R Series ® Service Manual October 2013 9650-0903-01 Rev.
© 2013 ZOLL Medical Corporation. All rights reserved. R Series, CodeNet, SurePower, OneStep and ZOLL are trademarks or registered trademarks of ZOLL Medical Corporation in the United States and/or other countries. Masimo is a registered trademark of Masimo Corporation in the United States Warranty (U.S. Only) and/or other countries. All other trademarks are the property of their respective owners.
TABLE OF CONTENTS Preface Safety Considerations ...................................................................................................................................................i Additional Reference Material .....................................................................................................................................ii Conventions .........................................................................................................................................
NIBP Transducer Calibration Test ...................................................................................................................... 1-37 NIBP Monitor Test .............................................................................................................................................. 1-39 NIBP Volume Leak Test .....................................................................................................................................
TABLE OF CONTENTS Chapter 4 Replacement Parts List of Replacement Parts........................................................................................................................................ 4-2 Diagrams...................................................................................................................................................................4-11 Chapter 5 Functional Description AC Charger .............................................................................
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R Series Service Manual Preface ZOLL® Medical Corporation’s R Series® Service Manual is intended for the service technician whose responsibility is to maintain and inspect the R Series defibrillators. The ZOLL R Series Service Manual has five main sections and one appendix. Preface—Contains safety warnings and an overview of the manual’s contents. Be sure to review this section thoroughly before attempting to use or service the R Series unit.
R Series Service Manual WARNING! This unit can generate up to 2,850 volts with sufficient current to cause lethal shocks. All persons near the equipment must be warned to STAND CLEAR prior to discharging the defibrillator. Do not discharge the unit’s internal energy more than three times in one minute or damage to the unit may result. Do not discharge a battery pack except in a ZOLL SurePowerTM Battery Charger Station.
R Series Service Manual Service Policy Warranty In North America: Consult your purchasing agreement for terms and conditions associated with your warranty. Outside of North America, consult ZOLL authorized representative. In order to maintain this warranty, the instructions and procedures contained in this manual must be strictly followed. For additional information, please call the ZOLL Technical Service Department 1-800-348-9011 in North America.
R Series Service Manual Attn: Technical Service Department, SR# XXXXXX Telephone: 1-800-348-9011; 1-978-421-9655 FAX: 978-421-0010 Technical Service Outside of the United States Customers outside of the United States should return the unit in its original container to the nearest authorized ZOLL Medical Corporation Service Center. To locate an authorized service center, contact the International Sales Department at ZOLL Medical at the above address. iv 9650-0903-01 Rev.
R Series Service Manual Chapter 1 Maintenance Tests Overview The R Series has two checkout procedures: the R Series Operator’s Guide defibrillator testing checklist and the extensive 12-month maintenance test checkout procedures. Because the R Series units must be maintained ready for immediate use, regular readiness testing is required. It can either be performed manually or automatically. Refer to the R Series Operator’s Guide for details.
R Series Service Manual • 16.0 Advisory Message Test (Manual/Advisory Units) • 17.0 Pacer Test • 18.0 SpO2 Monitor Test (for SpO2 Option) • 19.0 EtCO2 Monitor Test (for EtCO2 Option) • 20.0 Barometric Pressure Calibration Check • 21.0 CO2 Accuracy Check (for EtCO2 Option) • 22.0 NIBP Transducer Calibration Test • 23.0 NIBP Monitor Test • 24.
R Series Service Manual • 2 black miniature alligator to miniature alligator test leads. • DC power supply (15 Amp minimum). • 0.1resistor (¼W or greater). • 1000 1% ¼W resistor. • Fluke 75 multimeter or equivalent. • Fluke Biomedical Index 2PFE SpO2 Simulator or equivalent (if option is installed). • SpO2 cable and sensor (if option is installed). • Fluke BP Pump 2 NIBP simulator (if NIBP option is installed). • CAPNOSTAT 5 Mainstream cable with airway adapter (if EtCO2 option is installed).
R Series Service Manual 1.0 Physical Inspection of the Unit Tools Needed: None. Test Setup: None. Observe this... 1.1 Housing Pass/Fail/NA o o o Is the unit clean and undamaged? 1.2 Does the unit show signs of excessive wear? o o o 1.3 Is the handle undamaged? o o o 1.4 Does the recorder door open and close properly? o o o 1.5 Are input connectors clean and undamaged? o o o 1.6 Are there any cracks in the housing? o o o 1.
R Series Service Manual Observe this... 1.15 Pass/Fail/NA Battery Place battery in battery well. 1.16 Is the battery seated in the battery well correctly? o o o Record your results on the Maintenance Test Checklist. 9650-0903-01 Rev.
R Series Service Manual 2.0 Front Panel Button Test Tools Needed: Fluke Impluse 4000. Test Setup: 1. Install strip chart paper into the printer compartment. 2. Install the battery in the unit or connect the A/C power cord to the unit and then plug the cord into an electrical outlet. 3. Connect the OneStepTM cable and ECG cable (3 lead adapter (part #8009-0762-XX), 3 lead cable, or 5 lead cable) to the Fluke Biomedical 4000 Analyzer (or equivalent). 2.1 2.2 Do this... Observe this...
R Series Service Manual Do this... Observe this... Close the printer door. o o o Press RECORDER button. Strip chart paper flows out of printer compartment. Verify that the CHECK RECORDER message no longer displays. 2.8 Press RECORDER button. Strip chart paper stops flowing out of printer compartment. o o o 2.9 Connect A/C current and install the battery. Turn the unit off. The AC Power LED should be illuminated. o o o 2.7 Pass/Fail/NA The battery LED will be green or amber.
R Series Service Manual 3.0 3 and 5 Leads Test Tools Needed: Impulse 4000,3 lead adapter (part # 8009-0762-XX) or 3 lead cable, and 5 lead cable. If applicable, test each cable separately. Test Setup: 1. The R Series unit must be configured to display ECG LEAD OFF message. 2. Connect the lead wires appropriate to each test to the Fluke Biomedical 4000 or equivalent. Do this... Observe this... Pass/Fail/NA 3.1 Turn the selector switch to MONITOR (for AED units turn to ON.) Select leads.
R Series Service Manual 4.0 Power Supply Test (Optional) Note: Tests in this section will produce battery errors due to the use of a power supply in place of a SurePower Battery. Tools Needed: • 2 red miniature alligator to miniature alligator leads. • 2 black miniature alligator to miniature alligator test leads. • DC power supply (15 Amp minimum). • 0.1resistor (¼W or greater). • 1000 1% ¼W resistor. • Fluke 75 multimeter or equivalent. Test Setup: 1. Disconnect the AC line cord from the unit.
R Series Service Manual Red Battery Well ? ? 15 Amp Supply Black Do this... Observe this... 4.1 Turn the selector switch to MONITOR (for AED units turn to ON.) The unit should not turn on. o o 4.2 Turn the unit off. 4.3 Adjust the power supply voltage to 10.8V and turn the selector switch to MONITOR. The unit should turn on. o o Low Battery Test LOW BATTERY message displays within 30 seconds. o o REPLACE BATTERY message displays within 30 seconds. o o 4.
R Series Service Manual Test Setup: 1. Remove red lead from power supply and connect to 0.1resistor. 2. Connect other end of resistor to “+” terminal of power supply using a second red lead. 3. Connect multimeter across the resistor. 4. Set voltage scale (if DVM is not autoranging) to 220 mV. ? Red DMM Battery Well ? Black Do this... 4.7 ? 15 Amp Supply Observe this... Pass/Fail/NA System Current Test Set power supply to 10.8V. 4.8 Turn the selector switch to MONITOR.
