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ECG OPERATION/SERVICE MANUAL

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1. Default Interpretation And Acquisition Display Settings Disable Quick Edit e On Off Default is off cleared If On checked the software defaults to free text entry method for adding any diagnostic statements instead of the Quick Edit feature of the Add a Statement dialog box see Editing Diagnostic Statements Table 2 0 Default Interpretation and Acquisition Display Settings A NOTE on Filters For all pacemaker patients it is strongly recommended that ECG be performed with all filters turned off particularly the MYO filter Any artifacts in the ECG should be corrected at the source 1 e making sure the electrode sites are clean of lotion or body hair the electrodes are fresh and sticky and are adhering properly on the skin Refer to ECG signal quality problems in the Troubleshooting Guide for more details Click Printer Format Settings tab of the ECG Settings Fig 2 11 to select the default ECG report format as shown below ECG SETTINGS x Default Interpretation And Acquisition Display Settings Printer Format Settings R A Variability Settings Configuration Printer Format Settings Six By Two Twelve Lead Format Twelve Lead With Three Lead Rhythm Format Twelve Lead Format 2 Page Format f 2immisec 0 50 mm sec Rhythm Lead Print After Analysis ji Print Measurements Rhythm Lead Group M Grid E fanm Eo Help caca 10 Figure 2 12 ECG Settings Printer For
2. Keep the patient cable clean 2 Do not unplug the patient cable from the IQmark Digital ECG hardware 3 When the device LED turns red or the computer screen displays low battery 42 Series RS232 version only replace the batteries inside the unit before continuing The IQmark Digital ECG acquisition module contains no user adjustable or serviceable parts For repair or technical support refer to the information below A NOTE Return authorization is required prior to the return of the device Midmark Diagnostics Group personnel will issue a RETURN MATERIALS AUTHORIZATION RMA number prior to shipment Midmark Diagnostics Group Customer Service Technical Support Tel 310 530 5955 ext 2 Fax 310 530 1421 53 IQmark Digital ECG Service Manual This page 1s intentionally left blank 54
3. ooooonocnnnnnonononanannnonnnnnnn nono no nnnnnnonons Ze C STARTING THE PROGRAM sra uri iia 23 D ORENING SCREEN Dos 23 SLAT T Bs Gert ee eae ae a A A 24 E LESTING NECWEA TEN isiin an AE E a re 25 ED E O eae atau eet eae ick aa tae cee io We Mace et aaan 26 F REVIEWING PATIENT REPORTS 0 aid 29 ECO REPO REE e o e 29 Edine DIA SNOSTEC LICENSE ti 30 ECG Report DCS RCV West 31 Sr al COMO ITS ON EEE S ETE E EA ai 34 IQmark Digital ECG Operation Manual IV No lt On Oo 3 0 11 RRI Ora Uy REPOT REVIEW veut os 35 ATRENDE Silla 37 OPERATIONS ATA GLANCE alii 37 A condensed guide to using the Midmark IQmark Digital ECG with new DOS ASA ASAS A AA 37 TROUBLESHOOTING CUIDE jaz scissirssbats ect taeg sacaceet une tiateich tia et laos ins ateheusatydsevinc ieee 38 MAINTENANCEAND STORAGE to ette 44 A A isl a 44 Preventative LAS DECO lacio 44 OAO E E E RET CTT ETE ene arr ECE MTT eee 44 Radio and Leleviston Interferencia 44 CUSTOMERS SUPPORT siii iii 45 A saan la ae hanes sea etnies Dn ace E 45 kein Materials A NORTON A ES 45 A PE 45 SAFETY AND INTERNATIONAL SYMBOLS cccccccccccnnnnnnnnnnnnnnnnnnonnnnnnnnnnnnnnnnnnnnnnnnnnnnnes 46 GIEOSSAR Vota cdas 47 IQMARK DIGITAL ECG SERVICE MANUAL occcminiiiii 49 INTRODUCTION Suda ts das 49 THEORY OE OPERATION ia 49 2 SWIEMBLOCK DIAGRAM ta 50 22 POZRCAAWIRE POMCHECGOIC std 50 29 LCG BU CP AMOLES ears A earache A das 50 2A ANS TUMENTATOR ADIL CIS NS AA AS 50 293 AUTE RS ONG Gan AMPU e
4. WARNING For continued patient protection replace only with the same type of patient cable equipped with defibrillation protection devices Contact Midmark Diagnostics Group for cable replacement CAUTION Refer servicing to qualified service personnel IQmark Digital ECG Operation Manual This page 1s intentionally left blank vi IQmark Digital ECG Operation Manual I General Information A Description Hb gt 4 p i K D SS W qa y E pa P FA K DY UE gt DN yd H q Figure 1 0 The IOmark Digital ECG Serial type with On Off switch WS D lt amare sa A AA 3 a Wy ae i n i y i AN sE NT E _ Figure 1 1 The IOmark Digital ECG USB type without On Off switch The IQmark Digital ECG is a portable device that converts any Microsoft Windows based personal computer PC be it desktop laptop notebook or pen based to an electrocardiograph with interpretive capabilities The device is electronically isolated from the PC and connects to it directly through the USB port or serial port Together with the IQmark Diagnostic Workstation see Operation Manual part 3 100 1038 the IQmark Digital ECG makes it easy to record 12 lead ECG interpret them archive the reports for future reference and share them with your colleagues via networks or email As simple to use as a traditional office EKG device it features fully integrated PC technology and a host of a
5. e Input impedance gt 100 MegaOhm e Frequency response 0 05 150 Hz 3 dB e Sensitivity 5 10 20 mm mV 10 e Dynamic range 10 mV e ADC resolution 13 bits at 2 44 uV bit e Acceptable electrode offset 300 mV per AAMI and EC 11 specifications e A D 500 samples sec protection and patient isolation resolution e Midmark 12 Lead Resting Electrocardiogram Analysis Program e Windows supported ink jet or laser printer e Plain 8 5 x 11 Letter size or 210 mm x 297 mm A4 size IQmark Digital ECG Operation Manual II System Installation A NOTE Please give us a call before you install and set up your IQmark Digital ECG Computers today are more complex then ever They come with wide variations of software and hardware options making your computer almost unique Midmark wants to make sure that your IQmark Digital ECG 1s installed and configured as quickly and easily as possible Please call 1 800 624 8950 and our technical support will make sure your system 18 Up and running in no time A Computer Requirements The IQmark Digital ECG system employs 32 bit Windows based medical software In order to install and successfully use the IQmark Digital ECG system your computer must meet the following minimum requirements e Microsoft Windows based PC with Windows 98 Windows 2000 or Windows XP e Hard disk with a capacity of at least 200 megabytes of free space e CD ROM drive e Intel Penttum clas
6. patient s medical data prior to acquiring an ECG Overall we believe that you will find this program to be both user friendly and flexible For your convenience we have included a condensed guide to the operation of the IQmark Digital ECG with new patients in the Appendix under Operations at a Glance Section IV A It can be used when you are familiar with the use and operation of the program B Preparation Prior to initiating the ECG acquisition program for resting ECG or R R Variability analysis you must ensure that the patient is prepared for the procedure Itis essential that you comply with the following instructions on patient preparation as closely as possible Otherwise the integrity of ECG data can be compromised 21 IQmark Digital ECG Operation Manual Instructions for Performing ECG Acquisition Note Please refer to the Quick Reference User s Guide Performing a 12 lead Resting ECG Test for more detailed instructions Patient Position The patient should be placed comfortably in a supine position Any variation should be noted on the ECG report Electrodes When using disposable electrodes check to ensure the electrode is fresh and sticky Always make sure your fingers are clean and free of lotion when handling electrodes Skin Prep Patients with excessive chest hair should be shaved at the electrode site Abrade these areas with fine sandpaper or an abrasive pad and then clean with an alcohol
7. ECG module is connected to the correct serial port Refer to sections II B and I D For Valentine ECG module Verify that the ON LED on the ECG Module is lit If it is not push the POWER button on the ECG Module to turn on its power For Valentine ECG verify that the Low Battery LED 1s not blinking If it is install new batteries For IQmark Digital ECG module Verify that the LED on the top cover is green If the LED 1s red install new batteries If there is a O symbol on the module you may need to press it to turn on its power ECG signal quality problems such In order to have good ECG signal quality it is essential as a low amplitude wandering that the patient is properly prepared the lead baseline noisy signal etc placements are correct the electrodes and lead wires are secured firmly Follow Section II B Preparation closely for best performance e For the Valentine ECG Verify that the Low Battery LED on the ECG Module is not blinking If it is install new batteries For the IQmark Digital ECG module Verify that the LED is not red or the Low Battery message is not displayed on the screen If it is install new batteries e Verify that the electrodes are fresh moist and sticky not dry or hard Check electrode expiration date on package e Verify that the patient lead wires and cables are not damaged or worn out 40 IQmark Digital ECG Operation Manual Troubleshooting Guide Err
8. In the United States this frequency is 60 Hz If you are using this product outside of the United States please consult with the local power utility company to determine the appropriate frequency Configuring for Serial Type ECG Module If you have a serial type ECG module you can select the serial port for the ECG module in the configuration screen Fig 2 1 Click the Serial Port button to open the following dialog box A NOTE The default serial communications port is COM 1 x ECG COM Port p Spirometry COM Port Wital Signs Com 1 y BF Disabled Sp02 Disabled Auto Detect Auto Detect Temp Disabled Weight Disabled Enable Vital Signs Interface D Setup Cancel Help Figure 2 2 Serial Communications Port Setup For Serial Type ECG Module IQmark Digital ECG Operation Manual Use the Auto Detect button to find the port that the ECG module is connected to see Section I E To use Auto Detect you must have the ECG module connected to an available serial port on the computer Confirm that a fresh set of batteries is installed in the ECG Module and click the left Auto Detect button The result of the auto detection appears on the screen Some ECG modules may need to be turned on manually for Auto Detect to work Simply press the switch to turn on the module Configuring for USB Type ECG Module If you received a USB type ECG module and it is already connected to the
9. MD PACs 0 Max RR 964 msec s Review Date 08 14 03 Settings Comments _Gain 1X Show ECG E Figure 3 14 RR Vartability Report Review Graphs Screen On both the resting ECG and RR Variability Report Review screens there are fields labeled Technician and Reviewed By Ensure that the name of the technician doing the ECG is entered in the Technician field and that the name of the doctor performing the ECG review and confirmation in entered in the Reviewed By field These names are important as they serve to document the ECG collection process and will assist people reviewing these reports in the future Click the Print button to print the report displayed on the screen When you have finished reviewing the patient s reports you can exit the Report Review screen by clicking the appropriate button on the bottom of the screen If you edited the diagnostic statements or filled in blank fields you will be prompted to save your changes prior to exiting the screen You are allowed to proceed to the appropriate screen regardless of whether you save your changes or not 36 IQmark Digital ECG Operation Manual IV Appendix A Operations at a Glance A condensed guide to using the Midmark IQmark Digital ECG with new patients 1 2 3 4 5 6 7 8 9 10 11 12 Start the IQmark Diagnostic Workstation program Select New Patient from the opening screen For returning patient s
