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User Manual - PIC 40 and PIC 50 Portable Intensive

1. SAED COs IBP Adv Record Review More Back Options Available Cell Analys Mobitex Biphas Pacer Fax Back Active Shift Menu The Active Shift menu PESTS allows the supervisor to select and save PIC configurations for use by Save As 1 specific shift It also allows loading from and saving the log to a memory card WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 13 33 MENUS EE Treatment Setup The Treatment Setup menu allows the Treatment Setup Menu p Button supervisor to choose and customize the bottom treatment summary menu window buttons Press the UP and DOWN arrow buttons to scroll through the available options Unit ID 7 The Unit ID menu allows the supervisor Identifier l a to set unit and department IDs This information is printed in the System On heading on the chart recorder Set Code Menu The default access code for accessing the supervisor menus is 1 2 3 4 To set a new supervisor code enter a number of your choice 0 9 in all four number areas Press CANCEL to cancel the number code selection Press ENTER to save the new NOTE Be sure to write down the new j supervisor passcode and store it ina safe place Set Code Printer Options The Printer Options menu allows the Printer Options supervisor to control the printout information on the chart recorder Turn an option On to include it in the printout Turn
2. If the PIC has been configured to power up in the SAED Basic mode the voice memo supervisor configurable chart recorder hold blood pressure SpO treatment summary and disarm controls will be active Below is an example of the active controls and display WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM PIC SYSTEM OVERVIEW Loo Blood Pressure 4 N BPM Voice menu B 100 18 Ece 98 SPO Manual Lead PAD Signal OK 4 2 Chart Recorder nee A ANALYZING ECG ai STAND BACK QS 00 00 00 0 SAED BASIC MODE 509094 Enets 7 haa sme 200 my z H i Oa Disarm ep Cpr Strt Log Manual mode Manual Mode If the PIC has been configured to power up in the Manual Defibrillation mode all the controls will be active Below is an example of the display 120 io rv Beis 98 eae PIC50 MONITOR l Lead 99 0 DEFIBRILLATOR 56 br i H eF hs FS if 9 AA PACING 9 12 ae A Selected En 60 BPM PACER 110 mA ce 522 em eet 200 3 0 Tntubate IW EPI Lipo BRET Sample Clear i Gere Gam c 3 C a gt 3 a gt C 4 Qe SS Sere VE N N NS ST INSS aS WELCH ALLYN PORTABLE INTENSIVE CARE S
3. ccceeeeeeees 8 6 Pulse OxiMeter sssnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn eats 9 1 Pulse Oximeter Controls and Displays eee 9 2 Pulse Oximeter Operation Procedures cceeeeeeeees 9 5 Non Invasive Blood Pressure NIBP and TEMP OT ALUN G siisii aaia 10 1 NIBP and TEMP Controls and Displays 10 2 NIBP Operation Procedures cccssseeseeeeeeeeeeeeeeees 10 5 Temperature Display and Operation Procedures 10 8 Respiration and CO optional cccccssssseeeeeeeeeees 11 1 Respiration Display eisai Ses detach shah dc taal eats etc eences 11 2 Respiration Operation Procedures ccccccceeeeeeees 11 4 O Optima eisa dl eho ois 11 5 Measurement of Resp Rate Using CO Monitor 11 8 CO Typical Usage Procedures 20 eeeeeeeneeeees 11 9 Vi WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM Lee DOCUMENTATION ccssiccseutuscarniswechuditenrsidetsssladorisndsceevastueans 12 1 Chart Recorder Printouts ientra a 2 Treatment SUMMMATY s csssnasoakschornesesasancanadcnos sedeneadesaueads 12 6 Loe Func HONS ceo a a ha ees aia ae 12 9 Loadine Chart Papei cni r 12 12 Voice MeMO ss oiitnccncctesicellicad cas Sealawedsedanvapeiawniededialzees 12 13 Using the Welch Allyn Data Card cesses 12 14 Reviewing Data on the Welch Allyn Data Card 12 19 Voce Memo REView snime iieihadenes 12 26 MENUS nceann E O AA 13 1 User Menu OVer Vie W oneitan aaa 13 2 Super
4. 0004 14 8 RESDA la eR ee Rn eRe EERE Tee an TR re RTT 14 10 TOT el ATI sia hsa carci plocta dt a a 14 12 End Tidal CO ETCO Alarm eee 14 14 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM Vil EE POWT SOUCO onoaiiae eee 15 1 General Safety Precautions eesssesssseeereeesssssssssee 15 2 Power Supply Paddle Holder option 971029 15 3 Power Source Controls and Indicators eee 15 4 Welch Allyn Quick Charger Conditionert 15 6 Battery Charger Defibrillator Tester Operation Procequres yiciii5c25 acs a icauastace estas ce eadeuence 15 8 Welch Allyn 12 Volt Vehicular Adapter 15 12 Welch Allyn Battery Analyzet ccccccceeeeeeees 15 13 Power Options Comparison Chart eeseesseeeee0ee 15 14 Maintenance and Care ccccccceeeseeeeeeeeeeeeeeneeeeeseees 16 1 I NUS TVA Saas E A tate ecard T lt 16 1 Pune tional Chek Sansen a secon taateeae 16 4 Mandatory Minimum Preventive Mamtenance SChedule totic hed cnnsectomiecsetieedetaiedaies 16 8 Monthly Capacity Test ccccssssssseeeeeeeeeeeeeeeens 16 9 Guidelines for Maintaining Peak Battery Peri OrmManCe xone otis ssdesincstesnncsestinciavssetececaens 16 9 Battery Capacity Test and Reconditioning Proceduro sacatesatactesasactas n a 16 10 Cleaning Instructions ccccesccccceeecceesseseeeeeeeeeees 16 12 IB Pos E 17 1 Intended USE cansa nran a Sactea ieteaeoseens 17 2 IBP Controls
5. ADDENDUN 4 Analyzing Pads Indicates the electrodes have been properly attached and the PIC is monitoring the patient s ECG for criteria that may indicate a shockable rhythm The PIC will announce Stand clear analyzing heart rhythm Avoid touching or moving the patient Touching or moving the patient can cause artifacts which may interfere with the analysis process No Shock Advised Indicates the PIC has completed one analysis of the patient s ECG and that No Shock was advised The PIC resumes monitoring the patient After 3 consecutive No Shock analyses the PIC displays NO SHOCK ADVISED and ANALYZING PADS The PIC will announce No shock advised Check airway check breathing check pulse If no pulse start CPR The PIC will continue to assess the patient s heart rhythm If the ECG is non shockable the display flashes NO SHOCK ADVISED If the PIC detects a shockable rhythm it will direct the operator by announcing Stand clear analyzing heart rhythm as it begins to analyze the patient s heart rhythm Shock Advised Charging Stand Clear Indicates the PIC completed analyzing the patient s ECG and that a shockable rhythm was detected The PIC will automatically select the proper energy and begin to charge the defibrillator The display will indicate SHOCK ADVISED CHARGING and STAND CLEAR The PIC will announce Shock advised stand clear Periodic tones will be heard to signify the defibrillato
6. ____ Date Temp LineFreq Audio Language Lead More Back Supr Setup 3 lt __ Data Xfr CO2 Back 12 Lead Phone Fax Printer Freq Analysis Copies Back Supr SAED ALSCode E Prot Audio EMS Startup Back _ _ Supr Pacer Rate Mode Back E e Supr Defib Ext Eng Int Eng Mode Alarm Back 13 24 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MENUS Lo Supervisor Menus Defibrillator External Energy Menu Internal Energy Menu A supervisor can configure the defibrillator external and sync settings from the Defibrillator menu This menu is accessible through the Treatment Configuration Set Up menus Set Up Supvsr Date Time Shifts DataXfr Back Enter Passcode here Supervisor UNLOCKED Defibr Pacer SAED 12Lead Set Up Diag Exit oo Supr Defib Ext Eng Int Eng Mode Alarm Back Ext Int Sync Charge Energy Energy After CV Alarm Menu Menu Menu Menu The Ext External Energy menu sets the default energy selected when the PIC is first turned on The selected setting displays in this menu To change the setting press the UP arrow A or DOWN arrow B to increase or decrease the selection Options are 2 5 7 10 20 30 50 70 100 150 200 300 or 360 joules Press EXIT C to return to
7. 4 Press the NEXT gt CO button on the quick access menu The power light on CO sensor will activate The CO waveform and value window will be displayed in waveform 3 The CO value window will show Zeroing Once the measurement has been established the most recent ETCO measurement will be displayed in the CO value window The Resp value window will show Respiration Searching to indicate that the unit is analyzing the patient s respirations Once the respiration rate is determined it will appear in the Resp value window 5 Select the CO Trend trace in waveform 2 of the Traces menu The CO Trend trace will be displayed in the waveform 2 window and the CO Trend value window will appear on the right side of the window It will show the most recent CO Trend measurement and the ETCO Trend waveform will begin displaying trend information WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM OOo o CHAPTER 12 DOCUMENTATION This chapter provides information on the PIC System documentation capabilities It describes each type of documentation and provides instructions for creating it Chapter Overview Chart Recorder Printouts Treatment Summary Log Functions Loading Chart Paper Voice Memo Using the Welch Allyn Data Card Reviewing Data on the Welch Allyn Data Card Voice Memo Review CAUTION First read chapter 1 Safety Information before proceeding with this chapter NOTE The recorder will annotate ECG waveforms and sy
8. Heart Rate Alarms Pulse Oximeter SpO5 Alarm Non Invasive Blood Pressure NIBP Alarm Invasive Blood Pressure IBP Alarm RESP Alarm TEMP Alarm End Tidal COs ETCO gt s Chapter Overview CAUTION First read chapter 1 Safety Information before proceeding with this chapter Global Alarm and Alarm Icons Alarms are available for all parameters SPO NIBP IBP HR Resp CO Temp Alarm All alarm parameters can be globally disabled by the GLOBAL ALARM button located in the quick access window The quick access GLOBAL ALARM button enables or disables all set alarm parameters When the PIC System is turned on the global alarm will default to the last setting at system shutdown either enabled or disabled 4 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 14 1 ALARMS EE To enable global alarms press the GLOBAL ALARM button A to display the alarm on icon with the global alarms enabled any set alarm parameter will be enabled To disable global alarms press the Quick Access Window GLOBAL ALARM button twice The first press of the button B will change the icon to PUSH TO DISABLE The second press C will change the alarm icon to OFF If the button is not pressed a second time within 10 seconds global alarms will automatically revert to enabled with the global alarm disabled 7 ll t l ill b al parameters alarms will be B e disabled Global alarm ODO
9. Mains power quality should be that of a typical commercial or hospital environment If the user of the PIC requires continued operation during power mains interruptions it is recommended that the PIC be powered from an uninterruptible power supply or a battery Power frequency magnetic fields should be at levels characteristic of a typical location in a typical commercial or hospital environment Note Uy is the AC mains voltage prior to application of the test level ADDENDUM 18 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM PIC 40 50 USER S MANUAL ADDENDUM Guidance and Manufacturer s Declaration Electromagnetic Immunity IEC 60601 1 2 Table 203 The Welch Allyn PIC is intended for use in the electromagnetic environment specified below The customer or the user of the PIC should assure that it is used in such an environment Immunity Test IEC 60601 Test Level Compliance Electromagnetic Environment Level Guidance Portable and mobile RF communications equipment should be used no closer to any part of the PIC including cables than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter Recommended Separation Distance Conducted RF 3 Vrms d 1 17 VP IEC 61000 4 6 150 kHz to 80 MHz outside ISM bands 10 Vrms d 4 p 150 kHz to 80 MHz in ISM bands Radiated RF 10 V m d 1 20 VP IEC 61000 4 3 80 MHz to 2 5 GHz 80 MHz to 800 MHz
10. SCRUTION purchased and a valid datacard is inserted eee users will be able to review patient data Defibrillator and stored on the card on the PIC display Disabled in 1 1 See chapter 12 for instructions on how to Are you sure use this option Press EXIT to return to the Recorder Configuration menu Use the Trend menu to record patient vital signs BP HR OX Temp Resp IBP to the internal log and printer at every trend interval If set to Off trend data will not be collected If set to On a trend event will be generated at each elapsed time interval If set to at B P a trend event will be generated each time a BP reading occurs Press EXIT to return to the Recorder Configuration menu WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 13 21 MENUS User Menus Setup Enter Code Menu Set Date Menu 13 22 Treatment Intubate IV EPI Lido Atrop Sample Clear Next Recorder Display Alarms SPO NIBP Resp Recorder Set Up Back Set Up a Supvsr Date Time Shift DataXfr Back Enter Set Date Set Time Active Data Code Menu Menu Shift Transfer Menu Menu Menu The default access code for entry to the Supervisor menus is 1 2 3 4 Supervisors may change this code in the Supervisor Menus Press a button to increment the corresponding digit A When all four digits are entered press ENTER B
11. SSS SS 12 Lead Phone Fax Printer Freq Analysis Copies Back re tl Supr SAED ALSCode E Prot Audio EMS Startup Back Sn Supr Pacer Rate Mode Back nN a Supr Defib ExtEng Int Eng Mode Alarm Back WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM ADDENDUM 7 PIC 40 50 USER S MANUAL ADDENDUM EE Supervisor Menus Defibrillator corrections to page 13 25 A supervisor can configure the defibrillator energy sync and mode settings from the Defibrillator menu This menu is accessible through the Treatment Configuration Set Up menus Set Up Suprvisr Date Time Shifts DataXfr Back Enter Passcode here Supervisor UNLOCKED Defib Pacer SAED 12Lead SetUp Diag Alarms Exit Supr Defib Ext Eng Int Eng Mode Alarm Back Ext Int Sync Charge Energy Energy After CV Alarm Menu Menu Menu Menu External Energy Menu Internal Energy Menu ADDENDUM WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM PIC 40 50 USER S MANUAL ADDENDUM Supervisor Menus Pacer correction to page 13 27 Set Up Suprvisr Date Time Shifts DataXfr Back Enter Passcode here Supervisor UNLOC
12. MENUS Loo User Menus Non Invasive Blood Pressure The three non invasive blood pressure NIBP reading modes are available Users select the NIBP mode from the NIBP Setup menu which is accessed through the Treatment Configuration menus Treatment Intubate IV EPI Lido Atrop Sample Clear Next Configuration Display Alarms SPO NIBP Resp Recorder Set Up Back r NIBP Setup Menu NIBP Setup Menu In the NIBP Setup menu users can select the Manual Auto or Stat mode e Manual a blood pressure reading will be taken each time the NIBP button is pressed e Automatic Auto a blood pressure reading will be taken at the indicated interval To increase or decrease the interval press the UP or DOWN arrow buttons e Stat blood pressure readings will be taken one after another for five minutes starting from the time the NIBP button is pressed A bold outlined box indicates the selected NIBP Setup configuration Press EXIT to return to the Configuration menu WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 13 13 MENUS User Menus Respiration ECG z Resp Size Menu Resp Speed Menu 13 14 Respiration data is sourced from ECG leads Users can configure the size speed and response settings of the ECG respiration display using the Respiration menus Access the Respiration menus from the Treatment Configuration menus NOTE ECG Respiration is not availa
13. Measurement 1 Press the NIBP button the START will change to STOP The NIBP monitor will inflate the cuff to the initial cuff pressure The NIBP monitor has an automatic cuff detection and will inflate the cuff to the proper pressure accordingly NIBP monitor will inflate adult thigh and child cuffs to 154 mmHg and will inflate infant cuffs to 125 mmHg WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 10 5 NIBP AND TEMPERATURE EE Auto Mode Measurement 10 6 After the initial cuff pressure has been reached the display will indicate the cuff pressure and begin deflating the cuff in a stepped sequence monitoring the pressure pulses until a measurement can be made To cancel the measurement at any time and to deflate the cuff press the NIBP button the STOP will change to START If the NIBP monitor is unable to make a determination of the systolic pressure the cuff will automatically re inflate and attempt another measurement Adult thigh and child cuffs will re inflate to 190 mmHg and infant cuffs will re inflate to 142 mmHg If the PIC is still unable to obtain a measurement the adult thigh and child cuffs will automatically re inflate to 250 mmHg and attempt a third measurement When a measurement is complete the systolic diastolic and MAP pressures will be displayed TAKING A MEASUREMENT IN THE AUTO MODE 1 Select the desired interval from the NIBP configuration menu see User Menus NIBP in chapter 13
14. 11 CO connector magenta a 10 SpO connector gray 14 Annotating chart recorder ______ z e 9 Defibrillator A i s release button SSS 8 Defibrillator 4 connector ki 4 15 Front panel 7 ECG patient gt i T cable connector on l 1 System i power Se switch i E 6 Battery slot 2 Display 3 5 Datacard slot 1 Volt 4 or fax RS 232 output Data comm port 1 System power switch Switch for main system power 2 Display 6 5 screen that displays ECG and other parameter information 3 1 Volt output or fax Provides an analog output scaled to 1V output for a optional ImV input signal Used for telemetry radio transmissions Fax output optional Provides fax transmission capability on 12 Lead PIC s 4 RS 232 Data com port Download the internal log to a computer external or wireless device 5 Datacard slot For system upgrades data recording and configuring 6 Battery slot Accepts Welch Allyn SmartPak Plus or Welch Allyn SuperPac batteries 3 2 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM PIC SYSTEM OVERVIEW Loo 10 11 12 13 14 15 ECG Patient Cable Connector Defibrillator connector Defibrillator release button SpO connector optional CO Connector optional Temp connector optional NIBP connector optional Annotating Chart recorder Front panel Accepts 3 lead 5 lead 12 lead Welch Allyn patient cab
15. 40 mmHg Resolution mmHg Respiration Range 2 60 bpm A 8 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM SPECIFICATIONS Loo Pulse Oximeter optional Blood Pressure optional Measurement Range 31 to 99 Heart Rate Range 30 to 250 BPM 5 or 5 BPM whichever is less Accuracy 81 to99 2 70 to 80 3 0 to 69 unspecified Update Period Every pulse after 4 valid pulses Messages Check Probe Searching Signal OK No Signal Poor Signal Alarms Enabled Disabled icon Testing Alarm Limits 60 lower limit 70 upper limit to 99 Probe Finger or multi site probe Technique Non invasive oscillometric method referenced to auscultatory standard using the 5th Korotkoff sound as the diastolic reference Operating Modes Automatic and manual Initial Cuff Inflation Adult and child 154 mmHg Infant 125 mmHg Automatic Cycle Times 1 2 3 5 10 30 minute intervals Blood Pressure Range Systolic 30 to 245 mmHg diastolic 10 to 210 mmHg Heart Rate Range 30 to 200 BPM 10 or 5 BPM Blood Pressure Accuracy 5 mmHg mean error 8 mmHg standard deviation Blood Pressure Validation Blood pressure measurements determined with this device are equivalent to those obtained by a trained observer using the cuff stethoscope auscultation method within the limits prescribed by the American National Standard Institute WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM A 9 SPECIFICATIONS E
16. ANALYZING Avoid touching or moving the patient Touching or ie i moving the patient can cause artifact which may interfere with the 00 06 43 ro S analysis process x ot PA E Ss POEN Pe Pe ee Pee a ANALYZING ECG er RAS 7 12 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM SEMI AUTOMATED EXTERNAL DEFIB OPTIONAL Loo 000643 O P NO SHOCK ADVISED ANALYZING ECG STAND BACK o SAED BASIC MODE 7 ra 00 06 43 SHOCK ADVISED CHARGING STAND CLEAR 59 Ki a __SAED BASIC MODE _ A 200 ewe j No Shock Advised Monitoring ECG Indicates the PIC has completed one analysis of the patient s ECG and that No Shock was Advised The PIC resumes monitoring the patient Two BEEFPs will be heard signifying the No Shock analysis result After three consecutive No Shock analyses the PIC displays CHECK PATIENT IF NO PULSE START CPR The PIC will also announce CHECK PULSE IF NO PULSE START CPR The PIC will continue to assess the patient s heart rhythm If the signal is non shockable No Shock Advised will continue to flash on the display and an audible beep sounds every minute but if the PIC detects a shockable rhythm it will direct the operator to stand back as it begins to analyze the patient s heart rhythm Shock Advised Charging Stand Clear Indicates the PIC completed analyzing the patient s ECG and that a
17. Portuguese and J Italian To change a language selection OY press the arrow buttons to change the e language then press Save Turn the PIC off then restart it to activate the language option Lead Menu The Lead menu allows the supervisor to change the default lead displayed on start up CO Units Menu Use the CO Units menu to change the unit CO2 Units of measure for displayed CO and ETCO Eo readings Select mmHg or kPa Data Transfer Menu Use the Data Transfer Menu to program up Mobitex to 16 different MAN addresses for Mobitex modems ospa A Upgrade Password The Upgrade menu allows the addition of options to the PIC System Menu in the field Contact your Welch Allyn customer service representative for instructions on upgrading the PIC System 13 36 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MENUS Loo Options Available SAED CO IBP ADV Record Review More Back Options Available a Cell t Analysi Mobitex Biphas Pacer Fax Back ENTERING THE UPGRADE PASSWORD The Password menu gives the operator the option of moving the cursor forward or backward or clearing canceling or saving the entry Follow these instructions to upgrade the password 1 Enter a new character by pressing once on the group of characters containing the character of your choice B In this case we want to change the 1 to a 0 The password is displayed
18. The display will indicate NOISE DETECTED or MOTION DETECTED The PIC will announce Motion Detected only 1f the current ECG rhythm is potentially shockable WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM SEMI AUTOMATED EXTERNAL DEFIB OPTIONAL Changing to Advanced Life Support ALS personnel can exit the SAED mode Manual and operate the PIC as a manual defibrillator by pressing the Defibrillation Mode MANUAL button on the bottom menu NOISE DETECTED ANALYZING STAND BACK SAEDBASIC MODE feed Hh The PIC can be configured to require a passcode to enter the manual mode see Configuring the SAED in chapter 13 This feature prevents unauthorized users from using the manual defibrillation mode If the PIC has been configured to require a passcode it will prompt the user to enter the code when the MANUAL button is pressed The 4 digit code is entered by repeatedly pressing the secondary menu buttons to increment each of the 4 digits Upon pressing the ENTER button the PIC will change to the manual mode if the correct passcode or the supervisor access code was entered E NOTE All information in the Treatment Summary Log will remain intact after switching to Manual Mode WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 7 5 SEMI AUTOMATED EXTERNAL DEFIB OPTIONAL i mZ2ZYTzHYz SAED Basic Mode If the PIC has been configured to power up in the SAED Basic mode only the controls that have been highlighted below wi
19. They must be disposed of properly Consult local authorities for proper disposal WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 1 15 SAFETY INFORMATION EE Charger Precautions Charge only Welch Allyn SmartPak or SuperPac batteries in the Welch Allyn Quick Charger Conditioner Charging any other battery can cause damage to the Quick Charger Do not insert objects into or block the charger s ventilation ports When testing the defibrillator on the charger s defibrillation output tester ensure that the paddle surface is positioned properly in the paddle test well Do not use gel during this test and ensure that the paddle surface is not contacting the metal charger frame When discharging the paddles into the tester press the paddles firmly into the test well to prevent pitting the paddle surfaces Only test Welch Allyn defibrillators on the charger s defibrillation output tester Testing other brands of defibrillators will damage the charger s defibrillation output tester Do not take charger or paddle holder apart or attempt to repair it yourself The Welch Allyn charger should not be used in the presence of flammable anesthetics or materials If the charger has been dropped or shows visible signs of abuse refer device to qualified service personnel for verification of proper operation Do not immerse the charger or expose it to water or other liquids Wipe only the outside with a damp cloth Tighten clamp
20. WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM INTRODUCTION Loo Three Simultaneous Traces Treatment Summary Voice Memo Card Review User Configurable Options Simple Menu Hands Free Defibrillation Pads Mains AC and Battery power capability Upgradable Design ECG plethysmograph and or respirations waveforms can be displayed at one time thus providing more information with which to assess the patient Welch Allyn exclusive documentation systems will record the time and ECG sample of key ACLS procedures and drugs for future retrieval A quick and convenient means of documenting important information When you are busy treating the patient and you need to document an important piece of information initial vital signs medications allergies etc just press the Voice Memo button and the audio information will be digitally recorded in the PIC The recorded information can be played back directly from the PIC The PIC System s Card Review option is a unique feature used to assist the operator in reviewing patient information that has been recorded to a data card including ECG event and speech data The Card Review feature groups ECG event and speech data into individual patient records This information can be viewed and printed on the PIC System using the Card Review menu or viewed and printed on a PC using Welch Allyn provided Smart View software Allows flexibility by configuring the PIC t
21. in 3 hours Defib Charge No Separate Auxiliary Supply is required No Separate Auxiliary Supply is required No Separate Auxiliary Supply is required 15 15 CO gt CHAPTER 16 MAINTENANCE AND CARE This chapter provides information on maintenance activities including functional checks cleaning instructions and scheduled and preventive maintenance of the Welch Allyn Portable Intensive Care PIC System Chapter Overview Maintenance Maintenance Functional Checks Mandatory Minimum Preventive Maintenance Schedule Monthly Capacity Test Guidelines for Maintaining Peak Battery Performance Battery Capacity Test and Reconditioning Procedures Cleaning Instructions To insure the readiness and optimum working condition of the PIC System the following inspections and tests should be performed daily or at each shift change In addition to the daily check performance and calibration testing must be completed by authorized personnel at regularly scheduled intervals which should not exceed one year Information such as circuit diagrams parts lists descriptions and calibration procedures may be requested from Welch Allyn to aid in repairing those components designated as field repairable A maintenance log is an important part of a successful maintenance program in which information is recorded on a regular basis This allows for verification of necessary maintenance and for scheduling p
22. intercostal space Red LL Green Left mid clavicular line between 6th and 7th intercostal space White RA Right mid clavicular line directly below clavicle Black LA Left mid clavicular line directly below clavicle Chest Place per figure at left for V1 V6 V1 4th intercostal space at right sternal margin i a V2 4th intercostal space at left sternal margin a ff o o oo V3 Midway between V2 and V4 leads a ae V4 5th intercostal space at mid clavicular line V5 Same transverse level as V4 at left anterior axillary line V6 Same transverse level as V4 at left mid axillary line WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 4 9 ECG MONITORING E gt MONITORING WITH HANDS FREE DEFIBRILLATION PADS R lt Multipurpose 1 i hands free connector CAUTION Be sure that the hands free adapter is firmly seated in the defib connector before monitoring with hands free defibrillation pads CAUTION Use only R2 multifunction pads with Welch Allyn hands free adapter Do not connect R2 ECG sets to the Welch Allyn hands free adapter an ECG will not be obtained 1 Press POWER switch ON Press the LEAD button to the PAD position 2 Connect the disposable Hands Free Pad Placement defibrillation pads to the hands free adapter cable 3 Remove or loosen clothing if necessary for application of pads Clean and dry skin sites preferably with a coarse dry terry cloth 4 Check expiration
23. lt and gt gt buttons step the trace backwards and forwards the selected step size Sync and Pace markers are displayed similarly to their real time display A Defib Fired mark is displayed as on the bottom of the Trace Window indicating the point at which the defibrillator was discharged Active Event The Active Event Window is located at the top of the display It Window contains detailed information of the active event being previewed The event timestamp 1s listed along with all other relevant information Just above the trace window in the Active Event Window is the event number of the currently displayed event also the same number as in the Event History window WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 12 21 DOCUMENTATION EE Event History Window Viewing Active Events 12 22 CARD REVIEW 09 19 36 Card Inserted PIC SN 80023 Sw Aeav G Dept ID xxx XX Unit ID 0000 Active Event 001 Event History Card Usage Patient Info oot E ene Poe sec Tey gt Prev Net EXIT Sanaa The Event History Window is Ist event gt 05 19 36 Card Inserted located in the lower left se fr anal corner of the display The iis window has a title row that includes the words Event History as well as the event number of the active event The active event being previewed is the first event listed in the Event History Window and its originally associated ECG is displayed in the Trace Window wit
24. press the push button again Allow the battery to remain in the charger until the yellow battery light begins to flash again The time required for the discharge cycle to be completed varies depending on battery capacity and state of charge A fully charged battery with normal capacity will require approximately 8 hours to discharge in the reconditioning slot and a high capacity battery will require 18 hours Partially discharged batteries will require less time After the discharge portion of the reconditioning cycle has been completed the battery pack will undergo a normal charging cycle Reconditioning To recondition the battery in the unit using the paddle tray charger with Paddle Tray option perform the battery capacity test and reconditioning procedure Charger in chapter 16 9 Defibrillator Tester The Welch Allyn Battery Charger and the paddle holder contain a defibrillator tester for verifying the operation of the Welch Allyn defibrillator WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 15 9 POWER SOURCE 15 10 z WARNING Hazardous high voltage is present when the defibrillator is discharged during this test Observe safety precautions regarding the use of a defibrillator TESTING THE DEFIBRILLATOR 1 Charge the Welch Allyn defibrillator to 200 Joules 2 Place the defibrillator paddles against the test contacts located on the sides of the battery charger or in the wells of the paddle holder Make sure that the padd
25. regarding this notice WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM IV Loo Table of Contents Safety Information ccececeeeseeeeeseeeeneeeeeeeeenseeeeneeeeneeees 1 1 SVM DOIS ANGICONG aaa 1 2 General Prec Iuin Seanas e 1 5 Monitorins Precautions cenae 1 8 Defibrillator Precautions esinaine 1 9 External Pacing Precautions ccccccccssseesseeeeeeeeees 1 11 Pulse Oximeter Precautions cccccccsssssseeseeeeeeeeees 1 13 Non Invasive Blood Pressure Precautions 1 14 Battery Precautions ccccccccccceccceeceeeeeeeeeaeeeeaeeeaas 1 15 Charger PrecautlOns sodain teiteetie sciences 1 16 SAED PreCaUUlOns resini e 1 17 BE Precio Se 1 17 COs Precautions en ide eaesdiai ete ecd 1 18 IEF OGUI CUO I minmin ices 2 1 PROGUCE OV C0 VIC Wessen ee pay Indicanon s Tor W SE erena cies sus aataenadersaeias 2 4 Part INUMIDETS sc ceusievans Madan Siteershidtan volt dactsemsbahednetiecunctous 2 6 Options and ACCESSORIES tsiich seni che taesnh Giwncdet easaenaaileh Naess Zeal Initial Installation Evaluation cc eeeeeeseeeeeeeeeeees 2 9 Summary Of Operations ccceesseeesseeeeeeeeeeeeeeeeeeees 2 11 PIC System Overview cscccssseeseseeeesseeseseeeenneeseeeeneaees 3 1 PIG Systenn Mitemaces aran a catalan enetiaaates a2 PIC System Controls and Indicators 3 4 PIC System Display Windows and Modes 4 3 6 PIC System Defibrillation Paddles eee 3 8 PIC Sy
26. the green light will flash off When the pacer is on and there is an ECG lead fault or a pacer lead fault the indicator will be red Pressing MODE button changes the pacing mode from demand to async mode The selected mode will be displayed in the pacing window PACER On Off O lt PACING PACING 60 BPM 60 BPM 30 MA 30 MA DEMAND ASYNC Demand Mode Async Mode NOTE The initial pacing mode can be set in the Pacing Supervisor Menus See chapter 13 sene 8 4 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM EXTERNAL PACING Rate Pressing the RATE button selects the pacing output rate measured in beats per minute BPM Pressing the up arrow will increase the rate Pressing the down arrow will decrease the rate When the pacing rate is below 100 BPM each press of the RATE button will change the pacing rate by 5 BPM When the pacing rate is above 100 BPM each press of the RATE button will change the pacing rate by 10 BPM NOTE The initial pacing output rate can be set in the pacing supervisor menus See chapter 13 a Output Pressing the OUTPUT button selects the pacing output current output A measured in milliamperes mA Pressing the up arrow will increase the selected output by 10 mA Pressing the down arrow will decrease the selected rate by 5 mA PACING 60 BPM Rate 30 MA Output DEMAND Start Stop Pressing the START STOP button will allow pacing or pause the delivery of pacing stimulus to th
27. 001739 001966 002111 002052 Pulse oximeter NIBP and Temperature Voice Memo SAED Fax Adult paddles Adult deluxe paddles Pediatric adapters set Hands free defibrillator adapter Hands free defibrillator tester Welch Allyn Smart Pak battery Welch Allyn Smart Pak Plus battery Welch Allyn SuperPac Carrying case Carrying case for unit with integral charger Welch Allyn Quick Charger Recorder paper SPO adapter cable Finger probe reusable adult KLEAN TRACE con ductive spray WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 0D ODO Q 0D ODO wv E 971024 971016 971017 971018 001790 001794 001795 001796 001720 001834 001837 001798 001948 980139 980140 001938 001726 002051 001853 Data Card Review Record COs IBP 12 Lead Analysis 3 lead patient cable 3 lead patient cable w intnl color code 5 lead patient cable 5 lead patient cable w intnl color code Bitrode limb electrodes 12 Lead breakaway patient cable 12 Lead breakaway patient cable IEC 3 Lead patient cable for 12 Lead 3 Lead patient cable for 12 Lead IEC 3 Lead Simulator 12 Lead Simulator Fax output cable ECG electrodes Defibrillator gel Multipurpose electrodes adult 2 1 INTRODUCTION EE 2 8 Oo 001942 001943 001944 001945 001946 001911 001915 001912 001913 001914 001922 001923 001957 0
28. 10 seconds of Lead II data following the 12 lead 3x4 or 2x6 print out ADDENDUM 10 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM PIC 40 50 USER S MANUAL ADDENDUM LO eee Supervisor Menus Setup corrections to pages 13 33 and 13 36 Set Up Suprvisr Date Time Shifts DataXfr Back Enter Passcode here Supervisor UNLOCKED Defib Pacer SAED 12Lead SetUp Diag Alarms Exit l Ea Supr Setup Menu Shifts Treatment Upgrade Unit ID Code Printer More Back Y y y Active Treatment Identifier Set Code Print Shift Setup Menu Menu Options Menu Menu Menu Supr Setup 2 Date Temp LineFreq Audio Language Lead More Back Y y y yY y 4 Date Temp Line Freq MANUAL Language Lead Format Format Menu Audio Menu Menu Menu Menu Menu Supr Setup 3 lt Data Xfr CO2 Back gt Options Available SAED CO5 IBP Adv Record Review More Back Options Available a Cell t Analysi Mobitex Biphas Pacer Fax Back Active Shift Menu The Active Shift menu allows the supervisor to select and save the current PIC configuration parameters for use by a Save As 2 PA a specific shift in the internal memory of Save As 1 the PIC The current configuration can be Save t
29. 13 16 are user editable selecting one of aoe Hospital 2 Mobitex Menu Selecting one of editable numbers opens the editing menu 4 Pressing the ADDRESS button Opens a numeric entry screen to TE manually edit the MAN address Hospital 13 a ae Address When finished editing save the numeric entry and press the cd Mobitex 13 SEND button 5 The status menu displays the name of the address that is _____Mobitex Pa TORF Sending receiving the transmission the 12 Lead T status events and the errors that Connecting WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 19 3 WIRELESS TRANSMISSION EE Mobitex Status Status messages will appear in the left menu during the 12 lead Messages wireless transmission Opening The modem is initializing the Mobitex modem with the local settings Connecting The local modem is communicating with the modem at the remote address to establish a connection Sending Displays the percentage of the transmission sent Disconnecting The local modem is communicating with the modem at the remote address to terminate a connection Complete Displays when the transmission successfully completes Mobitex Error NOTE Ifthe Mobitex modem has just been powered up allow at Messages least one minute for the PIC to establish network communication NOTE Excessive network traffic can cause some of the errors to E NOTH Bee ewer ooon O Resomton Modem Offline
30. 16 5 MAINTENANCE AND CARE EE 16 6 Function Remove the paddles from the PIC and connect the hands free adapter to the defibrillator Connect the hands free tester P N 900322 to the patient end of the hands free adapter 17 Press LEAD SELECT button until PAD is selected Press PACER button Connect ECG patient cable to the PIC and to the Welch Allyn Cardiac Demonstrator P N 980128 Press the lead button to select lead I Press PacerSTART STOP button on the pacer controls While the pacer is pacing disconnect the patient cable from the PIC System Press PACER button 23 Press the SPO2 button Connect the pulse oximeter sensor to the PIC System and apply it to your finger Apply BP cuff Press NIBP button to take measurement Press the CHART button until the header and footer are printed out completely Response Connect Paddles message should appear in the defibrillation window when the paddles have been removed The Connect Paddles message should disappear when the hands free adapter has been installed The lead fault message should disappear The Pace indicator should illuminate red and Pacer fault Set Lead to I II HP should be displayed in the Pacer window An ECG trace should appear in the ECG window In the Pacer window Pacer Stop should appear with the default pacing parameter i e rate and output setting The pacer window will
31. It J ea biet 121D 1 Signal OK PICSO l Quick access A MONITOR Lead controls and windows Lead HVOR DEFIBRILLATOR AA T 4 l PACER 110 ag j l e rate A DEMAND i ael y m De Count Sr a ae a Waveform window Monitoring in The Active 12 lead Mode is an easy way of analyzing storing and Active 12 lead transmitting 12 lead data This mode is a useful tool when there is a Mode need for more in depth information about the patient s cardiac condition The Active 12 lead Mode acquires and analyzes 10 seconds of 12 lead ECG Once acquired the operator can view the ECG on the PIC System s display along with a real time trace of each lead ENTERING THE ACTIVE 12 LEAD MODE 1 Press the PIC System s POWER switch on 2 The PIC will automatically sense the type of patient cable inserted into the PIC system Check the lead window to insure that the display indicates a 12 lead patient cable is inserted into the patient connector 3 Press the 12 button A on the quick access window This will display the Patient ID menu and change the waveform window to display 3 traces The display initially displays leads I II IHI The frequency response in Active 12 lead mode will be set to either diagnostic 05 150 Hz or filtered diagnostic 25 40 Hz as configured in the supervisor menu 4 Acquire New 12 Lead Snap
32. P at B P 30 sec 1 2 3 5 min 13 2 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MENUS Configuration Factory Menu Choices Choice Range Default Sap feo eere OBC Date Month January thru December Day 0 31 Year 99 00 01 02 03 Time Hour 1 23 Minute 0 60 Active Shift Shift 1 Shift 2 Shift 3 Defaults Lf Data Xfrt Not Used Mobitex SmartLink tf Not Used t If option has been purchased WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 13 3 MENUS Supervisor Menu Overview Menu Defibrillator Pacer SAEDtT 12 Leadt Set Up Default Ext Energy sr 2 5 7 10 20 30 50 70 100 150 200 Joules 200 300 360 Int Energy Yes 2 3 4 5 6 7 8 9 10 20 30 50 20 Joules Mode On Off Off sync after cv Charge Alarm Alarm Volume Max Volume Set ALS Code 0 0 9 0 0 9 0 0 9 0 0 9 Cancel Required not required Required E Prot SAED 200 200 360 or 200 300 360 200 300 360 Protocol Joules SAED Audiot Memo Start Stop Continuous ae Continuous t Memo Startup Manual Basic Basic rT 4 Basic Phone Name Prefix Phone Number Postfix 16 phone numbers Receiver Type Printer 2x6 I V1 2x6 V1 V2 3x4 I III DoS 3x4 IIIN Fax Grid Full Grid Partial Grid Full Grid Audio Output On off On BROWD Baud Rate 2400 4800 7200 9600 Fast Fax Enabled Disabled Disabled Shifts Save as 1 2 3 Save to card Load from card Treatment Button 1 2 3 4 5 Int
33. PIC System option or function Basic Quick Access Buttons and Icons voy VOLUME Adjusts the overall volume on the PIC System EN GLOBAL ALARMS Enables and disables global alarms di QRS BEEPER Enables and disables the QRS Beeper JL CALIBRATION Calibrates the display Set e SET HEART RATE Sets the value to be use in automatic HR alarm settings NEXT Open another Quick Access window if advanced options 12 lead CO gt IBP etc are available A ADVISORY optional Analyzes current ECG as shockable or non shockable 12 12 LEAD optional Allows the operator to acquire a 12 lead analysis LOG Allows the operator to print or clear the log IBP optional Allows the operator to measure pressure invasively CO optional Allows the operator to measure end tidal carbon dioxide levels BACK Return to the previous quick access window 13 6 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MENUS Lee Quick Access Buttons and Pop Up Menus The Quick Access buttons are also used to select pop up menu options including the User and Supervisor menu options ee ee eee ee Tee ee eee eee eee ee Wl ee ee ae Laer Laer iia are ii ae lm Voice Memo anua x igna z J Print Log N MONITOR re ea 7 ea S 7 i l l voaa i gli Hy DEFIBRILLATOR on C Yo Clear Log PACING R 98 6 F Selected Energy 60 BPM aida PACER 110 mA eee
34. PIC50 5 Lead 971083 PIC50 12 Lead All Deluxe base units include Color Display Nellcor Oximeter 971074 Voice Memo 971005 and Blood Pressure 971001 971082 PIC50 5 Lead 971084 PIC50 12 Lead All regular base units include Color Display and no options 971085 PIC50 5 Lead 971086 PIC50 12 Lead PIC40 All units have Color Display 973092 PIC40 Basic 973093 PIC40 with Blood Pressure 971001 option 973094 PIC40 with Blood Pressure 971001 and Pacing 971091 options 973095 PIC40 with Pacing 971091 option Destination Codes Destination code denotes required language and power options E English US S Spanish Europe G German F French Italian P Portuguese U English UK A Australia M Mexico Spanish Central and South America T South Africa W English World WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM INTRODUCTION Loo Options and Accessories Options Available Accessories The following options and accessories are available for the PIC For future reference check off which options and accessories you currently have from the information provided on the packing list Should you want to upgrade your system or purchase additional accessories please contact Welch Allyn at 800 462 0777 0D ODODO Oooo DO E 971074 971001 971005 971008 971019 971106 971108 001537 971107 900322 001636 001638 001647 900214 900223 971104
35. PORTABLE INTENSIVE CARE SYSTEM IBP Step 6 Exiting the Invasive Pressure Menu Once you have zeroed the transducer adjusted the scale and selected the channel source you can press BACK to exit the IBP setup then press EXIT to view patient data Scale 1 O to 40 Channel Source ART Inv Pressure IBP1 Disable IBP1 Setup IBP2 Enable Printing IBP IBP Traces that are displayed on the screen will be printed when the Traces print button is pressed or when the summary event is printed if the Recorder gt Traces Menu gt Printer Traces selection is set to 3 traces WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 17 7 OO gt CHAPTER 18 12 LEAD INTERPRETIVE ANALYSIS ortionat This chapter describes the controls displays and operation of the 12 Lead Analysis module It includes a discussion of the process for performing an analysis of 12 Lead ECG data and transmitting it to a remote location via fax This chapter also includes information on using the 12 Lead Analysis Setup menu to enter remote location address and fax information Overview e Warnings and Precautions e 12 Lead Interpretive Analysis CAUTION Read chapter 1 Safety Information before proceeding with this addendum NOTE Before reading this addendum review chapter 4 ECG Monitoring and chapter 5 12 Lead Monitoring for information on basic ECG and 12 lead displays operations and functions Welc 2 hAllyn PIC50 A M
36. SYSTEM MANUAL DEFIBRILLATION Energy Select The ENERGY SELECT button is used to select defibrillator energy Pressing either the up or down arrow will cause the Energy Range Bar to be displayed on the right side of the display The selected energy will be highlighted by a surrounding box and indicated in the defibrillator display window Ssinslud Enar To increase the selected energy press the up arrow To decrease the selected energy press the down arrow Energy Range Bar NOTE The default energy level upon power start up can be changed to a lower or higher setting See Configuring the Defibrillator supervisor menus later in this chapter Charge The CHARGE button initiates the defibrillator charge When the charge button is pressed a periodic audible tone will sound the energy range bar graph will highlight the relative charge state until it reaches the selected energy When the defibrillator is fully charged the periodic tone will change to a continuous tone and the highlighted energy range bar graph will include the selected energy NOTE If the energy selection is changed during the charge sequence the unit will automatically charge to the new energy level and the display will be updated accordingly wawessgas z oO gt Fully Charged WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 6 3 MANUAL DEFIBRILLATION Disarm Pressing the DISARM button will safely discharge the de
