Se ttings 374 Respiration Default Settings SpO 2 D efau lt Setting s Respiration Settings F ac tory de faults H10 / H20 / H40 H30 (deviations from H10/20/4 0) Adul t Pe d i Neo Adul t Pe d i Ne o High Limit 30 rpm 100 rpm Low Li mit 8 rpm 30 rpm Apnea T ime 20 se c Alarms On Resp On Off Auto/Man[...]

NBP Defaul t Setting s 35 Default Setti ngs Appendix 375 NBP Default Settings Temperature Default Settings P ulse Ala rms On /Off on on on Pulse High Limit 120 bp m 160bp m 200 bpm Pulse Low Limit 50 bpm 75 bpm 100 bpm ∆ Extr Brady 20 bpm 20 bpm 20 b pm Brady Cla mp 40 bpm 4 0 bpm 5 0 bpm ∆ ExtrT achy 20 bpm 20 bp m 2 0 bpm T achy Clam p 200 bp[...]

35 Default Sett ings Appen dix Invasive Pressure Defaul t Settings 376 Invasive Pressure Default Settings ABP , AR T , Ao, BAP , F AP , P , P1, P2, P 3, P4, U AP Settin gs Fa ctory de faults H10 / H20 / H40 H30 (deviations from H10/20/40) Adult Pe d i Neo Adult Pe d i Ne o Alarms fr om Sys. High Limit 160 / 90 (110 ) 120/ 70 (9 0) 90/ 60 (70) 180/ [...]

Cardiac Out put Defa ult Setting s 35 Default Settings Appen dix 377 Card iac Outpu t Defau lt Sett ings Mea n O nl y No Y e s F ilter 12 Hz 12 Hz Mer cur y C al . Y es Y e s Artifact Suppr . 6 0 sec 60 sec Un it mmHg mmH g Colo r Y el low Mage nta Invas iv e P ressur e Settings P AP Settings ICP , IC1, IC2 Settings Fac t o r y Ad u lt Fac t o r y [...]

35 Default Sett ings Appen dix CO 2 Defa ult S etti ngs 378 CO 2 Def ault Settings Spirometry Default Settings CO 2 Sett ings F a ctory defaults H 10 / H20 / H40 H30 (deviations from H10/20/ 40) Adul t Pe d i Ne o Adu lt Pe d i Ne o etCO 2 lo w 30 25 etCO 2 high 50 60 imCO 2 high 4 CO 2 Alarm s on Unit mmH g Scale 40 mmH g 5 0 ImCO 2 on Off N 2 O C[...]

tcGas Defa ult Setting s 35 Default Settings Ap pendix 379 tcGas Default Settings SvO 2 D efault S etting s tcG as Se ttings Fac t o r y Ad u lt Fac t o r y Ped i Fa ct o r y Ne o tcpO 2 H igh 80 mmHg tcpO 2 Low 50 mmHg tcpO 2 Alarm s On tcpCO 2 H igh 50 mmHg tcpCO 2 Low 30 mmHg tcpCO 2 Alarm s On Site T i me 4. 0 hou rs Disabl e T i mer N ot Al lo[...]

35 Default Sett ings Appen dix EEG Defaul t Se ttin gs 380 EEG Default Settings BIS Default Settings EEG S ettings Fac to r y A du l t Fac t o r y Pe d i Fa ct o r y Neo TP , SEF O n M D F, P P F, D e l t a , T h e t a , Alpha, Beta Off SEF Th reshold 90 % Nu meric A verage 8 sec W a ve Scale 100uV (o r +/- 50uV if Show Gridlines is co nfigure d to[...]

VueLink D efault Settings 35 Default Settings Appendix 381 VueLink Default Settings Device Alarms Ignored Color Gre en[...]