10. The configuration program can be accessed from the Windows Taskbar through the following sequence Or double click the following IQmark Configuration icon on the Desktop P Li rnark Configuration The following dialog box appears IQmark Digital ECG Operation Manual O IQmark Workstation Configuration Settings i 7 x Institution Mame ha idmark Medical Group Institution Address 3300 Fujita Street Torrance CA 30505 Units Serial Port f English F Metic E MM DD AV Database Settings O rtdh DD List Management ECG Settings Holter Settings Spirometry Settings Stress Settings Default Help Cancel Line Frequency i 6OHz O 50 Hz Time Format f 24 Hour Clock 12 Hour Clock Default Fax Printer rT select Figure 2 1 Configuration Settings Dialog Box Complete the Institution Name and Institution Address boxes with information about your own medical practice The IQmark Digital ECG will display your institution name on each of the procedure screens and on printed reports Enter a name that describes your practice or operation to enable other medical personnel to identify your reports You may choose between International metric and American English units of measurement and between the AC power source frequencies of 50 Hz or 60 Hz The Qmark Digital ECG uses the latter information to filter out background noise introduced by the power source through its AC filter
11. be accurately entered Refer to section III E Testing A New Patient Edit the diagnostic statements accordingly Refer to ECG Report Review in section III F No error message and no ECG trace Refer to solutions for ECG MODULE NOT on Live ECG screen RESPONDING in this section Refer to solution for SERIAL PORT ERROR in this section 42 IQmark Digital ECG Operation Manual Troubleshooting Guide Error Message or Problem Solution or Recommendation Prints too slowly when printing live Depending on your computer print jobs may be slower ECG tracing or printing if the IQmark Digital ECG is still actively collecting automatically after analysis live ECG data e Click Freeze before printing the ECG tracing displayed on the screen Refer to Live ECG in section II E Verify that Print After Analysis is not checked Refer to Settings section table 2 1 Printer Format Settings and table 2 2 RR Variability Settings Uncheck Grid setting Refer to Table 2 1 Printer Format Settings Printing ECG reports without the grid will expedite the print jobs SERIAL PORT ERROR EXIT The IQmark Digital ECG cannot communicate with the ECG Acquisition Module Itis either connected to the wrong serial port or the setup in the IQmark Configuration is incorrect Note for Palm Pilot or other similar PDA users If you are using the same COM port for IQmark Digital ECG and the Palm Pilot exit the
12. computer the ECG COM Port setting will be disabled once it is detected as shown below Serial Communications Port Setup q x ECG COM Port m Spirometry COM Port Wital Signs fc OM 1 Com 1 y BP Disabled Sp02 Disabled USB Detected Nita Dee Temp Disabled Weight Disabled Enable Vital Signs Interface D Setup Cancel Help Figure 2 3 Serial Communications Port Setup For USB Type ECG Module Database Settings The IQmark Diagnostic Workstation uses the local database by default If you have setup the database on a network you will have the option to select between the local or network to be the default database Click the Database Settings in the configuration screen Fig 2 1 for this option Database Settings i x E Archive E Mail ECG Reports As Default Database 0 Compressed Archive Report car f Local O SCP ECG scp f Hetwork Holter ECG File Storage Path ia rentwoodr Database Holter Browse 1540 MBytes available Cancel Default Help Figure 2 4 Database Settings 10 IQmark Digital ECG Operation Manual To select Network database as your default first check the Enable Network Database box then click Network Refer to the IQmark Diagnostic Workstation operation manual for more details on setting up a network database The IQmark Diagnostic Workstation allows you to archive the ECG reports from the database as individual
13. e On Off e On Off IQmark Digital ECG Operation Manual Default setting 1s 25 mm sec Sweep Speed setting only applies to real time ECG display The ECG report only prints at 25mm sec scale except if a 2 Page Format is selected See Printer Format Settings Y gain Standard gain default setting 2X gain Default settings are MYO Off AC On Drift On See Note on Filters following this table Default setting 1s lead II This setting applies to both the 3x4 and 4 lead display formats and to the RR Variability analysis rhythm lead Default setting is I IL HI This setting applies to the 4 lead display format Default setting 1s 3x4 plus rhythm lead Default setting 1s On checked If this setting 1s Off cleared the live ECG screen will not display real time tracings while acquiring ECG data Set it to Off cleared only if your computer has problem with displaying real time ECG Default setting 1s On Controls how the ECG waveforms are drawn in the real time display screen Selecting On produces smoother waveforms In contrast selecting Off may produce waveforms that appear jagged Note If you are using a slow PC or having delayed ECG tracing use the Off setting Default is off cleared If On checked the ECG will not produce any diagnostic statements and the interpretation portion of the report ECG Review and the Edit Screen will be blank 15 IQmark Digital ECG Operation Manual
14. files It also allows you to send the ECG reports using your default E mail program The default format for this report is Compressed Archive Report car The SCP ECG scp format is more popular in the European countries If you have purchased an IQmark Holter product you also have the choice to select a different location to store your Holter ECG files List Management The List Management button on the configuration screen Fig 2 1 enables you to add or customize medications history statements race categories ECG Holter indications and ECG diagnostic statements You can also enter the names of the doctors and technicians using the Workstation Once these items are entered you can later select them from the appropriate lists in the test without having to retype them Click List Management in the configuration screen Fig 2 1 and choose to configure the lists for your local database or network database If the network database 1s not setup the Network Database selection will be disabled as shown below List Management Utility x Select a database then click on Manage Lists Database Selection O Network Database OF Help Figure 2 5 List Management Utility Click Manage Lists and the following dialog box appears You can add edit or delete any item in the Medications History Statements ECG Holter Statements and Race Categories lists 11 IQmark Digital ECG Operation Manual Local Database List Ma
15. not assume responsibility for damage incurred by improper packaging shipment or product use Such actions will void all applicable warranties 45 IQmark Digital ECG Operation Manual F Safety and International Symbols The following symbols are used on Midmark products These symbols appear on products when applicable Refer to this directory for details concerning the symbols used on equipment TE ATTENTION Refer to manual for instructions Year manufactured i Battery Orientation This device uses 2 AA Alkaline batteries The icon indicates the orientation El of batteries to be installed DC Voltage This device uses 3 Volt power and consumes 30mA when in use CE Mark Equipment displaying this symbol has passed specific safety tests and adheres to international quality standards established by the European Community IEC 601 Defibrillator proof Type CF equipment Equipment displaying this symbol contains an F type isolated floating applied part that provides a high degree of protection against electrical shock and 1s suitable for use during defibrillation ETL Listing Mark ETL LISTED N Equipment displaying this symbol has been tested and complies with the M s following safety standards 2001491 Conforms to UL STD 2601 1 Certified to CAN CSA STD C22 2 No 601 1 46 G Glossary ARCHIVING IQMARK DIAGNOSTIC WORKSTATION CLICK DATABASE DESKTOP DIALOG BOX ECG Email ELECTR
16. properly grounded Verify patient or examination room is not susceptible to energy interference such as electromagnetic fields from high power equipment like X ray machines power generators power compressors etc 41 IQmark Digital ECG Operation Manual Troubleshooting Guide Error Message or Problem Solution or Recommendation ECG SECURITY KEY NOT The Workstation cannot find the Security Key for the FOUND Valentine PC ECG because it is either not installed or there 1s a conflict with the parallel port Message appears after clicking the Analyze button This message e Verify that the Security Key is installed directly on only appears when using the the parallel printer port of the computer and that Valentine PC ECG module and not the printer cable is connected to the back of the with the IQmark Digital ECG Security Key Ensure that the printer is ON and module READY or ON LINE Print from Windows Notepad or any text file to verify the parallel port 1s working properly with the Security Key installed ERROR THERE MUST BE AT Serial comparison in ECG requires at least 2 ECG LEAST 2 REPORTS FOR reports completed under the same patient ee PARISON e Click OK Perform additional test if needed Message appears after clicking the Serial Comparison button Incorrect diagnostic interpretation Refer to solution for ECG signal quality problems in this section Patient s Date of Birth Sex and Medications must
17. where humidity ventilation direct sunlight or air containing dust salt sulfur etc might affect it c Prevent the instrument from slipping and vibration shock or dropping be careful when transporting it d Do not install the instrument in a chemical storage area or where gas 1s generated Preparation of the instrument prior to operation a Verify proper instrument operation b Check that all cable connections are safe and secured c When using with other equipment such as a personal computer request the assistance of personnel familiar with the equipment Observe the patient and instrument closely during use If any abnormality is found proper action which may include stopping the operation of the instrument should be taken immediately for the safety of the patient Keep the instrument clean to ensure trouble free operation for the next use Incase of malfunction call a technician and describe the problem precisely Inspection the instrument and accessories regularly Do not make any modifications to the instrument Environmental operating limits a Operating 59 to 95 F 15 to 35 C 30 to 75 humidity non condensing 760mm Hg 20 b Storage Shipping 4 to 120 F 15 to 50 C 30 to 95 humidity non batteries removed condensing 760mm Hg 20 10 Cautions for the operator DANGER Possible explosion hazard if used in the presence of flammable anesthetics