37. The number indicates the current set HR limit that will be active when the HR alarm is turned back on Example HR Alarm ees cm HR alarm off upper limit setting is 120 Lower Limit HR alarm off lower limit setting is 35 Off 35 NOTE Ifa limit is disabled the word DISABLED will appear E instead of Off number SETTING HR ALARMS TO ON 1 Set the HR alarm to on by pressing the OFF ON AUTO button A until On 1s selected If the upper and lower limits are set the alarm on icon will appear in the HR window and the global alarms will be enabled _ 2 Set the upper limit The upper limit can be either set or AA disabled To set the upper limit press the UPPER LIMIT On ie button B A bold line will appear around the box Press the up or down arrow C to increase or decrease the upper limit value You can disable the upper limit by pressing the UPPER LIMIT button again to display Disabled below the words Upper Limit The alarm icon in the heart rate window will display the appropriate status 14 4 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM ALARMS Lo Eee 3 Set the lower limit The lower limit can be either set or disabled To set the lower limit press the LOWER LIMIT button D A bold line will appear around the box Press the up or down arrow C to increase or decrease the lower limit value You can disable the lower limit by pressing the LOWER LIMIT button again to disp
38. Voice Trends Back ytttt Time A 1 sec lt lt gt gt Prev Next Exit Respiration ECG CO Trend Back ttt tt tt Trend Setup Speed Back CO Setup Response Reset Back ECG Resp Setup Response Back SPO Back Alarm BP Resp Temp CO2 Back t Display Traces Freq Filter Pt Cable z4 Contrast Back t tt t t Available only if purchased Available only in 5 Lead PIC tt Available only in 12 Lead PIC TTT T Visible only if memory card is in place 13 8 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MENUS Lee User Menus Display Trace Menu Trace Menu enu a The Display menu options allow users to configure the PIC Display area to show multiple traces choose frequencies patient cable and filter options and adjust the brightness and contrast 1f the display type supports variable brightness and contrast The Display options are accessed from the Treatment Configuration menus Treatment Intubate IV EPI Lido Atrop Sample Clear Next Configuration ao oO Display Alarms SPO NIBP Resp Recorder Set Up Back O Display Traces Freq Filter Pt Cable xX Contrast Back Trace Frequency Filter Pt Cable Brightness Contrast Menu Menu Menu Menu Function Function In the Trace menu users can choose from se
39. acquiring samples for arterial blood gas and electrolyte monitoring The chest was shaved and adhesive defibrillating electrode pads were placed on the left and right chest walls Fibrillation was induced by delivering 60 Hz current to the external electrodes The ED50 energy that required to defibrillate with 50 probability was determined by a protocol modeled after that of Dixon An initial shock strength of 30 Joules was used which was applied after 15 seconds of ventricular fibrillation VF If successful VF was re induced after a 4 minute rest period and the shock strength was reduced by one energy step for the next defibrillation attempt If the initial shock failed a rescue shock was delivered and after a rest period VF was again induced The energy was now increased one energy step for the next defibrillation attempt This procedure was continued until a nominal sample size of six episodes was achieved both sides of the first reversal in result plus 4 episodes Three ED50 estimation procedures were run in parallel with the device being used alternated on each shock After each of the three independent ED50 estimation procedures had been completed the entire protocol was repeated twice more each time starting all devices at an energy of 30 joules The ED50 peak current and energy was then estimated for each animal by logistic regression analysis Individual phase durations and overall pulse durations were measured and recorded o
40. an option Off to exclude it from the printout but it will be sent to the log 13 34 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MENUS Date Format Menu Temp Format Menu Line Freq Menu Manual Audio Menu Use this menu to set the date format for displaying the month Date Format mm dd yy day and year 7 eae A mm dd yy month day year C dd mm yy day month year yy mm dd year month day To select a format press the corresponding button A then press EXIT B oo Temperatures readings can be set to display in Fahrenheit F or Celsius C Press the CABG corresponding Fahrenheit or Celsius button to select an option A bold outlined box ay indicates the selected option Press EXIT to C return to the Supervisor Calibration menu The Line Frequency menu allows the supervisor to choose the desired line frequency either 50 or 60 Hz Press EXIT to return to the Supervisor Calibration menu Use the Audio menu to select the voice MANUAL Audio f ene Dae prompts voice memo and voice log Voice Prompts 7 modes These options are only available if oice Mode purchased D Press EXIT to return to the Supervisor og Calibration menu WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 13 35 MENUS EE Language The Language menu allows the supervisor to select the language used in the display The available languages are English Language Spanish French German
41. and Display cccessseeeeeeeeeeeeeeeeeeees 17 2 IBP Operation Procedures eeesssessooeeesssssssseeeeeeeee 17 3 12 lead Interpretive Analysis ccccsssceeseeeeneeeeeeeeees 18 1 Warnings and PrecattionSs essssssoeeeersssssssssseerrresses 18 2 12 lead Interpretive Analysis Operation 0 18 2 Wireless TranSmMiSSION 22 ce sseceseseeceneseecenneesennees 19 1 CDV CL VIC W vant ose das esse siaoat eine TA O cen oenesaeeeae 19 2 Mobitex Configuration sssaaa 19 2 Cellular Conf Cura OM reri aisa 19 6 Specifications sssaaa eana s aae A 1 Addendum to PIC 40 50 User Instruction Manual csesecseseeneess Addendum 1 Vill WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM OO gt CHAPTER 1 SAFETY INFORMATION This chapter provides informaton on the safe operation of the Welch Allyn Portable Intensive Care PIC System Chapter Overview Symbols and ICONS 00 eee 1 2 General Precautions 0 0 ee AA 1 5 Monitoring Precautions 0 0 eee 1 8 Defibrillator Precautions 0 0c ee 1 9 External Pacing Precautions 0000 cece 1 11 Pulse Oximeter Precautions 0 0c aana 1 13 Non Invasive Blood Pressure Precautions 1 14 Battery Precautions 0 ee es 1 15 Charger Precautions cee 1 16 SAED Precautions sss eid ac dente hk ok eee eee 1 17 IBF PICCAULMONS cir is city a Grd niece a tee Noes Buea ee 1 17 COD PICCAUTONRS shits ph ateo
42. and Paddles Chapter Overview SAED Basic Mode 0 0 ce eee 7 2 SAED Basic Mode 0 ccc ee eee 7 6 SAED Operation ProC dureS 1 0 anana 7 7 EMS M0066 ciicd one neu ek Chee whe ede ewes 7 8 SAED Mode Operation with Multipurpose Hands Free PadsS 0000 aaa 7 9 Defibrillation with Paddles while in SAED Mode 7 12 CAUTION First read chapter 1 Safety Information before proceeding with this chapter z NOTE The unit contains an automatic disarm of the SAED If the operator has not delivered the energy to a patient or load an internal timer will disarm the defibrillator after 30 seconds he is Zz Defibrillator is fire button Le p EH E m Defibrillator or l Defibrillator Connector ON K a y release button J A ks fl N WM To install defibrillator paddles or il i l n a Hands free hands free adapter slide the adapter adapter onto defibrillator connector track Make sure the release button clicks into place Defibrillator controls WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 7 1 SEMI AUTOMATED EXTERNAL DEFIB OPTIONAL i _T e_ SNNt fytTAYXKYY xNXNXXX SAED Basic Mode Defibrillation Modes 7 2 When the Semi Automatic Defibrillation SAED option has been installed the PIC can be configured to power up in either SAED Basic SAED Basic or Manual defibrillation mode If the PIC has been configured to power up in the
43. and people WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM ADDENDUM 21
44. battery be inserted in the PIC even when operating on auxiliary WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM POWER SOURCE Loo power To achieve optimum performance from your Welch Allyn Quick Charger Conditioner and SmartPak battery packs e Charge battery packs in a moderately cool environment 5 to 30 C 41 to 86 F All NiCad batteries are adversely affected by charging at extreme temperatures and will exhibit a significant decline in useful operating time if charged at temperatures above 95 F 35 C or below 32 F C e Keep charger ventilation ports free of obstructions Install the charger in an area were air is allowed to circulate freely on all sides e Do not store battery packs or other objects in between the charging slots or on top of the charger e Do not place charger near a heat source or in direct sunlight e Allow battery packs to charge fully before removing them from use e Perform periodic conditioning cycles on battery packs Recommended If batteries are charged in moderate temperatures and are used with Reconditioning low to medium frequency one or less charge discharge cycles per Schedule day recondition battery packs once every 90 days If batteries are charged in a high temperature environment above 30 C 80 F or normally encounter more than one charge discharge cycle per day recondition battery packs once every 30 days Due to the critical nature of battery packs replac
45. cable and the words 12 LEAD will display on the screen The 12 quick access button on the side menu will be active 7 8 BPm P02 A Ecc X 9 8 AUTO E 12LEAD x1 Signal OK Press 12 PACING 60 BPM 110 mA DEMAND 12 Selected Energy a Treatment m 200 Intubate Iv EPI LIDO BRET Sample Clear Next WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 18 3 12 LEAD INTERPRETIVE ANALYSIS OPTIONAL EE 18 4 3 Press the 12 quick access button to display patient information on the side menu Press Acquire Sex M Identifier 010901743000000 12 Lead Log Review 4 optional Enter the information for a new patient or select the patient s name from the list of previously entered patients See chapter 5 for more information 5 Press the ACQUIRE quick access button to begin 12 lead data collection It will take 10 to 15 seconds to collect the data The word ACQUIRING will flash in the center of the screen and in the user menu at the bottom of the screen a NOTE aml NOTE 120 19 x T8 amp las 98 i 80 Signal OK E PACING 60 BPM 110 mA DEMAND ACQUIRING N 12 rte Selected Energy 200 Intubate BRET Clear Next Sample Push the STOP button to abort the data acquisition process At the end of data collection the word SAVING will fl
46. can still produce chest size changes creating impedance changes which can be detected by the respiration detector It is best to use the pulse oximeter whenever monitoring the respirations to accurately depict the patient s respiratory condition f Ml a WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 1 13 SAFETY INFORMATION EE Non Invasive Blood Pressure Precautions e Only a physician can interpret pressure measurements e Blood pressure measurement results may be affected by the position of the patient his or her physiological condition and other factors e Substitution of a component different from that supplied by Welch Allyn e g cuff hoses etc may result in measurement error Use only Welch Allyn cuffs and hoses e Do not use a blood pressure cuff on the limb being used for IV infusion or for SpO monitoring e Accurate pressure readings may not be achieved on a person experiencing arrhythmias shaking convulsions or seizures Medication may also affect pressure readings The correct size cuff is essential for accurate blood pressure readings e Blood pressure hoses must be free of obstructions and crimps e If the patient s cuff is not at heart level an error in measurement may result e When monitoring blood pressure at frequent intervals observe the cuffed extremity of the patient for signs of impeded blood flow e WARNING THIS DEVICE IS NOT APPROVED FOR USE ON NEO NATAL PATIENTS e Do not
47. change ON to OFF and the button will become un highlighted The CO value window and CO trace will automatically be removed from waveform 3 and the power light on the CO sensor will turn off unless CO Trend is displayed in another trace NOTE Upon deactivation of the CO Monitoring function the CO gt j trace will no longer be presented in waveform 3 The previous traces displayed prior to enabling the CO gt monitoring function shall be restored 11 6 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM RESPIRATION AND C02 OPTIONAL CO Trend ACCESS ETCO Value Window z The CO trace plots the instantaneous CO partial pressure measurements as a function of time in histogram format a capnogram NOTE Accuracy is based upon I atm pressure and no residual CO gt gas left in the sensor from previous expiration The CO trace will be displayed as if that is the case which may affect readings CO Trend can be displayed while CO is ON or OFF To display the CO Trend trace access the traces menu by pressing Next gt Display gt Traces in the Treatment Summary window of the PIC System display Once in the Trace menu the user can select waveform 2 or 3 to display the CO Trend Select CO Trend in waveform window 2 or 3 and press SAVE The power to CO sensor will be powered on unless already on due to CO trace being activated The CO Trend trace displays a historical representation of the patient s end tid
48. date on the multipurpose pads package Remove multipurpose defibrillation pads from packaging Remove the protective cover and apply the pads to the patient in the position illustrated here Do not use if gel area is dry 5 When applying pad gently adhere opposite edge of pad to patient and lightly roll pad against patient s skin 6 Observe the patient s electrocardiogram on the monitor scope 7 Adjust SIZE control as necessary i NOTE Apex anterior or apex posterior placement of pads results in a modified Lead II ECG trace 4 10 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM ECG MONITORING MONITORING WITH WELCH ALLYN BITRODE 1 Press POWER switch ON 2 Insure that the display indicates 3 lead patient cable has been selected 3 Attach the black and red leads of the standard 3 lead patient cable to the dual contact Welch Allyn BITRODE by snapping the clip on the lead over the lead terminals Similarly attach the white lead to the single contact Welch Allyn BITRODE Press the LEAD button to select the LEAD I or LEAD II position BITRODE 4 Squeeze a small amount of Welch Allyn 2051 ELECTRODE GEL onto the contact area on the inner portion of each limb clip or apply Welch Allyn 2052 KLEAN TRACE on the patient s arms where the Welch Allyn BITRODE contact will be placed 5 Place the dual contact clip on the patient s left wrist or on the forearm if the wrist is not large enough to
49. detected a valid ECG source PADS or Lead IT and is analyzing the patient s ECG to assess if it is a shockable rhythm The PIC will announce STAND BACK ANALYZING Avoid touching or moving the patient Touching or moving the patient can cause artifact which may interfere with the analysis process No Shock Advised Monitoring ECG Indicates the PIC has completed one analysis of the patient s ECG and that No Shock was Advised The PIC resumes monitoring the patient Two BEFPs will be heard signifying the No Shock Analysis result After 3 consecutive No Shock analyses the PIC displays CHECK PATIENT IF NO PULSE START CPR The PIC will also announce CHECK PULSE IF NO PULSE START CPR The PIC will continue to assess the patient s heart rhythm If the signal is non shockable No Shock Advised will continue to flash on the display and an audible beep sounds every minute but if the PIC detects a shockable rhythm it will direct the operator to stand back as it begins to analyze the patient s heart rhythm Shock Advised Charging Stand Clear Indicates the PIC completed analyzing the patient s ECG and that a shockable rhythm was detected The PIC will automatically select the proper energy and begin to charge the defibrillator The display will indicate SHOCK ADVISED CHARGING and to STAND CLEAR The PIC will announce SHOCK ADVISED STAND BACK Periodic tones will be heard to signify the defibrillator is charging The energy
50. e Staphene e Misty e Glutaraldehyde 16 12 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MAINTENANCE AND CARE Loo Cleaning the BP Clean the BP cuff with common hospital disinfectants including Cuff Clorox 1 10 solution isopropyl alcohol Lysol solution Phisohex Quatricide Virex and Vesphene Wash gently with the solution then rinse DO NOT allow solution to enter cuff tubes Cleaning the SpO Clean the SpO probes with a cloth that has been slightly dampened Probes with one of the recommended agents listed above DO NOT submerge the probe or its connector in any liquids or cleaning agents Thoroughly wipe off any excess cleaning solution with a dry cloth Cleaning the Clean the Bitrodes with warm water to remove all electrode gel Bitrode Limb Accumulated deposits of gel may require the use of a scrub brush Electrodes Check each snap contact on each Bitrode for evidence of any gel deposits and clean as needed After removal of all gel clean the Bitrodes with any of the recommended cleaning agents and rinse NOTE Ifgel was found on Bitrode snap contacts inspect the patient E cable snaps for gel deposits dried gel deposits appear as a greenish discoloration Gel deposits can damage patient snaps If dried gel deposits have damaged a snap on the on the patient cable replace the cable to avoid interference with the ECG signal Cleaning Cables Cables cuff tubing paddles and other accessories can be wip
51. following corrections are included e Cellular Configuration page 19 6 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM ADDENDUM 13 PIC 40 50 USER S MANUAL ADDENDUM EE Cellular Configuration correction to page 19 6 From the configuration menu select Setup then DataXfr Use the Data Transfer menu to select one of the following Mobitex If the Mobitex option has been purchased Not Used If the Cellular option has been purchased but the Mobitex option has not been purchased Sending a Cellular On average sending a Cellular transmission takes 10 15 seconds Transmission Press the 12 quick access button to display the Patient ID menu Either acquire a 12 Lead snapshot or retrieve the desired snapshot from the 12 Lead log review see chapter 5 for instructions The 12 Lead quick access button will appear 1 Press the FAX WIRELESS button to open the Send menu 2 Select CELLULAR Note Cellular option must be purchased Cellular ADDENDUM 14 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM PIC 40 50 USER S MANUAL ADDENDUM Loo 3 Select the receiving Hospital Group ID 1 12 are programmed in Group ID 1 the Supervisor gt Setup gt DataXfr gt l Group ID 2 Cellular Menu Selecting one of the programmed numbers opens Group ID 3 h 513 16 Server Name 3 the status menu see step 3 13 Group ID 4 are user editable selecting one of Server Name 4 able entr the editable entries opens
52. in the temperature window indicates the temperature PROBE alarm condition X Temp alarm is off g Temp alarm is On A Temp alarm upper limit is set amp Temp alarm lower limit is set If a temperature probe is connected and taking a reading the temperature will be displayed in the temperature window The x 98 6 reading will gradually increase and settle at the patient s body temperature in approximately 70 seconds A flashing temperature means that the temperature has exceeded the temperature alarm limits NOTE The temperature reading can be set to either Celsius or Fahrenheit in the supervisor SETUP TEMP menu See chapter 13 10 8 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM NIBP AND TEMPERATURE Loo Measuring TAKING A TEMPERATURE MEASUREMENT Temperature 1 Press POWER switch to ON 2 Connect the Welch Allyn Temperature Probe to the connector marked Temp If the probe is not connected properly a NO TEMP PROBE indication will appear in the temperature window 4 Monitor the patient s temperature using standard continuous temperature monitoring techniques Patient s temperature will be displayed in the temperature window 5 After temperature monitoring has been completed disconnect the probe Clean the probe and store it in a clean dry place NOTE Only use YSI 400 series compatible probes WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 10 9 CO gt CHAPTER 11 RESPIRAT
53. index middle or fourth finger of the patient Attach the Welch Allyn finger probe to the patient by inserting the patient s finger into the probe until the finger touches the inside probe wall NOTE Be sure the patient s hand is relaxed and that no tension is exerted on the probe cable WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 9 5 PULSE OXIMETER EE 9 6 Press the SPO button on the front panel the ON indicator will be highlighted in the SpO window signifying the pulse oximeter is on The display will show Searching indicating the pulse oximeter is searching for a recognizable pulse waveform Once the measurement has been established the percentage of oxygen saturation will be displayed in the SpO window If the patient s ECG 1s not being monitored from the ECG patient cable the Nellcor SpO probe will automatically assess the patient s heart rate The heart rate will be displayed in the ECG window An OX appearing in the heart rate window indicates the heart rate is being derived from the Nellcor M SpO probe To display the patient s plethysmograph see User Menus Display in chapter 13 When pulse oximeter monitoring is finished remove the probe from the patient s finger and disconnect the probe from the oximeter Clean the probe with soap and water or with alcohol and store it in a clean dry place WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM Me CHAPTER 10 NIBP AND TEMPERATURE Thi
54. indicate pacing The pacer indicator light will illuminate green and flash off with each delivered pacing pulse The pacer window should indicate Pacer Fault ECG Lead Fault also Lead Fault should appear in the ECG window The pacer indicator lights red indicating the fault condition and that the pacing output has been suspended Pacer indicator light should turn off and pace window should be blank Verify that the SpO window displays No Signal Verify that the SpO window displays Searching Signal OK and a valid SpO reading Verify that the NIBP window displays a valid blood pressure reading Verify that the date and time are properly set WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MAINTENANCE AND CARE Loo FFT Function Response 27 Press the NEXT button on the The Log menu should appear next treatment summary menu Then to the quick access buttons press Recorder and Log 28 Press Clear Log button to erase Clearing event storage will be the log printed to confirm clear 29 Turn the PIC System off and replace all accessories WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 16 7 MAINTENANCE AND CARE EE Mandatory Minimum Preventive Maintenance Schedule The following items should be performed EVERY DAY e Complete the daily shift check procedure EVERY MONTH e Perform the daily tests found on check list e Inspect unit for wear e Inspect padd
55. is the date and time the active patient s data was recorded the number of shocks recorded and the number of events recorded Use the PREV and NEXT buttons located below the Patient Window to choose another patient if more than one 1s recorded on the data card Prev steps to the previous patient on the data card If there is no previous patient the unit will beep twice and will advance to the last patient on the data card Next steps to the next patient on the data card If there is no next patient the unit will beep twice and will reset to the first patient on the data card Lead Gain Window The Lead Gain Window is located in the lower right corner of the display The ECG lead source for the active ECG event displayed in the Trace Window is displayed below the word Lead The ECG size gain for the active ECG event displayed in the Trace Window is displayed below the word Gain The ECG frequency response for the active ECG event displayed in the Trace Window is shown at the bottom of the window WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 12 23 DOCUMENTATION Card Usage Window Quick Access Buttons 12 24 z The ECG size gain can be changed by depressing the Size button in the face of the unit The ECG lead source button is only active when displaying a 12 lead event depressing the Lead button on the face of the unit will cause the next group of three leads to be displayed NOTE Upon entry into the Card Rev
56. is still unable to obtain a measurement the adult thigh and child cuffs will automatically re inflate to 250 mmHg and attempt a third measurement 4 After the initial cuff pressure has been reached the display will indicate the cuff pressure and begin deflating the cuff in a stepped sequence monitoring the pressure pulses until a measurement can be made 5 To cancel the measurement at any time and to deflate the cuff press the NIBP button the STOP will change to START The NBIP monitor will remain in the stat standby mode To return to stat measurements press the NIBP button again the START will change to STOP WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 10 7 NIBP AND TEMPERATURE EE 6 When the measurement is complete the cuff will deflate and the systolic diastolic and MAP pressures will be displayed in the BP window The NIBP monitor will immediately begin taking another reading 7 After five minutes the NIBP monitor will automatically change to stat standby mode and the STOP will change to START To return to stat measurements press the NIBP button again the START will change to STOP 8 To return to the manual mode select manual in the NIBP configuration menu See User Menus NIBP in chapter 13 Temperature Display and Operation Procedures Temperature When the PIC System is powered on the temperature window will Display display NO TEMP PROBE if the temperature probe is not connected NO TEMP The alarm icon
57. je 24 Alarm Icons Off On Auto Lower limit set upper limit disabled Upper limit set lower limit disabled PrP Supervisor Alarms If the Supervisor Alarms menu is set to Active Shift the alarm Setting settings changed by the user will be reset to the current shift setting after the PIC has been powered down for 2 minutes 14 2 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM ALARMS Loo Alarm Configurations User Menus Treatment EPI Lido Atrop Intubate lV Alarms Sample Clear Configuration SPO NIBP Resp Recorder Set up SPO2 _ NIBP NIBP Alarm Next Temp Alarm Sys Upper Limit J off 160 Sys Lower Limit Off 80 Dia sy Limit Off 100 Dia Lower Limit Off 50 SPO2 Alarm Bisabied Lower Limit Of fas WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM Resp Alarm Upper Limit bit 100 Lower Limit Off 36 Upper Limit Bif 105 Off 92 Lower Limit 14 3 ALARMS Heart Rate Alarms In the HR alarm menu the HR alarms can be set to either OFF ON 60 even or AUTO The appropriate alarm icon appears in the heart rate window indicating the current state of the alarm Heart Rate Window Setting HR Alarms SETTING HR ALARMS TO OFF To set the HR alarm to off press the OFF ON AUTO button A until Off is highlighted When the HR alarm is set to Off the upper and lower limits will each display Off and a number in parenthesis
58. oniy PARTIAL charge may he available Do not directly connect the negative and positive terminals Do not incinerate 2 To prevent deterioration or damage to the battery To check battery condition press the TEST button T Do not drop or subject to strong physical shock Status indicator will illuminate indicating battery condition YEDo not use to power equipment other than MRL products Do not test while battery is in use or being charged Press T to TEST WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 15 1 POWER SOURCE EE General Safety Precautions Welch Allyn Quick The Welch Allyn Quick Charger Conditioner provides the user with Charger charging conditioning capability that when combined with proper Conditioner battery care and maintenance will result in consistent battery performance and prolonged battery life To ensure that you get optimum performance from your Welch Allyn battery packs please read this manual carefully and follow the recommendations for battery care and maintenance General Safety e Do not insert objects into or block the charger s Precautions ventilation ports e Charge only Welch Allyn battery packs in this charger e Avoid touching defibrillator paddles to the metal charger frame e Do not take charger apart or attempt to repair it yourself e Do not use the defibrillator tester for testing defibrillators other than Welch Allyn defibrillators e The Welch Allyn charger s
59. pads Clean and dry skin sites preferably with a coarse dry terry cloth Shave patient if appropriate To remove lotions or moisturizer clean patient s skin with alcohol and allow to dry completely before applying pads WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MANUAL DEFIBRILLATION Lo 3 Check expiration date do not use pads that have expired Remove disposable multipurpose pads from packaging Use Welch Allyn multipurpose electrodes model 001853 for adult patients pediatric multipurpose electrodes model 001828 for pediatric patients lt 10kg Remove the protective cover from the pads and apply the pads to the patient in the position illustrated below or according to pad package Do not use if gel area is dry Hands Free Pad Placement 4 Press the ENERGY SELECT button on the front panel up or down to select the desired energy level 5 Pressing the CHARGE button on the defibrillator panel to charge the defibrillator An audible tone will sound periodically indicating that the unit is charging The energy range bar on the right side of the display will highlight the relative charge state until it reaches the selected energy When the unit is fully charged the periodic tone will change to a continuous tone and the highlighted energy range bar will include the selected energy 6 Visually and verbally ensure that all personnel including the operator are clear from the patient Press the 7 button on the multipurpose h
60. produce fire or explosion hazards e After a synchronized cardioversion the SYNC mode may be cleared after each shock or disarm The user may have to reselect press the SYNC button after each synchronized cardioversion shock performed on a patient The PIC can be configured in the Supervisor Defibrillation Set up menu to remain in the SYNC mode after each synchronized cardioversion e Synchronized cardioversion can be performed in the paddle monitoring mode However it is possible that artifact can be produced by the moving paddles which could cause the defibrillator to trigger on the artifact It is recommended that monitoring in leads I II or III be used during synchronized cardioversion Paddle monitoring should not be used for elective cardioversions procedures WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 1 9 SAFETY INFORMATION EE e To avoid stress to the defibrillator or the tester never attempt to repeatedly charge and discharge the defibrillator in rapid succession If a need for repetitive testing arises allow a waiting period of at least 2 minutes for every third discharge e Monitoring ECG through the paddles may result in inaccurate heart rate display due to artifact e Inthe SYNC mode the defibrillator will not discharge without a command signal R wave detection from the ECG monitor indicated by a SYNC marker on the trace flashing SYNC indicator and an audible beep if the R wave beeper is enabled e Do no
61. res ey iS_ is a D When the CHECK PATIENT prompt is spoken the user should verify that the patient is pulseless apneac and unconscious and eliminate sources of motion artifact before pressing the A button to Enter Voice On mode In Voice On mode the PIC will issue verbal prompts fully analyzing the patient s heart rhythm and charging the defibrillator if necessary Follow normal SAED mode operating procedures in Voice On mode WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM SEMI AUTOMATED EXTERNAL DEFIB OPTIONAL NOTE The A button can be pressed at any time in EMS mode to pannel perform a full analysis of the patient s heart rhythm NOTE The Check Patient prompt may be spoken in response to excessive motion artifact or CPR Eliminate sources of motion artifact before pressing the A button If defibrillation is necessary the PIC will perform the normal three charge SAED protocol set by the supervisor If a patient is successfully defibrillated the PIC will return to Voice Off mode If three successive shocks are delivered the CPR timer will begin after the third shock Following completion of CPR the unit will speak Stop CPR and return to Voice Off mode to continue background monitoring To Enable EMS Mode 1 Go to the Setup Menu and select Supervisor 2 Enter the Supervisor passcode 3 Next enter the SAED menu and select EMS Mode On The unit will reboot with EMS Mode ON Follow t
62. several minutes WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM POWER SOURCE Loo FFT 4 Welch Allyn SmartPak contain NiCad batteries which tend to lose charge capacity if they are repeatedly charged after not being fully discharged or are charged at high temperatures In order to counteract these cumulative deteriorating effects it is recommended that you periodically exercise the SmartPak by deeply discharging it in the Reconditioning Slot Slot 3 before recharging See reconditioning schedule later in this chapter 5 Slot 3 on the Welch Allyn Battery Charger has dual charging and reconditioning capabilities To use slot 3 only to charge a battery pack follow the directions above Conditioning INITIATING A BATTERY CONDITIONING CYCLE Battery Packs 1 Insert the battery into slot 3 Important 2 Press the red push button switch on the top of the charger behind slot 3 3 The red reconditioning light next to the push button will light indicating that the battery pack is being exercised At the end of the exercise period the charger will automatically begin a normal charge cycle and will illuminate the yellow battery light indicating that the battery is charging When the yellow battery light begins to flash the conditioning cycle is complete The red conditioning light will remain on until the battery is removed to serve as a reminder that the battery has been exercised If an additional conditioning cycle is desired
63. the editing menu 4 Pressing the GROUP ID or Cellular 13 SERVER NAME button opens a z amr 5 alpha numerical entry screen to Group ID 1 Server Name Server Name 2 manually edit the selected entry When finished editing save the new entry and press the SEND button 5 The status menu displays the Group ID that is receiving the neon transmission status and errors that Le head occur WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM ADDENDUM 15 PIC 40 50 USER S MANUAL ADDENDUM EE Appendix Specifications This section of the addendum addresses changes to the Appendix The following corrections are included e Recorder page A 5 e Electromagnetic Compatibility page A 7 Electromagnetic Compatability Category Standard Level Conducted Emissions EN55011 CISPR11 B Harmonic Current Emissions EN61000 3 2 Class A per A14 EU limits Voltage Fluctuations and Flicker EN61000 3 3 EU Limits Radiated Immunity EN60601 2 4 10 V m normal operation EN6060 1 2 4 20 V m no defibrillator discharge EN60601 2 34 3 V m normal operation IBP only Conducted Immunity EN61000 4 6 3 Vrms ESD Immunity EN61000 4 2 8 kV air 6 kV contact Magnetic Field Immunity EN61000 4 8 3 A m 50 Hz Electrical Fast Transient and Burst EN61000 4 4 2 kV 2 min Immunity Surge and Transient Immunity EN61000 4 5 1 kV Line to Line 2 kV Line to Earth Voltage Dips and Interruption EN61000 4 11 40 5 cycles 100 ms Im
64. the Defibrillator Supr Defib menu The Int Internal Energy menu sets the default energy selected when the PIC is first turned on The selected setting displays in this menu To change the setting press the UP arrow A or DOWN arrow B to increase or decrease the selection Options are 2 3 4 5 6 7 8 9 10 20 30 50 Joules Press the EXIT C to return to the Defibrillator Super Defib menu WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 13 25 MENUS EE Sync After CV Menu The Sync after CV cardioversion menu allows the user to configure the defibrillator to stay in the sync mode after each synchronized cardioversion If this option is Off A the defibrillator will revert to the asynchronous mode If this option is On B the defibrillator will remain in the Sync mode after each cardioversion Press EXIT to return to the Defibrillator Supr Defib menu The Charge Alarm menu allows the user to select the Charge Alarm volume setting Press the ALARM VOLUME ALARM Volume button to use the Volume icon in the MAX Volume Tira Quick Access window to adjust the charging tone Press the MAX VOLUME button to set the charging tone to the maximum volume and by pass the Charge Alarm Menu Volume icon A bold outlined box indicates the selected option Press EXIT C to return to the Defibrillator Supr Defib menu 13 26 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MENUS Loo Supe
65. the defibrillator will charge to the selected energy e Transcutaneous pacing should not be used to treat V FIB ventricular fibrillation In cases of V FIB immediate defibrillation is advised e Transcutaneous pacing may cause discomfort ranging from mild to severe depending on the patient s tolerance level muscle contractions and electrode placement In certain cases discomfort may be decreased by slightly relocating the pacing pads e Itis important to monitor the patient closely to verify that both mechanical and electrical capture are occurring Electrical capture can be verified by observing the presence of a large ectopic beat after the pacing pulse is delivered The size and morphology of the beat are dependent on the patient In some instances the beat may appear as a relatively normal looking QRS pulse Mechanical capture can be verified by checking for signs of increased blood flow 1 e reddening of WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 1 11 SAFETY INFORMATION EE the skin palpable pulses increased blood pressure etc See chapter 8 Continuously observe the patient during pacing administration to insure capture retention Do not leave the patient unattended when administering external pacing therapy Some erythema of the skin and or minor burns may occur under the pacing electrodes in some patients For prolonged periods of pacing gt 4 hours periodically inspecting the skin beneath the electrodes w
66. the speech plays the ECG will advance every 5 seconds to simultaneously show ECG events and speech events The Cassette button will remain highlighted during the speech playback The Voice Memo will not stop until the end of the recorded information on the data card To stop playback any button can be pressed When stopped the presently displayed ECG will remain in the Trace Window WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM E gt CHAPTER 13 MENUS This chapter covers in detail all the User and Supervisory Configuration Menu Options available in the PIC System Chapter Overview User Menu Overview Supervisor Menu Overview Quick Access Buttons and Icons Quick Access Buttons and Pop up Menus User Menus User Menus Display User Menus SPO User Menus Non Invasive Blood Pressure User Menus Respiration ECG User Menus Respiration COs User Menus Respiration Trend User Menus Recorder User Menus Setup Supervisor Menus Supervisor Menus Defibrillator Supervisor Menus Pacer Supervisor Menus SAED Supervisor Menus 12 lead Supervisor Menus Setup Supervisor Menus Calibration Supervisor Menus Alarms WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 13 1 MENUS User Menu Overview Configuration Factory Menu Choices Choice Range Default Display Traces Waveform2 Off Resp Pleth CO2 Trend Il Ill Off Waveform3 aVR aVL aVF V1 6 Freq Limited 2 20 Hz Monitor Monit
67. therapy refractory tachycardia supraventricular or ventricular and bradyasystolic cardiac arrest Patients may range from pediatric to adult 2 4 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM INTRODUCTION Loo Non Invasive Blood Pressure Function Temperature Monitor Function Pulse Oximeter Function Respiration Rate Monitor Function CO Monitor Function The non invasive blood pressure function of the PIC is used to make non invasive measurements of arterial pressure and heart rate and to alarm if either parameter is outside of the limits set by the user Measurements are made using an inflatable cuff on the patient s arm or occasionally leg Patients may range from pediatric to adult The temperature monitor function of the PIC is used to make continuous measurements of rectal esophageal or surface temperature and to alarm if the temperature is outside of the limits set by the user It is used on patients ranging from neo natal to adult The pulse oximeter function of the PIC is used to monitor pulse rate and oxygen saturation of arteriolar hemoglobin and to alarm if either parameter 1s outside of the limits set by the user It is used on patients ranging from neo natal to adult Measurements are made non invasively at remote sites such as a finger toe ear lobe bridge of nose etc Itis used on patients ranging from neo natal to adult The respiration rate monitor function of the PIC is used to continuo
68. there is an adequate amount of chart paper 7 Perform the functional checks as described on the following pages WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MAINTENANCE AND CARE Loo FFF MANUAL DEFIBRILLATORS OPERATORS SHIFT CHECKLIST Date Shift Location Mfr Model No Serial No or Facility ID No At the beginning of each shift inspect the unit Indicate whether all requirements have been met Note any corrective actions taken Sign the form AR OEE Ceen noale dewrofonemsontnomngmet S P Peaaes ncbgpediaticaseplr a a Clean not pitted b Release from housing easily 3 Cables Connectors ee a Inspect for cracks broken wire or damage b Connectors engage securely a Two sets of pads in sealed packages within expiration date b Monitoring electrodes c Alcohol wipes d Hand towels e Scissors a Battery powered units 1 Verify fully charged battery in place 2 Spare charged battery available 3 Follow appropriate battery rotation schedule per manufacturer s recommendations b AC Battery backup units 1 Plugged into live outlet and maintain battery charge 2 Test on battery power and reconnect to line power 6 Indicators ECG Display a Power On display Self test OK Monitor display functional Service message display off Battery charging low battery light off Correct time display set with dispatch center b Recorder prints a Adequate ECG paper 8 Charge Display Cyc
69. to the desired fax number to dial the number and send the fax The fax printout will contain the 12 Lead Interpretive Analysis and the 12 Lead Acquisition data as shown in the following sample WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 18 7 12 LEAD INTERPRETIVE ANALYSIS OPTIONAL 120 to a 78 x 98 Manual 12 LEAD 1 Signal OK SAVING REAL TOME R PACING A 1 2 sate A 98 6 oF Salactad Energy 60 BPM tie 110 mA DEMAND i 2 0 0 J SAVING Irftubate iy LID BRET sample Llaal Next 11 Optional Save the results Press the DISK quick access button on the side menu to save the 12 Lead Interpretive Analysis to the disk on the memory card The PIC will Auto Save a 12 Lead Interpretive Analysis to the memory card when it is installed before the analysis button is pushed NOTE This option is only available on PIC systems that have a J memory card installed 18 8 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 12 LEAD INTERPRETIVE ANALYSIS OPTIONAL Loo FFT Select Automatic or Manual Mode Analysis Setup Menu Use the 12 Lead Analysis Setup menu to select the Automatic or Manual mode This menu is available through the Supervisor Treatment Configuration Menu options See chapter 13 for more information Treatment Intubate IV EPI Lido Atrop Samples Clear Next Configuration lt
70. will be printed 12 4 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM DOCUMENTATION Loo Sample of Treatment Summary Alarm Condition If the global alarms are enabled and a parameter s alarm limit is exceeded the alarm condition and the time will be printed on the chart recorder TT LLI LL ELEL TELELE LL Se Peed ee ee ee ee ee SpO LOW ALARM 12 13 01 a oe ee PT WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 12 5 DOCUMENTATION Treatment Summary Common ACLS treatment events are labeled for each button to assist in providing a Treatment Summary of the incident Pressing any of the treatment buttons will store a 4 second ECG sample in memory along with the type of event time date as well as other status annotation information before the chart recorder has completed printing the information of the previous ACLS treatment event a low tone will sound indicating that the second event was not stored into the log or printed on the chart recorder i NOTE If a subsequent ACLS treatment event button is pressed i Pee eaea a be ceshesssssfjecccsodp FREQ Monitor Response intubate IV EPI Lido Bret Sample Clear Next Clearing Event To clear a Treatment Summary event press the CLEAR TREATMENT SUMMARY button A message indicating that the event was cleared will be printed on the chart recorder and the cleared event will be erased form the internal log NOTE You can only clea
71. 01927 971126 981120 981122 NIBP Adult disposable cuff L NIBP Thigh disposable cuff NIBP hose for use with disposable cuffs 6 NIBP Pediatric disposable cuff NIBP hose for use with disposable cuffs 10 NIBP adult thigh cuff NIBP adult large arm cuff NIBP adult arm cuff NIBP child cuff NIBP infant cuff NIBP cuff hose 6ft NIBP cuff hose 10ft IBP Adapter Cable Disposable skin tempera ture sensor Hands free adapter straight Defib cable tester 2 bay charger SuperPac Q Q Q E Q Q 001828 001930 001931 001932 001933 001950 001951 001954 001934 001910 980136 980137 980138 971029 001941 002129 981124 Multipurpose electrodes child Adult disposable tympanic temp sensor Pediatric disposable tym panic temp sensor Reusable 10 ft extension cable for all disposable temp sensors Calibration check plug CO airway adapter Qty 5 COs airway adapter Qty 50 CO adapter CO sensor SmartView Software and Manual CardioLog memory card 4mb CardioLog memory card 8mb CardioLog memory card 16mb Internal Charger Quick combo pad adapter Welch Allyn to Zoll pad adapter cable 1 bay charger SuperPac WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM INTRODUCTION Loo Initial Installation Evaluation To determine the initial installation condition of the Welch Allyn PIC System after
72. 50 NOTE Ifa limit is disabled the word disabled will appear instead of Off number Setting NIBP alarm to on WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 14 7 ALARMS EE To set the NIBP alarm to on press the OFF ON SET SYS SET DIA button until On is highlighted When an upper and lower NIBP alarm limit is set to On the alarm on icon will appear in the IBP window and the global alarms will be turned on Current settings for systolic Sys and diastolic Dia will be listed SETTING SYSTOLIC AND DIASTOLIC LIMITS 1 To set the systolic or diastolic limits press the OFF ON SET SYS SET DIA button A until Set Sys or Set Dia is highlighted i Select either the upper or lower systolic diastolic limit to set limits B The limit selected will be surrounded by bold outlined box 3 Press the up or down arrows C to increase or decrease the limit value You can disable either limit by pressing the upper or lower systolic diastolic limit button again to display Disabled The alarm icon in the BP window will display the appropriate sy Status ort On he 4 Press EXIT D to leave menu Sys Upper Limit aye Lewer cin NOTE Both systolic and diastolic upper or lower Baia limits must be disabled for the alarm icon in the l IBP window to display an upper amp amp or lower Qa limit icon Invasive Blood Pressure IBP Alarm In the IBP1 and IBP2 alarms menu the IBP alarms can be set Off or On
