Zargis TeleSteth and the Littmann 3200 Electronic
Contents
1. WiBTelehealth Zargis TeleSteth and the Littmann 3200 Electronic Stethoscope USER GUIDE Version 1 3 MBTelehealth February 2010 MBTelehealth Zargis TeleSteth TABLE OF CONTENTS 1 0 EQUIPMENT TE GU RE 3 2 0 SE Tee 3 3 0 CONNECTING THE PATIENT SITE 4 4 0 CONNECTING THE PROVIDER SITE EE 5 5 0 Ia enee WEE 6 5 1 Chestpiece Buttons and Indicators cceeccccccseeeeeeeeeeeeeeeeeaeeeeeeseeeeeeesessaeeeeeessaneeeeeeeas 6 5 2 Eelere ECH UE 7 5 3 Adjust Sound AMplifiCation 2 0 0 ccecccccccceceeesseeeceeeeeeseeeseeceeeeessueeseceeeeessueeaeeeeeeseessaaaeeess 7 5 4 Placement Indicator DiaQram ccccsesccccsseeceeseeeeeesseeeeseeeeeeeeeeeseaseeesueeeeseneeessaeseeeneaes 7 5 5 Battery Hepl cement E 9 5 6 PO Mon HCA E 9 5 7 Adjust Headset ior eu e 9 5 8 Monitor Patient Heart EE 10 6 0 APPENDIX A TECHNIQUES OF AUSCULTATION ociiiininsiisiernniiisccii innnan 10 7 0 APPENDIX B TROUDIEGHOOTING ccc ccccccccsseeceeeeeeeeaeeseeeeeeeeeesueaeeseeeesesaeaeeeeeeees 11 Page 2 of 11 MBTelehealth Zargis TeleSteth 1 0 EQUIPMENT REQUIRED 1 A video conference unit connected to the MBTelehealth Network 2 A laptop that has the TeleSteth Application Installed and is configured to work with the Video Conference unit SS Note The laptop will only work with a designated video conference unit unless _ the IP address is changed Contact the MBTelehealth Service Desk at 1 866 667 9891 Opti2. 5 0 INSTRUCTIONS FOR USE Once connected through the TeleSteth software adjustments can be made to the device to ensure optimum performance 5 1 Chestpiece Buttons and Indicators Filter Indicator i Battery Life Indicator Amplification Indicator EE EE M Button Filter Button Decrease Amplification Power Page 6 of 11 MBTelehealth Zargis TeleSteth 5 2 Selecting a Filter The electronic stethoscope allows the user to select between three different digital frequency filters to better emphasize the specific patient sounds of interest Filter settings are adjusted by the provider and are not dependent on the facilitator at the client end The default setting is the Diaphragm filter Press the filter button on the chestpiece to toggle between options Digital Filter Settings Press the Filter Button until desired mode appears on screen Diaphragm mode Amplities sounds from 20 2000Hz but emphasizes the sounds between 100 500Hz Bellmode Amplities sounds from 20 1000Hz but emphasizes bower frequency sounds between 20 200Hz Extended Range Amplifies sounds from 20 2000Hz but provides more low frequency response between 50 500Hz 5 3 Adjust Sound Amplification The Model 3200 sound level can be amplified in 8 increments up to 24X amplification of a non electronic cardiology level stethoscope Level 1 is equal to a non electronic stethoscope Level 9 is equal to 24X amplification of a no
3. Mitral and left heart sounds are heard best in this area c Base Right Ssecond intercostal space to the right of the sternum Sounds from the aortic valve are best heard here d Base Left second intercostal space to the left of the sternum Sounds from the pulmonic valve are best heard here 7 Ability to selectively listen One sound at a time is attended to When listening to sounds in systole sounds in diastole are initially ignored The sequence listed above is only one of the many acceptable ones The important point is that the four areas mentioned are auscultated each time in a consistent manner and that each area is assessed for sounds of both low and high frequencies Differences in Acoustics There are many factors that contribute to acoustic response such as a complete seal from the point of auscultation to the stethoscope user s ear canal Our laboratory results do not include factors like ambient noise motion artifact and ear canal seal Because of these variables and differences in each individual s hearing ability we recommend trying different stethoscope models before purchasing 7 0 APPENDIX B TROUBLESHOOTING Contact the MBTelehealth Service Desk at 1 866 667 9891 Option 1 Page 11 of 11