18. 0 80 Premature Mean HR 66 BPM VECs Mean RR 897 msec Reviewed By David Lang MD PACS Review Date 08 14 03 Settings Comments lt lt lt gt gt gt lt lt lt gt gt Gain 1X Show Graphs E 0 30 Sec EA g Max RR 964 msec M Figure 3 13 RR Variability Report Review ECG Screen The diagnostic results for the RR Variability analysis are displayed in text boxes on the upper right portion of this screen These results cannot be edited You can view the patient s ECG tracing from the entire data collection period 30 360 seconds by clicking the lt lt lt gt gt gt arrows above the traces Click the Gain 1X button if the amplitude of the ECG is too tall or too short It will first increase the amplitude to 2X 20mm mv Click it again and it will decrease the amplitude to 1 2X Smm mv Third click on the same button will return to the standard 1X gain 10mm mv You can also review the data collected during the RR Variability analysis in R R Trend and R R Histogram formats by clicking the Show Graphs button An example of this screen is shown 35 IQmark Digital ECG Operation Manual KJ Reports For R R Yariability 218 x ECG RR Variability Holter Spirometry Stress Vitals 1 08 14 03 19 24 44 Report 1 of 1 Technician Tina May RN Beats 64 Duration Normal 60 Number of RR Interval Blood Pressure 120 80 Premature 0 an HR VECs 0 Reviewed By David Lang
19. 16 Report 1 of 1 Serial Comparison Technician Tina May RN Sinus Rhythm ARS 1 1 Normal P axis H Rate 81 BP 120 90 WITHIN NORMAL LIMITS Reviewed By Review Date Details a Gain 1x Settings Add Delete Modify Clear Add Figure 3 6 ECG Report Review Screen The analysis results are displayed in the two text boxes on the upper right portion of the Report Review screen The attending physician should review and evaluate the diagnostic interpretation and the measurements Editing Diagnostic Statements Some patients have specific physiological profiles that can affect the IQmark Digital ECG interpretation of their results If the physician believes there are any discrepancies in the diagnostic statements the statements can and should be edited To delete or modify the diagnostic statement simply select the statement you want to delete or modify then click the appropriate button below the box Click the Add or Clear Add button to enter new diagnostic statements or to clear all statements and add new ones as shown in the following screen 30 IQmark Digital ECG Operation Manual 115 Repolarization abro JE a a 21 leche UEN anterior leads Rerolarizaton abnor suggests lechemia anterior leads Cancel Figure 3 7 Add a Statement Screen In the top box type the abbreviation e g RBBB of a statement and the statement e g Right bundle branch block will appear in t
20. Add Edit Delete Delete All Figure 2 7 List Management IOmark Default ECG Statements The Delete All button will delete all ECG statements so that you can enter your own diagnostic statements from scratch or choose from the two lists available through the Load Default Statements button 12 IQmark Digital ECG Operation Manual Local Database List Management j x General List Management ECG Statements User Names statement Category an Edit Categories Double click on an abbreviation to edit the statement Load Default Statements View Report Add Edit Delete Figure 2 8 List Management Load Default Statements The two ECG statement list options are IQmark Default List or AAMI SCP ECG Select The Default ECG Statement List A Qmark Default List e E AAMI SCP ECG Cancel Help Figure 2 9 List Management Select Default ECG Statements The IQmark Default List is the default list installed with the IQmark Diagnostic Workstation To enter the names of doctors and technicians who use the Workstation select the User Names tab Click the Add button You can type in a user s name and define the user as a physician technician or both 13 IQmark Digital ECG Operation Manual Local Database List Management x General List Management ECG Statements User Names Double click on an item s text to edit that item Jason Smith AH Robert Wrest MD Tec
21. Each differential amplifier has two inputs positive and negative IQmark Digital ECG Service Manual The following table lists the positive and negative inputs for each channel Channel Number Positive Input Negative Input RA The Wilson Center is a reference point combined with the three limb leads The purpose of the instrumentation amplifier 1s to provide a high CMRR Common Mode Rejection Ration rejecting common mode signals such as 60 Hz line noise 2 5 Filters and Gain Amplifiers After the instrumentation amplifiers the 8 channel ECG signals are passed into two stages of filters The first stage consists of eight first order high pass filters with a cutoff frequency of 0 048Hz The second stage consists of eight low pass filters with a cutoff frequency of 159Hz The ECG signals are also amplified to match the AD converter input dynamic range of 0 2 5V There are eight test points provided on the PCB board The test points are labeled as CHO CH1 CH2 CH3 CH4 CH5 CH6 and CH7 The signals measured on these test points are amplified with a gain of 125 and DC offset to 1 25 Volt 2 6 Analog to Digital Conversion The AD converter used is ADC12138 from National Semiconductor The AD converter is 12 bit plus sign serial I O A D converter with MUX and Sample Hold The amplified and filtered 8 channel ECG signals are passed to the 8 channel inputs of the AD converter The sampling rate for each channel is 500 Hz The digitize
22. Hot Sync Manager or similar software before you run the IQmark Digital ECG application Note for Touchscreen Display users If you are using the same COM port for the IQmark Digital ECG and the Touchscreen Display close or disable the touchscreen driver before running the IQmark Digital ECG application Message appears after starting a New ECG No ECG trace 1s displayed on the screen e Refer to sections II B and II D for communication port selection and setup Use the Auto Detect feature to find the correct COM port All other operational problems Please refer to the online help by clicking on the Help button found on all screens Additional troubleshooting covering ECG diagnostics is available in the IQmark Diagnostic Workstation Operation Manual available through Midmark Customer Service For technical support please see the contact information at the end of this manual 43 IQmark Digital ECG Operation Manual C Maintenance and Storage Cleaning CAUTION Do not use aromatic hydrocarbons rubbing alcohol or chlorinated solvents for cleaning the ECG module Do not use alcohol or acetone on lead wires or cables since they can stiffen and crack the insulating plastic Clean the outside of the ECG module with a mild solution of detergent and water using a soft cloth Avoid using excessive amounts of solution which may infiltrate the connectors battery compartments or ECG Module If necessary u
23. O symbol and if the LED is not lit at this time you may need to turn it on manually by pressing 26 IQmark Digital ECG Operation Manual If you have a USB type ECG module the Workstation software will turn on the module automatically as needed A NOTE The laptop computer s AC Adapter may introduce electrical interference For best ECG result do not use the AC Adapter while running a live ECG ECG for Bill Hackings 121 32 4567 3 B cem Print Analyze Freeze Settings Help Review Figure 3 5 Live ECG Screen The live ECG screen displays the results of the 12 channel ECG in the three by four 3x4 leads display format This format can be changed by using the Settings function which is explained later Your facility s name the date time and the patient s heart rate appear at the top of the screen The ECG tracings are in the center of the screen moving from left to right Below the moving tracings are the sweep speed gain and filter settings You can click the appropriate button to modify its setting Changes made here to these settings are temporary and only apply for as long as you are 1n this test You can change and set them as the default settings for all new ECG tests through the Settings button Clicking on the INST button resets the ECG module and stabilizes the ECG baselines If there is no INST button on the screen manually turning the ECG module power off for one second and then turning 1t
24. OCARDIOGRAM ELECTRODES FOLDER MICROSOFT WINDOWS BASED COMPUTER MY COMPUTER IQmark DIGITAL ECG PORT IQmark Digital ECG Operation Manual Placing data into temporary storage where 1t cannot be damaged or altered Archived data such as ECG reports prepared by the IQmark Workstation can be retrieved at a later date for review The name of the software application you install on your Microsoft Windows based computer in order to use the Midmark IQmark Digital ECG In this manual Click refers to tapping a mouse button once quickly and firmly For example if you want to pull down the Medications menu you will Click on the menu name Double Click refers to performing this task twice and is generally used to start programs A collection of data arranged into methodically organized categories In this manual the term refers to the collection of ECG reports that the IQmark Digital ECG stores on your hard drive The background image that appears on your computer screen behind the application window s An on screen form you complete to provide the IQmark Workstation with information needed to accomplish tasks an example is the Medications window See electrocardiogram Electronic mail that is sent from one computer to another via telephone lines through Internet access Patient reports are sent as attachments to the email A graphic recording that displays the electrical activities of the heart Permits the detection o
25. OPERATION MANUAL Qmark Digital ECG Version 0 MIDMARI Diagnostics Group Part Number 3 100 1021 Revision 7 0 2005 Brentwood Medical Technology Corp IQmark Digital ECG Operation Manual TABLE OF CONTENTS A WORD OF THANKS cosido d dnd condi riadd Ul CAUTION iconii E V I GENERAETN FORMATION isos aE nica 1 A DESCRIPTION uo a l B NECESSARY COMPUTER tie due aes cores 2 Es CONFIGURATION iana aT A steduceas veaten sua auases T 2 Typical C COn oural AA O tana Re aenaeaeeanee 2 Typical Ihin Client Configuration seag aE E E 2 D SYSTEMS PECICA TON talca 4 II SYSILTEM INSTALLATION sirosis eeo a ae osae aeaa 5 A COMPUTER REQUIREMENTS 12d A ea 5 B HARDWARE INSTALLATION canon dada did dais 5 C SOFTWARE INSTALLATION aa EE A ddaushacays 6 O LAS A A E ee eae A A A E ae 7 ELA a A E EEE E EE O EEA ON 7 Tasta a On SI a E taco eeeana Neher ates 7 D CONNECTING THE IQMARK DIGITAL ECG MODULE coooocccccnnnnnnnnnnnnnnnnnnnnnnnnnnnannnnnss 8 DEVICE VIC LCG MOTU n e a 8 USB Ey 92 EC S MOI a cas 8 E CONFIGURING THE IQMARK DIGITAL ECG ooocccnncccnnnnnoconnnonoconnnnnoconnnnonocnnnnnorononnnooos 8 Configuring for Serial Type ECG Module oooooooooccconnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnos 9 Confisurine for USB Type ECG MOI A A 10 Database SCUINGS ii Ga 10 TST VIGNE COMA a a 11 BOS DEUMES ld dida 14 HI OPERATIO Niutin iii 21 A INTRODUCTORY NOTE S pa 21 B PREPARA TIO Nos 21 Instructions for Performing ECG ACQUuisiliOM