73. 81114 See Kit No 981119 Yes Charges a battery in the PIC in 8 10 hours Yes Charges up to 3 PIC bat teries in 8 10 hours Yes Charges a battery in the PIC in 8 10 hours Yes Charges a battery in the PIC in 8 10 hours Yes Charges a battery in the PIC in 8 10 hours Yes Charges up to 4 PIC bat teries in 3 hours Yes If con nected to vehicle circuit of at least 15 Amps No Must be used with 981114 See Kit No 981119 Yes Full power from AC mains Yes Full power from AC mains Yes If con nected to a vehi cle circuit of at least 15 Amps Yes Full power from AC Mains Yes Full power from AC mains No Separate Auxiliary Supply is required WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM POWER SOURCE Battery Charger Only Battery Charger Only Battery Charger Only 981115 981124 981122 Battery Charger Single Slot Battery Charger 1 Bay Battery Charger 2 Bays Battery charger and conditioner for PIC bat tery pack Operate from mains 110 240 V AC Battery charger and conditioner for Super Pac Operate from mains 110 240 V AC Battery charger and conditioner for Super Pac Operate from mains 110 240 V AC WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM Yes Charges one PIC battery in 3 hours Yes Charges one SuperPac battery to 80 in 3 hours Yes Charges up to two Super Pac batteries to 80
74. 9 leads press the up or down LEAD arrow button The same 3 33 seconds of ECG for the next set of 3 leads will be displayed c To go to page two of the snapshot window and view the next 3 33 seconds of ECG information press the PAGE button in the quick access window WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 12 LEAD MONITORING OPTIONAL Libis Lob w Press the Icon to go to a different snapshot page yp Page Page 3 Ea gt F F dim teei eee aaa er m eee de A aS a eee ee ee oe ee a ae Sane a mua nTa a a i ee ee ta i a ee T Press the 7 i m m m a i m Dai h i D i ress the j f i j i j up or EEE Aa nr el BEP E E PEE EE EE EE E E E oe down LEAD button AES cs Genes GE SA Mia Riles Ns GE SiS SOSSI a fab to scroll jon nn A woes heel Was aa Sit a ses ET gee ae ees ae through Fa Poe Fe ae es ee l i r j the leads hosts mim shamia shami siasi mien i 1 tla Jn J J l A lA A A a A A a A 7 A F A E a i t ne e malltiemeniion eal in satlimeatits eae e i a esis id and mel a e e eee t j j j i i f l F a r m l a a 2 ee eee ee ee ee ee ee ee eee eee ee ee eee eee eee a fi l a l e j A a S E p ee E a S i i I l an fem oe ee S eee ee eee eee eee 3 33 Seci 3 33 Seconds 3 33 Seconds Snapshot Page 1 Snapshot Page 2 Snapshot Page 3 Quick Access Functions of the Active 12 lead Mod
75. C System Press the button next to the SpO window to turn on the SpO monitor To display the patient s plethysmograph select Pleth in the display Trace menu Attach the appropriate size cuff and hose to the PIC System Apply the cuff snugly to the limb of the patient Select the NIBP mode manual or automatic from the NIBP configuration menu In AUTO mode select desired time interval Press the button next to NIBP window to START NIBP measurement During a measurement press the button next to NIBP window to stop the NIBP measurement The cuff will deflate WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM OO gt CHAPTER 3 PIC SYSTEM OVERVIEW This chapter describes the Welch Allyn Portable Intensive Care PIC System operations including interfaces controls and indicates and display windows It also describes the operation of the PIC System paddles Chapter Overview PIC System Interfaces 5 tara ty Whe dra aa ee BNE wate 3 2 PIC System Controls and Indicators 005 3 4 PIC System Display Windows and Modes 3 6 PIC System Defibrillation Paddles 0000005 3 8 PIC System Defibrillation Hands Free Pads 3 9 HR ve Syn gt DEFIBRILLATOR Dirar WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 3 1 PIC SYSTEM OVERVIEW PIC System Interfaces 13 Non Invasive Blood Pressure connector IBP2 connector blue 45 Temp connector white IBP1 connector blue
76. DF39 1993 section 3 3 18 and the sensitivity and specificity levels Performance recommended by the AHA Automatic External Defibrillators for Public Access Use Recommendations for Specifying and Reporting Arrhythmia Analysis Algorithm Performance The test database includes shockable rhythms consisting of ventricular fibrillation rhythms gt 99uV and wide complex ventricular tachycardia at a rate greater than 160 BPM Non shockable rhythms include various sinus rhythms including supraventricular tachycardia atrial fibrillation atrial flutter sinus rhythm with PVC s asystole pacemaker rhythms and ventricular tachycardia with a rate less than 160 BPM and or narrow complexes Rhythm Recognition Performance Rhythm Performance Observed 90 one sided Class Goal Performance lower Conclusion confidence i level Shockable VF PIC meets the AAMI sensitivity DF39 requirement and AHA recommendation Shockable VT 33 gt 75 PIC meets the AAMI sensitivity DF39 requirement and AHA recommendation Nonshockable gt 99 PIC meets the AAMI NSR specificity DF39 requirement and AHA AHA recommendation Nonshockable gt 95 PIC meets the AAMI asystole specificity DF39 requirement and AHA recommendation Nonshockable gt 95 PIC meets the AAMI all other specificity DF39 requirement and rhythms AHA recommendation CQO optional Mainstream CO CO and ETCO display Range 0 to 76 mmHg Accuracy CO 4 mmHg lt 40 mmHg 10 gt
77. E IBP Temperature with NIBP optional A 10 Alarms Artifact Check Cuff Tighten Cuff Cuff Leak Motion Alarm Limits Systolic 30 to 250 mmHg Diastolic 25 to 250 mmHg Number of Channels 2 Display Numerical and one or two graphical waveforms Numerical Systolic Diastolic Mean pressure Waveform Display Ranges 40 80 160 300 mmHg Waveform Labels ART CVP PA ICP Misc P Pressure range 30 to 300 mmHg Accuracy 2 mmHg or 2 of reading whichever is greater plus transducer error Transducer Sensitivity 5uV V mmHg Offset 125 mmHg including transducer offset Excitation Impedance Range 150 to 10 000 ohms Excitation Voltage 4 75 0 25 VDC Connector 6 pin circular MS3100 series Signal Type Sig Exc Sig Exc Measurement Range 0 to 50 C Accuracy 0 2 C Resolution 0 1 C Scale Fahrenheit or Celsius Probe YSI Series 400 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM SPECIFICATIONS Loo Welch Allyn Quick Charger Alarm Limits High 99 109 F 37 42 C and low 85 98 F 29 36 C alarm limits Mains Line Voltages 100 to 240 VAC four user selectable ranges 100 120 220 240 VAC Mains Line Frequency 50 to 60 Hz AC Power Consumption 50 W while charging batteries only 70 W while powering monitor 300 W while charging defibrillator Charger Bays Three charges three batteries concurrently Indicators Battery Chargin
78. E quick access button to print the analysis data to the chart recorder The chart recorder produces a printout along a continuous strip of paper GE ECRL HEDER Date OLS 08 01 Heart Rate Time 14 04 56 ID OLOgOLe 200no0n Hamne Patient X Init 1 Diag 0 05 to 40 Hs E ___ _ S S av F PR Interval Page 1 dGHAFSHOT 1 QRS Duration OT Interval QTE Irterval ge 45 Jex A F axis PIC 3H QRS axi Dept 1 T axis EL GL RESULTS dimas Fkartiin f F QBS 1 1 Hermal F axis H Rate Ti WITHIN HOREL LIMITS II A r I I I i io St a ace a ST SaaS ee aT s crit rie crt rine 1 0 1 0 WL n a ee ee Web T ee peated Beg e Ga i m Pith nT Ps eso 1 TENE er TOIRE a AAR a ee P r Py fai L E aa ate b a jg BEE Ve Vs Ve S P an i A Soe Optional Fax or transmit the results Press the BACK quick access button to retrieve the analysis data The word RETRIEVING will flash in the center of the screen and in the user menu at the bottom of the screen Press the FAX WIRELESS 4 quick access button on the side menu to display the Send menu To send a fax press Fax then select a fax number you may also enter a fax number See Chapter 5 for more information To send a wireless transmission press Mobitex or Cellular then select a MAN address See Chapter 19 for more information Cellular Fax Press the quick access button next
79. H ALLYN PORTABLE INTENSIVE CARE SYSTEM DOCUMENTATION Eee Record Review Options Card Review Icons z Data Card Indicators The abilities to record and review data to the data card are separately purchasable options If the record option has been installed and a Welch Allyn data card is inserted into the PCMCIA slot the No Card icon will change to a card gauge icon and moving dots will indicate ECG and Events are being recorded to the card If the Review option has been installed and a Welch Allyn compatible data card is inserted Review can be chosen in the Configuration window Recorder menu The Review options allows the operator to view and print recorded patient information on the PIC System If the Review menu does not appear this option is not installed The options can be purchased from Welch Allyn and installed through the Supervisor Setup Menu see chapter 13 As another indicator if the voice option is installed the voice recorder icon will move directly under the card gauge rather than under the internal log gauge which indicates the destination for voice memos has changed to the card NOTE Use only Welch Allyn supplied CardioLog cards to guarantee compatibility and performance When a data card is inserted into the PIC System the following indicators may be seen to the left of the Defibrillator Energy window Remaining Data Card Capacity Remaining data card capacity is indicated by a Card Gau
80. ION AND CO OPTIONAL This chapter provides information on the respiratory displays and operation procedures It also provides information about the optional CO2 monitoring functions Chapter Overview Respiration Display Respiration Operation Procedures CO optional Measurement of Resp Rate Using CO Monitor CO Typical Usage Procedures CAUTION First read chapter 1 Safety Information before proceeding with this chapter WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 11 1 RESPIRATION AND C02 OPTIONAL Respiration Display ST i TO Tae Tae ie en iW Tr Ta en Le Tar ia en i Te eT Lr TL i Le i Ye i i i eee Tr TL iL i LS i IY i LIL ii ae eee PIC50 MONITOR Lead DEFIBRILLATOR ise PACING Ba 6 elected Ener 60 BPM PACER 110 mA a DEMAND Oo n i ves ntubate ample ear ex ves 5 z S 5 i ee W ou ourpurZs _ _ a OUI T Respiration window Respiration waveform The respiratory functions on the PIC System are viewed in the Resp window and on the waveform trace NOTE The following operations of the respiration monitor depict normal factory default settings In chapter 13 we will discuss configuring the respiration monitor Measurement of The PIC System has the capability of providing respiration rate Resp Rate measurements utilizing the impedance pneumography technique 5 lead units only or the optional CO Monitor The i
81. Indicates that the Mobitex modem is Verify that the Mobitex modem is not ready connected and has power No Modem Resp After sending a message to the Mobi Verify that the Mobitex modem is No Modem Response _ tex modem the PIC timed out wait connected and has power Cycle the ing for an acknowledgement power to the Mobitex modem No Net Resp The PIC successfully sent the data to Wait 30 seconds and retry sending No Net Response the Mobitex modem but the modem did not receive a confirmation from the Mobitex network No Host Resp The PIC unsuccessfully connected to __ Retry sending the data If problem the host computer persists verify that the host computer is operating properly Host Offline Confirmation not received from host Retry sending the data computer after transmission Modem Failed Modem is online but cannot be Cycle the power to the Mobitex initialized and a modem failure and modem and retry sending the data after invalid message were received from the 30 seconds Mobitex modem No Host Response 19 4 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM WIRELESS TRANSMISSION Network Offlin The Mobitex modem has lost contact Verify antenna is connected and placed Network Offline with the Mobitex network for more C0 rectly If problem persists verity than ten seconds geographical coverage with network carrier Net Buf Full The Mobitex modem ca
82. KED Defib Pacer SAED 12Lead Set Up Diag Alarms Exit Supr Pacer Rate Mode Back Pacer Pacer Rate Mode Menu Menu Supervisor Menus SAED correction to page 13 28 Set Up Suprvisr Date Time Shifts DataXfr Back Enter Passcode here Supervisor UNLOCKED Defib Pacer SAED 12Lead Set Up Diag Alarms Exit Supr SAED ALSCode E Prot Audio EMS StartUp Back Set ALS SAED SAED SAED Code Protocol Audio Start Up Menu Menu Menu Menu ADDENDUM 9 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM PIC 40 50 USER S MANUAL ADDENDUM eee Supervisor Menus 12 Lead corrections to pages 13 30 13 31 Set Up Suprvisr Date Time Shifts DataXfr Back Enter Passcode here Supervisor UNLOCKED Defib Pacer SAED 12Lead SetUp Diag Alarms Exit 12 Lead Phone Fax Printer Freq Analysis Copies Back Phone Fax Printer Frequency Analysis Copies Entry Menu Menu Menu Menu Menu Menu ee Telephone Prev Next Test Exit Printer Menu Use the Printer Menu to change 12 Lead printing formats 3x4 III II is the default format which prints three rows by four Exe SNe columns of ECG traces 2x6 I V1 format Traces prints two rows by six columns with leads a I and V1 in the first column The 2x6 V1 V2 prints two rows by six columns with L leads V1 and V2 in the first column The 10 sec Lead II option when enabled prints
83. L Orbital Biphasic waveform in the Welch Allyn PIC is as effective as the 2K V biphasic truncated exponential waveform in another commercially available defibrillator 3 The MRL Orbital Biphasic waveform in the Welch Allyn PIC requires less peak current to achieve defibrillation effectiveness than either of the two monophasic waveforms or the 2K V biphasic truncated exponential waveform that is used in another commercially available defibrillator WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM A 17 SPECIFICATIONS Fax Country Codes scan OO mn OO ewe 6 Pitan A 18 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM SPECIFICATIONS Spain Sweden Switzerland Thailand Turkey Taiwan United Kingdom United States WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM A 19 CO gt ADDENDUM PIC40 50 USER INSTRUCTION MANUAL This addendum provides revisions and additions to the Welch Allyn PIC40 50 User Instruction Manual resulting from changes in software revisions and improvements in system electromagnetic compatibility Chapter 3 PIC System Overview e PIC System Controls and Indicators correction to page 3 4 Chapter 7 Semi Automatic External Defibrillation Unit optional e SAED Basic Mode Chapter 13 Menus e Supervisor Menu Overview User Menus Setup Supervisor Menus Supervisor Menus Defibrillator Supervisor Menus Pacer Supervisor Menus SAED Supervisor Menus 12 Lead Supe
84. LLYN PORTABLE INTENSIVE CARE SYSTEM 19 1 WIRELESS TRANSMISSION EE Mobitex Configuration Selecting the Mode of Transmission Entering a MAN Address Sending a Mobitex Wireless Transmission 19 2 From the Configuration menu select Setup then DataXfr Use the Data SOLR Transfer menu to select the type of wireless transmission Selecting Mobitex activates the Mobitex M driver to monitor the communication port for a Cancel Mobitex modem saat ci From the Configuration menu select Setup gt Supervisor gt Setup gt DataXfr gt ake debi Mobitex Use this menu to program up to 20000000 16 different MAN addresses for Mobitex modems On average sending a Mobitex transmission takes 45 seconds Press the 12 quick access button to display the Patient ID menu Either acquire a 12 lead snapshot or retrieve the desired snapshot from the 12 lead log review see chapter 5 for instructions The 12 lead quick access buttons will appear 1 Press the FAX WIRELESS button to open the Send menu 1 Mobitex is a trademark of Telia AB Sweden WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM WIRELESS TRANSMISSION Eee 2 Select Mobitex Send NOTE Mobitex must be selected in the user Setup gt DataXfr menu a 3 Select the receiving Hospital address 1 12 are programmed in ital 1 the Supervisor gt Setup gt DataXfr gt the programmed numbers opens 20000002 the status menu see step 5
85. LYN PORTABLE INTENSIVE CARE SYSTEM 12 25 DOCUMENTATION EE Voice Memo Review Manual Voice Memo Mode Automatic Voice Memo Mode 12 26 There are two voice memo playback modes corresponding to the two voice memo recording modes Manual and Automatic Voice Memo events are generated by the user depressing the Voice Memo button on the PIC System display The recorded voice events are listed in the Event History Window To playback speech the active event must be a Voice Memo event Press the Cassette quick access button The Cassette button will be grayed out or inactive when the active event is not a Voice Memo event As the speech plays the ECG will advance every 5 seconds to simultaneously show ECG events and speech events The Cassette button will remain highlighted during the speech playback When the Voice Memo event is completed the presently displayed ECG will remain in the Trace Window To stop playback any button can be pressed When stopped the presently displayed ECG will remain in the Trace Window Automatic Voice Memo mode can be enabled for both SAED and MANUAL modes see chapter 13 for more information Automatic Voice Memo events are not listed in the Event History Window The Cassette quick access button will never be grayed out it will always be active When the Cassette button is pressed the Voice Memo will start playback at the time of the present ECG trace displayed in the Trace Window As
86. MENUS EE CO Cal Menu From the CO menu the supervisor can aaa check the CO calibration based on a 40 mmHg simulated trapezoidal signal 13 40 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MENUS Lo Supervisor Menus Alarms The UNLOCKED Supervisor menubar displays the Alarms option as shown below Supervisor unlocked Defib Pacer SAED 12Lead SetUp Diag Alarms Back The Supervisor Alarms menu allows the user to select whether or not alarms settings will be reset to their shift default when a new patient event is triggered This menu is accessible through the Treatment Configuration Set Up menus Set Up Supvsr Date Time Shifts DataXfr Back Enter Passcode here Supervisor unlocked Defib Pacer SAED 12Lead Set Up Diag Alarms Back Supervisor Alarms Menu From the New Patient menu the supervisor can enable either the Active Shift or User options The Active Shift selection will restore all alarms to their default settings each time a new patient event is created while the User selection will retain all current alarm settings whenever a new patient event is created WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 13 41 CO gt CHAPTER 14 ALARMS This chapter provides information about the PIC System alarms and alarm parameters including the display icons and indicators Global Alarms and Alarm Icons Alarm Configurations User Menus
87. N or OFF upon startup based on its state at last PIC power off Pressing the CO quick access button B will turn on CO highlight the CO icon and turn on the power light on the CO sensor Waveform 3 is automatically opened or changed from its current setting to display CO information unless IBP1 and IBP2 are enabled The CO gt trace will be displayed in the left portion while the ETCO value alarm status and size will appear on the right of the wavetorm 3 window RESPIRATION AND C02 OPTIONAL EE Select the CO unit of measure either mmHg or kPa from the supervisor setup menu See Supervisor Menus CO Units in chapter 13 for instructions on how to change units of measure Waveform 3 CO2 Waveform ETCO2 Value window window NOTE Upon activation of the CO monitoring function the display will change such that the CO gt trace will be presented in waveform 3 If the display was previously in I or 2 trace mode the CO trace will be presented in waveform 3 with the previous trace s still displayed If the display was previously in 3 trace mode the CO trace will replace the previously displayed trace in waveform 3 but if the IBP1 and IBP2 traces are active then the ETCO gt value will display at the end of trace 1 NOTE While CO monitoring is activated no other trace parameters a can be selected for display in waveform 3 Turning Off CO Pressing the CO quick access button a second time will
88. ONITOR Jw e WE i J ku ee WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 18 1 12 LEAD INTERPRETIVE ANALYSIS OPTIONAL Warnings and Precautions z The Welch Allyn 12 Lead Resting ECG Analysis software is a computerized ECG interpretation library When integrated in an electrocardiograph the ECG Analysis Library is intended to perform ECG waveform rhythm measurements and interpretations on 12 Lead resting ECG signals NOTE The measurements and interpretations generated by the library are intended to assist in diagnosis and should be reviewed by qualified physicians These measurements and interpretations are not intended as the sole basis for diagnosis 12 Lead Interpretive Analysis 12 Lead Data Acquisition and Analysis 18 2 12 Lead Interpretive Analysis is an option part number 971018 purchaseable through the upgrade menu see chapter 13 It enables the PIC to perform interpretive analysis of 12 Lead ECG and allows the user to display print or fax the results acquisition followed by data analysis Collected data may be analyzed immediately after it is collected or it may be saved temporarily if the PIC has an installed memory card and recalled for analysis 0 12 Lead Interpretive Analysis is a two part process data A For both 12 lead data acquisition and 12 lead interpretive analysis the user may
89. ORTABLE INTENSIVE CARE SYSTEM SAFETY INFORMATION Loo Pulse Oximeter Precautions e Keep the Welch Allyn finger probe clean and dry e SpO measurements may be affected by certain patient conditions severe right heart failure tricuspid regurgitation or obstructed venous return e SpO measurements may be affected when using intravascular dyes in extreme vasoconstriction or hypovolemia or under conditions where there is no pulsating arterial vascular bed e SpO measurements may be affected in the presence of strong EMI fields electrosurgical devices IR lamps bright lights improperly applied sensors the use of non Welch Allyn sensors or damaged sensors in patients with smoke inhalation or carbon monoxide poisoning or with patient movement e Tissue damage can result if sensors are applied incorrectly or left in the same location for an extended period of time Move sensor every 4 hours to reduce possibility of tissue damage e Do not use any oximetry sensors during MRI scanning MRI procedures can cause conducted current to flow through the sensors causing patient burns e Do not apply SpO sensor to the same limb that has an NIBP cuff The SpO alarm may sound when the arterial circulation is cut off during NIBP measurements and may affect SpO measurements e WARNING In some instances such as obstructed airway the patient s breathing attempts may not produce any air exchange These breathing attempts
90. PIC 40 and PIC 50 Portable Intensive Care System Monitor Defibrillator Pacer User Manual Software Revision X3 X9 WelchAltyn Advancing Frontline Care Copyright 2006 Welch Allyn All rights are reserved No one is permitted to reproduce or duplicate in any form this manual or any part thereof without permission from Welch Allyn Welch Allyn assumes no responsibility for any injury to anyone or for any illegal or improper use of the product that may result from failure to use this product in accordance with the instructions cautions warnings or statement of intended use published in this manual Welch Allyn PIC and BITRODE are registered trademarks of Welch Allyn Hands Free SuperPak and SmartPak Plus are trademarks of Welch Allyn Nellcor and Oximax are registered trademarks of Nellcor Puritan Bennett Mobitex is a trademark of Telia AB Sweden software in this product is Copyright Welch Allyn or its vendors All rights are reserved The software is protected by United States of America copyright laws and international treaty provisions applicable worldwide Under such laws the licensee is entitled to use the copy of the software incorporated with this instrument as intended in the operation of the product in which it is embedded The software may not be copied decompiled reverse engineered disassembled or otherwise reduced to human perceivable form This is not a sale of the software or an
91. Press the NIBP button to initiate the first reading in the automatic mode the START indicator will change to STOP The NIBP monitor will inflate the cuff to the initial cuff pressure The NIBP monitor has an automatic cuff detection and will inflate the cuff to the proper pressure accordingly The NIBP monitor will inflate adult thigh and child cuffs to 154 mmHg and will inflate infant cuffs to 125 mmHg The inflation pressure will also adjust itself based on the last reading 30 mmHg over the last systolic reading If the NIBP monitor is unable to make a determination of the systolic pressure the cuff will automatically re inflate and attempt another measurement Adult thigh and child cuffs will re inflate to 190 mmHg and infant cuffs will re inflate to 142 mmHg If the PIC is still unable to obtain a measurement the adult thigh and child cuffs will automatically re inflate to 250 mmHg and attempt a third measurement After the initial cuff pressure has been reached the display will indicate the cuff pressure and begin deflating the cuff in a stepped sequence monitoring the pressure pulses until a measurement can be made WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM NIBP AND TEMPERATURE Lo 5 To cancel the measurement at any time and to deflate the cuff press the NIBP button the STOP will change to START The NIBP monitor will remain in the automatic standby mode To return to automatic measurements at regular intervals
92. RE buttons Return the paddles to their holder Press the SYNC button Press the CHARGE button on the front panel Apply the paddles to the test contacts on the Quick Charger Ensuring that the paddles are properly applied to the test contacts press both the sternum and apex paddle discharge buttons Press the DISARM button on the front panel WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM Verify that the energy graph highlights as it charges up to 200J A periodic tone will sound while the defibrillator is charging At the completion of the charge cycle the tone will be constant and the energy graph will fill up to and include 200J The charge time should be less than 7 seconds The defibrillator should not discharge The defibrillator should discharge and the defibrillator test light on the top of the Quick Charger must flash indicating defibrillator discharge Verify that the Del Energy in the Defib window is between 190 J and 210 J The Defib window should indicate Sync and the Sync Indicator light should illuminate Verify that the energy graph highlights as it charges up to 200J A periodic tone will sound while the defibrillator is charging At the completion of the charge cycle the tone will be constant and the energy graph will fill up to and include 200J The defibrillator should not discharge The defibrillator should discharge internally and the charge done tone and graph will disappear
93. SAED Basic mode only the controls that have been highlighted below will be active All other controls will be disabled to simplify operations M lt __ ANALYZING ECG STAND BACK Elapsed Time SAED BASIC MODE Log rae F al Available options in SAED Basic mode are highlighted below NOTE The Pulse Oximeter Non invasive Blood Pressure Pacer and Treatment Summary menu will not be available in basic mode In the SAED Basic mode the PIC will continuously monitor the patient s ECG and determine if a shockable rhythm is present When a shockable rhythm is detected the PIC will automatically select the appropriate energy based on the energy protocol selected in the Supervisor configuration menu and automatically charge the defibrillator to the selected energy After three consecutive No Shock analysis results the PIC will display text and provide a voice prompt to Check Pulse If no pulse start CPR After each set of three consecutive defibrillation attempts the PIC will provide the same text and voice prompts and enter into CPR mode when the A Analyze button and CPR timer v CPR TIMER o displays NOTE Ifan ECG rhythm is potentially shockable it may qualify as 2 No Shock analysis results to hasten entry into CPR mode During CPR mode the PIC System continues to monitor for shockable rhythms If a shockable rhythm is detected during CPR mode
94. SSION NOTE This does not mean that the 12 lead has been transmitted to the 12 Lead Server Refer to the status on the eSync device for the actual wireless transmission status of the 12 lead Cellular Error Messages Error Description Resolution The PIC cannot establish __ Verify serial connection communication with the between the PIC and eSync eSync device device Verify operation of the eSync program WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 19 7 CO gt APPENDIX A SPECIFICATIONS This chapter provides specification information for the Welch Allyn Portable Intensive Care PIC System components required and optional Chapter Overview Data Acquisition and Analysis 0 0c cence A 1 DI CTDNUQNON s yra eseni dae VB ad IR a es ee Sh hs A 1 Monitor Display sesse 0c es A 3 Alal 6 oe 3 00 Joon ee beeen dees cae oe ede A 4 FICCOIOGE 2 6s he oo ded SAS ee SR ee a LS A 5 BANOV ee Roe ee he eee oe eee oka ee A 5 OTST ise 5 sk sea Reset a r Sh me a Hh sels A 6 PAC 2 en She eared eR Go RD ict aN Be hse ede Pe ea A 7 SAED Rhythm Recognition Performance A 8 COS ODUORAL x eam tue pita RACERS AE PERE ae BSN BRR A 8 Pulse Oximeter 1 tenes A 9 Blood Pressure optional 00 cc ee eee A 9 DP oa fer taka S castes en ae Gah ao ele Coe A te E Ried Bess A 10 Temperature with NIBP optional n anaa cca A 10 Welch Allyn Quick Charger 0 0000 ccc nee nee A 11 Safety Eff
95. T XZE2Hxz PIC System Display Windows and Modes SAED Basic Mode SAED Basic Mode 3 6 When the Semi Automatic External Defibrillation SAED option has been installed the PIC can be configured to power up in one of three modes SAED Basic SAED Basic Manual defibrillation mode Each mode has a unique display and some controls and indicators may be deactivated Refer to Defibrillator Controls and Indicators section The SAED Basic mode has been designed to all those BLS personnel who have completed additional training to assess the patients vital signs NIBP and Pulse Ox In the SAED Basic mode the operator would be able to operate the Pulse Oximeter and the Non Invasive Blood Pressure In the SAED Basic mode these parameters have been disabled to simplify operations If the PIC has been configured to power up in the SAED Basic mode only the voice memo supervisor configurable chart recorder hold and disarm controls will be active Below is an example of the active controls and display A N Voice menu B E OS mame eae re ce ra Chart Recorder _ B gt ooo E a Hold A ANALYZING ECG ct STAND BACK S qy Disarm aa m Manual mode Elapsed Time Shocks Delivered 00 00 00 0 SAED BASIC MODE Lo a y EMDI Emr aces O Cpr Strt Intub IV Event Als Arvi Log Manual E
96. The IBP Alarms must be set for each channel IBP1 and IBP2 The appropriate alarm icon appears in the IBP window indicating the current state of the alarm 14 8 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM ALARMS as FFT Setting IBP Alarms SETTING IBP ALARM To OFF To set the IBP alarm to off press the OFF ON SET SYS SET DIA button A until Off is highlighted When the IBP alarm is set to Off the upper and lower limits will each display Off and a number The number indicates the current set IBP limit that will be active when the IBP alarm is turned back on See example below IBP1 alarm off Sys upper limit is 160 IBP1 alarm off Sys lower limit is 80 a y Sys Upper Limit IBP1 alarm off Dia Upper limit is 130 Off 160 Sys Lower Limit IBP1 alarm off Dia Lower limit is 50 Off 80 Dia Upper Limit off 1 NOTE Ifa limit is disabled the word 30 disabled will appear instead of Off 50 Off number Setting IBP alarm to on will enable the alarm To set the IBP alarm to on press the OFF ON SET SYS SET DIA button until On is highlighted When an upper and lower IBP alarm limit is set to On the alarm on icon will appear in the IBP window and the global alarms will be turned on Current settings for systolic Sys and diastolic Dia will be listed SETTING SYSTOLIC AND DIASTOLIC LIMITS If the IBP source is set to ART a systolic diastolic menu will be displayed ET IBPI Alarm 1 To set the sy
97. Time Shifts DataXfr Back Enter Passcode here Supervisor UNLOCKED Defibr Pacer SAED 12Lead SetUp Diag Exit Supr SAED ALSCode E Prot Audio EMS StartUp Back Set ALS SAED SAED SAED Code Protocol Audio Start Up Menu Menu Menu Menu Pe 7 200 150t 200 300 150 200 300 360 150t 200 300 360 The supervisor may use this menu to setup a separate pass code that allows ALS personnel to enter the Manual Defib mode from the SAED mode Use the SAED Protocol menu to select an energy protocol Press a corresponding button to select an option then press EXIT to save the setting The 150 Joules energy level selection is only available on biphasic units with a defibrillator software revision of L6 or newer Please see the diagnostic menu section for instructions on how to determine the software revision of the unit This energy level selection is only available on biphasic units WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MENUS Lea SAED Audio Menu Use the SAED Audio menu to select a Voice Memo option Memo Memo User must press and hold the MEMO button to record audio Start Stop Recording will end when button is aan ontinuous released aed Start Stop User must press the MEMO od button to record audio Recording will end when button is pressed again Continuous Recording will start when the PIC is turned on if a data card is inserted NOTE Cont
98. Y INFORMATION Loo General Precautions The Welch Allyn PIC is intended for use by trained authorized medical personnel who are familiar with basic monitoring vital signs assessment and emergency cardiac care The PIC is also intended for use by physicians at the scene of an emergency or in a hospital emergency room Federal USA law restricts this device to sale by or on the order of a physician Any authorized person using the Welch Allyn PIC should be completely knowledgeable of the information in the User Instruction Manual The defibrillator function of the PIC is used to treat ventricular fibrillation and pulseless ventricular tachycardia The biphasic waveform employed by the PIC has not been clinically tested on pediatric patients The device has not been evaluated for cardioversion of atrial fibrillation or direct internal cardiac defibrillation The semi automatic mode should not be used on pediatric patients less than 8 years old Accessories Use only authorized Welch Allyn accessories listed in the Introduction chapter of this manual Use of unauthorized accessories may cause the device to operate improperly and provide false measurements Sterilization Do Not attempt to sterilize any accessory or equipment Battery Care Proper care and maintenance of the Welch Allyn batteries is important to insure continuous operation during patient care If the batteries are not maintained properly loss of power during patie
99. YSTEM 3 7 3 8 PIC SYSTEM OVERVIEW a TTNXXX 2 2YXTX RXXKXtzx PIC System Defibrillation Paddles Standard adult paddles Sternum Paddle Discharge button Apex Paddle Discharge button Deluxe adult paddles optional Sternum Paddle Discharge button Energy selection button Apex Paddle Discharge button Charge button Defibrillator Connector Defibrillator connector release button Note When sliding the defibrillator adapter on make sure the release button clicks into place and returns to its up postition WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM PIC SYSTEM OVERVIEW as FFT PIC System Defibrillation Hands Free Pads Multipurpose Hands Free Adapter and Electrodes optional Multipurpose Pads Pad Connector Connects to patient connector Patient Connector Accepts disposable monitoring defibrillation non invasive pacing pads Welch Allyn part 001853 4 Multipurpose Hands Free Adapter 5 Shock Button Hands free discharge button 6 Adapter Release Button Unlocks the adapter connector from the defibrillator to allow removal NOTE When sliding the multipurpose hands free adapter on make sure j the release button clicks into place and returns to its up position WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 3 9 Me CHAPTER 4 ECG MONITORING This chapter describes the ECG Monitoring process including how to use the standard and quick access cont
100. _______ Display Alarms SPO NIBP Resp Recorder Set Up Back Set Up Supvsr Date Time Shifts DataXfr Back Enter Passcode here Supervisor UNLOCKED Defibr Pacer SAED 12Lead Set Up Diag Alarms Exit 12 Lead Phone Fax Printer Freq Analysis Copies Back Analysis Setup Menu The Analysis Setup menu allows the Supervisor to select the Manual or Automatic mode for analyzing 12 lead data The Manual mode requires the operator to press the Analysis button to start the analysis The Auto Automatic mode starts an analysis at the end of the data acquisition cycle WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM ___ Analysis Setup Manual Auto 18 9 CO gt CHAPTER 19 WIRELESS TRANSMISSION This chapter provides information and operation procedures for optional wireless transmission of 12 lead information Chapter Overview e Overview e Mobitex Configuration e Cellular Configuration Overview Wireless transmission is available for 12 lead units and makes it possible to send acquired and analyzed 12 lead snapshots to a PC There are two modes of wireless transmission Mobitex and Cellular Each requires special software and accessories to send and receive wireless transmissions Contact your sales representative for details Purchase the wireless transmission option from the Supervisor gt Setup gt Upgrade menu See chapter 13 for instructions Contact your sales representative for details and necessary codes WELCH A
101. a in the Trend Summary is printed as a tabular display The Trend Summary events include the time the summary information was acquired heart rate HR pulse oximeter reading OX blood pressure BP carbon dioxide level CO3 indicating the set units invasive Pressure IBP1 IBP2 temperature Temp and the respiration rate Resp WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM DOCUMENTATION Loo Stop Print Print Log Print Trend Stop Print Clear Log Clear Log Print Lag Print Trend Stop Print Clear Log WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM To stop printing the Treatment Summary Log while it is printing press STOP PRINT A The information in the log will not be affected To clear the Treatment Summary Log and the voice memo log press CLEAR LOG B button NOTE To prevent the previous patient s Treatment Summary Data to be printed with a new patient s data always clear the log prior to starting a new patient 12 11 DOCUMENTATION EE Loading Chart Paper 12 12 The check recorder icon gt will appear in the message window of the display when the chart paper is empty or the chart recorder door is not closed properly 5 os L y e j a Oo Free end of E e paper on top A S i CG i ee S s AANI 8 i Swing door Release lever RR Ii ANN OQ When inserting the Roll in chart record
102. able on the devices tested The ED50 peak current and energy was then estimated for each animal by logistic regression analysis This study simulated a higher impedance patient by having a 32 ohm resistor placed in series with each subject Results The study consisted of 98 total fibrillation defibrillation episodes The mean ED50 and ID 50 estimates for peak current and energy for each animal to one decimal place are shown below The significance of difference p value was calculated by the Wald test in each case and are shown below Also shown are the mean total durations measured for each device Summary Table ED50 amp ID50 Mean Welch Allyn PIC 2kV Biphasic Biphasic Waveform ID50 Peak Current Amps Significance of difference p value ED50 Delivered Energy Joules Significance of difference p value Total Duration 215 15 6 msec Study 3 Conclusion The MRL Orbital Biphasic waveform was as effective as the 2K V Biphasic waveform in this model of a higher impedance patient When these devices are compared on the basis of WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM SPECIFICATIONS Loo peak current the MRL Orbital 1M Biphasic required less peak current than the 2KV Biphasic waveform Rationale for Animal Studies Electrical waveforms for transthoracic ventricular defibrillation have been well studied for nearly 50 years These studies led to the development of monophasic waveforms such a
103. ach paddle simultaneously NOTE Ifdefibrillation is not required pressing the DISARM button Del Energy 202 Delivered Energy 8 located on the front panel will discharge the energy internally 7 Observe the effect of the delivered countershock by observing the patient s ECG 200 J on the display The amount of energy delivered will appear in the defibrillation display window Verify that the proper amount of energy has been delivered For additional countershocks repeat steps 3 8 NOTE For monitoring through the defibrillator paddles the ECG 10 waveform can be monitored immediately after the FIRE buttons are released as long as the paddles are held in place and the LEAD select is set to PDL Paddles To secure the instrument turn the power switch to Off Clean the paddle electrodes patient cables and controls as outlined in chapter 16 If battery power was used recharge the battery by connecting the unit to AC power or replace the used battery with a fresh fully charged battery and check that there are sufficient supplies for the next use defib gel recorder paper ECG electrodes etc Connect the multipurpose hands free adapter by sliding it onto the defibrillator connector track Make sure the release button clicks into place and is in the up position i Press POWER switch to ON and ensure lead selector is set to PAD Remove or loosen patient s clothing if necessary for application of
104. act may result in patient burns and inability of the device to function properly 1 10 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM SAFETY INFORMATION Loo e The device contains an automatic disarm of the capacitor bank If the operator has not delivered the charge to a patient or test load an internal timer will disarm the capacitor bank 1 minute in manual mode and 30 seconds in SAED Basic or SAED Basic mode after the ready charge signal The ready charge signal is indicated by a continuous audible tone and the energy availability graph displayed on the monitor e Ifa new energy level is selected after the charge button is pushed and while the defibrillator is charging defibrillator will automatically charge to the new energy selection The CHARGE button need not be pressed again to select the new energy level e Disconnect from the patient any medical electronic device that is not labeled defibrillation protected e Before charging the defibrillator verify that the energy selected on the display is the desired output e Some erythema of the skin and or minor burns may occur during defibrillation Use proper defibrillation techniques as outlined in the User Instruction Manual to minimize erythema burns External Pacing Precautions e Defibrillation will take priority over external pacing Should the defibrillator be charged during the administration of external pacing the pacer will automatically be turned off and
105. ailable capacity If the operating time remains short remove the battery from service and replace it e If battery run time is short be sure that the correct PIC and battery type have been selected on the comparison chart e Verify that the battery is fully charged prior to the capacity test e Consider the age of the battery and the frequency of its use The recommended replacement interval in this critical application 1s every 2 years as indicated on the battery label WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 16 11 MAINTENANCE AND CARE EE Cleaning Instructions PIC System To clean the PIC System use a nearly dry cloth containing one of the Cleaning mild cleaning agents listed below DO NOT allow cleaning agent or Recommendations water to run into the crevices or connector opening at any time Thoroughly wipe off any excess cleaning solution from the PIC system with a dry cloth Always check monitor and connector opening for unusual wear damage or dampness while cleaning Use only the recommended cleaning agents listed below Recommended Cleaning Agents e Warm water e Hydrogen peroxide solution e Coverage e Liquid soap Wex cide Formula 409 Fantastik e Windex e TB Q Never use these cleaning agents e Butyl alcohol e Denatured ethanol e Freon e Mild chlorine bleach solution e Isopropyl alcohol e Trichloroethane trichloroethylene e Acetone e Vesphene II e Enviroquat
106. ake a few minutes to complete depending on the size of the card NOTE After formatting a card it must be removed and reinserted or p the PIC power must be cycled to begin data recording Viewing Card In the Card Menu card information can be shown by pressing CARD Information INFO see chapter 13 for more detailed information If a valid and properly formatted Welch Allyn compatible card is detected the following information will be presented e Card Contents e Card Type e Card Size in KB e Format Count of times formatted on a PIC or PC e Format Date last format date If no card or an unreadable card is detected when pressing Card Info entry into the Card Info menu will be prevented and a warning tone will sound 12 18 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM DOCUMENTATION Lo Eee Recording Data If the Review Recording option is installed and an Welch Allyn data card is inserted patient information will be automatically recorded to the Welch Allyn data card whenever the PIC System is turned on The following patient data is recorded to the data card e ECG data that is displayed in waveform 1 will be recorded to the data card whenever an Welch Allyn compatible data card is inserted e Status Events and Trend Data are recorded to the data card as they occur e Audio is recorded to an Welch Allyn compatible data card when the Voice memo button is pressed or when the unit is operating with continuous voi
107. al CO ETCO values The value in the upper left corner of the waveform window indicates the time period over which the measurement is being made 10 min is the default setting See User Menus CO Monitoring in chapter 13 for instructions on how to change trace configurations When the CO or CO Trend traces are added to the waveform window the ETCO value windows will appear on the right side of the respective waveform window CO or CO Trend will appear in the upper left corner of the window indicating that the CO waveform is active If both waveforms are displayed ETCO value will be displayed in the CO window only Bell symbols in the or ETCO value windows indicate the status of the ETCO alarm enabled alarm on or disabled X alarm off A alarm upper limit set 4 amp alarm lower limit set Refer to Chapter 14 for instructions on how to change alarm settings The ETCO alarm settings apply to both the CO and CO Trend waveforms When there is measurement available the most recent ETCO values shall be displayed in the ETCO value windows The value is updated with each breath WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 11 7 RESPIRATION AND C02 OPTIONAL EE The CO and CO Trend trace measurements ranges are indicated via a scale bar displayed in the left portion of the CO and CO Trend value windows The marked values are 20 40 and 60 mmHg for the default settings A wil
108. alysis is in process Take precautions to eliminate sources of motion or artifact before monitoring in SAED mode IBP Precautions e To insure compatibility and electrical safety accessory pressure sensors should comply with ANSI AAMI BP 22 and IEC 601 2 34 for IBP or ANSI AAMI NS28 for ICP e Follow instructions supplied with any accessory pressure sensor regarding calibration and removal of trapped air e Avoid touching metal parts of any transducer while it is in contact with the patient e Do not reuse any components that are labeled for single use only e Transducers should be rated to withstand an accidental drop of at least a meter onto a hard surface e Transducers that are subject to immersion in liquids should be rated as watertight WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 1 17 SAFETY INFORMATION EE CO Precautions e Do not use CO sensor during MRI scanning MRI procedures can permanently damage the CO sensor e CO ETCO measurements may be affected by the presence of interfering gases or vapors Do not use on a patient being administered oxygen or nitrous oxide e Use only Welch Allyn CO sensors and adapters e Do not reuse airway adapters that are labeled for single patient use e Prior to using airway adapter check for lodged obstructions After attaching check the sensor for proper placement of the sensor e If using the CO Monitor for extended critical care replace the airway adapte