R Series Service Manual Test Setup for Off Current Test: 1. Remove 0.1 resistor and replace with 1K. 2. Connect DMM across resistor. 3. Set voltage scale to DCV. 4. Measure voltage across resistor. 4.10 Do this... Observe this... Off Current Test Voltage should be less than 270 mV (<270 A of current). Pass/Fail o o Measure across resistor with unit turned off. Record your results on the Maintenance Test Checklist.
R Series Service Manual Do this... Observe this... Pass/Fail 4.13 Observe the voltage. Verify the charger voltage is 11.97V-12.43V. o o 4.14 On the Test Fixture set the switch to 20 Ohms. Verify the charger voltage is 9.50V-11.87V. o o 4.15 On the Test Fixture set the switch to 27 Ohms. Verify the charger voltage is 11.97V-12.43V. o o 4.16 Remove the charger load Test Fixture. 4.17 Connect the universal cable to the Impulse 4000. 4.
R Series Service Manual 5.0 Leakage Current Test Tools Needed: See the manufacturer’s instructions or supplied specifications for the leakage tester you use. Test Setup: See the manufacturer’s instructions or supplied specifications for the leakage tester you use. Repeat leakage test with applicable accessories: OneStep Cable, external paddles, internal paddles, and anterior/posterior paddles.
R Series Service Manual 6.0 Paddles Test Tools Needed: None. Test Setup: If applicable, connect the OneStep cable to the paddles and place the paddles in paddle wells. Do this... Observe this... Pass/Fail/NA 6.1 Turn the selector switch to DEFIB (for AED units, turn the selector switch to ON, and select Manual Mode.) Press and hold the ENERGY DOWN button on the sternum paddle. The energy selection decreases to 1J. o o o 6.
R Series Service Manual 7.0 Heart Rate Display Test Tools Needed: • Impulse 4000 • ECG Cable (3 or 5 leads). Test Setup: 1. Turn the selector switch to MONITOR (for AED units turn to ON.) Press LEAD button until “I” displays. 2. Connect the ECG leads to the Fluke Biomedical 4000 or equivalent. 3. Connect the ECG cable to the unit. 7.1 Do this... Observe this... Set the Impulse 4000 to 120BPM. The Heart Rate displays as 120 +/- 2 bpm.
R Series Service Manual 8.0 Calibrating Pulses on Strip Chart Test Tools Needed: None. Test Setup: None. Do this... 8.1 Press the RECORDER button. 8.2 Press and hold SIZE button to activate the calibration signal. Observe this... The strip chart displays a signal of 300 ppm with an amplitude of 10 mm +/- 1 mm. The signal also appears on the video display. Pass/Fail/NA o o o Record your results on the Maintenance Test Checklist. 9650-0903-01 Rev.
R Series Service Manual 9.0 Notch Filter Test Tools Needed: Impulse 4000 (or equivalent). Test Setup: 1. Connect the ECG cable to the Impulse 4000. 2. Connect the ECG cable to the unit. Do this... 9.1 Turn the selector switch to MONITOR mode (for AED units turn to ON.) 9.2 Select lead I, size 3x. Observe this... Pass/Fail/NA Select 60Hz sine wave (or 50 Hz for a 50Hz unit) on the Fluke 4000. 9.3 Press RECORDER button. 9.4 Turn the unit off.
R Series Service Manual 10.0 Heart Rate Alarm Test Tools Needed:Impulse 4000. 10.1 Do this... Observe this... Turn the selector switch to MONITOR mode( for AED units turn to ON.) Lead II waveform displayed on monitor. Pass Fail/NA o o o NSR ECG at 120 BPM +/- 2 displayed. Connect the ECG leads to the Impulse 4000. Set the simulator to 120 BPM and the defibrillator to lead II. 10.2 Press ALARMS softkey. The alarm menu displays. o o o 10.3 Press NEXT PARAM softkey until ECG HR displays.
R Series Service Manual Do this... Observe this... Pass Fail/NA 10.16 Remove a lead wire from the Impulse 4000. The bell symbol flashes and the heart symbol stops flashing. The ECG LEAD OFF alarm tone sounds and the Heart Rate Value is highlighted. Recorder prints a stripchart showing a low heart rate, if enabled. o o o 10.17 Reattach ECG Lead wire to Impulse 4000 and hold the ALARM SUSPEND button on unit for 4 seconds. The bell symbol has an “X” through it. o o o 10.
R Series Service Manual 11.0 Defibrillator Self Test SHOCK HAZARD! TAKE THE NECESSARY PRECAUTIONS TO GUARD AGAINST SHOCK OR INJURY BEFORE YOU START CONDUCTING THE DEFIBRILLATOR TESTS. Keep hands and all other objects clear of the multi-function cable connections and defibrillator analyzer when discharging the defibrillator. Before you discharge the defibrillator, warn everyone near the equipment to STAND CLEAR. Caution Do NOT internally discharge the unit more than 3 times in 1 minute.
R Series Service Manual Do this... Observe this... Pass/Fail 11.3 Select energy level of 100J and press the CHARGE button. The charge time is >2 second and <10 seconds and SELECT 30J FOR TEST is displayed. o o 11.4 Press the SHOCK button. Unit does not discharge. DEFIB PAD SHORT message displays. o o 11.5 Set energy level to 30J. Unit internally discharges. o o 11.6 Press the CHARGE button. Unit charges to 30J and displays DEFIB 30J READY. The charge ready tone sounds. o o 11.
R Series Service Manual 12.0 Synchronized Cardioversion Test Tools Needed: Impulse 4000 or equivalent defibrillator analyzer. Test Setup: 1. Connect the OneStep cable via the adapter (D.N.I #3010-0378) to the defibrillator analyzer. 2. Select cardioversion on analyzer. Input 1mV ECG signal at 60 BPM. Do this... 12.1 Press LEAD button to select PADS and Size X1. 12.2 Press the SYNC softkey on the defibrillator. Enter synchronized cardioversion timing test mode on the defibrillator analyzer.
R Series Service Manual 13.0 Synchronized Cardioversion for Remote ECG Monitoring Test (Optional) If applicable, the R Series may be configured to receive defibrillation synchronization pulses from a remote ECG monitoring device (see the R Series Configuration Manual). Remote Sync should be tested as a complete system that includes the remote monitor and R Series defibrillator. Be sure that the remote device is connected to the Sync In/Marker Out connector on the R Series unit.
R Series Service Manual 14.0 Shock Test Tools Needed: Fluke Biomedical 4000 or equivalent defibrillator analyzer. Test Setup: 1. Stop watch. 2. Connect the OneStep cable via the adapter (D.N.I #3010-0378) to the defibrillator analyzer. 3. Ensure that a fully charged battery is installed in the unit. Do this... Observe this... Pass/Fail/NA 14.1 Turn the selector switch to DEFIB mode.(for AED units, turn to ON, and select MANUAL MODE). 14.2 Press the ENERGY SELECT down arrow until 5J displays.
R Series Service Manual Do this... Observe this... Pass/Fail/NA 14.11 Press the ENERGY SELECT up arrow until 200J displays. Verify that DEFIB 200J SEL is displayed. o o o 14.12 Press the CHARGE button. Wait for the SHOCK button to illuminate. Verify that DEFIB 200J RDY is displayed. o o o 14.13 Press the SHOCK button. Verify the unit discharges 196J-264J into the simulator. o o o 14.14 Press the CHARGE button and start timing with a stopwatch. Stop timing when the SHOCK button illuminates.