26. RR Variability reports are automatically stored in the designated database for future reference whether locally on your computer hard drive or remotely in a central database The IQmark Diagnostic Workstation provides many record management features that make 1t easy for you to retrieve and review this information later F Reviewing Patient Reports After a report has been collected through Analyze or Start RR clicking the Review button on the Live ECG screen Fig 3 5 will automatically bring you to the Report Review screen Data from the latest report collected will be displayed with the format reflecting the method of collection i e either by Analyze or Start RR function ECG Report Review Reports collected using the Analyze function are displayed on the Report Review screen with ECG data traces from each of the patient leads You can click on any part of the 29 IQmark Digital ECG Operation Manual ECG tracings to zoom in to view in 2X magnification While in this mode you can move or pan the ECG tracings to view the other leads by holding down the Shift key and dragging with the mouse Click again on the ECG tracings to return to the normal view If the ECG amplitude 1s too tall or too short you can click the Gain 1X button to increase the amplitude gain to 2X 20mm mv or decrease to 1 2X 5mm mv y Reports For Bill Hackings lal x ECG RR Variability Holter Spirometry Stress Vitals 1 11 07 04 10 03
27. S A RI ae es 51l 20 Andos TO IMITA CONVE Or A SS 51 A ES A 51 ZO OA L Crta INCAS E E E yz DZD NO ETA AAA O 32 ZAPU Facemakor DICTE e ias 52 Zid DC DC F wer Convertor siirsin tas TZ SYSTEM MAINTENANCE AND OBTAINING SERVICE 53 IQmark Digital ECG Operation Manual A Word of Thanks Thank you for purchasing the Qmark Digital ECG Midmark Diagnostics Group has used the latest microelectronic and computer software technology to develop a compact low maintenance and high quality ECG system Our goal 1s to enable healthcare professionals to provide quality and efficient patient care With that in mind our product is designed with intuitive layouts and features that will enable more physicians to conduct office based tests which will result in more timely diagnoses and enhanced patient outcomes We believe you will be pleased with the user friendly operation of our product and with your results As your partner in healthcare we look forward to working with you in the coming years as we develop even more sophisticated diagnostic technology for the cardiopulmonary field Your thoughts questions and comments about our product are welcomed Midmark Diagnostics Group PH 800 624 8950 or 310 530 5955 Caution Federal Law restricts this device to sale to or on the order of a physician 111 IQmark Digital ECG Operation Manual Physician s Responsibility The interpretations provided by the Midmark IQmark Digital ECG are for the excl
28. above COM port on the client to the server s COM port e g COM9 3 After the IQmark Diagnostic Workstation 1s installed on the Terminal Server select the new COM port e g COM 9 as the ECG COM Port through the IQmark Configuration screen See sections D Connecting the IOmark Digital ECG module and I E Configuring the IOmark Digital ECG on configuring for serial type ECG module IQmark Digital ECG Operation Manual D System Specifications The following are the physical and performance specifications for the IQmark Digital ECG Table 1 0 IO0mark Digital ECG Specifications Performance Specifications Intended Use To provide 12 lead resting electrocardiograms which permit the detection of abnormalities in the transmission of the cardiac impulse through the heart muscle serves as an important aid in the diagnosis of heart ailments Physical Characteristics e 2 8 7 1 cm x 5 12 7 cm x 88 2 3 cm W x Lx H e 0 56 lb USB type ECG module without batteries e 0 66 lb Serial type ECG module with batteries e Two 1 5V AA alkaline batteries Serial type ECG module only e 25 hours of ON time Serial type ECG module Anatomical Sites e Noninvasive device 12 lead electrocardiogram Safety Parameters e Patient electrically isolated from main current supply e Patient leakage current not to exceed 10 uA e Ground leakage current not to exceed 50 uA ECG Acquisition e 12 leads simultaneous
29. aveform Smoothing option is off and set to display in 4 leads display format This is found under Default Interpretation and Acquisition Display Settings tab on Settings function Fig 3 5 Verify that you do not have any other task or program running at the same time Exit the IQmark Workstation and close all running programs Start the IQmark Workstation program without restarting the computer If the above fails to correct the problem disable the Display Real time ECG Tracing under Default Interpretation and Acquisition Display Settings tab on Settings function Fig 3 5 39 IQmark Digital ECG Operation Manual Troubleshooting Guide Error Message or Problem Solution or Recommendation ECG MODULE NOT The program cannot communicate with the IQmark RESPONDING Digital ECG module because it is not on not connected to the computer or connected to the wrong port Note for Palm Pilot or other similar PDA users If you are using the same COM or USB port for the IQmark Digital ECG and Palm Pilot exit the Hot Sync Manager or similar software before running the IQmark Digital ECG application Note for Touchscreen Display users If you are using the same COM or USB port for IQmark Digital ECG and the Touchscreen Display close or disable the touchscreen driver before running the Qmark Digital ECG application Message appears after starting a new ECG test No ECG tracing is displayed on the screen e Verify that the
30. cific 49 IQmark Digital ECG Service Manual 2 1 SYSTEM BLOCK DIAGRAM Patient Lead Off Detector 0 Pacemaker i _ DC DC Power Detector Circuit 10 Leadwire Patient Cable ECG Buffer Instrumentation Filters and Gain with Defib Amplifiers Amplifiers amplifiers Protection lt o 8 Channel A D Microcontroller a Isolated Serial PC System Converter Interface 2 2 10 Leadwire Patient Cable 2 3 ECG Buffer Amplifiers The patient ECG signals are first fed to the 8 ECG buffer amplifiers These buffer The IQmark Digital ECG uses the special Midmark 10 Leadwire patient cable for its 12 lead ECG data acquisition The patient cable has 10 conductor shielded lead wires There is a 1Kohm 10 resistor embedded inside each lead wire Together with the voltage clamping circuit built into the ECG front end the IQmark Digital ECG provides the built in defibrillation protection capability required by AAMI EC 11 and IEC 60601 amplifiers provide high input resistance for the patient interface with low output resistance to the instrumentation amplifiers 2 4 Instrumentation Amplifiers 50 There are eight differential instrumentation amplifiers used in the IQmark Digital ECG providing eight output signals from CHO to CH7
31. d ECG data are sent to the microcontroller through the serial interface 2 7 Microcontroller The microcontroller is a PIC16LC67 chip from Microchip Technology This chip has 8Kx14 OTP 33 I O lines and built in serial interfaces for A D converter and RS232 The microcontroller receives the digitized ECG data from the AD converter and encodes the data with packets and sends out to the PC through serial 51 IQmark Digital ECG Service Manual interface circuitry The setting for the RS232 is 8 bit data 1 bit stop no parity and 115 000 baud rate and 1s usually handled automatically Settings for USB are automatic and are not user selectable 2 8 Isolated Serial Interfaces To provide the maximum safety for the patient the IQmark Digital ECG hardware and the PC are isolated with an optical coupler and or isolated DC to DC converters The serial signal sent out by the PIC microcontroller is coupled optically to the PC system either through the RS232 or USB interface There is no electrical connection between the patient and the PC system The isolation circuit can withstand up to 1000 volts 2 9 Lead off Detector The IQmark Digital ECG has a built in lead off detection circuit The lead off circuit senses the lead off condition and reports to the PIC microcontroller The PIC microcontroller sends out the lead off condition to the PC through the serial interface 2 10 Pacemaker Detector The pacemaker detection circuit in the IQmark Dig
32. dvanced diagnostic features IQmark Digital ECG Operation Manual Note There are two types of IQmark Digital ECG acquisition module a serial COM port type and a USB port type The serial type ECG module which has an On Off switch indicated by is designed for use with the Microsoft Windows based computer and Pocket PC handheld PDA devices Please refer to the Omark Diagnostic PDA Operation Manual part 3 100 1049 for instructions on using it with your Pocket PC device The USB type ECG module which does not require batteries 1s designed for using with a Microsoft Windows based computer only This manual is written for both types of modules on Windows based computer systems B Necessary Computer Skills This manual assumes that you are already capable of using Windows based applications that you have some understanding of how a PC works and that you are familiar with the basic operations of Microsoft Windows If this is true you will have no problem using the product However in the event that you have any technical questions or problems please refer to the Troubleshooting Guide in the Appendix of this manual for immediate assistance Customer Support information is also listed in the Appendix C Configuration Typical PC Configuration The block diagram below illustrates the standard configuration of the IQmark Digital ECG system The primary components are a Windows based PC a printer and the IQmark Digital ECG acquis
33. ed operation instructions please refer to the Omark Diagnostic Workstation Operation Manual IQmark Digital ECG Operation Manual D Connecting the IQmark Digital ECG module Serial type ECG module If you have a serial type ECG module attach the female end of the 9 pin communication cable to any available serial port on the PC If you are using a USB port with the serial type ECG module install the USB to serial port adapter before you connect the ECG module to the Adapter Secure the connections with the thumbscrews Do not over tighten A NOTE Almost all USB to serial port adapters come with specific software drivers that must be installed prior to use Before connecting the IQmark ECG module to any adapter ensure that all software drivers have been installed according to the manufacturer s instructions USB type ECG module If you received a USB type ECG module you can connect it to any available USB port on the computer after the IQmark Diagnostic Workstation 1s installed As with other USB devices Windows will attempt to identify the ECG module the first time 1t connects to it This may take a few seconds E Configuring the IQmark Digital ECG Through the IQmark Configuration program you can customize the IQmark Diagnostic Workstation and the IQmark Digital ECG for your operation If you are using the database on your local and network computers the configuration program also enables you to set your default database
34. elect Patient List and search by patient s last name or ID Complete the fields on the Patient Data screen as accurately as possible You must enter a name or ID number to perform a test Enter the date of birth and sex of the patient Enter the patient s vital signs If the patient has a cardiac history or is taking prescription medications make sure you enter them on the appropriate tabs When the Patient Data screen 1s complete prepare the patient for the resting ECG test Refer to the enclosed Quick Reference User s Guide for a standard 12 lead hookup If the ECG module has an On Off switch you may need to turn it on by pressing the O symbol The green LED on the module will light when the ECG module is on Select New Test on the menu bar select the ECG test type and enter relevant information Click OK when the patient is prepared and comfortable Adjust the sweep speed and gain as necessary If artifacts or noise occur in the ECG signal please refer to ECG signal quality problems in the Troubleshooting Guide for corrective actions Do NOT turn the MYO filter ON for pacemaker patients Wait for the ECG tracings to pass the screen twice about 20 seconds to verify that the signal quality is good and the baselines are stable To acquire a test report click either the Analyze or the Start RR button on the menu bar Analyze instructs the program to acquire analyze and store a resting ECG test Start RR instructs t