109. ands free adapter to deliver energy 7 Observe the effect of the delivered countershock by observing the patient s ECG on the display The amount of energy delivered will appear in the defibrillation display window Verify that the proper amount of energy has been delivered 8 For additional countershocks repeat steps 4 through 8 9 To secure the instrument turn the power switch to Off Clean the patient cables and controls as outlined in Chapter 16 10 If battery power was used recharge the battery by connecting the unit to AC power or replace the used battery with a fresh fully charged battery and check that there are sufficient supplies for the next use WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 6 7 MANUAL DEFIBRILLATION Performing Synchronized Cardioversion 6 8 ED WARNING Elective cardioversion should only be performed while monitoring patient with patient cable and electrodes or hands free defibrillator pads Although the device will allow synchronized cardioversion in the PDL paddle lead selection it is not recommended that Sync be performed in the PDL lead Artifact can be generated from the paddle cables which could cause the defibrillator to discharge on the artifact Press POWER switch to ON Attach an ECG electrode to each lead of the patient cable Attach the electrodes to the patient Position the electrodes to allow immediate placement of the defibrillator paddles Electrode Placem
110. ansfer menu to select the type of modem for 12 lead fax transmissions Select Not Used or Mobitex depending on options purchased If Mobitex option is purchased data transfer 1s automatically set to Mobitex on power up If the cellular option is purchased data transfer is automatically set to Not Used on power up WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM PIC 40 50 USER S MANUAL ADDENDUM Supervisor Menus correction to page 13 24 Treatment Intubate IV EPI Lido Atrop Sample Clear Next Configuration a oO Display Alarms SPO NIBP Resp Recorder Set Up Back i t Set Up Suprvisr Date Time Shifts DataXfr Back Enter Passcode here Supervisor UNLOCKED Defib Pacer SAED 12Lead SetUp Diag Alarms Exit es Supr Diagnostics SW Rev Modem Card Cal Back Supr Calibration NIBP SPO Mod Out COs Back M Sur Setup Shifts Treatment Upgrade UnitID Code Printer More Back Options Available SAED CO IBP Adv Record Review More Back Options Available lt W T _ Cell Analysi DataRd Mobitex Biphas Pacer Fax Back Supr Setup 2 lt _ _ Date Temp LineFreq Audio Language Lead More Back Supr Setup 3 lt amp W Data Xfr CO2 Back
111. arison chart to determine typical operating time for specific PIC options and battery types Battery Capacity Comparison Select Options Below to Determine the Minimum ECG Monitoring Time Minimum Battery Run Time Part Hours Number D eine SuperPac PIC with 5 Lead ECG and Mono LCD Display 972042 ig 5 PIC with 5 Lead ECG and Color LCD Display 971085 3 PIC with 12 Lead ECG and Color LCD 971086 a 25 Display 16 10 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MAINTENANCE AND CARE Loo Procedure 1 Completely charge the battery to be tested The charger s indicator begins to blink when the battery is fully charged 2 Disconnect the PIC from AC power so that it is powered only from the battery to be tested 3 Turn on the PIC monitor and note the starting time 4 Verify continued operation at intervals of 30 minutes or less 5 When the battery power runs out note the time This gives you the duration of time that relates directly to battery capacity Compare this run time to the value given in the comparison chart above that corresponds to the PIC and battery type being used Acceptable e Battery run time must meet or exceed the minimum time Results given in the comparison chart e Recharge batteries fully prior to placing them back into Service Corrective Action e If the actual battery run time is less than the value given in the chart repeat the test to determine 1f reconditioning was effective in improving av
112. ash if a memory card is installed in the PIC Voice memo is turned off during the 12 lead acquisition Process After data collection a snapshot of the results will display on the screen In addition three traces of continuing real time ECG monitoring will display on the right side of the screen If the PIC is operating in Automatic mode the analysis will begin immediately Go to step 7 If The PIC is operating in Manual Mode go to step 6 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 12 LEAD INTERPRETIVE ANALYSIS OPTIONAL 8 120 wae ppm SPO2 U go 100 a 78 cos _ 98 P Manual 42LEAD By Signal OK In Manual mode press Analysis SAVING REAL TIME pacing A 12 ena A 98 6 Salactad Energy 60 BPM 110 mA DEMAND 200 Imubate Vv EPI LIDO BRET Sample 6 If operating in Manual Mode Press the ANALYSIS quick access button The word ANALYZING will display in the center of the screen and in the user menu at the bottom of the screen Analysis will take 10 to 20 seconds During this time the screen will be blank except for one real time ECG trace NOTE Press the STOP button to abort the Analysis process 120 199 x Bie ls 98 80 AUTO x1 Manual voan 12 LEAD Signal OK REAL TIME PACING 60 BPM 110 mA DEMAND Selected Energy 200 Intubate Iv EPI LIDO BRET Sample Clear Next When analysis is done the results wi
113. ators hands 3 Press the ENERGY SELECT button on the front panel up or down to select the desired energy level energy selection is also available on the deluxe paddle set 4 Pressing the CHARGE button on the defibrillator panel to charge the defibrillator charge selection is also available on the deluxe paddle set An audible periodic tone will sound indicating that the unit 1s charging The energy range bar graph on the right side of the display will highlight the relative charge state until it reaches the selected energy When the unit is fully charged the periodic tone will change to a continuous tone and the highlighted energy range bar graph will include the selected energy activated additional time may be required to charge to the new energy NOTE If the selected energy is changed after charging has been 5 Place the sternum paddle firmly against the patient s chest inferior to the patient s right clavicle and lateral to the upper sternum place the apex paddle in the anterior axillary line inferior and lateral to the patient s left nipple as shown below Sternum Apex Paddle Placement WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 6 5 MANUAL DEFIBRILLATION z z Defibrillation with Multipurpose Hands Free Adapter 6 6 With the paddles in proper position clear all personnel visually ensure all personnel are clear including the operator from patient contact Press the f button on e
114. ays Pulse oximeter functions are displayed in the SpO window Pressing the button turns on or off the pulse oximeter The SpO display will highlight either on or off to show the current state Pressing the SPO9 button again will change the state NOTE The following operations of the pulse oximeter depict normal factory default settings In chapter 13 we will discuss configuring the pulse oximeter Pulse Oximeter connector re z Tanna a SspO gt window SpO button SP03 PO E3 98 o signal OK SpO Window When the PIC System is powered ON SpO will appear in the upper left corner of the SpO window indicating that the SpO option is installed and OFF will be highlighted by default Pressing the SpO button turns on the pulse oximeter and highlights ON Testing then Searching will appear in the window indicating that the pulse oximeter is searching for a recognizable waveform The unit will automatically adjust to achieve proper recognition Bell symbols in the SpO window indicate the status of the SpO alarm alarm off alarm on A alarm upper limit set fm alarm lower limit set 9 2 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM PULSE OXIMETER Loo If a searching message persists attempt to oncrease perfusion in the area of the probe by positioning the patient s arm so that the probe is near the level of the heart and circulation is not restricted If necessary t
115. bar graph on the right of the display will indicate the relative charge state WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM SEMI AUTOMATED EXTERNAL DEFIB OPTIONAL Loo Shock Advised Stand Clear Shock Now Indicates a shockable rhythm is still detected and that the defibrillator has completed charging to the selected energy The display will indicate SHOCK ADVISED STAND CLEAR SHOCK NOW The amn _ PIC will announce SHOCK NOW and the periodic charging tones ee pe will change to a steady tone signifying that the defibrillator is fully charged Lt SHOCK ADVISED CHARGING STAND CLEAR Make sure everyone is CLEAR of the patient announce CLEAR and press the discharge button on the Multipurpose Hands free adapter to deliver the shock The shock must be delivered within 30 seconds If the defibrillator remains charged for over 30 seconds the PIC will disarm the energy safely internally as a safety precaution The energy bar graph will disappear Observe the patient s response and follow the PIC s display and voice prompts If you would like to abort the defibrillation press the DISARM button on the front panel to discharge the defibrillator internally and safely WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 7 11 SEMI AUTOMATED EXTERNAL DEFIB OPTIONAL EE Defibrillation with Paddles while in SAED mode Ensure the Welch Allyn paddles and ECG patient cable have been connected t
116. battery slot if a battery is not already in the slot The Battery Status Indicator Light will illuminate yellow when a battery has been inserted When the battery pack has been fully charged the battery status indicator light will flash yellow The light in the auxiliary power connector will illuminate if a battery is inserted in the PIC System The PIC will perform a number of self tests and print out the results pass or fail on the chart recorder Verify that all the installed options Sp0 gt NIBP etc are displayed in their respective windows Verify that the AUX power icon is displayed in the Message window Verify that a lead fault message is displayed in the waveform window Verify that a lead fault message is displayed in the waveform window Verify that the lead fault message disappears from the waveform window and that the trace is in the center of the waveform window Verify that the energy graph is displayed on the right side of the display and that 200J has been selected WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MAINTENANCE AND CARE Eee WARNING Keep hands and fingers away from paddle electrodes Function Response Press the CHARGE button on the front panel Ensuring the paddles are properly applied to the test contacts press only the sternum paddle FIRE button and release Then press only the apex paddle FIRE button and release Press both the sternum and apex paddle FI
117. below the words lower Limit The alarm icon in the Resp window will display the appropriate status 3 Exit Press EXIT to leave menu WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 14 11 ALARMS Temp Alarm Setting Temp Alarm 14 12 In the Temp alarm menu the Temp alarm can X 98 6 beset Off or On The appropriate alarm icon appears in the Temp window indicating the current state of the alarm SETTING TEMP ALARM TO OFF To set the Temp alarm to off press the OFF ON button A until Off is highlighted When the Temp alarm is set to Off the upper and lower limits will each display Off and a number The number indicates the current set Temp limit that will be active when the Temp alarm is turned back on See example below Temp Alarm Off Temp alarm off upper limit is 104 Do Temp alarm off lower limit is 93 Lower Limit Off 93 NOTE lfa limit is disabled the word Disabled will appear instead of Off number SETTING TEMP ALARM TO ON To set the Temp alarm to on press the OFF ON button A until On is highlighted When both the upper and lower Temp alarm limits are set to On the alarm on icon will appear in the Temp window the global alarms will be turned on and the box surrounding the upper limit will be highlighted WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM ALARMS Lo Temp Alarm Off On y Upper Limit y ppd y ch Lower Limit 93 Se
118. ble for 12 lead unit Treatment Intubate IV EPI Lido Atrop Sample Clear Next Recorder Display Alarms SPO NIBP Resp Recorder Set Up Back Respiration ECG COs Trend Back ECG Resp Setup Size Speed Response Back Resp Resp Resp Size Speed Response Menu Menu Menu Use the Resp Size menu to adjust the size of the displayed respiration trace Press X1 X2 or X4 A to select the waveform size A bold outlined box indicates the selected size Press EXIT B to return to the Resp Configuration menu Use the Resp Speed menu to adjust the Respiration trace speed on the display and allow manual calculation of the respiratory rate The respiration waveform speed time it takes the trace to travel from the left side to the right side of the display options are 5 10 20 30 or 60 seconds C A bold outlined box indicates the selected speed Press EXIT to return to the Resp Configuration menu WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MENUS Response Menu Use the Respiration Response menu to select the averaging interval that will be used during a respiration measurement Slow averages the respiratory rate on a moving 60 second average Normal averages the respiratory rate on a moving 30 second average Fast averages the respiratory rate on a breath by breath basis Press a butto
119. ce recording enabled NOTE When recording data make sure that the write protect switch is off to allow the writing of information to the data card NOTE Treatment Summary events will also be recorded to the p internal Log during data card recording Reviewing Data in the Welch Allyn Data Card Card Review To review data on the data card the operator needs to access the Card Display Review menu in the configuration menu see below Treatment Bret Sample Clear Next Configuration Display Alarms SPO NIBP Resp Recorder Setup l Back Recorder Log Review Voice Trends Back Notice CAUTION Are you Sura Detibrillater and Pacer are DISABLED in Lard Review Cancel WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 12 19 DOCUMENTATION Card Review Windows Trace Window 12 20 Upon pressing REVIEW the Review Menu will appear It will caution you that if this option is selected Continue is pressed the operator will not be able to monitor pace or defibrillate the patient CAUTION All PIC functionality is disabled during Card Review In addition the Card Review menu will be locked out if the PIC is currently Pacing NOTE Welch Allyn compatible data card must be inserted in order to access the Card Review menu Switch the write protect switch to on before inserting the card into the PIC System to prevent any further information from being appended on to the data card while reviewi
120. charging The yellow light will flash when the battery is fully charged Defibrillator Test Indicator Green light is briefly illuminated to indicating that 200J or more has been delivered when testing the defibrillator Defibrillator Test Paddle Trays Paddle trays contain discharge contacts used for testing the defibrillator AC Inlet Connector accepts standard IEC 320 line cord with earth ground AC Power Cord A variety of cords are available to allow for connection of the PIC to virtually any worldwide AC line power source AC Power Cord E on Ce lt lt Pade holder AC Power Cord and defib tester ACpowor FESS ery Charger cai Defib tester i ical e forrin T Battery WelchAllyn WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 15 3 POWER SOURCE Power Source Controls and Indicators Welch Allyn SmartPak Plus Battery S Welch Allyn SmartPak Plus 12 volt battery provides power to the PIC System 1 Status indicator The status indicator will illuminate when the test button is pressed unless the battery is totally depleted A green light represents usable battery power while a red light indicates that the battery is low and should be exchanged for one that is fully charged To conserve power and extend shelf life the indicator lights only during a battery test unless the battery charge becomes low while in use This will cause the indicator to blink red as an a
121. d 2 30 VP 800 MHz to 2 5 GHz 3 V m d 4 P IBP only 80 MHz to 800 MHz d 7 67 VP 800 MHz to 2 5 GHz Where P is the maximum output power rating of the transmitter in watts W according to the transmitter manufacturer and d is the recommended separation distance in meters m Field strengths from fixed RF transmitters as determined by an electromagnetic site survey should be less than the compliance level in each frequency range Interference may occur in the vicinity of equipment marked with the following symbol Key A WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM ADDENDUM 19 PIC 40 50 USER S MANUAL ADDENDUM eee Note 1 At 80 MHz and 800 MHz the higher frequency range applies Note 2 These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people a The ISM industrial scientific and medical bands between 150 KHz and 80 MHz are 6 765 MHz to 6 795 MHz 13 553 MHz to 13 567 MHz 26 957 MHz to 27 283 MHz and 40 66 MHz to 40 70 MHz b The compliance levels in the ISM frequency bands between 150 kHz and 80 MHz and in the frequency range 80 MHz to 2 5 GHz are intended to decrease the likelihood that mobile portable communications equipment could cause interference if it is inadvertently brought into patient areas For this reason an additional factor of 10 3 is used in calculating the recommended separation distance for
122. d deferlaretion of Lime ta the battery drop or mebyd bo ehen piristi bhoti thar than WAL pi docti 15 5 POWER SOURCE EE Welch Allyn Quick Charger Conditioner 15 6 Controls and indicators listed below are illustrated on the following graphic l 10 12 13 14 15 16 Power On Indicator Green Power On light is illuminated when the unit is plugged into an AC outlet or into vehicular power 1f equipped with 12V adapter option Defibrillator Test Indicator Red light is briefly illuminated to indicate delivered defibrillation energy of 200J or more has been delivered by a Welch Allyn defibrillator Defibrillator Test Paddle Trays Paddle trays containing discharge contacts used for testing Welch Allyn defibrillator Battery Charging Indicator Yellow light is illuminated continuously to indicate that a Welch Allyn SmartPak battery is charging The yellow light will flash when the battery is fully charged Reconditioning Pushbutton Pressing this button will initiate a reconditioning deep discharge charge cycle on the battery located in slot 3 Reconditioning Indicator Red light is illuminated to indicate that the battery in slot 3 is undergoing a reconditioning cycle Charge Reconditioning Slot Dual function slot used for either charging or reconditioning battery packs Slot 3 Charge Slots Slots used for charging battery packs only Slots 1 amp 2 Welch Allyn Batteries inserted in Slo
123. d for G E the motherboard preamp defibrillator oximeter and blood pressure board The Modem Self Test menu allows the supervisor to run a modem self test Note Test will take Modem Self Test approx 8 sec to finish 13 38 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MENUS Lea Card Menu From the Card menu the supervisor can get Card f information about the memory card size type contents format count and format date erase the memory card and program L the Welch Allyn PIC from a programmable Program PIC card NIBP Cal Menu The NIBP Calibration menu is used by NIBP authorized service personnel to calibrate the PIC blood pressure measurement Pump Up WARNING This menu should be used only by authorized service personnel DO NOT attempt to calibrate the blood pressure when the PIC System is being used ona person SPO Cal Menu From the SPO Cal menu the supervisor SPO Ca can press the up down arrow buttons to select a bias calibration The options are 0 1 or 2 Mod Out Cal Menu From the Mod Out Cal menu the supervisor can test the calibration of the 1V out connection Press OmV and the measured voltage should be OV Press 1mV and the measured voltage should be 1V Press MAX and the measured voltage should be less than 4 52V Press MAX and the measured voltage should be less than 4 76V WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 13 39
124. der Voice configuration menu Follow steps below to play skip forward skip backward currently playing audio only or stop internal log s audio events WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 12 13 DOCUMENTATION EE Voice memo playback options Press Play Skip A FWD Skip BWD D f RECORDER Stop y ese esa nse slender el SSE SAE naan Se Press Exit to ch exit window E U E intubate Iv i Sample Clear Next Press Next SPO NIBP Resp Recorder Set up Fress Recorder Back Trends Voice Fress Voice Voice Mama Grid log Review Voice Trends Back m Press Back twice to exit F recorder menu Using the Welch Allyn Data Card Card Review optional 12 14 The PIC System s Card Review option is a unique feature used to assist the operator in reviewing patient information that has been recorded to a data card including ECG event and speech data The Card Review feature groups ECG event and speech data into individual patient records This information can be viewed and printed on the PIC System using the Card Review menu or viewed and printed on a PC using Welch Allyn s SmartView software CAUTION During Card Review all other PIC functionality will be disabled including Defibrillator and Pacer functionality In addition the PIC will not allow entry into the Card Review mode unless both the Defibrillator and Pacer are in the inactive or paused states WELC
125. e After the PIC system has acquired the 12 lead information the operator can use the quick access functions to review store and transmit data to a remote location by pressing any of the quick access buttons Analyze Function If installed the analyze function displays the diagnostic results of the acquired 12 lead ECG See chapter 18 for details and instructions for 12 lead interpretive analysis Save Function LI If a data card is installed pressing the save button will download the acquired 12 lead information to the PIC System s PCMCIA data card Autosave Function If a data card is installed printing or faxing a 12 lead snapshot will automatically save the snapshot to the datacard An S will appear on the save icon indicating that the current snapshot has been saved log in a rotary queue which stores the 8 most recent NOTE Each 12 lead snapshot is automatically saved to the internal snapshots WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 5 11 12 LEAD MONITORING OPTIONAL 9 12 z z NOTE Transmission time after connecting will be approximately NOTE For instructions on Mobitex and I minute 40 seconds at 9600 baud This time will be slightly longer if a datacard is installed Send Function KDY A Optional functions for the Send remote transmission of 12 lead ECG data include fax PaaS Mobitex and Cellular gt eS Cellular operation see Chapter 19 If
126. e active event is a 12 lead event press the Analysis icon to NY analyze the data for interpretation See chapter 18 12 lead Interpretive Analysis for details NextPage If the active event is a 12 lead event it will display the next 3 3 seconds of the displayed traces gt P1 card will be rescanned to determine its usage and capacity This function also allows for the capability to review a different data card without having to reboot 1 e Insert the memory card first then press P1 P1 Resets to Patient 001 the first patient on the data card The Exit To exit the Card Review menu press the Exit button It is the bottom button on the right The PIC will reboot o ise gt gt Pe Next E Printing To print out the Card Review press the printer quick access button The information printed will include current patient information the four events currently displayed in the Event History Window and 12 seconds of single trace ECG 4 seconds preceding the active event and 8 seconds following the active event if available A vertical line will encase the Card Review printout to separate it from Log Printouts and or Sample Printouts Printout of a 12 lead event will be the same format as that selected in the Supervisor gt 12Lead gt Printer menu see page 5 8 ie a rmk ren wi F i calle i malia aa a AA f l 1 m Pte le Bi a Pala oe ee a aa a a Ei cae WELCH AL
127. e following corrections are included e SAED Basic Displays pages 7 2 7 4 SAED Basic Mode corrections to pages 7 2 7 4 Defibrillation Modes Note If an ECG rhythm is non shockable it may qualify as 2 No Shock analysis results to hasten entry into CPR mode SAED Basic Displays Self Test Passed The PIC performs a self test when the power is turned on The display shows SELF TEST PASSED when the test is successfully completed and the PIC begins SAED Basic Mode operation _ SAED BASIC MODE j Lead Fault Indicates a lead fault condition Neither the defibrillation electrodes nor the ECG cables have been properly attached to the patient Check to see that the defibrillation electrodes have been properly attached to the patient and to the Hands free adapter The PIC will announce as as i Apply defib pads check ECG electrodes during this condition The m display will indicate LEAD FAULT and in lieu of an ECG to signify lead fault WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM ADDENDUM 3 PIC 40 50 USER S MANUAL ADDENDUM Bee ae ew ee ee ee A ANALYZING PADS STAND BACK l o006 43 pe lay SAED BASIC MODE ZT te te fF is fe a HO SHOCK ADVISED AR ING PADS SAED BASIC MODE SHOCK ADVISED CHARGING STAND CLEAR ik bh CHECK PULSE iF NO PULSE START CPR
128. e or weighing less than 22 pounds or patients with a respiration rate greater than or equal to 60 breaths per minute ee Attach airbag 00 n airway adapter Attach I Intubation Tube CO connector N magenta pra jl qd CO airway a EAT co adapter attached ew gensor dp to the CO sensor lt k F S BA 4 4 t U IA Le O CO cable adapter J GE p e x CO and ETCO USING THE CO AND ETCO gt OPTION Options 1 Press the POWER switch to ON A 2 Connect Welch Allyn CO cable CO sensor Airbag and Intubation tube a Connect the Welch Allyn CO cable adapter to the Welch Allyn CO connector b Connect the Welch Allyn CO cable adapter to the Welch Allyn CO sensor c Connect the Welch Allyn airway adapter to the Welch Allyn CO sensor WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 11 9 RESPIRATION AND C02 OPTIONAL 11 10 D Q CAUTION Do not reuse airway adapters that are labeled for single patient use CAUTION Prior to using airway adapter check for lodged obstructions After attaching check the adapter for proper placement of the sensor NOTE Ifusing the CO monitor for extended critical care replace the airway adapter every 24 hours or when it becomes occluded 3 Place smaller end of airway adapter into the intubation tube Make sure the airway adapter sits comfortably without discomfort Secure with tape if patient is unconscious
129. e parameters alarm settings and status are displayed to the right of the trace 17 2 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM IBP Loo NOTE Upon activation of the IBP monitoring function the display will change such that the IBP trace will be presented in waveform 2 or 3 If the display was previously in I or 2 trace mode the IBP trace will be presented in waveform 2 or 3 with the previous trace s still displayed If the display was previously in 3 trace mode the IBP trace s will replace the previously displayed traces in waveform 2 and 3 NOTE While IBP monitoring is activated no other trace parameters can be selected for display in the trace that is enabled IBP Operation Procedures Step 1 Attaching equipment to patient and the PIC System 1 Inspect the IBP Adapter Cable 001957 for any damage or fraying Replace if damage is apparent 2 Attach the IBP Adapter to the PIC System in the IBP1 or IBP2 Connector 3 Attach the IBP Adapter Cable to the interface cable and to the transducer according to your transducer manufacturer s directions NOTE Contact Welch Allyn for appropriate interface cable for your transducer Step 2 Setting up the PIC to view IBP information Follow the steps below to configure the PIC System s IBP 1 Turn ON the PIC 2 Select the IBP QUICK ACCESS button to bring up the IBP menu WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 17 3 IBP Step 3 17 4
130. e patient When the pacer is in the paused mode a PACER STOP message will be displayed in the Pacer Window When the pacer is not paused a PACING message will be displayed in the pacer window PACER STOP Pacer Stop 60 BPM 60 BPM 30 MA 30 MA DEMAND DEMAND Pacing Pacing Stopped paused automatically stop and a fault message will be displayed in F NOTE Whenever a pacer or ECG lead fault occurs the pacer will the pacer window WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 8 5 EXTERNAL PACING EE External Pacer Operation Procedures Anterior Posterior To perform external pacing perform the following steps 1 Press POWER switch to ON 2 Apply ECG monitoring electrodes as illustrated above return to chapter 4 for more details if needed 3 Connect Welch Allyn ECG patient cable to the patient and the PIC System 4 Connect the multipurpose hands free adapter to the PIC System Make sure that the connector locks into place 5 Apply multipurpose defibrillation pacing electrodes to patient as illustrated on the electrode package Use Welch Allyn Multipurpose electrodes model 001789 for adult patients and model 001781 for pediatric patients lt 10kg 6 Connect multipurpose defibrillation pacing electrodes to the multipurpose hands free adapter 7 Press LEAD and select I II or III to provide the largest amplitude QRS complex 8 Press SIZE and adjust size to insure proper sensing of the pati
131. e quick access volume increases and decreases the volume of the PIC System There are four volume settings that can be selected with each press of the VOLUME button The volume ramp a1 indicates the volume level selected Alarm A A ne The quick access global alarm enables or disables all set alarm parameters When the PIC System is turned on the global alarm will default to the last setting at system shutdown either enabled 4 or disabled X To enable global alarms press the GLOBAL ALARM button 1 to display the alarm on icon With the global alarms enabled any set alarm parameter will be enabled To disable global alarms press the GLOBAL ALARM button Oo D Al two times The first press of the button 2 will change the icon to PUSH TO DISABLE The second press 3 will change the alarm icon to OFF X If the button is not pressed a second time within 10 seconds global alarms will automatically revert to enabled 4A With the global alarm disabled all parameter alarms will be disabled WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 4 5 ECG MONITORING QRS Beeper Icon qh Calibration Icon JL z Auto Heart Rate Set w 4 6 The quick access QRS beeper turns the beeper on and off Beeper OFF Ne Beeper ON cL The quick access calibration control is used to send a calibration signal to the monitor chart recorder 1V and modulated outputs NOTE Cal button is disabled in x4 gai
132. e the pulse oximeter whenever monitoring the respirations to accurately assess the patient s respiratory condition The waveform window can display the respirations and or the plethysmograph waveform with the ECG waveform when properly configured see User Menus Display in chapter 13 or see below When configured the waveform window will display a respiration waveform Resp indicates the respiration waveform window In this example x1 indicates the waveform size and 5s indicates the waveform speed in seconds Resp x1 5s Pacer On Resp disabled NOTE If the external pacer has been turned on the respiration detector will be disabled and a status message will be displayed in the respiration waveform window indicating Pacer On Resp disabled See below WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 11 3 RESPIRATION AND C02 OPTIONAL Respiration Operation Procedures NOTE Respiration monitoring through ECG Electrodes on pads is not available on units with the 12 lead option installed 1 Connect either ECG electrodes or TE hands free pads to the patient N I FAN 2 Press POWER switch to ON 7 TST a i 3 To activate the respiration monitor you must select the respiration l ie A i waveform in the Traces menu see Jf of a instructions below Bret Sample Clear Configuration Alarms SPO Recorder Setup Back Display Menu Filters Pt Cable Brightness Contrast Back Re
133. e window WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 14 5 ALARMS Pulse Oximeter SPO Alarm Setting SpO Alarms 14 6 z SPO Alarm Upper Limit Lower Limit B5 In the SpO alarms menu the SpO alarms can be set Off or On The appropriate alarm icon appears in the SpO window indicating the SPO x 98 0 Signal OK t current state of the alarm SETTING SPO2 ALARM TO OFF To set the SpO alarm to off press the OFF ON button A until Off is highlighted When the SpO alarm is set to Off the upper and lower limits will each display Off and a number The number indicates the current set SpO limit that will be active when the SpO alarm is turned on See example below F02 Alarm Off SPO alarm off upper limit setting is 99 SPO alarm off lower limit setting is 85 NOTE Ifa limit is disabled the word DISABLED will appear instead of Off number SETTING SPO ALARM TO ON To set the SpO alarm to on press the OFF ON button A until On is highlighted When both the upper and lower SpO alarm limits are set to On the alarm on icon will appear in the SpO window and the global alarms will be turned on On 1 Set the upper limit Press the UPPER LIMIT button B to select upper limit A bold line will appear around the box Press the up or down arrows C to increase or decrease the upper limit value You can disable the upper limit by pressing the upper limit bu
134. each test shock 4 Measure the charge time for the 10th shock This time should be less than 7 seconds for the SmartPak Plus battery or less than 9 seconds for the SuperPac battery NOTE Technique and reaction time are human factors that may i affect the consistency of these measurements 5 If the charge time exceeds the limits given in step 4 recondition the battery pack and perform the test again If the battery pack again fails the test consider the age of the battery and the frequency of its use These factors determine how long a battery can continue to provide adequate performance A weak battery should be removed from service and replaced with a new fully charged battery 6 Keep discharged batteries separated from spare batteries what are charged For example when removing a discharged battery from the monitor never place it in the location intended to carry a spare Guidelines for Maintaining Peak Battery Performance 1 Each battery should be identified with a number or letter An identification mark will be useful in tracking battery performance 2 Keep extra batteries in the Welch Allyn charger where their status can be quickly determined A blinking indicator is the most positive indication of a fully charged battery 3 Always carry at least one fully charged spare battery If no other source of back up power is available two spare batteries are advisable 4 Rotate spare batteries routinely The charge l
135. ead Mode Basic 12 lead mode is the default start up mode of the PIC System 1f the 12 lead option is installed and the 12 lead cable is connected In this mode the operator will be able to view each of 12 leads in the waveform window 1 Press the PIC System s POWER switch on 2 The lead window will automatically sense the type of patient cable inserted into the PIC System Check the lead window to insure that the display indicates a 12 lead patient cable is inserted into the patient connector 3 Thoroughly prep patient skin for electrode attachment Clean and dry skin sites preferably with a coarse dry terry cloth Next clean skin with alcohol and allow to dry completely before applying pads 4 Connect each lead of the 12 lead patient cable to the appropriate disposable electrode Arrange the electrodes as shown on page 4 7 Make sure that the ECG electrodes are placed to allow defibrillation if necessary 5 Observe the patient s electrocardiogram on the DISPLAY Adjust size of the ECG trace with the SIZE button as necessary 6 The displayed lead in the waveform window can be selected by pressing the LEAD button WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 5 7 12 LEAD MONITORING OPTIONAL Active 12 lead Monitoring Controls and Displays Lead Size window s TT SS SG iS i i 0 _ I _ i m TS TS SS TS SS i SS Sr re ee rr rr ea ser et Voice fam 48 oa 1 ___ WelchAllyn
136. ectiveness Summary 000 cece ees A 12 Data Acquistion The PIC is no longer automatically configured to a certain frequency and Analysis response There are two diagnostic frequency options Diagnostic Frequency Filter and Filtered Diagnostic Frequency Filter See chapters 5 and 13 on switching between these two options Defibrillator Waveform Details The tables below provide details of the waveforms delivered by the PIC when connected to resistive loads of 25 50 and 100 Ohms and set to its maximum output The waveforms are characterized by typical values for peak current I and for monophasic duration of the output phase t or for biphasic duration of the first output phase tphase1 and duration of the second output phase tphase2 The values shown are within 10 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM A 1 SPECIFICATIONS A 2 Waveform Welch Allyn Model PIC Truncated Exponential Ip Amps Monophasic Waveform Welch Allyn Model PIC Truncated Exponential Biphasic Load Output Energy Accuracy 10 or 1J whichever is greater at 50 ohms 15 or 1J whichever is greater at 25 to 100 ohms Energy Select External 2 5 7 10 20 30 50 70 100 150 200 300 360 J Charge Time lt 7 seconds 360 J with a SmartPak Plus battery after 15 discharges lt 9 seconds 360 J with a SuperPac battery after 15 discharges lt 15 seconds 360 J no battery 90 AC mains vol
137. ed initially in the 12 Lead Review Menu If VIEW is pressed the presently selected snapshot from the internal log will be drawn on the screen for review The quick access window will change to display analysis save send print page and back icons NOTE Ifmore than 10 snapshots are stored the oldest snapshots will be overwritten WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 5 9 12 LEAD MONITORING OPTIONAL Active 12 lead Display 5 10 After the PIC system has either acquired a new 12 Lead snapshot or reviewed an old 12 Lead snapshot from the internal log the display is divided into a SNAPSHOT window on the left and a real time ECG window on the right The snapshot window first displays 3 33 seconds of stored information from leads I H and III The real time window will display a real time trace of the corresponding leads I II and HI EEEL is Sis is 100 8 i 98 IZ LEAD f signal tK Analysis e ave pii r RE Fax Print gt Page RCS TPA PACH Ky Es mp Sekcia Energy G0 DPM 96 a iio mA DEMAND d iniutabe EP Back VIEWING THE SNAPSHOT INFORMATION The snapshot of each lead is 10 seconds in duration The snapshot window displays 3 33 seconds of each of 3 leads at a time Each snapshot consists of 3 pages of 3 33 seconds of ECG a Leads I II HI are displayed first in page one of the snapshot window b To scroll through the other
138. ed clean and Accessories with a damp cloth moistened in a mild detergent solution or according to manufacturer s instructions WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 16 13 MT CHAPTER 17 IBP This chapter provides information on the IBP controls displays displayed waveform names and the operation procedures Chapter Overview e Intended Use e IBP Controls and Displays e IBP Operation Procedures IBP1 Connector IBP2 Connector WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 17 1 IBP EE Intended Use The Welch Allyn IBP option has been designed to measure arterial venous and intracranial pressures using invasive transducers with Su V V mmHg sensitivity IBP Controls and Display IBP functions on the PIC System are viewed on and controlled by the areas highlighted below The following operations of IBP depict the normal factory default PACING k Selected Energy 60 BPM nS 200 DEMAND 54 J Treatment Intubate Atrop Sample Clear Controls IBP is operated by using both the QUICK ACCESS and BOTTOM MENU buttons If the primary Quick Access menu is displayed press the NEXT button to access the IBP controls The IBP Quick Access menu allows the user to zero the sensors scale the traces and select the IP channel source Display To operate the IBP the IBP trace must be displayed Using the QUICK ACCESS MENU buttons the operator can choose to enable two simultaneous trace data from IBP1 or IBP2 Pressur
139. ee eae displayed when turned on System On 12 06 56 Manual Mode 12 06 56 Self Test Passed TURNING ON OFF THE CHART RECORDER 1 Press PRINT button to begin printing 2 Press PRINT button again to stop printing Manual Printout Each time the chart recorder button is pressed the following information will be printed Welch Allyn PIC Date Time ECG Lead LEAD ECG Size A indicates AUTO sizing setting Frequency Response FREQ Heart Rate HR Sync on if activated SpO2 reading OX Off or OX On Notch On or __ Notch Off __ Lean emmy A ENNIS 1E1323 RS FREQ Monitor Response SpO 98 Standard Printout WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 12 3 DOCUMENTATION Lead II 1cm mV A 2 01 98 12 13 23 1 4 1 i 4 1 1 4 1 i 1 1 1 i 1 1 1 1 1 i ECG Lead Fault Defibrillation After the defibrillator has been discharged the chart recorder will automatically run for 12 seconds providing 4 seconds of pre shock ECG and 8 seconds of post shock ECG In addition the selected defibrillation energy will be printed R DEFIBFIRED Sel 200J Del 200j 12 13 18 LEAD II 2cm mV A HR 60 Defibrillation Pacer Activation After the pacer has delivered pacing pulses the chart recorder will automatically run for 8 seconds providing 4 seconds of pre pace ECG and 4 seconds of post pace ECG In addition to the standard chart annotation the pacing rate output and mode information
140. ee insertion and backup reliability Weight 13 2 pounds 6 kg with battery Dimensions 13 2 L x 12 6 W x 5 4 H 33 5L x 32W x 13 7H cm Operating Temperature 0 to 45 C Humidity NC 15 to 95 RH 30 to 90 with CO2 probe Vibration MIL STD 810E Shock Drop MIL STD 810E Altitude Up to 4572 M 15 000 feet Transport and Storage Temperature 30 to 70 C 20 to 70 C with CO2 probe Humidity 15 to 95 RH non condensing Atmospheric pressure 860 to 1060 hPa Shock vibration ISTA 1A Enclosure Protection Solid Foreign Object IEC 529 IP2X Water IEC 529 IPX4 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM SPECIFICATIONS Loo Operating Power Welch Allyn SmartPak or auxiliary power from either Welch Allyn Quick Charger 971104 or the Welch Allyn Power Supply Paddle Tray 971029 Electrical Fast Transients Magnetic Field Susceptibility Pacer Type External transmittances pacing Pacer Rate 30 to 180 BPM 5 Output Current 30 to 180 mA 10 or 5 mA whichever is greater Modes Demand and asynchronous Status Indicators ECG lead fault pace lead fault pace marker on monitor and chart start stop LED Pulse Type Rectangular constant current Pulse Width 20 ms Refractory Period 250 ms Output Protection 360 Joules WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM A 7 SPECIFICATIONS EE SAED Rhythm The PIC SAED algorithm exceeds the requirements of ANSI AAMI Recognition
141. elected Energy ple Clear Next Card Lock selected Energy Clear Next PGM Card Selected Energy 200 ple Clear Next CFG Card selected Energy 200 Clear Next WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM Displayed when a data card is being formatted or whenever data is being read from the data card Displayed when data card has write protect on Displayed when a properly formatted program card is inserted into the PIC with write protect on or off Displayed when a properly formatted configuration card is inserted into the PIC with write protect on or off 12 17 DOCUMENTATION EE Formatting the A data card can be erased and formatted in the Card Menu Data Card FORMATTING THE DATA CARD 1 Switch the write protect switch to off on the back of the PCMCIA card move switch to left which allows the card to be formatted and insert the card into the PIC System 2 Use the configuration window to access the Card Menu window by pressing Next gt Set Up gt Supervisor gt Diag gt Card See chapter 13 for more detailed information NOTE Upon entry into the Card Menu data recording to the data card will be halted Upon exiting data recording will restart if the card has not been formatted 3 Inthe Card Menu press CARD ERASE to begin formatting The Card Busy display will be shown Format status will be displayed on the screen The formatting process will t
142. elivers less than half of the peak current of an MDS waveform defibrillator at equal delivered energies A new Welch Allyn defibrillator the Welch Allyn PIC has been introduced which offers a biphasic truncated exponential waveform that incorporates MRL s original low peak current impedance compensation design The MRL Orbital M biphasic truncated exponential waveform has been extensively tested in multiple scientific safety and effectiveness studies Over 524 fibrillation defibrillation shock episodes have been conducted using the MRL Orbital Biphasic waveform comparing it to MDS MTS and another commercially available 2kV biphasic 360 J capable defibrillators Results of three of the scientific safety and effectiveness studies are summarized below Study 1 Objective To evaluate the MRL Orbital Biphasic waveform defibrillator against a monophasic damped sinusoidal waveform defibrillator Methods A canine model n 5 71 7 Ibs was used in a study that was approved by the Institutional Animal Care and Use Committee The animals were anesthetized with 20 mpk sodium pentothal 1 v and maintained as required through an intravenous catheter in the foreleg The external jugular vein was cannulated and a bipolar pacing catheter was introduced under fluoroscopic control and advanced into the right ventricle The femoral artery was cannulated and an intra arterial line was placed for continuous measurement of arterial blood press
143. em 6 Select the proper lead setting for the desired lead configuration by pressing the LEAD button to the appropriate position I IT or IM 7 Observe the patients electrocardiogram on the display Adjust size of the ECG trace with the SIZE button as necessary MONITORING WITH 5 LEAD PATIENT CABLE 1 Press POWER switch ON 2 Insure that the display indicates a 5 lead patient cable has been configured If not see chapter 13 for setting patient cable 3 Thoroughly prepare patient skin for electrode attachment Clean and dry skin sites preferably with a coarse dry terry cloth Next clean skin with alcohol and allow to dry completely before applying pads 4 Connect each lead of the 5 lead patient cable to the appropriate disposable electrode Arrange the electrodes as shown below Make sure that the ECG electrodes are placed to allow defibrillation if necessary 5 Insert the patient cable plug into the input ECG connector on the PIC System 6 Select the proper lead setting for the desired lead configuration Press the LEAD button to the appropriate position corresponding to the desired configuration 7 Observe the patient s electrocardiogram on the display Adjust size of the ECG trace with the SIZE button as necessary 4 8 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM ECG MONITORING 5 Lead Electrode Placement 5 Lead Electrode Placement oar RL Black N a mid clavicular line between 6th and 7th