4. Press M on the stethoscope to select CONNECT and then press the M button again Connecting to Stethoscope steth2 ers Patient ID Posture ben Tt Patient Name fy Tips for Preventing Lost Wireless Connections Listening Site 1 Auscultate the patient as close to the PC as possible Scale 2 Avoid having objects or people between the stethoscope and the PC C High 3 Avoid having your hand cover the entire chest piece location of the Mid stethoscope s Bluetooth antenna r 4 You may need to turn the stethoscope off and then on to reestablish a lost connection Support www zargis com Page 4 of 11 MBTelehealth Zargis TeleSteth 2 Read the Session ID to the Provider Zargis Telemed 02 01 0004 Zargis Demo Real Time Streaming Session Upload Download li Gu MEDICAL Session ID 32145517 Host User Two ha The provider can use this diagram to give direction on placement of the stethoscope on the patient Support www zargis com 3 Once connected watch the placement indicator white dot for placement instructions from the provider 4 0 CONNECTING THE PROVIDER SITE 1 Click the Join a Session button then enter the Session ID provided by the patient site and press Join ZargisTelemed 02 01 0004 Zargis Demo Real Time Streaming Session R Upload Download f My Account EE MEDICAL Session ID Host Guest Please enter the sessi
5. User Two Guest Placement Indicator Preset Placement Sites Patient ID ge i Patien Listening Site Tricuspid site 4L ew Preset Sites gi Middle Last Torso Display Options Support www zargis com Note See below for recommended location for holding the stethoscope while in use Page 8 of 11 MBTelehealth Zargis TeleSteth 5 5 Battery Replacement Hold chestpiece in one hand while slightly twisting the battery cap approximately 25 counter clockwise Remove battery cap Insert new battery with positive end out plus sign will be visible in the battery compartment Remount battery cap twisting cap approximately 25 clockwise until locked d Make sure the two marks are aligned 5 6 Position Headset Eartips should point in a forward direction as you insert them into your ear canals When ear tips are properly positioned diaphragm will face towards your body Your new 3M Littmann Electronic Stethoscope Model 3200 is designed to give you a very comfortable acoustically sealed fit It comes with two sizes of eartips to assure a perfect fit The large eartips are pre installed Smaller eartips are included in package Please choose the set that is most comfortable for you To remove eartips pull eartips firmly away from eartube To apply new eartips push eartip firmly onto eartube to secure 5 7 Adjust Headset for Comfort To reduce spring tension in the headset
6. hold each eartube at the bend near the eartips and gradually pull apart until fully extended 180 degrees To increase spring tension grasp the headset with one hand where the metal eartubes enter the plastic tubing and squeeze until the plastic tubing on one eartube touches the other Repeat as necessary Reduce Tension Page 9 of 11 MBTelehealth Zargis TeleSteth 5 8 Monitor Patient Heart Rate The Model 3200 detects and displays an acoustic based heart rate when presented with consistent heart sounds heart rate variation lt 10 It takes five seconds to compute the initial heart rate and updates are provided every two seconds The heart rate will then be displayed for 10 seconds after removal of the chestpiece from the patient Prior to the initial reading the display shows two dashes For heart rates outside a range of 30 199 bpm the display will also show two dashes The acoustic based heart rate display functions best when the Model 3200 is placed near the apex of the patient s heart and can be monitored while using any filter mode and or volume level If the heart rate changes from consistent to inconsistent or if there is excessive ambient noise patient movement or lung sounds during auscultation the heart rate display number will display two dashes 6 0 APPENDIX A TECHNIQUES OF AUSCULTATION The following are recommendations to perform adequate auscultation 1 A quiet well lit
7. n electronic stethoscope The greater the amplification the more bars you will e Increase Amplification Press button until desired amplification level is achieved e Decrease Amplification Press button until desired amplification level is achieved 5 4 Placement Indicator Diagram The Zargis software includes an option for identifying the desired location of the stethoscope By clicking on the model a provider can indicate to the patient site the exact location the want the stethoscope to be placed Clicking in the desired location moves the white dot to that location on both the provider and patient site displays There are four 4 options for torso display that can be selected by clicking on the desired option and there are also preset sites that can be selected from a drop down listing The patient site sees exactly what the provider site sees Page 7 of 11 MBTelehealth Zargis TeleSteth To use the placement indicator diagram 1 Instruct the patient site to look at the laptop and find the white dot on the model 2 Click the desired location for stethoscope placement 3 Ask the patient site to place the stethoscope in that location 4 Click the torso display options to change display or select from the preset placement sites to select specific locations Zargis Telemed 02 01 0004 Zargis Demo Real Time Streaming Session Upload Download My HEU ZARGIS Qe MEDICAL Session ID 32145517 Host