35. ent field ZZ IQmark Digital ECG Operation Manual C Starting the Program You start the ECG test through the IQmark Workstation located on your Windows Desktop as a shortcut icon Double clicking on this icon starts the Workstation program bd mark Workstation Or start from the Windows Taskbar through the following sequence A Start Programs gt Midmark Diagnostics IQmark Diagnostic Workstation A NOTE Fora detailed description of other diagnostic functions available through the IQmark Workstation please see the Omark Diagnostic Workstation Operation Manual part 3 100 1038 D Opening Screen When you start the IQmark Diagnostic Workstation an opening screen appears EJ Midmark Diagnostics Group E lex lQmark ALIAS ES l l Diagnostics Group Diagnostic Workstation New Patient Register a new patient i STAT ECG Patient List st Search the patient database Configuration Database Local MS Access IQmark Products Available Digital ECG Digital Holter Help Digital Spirometry E Digital Stress Vital Signs Return To Windows Institution Midimark Medica Group Figure 3 1 Opening Screen 23 IQmark Digital ECG Operation Manual STAT ECG In the event that a stat ECG is required hook up the patient to the IQmark Digital ECG and click on the STAT ECG button to immediately access the live ECG test screen without having to enter the patient information You can either prin
36. f abnormalities in the transmission of the cardiac impulse through the heart muscle and serves as an important aid in the diagnosis of heart ailments During an electrocardiogram the heart s electrical impulses are typically measured through electrodes placed on the chest and limbs A device used as an interface between an electrical conductor and an organism Folders which function like the drawers in a filing cabinet are used by Windows to organize files and applications The IQmark Workstation application resides in a folder named Brentwood located on your hard drive Any computer that runs on Microsoft Windows operating system The Midmark IQmark Digital ECG requires a personal computer that runs on Windows 2000 or XP platform for operation A Microsoft Windows icon that appears on the desktop in the form of a stylized computer Clicking on My Computer allows you to explore your computer s disks printers Control Panels and other functions Midmark Diagnostics Group s portable ECG device for converting a Microsoft Windows based PC into an electrocardiograph with interpretive capability The IQmark Digital ECG is operated using the IQmark Diagnostic Workstation software application A place where data is passed in and out of a computer Windows 47 IQmark Digital ECG Operation Manual SERIAL PORT SHORTCUT ICON START BUTTON TASKBAR USB PORT TEXT BOX 48 based PCs typically have several port
37. fferent reports as indicated at the lower left corner Clearing a report check box turns off the median beats for that report displayed on the left side of the screen Median beats are superimposed so that subtle differences can be viewed easily Rhythm strips from each report are also displayed in the lower right section together with the report number and lead label You can view different rhythm leads by clicking the down arrow button next to the Rhythm Lead indicator Y ou can click inside the median beat or the rhythm strip area to zoom in on the ECG tracings Click again and ECG views return to the previous scale Rhythm 10 31 01 120 70 80 156 372 407 104 4 WITHIN NORMAL LIMITS 07 16 01 Sinus Rhythm 06 26 02 150 90 P QRS 1 1 Normal P axis H Rate 66 WITHIN NORMAL LIMITS 4 b V Repot1 Rhythm Lead v1 Gain 1X Preview Settings Report 2 2eport 4 Show All Print Print Setup Help Figure 3 12 Serial Comparison Screen 34 IQmark Digital ECG Operation Manual RR Variability Report Review If a report was collected using the Start RR function then the ECG data is displayed on the Report Review screen as shown below Reports For R R Yariability E a x ECG RR Variability Holter Spirometry Stress Vitais 08 14 03 19 24 44 Report 1 of 1 Technician Tina May RN Beats Duration 60 sec Normal Number of RR Interval 63 Blood Pressure 12
38. gs Click R R Variability Settings tab of the ECG Settings Fig 2 11 or 2 12 to preset the default test duration and report format as shown below 17 IQmark Digital ECG Operation Manual ECG SETTINGS Xx Default Interpretation And Acquisition Display Settings Printer Format Settings A A Variability Settings Configuration AR Duration 30sec 120eec 210sec o Elsec 150sec 240 sec AR Print Speed 5 mm sec 10 mm sec e 25 mm sec Print After Analysis Print Graphics Report Help caca 1 Figure 2 13 ECG Settings R R Variability Settings The following table explains the settings for acquiring and printing a R R Variability report R R Variability Settings RR Duration e 30 sec Default setting is 90 sec e 60 sec This setting defaults the length of the rhythm strip acquired through Start R R test The rhythm strip is defined in the ECG Settings Fig 2 11 e 90 sec e 120 sec e 150 sec e 180 sec e 210 sec e 240 sec e 360 sec RR Print Speed e 5 mm sec Default setting is 25 mm sec e 10 mm sec This setting defines the print scale of the ECG mimi tracings for R R test Print After Analysis Default setting is Off cleared When set to On checked the R R test report is printed automatically following successful completion of R R test analysis Recommendation To speed up printing set to No and print report manually after the test 1s completed 18 IQmark Dig
39. h Susan Terry Jones MD Tina Mar AN Figure 2 10 List Management User Names Click OK to close the List Management Utility ECG Settings You can set the default settings use for ECG tests by clicking the ECG Settings button in the configuration screen Fig 2 1 The following dialog box appears ECG SETTINGS x Printer Format Settings R A Variability Settings Configuration Default Interpretation 4nd Acquisition Display Settings Sweep Speed 10 mm sec Gain CS mmm f 10 mmnm f 20 mmen Filters fw AC Filter Muscle Filter i Drift Filter 50 mmtzec 100 mmtzec Rhythm Lead Lead Group II LILII r Display Format 3x4 Leads C 4 Leads 12 Leads W Display Real time ECG Tracing e Waveform Smoothing Tl Disable Interpretation T Disable Quick Edit Help Figure 2 11 ECG Settings Default Interpretation And Acquisition Display Settings The following table explains the setting options available 14 Default Interpretation And Acquisition Display Settings Sweep Speed Rhythm Lead Lead Group Display Format Display Real time ECG Tracings Waveform Smoothing Disable Interpretation e 10 mm sec e 25 mm sec e 50 mm sec e 100 mm sec e Muscle On Off e AC On Off e Drift On Off Select any lead e IL III e aVR aVL aVF e V1 V2 V3 e V4 V5 V6 e 3x4 leads plus rhythm e 4 leads e 12 leads e On Off
40. he RR Variability Settings to print reports automatically see Settings function below IQmark Digital ECG Operation Manual The Settings button opens a four tab dialog box for changing the Default Interpretation And Acquisition Display Settings Printer Format Settings R R Variability Settings and Configuration which are similar to those described in section I E Configuring the IQmark Digital ECG see Tables 2 0 2 1 and 2 2 Displays the online Help screen Exit indicates an ECG or R R Variability Report has not been collected Click this button to return to the previous screen the Patient Data screen and terminates ECG acquisition Review Review indicates at least an ECG or R R Variability test has been Ar performed Click to display the most recent report in the Review Reports screen Review The IQmark Digital ECG collects and stores a test report when you click on Analyze or Start RR from the Live ECG screen Fig 3 5 Selecting Analyze instructs the program to acquire analyze and store a resting ECG Report Selecting Start RR instructs the program to begin acquisition for an R R Variability Report When a minimum of 30 seconds of ECG data has been acquired the program proceeds to analyze the data and will store an R R Variability report in the Workstation database There is no limit to the number of reports you can collect for a given patient using the Analyze and Start RR functions Both the resting ECG and
41. he edit box below You can also select a statement from the list by clicking the down arrow You can further edit the statement that appears in the lower edit box or you can type in any statement you wish A NOTE Ifthe statement list is empty no default ECG statement list is selected in List Management Refer to section H E Configuring the IQmark Digital ECG on how to load the default statements through List Management If Disable Quick Edit is checked on the Default Interpretation and Acquisition Display Settings dialog box see Table 2 0 the cursor is placed in the lower edit box by default for free text entry You can also edit the diagnostic statements through the Details screen described later in this section The measurements displayed in the text box on the right Fig 3 6 can be changed if desired Simply double click the item you want to change e g Rate and a dialog box will appear allowing you to overwrite the current value A NOTE If Disable Interpretation is checked on the Default Interpretation and Acquisition Display Settings dialog box Fig 2 11 no interpretive statement appears in the ECG Report Review Screen and the top center box is blank The top right box however still displays the measurements If the ECG is a stat ECG the word STAT ECG is displayed inside the ECG window above lead I ECG Report Details Review Click the Details button to display a detailed measurement screen like the one show
42. he program to acquire a preset duration of the rhythm strip and prepare a RR Variability report Reports are automatically saved and can be viewed upon exiting the ECG screen by the Review button Reports on the Report Review screen are in chronological order for the patient being tested and are displayed on the ECG or RR Variability tabs You can review reports from other patients by clicking Patient List 37 IQmark Digital ECG Operation Manual B Troubleshooting Guide This Troubleshooting Guide provides a comprehensive list of solutions and recommendations to problems you might encounter with the IQmark Digital ECG Before calling Midmark Diagnostics Group for Technical Support please refer to the following table for help Error messages are displayed at the center or at the bottom right corner of the screen A NOTE For errors that occur during the analysis or management of ECG files please refer to Troubleshooting Section in the Omark Diagnostic Workstation Operation Manual Table 4 0 Troubleshooting Guide Troubleshooting Guide Error Message or Problem Solution or Recommendation DATA FORMAT ERROR A format error has occurred in the ECG data collected Message appears after starting a e This Error message can be cleared by clicking on New ECG Settings then Cancel Verify that the Low Battery LED on the ECG Module is not blinking If it is install new batteries Switch to 4 leads display format Refer to section