144. em accessories and cables in a position where they Harm cannot harm the patient should they fall Keep all cables and hoses away from patient s neck Performance The Welch Allyn PIC System may not meet performance specifications 1f stored transported or used outside the specified storage or operating environmental range limits Treatment Summary To prevent incorrect trending data from being printed clear the Log Treatment Summary Log from the Recorder Log menu prior to use on a new patient Use on One Patient The Welch Allyn PIC System is intended to be used on only one patient at a Time at a time WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 1 7 SAFETY INFORMATION Monitoring Precautions e WARNING PACEMAKER PATIENTS The Welch Allyn PIC includes a pacemaker rejection circuit The following warning is in accordance with the disclosure requirement of AAMI Standard EC13 3 1 2 1 8 The rate meter may continue to count the pacemaker rate during some occurrences of cardiac arrest or some arrhythmias Do not rely upon the heart rate meter alarms to assess the patient s condition Keep pacemaker patients under close surveillance Pacemaker pulses of the type specified in AAMI EC13 1992 section 3 1 4 are detected at amplitudes greater than 20mV and rejected by the heart rate display However pacemaker pulses that are superimposed on the ECG at very low amplitudes may be counted by the heart rate display NOTE This warnin
145. ement of the Welch Allyn batteries is recommended every 24 months Do not use the battery after the Do Not use after date labeled on the battery pak WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 15 11 POWER SOURCE EE Welch Allyn 12 Volt Vehicular Adapter About the Welch The Welch Allyn 12 Volt Vehicular Adapter provides continuous Allyn 12 Volt monitoring pacing and defibrillation auxiliary power to the PIC Vehicular System The 12 volt adapter can be plugged into the PIC System while the PIC is on or off without interfering with patient monitoring pacing or defibrillation The 12 volt adapter will work with or without a battery inserted in the PIC System Charge times however will be slightly slower if there 1s no battery inserted not greater than 12 seconds per 360 Joule charge A fully charged battery inserted with 12 volt auxiliary power connected will decrease the charge time to 7 seconds or less CAUTION If a battery is inserted in the Welch Allyn PIC System while using the 12 volt adapter energy from the battery will be utilized for charging and discharging the defibrillator Therefore it is recommended that the inserted battery be replaced with a fully charged battery before disconnecting the 12 volt auxiliary power while monitoring a patient and before the next call OPERATING THE 12 VOLT ADAPTER 1 Plug the 12 volt plug into the vehicle s 12 volt cigarette lighter receptacle NOTE The cigarette li
146. ent Connect the ECG patient cable to the ECG input connector Press the LEAD button to select lead H position if using the hands free defibrillator pads select PAD lead position If using 5 lead patient cable see chapter 13 to change 3 lead selection to 5 lead select lead II position Observe the patient s ECG on the display Apply electrode gel to the center of one paddle electrode Lightly press the paddle electrodes together and spread the gel evenly over both paddle surfaces Make sure the gel covers the entire paddle surface Do not allow any gel to touch the paddle handle or the operator hands Press the SYNC button to engage the synchronizer The light next to the Sync button will illuminate and an S marker will appear over the portion of the ECG that the defibrillator will trigger on The Sync light will flash off with each Sync marker WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MANUAL DEFIBRILLATION select to another position I I IIT or adjust ECG size If the Sync marker is not obtained the defibrillator will not discharge Do not switch the lead from PADS if monitoring with hands free defibrillation pads NOTE If the marker pulse does not appear over the R wave turn lead 6 Press ENERGY SELECT button on the front panel up or down to select the desired energy level 7 Charge the defibrillator by pressing the CHARGE button on the defibrillator panel or the CHARGE button on the deluxe apex padd
147. ent s heart rate Confirm that the displayed heart rate coincides with the patient s heart rate 9 Press PACER to turn pacer on the pacer window will become active The pacer indicator will illuminate orange indicating that the pacer is stopped and that no pacer pulses are being delivered to the patient NOTE When the pacer is on the lead selection will be restricted to Leads l II or II S 8 6 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM EXTERNAL PACING 10 Press RATE button to select the desired pacing rate NOTE The initial pacing output rate can be set in the Pacing Supervisor Menus See chapter 13 11 Press the MODE button to select the appropriate therapy Each time the MODE button is pressed the pacing mode will change between demand and async mode The selected mode will be displayed in the pacing window NOTE The initial pacing mode can be set in the Pacing Supervisor Menus See chapter 13 In DEMAND MODE pacing pulses will be inhibited by the patient s QRS complexes that occur during a time interval that is dependent on the setting of the rate control If during that interval no QRS complexes occur a pacing pulse will be delivered to the patient In the demand mode the pacer supplies the required number of pacing pulses to maintain the patient s heart rate at approximately the rate selected in the pacing rate window Due to the delay between delivered pacing pulse and the patien
148. er paper roll the free with swing door closed end should be over the top of the roll NOTE The low paper indicator is signified by a black or red strip at the top of the chart recorder paper When the indicator appears approximately 8 feet of paper is left on the roll LOADING CHART PAPER l Open the door by pushing on the release lever located on the side of the chart recorder Remove the empty spool core Place the new roll of ECG paper with the free end of the paper on top of the roll Insert the new spool until it snaps onto the spool retaining arms The spool should be positioned so the inside or shiny side of the paper contacts the thermal array print head The spool should feed paper from the top Pull out approximately 2 3 inches of paper and bring the free end of the paper around to the front of the swing out door then completely close the door With the power switch on press the chart recorder button and allow the paper to feed through the roller automatically NOTE If icon flashes on the display the paper is probably not moving freely through the slot in the door or the door is not completely shut Open the door and make sure the paper moves freely through the slot after closing the door again WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM DOCUMENTATION Voice Memo Voice Memo z If the chart recorder runs but nothing is printed the paper is in backwards Rotate the
149. erform a series of self tests and a Self Test Passed message will be printed on the chart recorder paper Installed options will appear on the display after the self test has been completed Compare the installed options on the display with the options you checked off on previous page To set time and date see chapter 13 Perform daily shift test see chapter 16 To review default menu settings see chapter 13 If you note any discrepancies please contact Welch Allyn with your model and serial number WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM INTRODUCTION Summary of Operations System Setup ECG Monitoring cr ae 0 0o Defibrillating m 7 ie T CAUTION The Summary of Operations should be used as a mo oF ue reference only by those who have already read the User Instruction Manual Please read the User Instruction Manual completely before using the PIC System Press POWER switch to OFF Connect appropriate options and accessory equipment Install charged battery or auxiliary power source Press POWER Switch to ON Clear log if the graph indicates a previous patient s events are in the log Verify that the configuration menus are set appropriately Connect ECG patient cable multipurpose hands free adapter or paddles to the PIC System Prep patient s skin and connect electrodes to patient Select appropriate LEAD Adjust SIZE as necessary Monitor patien
150. eriodic requirements such as calibration and certification Additionally the log can be used to track the age of accessories such as batteries which require periodic testing and replacement WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 16 1 MAINTENANCE AND CARE EE Daily Shift Check Procedure 16 2 In accordance with the recommendations of the Defibrillator Working Group of the Food and Drug Administration Welch Allyn has provided an operator s shift check list which can be copied for use as needed VISUAL INSPECTION 1 Inspect the PIC s Performance Calibration Log located on the bottom of the PIC System to insure that a PM Calibration has been performed within one year 2 Visually inspect the AC power cord for the Welch Allyn Quick Charger auxiliary power cable ECG patient cable hands free and or paddles adapter pulse oximeter sensor blood pressure cuff hose and sensor and temperature probe for signs of wear or damage Replace if damaged 3 Locate and inspect the batteries monitoring electrodes Multipurpose electrodes and paddle gel and ensure they are within the expiration date stamped on the package 4 Verify that a charged battery has been fully inserted into the battery compartment of the PIC System 5 Inspect the PIC System and Welch Allyn Quick Charger to insure they are clean that no liquid has been spilled on them and that they have not been damaged 6 Inspect the chart recorder to insure
151. ery weak pacemaker pulses my not consistently produce markers Therefore always check patient history especially when wide QRS complexes indicate the presence of an internal pacemaker NOTE Ifa patient has an internal implanted pacer pacer marker NOTE Pacer markers may inadvertently be generated by high frequency external interference Therefore randomly occurring infrequent pacer marker spikes may be seen on the ECG and may not signify the presence of an internal pacemaker If inadvertent spikes are frequent enough to create a nuisance attempt to eliminate any close sources of interference or move to a different location Pacing Messages PACER STOP indicates that pacer is on and paused will not deliver Pacer Stop 60 BPM pacing pulses to patient 60 BPM indicates pacing rate set at 60 beats 30 mA DEMAND per minute 30 MA indicates the pacer output in milliamperes DEMAND indicates that the pacer is set in demand mode Pacer Faults Messages may appear if the pacer detects a fault condition Pads Lead Fault Pacer Fault The pads lead fault indicates that the multipurpose hands free adapter Pads Lead Fault Connect Pads has not been installed or that the multipurpose pads have not been E attached to the patient or multipurpose hands free adapter To correct fault install the multipurpose hands free adapter and connect the hands free Pads to the adapter and patient ECG Lead Fault Phill The ECG
152. essure measurement A loose cuff will often result in decreased sensitivity to pressure pulses Making sure that a properly sized cuff is applied and that the cuff is fitted snugly will reduce the likelihood of TIGHTEN CUFF messages 10 4 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM NIBP AND TEMPERATURE Lo NIBP Operation Procedures NIBP Setup TO PREPARE THE PIC FOR NIBP 1 Press POWER switch to ON 2 Attach the appropriate size cuff and hose to the PIC System 3 Apply the cuff snugly to the limb of the patient If the cuff is too loose or too tight inaccurate readings may result The cuff should never be applied so tightly as to impede venous return between blood pressure measurements Be sure the index line falls between the two range lines on the blood pressure cuff Applying BP Cuff Cuff range lines 4 Verify that the mode Manual Auto or Stat displayed in the NIBP window is the desired mode of operation The mode can be changed from the NIBP configuration menu see User Menus NIBP in chapter 13 NOTE When the PIC System is turned off the NIBP will remain in i the mode last used NOTE The START or STOP shown in the display will change as the NIBP button is pressed The word displayed indicates what will happen when the NIBP button is pressed For example if START is displayed then pressing the NIBP button will start the NIBP monitor Manual Mode TAKING A MEASUREMENT IN THE MANUAL MODE
153. etter of your choice B The menu will be replaced with a menu displaying the individual letters P Q R S T In this case we want to change the J to an S 5 4 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 12 LEAD MONITORING OPTIONAL Loo 3 Next press on the actual character C Your selection will be entered and the cursor will move to the next letter in the name Continue this procedure to complete the name S FGHIJ PORST Www e 4 Pressing the SAVE button in the Name menu will save the name selection and return to the patient ID menu ENTERING PATIENT S AGE SEX NOTE The Default setting on patient s age is 40 1 Press the AGE SEX button to display the Age Sex Menu 2 Pressing the up or down arrows will increase or decrease the displayed number by increments of 5 from 15 to 100 3 Press the SEX button to toggle between M for male and F for female 4 Once the age sex is selected press BACK to return to the Patient ID menu ENTERING A NEW PATIENT IDENTIFIER The PIC System 12 lead automatically gives each patient a unique identifier that is comprised of the current date time and the unit serial No at which monitoring began The operator can change the automatic patient identifier by following the instructions below 1 Press the IDENTIFIER button A The Identifier menu appears in place of the Patient ID menu and the Treatment Summary window is replaced with
154. evel gradually diminishes in a battery after it is removed from the charger WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 16 9 MAINTENANCE AND CARE EE 5 Whenever possible recharge a partially depleted battery This can be accomplished following any incident that involves patient monitoring It will insure maximum operating time for each use without reliance on spares The need for a spare can then serve as an alert when an aging battery fails to provide normal operating time 6 Keep discharged batteries separated from spare batteries that are charged For example when removing a discharged battery from the monitor never place it in the location intended to carry a charged spare Battery Capacity Test and Reconditioning Procedure Due to the critical nature of this equipment it is important to test PIC batteries at least every 90 days to verify adequate available battery capacity The test should be performed every 30 days if batteries are charged in a high temperature environment above 30 C 80 F or if they are heavily used charged and discharged more than once a day Because this test completely drains the battery it also serves an important reconditioning cycle that will help insure maximum capacity Equipment e Stopwatch or clock to measure elapsed time Required e PIC with only the ECG monitor function activated NOTE Battery run time is different for the various PIC options available Refer to the following comp
155. exists In an ECG Lead Fault check that the ECG electrodes and patient cable are connected properly In a Pads Lead Fault check to see that the multipurpose electrodes and multipurpose hand free adapter are connected properly When the lead fault has been corrected the lead fault message will be removed from the display and the pacing indicator will change from red to orange To begin pacing again press the START STOP button NOTE Should a lead fault occur after you have achieved capture the pacer will automatically revert to the stop mode The rate and output current settings will remain at the last settings used before the lead fault occurred To resume pacing correct the lead fault and press the START STOP button WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM CO gt CHAPTER 9 PULSE OXIMETER This chapter provides information on the use of the pulse oximeter controls displays and its operation Chapter Overview e Pulse Oximeter Controls and Displays 9 2 e Pulse Oximeter Operation Procedures 9 5 NOTICE Purchase of this instrument confers no express or implied license under any Mallinckrodt patent to use this instrument with any oximetry sensor that is not manufactured by Mallinckrodt CAUTION First read chapter 1 Safety Information before O proceeding with this chapter WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 9 1 PULSE OXIMETER EE Pulse Oximeter Controls and Displ
156. fibrillator internally and the energy range bar display will disappear NOTE Note The unit contains an automatic disarm of the defibrillator c If the operator has not delivered the energy to a patient or load an internal timer will disarm the defibrillator after 1 minute when in manual mode Sync Pressing the SYNC button activates the synchronization mode and illuminates the SYNC indicator light which flashes off when a QRS O has been detected Sync will appear on the display and a SYNC marker will also appear over the portion of the ECG that the defibrillator will trigger on Pressing the SYNC button again reverts to the asynchronous mode Sync marker Sync in the display NOTE After synchronized cardioversion discharge the defibrillator can be configured to remain in the Sync mode or revert to the asynchronous mode See configuring the defibrillator Supervisor Menus in chapter 13 NOTE The factory default Sync setting after discharge is the i asynchronous mode 6 4 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MANUAL DEFIBRILLATION Manual Defibrillation Operation Procedures Defibrillation with 1 Press POWER switch to ON External Paddles 2 Apply electrode gel to the center of one paddle electrode Lightly press the paddle electrodes together and spread the gel evenly over both paddle surfaces Make sure gel covers the entire paddle surface Do not allow any gel to touch the paddle handle or the oper
157. g Ready Reconditioning Defibrillation Test Indicator Power On Reconditioner Simple one button operation Reconditioning Load 220 mA 10 constant Recondition Cycle Time Dependent on battery capacity and state of charge typically lt 12 hours External Power Output Voltage 13 Volts 0 65 V Fuse Ratings Dual Line Fuses 120 VAC 2 Amp SB Welch Allyn 500218 220 VAC 1 Amp SB Welch Allyn 500241 General Charger Operating Temperature 0 to 45 C Humidity 15 to 95 Size 11 5 x 7 25 x 4 4 inches 29 2 x 18 4 x 11 2 cm Defibrillator Tester Built in 50 Ohm load Paddle Holder Charger Mains Line Voltage 100 to 240 VAC 10 autoranging Mains Line Frequency 50 to 60 Hz 5 AC Power Consumption 18 W Typical Maximum 190 W while charging defib WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM A 11 SPECIFICATIONS EE Summary of Studies of Waveform Safety and Effectiveness Introduction Over 30 years ago Medical Research Laboratories MRL patented a unique monophasic truncated exponential waveform which utilized a low peak current impedance compensated defibrillation waveform The MRL monophasic waveform was developed as an alternative to the monophasic damped sine MDS waveform often referred to as the Edmark waveform defibrillator which was associated with higher peak currents and did not actively compensate for varying patient impedances In fact the MRL monophasic waveform defibrillator d
158. g is an AAMI requirement that applies to all ECG monitors regardless of make or model e Use only Welch Allyn patient cables Other cables can produce excessive artifact causing an inability to interpret the ECG e Use only ECG electrodes that meet the AAMI standard for electrode performance AAMI EC 12 Use of electrodes not meeting this AAMI standard could cause the ECG trace recovery after defibrillation to be significantly delayed e The type of surface electrode and the technique used in applying the electrodes are major factors in determining the quality of the signal obtained Use high quality silver silver chloride electrodes These electrodes are designed to provide excellent baseline stability provide rapid recovery from defibrillation and minimize artifacts from patient movement e When attempting to interpret subtle ECG changes ST segments etc use only the diagnostic frequency response mode Other frequency response settings may cause misinterpretation of the patient s ECG See Frequency Response in chapter 13 for further details e Excessive artifact can result due to improper skin preparation of the electrode sites Follow skin preparation instructions in chapter 4 e Do not operate the PIC System in conjunction with electrocautery or diathermy equipment Such equipment as well as equipment that emits strong radio frequency signals can cause electrical interference and distort the ECG signal displayed by t
159. ge gt cane single gauge representing the space occupied on the card The gauge will be displayed if a properly formatted card with remaining storage capacity is inserted in the PIC Selected Energy Clear Next Event Recording Dots Advancing dots shall be displayed whenever ECG or Events are being recorded to the card Selected Energy Advancing dots gt 200 J Clear WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 12 15 DOCUMENTATION EE Voice Cassette Icon Selected Energy Card 200 J Clear Next Card Low Selected Energy 200 ple Clear Next Card Full Selected Energy 200 ple Clear Next No Card selected Energy 200 ple Clear Next Card Fail Selected Energy 200 Next Clear 12 16 The voice cassette icon shall be displayed beneath the card gauge instead of below the log gauge 1f a properly formatted card is inserted and the Voice Memo option is installed The wheels of the tape icon will rotate when speech is being recorded to the card Displayed with accompanying tone when there are 5 3 and 1 minutes of capacity remaining on the card Displayed with accompanying tone when there is no more capacity on the card Displayed when no data card is inserted into the PIC Displayed when an unformattable unformatted or unreadable card is inserted WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM DOCUMENTATION Busy Card S
160. ghter receptacle must be on a circuit that can deliver at least 15 amps check fuse in the vehicle 2 Plug the auxiliary connector into the Auxiliary Power interface on top of the PIC System to activate auxiliary power supply PS A _ p 4 A A FA 4 g _ ge ta al a r i k k Ep 24 EA EA NOTE A light on the auxiliary connector indicates that there is a battery inserted in the PIC System and it is being trickle charged NOTE The 12 volt adapter will slowly trickle charge a battery that is ae inserted in the PIC System but is not intended to be used for battery charging To charge the battery properly use the Welch Allyn Rapid Charger 15 12 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM POWER SOURCE Lo Eee Welch Allyn Battery Analyzer The premium charger and maintenance system for Welch Allyn batteries analyzes conditions and identifies problem batteries It analyzes batteries by making capacity measurements while discharging and then automatically recharging the battery It conditions batteries by charging and discharging to remove voltage depression It identifies battery packs with open cells shorted cells and reversed cells For information on how to use the battery analyzer please refer to its operator s manual WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 15 13 POWER SOURCE Power Option Comparison Chart Type Auxiliary Power Auxiliary Power Au
161. h other relevant information displayed in the Active Event Window All other events for the current patient are listed in the Event History Window with the timestamp of occurrence If the ECG is advanced the active event will not change until the ECG for the next event listed is shown in the Trace Window The active event will become the event that corresponds to the displayed ECG The active event can be changed by pressing 4 or These buttons are located below the Event History Window The steps to the previous event for the current patient If there is no previous event a warning tone sounds and does not change events The steps to the next event for the current patient If there 1s no next event a warning tone sounds and does not change events WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM DOCUMENTATION Loo CARD REVIEW 09 19 36 Card Inserted PIC SN 80023 Sw Rev G Dept ID XXX XX Unit ID 0000 001 Event History Card Usage Patient Info 05 19 36 Card Inserted E C F 06 30 99 05 19 36 Lead I 05 19 36 Defib Fired Shocks 0 05 19 36 Events 1 Monitor EXIT Patient Window Patient Info The Patient Window 1s located in the lower 06 30 99 right center of the display The window has a 05 19 36 Shocks 0 title row that displays the words Patient Info and Events 1 the patient number The first patient on the data card is patient number 001 Below the title bar
162. he defibrillator will not fire When ready to defibrillate again firmly position the paddles then press and hold the DISCHARGE buttons until a QRS wave is detected and the defibrillator delivers the energy 11 Press the DISARM button on the front panel to disarm defibrillator at any time during procedure CAUTION There is no energy limit for pediatric electrodes Care should be exercised to insure appropriate selection of defibrillation energy level for pediatric patients NOTE To facilitate rapid defibrillation for pediatric use the power on default defibrillation energy can be auto set in the supervisor defib menu 1 Shut the unit off before attaching the pediatric electrodes to the paddles 2 Slide the pediatric electrode onto the adult paddle set Be sure to slide the electrode in the end for a snug fit Pediatric Electrodes 3 Follow instructions for defibrillating with external paddles to defibrillate patient NOTE Pediatric defibrillation research has shown that adult paddles should be used as soon as chest size permits The larger paddle size has been found to help decrease transthoracic impedance thus facilitating cardioversion and defibrillation WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM OO gt CHAPTER 7 SEMI AUTOMATED EXTERNAL DEFIB ortionat This chapter describes the functions and operation of the Semi Automated External Defibrillation SAED unit including using Multipurpose Hands Free Pads
163. he monitor thereby preventing accurate rhythm analysis 1 8 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM SAFETY INFORMATION Loo e Do not operate the PIC in close proximity to any other monitor with respiration measurements The two devices could affect the respiration accuracy e Any external connection to the 1V or MOD outputs must comply with clause 19 of IEC 601 1 for leakage current and must not exceed 450 mA e Shock Hazard Use of accessories other than those specified in the operating instructions may adversely affect patient leakage currents e Certain line isolation monitors may cause interference on the ECG display and may inhibit heart rate alarms Defibrillator Precautions e The Welch Allyn PIC can deliver 360 joules of electrical energy If this electrical energy is not discharged properly as described in the User Instruction Manual the electrical energy could cause personal injury or death to the operator or bystander e The operator and all other people must stand clear of the patient the bed and all conductive surfaces that are in contact with the patient during defibrillation The electrical energy delivered to the patient could also be delivered to any other person who is in contact with the patient or the conductive surface e Do not use the defibrillator in the presence of oxygen sources such as near bag valve mask devices or ventilators flammable gases or anesthetics These environments can
164. he respiratory rate Press a button C to select the trace redraw speed time trace travels from the left side of the display to the right A bold outlined box indicates the selected speed Press EXIT to return to the CO Configuration menu WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MENUS Loo CO Response CO Response adjusts the averaging Menu interval during a CO measurement Press a button D to select a rate Slow averages the CO level on a moving 60 second average Normal averages the CO level on a moving 30 second average Fast averages the CO level on a breath by breath basis A bold outlined box indicates the selection Press EXIT to return to the CO Configuration menu Reset Option The Reset option sends a Reset signal to the CO sensor The signal is used for diagnostic purposes only WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 13 17 MENUS EE User Menus Respiration Trend Use the Trend Respiration menu to configure the trend speed setting This menu is accessible through the Treatment Configuration menus Treatment Intubate IV EPI Lido Atrop Sample Clear Next Recorder Display Alarms SPO NIBP Resp Recorder Set Up Back Respiration ECG COs Trend Back Trend Setup Speed Back Trend Speed Menu Trend Speed Menu Use the Trend Speed to select the amount of time the system will mo
165. he same procedure to turn the EMS Mode OFF SAED Mode Operation with Multipurpose Hands Free Pads Monitoring and PROPER MONITORING AND DEFIBRILLATION IN THE SAED MODE Defibrillation 1 Assess Patient Confirm the patient exhibits e Unconsciousness e Absence of breathing e Absence of pulse 2 Press POWER switch to ON Ensure Self Test Passed and battery icon is not LOW 3 Remove or loosen patient s clothing if necessary for application of pads WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 7 9 SEMI AUTOMATED EXTERNAL DEFIB OPTIONAL EE 00 06 43 0 SAED BASIC MODE 5 lt T m pee Sas ow NO SHOCK ADVISED WNALYZING ECG STAND BACK me 00 06 43 _ 1 0 SAED BASIC MODE z La eva B as HOCK ADVISED CHARGING TAND CLEAR pone omer 00 06 43 o _ SAED BASIC MODE z 200 j e F wa 7 10 4 Check expiration date of the pads Do not use pads that have expired Remove disposable multipurpose pads from packaging Use Welch Allyn Multipurpose electrodes Model 001853 for adult patients and Model 001828 for pediatric patients lt 10kg Remove protective cover from pads and apply the pads to the patient Apply the RA pad to the patient s right side to the side of the breast bone and below the collar bone Apply the LL pad over the patient s ribs to the left of the nipple 5 Follow display messages and voice prompts Analyzing ECG Stand Clear Indicates the PIC has
166. hen patient s condition allows is recommended Discontinue external pacing if the skin is affected and if another form of pacing 1s available Disposable defibrillation pacing electrodes must be used in accordance with the manufacturer s instructions Do not use expired dry electrodes or reuse disposable electrodes as improper patient contact may result in patient burns and inability of the device to function properly The pacing rate determination can be adversely affected by artifact If the patient s pulse and the heart rate display are significantly different external pacing pulses may not be delivered when required WARNING PACEMAKER PATIENTS The Welch Allyn PIC includes a pacemaker rejection circuit The following warning is in accordance with the disclosure requirement of AAMI Standard EC 13 3 1 2 1 8 The rate meter may continue to count the pacemaker rate during some occurrences of cardiac arrest or some arrhythmias Do not rely upon the heart rate meter alarms to assess the patient s condition Keep pacemaker patients under close surveillance Note This warning is an AAMI requirement that applies to all ECG monitors regardless of make or model Artifact and ECG noise can make R wave detection unreliable affecting the HR meter and the demand mode pacing rate Always observe the patient closely during pacing operations Consider using asynchronous pacing mode if a reliable ECG trace is unobtainable WELCH ALLYN P
167. ho exhibit e Unconsciousness e Absence of breathing e Absence of pulse The PIC should not be used in the SAED Mode when the patient e Is Consciousness e Is Breathing e Has a Pulse The ECG analysis should not be used when the patient is being moved or transported Patient movement can cause artifact which can interfere with the analysis process Stop all patient movement and do not touch patient when the ECG analysis is in process CAUTION SAEDs are not designed to treat pediatric ECG rhythms The American Heart Association recommends SAEDs only on patients who are over 8 years old Do not use the PIC in the SAED mode on patients who are less than 8 years old Insure the Multipurpose hands free adapter has been connected to the PIC properly The PIC has been designed to allow monitoring of the ECG using the multipurpose defibrillation electrodes or a 3 Lead ECG cable If the multipurpose electrodes are used the PIC automatically sets the ECG Lead selection to PADS and the ECG Size to x1 The ECG Lead selection and ECG Size can not be changed in the SAED mode If only the ECG electrodes are attached to the patient the PIC automatically sets the ECG Lead selection to Lead II and the ECG Size to x1 If both ECG electrodes and Multipurpose Defibrillation electrodes are attached to the patient the Lead Selector will default to the PAD selection The PIC will acquire the patient s ECG from the more reliable ECG source the Multi
168. hould not be used in the presence of flammable anesthetics or materials e If charger has been dropped or shows visible signs of abuse refer unit to qualified service personnel for verification of proper operation e Do not immerse the charger or expose it to water or other liquids e Wipe only the outside with a damp cloth e Clamp power cord and tighten knob to prevent accidental removal e Unplug charger prior to changing fuse Welch Allyn e Do not incinerate Batteries e Do not directly connect the negative and positive terminals together e Use only the Welch Allyn Quick Charger to charge Welch Allyn batteries To prevent deterioration or damage to the battery e Do not drop or subject to strong physical shock e Do not use Welch Allyn batteries to power equipment other than Welch Allyn products 15 2 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM POWER SOURCE Loo FFT Power Supply Paddle Holder option 971029 The PIC can operate from AC line or battery power The AC line power cord is located in the back of the PIC and can be connected directly to any AC power source worldwide with the use of the proper power cable Contact Welch Allyn for more information on the power cables to fit your standard AC voltage AC Power Indicator The line power indicator is illuminated green when the unit is plugged into an AC outlet Charge Indicator Yellow light is illuminated continuously to indicate that a battery is
169. ibrillator Defibrillator Connector release button g T a gt a A 7 UG n To install defibrillator paddles or hands free adapter slide the lj a Hands free r adapter adapter onto defibrillator connector track Make sure the release button clicks into place Defibrillator controls WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 6 1 MANUAL DEFIBRILLATION Dene E A IxTmA xx t 7 Manual Defibrillator Controls and Displays a ee eee CO ZA MONITOR i Lead zeae P DEFIBRILLATOR HAERA Sync E ee PACING 60 BPM ACER 110 mA PACER On Off Start Stop lt 7oOutput7 Disarm Energy Select Charge Waveform window Defibrillation functions on the PIC System are viewed on and controlled by the areas illustrated above NOTE The following operations of the defibrillator depict normal factory default settings In chapter 13 we will discuss user configurations of the defibrillator Initial Displays When the PIC System is turned on the default selected energy is displayed 200 J as illustrated at left The defibrillator is not 200 charged CONNECT PADDLES in the defibrillator window indicates the defibrillator paddles or multipurpose hands free adapter are not Selected Energy NNECT r attached or are not seated firmly in the defibrillator connector 6 2 WELCH ALLYN PORTABLE INTENSIVE CARE
170. iew menu the size gain will be set to 1 cm mv by default anaa The Card Usage Window is located in the lower S center of the display A card usage gauge is displayed and a small tick indicates where the displayed ECG data is located on the card The ECG clock indicates the timestamp for the displayed ECG data The clock changes when changing ECG Events Patients or Speech 05 19 36 Volume Adjusts the volume for Voice Memo playback Printer Prints the current patient information header the four events currently displayed in the Event History Window and 12 seconds of single trace ECG 4 seconds preceding the active event and 8 seconds following the active event if available NOTE Printout of a 12 lead event will be of the same format as that selected in the Supervisor gt 12Lead gt Printer menu see page 5 8 Cassette If the active event is a voice memo event it will playback the entire memo until conclusion The ECG snapshots will advance every five seconds while the Voice Memo is playing to synchronize ECG and events to the speech playback 12 Lead If the active event is a 12 lead event it will display the 1 2 snapshot data in the Trace Window By pressing the 12 button the Lead button will be active to allow the selection of leads shown in the Trace Window The 12 button activates the NextPage icon and the Analysis icon WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM DOCUMENTATION Analysis Ifth
171. imes appearing as a relatively normal QRS complex Mechanical capture can be verified by monitoring the physical condition of the patient Check for the following physiological signs reddening of the skin palpable pulses increased blood pressure and other signs of increased blood flow NOTE The initial pacing output rate will automatically be set to the lowest current output to prevent accidental high currents from being delivered to the patient External transcutaneous pacing may be uncomfortable for certain patients Depending upon local protocol consider administering a sedative or analgesic should the pacing therapy become uncomfortable 15 To stop pause the delivery of pacing pulses momentarily press the START STOP button The pacing display will indicate pacer stopped and the pacing indicator light will change from green to orange The rate and output settings will remain the same as what was selected prior to the START STOP button being pressed To re initiate pacing press the START STOP button again NOTE Should the patient require defibrillation during pacing follow the defibrillation procedure as outlined in chapter 6 When the defibrillator is charged the pacer will automatically be turned off for safety reasons If a LEAD FAULT occurs the display will indicate the faulting leads ECG or pads During lead fault conditions the pacer light will illuminate red to caution the operator that a lead fault condition
172. inuous Voice recording is turned off during 12 lead ia acquisition EMS Mode EMS mode is a feature specifically designed for the use by an Emergency Medical Technician EMS mode is recommended when continuous SAED mode analysis is required while transporting a patient or performing another procedure such as intubation EMS Mode is a supervisor selectable mode of operation that performs continuous background analysis but requires the user to press the A button for full analysis in response to a prompt from the PIC The following section describes the operation and various features of EMS mode To toggle EMS mode push the coresponding menu button Once the desired selection is made cycle the power off and on Supr SAED ALSCode E Prot Audio EMSOn StartUp Back Supr SAED ALSCode E Prot Audio EMS Off StartUp Back SAED Startup Menu Use the SAED Startup menu to select either Manual Basic or Basic as the PIC startup option Your selection will be in effect the next time the unit is Started NOTE The ALS supervisor passcode must be entered to go from Basic or Basic mode to Manual mode WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 13 29 MENUS EE Supervisor Menus 12 Lead A supervisor can configure options that are specific to collecting and transmitting 12 lead data These options include telephone and fax numbers the number of printout copies produced and frequency and analysi
173. is dry Hazard The PIC can deliver 360 Joules of electrical energy If this electrical energy is not discharged properly as described in the User Instruction Manual the electrical energy could cause personal injury or death to the operator or bystander Always verify expiration dates on dated items such as disposable defibrillation or pacing pads monitoring electrodes and battery packs If the expiration date has passed replace the disposable items immediately Biomedical equipment and accessories such as ECG electrodes cables and oximeter probes contain ferromagnetic materials Ferromagnetic equipment must not be used in the presence of high magnetic fields created by magnetic resonance imaging MRI equipment The large magnetic fields generated by an MRI device can attract ferromagnetic equipment with an extremely violent force which could cause serious personal injury or death to persons between the equipment and the MRI device Observe all PRECAUTION and WARNING labels on the Welch Allyn PIC System and Quick Charger Conditioner Hazard Care should be exercised when operating the Welch Allyn PIC and Welch Allyn Quick Charger Conditioner in the presence of oxygen sources such as near bag valve mask devices or ventilators flammable gases or anesthetics These environments can produce fire or explosion hazards WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM SAFETY INFORMATION Loo Patient Physical Place the PIC Syst
174. ive 12 Lead Monitoring Controls and Displays 5 8 e Quick Access Functions of the Active 12 Lead Mode 5 11 CAUTION First read chapter 1 Safety Information before proceeding with this chapter NOTE Before reading this chapter review chapter 4 ECG monitoring to familiarize yourself with basic ECG monitoring controls displays and operation procedures aA Oe eS eee sen i re ea Se i re Sree a eae ia re ea Se i re a eae ia sei ea Se i ea Sree i re Sea se a se _ rea sea sen a ee ea sree ea srr ea srr ea eee See eos See S au SET 98 Paton Pes 12LEAD 1_ PICSO id MONITOR ep Size Lead ance DEFIBRILLATOR ee pacing PACER a oes i S Gam ml PACER On Off We rr _ i ei re ie re a rea srr eel a el WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 5 1 12 LEAD MONITORING OPTIONAL nnn O T O V V 7VN 7 T 2E UUP qN YmRTrXMZXNXxXXYN Basic 12 lead Monitoring Controls and Display Lead Size Window MONITOR o Lead Quick access controls and windows l DEFIBRILLATOR a 60 BPM i PACER 110 mA i a _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ D l D _ Sta starvstor outputds Waveform window The illustration above highlights the areas that are used to operate the 12 lead o
175. just above the numeric window NOTE The upgrade menu window is replaced by a numeric window with an active cursor in the first space Options Available SAED CO IBP ADV Record Review More Back 1234 l 2 34 5 6 7 8 90 Space B 234 9 0 C qd2 3 4 ee 3 4 5 6 7 8 90 Space 2 Press on the actual character C Your selection will be entered and the cursor will move to the next character in the identifier Continue this process to complete the password 3 Press the SAVE button in the Password menu to save the selection and return to the Upgrade menu A symbol should now appear after Adv indicating that the option was successfully installed WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 13 37 MENUS EE Supervisor Menus Calibration Set Up Supvsr Date Time Shifts DataXfr Back Enter Passcode here Supervisor UNLOCKED Defibr Pacer SAED 12Lead SetUp Diag Exit Supr Diagnostics SW Rev Modem Card Cal Back Software Modem Card Version Self Test Menu Menu Menu Superv Calibr NIBP SPO Mod Out COs Back NIBP SPO Mod Out CO Cal Menu Offset Cal Menu Menu Menu Software Version The Software Version menu provides Menu information about the software installe
176. k Advised Shock Now Stand Clear Indicates a shockable rhythm is still detected and that the defibrillator has completed charging to the selected energy The display will indicate SHOCK ADVISED SHOCK NOW STAND CLEAR The PIC will announce SHOCK NOW and the periodic charging tones will change to a steady tone signifying that the defibrillator is fully charged Make sure everyone is CLEAR of the patient announce CLEAR and press the discharge button to deliver the shock The shock must be delivered within 30 seconds If the defibrillator remains charged for over 30 seconds the PIC will disarm the energy safely internally as a safety precaution The energy bar graph will disappear Check Pulse After each set of 3 consecutive defibrillation attempts the PIC advises the operator to CHECK PULSE IF NO PULSE START CPR After 60 or 30 or 90 if configured seconds the PIC will announce STOP CPR and resume monitoring the patient s ECG E NOTE Ifan ECG rhythm is potentially shockable it may qualify as H 00 05 43 RSE DETECTEL ANALYZING STAND BACK SAED BASIC MODE 7 4 2 No Shock analysis results to hasten entry into CPR mode Noise Detected or Motion Detected Indicates during an analysis period that noise was detected in the ECG and that the analysis was not completed Take measures to eliminate the source of motion or artifact Avoid touching or moving the patient while analyzing
177. kc ha a ae ee eS 1 18 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 1 1 S AFETY INFORMATION Symbols and Icons Symbols Graphical symbols letter symbols and signs listed below may be found on the PIC System and accessories distributed by Welch Allyn Please note the use of these symbols for safe and proper use of the equipment sane a Zi Alternating current Attention consult accompanying documents Auxiliary power operation Caution high voltage Dangerous voltage Defibrillator protected type BF patient connection Defibrillator protected type CF patient connection Earth ground Recycle the PIC and battery separately from other disposables www welchallyn com weee G OHOo For indoor use only on battery charger only Negative input terminal Positive input terminal Power off Power on Recycle battery Protective earth ground Defibrillator discharge button Release The symbols listed below may by found throughout this manual WARNING Hazards or unsafe practices that could result in ED severe personal injury or death CAUTION Hazards or unsafe practices that could result in minor personal injury or product damage NOTE Points of particular interest for more efficient or E convenient operation 1 2 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM SAFETY INFORMATION Loo Icons Graphical and text icons listed below may be fo
178. l appear if no apnea or invalid data is being received from the sensor or if the sensor is not connected to a patient so CO Trend A 40 20 CHECK SENSOR indicates the CO cable is not l 60 cond attached to the unit or the CO adapter is not 40 Check 2 Sensor functional x ZEROING indicates the CO sensor is re CO Trend oe calibrating itself There will be no 7 Zeroing measurements made during this 1 8 second period and the display will return to normal shortly Measurement of Resp Rate Using CO Monitoring Respiration data is sourced from ECG leads or CO sensor and defaults to CO sensor if active because of improved accuracy and response Upon the activation of either CO or CO Trend Monitoring Respiration Searching will appear in the Resp value window If a Respiration trace window had been displayed it will be removed while CO and or CO Trend is displayed 11 8 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM RESPIRATION AND C02 OPTIONAL Once the CO or CO Trend monitor has NI 1 2 iS determined the respiration rate it will appear al in the Resp value window The alarm icon will also indicate the Resp alarm status NOTE The respiration alarms status will become active upon the reading of a respiration rate via the ECG monitor or the CO monitor CO Typical Usage Procedures CAUTION Do not use on patients with a low tidal volume such as patients younger than 3 years of ag
