M Series

1. M Series/E Series Advisory MachineSelf-Paced Training Module

2. The ZOLL M Series/E Series Advisory MachineModule #2

3. The M Series/E Series Biphasic Advisory machine has many capabilities and options. It can perform the following: Monitor Heart Rate (HR) Monitor cardiac electrical rhythms Practitioner can chose to press an analyze button and have the machine analyze the rhythm and verbally prompt Defibrillate Pace Cardioversion Monitor oxygen in the circulatory system Monitor carbon dioxide being exhaled Monitor respiratory rate Monitor blood pressure Store, print and transmit patient date Default or programmable alarms

4. The First Responder must learn to �Set the Tone� Call for help (what number do you call to access the code response at your facility) Lower bed, get patient out of shower, whatever needed to get victim to area where team can work Begin CPR until code cart and M Series/E Series defibrillator arrives Dry chest if needed, apply Stat-Padz/paddles upon arrival of code cart and defibrillator Time is Tissue! Place CPR board while coordinating roll of patient.Place the Stat-Padz in the anterior/posterior placement or place paddles on chest for immediate evaluation of the rhythm

5. Change in Practice The BLS trained practitioner can now press the Analyze button and initiate AED functionality

6. Change in Technology New ZOLL Biphasic M Series/E Series Escalating Joules 120-150-200

7. Locate Selector Switch The Selector Switch Offers 3 settings: Monitor: Gray Defib: Red Pacer: Green Universal color code on all Zoll machines

8. Important Distinction of Monitor Capabilities This M-Series machine has the capability to monitor the ECG rhythm by electrode, pads, or paddles in all 3 modes: Monitor (Gray), Defib (Red) and Pace (Green) With the Selector Switch turned to Monitor Mode, Pacing and Defibrillating are not available. In order to discharge current (Joules or milliamps) turn the Selector Switch clockwise or counter clockwise to access Defib Mode or Pacer Mode Under Pace and Defib Mode, Monitoring and delivery of current are both available

9. Monitor (Gray) Mode Click Selector Switch to the Monitor(Gray) Mode 3 monitoring capabilities: A) Electrodes B) Stat-Padz C) Paddles Not capable of discharging current in Monitor Mode

10. Prepare the PatientCommon with ECG, Stat-Padz, or Paddles Explain to patient purpose of procedure Remove appropriate clothing Clean and dry skin Clip hair Avoid shaving since abrasions may cause burning, but perform if chest hairy and only choice Place monitoring device of choice (ECG, Padz, or Paddles)

11. Monitor Mode(Gray) A) Electrode Placement Apply 3 lead or 5 lead ECG electrodes as shown in the illustration

12. Monitor Mode (Gray)B) Stat-Padz Optimal placement anterior/posterior, but may be used sternum/apex-lateral. Either placement will allow a �quick-look� at the rhythm Connect Multifunction Cable to Stat-Padz For more information on stat-pads see Stat-Padz module

13. Monitor Mode (Gray) C)Paddles Placement of the paddles will allow a �quick-look� of the rhythm Place conductive gel or gel pads on patients chest Connect multifunction cable to apex paddle at lightning bolt Pediatric paddles are accessed by unclipping and slipping off adult paddle face

14. Defibrillation Mode (RED) Turn Selector Switch clockwise to Defib (Red) #1 mode A BLS practitioner can now press the Analyze button (#2) and let the AED component of the Advisory unit do its job The ACLS practitioner can also press the Charge button and manually manage the discharge current

15. Defibrillation Mode: Accessing the Analyze Button (Stat-Padz only) Press the Energy Select button if accessed energy is not at the desired level. Note: Your facility may have preprogrammed the joules. Press the Analyze button (#2) and allow for the analysis of the rhythm by the machine Don�t touch the patient since the machine is now functioning as an AED

16. After analyzing, the machine will verbally instruct and display a prompt If no shock advised, move through the ABC�s as directed If shock is advised, press the charge button per verbal prompt or machine will auto-charge itself Warn all persons to clear(verbal prompt) Wait for ready tone, and visualize the area again to make sure everyone is clear Press and hold Shock button (#3) per verbal prompt Unit will deliver shock to patient

17. Defibrillation Mode: Manual Management of the Rhythm If the ACLS responder chooses not to access the Analyze button, the M Series/E Series will: Display preset joules The provider can press the Energy Select arrows until the desired energy is displayed on the screen Manual defibrillation can be administered via Stat-Padz or paddles

18. Defib Mode:Manual Defibrillation with Stat-Padz Press Lead button until �PADS� are the lead selected Place pads Connect multifunction cable to pads connector cable Press Energy Select button and select energy if not programmed by facility Press Charge Button Clear Area

19. Defib Mode: Manual Defibrillation with Stat-Padz (continued) Prior to pressing the illuminated Shock (#3) Button: Stand clear of patient Call out �Everyone clear� Visually verify everyone (again) is clear Press button Machine will discharge energy into patient

20. Defib Mode: Manual Defibrillation with Paddles Attach multifunction cable to right (apex) paddle at lightning bolt Press down on release buttons on each paddle and release paddles from their holders

21. Defib Mode: Manual Defibrillation with paddles (continued) Press Lead button to until �Paddles� are the lead selected Place protective gel pads on patients chest or gel on each paddle. Increase energy by accessing the energy button on the sternal paddle to increase or decrease energy if machine not preprogrammed Press Charge(#2)button on the apex paddle