R Series Service Manual 15.0 Summary Report Test Tools Needed: Impulse 4000. Test Setup: 1. Connect the OneStep cable to the Impulse 4000 2. If you are using paddles, place the paddles on the analyzer’s discharge plates. Do this... Observe this... Pass/Fail 15.1 Press the Report Data * softkey, press Erase, then Erase All. ERASING REPORT displays. Wait for the message to clear. o o 15.2 Set selector switch to DEFIB(for AED units turn to ON, and select MANAUL MODE.
R Series Service Manual 16.0 Advisory Message Test (Manual/Advisory Units) Tools Needed: Impulse 4000 Test Setup: 1. Connect the OneStep cable via the adapter (D.N.I #3010-0378) to the defibrillator analyzer. Do this... 16.1 Observe this... Pass/Fail Connect OneStep cable to the simulator. Turn the selector switch to DEFIB mode (for AED units turn to ON, and select MANUAL MODE.) 16.2 Select VF (ventricular fibrillation) on the Impulse 4000, then press the ANALYZE button.
R Series Service Manual 17.0 Pacer Test Tools Needed: Impulse 4000 Analyzer (software 1.06 or higher) with optional external plug in pacing module (TQA-17) or equivalent. ? Note: The following tests are to be performed only on R Series units equipped with the optional pacing function. The pacer output can be measured using an oscilloscope set to DC coupling connected across a load resistor. (See above diagram for OneStep cable connector polarity.) The load resistor is a 100 ohm, 5 watt or greater.
R Series Service Manual Do this... Observe this... Pass/Fail 17.5 Increase the output to 80mA Output on the Impulse 4000 is 80mA or +/- 5mA. o o 17.6 Increase the output to 120mA. Output on the Impulse 4000 is 120mA or +/- 6mA. o o 17.7 Increase the output to 140mA. Output on the Impulse 4000 is 140mA or +/- 7mA. Pulse width is 40mS +/2mS. o o 17.8 Decrease the output to 60mA. Pacer rate on Impulse 4000 is 29-31 ppm. o o Decrease the rate to 30 ppm. 17.9 Increase the rate to 180ppm.
R Series Service Manual 18.0 SpO 2 Monitor Test (for SpO 2 Option) Tools Needed: • MasimoReusable Sensor. • Masimo Patient Cable. • Fluke Biomedical Index 2PFE SpO2 Simulator (or equivalent). Test Setup: 1. Connect the OneStep cable to the test port. 2. DO NOT connect the ECG cable to the simulator. 3. Install the Masimo Patient Cable and attach the Masimo sensor to the patient cable. 4. Connect the Masimo sensor to the finger simulation post. 5.
R Series Service Manual 18.5 18.6 18.7 Do this... Observe this... Using the Index SpO2 Simulator, press the BPM- softkey until the heart rate is 50 BPM. The SpO2 saturation of 96-100% displays on the unit. Using the Index SpO2 Simulator, press the 02+ The SpO2 saturation of 69-74% displays on the unit. softkey until the SpO2 output is at 72%. Press the OPTIONS softkey. Press TRACES. Pass/Fail o o o o The heart rate of 46-54 BPM displays on the R Series monitor.
R Series Service Manual 19.0 EtCO 2 Monitor Test (for EtCO 2 Option) Tools Needed: CAPNOSTAT 5 Mainstream cable with airway adapter. Test Setup: 1. Install the battery. Do this... Observe this... 19.1 Connect the CAPNOSTAT 5 CO2 Mainstream cable with airway adapter attached to the yellow connector at the back of the R Series. NOTE: Make sure the airway adapter is installed in the CO2 cable. 19.2 Set the front panel switch to MONITOR or ON. For AED units, enter Manual Mode.
R Series Service Manual 20.0 Barometric Pressure Calibration Check Tools Needed: None. Test Setup: None Do this... Observe this... 20.1 Connect the CAPNOSTAT 5 CO2 Sensor to the yellow connector at the back of the R Series unit, and connect an airway adapter to the sensor. 20.2 While pressing and holding the second softkey from the left, turn the selector switch to Monitor (ON for AED units). The unit displays EtCO2 Calibration screen. 20.3 Wait for the sensor to warm up.
R Series Service Manual 21.0 CO 2 Accuracy Check (for EtCO 2 Option) Tools Needed: Gas regulator, calibration gas (see note on page 36). Test Setup: None Do this... Observe this... Pass/Fail/NA 21.1 Connect the CAPNOSTAT 5 CO2 Sensor to the yellow connector at the back of the R Series unit, and connect an airway adapter to the sensor. 21.2 While pressing and holding the second softkey from the left, turn the selector switch to Monitor (ON for AED units). The unit displays EtCO2 Calibration screen.
R Series Service Manual Do this... 21.10 Observe this... Pass/Fail/NA Set the Gas Balance settings of the CAPNOSTAT 5 CO2 Sensor to that of the calibration gas mixture (N2, N2O, or He). The default gas balance is N2. 21.11 Allow a few seconds for the gas mixture to stabilize and observe the CO2 Percent value. 21.12 Press the Return softkey to return to the main EtCO2 Calibration screen. 21.13 Turn the device off when calibration is complete. The expected value is 5% ± 0.26%.
R Series Service Manual 22.0 NIBP Transducer Calibration Test The NIBP module’s pressure transducers are factory-calibrated prior to shipment. However, you can perform a two-point calibration procedure periodically to ensure accurate pressure measurements. This test should be performed annually or every 10,000 readings, whichever comes first. Tools Needed: NIBP simulator (The values and procedure provided in this manual are specific to the BP Pump 2) Test Setup: 1.
R Series Service Manual Do this... Observe this... On the R Series unit, press the Set High softkey to calibrate the transducer to a 250 mmHg pressure reading. The NIBP pressure transducer registers its voltage output at a known pressure of 250 mmHg. The field adjacent to the 250 mmHg value changes to PASS. 22.7 On the NIBP simulator, set the pressure parameter to stimulate a different cuff pressure (for example, 205 mmHg). The NIBP simulator displays the specified pressure reading. 22.
R Series Service Manual 23.0 NIBP Monitor Test The NIBP monitor test verifies the repeatability of the systolic, diastolic, and mean blood pressure measurements, as well as the patient pulse rate calculation. Tools Needed: NIBP simulator (The values and procedure provided in this manual are specific to the BP Pump 2) Note The primary propose of an NIBP simulator is to reproduce a pressure profile similar to a live patient to be used for testing repeatability and functionality of the system.
R Series Service Manual 3Not all simulators have a setting of 93mmHg, check the simulators user's manual for recommendations. 23.1 Do this... Observe this... Turn the selector switch to MONITOR mode. The R Series powers on in MONITOR mode. Pass/Fail (For AED units, turn the selector switch to ON and select Manual mode.) 23.2 Ensure that the LEADS parameters is set to PADS (default). The R Series displays PADS in the Lead selection field on the monitor.
R Series Service Manual 24.0 NIBP Volume Leak Test The volume leak test verifies the integrity of the pneumatic system on the R Series NIBP module. This test should be performed annually or every 10,000 readings, whichever comes first. Tools Needed: NIBP simulator (The values and procedure provided in this manual are specific to the BP Pump 2) Test Setup: 1. Connect the simulator hose to the NIBP connector on the R Series unit. 2. Configure the NIBP simulator for the volume leak test.