179. larm condition Q NIBP alarm is off NIBP alarm is on A NIBP alarm on a systolic or diastolic upper limit is set NIBP alarm on a systolic or diastolic lower limit is set START indicates what action would occur if the NIBP button were pushed For example if the NIBP button is pressed while the NIBP window displays START the NIBP would start to pump and take a measurement WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM NIBP AND TEMPERATURE 420 N 80 g9 Manual WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM The blood pressure icons and amp will animate pumping while the cuff is inflating and deflating during a measurement When the cuff has reached the initial inflation pressure the display will indicate the cuff pressure in mmHg The example at the left indicates the cuff pressure is 170 mmHg The cuff will deflate in a stepped sequence and will update the pressure reading in the display at each step This display indicates a completed blood pressure reading This information will stay on the display until the next reading If the alarms have been turned on and the BP values are flashing an alarm parameter has been exceeded This display indicates the blood pressure mode is set to Auto Press the NIBP button to initiate the first reading in the automatic mode The timer indicates the time remaining 2 50 minutes seconds before the next automatic measurement The displayed b
180. lay Disabled below the words Lower Limit The alarm icon in the heart rate window will display the appropriate status 4 Exit Press EXIT to leave menu SETTING AUTO HR ALARM 1 Set the HR alarm to auto by pressing the OFF ON AUTO button A until Auto is selected When the HR alarm is set to auto the auto alarm icon will appear in the HR window and the global alarms will be turned On C HR Alarm On Auto NOTE The upper and lower limits will be undetermined if a valid ECG is not present 2 Exit Press EXIT to leave the HR alarm menu 3 To set the automatic HR alarm limits press the quick access button AUTO HR D next to the amp icon The patient s heart rate at the moment the button was pressed will be displayed above the heart amp The HR alarm monitor automatically sets the upper and lower heart rate limits at 20 of that heart rate set point or 10 beats whichever is greater Each press of the AUTO HR button will adjust the heart rate set point and reset the auto HR alarm limits 4 You can view the upper and 3 eC D lower limits that were set HR Alarm by going back to the HR on on Auto alarm menu The undetermined upper and lower limits have been a replaced with automatically LC NOTE In either the On or Auto mode if BL the alarm parameters have been exceeded an audible tone will sound and the patients heart rate measurement will flash in the heart rat
181. le An audible tone will sound periodically indicating that the unit is charging The energy range bar on the right side of the display will highlight the relative charge state until it reaches the selected energy When the unit is fully charged the periodic tone will change to a continuous tone and the highlighted energy range bar will include the selected energy Sternum Apex Cardioversion Paddle Placement 8 Place the sternum paddle firmly against the patient s chest inferior to the patient s right clavicle and lateral to the upper sternum place the apex paddle in the anterior axillary line inferior and lateral to the patient s left nipple as shown to the right 9 To discharge hold the paddles firmly in place then press and hold both DISCHARGE buttons down until the defibrillator discharges NOTE Discharge may not be immediate upon pressing the paddle 4 buttons This is normal Keep the fire buttons depressed until the defibrillator discharges E3 NOTE For any additional shocks the SYNC button may or may not E need to be pressed This depends on the supervisor cardioversion mode setting WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 6 9 MANUAL DEFIBRILLATION EE Defibrillation with Pediatric Adapter 6 10 z Z 10 To negate the cardioversion after the buttons are pressed but before the next QRS wave is detected and the defibrillator discharges merely release both DISCHARGE buttons T
182. le for Paddle or Adhesive Pad Defibrillation ee Disconnect AC plug battery backup units Charge to manufacturer s recommended test energy level Charge indicators working Discharge per manufacturer s instructions Reconnect line power a a Pacer output cable intact b Pacer pads present set of two c Inspect per manufacturer s operational guidelines Applicable only if the unit has this supply or capability Signature WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 16 3 MAINTENANCE AND CARE EE Functional Checks Power System 16 4 Warning Keep hands and fingers away from paddle electrodes Function Response Verify that the AC power cord is firmly connected to the Welch Allyn Quick Charger with the AC cord holder and that the power cord is connected to the appropriate outlet Check each battery slot indicator for proper battery status Check the Auxiliary Power cable for proper operation Connect the auxiliary power cable to the PIC Press the system power switch on With no patient cable attached to the PIC press the Lead Selector button to select Lead I II or III Press the Lead Selector button to select PDL paddles Apply the paddles to the test contacts on the Welch Allyn Quick Charger Press the up or down energy select arrow to select 200 Joules on the defibrillator Green power light on the Welch Allyn Quick Charger is illuminated Insert a battery in each
183. lead fault occurs when lead wires are not properly connected to the ECG electrodes To correct fault confirm the ECG lead wires are attached to the ECG electrodes and the electrodes are properly applied to the patient DEMAND Restart Pacer When the pacer is active and a lead fault is detected after the connection is restored a flashing RESTART PACER will be displayed and a triple beep will sound Pressing the START STOP button will resume pacing WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 8 3 EXTERNAL PACING i rN NYz 0Z 7 PPFZ XXXYX XxftzerXKX _ Lead Selector Fault Pacer Fault Set Ld 1 1 IN This display indicates that the lead selector is not set to leads I II or I Select lead I H or III to allow pacing DEMAND Pacer Control Pressing the PACER button turns on the pacer The initial pacing Pacer S i 60 BPM parameters will be displayed in the pacing window Pressing the DEMAND PACER button again will turn off the pacer NOTE When the pacer is on and the defibrillator has been charged the pacer will automatically be turned off for safety reasons Pacing Indicator When the pacer is on but the pacing output is paused the indicator will illuminate a steady orange light When the pacer is on and the output is not paused the light will be green In this state the pacer will deliver a pacing pulse to the patient if it is required When a pacing pulse is delivered to the patient
184. lert to the low battery condition 2 Test button The test button provides a method for testing the SmartPak Plus battery in or out of the unit It initiates a brief load test that simulates the current drain of the monitor To quickly check a SmartPak Plus battery a Press the test button b Verify that the status indicator lights green A red light indicates a low battery No light during the test indicates a totally depleted battery 3 Multiple paired contacts Four contacts ensure swift error free battery insertion and backup reliability 15 4 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM POWER SOURCE Loo Welch Allyn SuperPac battery WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM The Welch Allyn SuperPac M battery is a nickel metal hydride NiMH battery NiMH batteries are less susceptible to the memory effect associated with NiCd batteries It weighs only a few ounces more than the SmartPak yet provides twice the capacity There are no light indicators as on the SmartPak batteries due to space limitations inside the battery case Therefore utilize the battery status J icon on the display to determine battery charge status AN ft em WelchyAllyn High Capacity Batlery it A C MULTIPLE CONTACTS ai Swill Error tree iecertion Backup reliability CAUTION 1 imparem rahet comaideretbons Charge ony m the MAL QUICE HAAGEN Ate ree bch es prep drab Z 2 cared poih te Do mot icemerats ere
185. les NOTE Only use Welch Allyn patient cables Excessive artifact could result Allows connection of external paddles or hands free adapter Unlocks the defibrillation connector from the defibrillator to allow removal of external paddles or hands free adapter NOTE When sliding defibrillation connector make sure the release button clicks into place and returns to its up position Allows connection of Welch Allyn pulse oximeter sensors Allows connection of Welch Allyn CO cable or cable adapter Allows connection of Welch Allyn temperature probe Allows connection of Welch Allyn non invasive blood pressure cuffs Accepts standard 50 mm paper Control panel with buttons for PIC System operation WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 3 3 PIC SYSTEM OVERVIEW PIC System Controls and Indicators 1 Voice memo 2 Print 3 Mute i po Start Stop 12 lt 15 Quick access 4 Blood pressure 44 rs 10 Pacer Pacer Pacer Pacer Pacer start stop mous opui on off indicator 1 Voice memo 2 Print 3 Mute 4 Blood pressure optional 5 SpO optional 6 Size 7 Lead 8 Hold 9 Pacer on off 10 Pacer on off indicator 3 4 Se ee t Sync 19 indicator 16 17 18 Defib Treatment Configuration Defib Defib disarm Defib controls energy charge sync select Allows documentation of audio messages Activates and deactivates the chart rec
186. les are not touching any part of the metal charger frame 3 Discharge the defibrillator into the paddle tray 4 The red defibrillator test light at the back of the charger should flash indicating that the defibrillator has delivered 200 Joules or greater NOTE Periodically test your defibrillator with a calibrated defibrillator energy tester Please reference the MRL performance verification procedure as outlined in the PIC system service manual The performance verification procedure must be completed by a qualified Biomedical Equipment Technician BMET Auxiliary backup power is available to operate the PIC System Either connect the Auxiliary Power Cable from the charger into the top of the 7 PIC System or plug in the AC ff eee a power cable from the back of f z the paddle holder The ib zz m i charger s AC power cord must be plugged in and the green power light must be illuminated to use the backup power The LED in the auxiliary power cable connector or on top of the paddle tray will illuminate when it is charging the battery in the PIC System When connected to the PIC System the auxiliary power cable will trickle charge a battery that is inserted in the PIC System Webco Allon NOTE When operating from auxiliary power only with no battery or fully depleted battery defibrillator charge time will be slightly longer 10 seconds typical 15 sec maximum CAUTION It is recommended that a fully charged
187. les for wear e Inspect multipurpose hands free adapter for wear e Inspect DC line backup and AC power cables for wear e Insure DC line backup makes proper connection to defibrillator e Inspect all SmartPak batteries for expiration dates e Insure all SmartPak batteries have been reconditioned within 90 days e Perform battery capacity test EVERY THREE MONTHS e In addition to daily and monthly tests Test ECG patient cable for electrical continuity EVERY YEAR e In addition to daily and monthly and three months tests it is recommended that Welch Allyn performance verficiation procedure be completed by a qualfied Biomedical Equipment Technician BMET every year or according to local requirements EVERY TWO YEARS e Replace ECG patient cables e Replace paddles and multipurpose hands free adapters e Replace all batteries EVERY FIVE YEARS e Replace internal data retention battery This must be performed by a qualified technician 16 8 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MAINTENANCE AND CARE es FFT Monthly Capacity Test To evaluate the minimum acceptable capacity of a battery pack perform the following tests monthly 1 Test only fully charged battery packs 2 Operate the defibrillator on battery power at a setting of 360 Joules 3 Charge the defibrillator and then discharge it into the test load of the battery charger Repeat this process 10 times allowing approximately minute between
188. ll be SAED Basic Treatment Menu 7 6 active If the Pulse Oximeter and or the Non Invasive Blood Pressure are installed options they will be available in the SAED Basic Mode Below is a sample display in SAED Basic mode BP HR Sp02 120 98 A 100 EcG Manual Lead PAD Signal OK ANALYZING ECG STAND BACK Elapsed Time hocks Delivered 00 00 00 SAED BASIC MODE vent Als Arvl 0 The display messages for the SAED Basic mode are the same for the SAED Basic mode Refer to the SAED Basic mode display section for the explanation of the SAED Basic display messages In the SAED Basic Mode the Treatment Menu will appear as shown below Cor Strt Pressing the Treatment items documents the time each event occurred and prints a 6 second ECG sample and saves a 4 second Intub IV Event Als Aml L Voice Manual ECG sample to internal log Voice Memo Log WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM SEMI AUTOMATED EXTERNAL DEFIB OPTIONAL Lee SAED Operation Procedures Indications for Using SAED Mode Contraindications for Using SAED Mode Defibrillation with Multipurpose Hands free Adaptor The PIC has been designed to be used by emergency care personnel who have been trained in basic life support cardiac care techniques and the use of the PIC The PIC in SAED mode should only be applied to victims of cardiac arrest w
189. ll display on the screen WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 18 5 12 LEAD INTERPRETIVE ANALYSIS OPTIONAL 18 6 as Age 45 Dept 1 Heart Rate PR Interval QRS Duration QT Interval QTC Interval P Axis QRS Axis T Axis Date 01 09 01 Time 07 43 30 ID 010901743000000 Name Patient X 98 Signal OK Sex M Unit 1 Ta 146 ms 112 ms 384 ms 405 ms 30 49 5 ANALYSIS Page 1 of 2 PACING A 1 2 a Selected Energy 60 BPM pe 200 DEMAND J analysis Intubate IV LIDO BRET Sample Clear Next Press the PAGE to scroll through UP and PAGE DOWN quick access buttons the analysis results The real time ECG trace will continue to display 120 80 Manual vo An Age 45 Sinus Rhythm P QRS 1 1 on 100 gt 01 09 01 ID 010901743000000 Name Patient X WITHIN NORMAL LIMITS Sp02 s 98 Signal OK AUTO 12LEAD ol Time 07 43 30 Sex M Unit 1 Normal P axis H Rate 72 ANALYSIS Page 2 of 2 REAL TIME PACING A 1 2 ae Selected Energy 60 BPM oe 200 DEMAND J anarysis f Intubate WV EPI LIDO BRET Sample Clear Next WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 12 LEAD INTERPRETIVE ANALYSIS OPTIONAL Lo Optional Print the results Press the PRINTER
190. ll personnel visually and verbally say CLEAR to ensure all personnel are clear including the operator from patient contact Press the discharge buttons on both paddles simultaneously SHOCK ADVISED SHOCK NOW The shock must be delivered within 30 seconds If the defibrillator remains charged for over 30 seconds the PIC will disarm the energy safely internally as a safety precaution The energy bar graph will disappear Observe the patient s response and follow the PIC s display and voice prompts If you would like to abort the defibrillation press the DISARM button on the front panel to discharge the defibrillator internally and safely 7 14 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM OO gt CHAPTER 8 EXTERNAL PACING This chapter discusses the controls and displays used when conducting external transcutaneous pacing with the PIC System Chapter Overview e External Pacer Controls and DisplayS 0005 8 2 e External Pacer Operation Procedures 5 8 6 CAUTION First read chapter 1 Safety Information before proceeding with this chapter treatment of hemodynamically compromising bradycardia bradycardia with escape rhythms that are unresponsive to pharmacological therapy refractory tachycardia supraventricular or ventricular and bradyasystolic cardiac arrest NOTE External transcutaneous pacing is used for the emergency Defibrillator release button pay Ot tae
191. lood pressure indicates the last blood pressure measurement This display indicates the blood pressure mode is set to Stat Press the NIBP button to initiate the first reading in the Stat mode 10 3 NIBP AND TEMPERATURE CHECK CUFF message indicates the blood pressure unit has detected that the cuff is not attached or a possible air blockage in either the cuff or the cuff hose exists CUFF LEAK message indicates a possible air leakage Check the fittings for a secure fit at both the PIC and cuff ends of the hose Inspect the hose and cuff for any cuts or punctures Ensure that the cuff has been applied to the limb properly MOTION indicates the blood pressure unit sensed excessive motion or shaking by the patient which can obscure the blood pressure signal If a motion alarm sounds during a pressure determination the pressure measurement should be considered suspect and another measurement should be obtained ARTIFACT indicates the blood pressure unit sensed sudden change in a blood pressure excessive arrhythmias or other artifacts that obscured the blood pressure signal Dashes in the systolic diastolic and MAP area indicate the blood pressure unit was unable to compute a measurement due to the excessive artifact TIGHTEN CUFF indicates the blood pressure unit sensed the patient s pulse was too weak to allow for an accurate measurement The pressure pulses must be of sufficient amplitude to allow the blood pr
192. low The customer or the user of the PIC should assure that it is used in such an environment Immunity Test IEC 60601 Compliance Level Test Level Electrostatic Discharge ESD IEC 61000 4 2 Electrical Fast Transient Burst IEC 61000 4 4 Surge IEC 61000 4 5 Voltage Dips Short Interruptions and Voltage Variations on Power Supply Input Lines IEC 61000 4 11 Power Frequency 50 60 Hz Magnetic Field IEC 61000 4 8 6 kV contact 8 kV air 2 kV for power supply lines 1 kV for input output lines 1 kV differential mode 2 kV common mode lt 5 Ur gt 95 dip in Ur for 0 5 cycle 40 Ur 60 dip in Ur for 5 cycles 70 Ur 30 dip in Uy for 25 cycles lt 5 Ur gt 95 dip in Ur for 5 sec 3 A m 6 kV contact 8 kV air 2 kV for power supply lines 1 kV for input output lines 1kV differential mode 2kV common mode lt 5 Ur gt 95 dip in Uy for 0 5 cycle 40 Ur 60 dip in U7 for 5 cycles 70 Ur 30 dip in Uy for 25 cycles lt 5 Ur gt 95 dip in Ur for 5 sec 3 A m Electromagnetic Environment Guidance Floors should be wood concrete or ceramic tile If floors are covered with synthetic material the relative humidity should be at least 30 Mains power quality should be that of a typical commercial or hospital environment Mains power quality should be that of a typical commercial or hospital environment
193. lyn Quick Charger Conditioner is able to charge three standard Welch Allyn battery packs simultaneously in approximately 4 hours 1 To initiate a battery pack charge cycle insert the Welch Allyn battery into any of the three numbered slots in the front of the charger When the battery has been firmly seated into the contacts at the back of the slot the yellow light behind the slot will illuminate indicating that the SmartPak battery is being charged This light will remain on for the duration of the charging cycle When the battery is fully charged the yellow light will flash to indicate it s ready for use 2 A completely discharged battery SmartPak Plus pack will require approximately 4 hours to recharge and a Welch Allyn SuperPac requires approximately 8 10 hours Charging time varies depending on battery capacity and state of charge Deeply discharged batteries and those with higher capacity will take longer to charge partially discharged batteries and those with lower capacity will require less time to charge NOTE Charging battery packs at temperatures above 30 C 86 F will prolong the charging time and may result in a gradual decline in battery capacity 3 Ifa fully charged battery is inserted into the charger it will be charged for a short period of time while the charger determines its state of charge When it is determined that the battery is fully charged the yellow light will begin to flash This process may take
194. ml 200 i A DEMAND RS A PACER V Rate A I Se Recorder On Off l Speed og Review Voice Trends Back Se ES a Sample Menu Recorder Speed Traces Grid On Log Review Voice Trends Back When you select an item on a menu located along the bottom of the PIC window a pop up menu will display next to the Quick Access buttons along the left side of the display Sample Pop Up Menu Lo T _ i Clear Log To select a pop up menu option or enter information press the QUICK ACCESS A button located next to your selection WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 13 7 MENUS EE User Menus User menus can be accessed by all operators and do not require a supervisor pass code Operators can configure a variety of PIC system options including some of the display features The User menus are shown in the following diagram This section also provides an explanation of how to access and set User menu options Treatment Intubate IV EPI Lido Atrop Sample Clear Next Treatment Configuration Menus Configuration lt lt _____ Display Alarms SPO NIBP Resp Recorder SetUp Back Set Up aad Supvsr Date Time Shifts DataXfr Back etup Menu tt Recorder Speed Traces Grid Log Review
195. monitor one patient s NIBP while monitoring another patient s ECG e Blood pressure measurement may be inaccurate if taken while accelerating or decelerating in a moving vehicle e If an NIBP measurement result is questionable or motion indication is displayed repeat the measurement If the repeated measurement result is still questionable use another blood pressure measurement method e Do not use the NIBP on cardiopulmonary bypass patients 1 14 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM SAFETY INFORMATION Loo Battery Precautions e Use only Welch Allyn SmartPak or Welch Allyn SuperPac batteries in the Welch Allyn PIC Use of any other battery can damage the Welch Allyn PIC and not provide sufficient power inhibiting patient care e Ifthe Low Battery indication occurs at any time during operation immediately replace the battery pack with a battery pack known to be fully charged Always have a fully charged battery pack available as a back up e Due to the critical nature of all batteries replacement of the Welch Allyn batteries 1s recommended at 24 month intervals e Proper care and maintenance of the Welch Allyn batteries is important to ensure continuous operation during patient care If the batteries are not maintained properly loss of power during patient care could result affecting patient care e The battery packs contain materials such as stainless steel cadmium and nickel which can be recycled
196. mpedance pneumography technique sends a safe low amplitude high frequency signal through the ECG electrodes or hands free pads to measure the patient s thoracic impedance During inhalation and exhalation the chest size changes resulting in changes of the patient s thoracic impedance The PIC System measures the impedance between the RA and LL electrodes or hands free pads The impedance changes are displayed as a waveform in the respiration waveform window and analyzed to calculate a breath rate that is then displayed in the Resp window 11 2 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM RESPIRATION AND C02 OPTIONAL Resp Window Display ED Resp Waveform Window z When the PIC System is powered on Respiration Off will appear in the Resp window This indicates that the respiration monitor is not active When the respiration monitor begins to analyze a patient s respirations Respiration Searching Searching will appear in the Resp window Once the respiration monitor has determined the respiration rate it will appear in the Resp Rate window The alarm icon will also indicate the alarm status In this example the alarm is off WARNING In some instances such as obstructed airway the patient s breathing attempts may not produce any air exchange These breathing attempts can still produce chest size changes creating impedance changes which can be detected by the respiration detector It is best to us
197. munity ADDENDUM 16 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM PIC 40 50 USER S MANUAL ADDENDUM Loo Guidance and Manufacturer s Declaration Electromagnetic Emissions IEC 60601 1 2 Table 201 The Welch Allyn PIC is intended for use in the electromagnetic environment specified below The customer or the user of the PIC should assure that it is used in such an environment Emissions Test Electromagnetic Environment Guidance RF Emissions The Welch Allyn PIC uses RF energy only for its internal CISPR 11 function Therefore its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment RF Emissions Class B CSPR 11 Class A The PIC is suitable for use in all establishments including IEC 6100 3 2 domestic establishments and those directly connected to the public low voltage power supply network that supplies buildings used for domestic purposes Harmonic Emission Voltage Fluctuations Complies Flicker Emissions IEC 61000 3 3 Medical Electrical Equipment needs special precautions regarding EMC and needs to be installed and put into service according to EMC information provided in this document WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM ADDENDUM 17 PIC 40 50 USER S MANUAL ADDENDUM Guidance and manufacturer s Declaration Electromagnetic IEC 60601 1 2 Table 202 The Welch Allyn PIC is intended for use in the electromagnetic environment specified be
198. n D to select a response rate A bold outlined box indicates the selected response Press EXIT to return to the Resp Configuration menu WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 13 15 MENUS EE User Menus Respiration CO3 CQ Size Menu CO Speed Menu 13 16 Respiration data is sourced from ECG leads or the CO sensor and defaults to the CO sensor if active for improved accuracy and response Use the CO menu to configure the CO size speed and response display settings Access this menu from the Treatment Configuration menus Treatment Intubate IV EPI Lido Atrop Sample Clear Next Recorder Display Alarms SPO NIBP Resp Recorder Set Up Back Respiration ECG CO Trend Back CO Setup Size Speed Response Reset Back CO CO CO Size Speed Response Menu Menu Menu Use the CO Size menu to select the displayed CO trace size Press button A to select a size scale a 0 to 80 mmHg 0 to 40 mmHg When kPa is the selected unit the 0 to 20 mmHg scale sizes are 0 12 kPa 0 8 kPa and 0 4 kPa A bold outlined box indicates the selected option Exit Press EXIT B to return to the CO i aor Configuration menu Use the CO Speed menu to adjust the displayed CO trace speed 5 10 or 20 seconds and allow manual calculation of t
199. n each shock Results The study consisted of 344 total fibrillation defibrillation episodes The mean ED50 and D50 estimates to one decimal place are shown below The significance of difference p value was calculated by the Wald test in each case and are shown below Also shown are the mean total durations measured for each device WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM SPECIFICATIONS Summary Table ED50 ID50 amp Duration Mean Monophasic Welch Allyn PIC 2kV Waveform Biphasic BiphasicWaveform ID50 Peak Current 6 4 8 3 Amps Significance of lt 0 001 lt 0 001 epee PIC vs Monophasic PIC vs 2kV Biphasic ED50 Delivered 40 2 21 4 207 Energy Joules Significance of lt 0 001 0 4937 anne PIC vs Monophasic PIC vs 2kV Biphasic Total Duration 11 9 12 3 13 1 msec Study 2 Conclusion The MRL Orbital Biphasic waveform was as effective as the Biphasic 2K V waveform and more effective than the monophasic waveform While both biphasic waveforms required less peak current than the monophasic waveform the MRL Orbital Biphasic waveform required statistically less peak current than the 2 KV biphasic waveform defibrillator Study 3 Objective Comparison of the defibrillation effectiveness of the Welch Allyn Orbital Biphasic waveform defibrillator with a commercially available Biphasic 2K V defibrillator capable of 360 J in a simulated higher impedance model Methods A canine model
200. n 6 53 7 6 1 lbs was used in a study that was approved by the Institutional Animal Care and Use Committee The animals were anesthetized with 20 mpk sodium pentothal 1 v and maintained as required through an intravenous catheter in the foreleg The femoral artery was cannulated and an intra arterial line was placed for continuous measurement of arterial blood pressure The chest was shaved and defibrillating patch electrodes were placed on the left and right chest walls Fibrillation was induced by delivering 60 Hz current to the chest electrodes The energy required to defibrillate was determined by a protocol that has been used in several other biphasic comparison WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM A 15 SPECIFICATIONS EE A 16 studies An initial shock strength of 70 to 100 Joules was used If successful VF was re induced after a 5 minute rest period and the shock strength was reduced by approximately 20 for the next defibrillation attempt If the initial shock failed a rescue shock was delivered and after a rest period VF was again induced The energy was now increased about 20 for the next defibrillation attempt This procedure was continued until approximately 4 reversals in result were observed with each waveform Two ED50 estimation procedures were run in parallel with the device being used alternated on each shock In practice actual clinical units were used so the energy steps were limited to those select
201. n setting The quick access auto heart rate HR control is used to set the automatic HR alarm IN ORDER TO SET THE AUTO HR ALARM LIMITS There must be a valid heart rate displayed in the HR window To set the automatic HR alarm limits press the quick access the AUTO HR button The patient s heart rate at the ee moment the button was A dlar eladod pressed will be displayed Setting auto heart rate alarm m 2 Global alarms above the heart The enabled monitor automatically sets the upper and lower heart rate alarms at 20 of that heart 3 Press auto HR rate set point or 10 beats alarm i Sok auth whichever is greater Each HR limits press of the AUTO HR button will adjust the heart rate set point and reset the auto HR alarm limits If an alarm parameter is exceeded an audible tone will sound and the heart rate will flash If there is no heart rate in the HR window the upper and lower heart rate limits will be undetermined and the set heart rate icon amp will appear WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM ECG MONITORING ECG Monitoring Operation Procedures MONITORING WITH DEFIBRILLATOR PADDLES 1 Press POWER switch on Set the LEAD to PDL paddles 2 Apply gel to paddles and place the sternum paddle firmly against the patient s chest inferior to the right clavicle and lateral to the upper sternum place the apex paddle in the i anterior axillar
202. n the PIC is turned on the default setting is 1 cm mv Example Autosize is set and 4cm mV was selected Example Manual size set at 2cm mV WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 4 3 ECG MONITORING Lead Pressing the LEAD button selects the ECG input Pressing up or down lead arrows will change the lead selection If the 3 lead cable is configured in the display menu the following lead options are available 3 LEAD x2 AUTO Lead II selected 3 LEAD I x2 AUTO Lead IIl selected 3 LEAD Il x2 If the 5 lead cable is configured in the patient cable menu the above lead selections and the following lead selections are available Lead aVR selected Lead aVL selected Lead V selected AUTO Lead aVF selected 5 LEAD aVF 12 AUTO 12 If a paddle set or hands free adapter cable is connected the following additional lead options are also available Se ee Lead paddles selected AUTO Lead pads selected JLEAD PAD 2 Hold Pressing and holding the HOLD button will freeze the trace s in the trace window When the hold button is released the traces will resume Chart recorder is not affected by the hold button 4 4 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM ECG MONITORING Lo Quick Access Controls and Displays Standard Features Optional Installable Features Volume A Analyze Global Alarm 12 Lead QRS Beeper Log Calibration IBP Set Heart Rate CO Next E S Back Volume a Th
203. n the display Press the CONTRAST button to add contrast to the display Each press of a button will increase the brightness or contrast setting until the highest setting 1s reached The next press of the button will return the setting to the lowest level 3 NOTE The Brightness and Contrast buttons are only visible if your display type supports variable brightness and contrast WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 13 11 MENUS EE User Menus SPO From the SPO menu users can configure the pulse oximeter size The Pleth Plethysmograph waveform display is automatically gain controlled and is not directly proportional to the pulse volume The SPO options are accessed from the Treatment Configuration menus Treatment Intubate IV EPI Lido Atrop Sample Clear Next Configuration Display Alarms SPO NIBP Resp Recorder Set Up Back SPO Size Back SPO Size Menu SPO Size Menu In the SPO Size menu users can choose from four Pleth sizes A bold outlined box indicates the selected size To choose a different size configuration press the corresponding button Press EXIT to return to the SPO Configuration menu NOTE The Plethysmograph waveform is automatically gain controlled to optimize the waveform display The waveform will not correlate with the patient s pulse strength 13 12 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM
204. naan zA TEER r diddi PY y s MLL i l l i SS ee a SES m T h Hands free adapter External pacing controls WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 8 1 EXTERNAL PACING External Pacer Controls and Displays 120 494 Ji is im Signal OK z gt A MONITOR Lead Be DEFIBRILLATOR PACING 60 BPM 110 mA DEMAND Start Sto i p Output Pacer Waveform window window External pacing functions on the PIC System are viewed on and controlled by the areas illustrated above factory default settings Later in chapter 13 we will discuss NOTE The following operations of the external pacer depict normal supervisor configurations of the external pacer Initial Displays When the PIC System is powered on the external pacer default position is off To turn on the external pacer press the PACER button When the pacer turns on the default parameters will be displayed in the pacing window ECG During Pacing PACING esp 0 Selected Energy 60 BPM 110 mA ASYNC Intubate Clear Next As seen in the above illustration when the PIC is externally pacing a patient small downward pacer marker spikes will appear when a pacing pulse occurs identified by the letter P below that spike 8 2 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM EXTERNAL PACING spikes without the letter P will appear on the ECG when an internal pacing pulse is detected However v
205. ng When CONTINUE is pressed the entire PIC System display will be replaced by the Card Review display Information from the Welch Allyn data card will be shown In the Card Review display there will be Trace Event History Active Event Patient Lead Gain and Card Usage windows CARD REVIEW 09 19 36 Card Inserted PIC SN 80023 Sw Rev G Dept ID Umit ID Qi Active Event oo Trace Event History Patient Info Ooi Lead 06 30 94 li 05 19 36 Gain Shocks 0 Card Usage 05 19 36 Card Inserted E a 05 19 36 Lead II 1 05 19 38 Detib Fired Monitor 05 19 36 Events 1 Prev Next Event History Step Card usage Patient Info Lead Gain Size The Trace Window occupies the same space as the waveform window during normal PIC System operating modes The Trace Window allows only one trace waveform 1 to be displayed in the window unless a 12 lead snapshot is being viewed in which case 3 traces will be displayed WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM DOCUMENTATION Lo CARD REVIEW 09 19 36 Card Inserted PIC SN 80023 Sw Rev G Dept ID xxx xx Unit ID 0000 001 Trace window Event History Card Usage Patient Info 001 Ei a F Backward step button Forward step button The trace can be moved by using the ECG step size backward step lt lt and forward step gt gt buttons The ECG step size button toggles between 1 second 5 seconds 30 seconds 1 minute and 5 minutes The lt
206. nitor the ECG or CO function The options are 10 min 30 min 2 hours 6 hours or 12 hours A The selected option is used to determine the maximum minimum and mean rate for each of 120 intervals Depending on the option selected the display trace segments max min and mean will be 5 sec 15 sec 1 min 3 min and 6 min respectively A bold outlined box indicates the selected speed Press EXIT B to return to the Trend Configuration menu 13 18 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MENUS Lo User Menus Recorder The Recorder menu allows users to configure the system recording options including print grid log review option voice memo and trends Access to this menu is through the Treatment Configuration menus Treatment Intubate IV EPI Lido Atrop Sample Clear Next Configuration ee Display Alarms SPO NIBP Resp Recorder Set Up Back Recorder lt Speed Traces Grid Log Review Voice Trends Back Chart Recorder Print Grid Log Review Voice Trend Speed Trace Menu Menu Notice Memo Interval Menu Menu Menu Menu Menu Recorder A Vv 1 sec lt lt gt gt Prev Next Exit Chart Speed Menu The Chart Speed menu allows the operator to select the speed of the chart recording during the trace output WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 13 19 MENUS EE Trace
207. nnot receive Cycle the power to the Mobitex Network Buffer Full messages from the network modem and retry sending the data after 30 seconds Buffer Full or Rec Buf Full The Mobitex modem cannot receive Cycle the power to the Mobitex Receiver Buffer Full messages from the PIC modem and retry sending the data after 30 seconds WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 19 5 WIRELESS TRANSMISSION EE Cellular Configuration From the configuration menu select Setup then DataXfr Use the Data Transfer menu to select one of the following Mobitex If the Mobitex option has been purchased Not Used If the Cellular option has been purchased but the Mobitex option has not been purchased Sending a Cellular 1 Press the FAX WIRELESS Wireless button to open ss Transmission 2 Verify that the Serial port is connected to the eSync as Mobitex device uo 3 Select CELLULAR Cellular 4 The status menu displays the status events and the errors 7 Sending that occur 12 Lead To 12 Lead Server Sending 19 Cellular Status Status messages will appear in the left menu during the 12 lead Messages transmission to the eSync device Opening Initializing the serial port Sending Displays the percent of the transmission delivered to the eSync device Complete Delivery of the 12 lead to the eSync device is complete 19 6 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM WIRELESS TRANSMI
208. nt care could result affecting patient care Always have a fully charged battery pack available as a back up Dropped or If this device has been dropped or damaged in any way refer the Damaged device to qualified service personnel for verification of performance and or servicing Ingress of Liquids To achieve the specified level of protection against spilled or splashed liquids thoroughly dry all exposed surfaces of this device prior to operation or connections to mains power WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 1 5 SAFETY INFORMATION EE Electrical Shock Electrical Shock Internal Electrodes Disposable Energy Discharge Expiration Date Ferromagnetic Equipment Labels Operating Near Oxygen 1 6 Hazard Do not use the PIC if it has been immersed in a liquid or if liquid has spilled on it Do not clean the PIC with alcohol ketone or any flammable agent Do not autoclave the PIC Conductive parts of electrodes and connectors for applied parts should not contact other conductive parts including earth Hazard This device does not contain any user serviceable parts Do not remove instrument covers or attempt to repair the Welch Allyn PIC System Refer servicing to qualified personnel When obtaining a new supply of disposable electrodes for monitoring defibrillation or pacing verify that they will properly connect to the existing Welch Allyn cables prior to putting in service Do not use if gel
209. number indicates the settings for z that shift have been saved Data Transfer Menu Use the Data Transfer menu to select the type of modem for 12 lead fax transmissions Select Not Used or Mobitex depending on options purchased Cancel WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 13 23 MENUS EE Supervisor Menus The Supervisor menus are only available to a supervisor after the successful entry of the supervisor passcode Using these menus a supervisor can configure the installed options The following diagram shows the structure of each Supervisor menu This section explains how to access and configure the Supervisor menu options Treatment Intubate IV EPI Lido Atrop Samples Clear Next Configuration as Display Alarms SPO NIBP Resp Recorder SetUp Back Set Up Suprvs Date Time Shifts DataXfr Back Enter Passcode here Supervisor UNLOCKED Defibr Pacer SAED 12Lead SetUp Diag Exit se Supr Diagnostics SW Rev Modem Card Cal Back Supr Calibration NIBP SPO Mod Out COs Back TTT Supr Setup Shifts Treatment Upgrade UnitID Code Printer More Back Options Available SAED CO IBP Adv Record Review More Back Options Available lt _ Cell Analysi DataRd Mobitex Biphas Pacer Fax Back Supr Setup 2 lt
210. o Card saved for Shift 1 3 by pressing SAVE AS Ai The default shift is Shift O unless a specific shift is selected with the Configuration Setup Shifts menu Note The alarms in use depend on the selection of Active Shift or S User in the Supervisor Alarms menu Press SAVE TO CARD to save the configuration parameters for all shifts including the default to a PIC Configuration PCMCIA card Press LOAD FROM CARD to restore the configuration parameters from a PIC Configuration card to the PIC internal memory WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM ADDENDUM 11 PIC 40 50 USER S MANUAL ADDENDUM EE Mobitex Data Use the Data Transfer menu to program up Transfer Menu to 16 different MAN addresses for Mobitex modems 20000000 v Cellular Data Use the Data Transfer menu to program up Transfer Menu to 16 different Group IDs and the TE corresponding Server Names roop i Server Name Server Name 1 Supervisor Alarms correction to page 13 41 Set Up Suprvisr Date Time Shifts DataXfr Back Enter Passcode here Supervisor UNLOCKED Defib Pacer SAED 12Lead Set Up Diag Alarms Back Alarms Menu Supervisor Alarms Menu ADDENDUM 12 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM PIC 40 50 USER S MANUAL ADDENDUM Chapter 19 Wireless Transmission This section of the addendum addresses the changes to Chapter 19 Wireless Transmission The
211. o meet the needs of your department shift or patient Includes Supervisor menus to eliminate confusing menus during emergency use Compatible with disposable multifunction monitoring defibrillation pacing pads allowing fast convenient and safe defibrillation and pacing Can operate from NiCad or NiMH quick change battery packs AC mains or 12V operation The design will allow for future expansion of enhanced 12 lead monitoring fax modem transmissions semi automatic shock advisory defibrillation capability invasive pressures and CO monitoring WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 2 3 INTRODUCTION EE Indications for Use Without the SAED option the PIC is intended primarily for use by emergency responders trained in advanced life support cardiac care techniques interpretation of ECG waveforms and the use of the PIC With the SAED option the PIC may be used by emergency responders trained in basic life support cardiac care techniques and the use of the PIC The usage may be in an ambulance or at the scene of an emergency The PIC is also intended for use by or on the order of physicians at the scene of an emergency or in a hospital emergency room intensive care unit cardiac care unit or other similar areas of a hospital It is also intended to be used during the transport of patients between any of the locations mentioned above The patient population will consist of adults and children described bel
212. o the PIC properly The PIC has been designed to allow monitoring of the ECG using a 3 Lead ECG cable The PIC automatically sets the ECG Lead selection to Lead II and the ECG Size to x1 The ECG Lead selection and ECG Size can not be changed in the SAED mode If ECG electrodes and Multipurpose Defibrillation electrodes are attached to the patient the Lead Selector will default to the PAD selection The PIC will acquire the patient s ECG for the more reliable ECG source the Multipurpose electrodes rather than from the smaller ECG electrodes di WARNING Do not use paddles for defibrillation unless you have been trained in the proper use of paddles STEPS INVOLVED IN DEFIBRILLATING WITH PADDLES 1 Assess Patient Confirm the patient exhibits e Unconsciousness e Absence of breathing e Absence of pulse 2 Press POWER switch to ON Ensure Self Test Passed and battery icon is not LOW 3 Thoroughly prep patient skin for ECG electrode attachment Clean and dry skin sites preferably with a coarse dry terry cloth 4 Connect each lead of the 3 Lead patient cable to the appropriate disposable electrode Arrange the electrodes as shown in chapter 4 Make sure that the ECG electrodes are placed to allow defibrillation if necessary 5 Follow display messages and voice prompts Analyzing ECG Stand Clear Indicates the PIC is analyzing the patient s ECG to assess if it is a shockable rhythm The PIC will announce STAND BACK
213. o zero the transducer connected to the IBP1 Connector The Zero Sensor will change to three dashed lines followed by a pressure reading of 0 Scale 1 0 to 300 8 Close the Venting Stopcock to the air atmosphere PA 9 Open the Transducer Stopcock to the patient The patient s pressure measurement will be displayed in the Pressure window WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 17 5 IBP Step 4 Displayed Waveform Names Step 5 17 6 Scale Adjustment The operator can adjust the scale of the desired IBP waveform by pressing the SCALE button in the O to 40 Each press of the button rotates through the following scale settings To assist the operator in identifying each transducer s source the pressure waveform display can be labeled with a specific pressure name It is important that you properly label the transducer in IBP1 and IBP2 with the appropriate pressure name Systolic Diastolic MAP Central Venous Pressure MEAN Pulmonary Arterial MEAN Pressure Miscellaneous Pressure MEAN Selecting the Channel Source The operator can select the channel source of the desired channel by pressing the CHANNEL SOURCE button in the IBP Setup Menu Each press of the button rotates through the following channel source settings ART Arterial Pressure CVP Central Venous Pressure ICP Intracranial Pressure PA Pulmonary Arterial Pressure or P for miscellaneous pressure WELCH ALLYN
214. onto power cord to prevent its accidental removal Unplug the charger prior to changing the fuse Use only the Welch Allyn Quick Charger to power the Welch Allyn PIC System from an auxiliary power source Do not use the Welch Allyn Quick Charger to power any non Welch Allyn devices A depleted battery could increase defibrillator charge times It is recommended that a fully charged battery be inserted in the PIC System even when operating on auxiliary power NOTE The PIC System will operate from an auxiliary power source as without a battery inserted or if the inserted battery is depleted However under these circumstances defibrillator charge time will be slightly longer 10 seconds typical 15 sec maximum WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM SAFETY INFORMATION SAED Precautions F e WARNING Cardiac Pacemakers The presence of an ED internal cardiac pacemaker may adversely affect analysis results If it is known or suspected that the patient is fitted with a cardiac pacemaker follow your own locally established procedure for dealing with defibrillation of such patients e The PIC in SAED mode should only be applied to victims of cardiac arrest who exhibit unconsciousness absence of breathing and absence of pulse e Excessive motion may affect analysis results ECG analysis should not be performed when the patient is being moved Stop all patient movement and do not touch patient when the ECG an
