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

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MRx Training with Q-CPR

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MRx Training with Q-CPR

ROC Refresher

&

EMT/ EKG monitoring parameters


System Components

Therapy/CPR Cable

Compression Sensor

MRx Defib Pads


Basic Orientation

  • Ready for use indicator

  • Therapy knob

  • Charge Button

  • Shock Button

  • Printer

  • Printer button

  • Speaker


Basic Orientation cont.

  • Menu select button

  • Navigation buttons

  • 4 soft keys

  • Event summary

  • Alarm pause

  • Lead select

  • Event mark button


Monitoring on the Left

3-lead patient cables

Spare electrodes

Defib on the Right

Patient / defib cable

Q-CPR puck

Shock test load plug

Defib patches

Razor

Patient connections


Ready For Use Indicator

Blinking Black Hourglass – Shock, pacing, and ECG are ready for use and sufficient battery power is available

X

Blinking Red X with a periodic chirp – Low battery that is not being charged

Blinking Red X without a periodic chirp – Low battery that is being charged

X

Solid Red X with a chirp – A failure has been detected that may prevent delivery of a shock, pacing, or ECG acquisition

Solid Red X without a chirp – No power or device failure


Compression Measurement

Compression Sensor

  • The sensor is…

  • Reusable

  • Easy to clean

  • Acts as landmark

  • Goes where your

  • hands would go

  • Weighs 8 Ounces

  • What the sensor does…

  • Detects motion using and accelerometer


Compression Measurement

Compression Sensor

  • Measurements:

  • Compression Depth

  • Compression Rate

  • Leaning (incomplete release)

  • Duty Cycle (duration)

  • No Flow Time (inactivity timer)

Sensor Adhesive Pad


Compression Measurement

  • Compression rate is moving average

  • of last 3 compressions

  • Target compression depth of 1.5 - 2 inches

  • indicated by lines

  • Incomplete release (“Leaning”)

  • is indicated by “*” on waveform


Typical

Max.

Min.

Volume (ml per Kg)

Impedance Change (Ohms)

Ventilation Measurement

  • A new role for our multifunction pads…

  • Detect changes in chest impedance

  • that correlate to ventilation volume

This is a new application

of a proven principle


Ventilation Measurement

  • Ventilation rate is moving average

  • of last 3 ventilations

  • Ventilation Volume Icon shows

  • 0, 1/3, 2/3 or 1+ of the target volume

  • Inactivity timer -- “30 Seconds without ventilation”


Real-Time Feedback

  • Q-CPR Feedback is…

  • Corrective -- it speaks up only when you need it

  • Prioritized -- based on clinical importance

  • User Friendly -- user is given time to react (3-4 sec.)


Real-Time Feedback

Clinical Priorities*

Compressions:

1. Incomplete Release

2. Compression depth shallow

3. Compression rate slow or fast

4. Compression depth deep

5. Duty Cycle

Ventilations:

1. Volume low

2. Frequency high or low

3. Inflation time fast or slow

* These priorities were set based on an evaluation

of published research data.


Batteries and the MRX


M3538A Lithium Ion Batteries

  • Batteries should be used as primary power source.

  • Fully charged battery will last 5-hours or 50-shocks.

  • No memory build up but should not be allowed to go dead.

  • Fuel cell is broken up into 5 LED’s or 20%

  • Full charge takes about 2-3 hours

  • Life expectancy is 2-years


Maintenance Activities

  • Observe Ready for Use indicator.

  • Once a week, perform an Operational Check and Shock Test.

  • Care for batteries.

  • Clean MRx and accessories.


Insert a charged battery (> 20%).

Turn the Therapy Knob to Monitor.

Press the Menu Select button.

Using the Navigation buttons, select Other.

Select Operational Check.

Respond to the prompts.

Performing an Operational Check


Operational Check Report


Operational Check Summary

  • Shows results of the last 60 Operational Checks

  • To print:

  • Select Other from the Main menu.

  • Select Op Check Summary.

  • Press the [Print] soft key.