43. ital ECG Operation Manual R R Variability Settings Print Graphics On Off Default setting 1s Off cleared Report When set to On checked the graphic report which includes the R R Trend and R R Histogram is printed automatically with the R R rhythm strip report Table 2 2 R R Variability Settings Click Configuration tab of the ECG Settings Fig 2 11 2 12 or 2 13 to access the Configuration settings ECG SETTINGS E Default Interpretation And Acquisition Display Settings Printer Format Settings R A Variability Settings Configuration Institution Mame Midmark Medical Group Units Com Port Com 1 Auto Detect Date Format E DEM E DEY E hD Time Format l Line Frequency 24 Hour Clock ee E 12 eur Clee ET E TE H Carcel amy Figure 2 14 ECG Settings Configuration f English Metric D Most of the settings on this screen are controlled by the IQmark Workstation Configuration Settings Fig 2 1 and therefore cannot be changed except the line frequency and COM port auto detection for ECG module You can make changes to these settings on either screen Click OK on the ECG Settings screen Fig 2 11 if you want to save any changes you made It will return you to the Configuration Settings dialog box Fig 2 1 Please refer to the appropriate operation manuals for details on Holter Spirometry and Stress Settings Once you are satisfied that the configuration
44. ital ECG ensures the device s capability of printing the ECG signal in the presence of pacemaker pulses with amplitudes between 2 and 250 mV duration between 0 1 and 2 0 ms recommended by AAMI EC 11 2 11 DC DC Power Converter 52 The IQmark Digital ECG 42 Series RS232 uses two AA batteries to supply its power The IQmark Digital ECG 43 Series USB does not require the use of batteries The USB port of the host computer provides the operating power A step up DC DC converter is used to provide a 4 5 Volt power source Two 3 3 Volt regulators are used to provide two 3 3 Volts power source for the analog circuits and digital circuit for the unit There is also a negative voltage converter used to generate a 3 3 Volt power source for the analog circuit A Linear Technology 1 25 Volt micropower shunt reference regulator provides precision 1 25 Volt reference voltage The IQmark Digital ECG 42 Series RS232 power 1s switched ON or OFF via the switch marked I O on the top label The IQmark Digital ECG 43 Series USB power is switched ON or OFF by the ECG program through the USB port Isolation is provided for signals entering the ECG module and can withstand up to 1000 volts 3 0 IQmark Digital ECG Service Manual SYSTEM MAINTENANCE AND OBTAINING SERVICE The IQmark Digital ECG is a portable device which requires little maintenance To ensure the best performance of the device the following procedures are recommended 1
45. ition module A portable computer is recommended if mobility is a consideration Please refer to this diagram when setting up your IQmark Digital ECG system ILmark Digital ECG Module EA A Ten lead patient a connection Windows based desktop Optional Windows Patient Cable or portable computer Compatible Printer Figure 1 2 Block Diagram for the IOmark Digital ECG system Typical Thin Client Configuration If you have a thin client environment you can install the IQmark Diagnostic Workstation software on the Terminal Server and operate the IQmark Digital ECG through a thin client terminal 2 IQmark Digital ECG Operation Manual A NOTE Since the thin client terminal does not support the USB type IQmark Digital ECG module you must have a Serial RS232 type ECG module and be able to connect to the thin client terminal Terminal Client Client Printer Server mark T lead patient imi a Digitale Ce Client Patient Cable a ODC Figure 1 3 Block diagram for the IO0mark Digital ECG on a typical thin client environment Setting up any application on a network environment typically requires special access rights and knowledge of the network Please have your network administrator install and setup the IQmark Diagnostic Workstation application so it fits your office s needs 1 Identify the COM port number on the thin client terminal where the ECG module is connected e g COM1 2 Map or redirect the
46. lled on your computer and you are now either upgrading or adding a new IOmark product please skip this section and refer to the IQmark Diagnostic Workstation Operation Manual for detailed installation information e Close all Windows programs before installing this software Do not interrupt the installation program while it is running The installation should take less than five minutes Before installing the IQmark Digital ECG on your computer it 1s important that you understand and carry out the following tasks Windows Taskbar The IQmark Digital ECG is designed to run as a full screen program For best results the Windows Taskbar should not be displayed in order to provide maximum display area Place the mouse pointer on the blank portion of the Taskbar on the bottom of the screen then right click and select Properties Ensure Always on top is NOT checked Screen Saver If a screen saver or any energy saving feature 1s enabled on the computer make sure that it does not activate and interfere with data acquisition during patient care Refer to your computer or software manual for these settings Installation Steps 1 Insert the Installation CD into the CD ROM or DVD ROM drive The installation starts automatically If the installation does not start automatically double click My Computer on the desktop and double click the CD ROM icon to start 2 Follow the instructions on the screen For detailed installation setup and detail
47. mat Settings The following table explains the ECG report printing options available 16 IQmark Digital ECG Operation Manual Printer Format Settings Printer Format e 6 x 2 format Default setting is 12 lead plus single rhythm Settings 12 lead with 3 lead format rhythm format 3x4 3 2 Page Format prints leads I II UL aVR aVL e 12 lead format 12x1 and aVF on the first page and V1 V6 on the l second page You can select the print scale of e 12 lead plus single 25 mm sec or 50 mm sec when printing in 2 rhythm format 3x4 1 page format Other formats will always print e 2 Page Format at 25mm sec scale Rhythm Lead Select any lead Default setting is II Applies to 12 lead with single rhythm format Rhythm Lead e J Il Il Default setting 1s I II II Group e aVR aVL aVF Applies to 12 lead with 3 lead rhythm format e V1 V2 V3 ADONE e V4 V5 V6 Print After Analysis Default setting is Off cleared When On checked resting ECG report is printed automatically following analysis Recommendation To speed up printing set to Off and print report manually after the ECG is acquired Print Measurements Default setting is Off cleared When On checked the detailed measurement matrix report is printed automatically with the ECG report On Off Default setting is On checked Black Red or Green When on grid is printed in the selected color if a color printer is used Table 2 1 Printer Format Settin
48. n below 31 IQmark Digital ECG Operation Manual Bill Hackings 121 32 4567 x 7 Measurement Matrix Meas l ll 111 aVR aL avn 84 86 72 82 86 Pa 0 117 0 180 0 068 0 031 0 124 82 P a 0 146 Qd 22 22 19 18 Qa 0 107 0 107 0 056 0 053 44 40 43 21 52 42 Ra 0 666 0 905 0 241 0 107 0 222 0 573 19 R a 0 097 Sd 26 18 24 42 20 Sa 0 061 0 134 0 100 0 783 0 107 Td 176 176 150 176 182 Ta 0 258 0 397 0 143 0 068 0 273 Td 174 Ta 0 324 VATd 40 40 26 14 40 38 QRSd 92 80 67 82 71 80 QRSa 0 773 1 039 0 341 0 890 0 278 0 680 ST 80 0 007 0 012 0 000 0 009 0 002 0 007 nen neo aan 327 ana Fa View 2x Calipers as ampl Pans d dur in msec Show Ref Points Edit Comments General Meas Show Medians Edit Diagnosis Axis Meas Print Cancel Help Po Gain 1x Figure 3 8 ECG Report Review Details Screen Click the View 2x button in the ECG Report Review Details screen to magnify the 12 lead ECG tracings on the left to 2x zoom Click the same button again and ECG tracings are displayed with 4x magnification The Show Medians button switches the ECG display between the median beats representative beats or the 10 second ECG tracings While displaying the Show Medians beats clicking the Show Ref Points button displays the reference points for onsets and offsets of the P QRS T component waves of the median representative beats Click the Calipers button to select be
49. n below Freezes the display and copies the last 10 seconds of ECG data into a memory buffer If there are less than 10 seconds of ECG data collected the freeze function is delayed until the 10 second buffer is filled Click this button a second time to unfreeze the display and clear the memory buffer When the display is frozen you can also click the Print or Analyze button This option is only available if the Display Real time ECG Tracing is disabled in the Settings Table 2 0 Click on this button to display the ECG tracing acquired in the last 10 seconds Tracings are displayed in static form and are not stored Click on the Analyze button to analyze and save the ECG displayed This option is only available if the Display Real time ECG Tracing is disabled in the Settings Table 2 0 Click on this button to start new acquisition of ECG data A message Acquiring ECG will display on screen Instructs the program to collect ECG data for R R Variability analysis A preset duration between 30 and 360 seconds of ECG data may be collected in 30 second increments see Settings function below Stop data collection by clicking this button a second time No RR Variability analysis is performed if less than 30 seconds of data have been collected Otherwise the program will automatically analyze the data and store the report Print RR Variability reports by clicking the Exit button and selecting Print or select Print After Analysis in t
50. n or task Select the text box by clicking on it then start typing 1 0 2 0 IQmark Digital ECG Service Manual IOmark Digital ECG Service Manual INTRODUCTION The Midmark Qmark Digital ECG is a PC based diagnostic instrument that converts any Windows based personal computer to a 12 lead electrocardiograph with interpretative and data storage capabilities A complete IQmark Digital ECG system consists of the ECG data acquisition module the PC system which includes the monitor and the printer the Microsoft Windows operating systems Windows 98 Windows NT 4 0 Windows 2000 and Windows XP and the IQmark Diagnostic Workstation software program This manual is provided to assistance primarily with service of the IQmark Digital ECG data acquisition module For information regarding the service and operation of the PC system please consult the IQmark Digital ECG operation manual or the documents provided by PC manufacturers THEORY OF OPERATION The IQmark Digital ECG data acquisition module is an improved version of previous hardware modules Some new features for the IQmark Digital ECG data acquisition module include Built in defibrillation protection circuit Hardware lead off detection circuit Hardware pacemaker detection circuit Analog bandwidth from 0 05Hz to 150 Hz Digital sample rate of 500 Hz USB computer interface Model Specific RS 232 COM port interface Model Specific Pocket PC compatible interface Model Spe