215. oper skin preparation electrode placement and limited patient movement For all other monitoring the Monitor response selection provides better trace stability Press the button next to a frequency to select it A bold outlined box indicates the selected frequency Press EXIT to return to the Display Configuration menu In the Filter menu press the Line Filter button to turn line filters On or Off The filters remove AC mains line interferences emitted from power lines and other electrical apparatus Turn the filter off for optimal diagnostic response Press EXIT to return to the Display Configuration menu aa NOTE To select a different line frequency refer to mil Supervisor Line Frequency menu In the Patient Cable menu users can select a 3 lead or 5 lead patient cable Press the corresponding button to choose a lead configuration A bold outlined box indicates the selected configuration If the patient cable inserted into the PIC System does not match the selected patient cable configuration a lead fault alarm may sound Press EXIT to return to the Display Configuration menu NOTE This menu is not available on PIC Systems with 12 lead preamplifiers because the 12 lead preamp auto detects the patient cable type WELCH ALLYN PORTABLE INTENSIVE CARE S YSTEM MENUS Brightness and The level of brightness and contrast in the PIC display is adjustable Contrast Options Press the BRIGHT button to brighte
216. or 67 40 Hz Diagnostic 0 05 150 Hz Filtered Diagnostic 0 25 40 Hz Pt Cable 3 lead 3 Lead 5 Lead Alarms HR Alarms Off On Auto Off UL Disabled On 60 300 BPM by 5 s 120 LL Disabled On 20 120 BPM by 5 s 50 Automatically determined SPO Alarmst Off On 70 99 by 1 s Off UL Disabled On 60 99 by 1 s 99 LL Disabled On 85 BP Alarmst Off On Set Sys Set Dia Off Sys UL Disabled On 30 250 by 5 s_ 160 Sys LL Disabled On 30 250 by 5s 80 Dia UL Disabled On 25 250 by 5 s 130 Dia LL Disabled On 25 250 by 5 s 50 Resp Alarm Off On Off UL Disabled On 20 150 by 5 s 30 LL Disabled On 3 100 by 5 s gt 15 and by 1 s lt 15 5 Temp Alarmt Off On Off UL Disabled On 99 109 by 1 s 100 F LL Disabled On 85 98 by 1 s 95 F CO Alarmst Off On Off UL Disabled On 10 100 mmHg 2 14 kPa 40mmHg 5kPa LL Disabled On 3 50 mmHg 0 4 6 kPa 5mmbg 5kPa NIBPt NIBP Manual Manual Auto 1 2 3 5 10 15 or 30 5 Stat Respiration ECG Resp Setup Size x1 x2 x4 1 Speed 5 10 20 30 60 sec 30 Response Slow Normal Fast Normal CO Setup Size 0 20 0 40 0 80 mmHg 0 4 0 8 0 12 kPa Speed 5 10 20 sec Response slow normal fast Recorder Speed 25 mm s 50 mm s 12 Ld 50 mm s Traces Printer Traces 1 3 Card Traces 1 3 Print Log Print Trend Stop Print Clear Log Voice Memot Play Skip Fwd Skip Bwd Stop Trends On Off 25 mm s On On at B
217. order Pressing the MUTE button once causes all audio alarms and tones to be muted for 90 seconds except defibrillator charge tones Starts or stops cuff inflation Turns on or off the pulse oximeter Selects ECG trace sizes Selects ECG input source Freezes the traces on the display Turns on off pacer circuit Automatically illuminates during pacing activity WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM PIC SYSTEM OVERVIEW Loo 11 12 13 14 15 16 17 18 19 20 21 Pacer start stop Pacer mode Pacer output Pacer rate Quick access Treatment Con figuation controls Defib energy select Defib charge Defib disarm Defib sync Sync indicator WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM Delivers pacing stimulus to the patient or pauses delivering pacing stimulus to the patient Changes pacing mode from DEMAND to ASYNC Selects pacing output current Selects pacing output rate Initiates menu functions appearing adja cent to each button on the display when PIC System is on Treatment allows documentation of spe cific treatment summary events and Configuration allows access to menu windows Selects defibrillation energy levels Initiates defibrillator to charge to selected energy Disarms charged defibrillator internally Activates the synchronization mode Light that indicates sync activation 3 5 PIC SYSTEM OVERVIEW i YN m z 7 yTNXE
218. ow and will consist of patients both with and without heart dysfunction The PIC will be used primarily on patients experiencing symptoms of cardiac arrest or in a post trauma situation It may also be used whenever it 1s required to monitor any of those functions that are included as options in the device Indications for each of the specific functions are discussed below Defibrillator The defibrillator function of the PIC is used to treat ventricular Function fibrillation and pulseless ventricular tachycardia The biphasic waveform employed by the PIC has not been clinically tested on pediatric patients The device has not been evaluated for cardioversion of atrial fibrillation or direct internal cardiac defibrillation The semi automatic mode should not be used on pediatric patients less than 8 years old ECG Monitor The ECG monitor function of the PIC is used to monitor and or Function record ECG waveform and heart rate and to alarm when heart rate 1s above or below limits set by the operator The PIC also provides output signals for the purpose of sending ECG waveforms to a remote monitor via direct connection telephone or radio transmission Patients may range from neo natal to adult External The external transcutaneous pacing function of the PIC is used for the Transcutaneous emergency treatment of hemodynamically compromising Pacemaker bradycardia bradycardia with escape rhythms that are unresponsive Function to pharmacologic
219. pO monitor is turned on and the probe is either not connected not properly connected or defective then Check Probe will be displayed in the pleth waveform window WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM PULSE OXIMETER Pulse Oximeter Operation Procedures The PIC System can provide non invasive SpO pulse oximeter measurements NOTE SpQOb gt style pulse oximeters measure the fractional oxygen saturation of arterial hemoglobin from peripheral sites such as fingers toes etc The term SpO gt typically refers to invasive oxygen saturation measurements from arterial blood samples SpO style pulse oximeter measurements may be affected by numerous factors such as bright lights improperly applied probes use of non Welch Allyn probes patient conditions movements The clinician should use good clinical judgment when interpreting SpO measurements Should the clinician question an SpO measurement an arterial blood gas oxygen saturation measurement should be obtained Connect Nelicor SP02 SP02 connector probe to patient finger gray Vs i zop ee a ze Ou 3 j d i Ei a PA 3 oe co eS M Connect SPO adapter Ss SS to SPO Connector i m D S Connect SPO adapter to Nellcor SPO Probe Press POWER switch to ON Connect the Nellcor SpO gt probe to the PIC System Connect SpO adapter to Nellcor SpO probe gee pes we US Select the
220. press the NIBP button again the START will change to STOP 6 When the measurement is complete the cuff will deflate and the systolic diastolic and MAP pressures will be displayed in the BP window The NIBP monitor will wait until the selected auto cycle time has elapsed before taking another reading A timer will appear in the BP window indicating the time remaining before the next measurement will begin 7 To return to the manual mode select manual in the NIBP configuration menu see User Menus NIBP in chapter 13 Stat Mode TAKING A MEASUREMENT IN THE STAT MODE Measurement 1 Select Stat in the NIBP configuration menu see User Menus NIBP in chapter 13 2 Press the NIBP button to initiate the first reading in the stat mode The START will change to STOP The NIBP monitor will inflate the cuff to the initial cuff pressure The NIBP monitor has an automatic cuff detection and will inflate the cuff to the proper pressure accordingly The NIBP monitor will inflate adult thigh and child cuffs to 154 mmHg and will inflate infant cuffs to 125 mmHg The inflation pressure will also adjust itself based on the last reading 30 mmHg over the last systolic reading 3 If the NIBP monitor is unable to make a determination of the systolic pressure the cuff will automatically re inflate and attempt another measurement Adult thigh and child cuffs will re inflate to 190 mmHg and infant cuffs will re inflate to 142 mmHg If the PIC
221. provide adequate clamping force by the Welch Allyn BITRODE Place the single contact clip on the patient s right inner wrist or inner forearm if necessary Make sure that the clips and arms are positioned and attached so minimum arm movement is allowed to preclude possible artifact on the display This will give a Lead I ECG NOTE Ifa weak signal is being obtained up in above configuration E Lead I then the dual contact Welch Allyn BITRODE can be placed on left ankle to monitor in Lead II Mode WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 4 11 ECG MONITORING EE Outputs 1 Volt Output optional Provides an analog ECG output scaled to 1 Volt out for a ImV input signal The 1V output is routinely used to transmit ECG over telemetry The frequency response of the output signal will match the display frequency response selection except that the upper frequency limit will be 100 Hz 4 12 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM OO gt CHAPTER 5 12 LEAD MONITORING cortionat This chapter describes the controls displays and operation of the Basic 12 lead option It includes a discussion of the basic 12 lead controls and displays the process for entering patient ID information and monitoring procedures Chapter Overview e Basic 12 Lead Monitoring Controls and Display 5 2 e Entering Patient ID Information 0 000 cca 5 4 e Monitoring In Normal 12 Lead Mode 57 e Act
222. ption if it is installed in the PIC System If needed refer to chapter 4 for basic ECG monitoring information portion of the PIC System depict normal factory default settings NOTE The following description and operation of the 12 lead Lead Selection When the 12 lead patient cable is connected the following lead options are available by pressing the LEAD button diii f lds k iz lead aVL sf i2 lead fj lt 1 ielead WR 1 iz lead Il 1 PJ ial 5 2 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 12 LEAD MONITORING OPTIONAL Waveform Window 12 lead Quick Access Functions Calibration Set Heart Rate Next lt The Basic 12 lead waveform window can display either 1 2 or 3 traces 129 100 ar 182 98 iil Signal OK i Manual 12 LEAD soa _ VOL m Set 7 ar To add or remove traces from the waveform window access the trace menu by pressing NEXT gt DISPLAY gt TRACES in the treatment summary menu Once in the Trace Menu you can select the waveform you would like displayed in waveform windows 2 or 3 Selectable options include Resp Pleth I II HI aVR aVL aVF V1 V2 V3 V4 V5 V6 and OFF Pressing SAVE will display your selection in the highlighted waveform window NOTE Pressing the LEAD button will allow the user to select the displayed ECG lead in waveform I window only If the 12 lead option is installed a Next icon will appea
223. purpose electrodes rather than from the smaller ECG electrodes WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 7 7 SEMI AUTOMATED EXTERNAL DEFIB OPTIONAL EMS Mode 7 8 Should the multipurpose electrodes become detached while the ECG electrodes are attached the PIC will announce CHECK DEFIB ELECTRODES and automatically switch over to monitoring through the ECG electrodes NOTE The ECG Lead indicator will signify Lead II If a shockable rhythm is detected the PIC will prompt you to ATTACH DEFIB PADS and will not allow you to defibrillate EMS mode is a feature specifically designed for the use by an Emergency Medical Technician EMS mode is recommended when continuous SAED mode analysis is required while transporting a patient or performing another procedure such as intubation EMS Mode is a supervisor selectable mode of operation that performs continuous background analysis but requires the user to press the A button for full analysis in response to a prompt from the PIC The following section describes the operation and various features of EMS mode Background Monitoring When the unit is powered on in EMS mode it is automatically set to a Voice Off mode This means that the PIC will analyze silently and will not speak any voice prompts unless it detects a shockable rhythm If a shockable rhythm is detected the screen will change and the PIC will speak and display CHECK PATIENT SAED BASIC MODE Log EmmoF
224. r at the bottom of the quick access window see below All other quick access controls function as described on page 4 5 a Patient ID John Doe Age 40 Global Alarm Identifier QRS Beeper 1122991645000000 Review Acquire Quick access controls WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 5 3 12 LEAD MONITORING OPTIONAL ee Entering Patient ID information Patient The operator can enter specific information about each individual Information patient such as Name Age Sex and an identifier code to be used for documentation To begin press the 12 button of the quick access window to display the Patient ID menu The defaults for the Patient ID menu ys are Age 40 Name John Doe Sex M 1122991645000000 Sex M Review Identifier today s date followed by et the time and serial number H mmddyyhhmm000000 Patient ID Name John Doe ENTERING PATIENT S NAME 1 Press the NAME button A The Name menu appears giving the operator the option of moving the cursor forward or backward or clearing canceling or saving the entry Li NOTE After pressing the name button the treatment window options are replaced by an alpha numeric window The default name John Doe is displayed just above the alpha numeric window with an active cursor highlighting the first letter of the name ABCDE _FGHIJ PEST Sn a a 2 Enter anew name by pressing once on the group of characters containing the l
225. r every 24 hours or when it becomes occluded e Do not use with patients with a low tidal volume such as patients younger than 3 years of age or weighing less than 22 pounds or patients with a respiration rate greater than or equal to 60 breaths per minute e Accuracy is based upon atmospheric pressure and no residual CO gas left in the sensor from previous expiration The CO trace will be displayed as if that is the case 1 18 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM OOo o CHAPTER 2 INTRODUCTION This chapter introduces the Welch Allyn Portable Intensive Care PIC System beginning with a brief listing of features and benefits This is followed by an explanation of the part numbers and checklists of available options and accessories The chapter concludes with procedures and considerations for unpacking installing and operating the system Chapter Overview Product Overview 0 ee eee 2 2 Indications for US 0 0 000 es 2 4 Par NUIMDCIS erinran ela Sern eh E Shae eRe a Ba 2 6 Options and Accessories 0 es 2 7 Initial Installation Evaluation 0 0 00 0c eee 2 9 Summary of OperationS 0 0 0 ees 2 11 ae he Te 100 2 Tea 7 or Ah Charge tpn Eg ae e Energy WV overienwiaron nia Welch Allyn Portable Intensive Care PIC System WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 2 1 INTRODUCTION EE Product Overview Key Features Flexible Design Small Lightweight M
226. r is charging The energy bar graph on the right of the display will indicate the relative charge state Check Pulse After each set of three consecutive defibrillation attempts the PIC advises the operator to CHECK PULSE IF NO PULSE START CPR After 60 seconds the PIC will announce Stop CPR and resume monitoring the patient s ECG Note If an ECG rhythm is non shockable it may qualify as 2 No Shock analysis results to hasten entry into CPR mode WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM PIC 40 50 USER S MANUAL ADDENDUM Lee Chapter 13 Menus This section of the addendum addresses the changes to Chapter 13 Menus The following corrections are included e Supervisor Menu Overview page 13 4 e User Menu Setup page 13 23 e Supervisor Menu page 13 24 e Supervisor Menus Defibrillator page 13 25 e Supervisor Menus Pacer page 13 27 e Supervisor Menus SAED page 13 28 e Supervisor Menus 12 Lead pages 13 30 13 31 e Supervisor Menus Setup pages 13 33 and 13 36 e Supervisor Menus Alarms page 13 41 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM ADDENDUM 5 PIC 40 50 USER S MANUAL ADDENDUM Supervisor Menu Overview _ correction to page 13 4 Factory Menu Choices Choice Range Default 12 Leadt Printer 2x6 I V1 2x6 V1 V2 3x4 III 3x4 II II 10 sec Lead II t If option has been purchased User Menus Setup corrections to page 13 23 Data Transfer Menu ADDENDUM 6 Use the Data Tr
227. r the immediately preceding event 12 6 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM DOCUMENTATION es FFT et ede Ml Aah i an FREQ Monitor Response Log Full If the Treatment Summary log is full and a TREATMENT SUMMARY EVENT button is pressed e g LIDO the event will be printed and a Log Full message will be printed The event will not be saved in the Treatment Summary log Log Full printouts should be saved and added to the log printout to provide a complete history of the event Pulse Timer The Pulse Timer is activated by pressing the SAMPLE button illustrated below The Pulse Timer allows the operator to take a patients pulse by timing one 60 second interval When the operator presses the Sample button two beeps sound at 0 15 30 45 and 60 seconds The time duration is illustrated in the sample time graph At the end of 60 seconds the sample time graph disappears Sample time graph Intubate IV WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 12 7 DOCUMENTATION EE The Recorder The Traces Menu under the Recorder Menu allows the operator to Traces Menu choose whether 1 or 3 traces are printed to the chart and whether 1 or 3 traces are recorded to the card Printer Traces 1 Card Traces 1 i Three trace mode will automatically disable voice recording in manual mode The following traces can be printed to the chart recorder while in three trace mode Chart Reco
228. ransmission phone numbers are entered in the Supervisor Menu See chapter 13 r m z j fa ma p pe ey et i a r I we e ee eee j a a r Print Function Pressing the print button will print 3 seconds of each lead in groups of three along with the patient ID information Select the desired page 1 2 or 3 of ECG data before printing NOTE The format of the 12 lead print out can be changed from the Supervisor gt 12 Lead gt Printer menu The print out shown above is the default 3x4 I II III format Page Function E This functions allows the operator to view 3 snapshot pages of 12 lead ECG data See previous section Viewing the Snapshot Information WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 5 13 CHAPTER 6 MANUAL DEFIBRILLATION This chapter describes the manual mode defibrillator controls and displays It provides operating instructions for manual defibrillation and using external paddles and the multi purpose hands free adapter Chapter Overview e Manual Defibrillator Controls and Displays e Manual Defibrillation Operation Procedures CAUTION First read chapter 1 Safety Information before proceeding with this chapter NOTE The unit has an automatic defibrillator disarm mode If energy is not delivered to a patient or load an internal timer will disarm the defibrillator after 1 minute in manual mode a o F Defibrillator o fire button TE Def
229. rder Traces Trace Speed Menu The Speed Menu under the Recorder Menu allows the operator to select the speed of the chart recording during trace output 25 mm s All chart printouts are at 22 mm s 50 mm s 12 Ld Only 12 Lead snapshots print at 50 mm s 50 mm s All chart printouts are at 50 mm s 25 MM S 50 MM S 12 Ld 50 MM S 12 8 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM DOCUMENTATION Loo FFT Log Functions Clear Log or Print Log Intubate IV Alarms Print Log To print out or clear the log follow the steps below Begin by pressing NEXT in the Treatment Summary menu A Then press RECORDER in the Configuration menu B Next press LOG to enter the Log menu C From the Log menu the user can print the log stop printing the log or clear the log D To exit press EXIT E Treatment Lida Bret Sampe Clear Print Lo Configuration g SPOZ WNIBP Resp Recorder Set up Print Trend Stop Print Clear Grid On Review Voice Trends Back A Treatment Summary printout is printed for each patient when the Log is printed out The Treatment Summary includes a place for the patient s name the time and date that system power was turned on the total number of ECG events stored for that patient the total number of defibrillator shocks delivered to that patient and the elapsed time the system was on The Treatment Summary is followed by a printout of all the ECG samples stored for that pa
230. ring system 1 HR Indicates the Heart Rate Window 2 78 BPM indicates heart rate displayed in beats per minute flashing heart rate indicates an alarm limit has been exceeded 3 ECG abbreviation indicates the origin of the heart rate In this case the source of the heart rate is derived from the ECG electrodes The PIC will derive the heart rate from the optimal source Size Lead Hold Priority 1 ECG electrodes 2 OX sensor or 3 BP cuff 4 Bell symbols in the Heart Rate window indicate the status of the HR alarm amp alarm off a alarm on A alarm upper limit set io alarm lower limit set 44 automatic HR alarm set WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM ECG MONITORING Loo FFT Lead Fault The ECG trace will be replaced with a dotted line and the words LEAD FAULT to indicate a lead fault condition Lead fault condition maybe occur due to improper connections on the patient cable lead wires should be inspected for proper contact and connection Replace the electrodes if necessary In rare cases an excessive offset voltage on the ECG electrodes may cause a lead fault condition Size Pressing the SIZE button selects ECG trace sizes from 0 125cm mv to 4cm mv and automatic trace sizing Pressing the up arrow will increase the ECG size Pressing the down arrow will decrease the ECG size The AUTO size setting will automatically select the proper gain to fit the ECG in the waveform window Whe
231. rm is turned back on See example below Resp Alarm Off Resp alarm off upper limit setting is 30 OF 5 Resp alarm off lower limit setting is 5 NOTE lfa limit is disabled the word disabled will appear instead of A Off number 14 10 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM ALARMS as FFT Setting Resp To set the Resp alarm to on press the OFF ON button A until On is Alarm to ON highlighted When both the upper and lower Resp alarm limits are set to On the alarm on icon will appear in the Resp window the global alarms will be turned on and the box surrounding the upper limit will be highlighted ee ir CASPAAArM 1 Set the upper limit Press the UPPER LIMIT nam on n button B to select upper limit A bold line will appear around the box Press the up or down A D arrows C to increase or decrease the upper limit setting by 5 RPM You can disable the upper limit by pressing the upper limit button again to display 5 Disabled below the words Upper Limit The alarm exit icon in the Resp window will display the appropriate status 2 Set the lower limit Press the LOWER LIMIT button D to select lower limit A bold line will appear around the box Press the up or down arrows C to increase or decrease the lower limit value the limit will change by 1 below 15 RPM and by 5 above 15 RPM To disable the lower limit alarm press the lower limit button again to display Disabled
232. rols and displays It provides instructions for conducting ECG monitoring and concludes with a discussion of output options Chapter Overview ECG Monitoring Controls and DisplayS 6 4 2 Quick Access Controls and DisplayS 000008 4 5 ECG Monitoring Operation Procedures 4 7 OUTDO S52 Ge Aa E E Ba EA E A ae iA 4 12 CAUTION First read chapter 1 Safety Information before proceeding with this chapter Defibrillator fire button Defibrillator release button ECG patient monitoring cable il 3 N interface _ Hands free r adapter Monitoring controls WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 4 1 ECG MONITORING ECG Monitoring Controls and Displays SSS aS Heart rate window m deg ar 12 LEAD 1B 3 a i 98 e PIC50 Sion Quick access controls and windows Heart Rate Window A i PACER it fessa l fessa Off iS oo outpurcs tputZ 4 2 DEFIBRILLATOR ASS ror ree ree rere ee ee Se ei Se Waveform window ECG monitoring functions on the PIC System are viewed and controlled by the highlighted areas illustrated at left NOTE The following description and operation of the ECG monitoring portion of the PIC System depicts normal factory default settings In chapter 13 we will discuss user configurations of the ECG monito
233. rvisor Menus Pacer The Supervisor Pacer menu is used to configure the power on mode and initial rate This menu is accessible through the Treatment Configuration Set Up menus Set Up Supvsr Date Time Shifts DataXfr Back Enter Passcode here Supervisor UNLOCKED Defibr Pacer SAED 12Lead Set Up Diag Exit Supr Pacer Rate Mode Back Pacer Pacer Rate Mode Menu Menu Pacer Rate Menu Use the Pacer Rate menu to set the power on pacer rate setting The range is from 30 to 180 PPM s Press the UP arrow A or DOWN arrow B button to increase or decrease the pulse per minute PPM selection Press EXIT C to close Pacer Rate menu Pacer Mode Menu Use the Pacer Mode menu to set the power on pacing mode Press the DEMAND A or ASYNC B button If Demand is selected the PIC will supply pacing as needed If Async is selected the PIC will provide continuous pacing A bold outlined box indicates the selected option Press EXIT C to close Pacer Mode menu WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 13 27 MENUS EE Supervisor Menus SAED Set ALS Code Menu SAED Protocol Menu 13 28 The supervisor can use the SAED Menu to change the SAED configuration settings This menu is accessible through the Treatment Configuration Set Up menus Set Up Supvsr Date
234. rvisor Menus Setup Supervisor Menus Alarms Chapter 19 Wireless Transmission e Cellular Configuration Appendix A Specifications e Recorder e Electromagnetic Compatibility WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM corrections to pages 7 2 7 4 correction to page 13 4 correction to page 13 23 correction to page 13 24 correction to page 13 25 correction to page 13 27 correction to page 13 28 corrections to pages 13 30 13 31 corrections to pages 13 33 and 13 36 correction to page 13 41 correction to page 19 6 correction to Appendix page A 5 correction to Appendix page A 7 ADDENDUN 1 PIC 40 50 USER S MANUAL ADDENDUM EE Chapter 3 PIC System Overview This section of the addendum addresses changes to Chapter 3 PIC System Overview This section addresses the change of the Mute button operation implemented in Software version X8 The following correction is included e PIC System Control and Indicators page 3 4 PIC System Controls and Indicators correction to page 3 4 3 Mute Pressing the MUTE button once causes all currently active audio alarms and tones to be muted for 90 seconds except defibrillator charge tone ADDENDUM 2 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM PIC 40 50 USER S MANUAL ADDENDUM Lee Chapter 7 Semi Automated External Defib optional This section of the addendum addresses changes to Chapter 7 Semi Automated External Defib Th
235. ry placing the probe on a different digit It is also recommended blood pressure and saturation measurements be performed on different arms to prevent the occurrence of a Searching message due to constriction of the artery by the blood pressure cuff Some shades of nail polish or long nails can also interfere with oximeter readings Signal OK indicates that the pulse SPO oximeter has found a recognizable a 8 pulse waveform the saturation jo measurement will be displayed as a ee F percentage If the alarm is on and the saturation measurement flashes the SpO alarm limits have been exceeded Poor Signal indicates a weak pulse SPO signal which may result in an N 6 inaccurate saturation determination 2 Corrective steps should be taken to Poor Signal NE ee F minimize any motion related interference and to increase perfusion in the area of the probe Check Probe indicates the probe is either not connected not properly NI connected or the probe may be A a5 oO i Check Probe i defective WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 9 3 PULSE OXIMETER EE Pleth Waveform Window 9 4 If the Pleth waveform window is active see User Menus Display in chapter 13 the Pleth waveform can be viewed If the Pleth waveform window is active and the SpO monitor is turned off Oximeter Off will be displayed in the Pleth wavetorm window If the Pleth waveform window is active the S
236. s Menu The Traces menu allows the operator to choose whether 1 or 3 traces are printed to the chart and whether or 3 traces are recorded to the card Printer Traces 1 Card Traces 1 Three trace mode will automatically disable voice recording in manual mode The following traces can be printed to the chart recorder while in three trace mode Chart Recorder Traces Print Grid Menu In the Print Grid menu users can choose to print or not print a grid on the chart paper Press the ON button to print a grid on plain white paper Select OFF and a grid will not be printed A bold outlined box indicates the selected option Press EXIT to return to the Recorder Configuration menu 13 20 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MENUS Lee Log Menu Voice Memo Menu z Review Menu Trend Interval Menu The Log menu allows the user to print Print Log review or clear the internal log See chapter 12 for specific instructions on how to use this function Press EXIT to return to the Recorder Clear Log Configuration menu The Voice Memo menu allows the user to select play skip forward skip backward and stop options for voice memo recordings stored in the PIC See chapter 12 for instructions on how to use this function Press EXIT to return to the Recorder Configuration menu NOTE This menu is not visible if the speech card option is not installed If the Memory Card Review option was
237. s chapter provides information on the NIBP and TEMP controls displays and operations procedures Chapter Overview e NIBP and TEMP Controls and Displays e NIBP Operation Procedures e Temperature Display and Operation Procedures CAUTION First read chapter 1 Safety Information before proceeding with this chapter WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 10 1 NIBP AND TEMPERATURE NIBP and Temperature Controls and Displays NIBP Displays 10 2 NIBP start stop NIBP button aril _ _ OO l a o M G G a O O O G G G G G a O U G OU O U U U OU O a 120 di I Bee vossa PIC50 MONITOR Lead DEFIBRILLATOR PACING 60 BPM PACER R D D i ae ouput A Temperature window NIBP and temperature functions on the PIC System are viewed on and controlled by the areas shown above NOTE The following operations of the NIBP and temperature mi depict normal factory default settings In chapter 13 we will discuss manual and supervisor configurations of the NIBP and temperature menus When the PIC System is powered on the NIBP default position is off BP Q indicates the non invasive blood Manual pressure option has been installed in d the PIC System Manual indicates the NIBP mode is set to manual operation if the NIBP mode is set to automatic or stat then Auto or Stat will be displayed in the NIBP window respectively The alarm icon in the BP window indicates the NIBP a
238. s settings This menu is accessible through the Treatment Configuration Set Up menus Set Up Supvsr Date Time Shifts DataXfr Back Enter Passcode here Supervisor UNLOCKED Defibr Pacer SAED 12Lead SetUp Diag Exit 12 Lead Phone Fax Printer Freq Analysis Copies Back Phone Fax Printer Frequency Analysis Copies Entry Menu Menu Menu Menu Menu Menu ee Telephone Proceed Next Test Exit Phone Entry Menu The Phone Entry menu allows the Name operator to add edit or delete up to 16 Hospital 1 PE telephone numbers that can be used to Phone Number transmit 12 lead data Once selected a esl telephone specific menu located along Postfix f the bottom of the display area is Receiver Type ee available 13 30 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MENUS Loo Fax Menu Sa The Fax menu controls the output of the fax display for the 12 lead data B5 Set Code Different countries have different fax protocols and are identified by certain codes Set this code according 2600 Baug to the country in which the fax will be received in the Set Code menu that will appear Please see Appendix A for a list of fax country codes Grid Full grid default setting provides grid masks every 0 2 cm Partial grid alternative setting provides grid masks every 1 0 cm and reduces fa
239. s the Edmark Lown and truncated exponential waveforms which have now been used in humans for over 30 years Starting in the early 1980s biphasic waveforms have been extensively studied in animal models of transthoracic ventricular defibrillation These studies have shown that a wide variety of biphasic waveforms exhibited superior defibrillation effectiveness to these conventional monophasic waveforms In many cases the waveform comparisons performed in animals were repeated in clinical trials involving humans These studies have conclusively demonstrated that well designed animal studies can and do predict the results that will be observed in humans The reasons for conducting animal trials as opposed to additional human clinical studies are 1 Animal studies can use a much larger sample size more shocks per subject and thus result in far more accurate comparisons 2 Animal studies do not place human subjects at risk from additional and clinically unneeded shocks 3 The animal hearts can be inspected for damage after the defibrillation studies Waveform Safety These scientific studies have demonstrated that amp Effectiveness 1 The data suggests that the MRL Orbital M Biphasic Conclusions waveform in the Welch Allyn PIC 1s at least as effective as and may be more effective than either of the two tested monophasic waveforms appearing to allow termination of fibrillation episodes using lower energies 2 The MR
240. select either a diagnostic frequency response or a filtered frequency response NOTE The ECG traces printed by the chart recorder and the printout generated when a fax is sent are produced using either the diagnostic or filtered diagnostic as selected by the supervisor There are two diagnostic frequency options 0 05 150 Hz Diagnostic Frequency Filter and 0 25 40 Hz Filtered Diagnostic Frequency Filter See chapters 5 and 13 for information on switching between these two options WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 12 LEAD INTERPRETIVE ANALYSIS OPTIONAL Loo The 12 Lead Interpretive analysis process described in the following procedure may be run in either Automatic or Manual mode e Automatic 12 lead data is collected and analysis follows immediately without operator intervention e Manual 12 lead data is collected and the operator initiates data analysis Procedure 12 LEAD DATA ACQUISITION AND ANALYSIS This procedure provides instructions for the collection and analysis of 12 lead data NOTE This procedure is consistent with the acquisition of 12 lead data described in chapter 5 See chapter 5 for additional information on the various functions of 12 Lead Analysis including collecting and analyzing the data 1 Make sure a 12 lead cable is properly attached to the PIC and to the patient s chest See Chapter 5 2 Press the PIC System Power Switch to turn on the unit The PIC will sense the patient
241. shipment follow the simple steps below Unpacking Visually inspect the carton and the equipment for any signs of Instructions damage or mishandling carton perforations cuts or dents bent or collapsed corners or broken carton seal If damaged contact Welch Allyn immediately BEFORE PROCEEDING FOLLOW STEPS 1 2 3 1 Open and carefully unpack each carton 2 Examine the instrument and accessories for signs of damage 3 Check the packing list to determine that all accessories have been received Save all packing materials invoicing and any other paperwork If any problem is encountered in unpacking the PIC System contact the Welch Allyn Service Department at 847 520 0300 for further instructions Fig 1 Connect defibrillator paddles hands free adapter by sliding connector on here Insert battery here TO DETERMINE INITIAL INSTALLATION CONDITION In order to ensure that the device is running properly after shipping follow the instructions below 1 Connect defibrillator multipurpose hands free adapter see Fig 1 2 Charge all batteries prior to first use 3 Insert a fully charged Welch Allyn Smart Pak battery into the battery slot or use the auxiliary power cable from the Welch Allyn Quick Charger or use the AC power cord from the paddle holder WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 2 9 INTRODUCTION EE 2 10 7 8 9 Press the PIC System power switch to on The PIC System will p
242. shipping containers and packaging materials When shipping the PIC System and accessories for calibration service or upgrades the original shipping containers and packaging materials must be used Manufacturer s Welch Allyn is responsible for the safety reliability and performance Responsibility of the Welch Allyn Portable Intensive Care System only if the following three conditions are met e Assembly operations extensions readjustments modifications or repairs are carried out by persons authorized by Welch Allyn e The electrical installation of the relevant room complies with the appropriate requirements e The PIC equipment is used in accordance with the instructions for use To ensure patient safety and proper operation use only Welch Allyn authorized parts and accessories lll WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM Lee FDA Medical Device Registration The FDA Safe Medical Device Act stipulates that each end user is required under penalty of law to register with the manufacturer all information pertinent to each medical device Please fill out the FDA Medical Device Registration card that shipped with this product and return it to Welch Allyn This card must be filled in and returned within 30 days of product delivery If the medical device is transferred from your possession you must notify Welch Allyn of the new registration information Please contact Welch Allyn 800 462 0777 if you have any questions
243. shockable rhythm was detected The PIC will automatically select the proper energy and begin to charge the defibrillator The display will indicate SHOCK ADVISED CHARGING and STAND CLEAR Periodic tones will be heard to signify the defibrillator is charging The energy bar graph on the right of the display will indicate the relative charge state While Defibrillator is Charging Apply defibrillation gel to the center of one paddle electrode Lightly press the paddle electrodes together and spread the gel evenly over both paddle surfaces Sternum Make sure gel covers the entire paddle surface Do not Apex allow any gel to touch the paddle handle or the operators hands Place the sternum paddle firmly against the patient s chest inferior to the patient s right clavicle and lateral to the upper sternum Place the Apex paddle in the anterior axillary line inferior and lateral to the patient s left nipple as shown to the left WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 7 13 SEMI AUTOMATED EXTERNAL DEFIB OPTIONAL EE Shock Advised Stand Clear Shock Now After the defibrillator has completed charging to the selected energy the display will indicate SHOCK ADVISED SHOCK NOW STAND CLEAR The PIC will announce SHOCK NOW and the Periodic Lee s _ charging tones will change to a steady tone signifying that the a pmm a 200 defibrillator is fully charged With the paddles in the proper position n clear a
244. shot a Press the ACQUIRE button B This will enter you into the Active 12 lead Mode The PIC System will begin storing 10 seconds of 12 lead ECG information The word ACQUIRING will blink in the waveform window and the quick access window will blank except for a stop icon at the bottom 5 8 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 12 LEAD MONITORING OPTIONAL NOTE To stop 12 lead acquisition press the STOP button and the patient ID menu will appear b After approximately 10 seconds the PIC System will prompt the user that it has completed acquisition A snapshot and real time window will appear each show ing leads I II and III The Quick access window will have also changed to display Analysis Save Fax Print Page and Back icons Review old 12 lead Press the 12 LEAD LOG REVIEW button If at least one 12 Lead Snapshot snapshot is in the internal log the 12 Lead Log Review menu will display which allows selecting from the 10 most recent acquired snapshots Ls snapshot 10 t Patiant X Snapshot 11 071 0 00 i 01 99 12 0101391200000 Selects Next newer snapshot Name when snapshot signal is acquired Snapshot Index Date Time when snapshot originally acquired ID when snapshot originally acquired Selects Previous older snapshot Review the present selected snapshot from internal log F 5 Returns to Patient ID menu NOTE The most recent snapshot header information is display
245. spiration waveform Press Next on the Treatment Summary menu A Then press Display B then Traces C When the Traces menu pops up press waveform 2 D Next press the up arrow to select Respirations E Press Save F to enter your selection and change the display When the respiration waveform window is selected Respiration Searching will be displayed The respiration waveform will appear in the waveform window and the resp rate will be displayed in the respiration window WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM RESPIRATION AND C02 OPTIONAL CO optional z Standard Features CO ACCESS Turning on CO WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM The next four pages describe the controls displays and operation of the CO monitoring functions If installed the CO option replaces respiration features and operation described previously in this chapter NOTE The following description and operation of the CO gt monitoring portions of the PIC System depict normal factory default settings In chapter 13 we will discuss user configurations of the CO monitoring systems Optional Installable Features A Analyze 12 12 Lead LOG Log IBP If the CO monitoring function is installed a NEXT icon will appear at the bottom of the quick access window see above Pressing NEXT A will allow access to an additional Quick Access menu containing the CO icon The CO option is set to O
246. splay is located at the top of the display and the font size is 48 points high and 32 points wide depending on num ber of digits in the heart rate Color is amber black white or whatever the color the display text is Lead Fault Alarm Audible 3 pulse 500 Hz triplet tone with a PW of 200 msec a PRI of 310 msec When the HR alarm is set or the pacer is on the lead fault tone repeats at a repetition interval of 20 seconds Visual Lead Fault condition causes a gt LEAD FAULT message to be displayed on the trace along with a dashed line the width of the trace The text is 20 points high and 16 points wide and is the color of the display text The signal is not modulated Physiological Alarms BP SpO Resp amp Temp Audible See Heart Rate Alarm Visual Physiological alarms cause the displayed parameter to flash at 2 Hz Color is amber white or the same as the display colored text WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM SPECIFICATIONS Loo Mute Duration 90 seconds Recorder Type High resolution thermal array Annotation Time date ECG lead ECG gain heart rate defibrillation and pacing parameters and treatment summary ACLS events Paper Width 50 mm Paper Speed 25 mm sec 50 mm sec Delay 6 seconds Frequency Response Automatically set to monitor s frequency response Treatment Summary 7 switches to record key ACLS events IV INTUB EPI LIDO ATROP etc Automatically logs in
247. spool so the inside of the paper contacts the print head PIC contains a unique feature to assist the operator in documenting information when a pen and paper may not be available Pressing the VOICE MEMO button on the front panel will digitally record speech The PIC can record up to 24 seconds of speech to the internal log and up to 2 hours of speech to a memory card 1f option was purchased To record speech press and hold the VOICE MEMO button As soon as the button is released the recorder will stop NOTE For memory card recording the voice memo mode can be setup in Supervisor gt Audio menu to be either Memo press and hold to record Start Stop press to start press again to stop recording or Continuous automatically records all the time See Supervisor Menu Setup in chapter 13 During audio recording the wheels of the tape icon gi will spin indicating the recorder is recording When the voice Internal Log memo is full and the voice memo button is pressed the words Voice Memo Full will be printed on the chart recorder Any further voice messages will not be recorded until the internal voice memo is cleared Voice Memo Full Voice Memo Recording LIDO BRET Sample Clear NOTE If memory card is installed and record option is purchased voice record defaults to memory card rather than internal log Speech events in the internal log can be played back directly from the PIC in the Recor
248. stance According to Frequency of Transmitter meters Rated 150 kHz to 150 kHz to 80 MHz to 800 MHz to 80 MHz to 800 MHz to maximum 80 MHz 80 MHz in 800 MHz 2 5 GHz 800 MHz 2 5 GHz output outside ISM ISM bands IBP only IBP only power of bands transmitter W d P2 VP d 7 VP d 7o VP d P o VP d VP d 2 VP For transmitters rated at a maximum output power not listed above the recommended separation distance d in meters m can be determined using the equation applicable to the frequency of the transmitter where P is the maximum output power rating of the transmitter in watts W according to the transmitter manufacturer Note 1 At 80 Hz and 800 MHz the separation distance for the higher frequency range applies Note 2 The ISM industrial scientific and medical bands between 150 kHz and 80 MHz are 6 765 MHz to 6 795 MHz 13 553 MHz to 13 567 MHz 26 957 MHz to 27 283 MHz and 40 66 MHz to 40 70 MHz Note 3 An additional factor of 10 3 is used in calculating the recommended separation distance for transmitters in the ISM frequency bands between 150 kHz and 80 MHz and in the frequency range 80 MHz to 2 5 GHz to decrease the likelihood that mobile portable communications equipment could cause interference if it is inadvertently brought into patient areas Note 4 These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects
249. stem annotation The paper is thermal sensitive and care should be exercised to prevent loss of recorded information Avoid extended exposure to sunlight high temperatures or humidity and contact with adhesive tapes PIC Leadi icm mV 2 01 98 12 13 23 HR 65 nh nn hn ht e G E ni Sn hh ht hth inh nh hh hhh hh hhh hn nih rnin hhh hn hn rn intr in nh hhh ini E E e e hn hn nn g E e E nn e E e e ge E e EEE CEEE TEEI EEEE EEEE EEE TEEN EENE lt i H 4 oS t i i xe H FREQ Monitor Response SPO2 98 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 12 1 DOCUMENTATION NT mRettEZJ Chart Recorder Printouts Chart Recorder System On Header Fach time the PIC is powered on the unit will perform a self test and the results of the test will be printed on the header The date and time the system was turned on and software revision level will be printed on the header if the device has been turned off for more than 2 minutes NEW PATIENT NAME z SYSTEM ON G y s 01 06 97 12 05 44 S g 3i 2 B N gt 8 a T SN 10001 gt 38 3 gt Dept NFLD FD Unit A29 SW Rev G Chart Recorder Startup Printout 12 2 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM DOCUMENTATION Lee If the device was switched off briefly for less than 2 minutes e g to change the battery the device will assume that the same patient is being monitored and the startup header shown at right will be fey