R Series Service Manual 24.5 Do this... Observe this... On the NIBP simulator, press the START TEST softkey. After approximately 1 minute, a number appears in the upper middle area of the NIBP simulator display. Note: You must press the START TEST softkey within 30 seconds of closing the valves on the R Series unit. If the simulator: Pass/Fail o o o o • displays a Volume Leak reading <55, then the R Series unit has passed the test.
R Series Service Manual Chapter 2 Troubleshooting Overview This chapter contains a list of error messages that users may see if the unit is not operating properly. If the problems you encounter are not listed below, call ZOLL Medical Corporation’s Technical Service Department for further assistance. (See page iii for contact information.) ZOLL R Series Error Messages The following is a list of ZOLL R Series error messages that may appear on your display.
R Series Service Manual Error Message Explanation User Advisory ALARM SET ALARM SET status message when setting alarms. ANALYSIS HALTED ECG analysis halted due to user interaction such as: Technical Action • Lead/size change • Analyze button was pressed again • Impedance fault • Charging error detected in auto defib mode 2-2 ASYNC PACE ONLY Posted along with other faults. Indicates that the PD module cannot detect sync pulses. ATTACH PADS AED: No pads on Auto Defib power-up.
R Series Service Manual Error Message Explanation CF TRANSFER FAILED Summary/DVCK/ALOG data file transfer error – either no CF card or CF card transfer failed CHANGE LEADS Unit is in Defib Sync mode and heart rate is less than 20 BPM. CHARGE FAILED Unit failed to perform the requested charge. CHECK CO2 ADAPTER Airway adapter is removed, occluded or adapter zeroing needs to be performed or was performed incorrectly. Replace/Clean airway adapter. Zeroing performed automatically.
R Series Service Manual 2-4 Error Message Explanation User Advisory Technical Action CHECK RECORDER Produced when paper tray is empty, paper jams or recorder door is opened. CHECK SPO2 SENSOR Reposition SpO2 sensor on patient. CLOCK BATTERY FAULT The RTC coin battery has failed. Replace lithium coin battery or digital board. CLOCK FAULT 11 Real time clock oscillator failure Replace lithium coin battery or digital board. CLOCK FAULT 12 Real time clock back-up power supply failure.
R Series Service Manual Error Message Explanation CO2 UNIT ERROR The EtCO2 sensor or module has detected a hardware error. User Advisory Technical Action Check that the sensor is properly plugged in. Re-insert the sensor. Turn R Series unit off, then on again to reset. perform a mainstream airway adapter or module zero, as described in “Zeroing the Mainstream CAPNOSTAT 5 CO2 Sensor/ Airway Adapter”. If the problem persists, contact ZOLL Technical Support.
R Series Service Manual 2-6 Error Message Explanation User Advisory Technical Action DEFIB NOT CHARGED Discharge button is pressed in a Defib mode but the unit is not charged. DEFIB OVERUSE More than 50 shocks were delivered in less than 20 minutes. DEFIB PAD SHORT Measured impedance between high voltage leads of MFC. DISK FORMAT REQ. Report error if any problem with DOC file access occurred. Replace digital board. ECG DISABLED Persistent Critical Hardware Failure on ECG module.
R Series Service Manual Error Message Explanation ENERGY INCREMENTED Defib energy has been automatically incremented to the next configured level after shock 1 or 2 has been delivered and the unit is configured for Basic Energy Auto Escalation. ERASING REPORT The unit is erasing the selected report data. FULL DISCLS STOPPED Full disclosure data exceeds the storage capacity: 4 hours or 32Mb. IF NO PULSE Message displayed upon entered CPR period specified by AHA protocol.
R Series Service Manual 2-8 Error Message Explanation User Advisory Technical Action NIBP FAULT 263 Fault 90 received from NIBP module. Replace NIBP module. NIBP FAULT 264 Fault 91 received from NIBP module. Replace NIBP module. NIBP FAULT 265 Fault 97 received from NIBP module. Replace NIBP module. NIBP FAULT 266 Fault 98 received from NIBP module. Replace NIBP module. NIBP FAULT 267 Fault 99 received from NIBP module. Replace NIBP module.
R Series Service Manual Error Message Explanation NO QRS DETECT Unit is in sync mode and heart rate is < 20 BPM or QRS amplitude is too low for proper synchronization. NO SHOCK ADV. No shock advised. Advisory message when analysis finds non-shockable rhythm. NOISY ECG Number of noisy analysis intervals exceeds threshold. OPEN AIR DISCHARGE Measured Defib Impedance was greater than 1000 ohms and no energy was delivered.
R Series Service Manual Error Message Explanation POOR PAD CONTACT Electrode impedance exceeds threshold. PRESS ANALYZE Alternate message for Check Patient message if this configuration option is selected. PRESS CHARGE • Discharge button is pressed in Manual Defib mode but the unit is not charged. • Advisory message following SHOCK ADVISED in Manual/Advisory Defib mode with auto-charge disabled. PRESS SHOCK Prompt issued in AED auto defib mode when defib is charged (ready).
R Series Service Manual Error Message Explanation REPEAT NIBP MEAS • The unit exceeded the maximum number of inflation attempts. • The unit exceeded the 180-second measurement time limit. REPLACE BATTERY Battery voltage is less than absolute minimum. Shutdown imminent. Replace with charged battery. REPORT FULL Summary report memory full. Erase summary report. RETRY ANALYSIS Advisory message in conjunction with noisy ECG. Analysis halted.
R Series Service Manual Error Message Explanation SHOCK ADVISED Advisory message when Analysis finds a shockable rhythm. Followed by PRESS SHOCK in Manual Advisory Defib with auto-charge enabled or in Auto Defib mode, or by PRESS CHARGE in Manual Advisory Defib with autocharge disabled. SPO2 AMBIENT LIGHT Ambient light is too bright. • Shield sensor from ambient light. • Replace sensor. • Replace SpO2 module SPO2 COMM ERROR No transmissions from SpO2 unit received.
R Series Service Manual Error Message Explanation SYSTEM FAULT 36 Filtered sum of all the supply voltages is out of range. Replace analog board or digital board. SYSTEM FAULT 37 1/2 scale reference voltage is out of range. Replace analog board or PD engine. SYSTEM FAULT 38 Failure to shutdown after "shutdown order" is written to the RTC. Replace digital board. TEST FAILED 30J defib self-test failed. TRANSFERRING DATA Transferring data message.
R Series Service Manual Error Message Explanation ZERO FAILED The zero operation did not complete successfully. User Advisory Technical Action Clear the occlusion, remove any source of CO2, and try zeroing again. If problem persists, contact ZOLL Technical Support. 2-14 9650-0903-01 Rev.
R Series Service Manual Chapter 3 Disassembly Procedures This chapter provides instructions on how to disassemble and reassemble the R Series unit, and includes the following sections: “Removing the Cable Caddy” on page 3-3 “Removing the Handle” on page 3-6 “Removing the Recorder, AC Charger and Battery Well” on page 3-7 “Removing the Front Panel Assembly” on page 3-12 “Removing the Side Panels” on page 3-16 “Removing the Connector Panel and Bezel” on page 3-18 “Removing the ECG Input Connector” on page 3-
R Series Service Manual • Needlenose pliers • Exacto knife • Compressed air • 1/2” Nut Driver • 3M Scotch-Weld Hot Melt Adhesive 3779 TC Amber Safety Precautions Warning! SHOCK HAZARD! Caution TAKE THE NECESSARY PRECAUTIONS TO GUARD AGAINST SHOCK OR INJURY BEFORE YOU CONDUCT DEFIBRILLATOR TESTS OR REPAIRS. • Only properly trained technicians should service the unit. • The unit can contain deadly voltages even if the unit is turned off. • Make sure to discharge the unit before working with it.