22. Defib Mode: Manual Defibrillation Paddles (continued) Prior to pressing the Shock (#3) buttons on both paddles simultaneously Stand clear of patient Call out �Everyone clear� Visually verify everyone (again) is clear Press buttons Machine will discharge energy into patient

23. Defib Mode: Internal Defibrillation If internal defibrillation is to be utilized Internal paddles or spoons will be accessed from a sterile tray

24. Defib Mode:Internal Defibrillation The multifunction cable will be attached to the end of the cable of the sterile paddles The M Series/E Series will recognize the internal paddles: 10 joules is initiated A range of up to 50 joules is allowed

25. Defib Mode:Synchronized Cardioversion The M Series/E Series must be in Defib (RED) Mode Note the softkey Synch on/off button The ANALYZE button on the Advisory M-Series will not analyze when the machine is synchronized

26. Defib Mode: Synchronized Cardioversion Cardioversion can be performed using paddles or the Stat-Padz Press the Sync on/off softkey Verify that arrows display over every �R� wave

27. Defib Mode: synchronized Cardioversion If arrows unable to find the �R� wave, (note: �R� waves are found in this illustration) Size button: Increase the size of the ECG Lead button: Try a change in lead Always SEDATE the patient who is stable and awake prior to release of current with cardioversion

28. Defib Mode: Synchronized Cardioversion Charge the machine, clear area and Press the Shock (#3) button Re-synch the machine after discharge of current. The machine will revert back to unsynchronized defibrillation mode Hold SHOCK button until the discharge of electricity is finished because it may take a few seconds to decide where to release the current to miss the �T� wave

29. Pacer: (Green) Turn Selector Switch to Pacer (Green)

30. Pacer (Green) Pace will be displayed on the monitor screen. The Default setting of 70 PPM (paced per minute) is shown. 0 Milliamps are being discharged

31. Pacer Mode: Prepare the patient Stat-Padz must be placed: optimal placement is anterior/posterior Also need 3 lead ECG if demand pacing

32. Pacer Mode The two green dials control the pacer rate (PPM) and the pacer output (milliamps or mA) (For more specifics on pacemaker, see pacemaker module.)

33. Pacer Mode 100% ventricular depolarization or �capture� is shown in this illustration. By pushing the 4:1 Button, the practitioner can evaluate the underlying rhythm by pausing for 4 beats without interrupting the milliampheres

34. Pacer Mode: Advisory Machine The advisory machine cannot read a rhythm when the Pacer (green) mode is accessed.

35. Lead/Size/Alarm/Recorder Pressing the Lead Button, will scroll through Lead Options Lead Selection is displayed and offers the options of: a.) Electrodes: I,II,III aVR, aVF or V1 (3 or 5 lead) b.) Paddles: if monitoring off of paddles c.) PADS: If monitoring is off Stat-Padz

36. Pressing the Size Button will scroll through Size Options for the Lead Selection Size Selection displayed Size button Size Selection Option x0.5,x1,x1.5,x2 and x3 Heart Rate (HR) is displayed in the right hand corner of the LCD screen

37. Alarm Suspend and Recorder Button Pressing the Alarm Suspend button will suspend the alarm (see alarm module) Pressing the Recorder button will begin running ECG strip documentation. Pressing the Recorder button a second time will stop the ECG strip

38. Energy Select Arrows If at any time, the practitioner wishes to decrease or increase the amount of joules to be discharged, use of the Energy Select arrows on the face of the machine (or on the sternum paddle)

39. Changing Paper If Check Recorder is displayed, check the paper tray at the bottom of the M-Series Locate the RELEASE label and press the ridge down located below the label Slide tray out Replace paper with one square dangling outside of tray. Red grid up, black arrows out Press RECORDER button to confirm proper placement

40. Accessing Softkey labels and Softkey buttons The softkeys at the bottom of the unit will reveal a menu of softkey labels when pushed. For example: if you press the Alarms softkey, the alarm menu is displayed. (For alarm information, see alarm module) To return to the main menu press the RETURN key.

41. Reading the Display Messages The M Series/E Series Advisory will display visual (and verbal if programmed) prompts to compete the next step or finish the treatment/process that has been started. This illustration reflects a machine in Defib mode, 200 joules selected and the machine has recognized a nonshockable rhythm.

42. Options Display: Upper Left Corner of LCD Options can include Non-invasive Blood Pressure SpO2 CO2 As shown in this illustration

43. Option Cables Attach on the Back of the Machine Cables should be kept clean and dry. Cables should be left attached to the cable port, and stored in the cable pouch The illustration shows all of the 4 option cables attached at the port on the back of the M-Series.

44. Battery Life The most common cause of defibrillation failures are battery related A new, fully charged battery pack has enough energy to do 1 of the following a.) 35 Defibrillator shocks at maximum energy b.) 1.5 hours of continuous ECG monitoring c.) 1.0 hour of continuous ECG monitoring and pacing Recharge (plug in unit to wall) or replace battery when LOW BATTERY or REPLACE BATTERY are displayed on the screen

45. This concludes the self-paced learning module for the M Series/E Series Biphasic Advisory Defibrillator. Please advance to the single modules regarding more detailed information on specific options