250. stem Defibrillation Hands Free Pads 3 9 ECG MONNOMO isaisa aa aaa aa 4 1 ECG Monitoring Controls and Displays 4 4 2 Quick Access Controls and DisplayS cccccceeees 4 5 ECG Monitoring Operation Procedures 0006 4 7 CUS eann seas eae acne eee 4 12 12 lead Monitoring Optional ccssesssssseseseeseeeees 5 1 Basic 12 lead Monitoring Controls and Display 3 2 Entering Patient ID Information sseeeeeeeeeeeeeeeseessssee 5 4 Monitoring in Normal 12 lead Mode 0068 5 7 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM V EE Active 12 Lead Monitoring Controls and Displays 5 8 Quick Access Functions of the Active 12 lead Mode ccccssssssesseeeeeeseeeeeeeeees 5 11 Manual Defibrillation 2 cccccseeseecccsnneeeeceenneeeeeeeees 6 1 Manual Defibrillator Controls and Displays 6 2 Manual Defibrillation Operation Procedures 6 5 Semi Automated External Defibrillation optional 7 1 SAED Basie M derris a dz SAED Basic MOG cane the ate tana nes 7 6 SAED Operation Procedure Seisa Tel EMS MOC EE 7 8 SAED Mode Operation with Multipurpose Hands Free PAGS casscacaseccsacancsoe r r steonsesseeee ee 7 9 Defibrillation with Paddles while in SAED Mode 7 12 Ext rnal PacMan ai aaaea 8 1 External Pacer Controls and Displays 000ssooeeeeenesss 8 2 External Pacer Operation Procedures
251. stolic or diastolic limits press the OFF ow I ON SET SYS SET DIA button A until Set Sys or Set Dia is highlighted Sys Upper Limit Select either the upper or lower systolic diastolic limit to set limits B The limit selected will be sur ae rounded by bold outlined box Dia Lower Limit 50 3 a 3 Press the up or down arrows C to increase or decrease the limit value You can disable either limit by pressing the upper or lower systolic dias a tolic limit button again to display Disabled The IBPI Alarm i a aa alarm icon in the BP window will display the Sys Dia appropriate status Sys Upper Limit d 4 Press EXIT D to leave menu 0 Sys Lower Limit 80 NOTE Both systolic and diastolic upper or lower limits must be disabled for the alarm icon in the IBP window to display an upper AX or lower Q limit icon WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 14 9 ALARMS EE OTHER IBP SOURCES Resp Alarm In the Resp alarm menu the Resp alarm can IN 1 2 Resp be set Off or On The appropriate alarm icon Rate appears in the Resp window indicating the current state of the alarm Setting Resp SETTING RESP ALARM TO OFF Alarms To set the Resp alarm to off press the OFF ON button A until Off is highlighted When the Resp alarm is set to Off the upper and lower limits will each display Off and a number The number indicates the current set Resp limit that will be active when the Resp ala
252. t s response the heart rate display may read less than what is selected on the pacer rate window How much less will depend on the time it takes the heart to respond to the pacing stimulus In the ASYNC MODE pacing pulses are not dependent on the patient s cardiac activity The pacer will deliver pacing pulses at the selected pacing rate 12 Press the START STOP button to initiate pacing The pacing display will indicate pacing and the orange pacing light will change to green indicating the pacer is active Each time a pacing pulse is delivered to the patient the green light will flash off briefly 13 Ensure that the pacing pulses are occurring in the appropriate position of the cardiac cycle 14 Press the OUTPUT button to adjust the pacing current output Pressing the up arrow will increase the current by 10 mA Pressing the down arrow will decrease the current by 5 mA Slowly increase the output current while observing the ECG for evidence of electrical capture Check patient s pulse or blood pressure to verify mechanical capture Select the lowest output current that will achieve both electrical and mechanical capture WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 8 7 EXTERNAL PACING EE 8 8 z z z Electrical capture can be verified by noting a large ectopic beat approximately 100 msec after the pacing pulse is delivered to the patient The morphology of this pulse may vary widely from patient to patient somet
253. t s ECG with the patient cable multipurpose hands free adapter or paddles Apply gel to paddles or apply Multipurpose electrodes to patient Select energy by pressing the ENERGY SELECT up down buttons Press CHARGE button on front panel or on apex paddle deluxe paddles After the defibrillator charges to the selected energy a continuous charge tone will be heard visually and verbally clear the patient Place the paddles firmly on the patient s chest To discharge the defibrillator press both DISCHARGE buttons on the paddles or press the DISCHARGE button on the multipurpose hands free adapter WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 2 11 INTRODUCTION EE Non Invasive Pacing ap 0 0 ecst Monitoring SpO aD 0 00 Monitoring NIBP T 0 00 2 12 Monitor patient s ECG with the ECG patient cable Set lead to I II or III Apply multipurpose pads to patient as illustrated on package Connect multipurpose pads to multipurpose hands free adapter Press the PACER ON OFF button to turn on pacer Press the MODE button to select either DEMAND or ASYNC modes Press the RATE button to select the desired rate Press the START STOP button to initiate pacing Press the OUTPUT up arrow to increase the pacing output current until capture is obtained Note If the defibrillator is charged the pacer will automatically turn off Attach appropriate SpO sensor to the patient and to the PI
254. t the upper limit Press the UPPER LIMIT button B to select upper limit A bold line will appear around the box Press the up or down arrows C to increase or decrease the upper limit value You can disable the upper limit by pressing the upper limit button again to display Disabled below the words Upper Limit The alarm icon in the Temp window will display the appropriate status Set the lower limit Press the LOWER LIMIT button D to select lower limit A bold line will appear around the box Press the up or down arrows C to increase or decrease the lower limit value To disable the lower limit alarm press the lower limit button again to display Disabled below the words lower Limit The alarm icon in the Temp window will display the appropriate status Exit Press EXIT to leave menu WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 14 13 ALARMS EE End Tidal CO ETCO Alarm The ETCO alarm settings apply to both the CO and ETCO waveforms Bell symbols in the CO or ETCO value windows indicate the status of the ETCO alarm enabled disabled X alarm upper limit set A or alarm lower limit set Q In the ETCO alarms menu the ETCO alarms can be set Off or On An alarm icon will appear in the CO and ETCO value window in the appropriate waveform window indicating the current state of the alarm Setting ETCO SETTING THE ETCO ALARM TO OFF Alarm To set the ETCO alarm to off press the OFF ON b
255. t use the defibrillator if excessive condensation 1s visible on the device Wipe only the outside with a damp cloth e Use only Welch Allyn approved disposable defibrillation and pacing pads and cables e Defibrillator paddles should be kept clean and dry when not in use When preparing electrodes and during defibrillation procedures extreme care should be exercised to prevent gel or any conductive material from forming a contact between the operator and the paddles Do not allow gel or any other conductive material to form an electrical bridge between the defibrillator electrodes or to the monitoring electrodes Electrical arcing and or patient burns could occur during defibrillation Arcing and patient burns could prevent sufficient energy delivery to the patient e WARNING If conductive gel forms a continuous path between the defibrillator electrodes delivered energy may be dramatically reduced to zero In this case reposition the electrodes to eliminate the shunting path before attempting additional shocks e Improper defibrillation technique can cause skin burns To limit possible skin burns use only Welch Allyn defibrillation gel on paddles insure the gel covers the entire paddle surface and press firmly against patient s chest e Disposable defibrillation electrodes must be used in accordance with the manufacturer s instructions Do not use expired dry electrodes or reuse disposable electrodes as improper patient cont
256. tage Charge Indicator Audible and graphic Output Adult paddles pediatric adapter and multipurpose hands free adapter available Synchronizer Delivers energy within 60 msec Disarm Front panel switch WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM SPECIFICATIONS Lee Monitor Display Input 3 lead 5 lead or 12 lead patient cable paddles or multi purpose hands free adapter Size 6 5 inches 16 5 cm diagonal non fade Type Electroluminescent EL color TFT or monochrome LCD Display Resolution 640 x 480 pixels Sweep Speed 25 mm sec Lead Selections Paddles Pads I H II AVR AVL AVF V1 6 Frequency Response User selectable 2 to 20 Hz Limited mode 0 5 to 40 Hz Monitor Mode before Rev S7 1 to 40 Hz Monitor mode before Rev T8 U8 0 67 to 40 Hz Monitor mode SW Rev T8 U8 0 05 to 40 Hz Filtered Diagnostic Mode SW Rev S3 to T6A U6A 0 35 to 40 Hz Filtered Diagnostic Mode SW Rev T7 U7 0 25 to 40 Hz Filtered Diagnostic Mode SW Rev T8 U8 0 05 to 150 Hz Diagnostic mode automatically sets chart recorder response Common Mode Rejection Complies with AAMI EC13 1992 section 3 2 9 10 Tall T Wave Rejection Meets AAMI EC13 1992 section 3 1 2 1c for 1 2 mV T wave 1 0 mV with diagnostic response and 1mV QRS Diagnostic Signals Applied to Patient Connections Leads off active noise suppression sensing circuit is lt 0 1 microamps DC The impedance respiration de
257. tector signal frequency is 45 4kHz at 78 microamps RMS 117mV RMS into an impedance of 1 5 KOhms pseudo sinewave Heart Rate Meter 20 to 300 BPM Heart Rate Alarms User selectable Size 0 125 0 25 0 5 1 2 4 cm mv and auto ranging Aspect Ratio 0 5 0 1 0 4 0 8 1 6 respectively ECG Output 1 V mV WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM A 3 SPECIFICATIONS EE Alarms A 4 Heart Rate Meter Response Time Responds to a 40 BPM step increase in heart rate in 2 to 4 5 seconds per AAMI EC 13 1992 section 3 1 2 1 f Responds to a 40 BPM step decrease in 1 4 to 3 9 seconds per AAMI EC 13 1992 section 3 1 2 1 f Response times include a 2 5 second display update interval Heart Rate Response to Irregular Rhythm AAMI EC13 1992 section 4 1 2 1 e Ventricular Bigeminy 80 BPM expected Slow Alternating Ventricular Bigeminy 60 BPM expected Rapid Alternating Ventricular Bigeminy 120 BPM expected Bidirectional Systole 45 BPM expected Tachycardia Response Time Response time to tachycardia alarm is on average 3 43 seconds with a range of 1 15 to 10 69 seconds per AAMI EC 13 1992 section 3 1 2 1 g Response times include a 2 5 second display update interval Heart Rate BP SpO Resp amp Temp Alarm Audible 5 pulse 800 tone with a PW of 150 msec a PRI of 225 msec and a repetition interval of 10 seconds Visual Heart Rate Alarm causes the displayed heart rate to flash at 2 Hz This di
258. ted one analysis of the patient s ECG and that No Shock was advised The PIC resumes monitoring the patient Two BEFPs will be heard signifying no shock advised result NO SHOCK ADVISED ec amem STANDGAGK muna of the initial analysis After 3 consecutive No Shock analyses the PIC gemes displays CHECK PULSE IF NO PULSE START CPR The PIC will continue to assess the patient s heart rhythm If the signal is non shockable No Shock Advised will continue to flash on the display and an audible beep sounds every minute but if the PIC detects a shockable rhythm it will direct the operator to stand back as it begins to analyze the patient s heart rhythm WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 7 3 SEMI AUTOMATED EXTERNAL DEFIB OPTIONAL EE SHOCK ADVISED CHARGING STAND CLEAR SHOCK ADVESED SHCHSK NOW STAND CLEAR SAED BASIC MODE SAED BASIC MODE CHECK PULSE IF NO PULSE START GPH Shock Advised Charging Stand Clear Indicates the PIC completed analyzing the patient s ECG and that a shockable rhythm was detected The PIC will automatically select the proper energy and begin to charge the defibrillator The display will indicate SHOCK ADVISED CHARGING and to STAND CLEAR The PIC will announce SHOCK ADVISED STAND BACK Periodic tones will be heard to signify the defibrillator is charging The energy bar graph on the right of the display will indicate the relative charge state Shoc
259. the A Analyze button will flash If the operator is performing CPR the A should be ignored Pressing the A button will abort the CPR cycle and analysis cycle will restart WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM SEMI AUTOMATED EXTERNAL DEFIB OPTIONAL Loo In the SAED Basic mode access to the manual defibrillation mode may be Locked Out by a Passcode SAED Basic Displays Self Test Passed Indicates the SAED Basic mode has been selected and the power on Lead Fault Indicates a lead fault condition Neither the defibrillation electrodes or the 3 lead ECG cable have been properly attached to the patient Check to see that the defibrillation electrodes have been properly attached to the patient and to the Hands free adapter The PIC will announce CHECK DEFIB ELECTRODES during this condition The display will indicate LEAD FAULT and in lieu of an ECG to signify lead fault Analyzing Pads Indicates the electrodes have been properly attached and the PIC is p monitoring the patient s ECG for criteria that may indicate a shockable rhythm The PIC will announce STAND BACK ANALYZING ECG Avoid touching or moving the patient SAED BASIC HODE Touching or moving the patient can cause artifact which may interfere E a with the analysis process E PON E Vee res See P ANALYZING PADS STAND BACE No Shock Advised Indicates the PIC has comple
260. the Alpha Numeric window The WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 5 5 12 LEAD MONITORING OPTIONAL E gt 5 6 z operator has the option of moving the cursor forward or backward or clearing canceling or saving the entry es ey Patient ID Identifier Name John DOs FORWARD Age 40 Sex M Identifier 11221645000000 Acquire NOTE After pressing the identifier button the treatment summary window options are replaced by an alpha numeric window The default Identifier Date and time is displayed just above the alpha numeric window with an active cursor in the first space of the identifier code 2 Using the Alpha Numeric window options enter a new character by pressing once on the group of characters containing character of your choice B In this case we want to change the first character of the identifier 1 to a 0 3 Then press on the actual character C Your selection will be entered and the cursor will move to the next character in the identifier Continue this procedure to complete the name 4 Pressing the SAVE button in the Identifier Menu will save the selection and return to the patient ID menu Treatment Summary window Treatment intubate w em tbo BRET Sample Clear Next __ ABCDEF LMNOPOR STUVWX Yz 12345 67890 Space WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 12 LEAD MONITORING OPTIONAL Loo Monitoring in Normal 12 L
261. the fax option is purchased the fax output cable 001949 must be connected to the fax output jack and to a wall phone jack or to the cellular phone adapter 900241 before initiating a fax operation LLL Dial 1 4 HOSP 1 Initializing HOSP 1 Dialing HOSP 1 Connecting HOSP 1 Sending 847 520 0300 2 847 520 0303 847 462 0777 T T e O O O O n no n n ae vu Ee w _ HOSP 1 847 520 0300 HOSP 1 Complete OPERATION OF THE FAX FUNCTION 1 Select the page 1 2 or 3 of ECG data to fax See page function on the following page 2 Press the FAX button A selection of 12 previously programmed phone numbers and 4 user programmed numbers will be displayed If the user dial menu on the 4th menu page is selected a alpha numeric entry menu will be displayed on the bottom of the screen The user can enter a phone number using the technique described previously in this chapter 3 Press the appropriate location phone number to send the stored 12 lead data or press NEXT PAGE to display the next page of phone numbers WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 12 LEAD MONITORING OPTIONAL 4 A sequence of status messages consisting of Initializing Dialing Connecting sending 20 40 100 Complete will display in the box of the number that was selected A fax transmission summary will be printed on the chart recorder and stored in the log NOTE Fax t
262. tient At the end of the ECG traces a System Off message will be printed along with the time the system was powered down If the system was powered down for more than two minutes a new patient is assumed and a new event summary is generated If the system is powered down for less than 2 minutes e g for a battery change it is assumed that the same patient is being monitored and subsequent events will be added to the current Treatment Summary Log Multiple copies of the Treatment Summary Log can be printed by printing the log again after the System Off message is printed WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 12 9 DOCUMENTATION EE EVENT SUMMARY Ae a e a RRs NAME RRN eg rreperi ee ee Bee ee ee SYSTEM ON Se EEE Se Ei CEE SEH LEA BBE ees HEH es GELE EEH EEH LEED EEB EEEE Dirt HEE FEH EEB EEE EEH EE ee HE E 01 06 97 12 52 42 H EON CEE ceeds kee E cee a ed s E pingen EF likens N E E E eet E H es eed E ae TOTAL EVENTS 24 HEFE EH EFH es Ae ee H ee Bee H HBHH se H LA TOTAL SHOCK cs SS gic died alk a ine aia Not mat Net ELAPSED TIME 00 32 46 EE DEEE SEEN EEEE BE SE EE EC SEEE EEEE EEEE DEEE E EEE DO EEE E EE a SN 10001 oe ee Dept NFLD FD pinpon PRR HE HH bisspersdisscsbescbesc EHRE HE E e st SW Rev G HEH HH HH HE E HE FREQ Monitor Response Print Trend A Trend Summary is printed for each patient when Print Trend is 12 10 pressed The Trend Interval must be On see User Menus Recorder If the Trend Interval is set
263. to B P a trend event will be generated when a BP reading occurs If the Trend Interval is set to a time interval a trend event will be generated at each elapsed time interval The Trend Summary information includes a place for the patient s name the date and time when the system was powered on the total number of ECG events stored for the patient the total number of shocks delivered to the patient and the elapsed time the system was on If the system is powered down for more than two minutes a new patient is assumed and a new Trend Summary is generated If the system is powered down for less than two minutes it is assumed that the same patient is being monitored and subsequent events will be added to the current Trend Summary printout EVENT SUMMARY Time HR OX BP CO2 mmHg Temp IBP 1 IBP 2 NAME J onathan Wilkens ee ee SYSTEM ON 08 54 03 59 N A 118 60 93 8 0 33 98 3 e pt poe 03 04 01 08 52 00 08 54 43 54 N A 120 60 95 29 29 29 98 5 pefeseee Sah popes TOTAL EVENTS 09 08 55 57 59 N A 124 60 93 98 5 ses pees TOTAL SHOCKS 07 08 56 40 63 N A 124 60 94 98 6 e 0 Sat eeso ELAPSED TIME 00 09 30 08 56 43 65 N A 124 60 94 98 6 a jasi S N 0 08 57 15 66 N A 126 60 96 98 7 aaen Ten l Dept 1 08 58 24 67 N A 126 60 6 on 98 6 sefte jee Unit 1 09 00 07 68 N A 127 60 97 1 98 6 e e HSS res SW Rev S4 09 01 02 12 N A 128 60 98 ae 98 6 sesa Caie psss Vital patient dat
264. to access the Supervisor menu To reset the code press the RESET TO 0 button The Lock icon on the Supervisor menu title block will open when the correct code is entered If the wrong code is entered the will remain locked NOTE If the code is lost contact your Welch Allyn authorized service representative To select the month option press the corresponding button A A bold outlined box indicates the selected option Press the UP or DOWN arrow buttons B to select a specific month Follow the same procedure to set the day and year When finished press SAVE C WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MENUS Loo Set Time Menu To select the hour option press the corresponding button A A bold outlined box indicates the selected option Press the UP or DOWN arrow buttons B to select the hour Follow the same procedure to set the minute When finished press SAVE C Active Shift Menu The Active Shift menu allows the user to select predetermined shift settings options Active Shift 1 established by the supervisor This option enables the user to save the user configurable menu items as shift 1 2 or 3 Press the corresponding button to Defaults activate shift 1 2 or 3 Then press EXIT to change to the settings for the selected shift settings Refer to Supervisor Menu Setup Active Shifts for additional information NOTE An asterisk next to a shift
265. to memory the type of event time and ECG sample Tx Summary Log 60 ECG events or 4000 non ECG events Record Modes Manual and automatic User configurable Battery Standard Type NiCad 12 volt Welch Allyn SmartPak Plus Standard Capacity Up to 2 hours ECG monitoring or 60 full energy discharges or 1 5 hours combined ECG SpO and BP monitoring while pacing Actual operating times will depend on the number of features activated and the duration of their use Proper battery care is required to maintain maximum available capacity Self Test Bi color LED indicates battery charge state Green usable charge Red requires charging Low Battery Indicator Flashing low battery icon on display and flashing LED on battery Recharge Rate 80 in 3 5 hours 100 in 4 5 hours WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM A 5 SPECIFICATIONS EE General A 6 High Capacity Type NiMH 12 volt Welch Allyn SuperPac High Capacity 110 full energy discharges or ECG monitoring PICS0 3 hours typical PIC 40 3 5 hours typical Or ECG monitoring SpO2 BP monitoring while pacing PICSO 2 hous 15 min PIC40 2 hours 35 min typical Actual operating times will depend on the number of features activated and the duration of their use Proper battery care is required to maintain maximum available capacity Recharge Rate 80 in 7 5 hours 100 in 9 5 hours Multiple Paired Contacts Insures quick error fr
266. transmitters in these frequency ranges c Field strengths from fixed transmitters such as base stations for radio cellular cordless telephones and land mobile radios amateur radio AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy To assess the electromagnetic environment due to fixed RF transmitters an electromagnetic site survey should be considered If the measured field strength in the location in which the Welch Allyn PIC is used exceeds the applicable RF compliance level above the PIC should be observed to verify normal operation If abnormal performance is observed additional measures may be necessary such as reorienting or relocating the PIC d Over the frequency range 150 kHz to 80 MHz field strengths should be less than V V m ADDENDUM 20 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM PIC 40 50 USER S MANUAL ADDENDUM Loo Recommended Separation Distances Between Portable and Mobile RF Communications Equipment and the Welch Allyn PIC IEC 60601 1 2 Table 205 The Welch Allyn PIC is intended for use in an environment in which radiated RF disturbances are controlled The customer or the user of the PIC can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment transmitters and the PIC as recommended below according to the maximum output power of the communications equipment Separation Di
267. ts 1 2 and 3 AC Inlet Connector accepts standard IEC line cord with earth ground 11 Fuse Holder Contains two fuses for 110 220 VAC use 2 Amp Slo Blow Welch Allyn 500218 For 220 240 VAC use 1 Amp Slo Blow Welch Allyn 500241 Line Voltage Selector 100 120 or 200 240 VAC 50 60Hz AC Power Cord Auxiliary Power Cable Provides auxiliary power source to the PIC Auxiliary Power Connector LED Indicates rapid charger is supplying power to PIC System and is trickle charging inserted battery Power Cord Retainer clamp WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM POWER SOURCE Rear Panel Whee beh Uhi Top Panel WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 15 7 POWER SOURCE EE Battery Charger Defibrillator Tester Operation Procedures Charging Battery Packs with Paddle Holder Charger optional Charging Battery Packs with the Welch Allyn Quick Charger Conditioner z 15 8 If purchased the optional paddle holder area of the unit can charge a battery when using AC power When the paddle holder is installed the charger will charge a battery that is inserted into the Welch Allyn PIC whenever the AC line power cord is connected to an outlet or the battery can be charged in the quick charger The yellow charge light on the paddle holder is illuminated continuously to indicate that a battery is charging The yellow light will flash when the battery is fully charged The Welch Al
268. tton again to display Disabled below the words Upper Limit The alarm icon in the SpO window will display the appropriate status WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM ALARMS as FFT 2 Set the lower limit Press the LOWER LIMIT button D to select lower limit A bold line will appear around the box Press the up or down arrows C to increase or decrease the lower limit value You can disable the lower limit by pressing the lower limit button again to display Disabled below the words Lower Limit The alarm icon in the SpO window will display the appropriate status 3 Exit Press EXIT to leave menu Non Invasive Blood Pressure NIBP Alarm Setting NIBP Alarms z In the NIBP alarms menu the NIBP alarms can be set Off or On The appropriate alarm icon appears in the BP window indicating the current state of the alarm SETTING NIBP ALARM TO OFF To set the NIBP alarm to off press the OFF ON SET SYS SET DIA button A until Off is highlighted When the NIBP alarm is set to Off the upper and lower limits will each display Off and a number The number indicates the current set NIBP limit that will be active when the NIBP alarm is turned back on See example below a NIBP Alarm Set Set Sys Dia Sys Upper Limi NIBP alarm off Sys upper limit is 160 eo it eee Sys Lower Limit NIBP alarm off Sys lower limit is 80 NIBP alarm off Dia Upper limit is 130 NIBP alarm off Dia Lower limit is
269. tup the Automatic or Manual modes for Manual conducting an analysis of 12 lead input In Automatic mode the analysis begins immediately after the data is collected In Manual mode the operator must initiate the analysis after the data is collected The Copies menu controls how many printed copies of the 12 lead data will be produced when the print icon button is pressed Copies WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MENUS Loo Supervisor Menus Setup Supervisors are able to access and change the options in the Set Up menus The date format language and the supervisor entry passcode are examples of options that supervisors can configure from these menus Set Up Supvsr Date Time Shifts DataXfr Back Enter Passcode here Supervisor UNLOCKED Defibr Pacer SAED 12Lead SetUp Diag Exit Supr Setup Shifts Treatment Upgrade Unit ID Code Printer More Back yo y Y y y Active Treatment Identifier Set Code Print Shift Setup Menu Menu Options Menu Menu Menu Supr Setup 2 Date Temp LineFreq Audio Language Lead More Back Y y vy vy y j Date Temp Line Freq MANUAL Language Lead Format Format Menu Audio Menu Menu Menu Menu Menu Supr Setup 3 Data Xfr CO2 Back gt Options Available
270. ubate Lido Bret CPR Arrival Intubate IV Event Atrop IV Surg Sedate EPI Lido Narcotic Dry Agt Anesth Custom1 2 Atrop 3 4 5 Sample IV EPI Upgrade SAED CO2 IBP ADV Record Review Biphasic Pacer Fax Analysi Mobitex DataRd Unit ID Department ID Unit ID 0 0 0 0 Cancel O O TI ro oO T Q O Fe D N 13 4 Printer Alarms On Off On Defib Pacer On Off On Trending On Off On Treatments On Off On Miscellaneous On Off On WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM MENUS Lee Menu Choices Choice Range Factory Default mm dd yy dd mm yy yy mm dd mm dd yy Fahrenheit F Celsius C F 60 Hz 50 Hz 60 Hz Voice Prompts Enabled Disabled Disabled Voice Mode Memo Start Stop Memo Continuous More Date Temp Line Freq Audiot Language Lead CO2t Data Xfrt Voice Log Enabled Disabled Enabled English Spanish French German Portuguese Italian 1 Il I Il mmHg kPa mmHg Mobitex BP Card Card Info Card Erase Program PIC Alarms Cal NIBPtT SPO2t Mod Out CO2t t If option has been purchased WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM Pump Up Pump Down 2 1 0 1 2 Om V 1 mV MAX MAX Off Simulate Reset Active Shift Active Shift User 13 5 MENUS EE Quick Access Buttons and Icons Quick Access buttons and icons are located along the left side of the PIC display window Press a button next to an icon to select a
271. ultiparameter Monitoring Large Bright Display 2 2 The Welch Allyn Portable Intensive Care PIC System is an extremely flexible device that incorporates an ECG monitor defibrillation manual and semi automated external pacer pulse oximeter non invasive blood pressure and respiration monitoring The PIC System s small lightweight package makes it ideal for transport situations and it has been designed for use in and out of the hospital e Flexible design e Small lightweight e Pulse oximetry and NIBP options available e Large 6 4 bright easy to read display e Three simultaneous traces e Treatment Summary documentation Voice Memo storage and retrieval e Card review e User configurable options e Simple menus e Hands free defibrillation e Mains AC and battery power capability e Upgradable for future expansion The PIC has been designed to allow additional monitoring options to be installed anytime in the future System can grow with your needs Weighing only 13 2 pounds and not much larger than a cardiac monitor this full function intensive care tool is ideal for transport portable applications Using surface mount component technology miniaturization allows pacing pulse oximetry NIBP respiration and temperature to be added in the same small package as the ECG monitor and defibrillator A large bright display allows viewing the critical parameters from across the room and from any angle
272. und on the display of the PIC System during operation i I Gir os i we ye 1 R WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM Alarm off Alarm on Alarm lower limit set Alarm upper limit set Automatic HR Alarm set Alarm push to disable Animated recording icon Battery full Battery low warning Battery partially depleted Auxiliary power Blood pressure pump 1 Blood pressure pump 2 Calibration pulse 12 lead 1V Log EOF Card EOF COs Check chart recorder Auto heart rate undetermined Auto heart rate set at 60 BPM Mute One volt output QRS beeper off QRS beeper on Volume level Supervisor menu locked Supervisor menu unlock Notch filter On Analyze Internal log Card review card usage Carbon dioxide on 1 3 SAFETY INFORMATION EE Invasive blood IBP C02 No pressure IIo Carbon dioxide off lw Resets to patient a Analyze 12 lead P1 001 in card review Card Review LELLLL CPR TIMER moo 12 lead next page mmm e SAED CPR timer 12 lead save Latching m function pl connection iy Ses Hi A Fax modem Do not sterilize Card review Press here to 4 12 lead printer Q unlatch Card review card Quick access Log m usage and location LUG button E F E A 12 lead analysis 12 Lead analysis AN W down page up page do 1 4 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM SAFET
273. ure The chest was shaved and defibrillating patch electrodes R2 part number 3200 1715 were placed on the left and right chest walls Fibrillation was induced by delivering 60 Hz current to the right ventricular electrode The energy required to defibrillate was determined by a protocol that has been used in several other biphasic comparison studies An initial shock strength of 50 to 70 Joules was A 12 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM SPECIFICATIONS Lo used If successful VF is reinduced after a 4 minute rest period and the shock strength is reduced by approximately 20 for the next defibrillation attempt If the initial shock fails a rescue shock is delivered and after a rest period VF is again induced The energy is now increased about 20 for the next defibrillation attempt This procedure was continued until at least 3 reversals in result were observed with each waveform Two ED50 estimation procedures were run in parallel with the device being used alternated on each shock In practice actual clinical units were used so the energy steps were limited to those selectable on the devices tested Results The study consisted of 82 total fibrillation defibrillation episodes ID50 peak currents and ED50 delivered energies are shown below for each group The mean impedance for these animals was 62 ohms The mean ED50 energies were compared and were found to be significantly different The significance of difference p
274. usly monitor respiration rate and to alarm if the rate falls outside of the range set by the operator The patients range from neo natal to adult Because the measurement method actually measures respiratory effort apnea episodes with continued respiratory effort such as obstructive apnea may not be detected It is not intended to be used as an apnea monitor It is used on patients ranging from neo natal to adult The respiration rate monitor function of the PIC is used to measure the concentration of carbon dioxide in a gas mixture to aid in determining the patient s ventilatory status This device is intended as an indicator of patient carbon dioxide concentration during expiration and is not intended as the sole basis for medical diagnosis This CO monitor is intended for use with patients 3 years of age and older This device is not recommended for patients with low tidal volume such as patients younger than 3 years of age or weighing less than 22 pounds or patients with a respiration rate greater than or equal to 60 breaths per minute WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 2 5 INTRODUCTION EE Part Numbers PIC System Part Numbering 2 6 Welch Allyn uses a part numbering system that allows both the user and service technician to understand what type of unit and installed options are in each PIC System PIC50 All Basic base units include Color Display Nellcor Oximeter 971074 and Voice Memo 971005 971081
275. utton A until Off is highlighted When the ETCO alarm is set to Off the upper and lower limits will each display Off and a number The number indicates the current set ETCO limit that will be active when the ETCO alarm is turned on See example below ETCO Alarm A i an ETCO alarm off default upper limit OTe aay setting is 40 setting is 5 ETCO alarm off default lower limit NOTE Ifa limit is disabled the word DISABLED will appear instead of Off number 14 14 WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM ALARMS Loo SETTING THE ETCO ALARM TO ON To set the ETCO alarm to on press the OFF ON button A until On is highlighted When both the upper and lower ETCO alarm limits are set to On the alarm on icon will appear in the CO and ETCO value windows and the global alarms will be turned on 1 pes ETCO2 Alarm Off On Upper Limit 40 Lower Limit 9 2 Set the upper limit Press the UPPER LIMIT button B to select upper limit A bold line will appear around the box Press the up or down arrows C to increase or decrease the upper limit value You can disable the upper limit by pressing the upper limit button again to display Disabled below the words Upper Limit The alarm icon in the CO and ETCO value windows will display the appropriate status Set the lower limit Press the LOWER LIMIT button D to select lower limit A bold line will appear around the bo
276. value was calculated by the Wald test in each case and are shown below The mean ED50 peak current for the biphasic waveform was 39 percent of that required with the MDS waveform Summary Table ED50 amp ID50 Mean Welch Allyn PIC Monophasic Biphasic Damped Sine ID50 Peak Current 6 4 16 6 Amps Significance of lt 0 001 difference p value ED50 Delivered 26 3 35 3 Energy Joules Significance of 0 014 difference p value Study 1 Conclusion The MRL Orbital Biphasic waveform is capable of converting fibrillation episodes using less energy than the MDS waveform and requires lower peak currents than MDS waveform defibrillators WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM A 13 SPECIFICATIONS EE Study 2 A 14 Objective Comparison of the defibrillation effectiveness of the MRL Orbital Biphasic waveform defibrillator with a commercially available Biphasic 2K V defibrillator capable of 360 J and a monophasic truncated exponential defibrillator Methods A canine model n 6 61 6 5 5 lbs was used in a study that was approved by the Institutional Animal Care and Use Committee The animals were anesthetized with an intravenous injection of 20 mg kg sodium pentothal They were then intubated with a cuffed endotracheal tube and maintained on isoflurane gaseous anesthetic The femoral artery was cannulated and an intra arterial line was placed for continuous measurement of arterial blood pressure and for
277. veral ECG trace display parameters including Resp Pleth CO2 Trend or Off for waveforms 2 or 3 If the PIC includes the 12 lead option users can select lead I II II aVR aVL aVF V1 2 3 4 5 6 ETCO2 Pleth or Off for waveform 2 or 3 Press the UP and DOWN arrow buttons to select an option Press SAVE to save the current selections ECG Waveform ECG and Waveform 2 Resp EGC Resp and Pleth Waveform WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 13 9 MENUS EE Frequency Menu Limited Filt Diag Filter Menu Line Filter On 60 Hz Patient Pt Cable Menu 13 10 Use the Frequency menu selections to set the display and chart recorder responses Four frequency options are available e Limited response is best used for paddle monitoring applications e Monitor response is best used for general ECG monitoring applications e Filt Diag is best used in the field when noise and or artifacts are a problem This option is only available if the 12 Lead Preamp Board ECG option is installed This selection does not affect the filtering used to acquire a 12 lead sample e Diagnostic response should be used when attempting to interpret subtle ECG changes ST segments NOTE Diagnostic frequency response Filt Diag or Diagnostic is j inherently more sensitive to motion artifact or other causes of ECG interference Choose these settings only for acquiring 12 lead cardiograms using pr
278. visor Menu Overview ccccccccecceeessseeeeeees 13 4 Quick Access Buttons and Icons cee eee eee 13 6 Quick Access Buttons and Pop up Menus ee User Menus aesan E ocoebontcectaion 13 8 User Menus Display ccccccccccecccceeeesseeseeeeeeeeees 13 9 User Menus SPO znne 13 12 User Menus Non Invasive Blood Pressure 13 13 User Menus Respiration ECG cccsseeeseeeeeeees 13 14 User Menus Respiration CO3 0 0 eeeeeeeeeeeeeeees 13 16 User Menus Respiration Trend cceeeeeees 13 18 User Menus Recorder onina EA 13 19 User Menus SCU isr atone 13 22 Supervisor Menis eiea a 13 24 Supervisor Menus Defibrillator ees 13 25 Supervisor Menus Pacer cccccescceeeeceeeeeeeeeeees 13 27 Supervisor Menus SAED ccccccceeeeeeeeeeeeeeeees 13 28 Supervisor Menus 12 lead cc ceceeccccccceeensneeeeees 13 30 Supervisor Menus Setup ccccsseccccceceeeeeeeeees 13 33 Supervisor Menus Calibration ccccceeeeeeees 13 38 Supervisor Menus Alarms cccccececeeeeeeeeeeees 13 41 PAVIA S rinra 14 1 Global Alarms and Alarm ICONS 14 1 Alarm Configurations User Menus ccccccceee 14 3 Heat Rate Alar eerun tedious 14 4 Pulse Oximeter SpO Alarm 14 6 Non Invasive Blood Pressure NIBP Alarm 14 7 Invasive Blood Pressure IBP Alarm
279. x Press the up or down arrows C to increase or decrease the lower limit value You can disable the lower limit by pressing the lower limit button again to display Disabled below the words Lower Limit The alarm icon in the CO and ETCO value windows will display the appropriate status Exit Press EXIT to leave menu WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 14 15 OO CHAPTER 15 POWER SOURCE This chapter provides information on the safe use of the Welch Allyn PIC System power source including controls and indicators and procedures for charging operation and maintaining the equipment Chapter Overview General Safety Precautions Power Supply Paddle Holder option 971029 Power Source Controls and Indicators Welch Allyn Quick Charger Conditioner Battery Charger Defibrillator Tester Operation Procedures 15 8 Welch Allyn 12 Volt Vehicular Adapter Welch Allyn Battery Analyzer Power Options Comparison Chart CAUTION First read chapter 1 Safety Information before proceeding with this chapter CAUTION Normal indicator conditions 1 Important saftey considerations FLASHING RED Indicates low battery Charge prior to use Indicator condition when PRESSING the TEST button Charge only in the MRL battery charger RED Low capacity battery needs to be charged GREEN Useable charge y Al h k lable g pan oe 7 paweravailane NO LIGHT Depleted battery Refer to manual for attery maintainence p
280. x transmission time by as much as 30 seconds Audio Output If hardware is installed On default enables and Off disables Fax audio output during dialing and negotiating phases Baud Rate Affects the fax transmission time Select a rate that will work with your cellular service 2400 4800 7200 and 9600 default available Fast Fax Disabled is the default When enabled only lead of the real time ECG trace displays and transmission time decreases Fast Fax is automatically enabled during a fax transmission when SPO is on Printer Menu Use the Printer Menu to change 12 Lead printing formats 3x4 II II is the default format it prints three rows by four 2x6 V1 V2 columns of ECG traces 2x6 I V1 format Cd prints two rows by six columns with leads I and V1 in the first column The 2x6 V1 V2 prints two rows by six columns with leads V1 and V2 in the first column WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 13 31 MENUS EE Freq Menu Analysis Setup Menu Copies Menu 13 32 The Freq menu controls the Rolloff Filter Ja Freq used when acquiring a 12 lead snapshot C FitDiag display and the acquired signal Listed below are the frequency values for The Freq Menu only affects the real time kan each mode of operation a Limited 2 20 Hz Monitor 0 67 40 Hz Diagnostic 0 05 150 Hz Filtered Diagnostic 0 25 40 Hz The Analysis Setup menu is used to select Analysis Se
281. xiliary Power and Battery Charger Auxiliary Power and Battery Charger Auxiliary Power and Battery Charger Auxiliary Power and Battery Charger Auxiliary Power and Battery Charger Battery Charger Only 15 14 980132 981118 971029 971104 981114 981117 981119 900252 12 V Adapter PIC AUX Power Supply Power Supply Pad Holder Integral Charger Quick Charger Conditioner Ambulance Mount PIC 12 V Aux Power Supply Battery Charger Ambulance Mount PIC Mains 4 Bay Charger with Power Supply Allows PIC to Operate from 12 V source Trickle charges battery Power supply to pro vide the 12 V required for ambulance mount Allows 981114 to oper ate from mains 100 240 Attaches permanently to the PIC Allows it to operate from mains 100 240 V AC Also charges battery Simultaneously charges 3 PIC Batter ies and provides auxil lary power to operate from mains 100 240 V AC Securely fastens the PIC and allows it to operate from 12 V Also charges battery Power supply to oper ate PIC and charge the battery from mains 110 240 V AC supply Securely fastens the PIC and allows it to operate from Mains 110 240 V AC Also charges battery This kit contains a 981114 and 981118 Four bay base that allows to power and mount up to four sin gle slot chargers in one base No trickle charge only No Must be used with 9
282. y copy of the software all right title and ownership of the software remain with Welch Allyn or its vendors USA 1 800 535 6663 Australia 6129 638 3000 1 315 685 4560 800 074 793 Canada 1 800 561 8797 China 86 216 327 9631 European Call Center 353 46 906 7790 France 3315 569 5849 Germany 49 747 792 7186 Japan 8133 219 0071 Latin America 1 305 669 9003 Netherlands 3115 750 5000 singapore 656 419 8100 south Africa 2711 777 7555 United Kingdom 44 207 365 6780 Sweden 46 85 853 6551 Caution Changes or modifications not expressly approved by Welch Allyn could void the purchaser s authority to operate the equipment Reorder Part Number 810 2558 XX Manual Part Number 810 2554 00 Rev A 01 2007 Welch Allyn 8500 SW Creekside Place Beaverton Oregon 97008 7107 www monitoring welchallyn com Printed in USA C 0297 WelchAllyn EE Foreword This manual is intended to provide information for the proper operation of the Welch Allyn PIC 40 and PIC 50 DO NOT ATTEMPT TO USE THIS EQUIPMENT WITHOUT THOROUGHLY READING AND UNDERSTANDING THESE INSTRUCTIONS User s The user is required to be trained in basic monitoring vital signs Responsibility assessment and emergency cardiac care The user should be completely knowledgeable of the information in the User Instruction Manual As with all other electronic patient care monitors good clinical judgment should be used when operating the Welch Allyn PIC User must save all
283. y line inferior and lateral to Sternum the patient s left nipple as shown to the right 3 Observe the patient s electrocardiogram on the display Adjust size of the ECG trace with the SIZE control button as necessary Apex Paddle Placement NOTE The type of electrode and the technique used in preparing the oy skin are major factors in determining the quality of the ECG signal obtained Use high quality silver silver chloride electrodes These electrodes are designed to provide excellent baseline stability rapid recovery from defibrillation and minimize artifact from patient movement Do not use electrodes if gel is dry MONITORING WITH 3 LEAD PATIENT CABLE 1 Press POWER switch ON 2 Insure that the display indicates a 3 lead patient cable has been configured If not see chapter 13 for setting patient cable 3 Thoroughly prep patient skin for electrode attachment Clean and dry skin sites preferably with a coarse dry terry cloth Next clean skin with alcohol and allow to dry completely before applying pads 4 Connect each lead of the 3 lead patient cable to the appropriate disposable electrode Arrange the electrodes as shown to the right Make sure that the ECG electrodes are placed to allow defibrillation if necessary 3 Lead Electrode Placement WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM 4 7 ECG MONITORING EE 5 Insert the patient cable plug into the input ECG connector on the PIC Syst
284. z Select IBP1 Enable or IBP2 Enable depending on the channel used IBP1 Enable NOTE This will cause the Trace O window to display an ECG IBP2 Enable waveform on top and then display your choice of waveform for IBP1 or IBP2 below Check Sensor will appear in the pressure readings window if a waveform is displayed and no sensor is detected in the IBP connector If a sensor is detected Zero Sensor will appear in the Pressure Readings window 60 40 ZERO 20 SENSOR Zeroing the Sensor Before IBP information can be viewed in the selected waveform window the operator must zero the transducer Zeroing the pressure transducer is extremely important to insure the displayed pressure measurements are accurate Transducers should be zeroed frequently Prior to initiating a change in treatment based upon the measured pressure data the operator should zero the transducer and confirm the pressure measurement WELCH ALLYN PORTABLE INTENSIVE CARE SYSTEM IBP TO ZERO A TRANSDUCER Inv Pressure 1 Goto the Quick Access window and inv Pressure press NEXT to view the IBP option IBP1 Disable 2 Press IBP to view the Invasive IBP1 Setup Pressure Menu 3 Select IBP1 Enable Ensure that the IBP2 Enable channel enabled is the channel connected 4 Select IBP1 Setup 5 Close the transducer stopcock to the patient 6 Open the venting stopcock to the air atmosphere 7 Press the ZERO 1 button t

User Manual - PIC 40 and PIC 50 Portable Intensive

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