R Series Service Manual Removing the Cable Caddy 1. Unplug all cables from the R Series. 9650-0903-01 Rev. J 2. There are 6 screws securing the cable caddy (3 at the rear of the R Series and 3 at the bottom).
R Series Service Manual 3. Remove the 3 bottom screws completely. 3-4 4. Loosen the 3 screws at the back. It is not necessary to remove the screws completely or to remove the mesh. 9650-0903-01 Rev.
R Series Service Manual 5. Unplug the AC Line Cord Extension Cable from the AC input receptacle when removing the cable caddy. 9650-0903-01 Rev.
R Series Service Manual Removing the Handle 1. Remove the 4 hex screws securing the handle. Note: 3-6 2. Lift the handle to remove. During reassembly, torque to 10 in-lbs. 9650-0903-01 Rev.
R Series Service Manual Removing the Recorder, AC Charger and Battery Well 1. Using a #2 Philips screwdriver, remove the 4 screws securing the AC Charger Assembly. Note: 2. Remove the AC Charger assembly from the chassis by lifting straight up. Unplug the cable from the charger to the PD Engine as shown. During reassembly, torque to 10 in-lbs. 9650-0903-01 Rev.
R Series Service Manual 3. If removing the battery well, disconnect the high and low current cables from the PD Engine as shown. 4. Remove the label from the battery well as shown (peel from back to front). Note: It may be necessary to use a new label upon reassembly. High current harness Low current harness 3-8 9650-0903-01 Rev.
R Series Service Manual 5. Remove the 3 screws securing the battery well. Note: 6. Lift the battery well from the front of the R Series, tilting towards the rear. DO NOT disconnect the low and high current harnesses. Feed them up through the chassis to remove the battery well. During reassembly, torque to 6 in-lbs. 9650-0903-01 Rev.
R Series Service Manual 7. Open the recorder door. Using a wooden stick (or similar tool) press in on the hinge to release the door as shown. 8. Remove the two screws that secure the recorder tray. Note: 3-10 During reassembly, torque to 6 in-lbs. 9650-0903-01 Rev.
R Series Service Manual 9. Lift up on the recorder tray from the rear of the R Series to release it. 10.Rotate device so the display is facing you. Lift up on the paper tray to expose cables. Disconnect the recorder interconnect cable from the print head and the motor/ sensor board. Note: Recorder interconnect cables 9650-0903-01 Rev. J During reassembly, observe the labeling on the cable to ensure you are connecting the cable correctly.
R Series Service Manual Removing the Front Panel Assembly 1. Remove 3 Phillips screws from the top of the rear Front Panel Assembly. 2. Remove the 3 hex screws from the bottom front of the Front Panel Assembly. Note: Note: 3-12 During reassembly, torque to 6 in-lbs. During reassembly, torque to 6 in-lbs. 9650-0903-01 Rev.
R Series Service Manual 3. Tilt the front panel carefully as shown. 4. Using needlenose pliers, carefully remove the hot melt glue from the Recorder and Controls cables. Carefully disconnect the 4 cables shown. Note: During reassembly, reapply hot melt glue (3M ScotchWeld Hot Melt Adhesive 3779 TC Amber.) Recorder cable LCD display 9650-0903-01 Rev.
R Series Service Manual Front Panel Disassembly 1. Remove 5 screws securing the metal shield. Note: 3-14 1. Lift display assembly straight out from the front panel. (See pages 4-38 thru 4-41 for display assembly parts breakdown) During reassembly, torque to 6 in-lbs. 9650-0903-01 Rev.
R Series Service Manual 2. Remove the main selector and pacer knobs by pulling them straight out, then remove nuts securing them to the front panel. 3. Remove 9 screws securing the control board to the front panel. Note: 9650-0903-01 Rev. J During reassembly, torque to 6 in-lbs.
R Series Service Manual Removing the Side Panels 1. Remove the 4 hex screws from right side panel. 2. Remove the 4 hex screws from left side panel. Note: Note: 3-16 During reassembly, torque to 10 in-lbs. During reassembly, torque to 10 in-lbs. 9650-0903-01 Rev.
R Series Service Manual 3. Remove the right panel by pulling towards you. The speaker may or may not come off with the panel. Disconnect the speaker from the Digital System Board by pulling straight out. Remove the shorting wire from the panel by taking off the nut. 4. Remove the left panel by pulling towards you. Remove the shorting wire from the panel by taking off the nut. Note: Note: During reassembly, torque nut to 6 in-lbs. 9650-0903-01 Rev. J During reassembly, torque nut to 6 in-lbs.
R Series Service Manual Removing the Connector Panel and Bezel 5. Remove the label covering the connector panel bezel. It may be necessary to use a new label upon reassembly. 6. Using a #1 Phillips screwdriver, remove the 9 screws securing the connector panel bezel. Note: 3-18 During reassembly, torque to 4 in-lbs. 9650-0903-01 Rev.
R Series Service Manual 7. Remove the connector panel by lifting straight up. Note: Note: Below is the connector panel with the EtCO2 and NIBP options. See the diagram on page 4-17 for further disassembly. Depending on the options, the RS232 connector may be attached to the panel. In that case the panel can be draped over the rear of the unit. 9650-0903-01 Rev.
R Series Service Manual Removing the ECG Input Connector Carefully lift the ECG Connector by tilting the rear of the connector up first. Then carefully remove the cable from the connector as shown, using a wooden stick. Remove the connector from the chassis. Note: 3-20 After removing all connectors, clean them with compressed air. 9650-0903-01 Rev.
R Series Service Manual Removing the NIBP Assembly 1. Disconnect the hose from the manifold and cut the cable tie securing the pump to the chassis. 2. Disconnect the cable from the NIBP assembly from parameter power supply by pushing down on latch at the top of the connector. Remove the 2 screws securing the NIBP assembly to the chassis. Note: Note: When reassembling, ensure NIBP tubing is not routed between pump wiring. Secure the NIBP bracket to the anchor with a cable tie. 9650-0903-01 Rev.
R Series Service Manual 3. Slide the NIBP assembly out of the chassis. 3-22 9650-0903-01 Rev.
R Series Service Manual Removing the System Brick Assembly Note: See the safety precautions on 3-2 before removing the system brick assembly. The system brick assembly consists of three boards attached together. Top: Digital system board Middle: Analog system board Bottom: Pace defibrillator engine Caution Use caution when pulling apart the three boards to prevent the EMI suppression plates from scattering. 1. Remove the printer housing barrier from the chassis. 2. Remove the ECG retainer pad.
R Series Service Manual 3. Carefully disconnect the speaker harness (1), the sync cable (2), and the patient impedance cable (3). Note: 4. Carefully disconnect the sync cable by pulling straight up from top. Disconnect the speaker on the opposite side of the brick assembly if you have not done this already. 2 3 1 3-24 9650-0903-01 Rev.
R Series Service Manual 5. From the top of the device, disconnect the USB and compact flash cables by lifting connector straight up from the board. 7 9650-0903-01 Rev. J 6. Carefully pull back the USB and compact flash cables and disconnect the MFC cable.