35 Default Sett ings Appen dix VueLink Default Setting s 382[...]

i # 10-lead placement (ECG) 100 12-lead placement (ECG) 100 3-lead placement (ECG) 98 4-channel recorder 258 5-lead placement (ECG) 98 A AAMI E CG lead labe ls 97 abdominal breathing and Re sp electro de placemen t 132 aberrantly conducted beats 108 AC power input 332 accessories 10-electrode cable sets 310 3-electro de cable se ts 309 3-electro de[...]

ii pvc-related alarms 116 short yel low 105 sinus and SV rhythm ranges 350 , 352 switc hing on/o ff 113 timeout periods 113 yellow 113 arrhythmia monito ring and def ibrillation 106 arrhythmia options 104 arrhythmia relearning with EAS I INOP 102 arterial catheter constant (PiCCO) 166 arterial pressure source 157 , 158 arterial pulsation 137 art er[...]

iii other bed wi ndow 87 pop-up window 88 catheter SvO2, in sertion 205 catheter constant, setting (PiCCO) 16 6 catheter preparation SvO2 204 cautions 1 CCO calibration statu s indicators 167 choosing the correct pressure source 166 how the measurement works 161 PiCCO method 164 central recorder choosing 261 cerebral perfusion 157 CFI 162 chaining [...]

iv display settin gs 24 disposal gas cyl inder 307 parts and accessories 307 docu mentin g even ts 251 dosemeter (drug calculator) 279 dPmax 162 drip table (drug calculator) 280 drug calc ulator 277 DSC (BIS) software revision 221 dual Sp O2 141 dual Temp measurement 150 dyshemogl obins intravascular (SpO2) 139 E early systolic blood pressure, NBP [...]

v connec ting vi a VueL ink 282 external pacing electrodes and ECG moni toring 106 extreme brady cardia alarm 105 , 129 extreme rate alarms 105 , 129 extreme tachycar dia alarm 105 , 129 F fallback (ECG) 97 FAST Fourier ar tefact suppression technology 137 filter (ECG filter setting) 95 filter (ECG) 95 filter fre quencies (E EG) 213 Filt erLine CO2[...]

vi low pass filter (BIS ) 220 LVCI 16 2 M M11 16B 257 M3160A recorder 258 main scree n over view 14 mainstream capnography 12 mainstream CO2 accessories 176 , 188 measuring 176 , 179 maintenance cables 305 cords 305 measurements, schedule 306 microstream CO2, calibration 306 schedule 305 visual i nspection 305 major parts and keys MP20 MP30 3 MP40 [...]

vii oscill ometri c meth od 143 pediatric cuffs 312 preparing to measure 144 repeat time 145 repeat time for automatic 14 6 repetition time, setting 146 reusable cuffs 311 single-hose disposable cuffs 312 site inspection 145 time of last measurement 145 units 145 venous punctu re 147 neon atal ev ent coun ting 248 neon ates Resp el ectr ode pl acem[...]

viii printing C.O. measurements 16 9 calculations reports 237 even t rep orts 251 ST map reports 125 status log 307 trends reports 228 wedge 159 priority list for trends 227 probes disposable temperature 149 profiles 24 default profile 26 patient category 25 swapping 25 swapping settin g block 26 prompt messages C.O. 172 protective earth 332 protec[...]

ix re-triggering even ts 245 retrolental fibroplasia (SpO2 ) 140 review calculation s 235 reviewing alarm messages 50 reviewing alarms 50 revi ewing al arms window 50 RH method computation consta nt 169 rhythm status messages (arrhythmia monitoring) 110 right heart thermodilution method (C.O.) 168 right heart thermodilution setup (C.O.) 168 rs-232 [...]

x scal e ST ma p 125 task window 124 trend view 123 trending interval , changing 125 trending priority 124 ST maps 122 ST point 120 standard 10-l ead placement 100 standard 3 -lead plac ement 98 standard 5 -lead placement (ECG) 98 standardized rate 277 stan dby sy mbo l 328 starting mo nitoring 33 stat us li ne 14 stat us lo g printing 307 status m[...]

xi volum e alarm 43 touch tone volume 31 volum e-f low loop s 289 VueLink alarm messa ges 283 device driver conflicts 28 4 language conflicts 284 module 281 module options 281 module setup 282 visible w aves and nume rics 281 W warn ings 1 wave adjusting 27 changing speed 27 scale (CO2) 183 , 192 scale (pressure) 154 size (CO2) 183 , 192 size (pres[...]

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