8. on 1 if you need to make a change 3 A Littman 3200 Electronic Stethoscope 4 A Zargis Medical Wireless Dongle 2 0 SET UP To set up the TeleSteth Application and the Littman 3200 1 Connect an Ethernet cable from the laptop to port FE1 on the Cisco router or if there is no router present plug the Ethernet cable into the identified drop on the wall To Codec Ethernet Port To Steth Laptop Ethernet Port To LAN drop From Laptop Or 2 Plug in and turn on the laptop 3 Plug the Zargis Medical wireless dongle into a USB port on the laptop it will flash Green when connected Page 3 of 11 MBTelehealth Zargis TeleSteth 4 Turn on the Littman 3200 by pressing the power button 5 Double click the TeleSteth Icon z on the laptop to launch the application AY Note It may take between 30 and 60 seconds to open Be patient 6 Enter the user name and password located on the bottom left hand corner of your laptop ES Note The password is always 1Mbtsteth and it is case sensitive 3 0 CONNECTING THE PATIENT SITE 1 Click the Host a Session button then follow the instructions to connect the Stethoscope EI Note Once the stethoscope is connected the My Stethscope status will change from a red X to a green checkmark Zargis Telemed 02 01 0004 Zargis Demo Real Time Streaming Session E Upload Download My Account Ge ZARG I S Stethoscope MEDICAL Session ID Host wS Guest
9. on ID to join the host must provide the ID Session ID Listening Site Page 5 of 11 MBTelehealth Zargis TeleSteth 2 Click Play to Stethoscope then follow the instructions to connect the stethoscope Zargis Telemed 02 01 0004 Zargis Demo Real Time Streaming Session tf Upload Download My Account Guest Audio Mode a Ces x Session ID 42445301 C Play to Stethoscope aa v ession ID RB Host User Two Guest User Three Press M on the stethoscope to select CONNECT and then press the M button again Chat Click the location you want the stethoscope placed M Connecting to Stethoscope steth2 es Patient ID Posture Japon fj Tips for Preventing Lost Wireless Connections Listening Site Tricuspid site 4L First Midde W er 1 Auscultate the patient as close to the PC as possible 2 Avoid having objects or people between the stethoscope and the PC 3 Avoid having your hand cover the entire chest piece location of the stethoscope s Bluetooth antenna d You may need to turn the stethoscope off and then on to reestablish a lost connection Support www zargis com Note If Play to Stethoscope is already selected click the Red X beside My Stethscope and then follow the instructions to connect 3 Once connected use the white dot to provide placement instructions for the patient site see 5 3 for instructions for use
10. warm room This eliminates extraneous noise and facilitates cardiac inspection 2 A properly disrobed patient This permits the stethoscope to be placed directly on the chest 3 Ability to examine patient supine sitting and in left lateral recumbent positions see Diagram A Various sounds especially abnormal sounds may be elicited in different positions 4 Ability to examine from right side This decreases the likelihood of producing extraneous sounds from the tubing of the stethoscope hitting objects 5 A stethoscope with both a bell and diaphragm or capacity to act as a bell and diaphragm The bell when held lightly against the chest picks up sounds of low frequency The diaphragm when firmly pressed so that it leaves an after imprint picks up sounds of high frequency 6 A sequence of auscultation see Diagram B Minimally four areas should be auscultated using first the diaphragm and then the bell a Left Lateral Sternal Border LLSB the fourth intercostal Space to the left of the sternum Tricuspid and right heart sounds are heard best in this area b Apex the fifth intercostal space in the midclavicular line Page 10 of 11 SCH Sittin re Left t m Lateral e Recomberct E ie 3 L Sapine Diagram A Base Right Base Lefi A artir Area Als Area S sc d e Amex Mitral Arca Left Lateral Stermal Border Tricespid Aren Diagram B MBTelehealth Zargis TeleSteth
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