R Series Service Manual 7. In applicable, disconnect the EtCO2 cable from the parameter power supply by pushing down on connector latch. 3-26 8. Carefully pull the brick assembly out slightly through the front; disconnect the SpO2 connector cable. 9650-0903-01 Rev.
R Series Service Manual 9. Ensuring that all cables are disconnected from the brick, slide the entire brick out of the front of the chassis. 9650-0903-01 Rev.
R Series Service Manual Discharging Capacitor WARNING! This unit may contain lethal voltages. You MUST completely discharge the high voltage capacitor before removing from unit. DO NOT SHORT THE TERMINAL ENDS OF THE CAPACITOR. 1. While capacitor is connected to the PD Engine assembly, discharge the capacitor by bleeding out the excess voltage using a resistor with values of approximately 5 kohms, 25 watts for 10-20 seconds. Apply the resistor across the terminals on the board.
R Series Service Manual Removing the Communication Module 1. Peel back the foam pads from the housing. 2. Remove 2 screws from the bottom of the housing. Note: 9650-0903-01 Rev. J During reassembly, torque to 4 in-lbs.
R Series Service Manual 3. Remove foam pads from cables and ferrite beads. Lift module up and route cables through slot in housing. 4. Remove 3 screws and slide board back to remove. Note: Note: 3-30 During reassembly, reapply foam pieces and secure it to the housing. During reassembly, torque to 2 in-lbs. 9650-0903-01 Rev.
R Series Service Manual Disassembling the System Brick Assembly Refer to the diagrams beginning on page 3-33 for details.
R Series Service Manual Diagram number Part Number Description 19 9301-0537-01 Assembly, PCB, Parameter PS (SpO2 only) 20 0163-0151 Scr. #4-40 X 1/4" 21 9310-0979 Isolator, IPS, EtCO2/NIBP 22 9330-0762 Adhesive, SpO2, PCB 23 9301-0510-01 Assembly, PCB, Parameter Power Supply 24 9310-0892 Isolator, IPS 25 0163-0151 Scr. #4-40 X 1/4" 26 0550-0025 Tape, Kapton 0.001 THK .
R Series Service Manual Diagrams Single use only ] Single use only 9650-0903-01 Rev.
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R Series Service Manual Bracket shown (Item 16) and Pad (Item 17) used in SpO2 only 9650-0903-01 Rev.
R Series Service Manual Bracket shown (Item 18) used in SpO2 with EtCO2/NIBP 3-38 9650-0903-01 Rev.
R Series Service Manual Parameter Power Supply shown used for SpO2 with EtCO2/NIBP. 9650-0903-01 Rev.
R Series Service Manual Parameter Power Supply shown used for SpO2 only. 3-40 9650-0903-01 Rev.
R Series Service Manual Parameter Power Supply shown used for SpO2 Parameter Power Supply shown used for SpO2 only. with EtCO2/NIBP. 9650-0903-01 Rev.
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R Series Service Manual Chapter 4 Replacement Parts This section contains a listing of the replacement parts available for the ZOLL R Series devices. Replacement parts may be ordered through an authorized ZOLL distributor or directly from ZOLL Medical Corporation. The prices for parts are available from ZOLL Medical Corporation’s Technical Service Department.
R Series Service Manual List of Replacement Parts Item numbers refer to the diagrams beginning on page 4-11. See also “System Brick Replacement Parts” on page 3-31.
R Series Service Manual Part Number Description Item number 9310-0894 Isolator, ECG 15 0140-0202 Ferrite Core Flat Cable Type 100 0162-0033 Washer.Ribbed Lock.M14. 15mm ID.x 22mm OD.x 2mm.ZINC. 25 0163-0029 Washer.Lock Int.7/16.0.456"ID.0.765"OD.0.036"THK.SS 28 0163-0286 Scr. #2-56, MCH, 5/16", PNH, PHL, STL, Int 21 0163-0401 Scr. PPH. #4.x 0.312".STL./ZNC.Hi/Lo 8 0163-2500 Nut.Hex.7/16 - 24 Unf.Chrome Plated Brass Panel Nut 26 0501-0001 Ty-Rap cable tie STD 18 LB .093W X 3.
R Series Service Manual Part Number Description Item number 0163-0286 Scr. #2-56, MCH, 5/16", PNH, PHL, STL, Int 21 0163-1231 Scr. PHH PNH. #6.0.500" Lg.STL/ZN.ZI.Hi/Lo 88 0501-0002 Cable tie, 8" X 0.
R Series Service Manual Part Number Description Item number 1009-0917-04 Assembly, Kit, SpO2, Digital Board, ALS/Plus 101 1009-0917-05 Assembly, Kit, Digital Board, ALS/Plus, Nellcor 101 1009-0917-08 Assembly, Kit, Digital Board, SpO2/EtCO2/NIBP 101 1009-0917-09 Assembly, Kit, Digital Board, SpO2/EtCO2/NIBP, Nellcor 101 1009-0917-10 Assembly, Kit, EtCO2, Digital Board 101 1009-0910-02 Assembly, Shielded Analog System Board, 3/5 Lead 102 1009-0909-01 Assembly, PD Engine, Capacitor 103
R Series Service Manual Part Number Description Item number 9310-1784-02 Cap, End, Left, Assembly 38 0163-0353 Scr. 8-32 X 7/16" SHCS SS Pass Black 39 0190-0100 Spring, Compression.0.210"X.0.375" SS 40 9320-0747 Spring, Paddle, Grounding 43 9310-0785 Latch, Paddle 41 9310-1515 Retainer, Latch, Paddle Release 42 0163-0401 Scr. PPH.#4.x 0.312".STL./ZNC.Hi/Lo 8 0163-0415 Scr.
R Series Service Manual Part Number Description Item number 1009-0904-05 Assembly, Display Panel, ALS, EtCO2 50 1009-0904-06 Assembly, Display Panel, BLS 50 1009-0933-01 Assembly, Handle 52 9302-0524-01 Assembly, Printer Interconnect Flex Cable 51 0155-0001 Magnetic.Sphere.Neodimium.0.187" dia 71 0163-2504 Scr. PPH.#2-32.X 0.312".STL.ZN.
R Series Service Manual Part Number Description Item number 9500-0748 Cable, Assembly, Main Switch 58 9500-0772 Cable Assembly, Main Switch, Non-Pacing 73 9305-0928-01 Label, Pacer Overlay, BLS 75 0163-0416 Scr. #6-32, MCH, 7/16", PNH, PHL, STL, Ext. 36 1009-0903-01 Assembly, Battery Well Module 76 1009-0919-01 Assembly, Printer 77 0163-0102 Scr. #6-32, MCH, 5/16", PNH, PHL, SST, Int.
R Series Service Manual Part Number Description Item number 9310-0792-01 Keypad, Front Panel, Manual 1, w/Pacer, Analyze, no NIBP 57 9310-0804-01 Keypad, Front Panel, Basic 1, w/Pacer, No Analyze, no NIBP 57 9310-0805-01 Keypad, Front Panel, Basic 2, No Pacer, No Analyze, no NIBP 57 9310-0886-01 Keypad, Front Panel, Manual 2, No Pacer, w/Analyze, no NIBP 57 9310-0970-01 Keypad, BLS 57 9310-0982-01 Keypad, Front Panel, Manual 1, ALS, w/NIBP 57 9310-0983-01 Keypad, Front Panel, ALS, Man
R Series Service Manual Part Number Description Item number 9330-0748 DISPLAY, SUPPORT, R SERIES 120 9500-0312 ASSY, CABLE, CONNECTOR, INVERTER, COLOR LCD 121 9230-0272 EDGE GROMMET, R SERIES 122 0163-1228 SCR.PHH/PNH.#6.0.250".ST.ZINC.HI/LO 123 9500-0777 CABLE, ASSY, FLAT, 51 CONDUCTOR 124 4-10 9650-0903-01 Rev.