51. nagement l x General List Management ECG Statements User Mames Medications v Current List History Statements ECG Holter Indications Race Categories Acebutolal Amiodarone Digoxin Diltiazem Disopyramide Ethmozine Flecainide Inderal Isordil Metoprolol 10 Mesiletine 11 Phenytoin 12 Pindalo 13 Procalnamide 14 Propafenone 15 Prooranalol co MN E oo Po Figure 2 6 List Management General List Management Select the ECG Statements tab to view the default ECG statements These statements will be available to you when editing the ECG interpretations online Local Database List Management l x General List Management ECG Statements User Names Statement Category Edit Categories Double click on an abbreviation to edit the statement First degree AW block Second degree AW block A rate W rate Third degree Aw block W rate SA with APCs in bigeminal pattern mean ventricular rate berrantly conducted atrial premature complexes Atrial fibrillation ventricular rate Atrial flutter with 2 7 conduction ratio 4 rate rate Atrial flutter with predam 3 7 conduction ratio 4 rate W rate Atrial flutter with predom 4 7 conduction ratio 4 1ate Werate Atrial flutter with varying conduction ratio A rabe brake Anterior infarct acute Anterior infarct old Anterior infarct age indeterminate z O nnb erek rik wit View Report
52. on Live ECG for Display Setting change instructions Turn off the Waveform Smoothing option Refer to section on Live ECG and Table 2 0 Default Interpretation And Acquisition Display Settings If an error message appears consistently at the beginning of New ECG verify that the ECG module is connected to the correct serial port Refer to sections H B and II D 38 IQmark Digital ECG Operation Manual Troubleshooting Guide Error Message or Problem Solution or Recommendation Details button does not work in the ECG Report Review screen DISPLAY DIAGNOSTICS Delays in the ECG display have been detected Click on Help to diagnose this problem Message appears while running an ECG Exit the IQmark Digital ECG application Start MS DOS Prompt Change directory to c windows system if Windows NT c winnt system32 Type regsvr32 msflxgrd ocx and press Enter Type regsvr32 oleaut32 dll and press Enter Exit MS DOS Prompt and start the IQmark Digital ECG application The graphics display adapter in the computer is too slow in displaying the live ECG for the current display settings The computer might also be too slow or too busy running other programs in the background C Ifyou are running live ECG in a thin client environment your bandwidth maybe too low Click on the Help button on the message window Follow the recommendations on the help screen Verify that the W
53. on would accomplish the same effect In the lower right corner of the screen are the status indicators for ECG Report and RR Variability An empty status indicator means that you have not acquired the specific report since entering the screen Once a report 1s created the indicator next to the test 21 IQmark Digital ECG Operation Manual type appears solid This indicator 1s not affected by tests that were previously stored or reviewed in the database The menu bar at the bottom of this screen provides different options you can take These available options change according to the settings and the process you have made Analyze Freeze Freeze Acquire Start RR 28 Prints the last 10 seconds of ECG data being collected This report contains no measurements or diagnostic statements If data 1s not actively being collected see Freeze below this function prints out the last 10 seconds of data in memory A NOTE Do not click on this button more than once before the report is printed as each click produces a separate printout The Exit button see below is disabled until the report is printed To speed up printing Freeze the display before clicking Print Performs resting ECG analysis on the last 10 seconds of data and stores this analysis as an ECG Report This report can be printed out from the Report Review screen or automatically by selecting Print After Analysis in the Printer Format Settings see Settings functio
54. or Message or Problem Solution or Recommendation Inspect connections between the electrodes clips lead wires lead cable and the ECG Module The exam room should not be too cold Patient under test may shiver causing a noisy signal If any of the I II III aVR aVL and aVF leads on the screen are noisy or flat lined always check the limb lead electrodes for proper contact in this order RL LL RA and LA Ifa precordial lead 1s noisy or flat lined check the limb lead electrodes first and then check the corresponding chest lead electrode for proper contact Once identified discard and replace the used electrode Prepare the problem site again or try a new electrode site in close proximity to the original site Note any site variance on test report If after the above steps noise or artifact still occurs in the ECG then try the filter settings on the ECG screen Turn AC filter ON if you see 50 60Hz noise Turn MYO filter ON if patient produces muscle tremor Turn Drift filter ON if the ECG baseline is drifting While these digital filters can improve signal quality they cannot correct hookup problems Note As with any ECG measuring device turning on the MYO filter may alter measurements which in turn may affect the diagnostic statements Do NOT turn on the MYO filter for pacemaker patients Click the INST button to help reset the baselines or manually turn off and on the ECG module Verify patient s bed is
55. products installed Exits the program and returns to the Windows Desktop E Testing A New Patient To register new patients click the New Patient button on the opening screen Fig 3 1 The Patient Data Entry screen appears The Patient Data screen enables you to enter data that is pertinent to your patient la x Last Name Hackings Date Of Birth 127121961 mm dd yyyy Pen First Name BI MI aa Sex Male C Female View Data ID 121 32 4567 Race Caucasian y Edit _ Diagnostic Reports Vital Signs Comments Format Weight 195 Ibs Temp 197 5 deg F Height 6s inches SpO2 99 BMI 29 6 BP 120 feo Pulse 82 BPM New Vital Signs Review Vital Signs fe S amp S EE E zd File Print New Patient Patient List Patent Data View Report New Test Help Figure 3 3 Patient Data Screen A NOTE You must enter a name or ID for the patient to start a new test 25 IQmark Digital ECG Operation Manual Click in any text box or press the tab key to enter information Although all this information 1s not essential for the acquisition of an ECG it is important to complete each of these fields as accurately as possible particularly Date of Birth Sex and Medications which are used by the Midmark 12 Lead Resting ECG Analysis Program to produce diagnostic statements The blood pressure values entered will be displayed and printed on the ECG report The Midmark analy
56. rews Do not over tighten A NOTE Almost all USB to serial port adapters come with specific software drivers that must be installed prior to use Before connecting the IQmark ECG module to any adapter ensure that all software drivers have been installed according to the manufacturer s instructions B For USB type ECG module DO NOT connect the module to the computer until the IQmark Diagnostics Workstation software is installed 4 Attach the patient cable to the 15 pin connector on the ECG acquisition module refer to figure 2 0 j Patient Cable r a me Connection Omak MARI Digital ECG pen i e Figure 2 0 Qmark Digital ECG Acquisition Module C Software Installation The medical diagnostic application IQmark Digital ECG uses the IQmark Diagnostic Workstation to manage patient records When you install or upgrade the IQmark Digital ECG the IQmark Diagnostic Workstation is automatically installed or upgraded IQmark Digital ECG Operation Manual accordingly see the Omark Diagnostic Workstation Operation Manual 3 100 1038 for further information You can also access other IQmark products such as the IQmark Digital Holter IQmark Digital Spirometer Digital Stress Vital Signs Interface and Weight Scale Interface from the IQmark Diagnostic Workstation Call Midmark Sales Department for the latest information on available IQmark products A NOTES e Ifyou already have Qmark Diagnostic Workstation insta
57. s on the computer The IQmark Digital ECG communicates the data it collects from patients through a serial or USB port A 9 and or 25 pin port that is used by computers to communicate serial data These ports are typically labeled COM1 and COM2 Hardware that typically uses these ports includes the mouse modem printer etc The IQmark Digital ECG connects to a 9 pin serial port or a 25 pin serial port if an adapter is used Consult your computer owner s manual for more information on configuration and capabilities Generally appearing on the desktop shortcut icons allow you to open a document application or folder simply by double clicking on them Appears at the left end of the Microsoft Windows Taskbar and allows you to start applications open files get to the Control Panel and exit Windows This feature first appeared with Windows 95 Consult your Windows owners manual for more information By default it appears as a horizontal bar at the bottom of your screen The Taskbar provides rapid access to the Start Button and applications you have started Set the Taskbar to Autohide will provide the IQmark Workstation with maximum display area Refer to section II C Software Installation or see your Windows owner s manual for more details Universal Serial Bus is a high speed communication port with plug and play support Windows 95 and NT do not support USB port A box where one is able to type in text relative to an applicatio
58. s or compatible microprocessor with 500MHZz or faster CPU speed e VGA display accommodating 800x600 1024x768 1280x1024 or higher resolution Minimum 256 colors 16 bit color recommended e 16 MB RAM for Windows 98 or 64 MB RAM for Windows 2000 XP e Microsoft compatible mouse e Keyboard e One high speed serial port 115 KB per second or an USB port B Hardware Installation 1 Remove the IQmark Digital ECG from its packaging and verify that you have the following items IQmark installation CD IQmark Diagnostic Workstation operation manual IQmark Digital ECG operation manual IQmark Digital ECG acquisition module Patient cable 10 lead 10 universal clips Package of electrodes IQmark Digital ECG Operation Manual e Four 4 AA alkaline batteries for serial type ECG module e USB to serial port adapter for serial type ECG module 2 A For the serial type ECG module slide out and remove the battery door underneath the module and install 2 AA batteries Be sure to follow the battery positions indicated Replace the battery compartment door B For the USB type ECG module no batteries are required 3 A For the serial type ECG module attach the female end of the 9 pin communication cable to any available serial port on the PC If you are using a USB port with the serial type ECG module install the USB to serial port adapter before you connect the ECG module to the adapter Secure the connections with the thumbsc
59. saturated gauze Allow the skin to air dry Limb Lead Placement RA White Right Arm electrode is placed on a distal portion of the right lateral side of the upper arm below the shoulder LA Black Left Arm electrode is placed on a distal portion of the left lateral side of the upper arm below the shoulder RL Green Right Leg electrode is placed on a distal portion of the lower leg above the ankle LL Red Left Leg electrode is placed on a distal portion of the lower leg above the ankle Precordial Lead Placement V1 Red 4 intercostal place at the right margin of the sternum V2 Yellow 4 intercostal place at the left margin of the sternum V3 Green Midway between V2 and V4 on top of the gn rib V4 Blue 5 intercostal place at the left mid clavicular line V5 Orange At the horizontal level of V4 at the left anterior line V6 Purple At the horizontal level of V4 at the mid axillary line Figure 3 0 ECG Hookup Diagrams Mid Clavicular Anterior Line Axillary Line A NOTE Lead placement does affect the ECG waveform When the limb leads are placed on the torso waveform changes might be seen in the QRS amplitude axis shift occurs Q waves can be seen and T waves might appear flipped or flattened These changes are clinically significant in that they are associated with cardiac ischemia If a non standard lead placement is used note the variation in the ECG comm