Data Transfer to card

  • Turn MRX to Monitor

  • Press the Menu Button

  • Select “Other” then Select “Data Management”

  • Press Menu & acknowledge the message

  • Select appropriate “EVENT”

  • Press “Menu” then select “Copy”

  • Place Data card in Defib Envelope!


Questions about the MRX???


ROC Sites


CPR Reporting

  • BLS & ALS MIRF’s

  • BLS AED Data card & ALS card if placed prior to ROSC

  • Dispatch / RMS report

  • ROC Protocol check sheet

  • Phone call to ROC Study within 1 hour

  • Data transfer to County server within 24-hours


Topics

ROC Study Protocols

  • Purpose of an ITD Valve

  • Analyze Early or Analyze Late


2

ITD Valve

  • Impedance Threshold Device

  • ITD is a circulation adjunct not a ventilation adjunct.

  • Increases blood flow back to the heart during the recoil phase of chest compression.


2

Analyze Early/Analyze Late

  • Analyze Early:

    • 1 round (30 compressions) of priming before AED analysis

    • Business as usual in King County

  • Analyze Late:

    • Longer period of priming before AED analysis

    • 3 minutes of CPR before first analysis


Target Population: ITD and AE/AL

Patients 18 years of age or greater who suffer non-traumatic cardiopulmonary arrest outside of hospital.

Enroll all NON-traumatic CPR cases,

EXCEPT…


Exclusion Criteria: ITD and AE/AL

Less than 18 years of age

Trauma cardiac arrest

DNAR orders in place

Known Pregnancy

Known Prisoner / In Custody


Exclusion Criteria: Specific to ITD

Tracheostomy present

AE/AL use is appropriate in this case.


Exclusion Criteria: Specific AE/AL

Analyze early or analyze late should NOT be used if:

EMS-witnessed arrest

AED applied by non-ROC agency (lay person/police/private AMB)

ITD use is appropriate in both cases.


Removal of ITD

Remove ITD immediately if:

1. Patient gets a pulse (ROSC)

2. Device fills with fluid twice, or cannot be cleared

3. Arrival at ED

4. No chest rise with patent (open) airway


Study Protocol #1—Analyze Early

1 round of CPR/Attach ITD valve

Shock (if indicated)

CPR Protocol


Study Protocol #2—Analyze Late

3 minutes of CPR/Attach ITD valve

Shock (if indicated)

CPR Protocol


EMT / EKG MONITORING

Questions?????

  • What do we need to know about EKG’s?

  • What “Guidelines” should we use to place the monitor on someone?


Electro what???

  • Rate ?Slow – Normal – Fast

  • P wave?Present or absent

  • Regular ?Regular or irregular spacing

  • Narrow or Wide?Width of QRS?

  • Rhythm?Who cares anyways????


Basic Normal Pathways


P QRS T


Normal Sinus Rhythm


OH, the boxes mean something??


What’s the rate???


Bradycardia


Irregularly Irregular


Atrial Fibrillation


Atrial Flutter


Atrial Flutter


Supraventricular Tachycardia


Narrow Complex Tachycardia


Ventricular Tachycardia


Wide Complex Tachycardia


Ventricular Fibrillation

  • Frequency - Tachyarrhythmia

  • Amplitude - Minimum

  • Waveform - Chaotic, Varying, Wide, Unorganized


What is it ??


What is it ??


What is it ??


What is it?


What is it?


What is it?


What is it?


What is it?


What is it?


What is it?


EMT / EKG MONITORING

Answers!!!!

  • What do we need to know about EKG’s?

    • Is there a pulse with every QRS?

    • How fast or How slow is it?

    • Is it wide or narrow?

  • What “Guidelines” should we use to place the monitor on someone?

    • A medical patient who you need to evaluate for a potential arrhythmia….. Who is that?

    • NEVER USE IT TO DECIDE IS THIS A HEART PROBLEM OR NOT!!!

    • When in doubt ask for assistance……… 


Any Questions?

Thank You

&

Good Luck!!!!!


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