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R Series Service Manual Chapter 5 Functional Description Overview The R Series system is partitioned as shown in the R Series Interconnect Diagram (see Appendix A). Defibrillation, pacing, ECG monitoring, SpO2 monitoring, EtCO2 monitoring, NIBP monitoring and printing and communication are all combined in the device. Power is provided by AC mains or by a replaceable battery pack that is rechargeable in the device.
R Series Service Manual Parameter Power Supply (SpO2, EtCO2, NIBP) The parameter power supply board provides power and communications for the Masimo SpO2 module, the EtCO2 Capnostat 5 sensor, and the Suntech Advantage A+ NIBP module. SpO2 and EtCO2 power and communications are isolated from the system to meet the requirements for applied parts in EN60601-1, EN60601-2-4 and EN60601-2-49. NIBP isolation requirements are met by the applied parts themselves; the cuffs and tubing are nonconductive.
R Series Service Manual Analog System Board The R Series Analog System Board contains both the isolated Core ECG circuitry and the non-isolated power supplies, power management, and analog support functions for the R Series defibrillator. Core ECG circuitry The Core ECG circuit consists of both analog and digital circuitry. The ECG analog front end subsystem comprises two individually isolated and shielded sections: • Multifunction (MFE)/Paddles Front End, and Patient Impedance Measurement.
R Series Service Manual Pace/Defib Core Engine The R Series P/D Core Engine is an independent module with its own controller. It generates pace and defib therapeutic energies when supplied with appropriate high power (10 - 15A @ 10V min - 18V max), low power (+12, +5, +3.3, -5), serial communication commands, and digital signals. Direct digital signals are provided to reduce timing delays on critical signals - an example is the SYNC signal used to synchronize the defibrillator pulse.
R Series Service Manual Accessories R Series accessories include the following: • All legacy M Series accessories (paddles, padz, internal handles, SpO2, 3/5Lead ECG, NIBP cuffs, etc.) • EtCO2 Capnostat 5 sensor. • R Series unicables and R Series electrodes. The fully featured models support defib, pace, CPR, date code, condition sensor, defib self-test while pre- connected, and monitoring while pacing. • Sync in/Sync out cable (Not sold by ZOLL - third party makes this cable).
R Series Service Manual P/D Settings The software attempts to establish a P/D setting that reflects an estimate of the battery ESR. This is to avoid shutdown due to loading of the DC bus. Tables have been prepared on the basis of nominal R Series operating conditions without the printer operating. We will rely on the defib module throttling to handle additional load conditions (such as printer).
R Series Service Manual Appendix Overview This appendix includes: • The Interconnect Diagram for the R Series Biphasic Unit. • The table listing Delivered Energy at Every Defibrillator Setting into a Range of Loads • The ZOLL R Series Maintenance Tests Checklist. Photocopy the checklist and use the copy to record the results of the maintenance tests performed on the R Series equipment. 9650-0903-01 Rev.
A-2 J120 (3) Pace Amp Knob J100 (20) J119 (3) Pace Rate Knob Front Panel LED backlighting J100 9301-0535 (20) J123 (5) NIBP A+ module J801 (6) J101 (31) J107 (1) J806 (21) J102 (11) J103 (11) On/off switch NIBP Conn EtCO2 Conn SpO2 Conn Sync In/Sync Out/ECG out/RS232 ECG Conn 9301-0512 SpO2 MS11 30050001 J106 (8) J106 (8) Flex Cable 9301-0526 J105(6) J105 (6) PAT + PAT - J108 (14) J101 (14) MMC Conn.
R Series Service Manual Delivered Energy at Every Defibrillator Setting into a Range of Loads Selected Energy 1J Load 25 50 75 100 125 1J 1J 1J 1J 1J 150 175 1J 1J Accuracy* ±15% 2J 1J 2J 2J 2J 2J 2J 2J ±15% 3J 2J 3J 3J 3J 3J 3J 3J ±15% 4J 3J 4J 4J 5J 5J 5J 4J ±15% 5J 3J 5J 6J 6J 6J 6J 6J ±15% 6J 4J 6J 7J 7J 7J 7J 7J ±15% 7J 5J 7J 8J 8J 8J 8J 8J ±15% 8J 5J 8J 9J 9J 10 J 9J 9J ±15% 9J 6J 9J 10 J 11 J 11 J 11 J 10 J
ZOLL R Series Maintenance Test Checklist Use this checklist to record the results of the R Series maintenance tests, and keep it for your records. 1.0 Physical Inspection Pass Fail 1.1 1.2 1.3 1.4 Result of Check: 1.5 o No action required 1.6 o Minor problems corrected 1.7 o Disposable supplies replaced o Major problems identified (unit out of service) 1.8 1.9 1.10 1.11 Additional Remarks 1.12 1.13 1.14 1.
ZOLL R Series Maintenance Test Checklist 14.0 Shock Test 11.0 Defibrillator Self Test Pass Fail 11.1 11.2 11.3 11.4 11.5 11.6 11.7 o o o o o o o Pass Fail N/A o o o o o o o o o o o o o o 12.0 Synchronized Cardioversion Test Pass Fail 12.2 12.3 12.4 o o o N/A o o o o o o 13.0 Synchronized Cardioversion Test (Remote ECG Monitoring) Pass Fail 13.2 13.3 13.4 o o o 14.2 14.3 14.4 14.5 14.6 14.7 14.8 14.9 14.10 14.11 14.12 14.13 14.14 14.15 14.16 14.17 14.
R Series Service Manual A-6 9650-0903-01 Rev.
R Series ® PLUS R Series ® BLS Operator’s Guide 9650-0904-01 Rev.
The issue date for the R Series Operator’s Guide BLS/Plus (REF 9650-0904-01 Rev. K) is December, 2013. If more than 3 years have elapsed since the issue date, contact ZOLL Medical Corporation to determine if additional product information updates are available. Copyright © 2013 ZOLL Medical Corporation. All rights reserved.
Table of Contents Chapter 1 General Information Product Description ............................................................................................................ 1-1 R Series Model Features .................................................................................................... 1-3 How to Use This Manual..................................................................................................... 1-4 Operator’s Guide Updates ...............................................
TABLE OF CONTENTS Chapter 2 Product Overview Defibrillator Controls and Indicators.................................................................................... 2-1 The Front Panel .......................................................................................................... 2-3 Display Screen ............................................................................................................ 2-6 Patient Cables and Connectors .....................................................
Chapter 5 Advisory Defibrillation Advisory Defibrillation Procedure........................................................................................ 5-2 Determine the Patient’s Condition Following Local Medical Protocols ....................... 5-2 Begin CPR Following Local Medical Protocols ........................................................... 5-2 Prepare Patient ........................................................................................................... 5-2 1 Select ON ......
TABLE OF CONTENTS Chapter 9 Noninvasive Temporary Pacing (Optional) Noninvasive Temporary Pacing .......................................................................................... 9-2 Determine Patient Condition and Provide Care Following Local Medical Protocols. .. 9-2 Prepare the Patient ..................................................................................................... 9-2 1 Apply ECG Electrodes/Hands-Free Therapy Electrodes .........................................
