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MRx Training with Q-CPR

MRx Training with Q-CPR. ROC Refresher & EMT/ EKG monitoring parameters. System Components. Therapy/CPR Cable. Compression Sensor. MRx Defib Pads. Basic Orientation. Ready for use indicator Therapy knob Charge Button Shock Button Printer Printer button Speaker.

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MRx Training with Q-CPR

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  1. MRx Training with Q-CPR ROC Refresher & EMT/ EKG monitoring parameters

  2. System Components Therapy/CPR Cable Compression Sensor MRx Defib Pads

  3. Basic Orientation • Ready for use indicator • Therapy knob • Charge Button • Shock Button • Printer • Printer button • Speaker

  4. Basic Orientation cont. • Menu select button • Navigation buttons • 4 soft keys • Event summary • Alarm pause • Lead select • Event mark button

  5. Monitoring on the Left 3-lead patient cables Spare electrodes Defib on the Right Patient / defib cable Q-CPR puck Shock test load plug Defib patches Razor Patient connections

  6. Ready For Use Indicator Blinking Black Hourglass – Shock, pacing, and ECG are ready for use and sufficient battery power is available X Blinking Red X with a periodic chirp – Low battery that is not being charged Blinking Red X without a periodic chirp – Low battery that is being charged X Solid Red X with a chirp – A failure has been detected that may prevent delivery of a shock, pacing, or ECG acquisition Solid Red X without a chirp – No power or device failure

  7. Compression Measurement Compression Sensor • The sensor is… • Reusable • Easy to clean • Acts as landmark • Goes where your • hands would go • Weighs 8 Ounces • What the sensor does… • Detects motion using and accelerometer

  8. Compression Measurement Compression Sensor • Measurements: • Compression Depth • Compression Rate • Leaning (incomplete release) • Duty Cycle (duration) • No Flow Time (inactivity timer) Sensor Adhesive Pad

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

  10. Typical Max. Min. Volume (ml per Kg) Impedance Change (Ohms) Ventilation Measurement • A new role for our multifunction pads… • Detect changes in chest impedance • that correlate to ventilation volume This is a new application of a proven principle

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

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

  13. Real-Time Feedback Clinical Priorities* Compressions: 1. Incomplete Release 2. Compression depth shallow 3. Compression rate slow or fast 4. Compression depth deep 5. Duty Cycle Ventilations: 1. Volume low 2. Frequency high or low 3. Inflation time fast or slow * These priorities were set based on an evaluation of published research data.

  14. Batteries and the MRX

  15. M3538A Lithium Ion Batteries • Batteries should be used as primary power source. • Fully charged battery will last 5-hours or 50-shocks. • No memory build up but should not be allowed to go dead. • Fuel cell is broken up into 5 LED’s or 20% • Full charge takes about 2-3 hours • Life expectancy is 2-years

  16. Maintenance Activities • Observe Ready for Use indicator. • Once a week, perform an Operational Check and Shock Test. • Care for batteries. • Clean MRx and accessories.

  17. Insert a charged battery (> 20%). Turn the Therapy Knob to Monitor. Press the Menu Select button. Using the Navigation buttons, select Other. Select Operational Check. Respond to the prompts. Performing an Operational Check

  18. Operational Check Report

  19. Operational Check Summary • Shows results of the last 60 Operational Checks • To print: • Select Other from the Main menu. • Select Op Check Summary. • Press the [Print] soft key.

  20. Data Transfer to card • Turn MRX to Monitor • Press the Menu Button • Select “Other” then Select “Data Management” • Press Menu & acknowledge the message • Select appropriate “EVENT” • Press “Menu” then select “Copy” • Place Data card in Defib Envelope!

  21. Questions about the MRX???

  22. ROC Sites

  23. CPR Reporting • BLS & ALS MIRF’s • BLS AED Data card & ALS card if placed prior to ROSC • Dispatch / RMS report • ROC Protocol check sheet • Phone call to ROC Study within 1 hour • Data transfer to County server within 24-hours

  24. Topics ROC Study Protocols • Purpose of an ITD Valve • Analyze Early or Analyze Late

  25. 2 ITD Valve • Impedance Threshold Device • ITD is a circulation adjunct not a ventilation adjunct. • Increases blood flow back to the heart during the recoil phase of chest compression.

  26. 2 Analyze Early/Analyze Late • Analyze Early: • 1 round (30 compressions) of priming before AED analysis • Business as usual in King County • Analyze Late: • Longer period of priming before AED analysis • 3 minutes of CPR before first analysis

  27. Target Population: ITD and AE/AL Patients 18 years of age or greater who suffer non-traumatic cardiopulmonary arrest outside of hospital. Enroll all NON-traumatic CPR cases, EXCEPT…

  28. Exclusion Criteria: ITD and AE/AL Less than 18 years of age Trauma cardiac arrest DNAR orders in place Known Pregnancy Known Prisoner / In Custody

  29. Exclusion Criteria: Specific to ITD Tracheostomy present AE/AL use is appropriate in this case.

  30. Exclusion Criteria: Specific AE/AL Analyze early or analyze late should NOT be used if: EMS-witnessed arrest AED applied by non-ROC agency (lay person/police/private AMB) ITD use is appropriate in both cases.

  31. Removal of ITD Remove ITD immediately if: 1. Patient gets a pulse (ROSC) 2. Device fills with fluid twice, or cannot be cleared 3. Arrival at ED 4. No chest rise with patent (open) airway

  32. Study Protocol #1—Analyze Early 1 round of CPR/Attach ITD valve Shock (if indicated) CPR Protocol

  33. Study Protocol #2—Analyze Late 3 minutes of CPR/Attach ITD valve Shock (if indicated) CPR Protocol

  34. EMT / EKG MONITORING Questions????? • What do we need to know about EKG’s? • What “Guidelines” should we use to place the monitor on someone?

  35. Electro what??? • Rate ? Slow – Normal – Fast • P wave? Present or absent • Regular ? Regular or irregular spacing • Narrow or Wide? Width of QRS? • Rhythm? Who cares anyways????

  36. Basic Normal Pathways

  37. P QRS T

  38. Normal Sinus Rhythm

  39. OH, the boxes mean something??

  40. What’s the rate???

  41. Bradycardia

  42. Irregularly Irregular

  43. Atrial Fibrillation

  44. Atrial Flutter

  45. Atrial Flutter

  46. Supraventricular Tachycardia

  47. Narrow Complex Tachycardia

  48. Ventricular Tachycardia

  49. Wide Complex Tachycardia

  50. Ventricular Fibrillation • Frequency - Tachyarrhythmia • Amplitude - Minimum • Waveform - Chaotic, Varying, Wide, Unorganized

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