60. se a mild sterilizing detergent with low alcohol content generally used in hospitals Verify that all equipment including accessories are completely dry before using Preventative Inspection A preventative inspection should be done prior to each use of the ECG module This is done to verify that there is no visible damage to the unit that may cause it to malfunction Visual inspection should include the module and all cables for signs of damage and deterioration including but not limited to cracks cuts discoloration or oxidation Ifa cable or other accessory exhibits any of these symptoms replace it immediately prior to using the ECG module Storage To prevent damage to the IQmark Digital ECG module due to battery leakage or oxidation remove all batteries if the IQmark Digital ECG module is not to be used for a long period of time Avoid extreme humidity and heat during storage Radio and Television Interference This equipment generates and uses radio frequency energy If not installed and used properly in strict accordance with the manufacturer s instructions 1t may cause interference to radio and television reception This equipment has been tested and proved to be in compliance with the standards for medical devices and in accordance with the IEC 601 1 rules which are designed to provide reasonable protection against such interference in a medical or hospital environment 44 IQmark Digital ECG Operation Manual D Cus
61. settings are set appropriately click OK on the Configuration Settings dialog box Fig 2 1 to store the settings These settings will become effective the next time the IQmark Diagnostic Workstation is started If you decide not to make changes to the configuration simply press Cancel You can also click Default to restore the IQmark Diagnostic Workstation configuration settings except Institution Name Address and List Management to their default values 19 IQmark Digital ECG Operation Manual This page 1s intentionally left blank 20 IQmark Digital ECG Operation Manual III Operation WARNING The Qmark Digital ECG module has been designed and tested to meet IEC 60601 2 25 and AAMI ECl11 defibrillation protection standards In the event of defibrillation follow the instructions on your defibrillator and adhere to all warnings and cautions A Introductory Notes This manual describes how to use the various IQmark Digital ECG features in the operational sequence most new operators will follow However this does not mean that you are restricted to following this particular sequence Many of the features are interconnected and can be accessed from more that one screen The menu bar buttons or tabs on each screen lead you to a different screen or feature To enter any of these screens simply click once on the appropriate selection Of course there are certain sequences that must always be followed such as entering a
62. sis program is capable of interpreting ECG from infant to adult age by using the appropriate age dependent criteria It automatically calculates the age of the patient based on the date of birth entered on the Patient Data screen and the current date of your computer Please make sure that the date and time on your computer is current Please refer to the Omark Diagnostic Workstation Operation Manual 3 100 1038 for additional information on the Patient Data screen Live ECG Once the patient is prepared calm and comfortable initiate ECG data acquisition by clicking the New Test button on the menu bar at the bottom of the Patient Data screen Fig 3 3 The New Test dialog box appears on which you can select the test type to run Click the ECG icon in the left hand portion of the dialog box x m Test Type Technician Tina May AN y BA ECG Requesting Physician Robert West MD Chest pain Indication Figure 3 4 New Test Dialog Box Enter the names of the technician conducting test and the requesting physician Enter the diagnostic reason for performing the ECG in the Indication field This information is optional If you have configured the list management for your practice you can select these entries from the lists Click OK button to open the live ECG screen A NOTE The green LED on the ECG module will light when the module is on If you have a serial type ECG module with an On Off switch indicated by the
63. t a live ECG report without saving the patient test or click Analyze to have the computer analyze and save the report You are prompted to enter the patient information when you exit the report review screen A NOTE The green LED on the ECG module will light when the module is on If you have a serial type ECG module with an On Off switch indicated by the symbol and if the LED is not lit at this time you may need to turn it on manually by pressing D If you have a USB type ECG module the Workstation software will turn on the module automatically as needed PE Freeze gt RR Help dl Figure 3 2 Stat ECG screen For normal operation there are five choices on the opening screen Fig 3 1 Allows the operator to register and proceed with ECG acquisition for a new patient 24 IQmark Digital ECG Operation Manual Allows the operator to view a list of patients already tested via the IQmark Workstation or entered into the database Select a patient from the list to access their records from previous tests Please refer to the Omark Workstation Operation Manual 3 100 1038 for detailed descriptions Allows the operator to view and customize the Workstation Configuration Settings See Fig 2 1 Configuring Settings Dialog Box Provides online assistance with the use operation and troubleshooting of the IQmark Diagnostic Workstation and other products The About Workstation displays the versions of various IQmark software
64. tomer Support For immediate help diagnosing any problems with this product refer to the online help or the Troubleshooting Guide Otherwise contact Midmark Technical Support at 310 530 5955 Inside the Continental United States dial 800 624 8950 Office hours are 8 00 AM 5 00 PM Pacific Standard Time Warranty All Midmark Diagnostics Group s products are warranted to be free from manufacturing and material defects for 12 months from the date of purchase Any misuse or abuse of a Midmark product voids all applicable warranties Return Materials Authorization To return any product for repair an RMA Return Materials Authorization number must be obtained from a Midmark Customer Support representative Mark this number on all the packaging containing the items to be returned and in any correspondence regarding the return Shipping Before shipping any unit to Midmark be certain that an RMA Return Materials Authorization number has been issued and that all guidelines regarding this authorization are followed We highly recommend that you follow all guidelines for the shipment of medical products set forth by the shipping company you choose to use If a question should arise regarding the appropriate method of shipment please feel free to ask when calling for your RMA number It is ultimately the responsibility of the customer when shipping a product to ensure that all packages and their contents get to Midmark safely Midmark will
65. ton displays a dialog box showing the axes frontal horizontal and sagital for the P QRS and T waves You can view and edit the diagnostic statements from this screen by clicking the Edit Diagnosis button The Edit Diagnostic Statements dialog box appears Edit Diagnostic Statements i x r Edit Statements P QRS 1 1 Normal P axis H Rate 81 WITHIN NORMAL LIMITS Add Delete Modify Clear All 4dd Cancel Help Figure 3 10 Edit Diagnostic Statements Screen Refer to Editing Diagnostic Statements section above for details 33 IQmark Digital ECG Operation Manual Serial Comparison This feature enables you to compare up to four ECGs from the same patient Ifthe patient has more than one ECG report click the Serial Comparison button on the Report Review screen Fig 3 6 and the Select ECG Reports dialog box appears Choose the test selections you want and click OK Select ECG Reports x m Report Selection Recnecessesenseecsncenseccsaconseacencnccsnee C Most Recent 4 6 10 04 01 05 47 44 Select From List View Report C Print Report Cancel Figure 3 11 Select ECG Reports For Serial Comparison The following sample Serial Comparison screen shows two ECG reports simultaneously Summaries of each ECG report are displayed at the top right section Each report is given a report number shown to the left of the date ECG tracings are color coded to identify di
66. tween Simple Calipers or P QRS T Calipers These electronic calipers allow you to measure the amplitude mv and duration ms of any part of the ECG waveform making it easy to overread ECG tests online without printing them The Simple Calipers are shown on the following screen shot To move the pair of Simple Calipers together with a fixed interval place the mouse on one of the calipers hold down the Ctrl Control key and drag to a desired location 32 IQmark Digital ECG Operation Manual Bill Hackings 121 32 4567 AS zi oOo A i l ni EEEE EAEE EEEE e EE thie HE E E EEHEEHE E A A ld do u e een E EEEE E A OO 037 avr PEE ERA E 938 i p a a e a 3 Aedo IEA opere 0 783 1 041 0 348 0 897 0 277 0 677 9 0 007 0 012 0 004 0 009 0 000 0 009 dopo E ll di ee szem nm d dur in msec E EEHEEHE EE a ae a NN Figure 3 9 ECG Report Review Details Screen with Simple Calipers The Edit Comments button displays a dialog box that allows entering and editing of the report comments Report comments will be printed at the top of the ECG report Edit Diagnosis displays a dialog box that allows editing of the diagnostic statements See Fig 3 10 below The General Meas button displays a dialog box showing the general measurements which are also displayed on the previous ECG Review screen Fig 3 6 and on the ECG report if printed The Axis Meas but
67. usive use of licensed physicians or personnel under their direct supervision The suggested interpretation including numerical and graphical results should be examined with respect to the patient s overall clinical condition It 1s the responsibility of the physician to ensure proper administration of the test making a diagnosis obtaining expert opinions on the results and instituting the correct treatment Notice The information in this manual 1s subject to change without notice Midmark Diagnostics Group shall not be liable for technical or editorial omissions made herein nor for incidental or consequential damages resulting from the furnishing performance or use of this guide This document may contain proprietary information protected by copyright No part of this document may be photocopied or reproduced in any form without prior written consent from Midmark Diagnostics Group IOmark is a registered trademark of Midmark Windows is a registered trademark of Microsoft Corporation Pentium is a registered trademark of Intel Corporation 1V IQmark Digital ECG Operation Manual Caution Read the following precautions to ensure proper operation of this instrument la 2 O 0 N NN Familiarize yourself thoroughly with the operational procedures of the instrument prior to use Installation and maintenance of the instrument a Install and keep the instrument away from splashing water b Do not install the instrument

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