Incident Logs .................................................................................................................... 11-8 Printing an Incident Log ............................................................................................ 11-8 Erasing Summary Report and Full Disclosure .................................................................. 11-9 Manual Erasure ........................................................................................................
TABLE OF CONTENTS Appendix A Specifications Defibrillator Specifications...................................................................................................A-2 Battery Pack Specifications ........................................................................................A-6 IEC 60601-1-2 Specifications .............................................................................................A-7 Electromagnetic Emissions Declaration ....................................................
Chapter 1 General Information Product Description The ZOLL® R Series® products combine a defibrillator, ECG display, advanced monitoring capabilities, and Noninvasive Transcutaneous Pacing (NTP) with communication, data printing and recording capabilities in a single lightweight portable instrument. The unit has been designed for all resuscitation situations and its small, compact, lightweight design makes it ideal for accompanying patients during transport.
CHAPTER 1 GENERAL INFORMATION up. When operating in the manual configuration, the device operates as a conventional defibrillator where the device’s charging and discharging are fully controlled by the operator. In advisory mode, some of the features of the device are automated and a sophisticated algorithm is used to identify shockable ECG rhythms (VF and wide complex VT >150 bpm) that should be treated by defibrillator shock delivery.
R Series Model Features R Series Model Features The following features are available in the R Series Plus and R Series BLS models. Pacing and SpO2 monitoring are additional options that may be purchased separately.
CHAPTER 1 GENERAL INFORMATION How to Use This Manual The R Series Operator's Guide provides information operators need for the safe and effective use and care of the R Series products. It is important that all persons using this device read and understand all the information contained within. Please read thoroughly the safety considerations and warnings section. Procedures for daily checkout and unit care are located in “Maintenance” on page 13-1.
Symbols Used on the Equipment Symbol Description Keep dry. This end up. Temperature limitation. Conformité Européenne Complies with medical device directive 93/42/EEC. Type B patient connection. Type BF patient connection. Type CF patient connection. Defibrillator-proof type BF patient connection. Defibrillator-proof type CF patient connection. Fusible link. Equipotentiality. Alternating current (AC). ,I 2. 45 2% )/. Direct current (DC). Contains lithium. Recycle or dispose of properly.
CHAPTER 1 GENERAL INFORMATION Symbol Description Keep away from open flame and high heat. Do not open, disassemble, or intentionally damage. Do not crush. Do not discard in trash. Recycle or dispose of properly. Return to a collection site intended for waste electrical and electronic equipment (WEEE). Do not dispose of in unsorted trash. Date of manufacture. Use by. Latex-free. Do not reuse. Do not fold. Not sterile. Nonionizing electromagnetic radiation from Wi-Fi during data transfer.
Conventions Symbol Description Catalogue number. Consult instructions for use. Prescription only. Maximum energy. Test port. Conventions This guide uses the following conventions: Within text, the names and labels for physical buttons and softkeys appear in boldface type (for example, “Press the SHOCK button or the Code Marker softkey”). This guide uses uppercase italics for audible prompts and for text messages displayed on the screen (for example, CHECK PATIENT).
CHAPTER 1 GENERAL INFORMATION Intended Use — Manual Operation Use of the R Series products in the manual mode for defibrillation is indicated on victims of cardiac arrest where there is apparent lack of circulation as indicated by: • Unconsciousness. • Absence of breathing. • Absence of pulse.
External Pacemaker (Optional) Intended Use — Real CPR Help The Real CPR Help function provides visual and audio feedback designed to encourage rescuers to perform chest compressions at the AHA/ERC recommended rate of 100 compressions per minute. Voice and visual prompts encourage a compression depth in accordance with AHA and/or ERC recommendations of 2 inches (5 cm) minimum for adult patients.
CHAPTER 1 GENERAL INFORMATION The output current of the pacemaker is continuously variable from 0 to 140 mA. The rate is continuously variable from 30 to 180 pulses per minute (ppm), by increments of 2. The pacing output pulse is delivered to the heart via ZOLL hands-free defibrillation/pacing electrodes placed on the patient’s back and the precordium.
Intended Use — SpO2 Monitoring Pacemaker Complications Ventricular fibrillation does not respond to pacing and requires immediate defibrillation. Therefore, the patient’s dysrhythmia must be determined immediately, so that you can employ appropriate therapy. If the patient is in ventricular fibrillation and defibrillation is successful but cardiac standstill (asystole) ensues, you should use the pacemaker.
CHAPTER 1 GENERAL INFORMATION saturation (SpO2) and pulse rate during both no motion and patient motion conditions for adult patients, and no motion conditions for pediatric and neonatal patients in a hospital or prehospital environment.
ECG Monitoring Pediatric Subpopulation Approximate Age Range Newborn (neonate) Birth to 1 month of age Infant 1 month to 2 years of age Child 2 to 12 years of age Adolescent 12-21 years of age ECG Monitoring The patient’s ECG is monitored by connecting the patient to the unit via a 3- or 5-lead patient cable, hands-free therapy electrodes, or through paddles.
CHAPTER 1 GENERAL INFORMATION of the unit. To switch between paddles and hands-free therapy electrodes, remove the OneStep cable from the apex paddle and connect the hands-free therapy electrodes to the cable. The Advisory function cannot be activated unless hands-free therapy electrodes are attached to the OneStep cable and used as the ECG monitoring lead. The R Series can monitor the patient’s ECG while pacing without the need for a separate ECG cable and ECG electrodes.
Code-Ready System Note: When the indicator is: It means: Alternating yellow and green No battery is installed or a battery charging fault has been detected. Not lit The defibrillator is not connected to AC mains. Upon power up, it takes approximately 45 seconds for the LEDs on the battery to accurately display run time. • External charging — use the ZOLL SurePower Battery Charger to charge the battery pack and test the battery’s capacity.
CHAPTER 1 GENERAL INFORMATION Only appropriately trained, skilled personnel who are familiar with equipment operation should perform emergency defibrillation. The prescribing physician should determine what training, such as Advanced Cardiac Life Support (ACLS) or Basic Life Support (BLS) certification, is appropriate. Only skilled personnel trained in Advanced Cardiac Life Support (ACLS) and who are familiar with equipment operation should perform synchronized cardioversion.
Warnings Do not use the unit in AED mode or advisory mode during patient movement. A patient must be motionless during ECG rhythm analysis. Do not touch the patient during analysis. If transporting the patient, cease all movement before beginning ECG analysis. ECG rhythm analysis does not warn of patient asystole, which is not a shockable rhythm. The ECG rhythm analysis function might not reliably identify ventricular fibrillation in the presence of an implanted pacemaker.
CHAPTER 1 GENERAL INFORMATION Never discharge the unit with the defibrillation electrodes or paddles shorted together or in open air. Do not discharge the defibrillator except as indicated in the instructions. Discharge the defibrillator only when defibrillation electrodes or paddles are properly applied to the patient. To avoid risk of electrical shock, do not touch the gelled area of the hands-free therapy electrodes during pacing or defibrillation.
Cautions Use only high-quality ECG electrodes. ECG electrodes are for rhythm acquisition only; you cannot use ECG electrodes for defibrillation or pacing. Do not use therapy or ECG electrodes if the gel is dried, separated, torn or split from the foil; patient burns may result from using such electrodes. Poor adherence and/or air pockets under therapy electrodes can cause arcing and skin burns. Check the expiration date on the electrode packaging. Do not use electrodes after their expiration date.
CHAPTER 1 GENERAL INFORMATION To protect the unit from damage during defibrillation, for accurate ECG information, and to protect against noise and other interference, use only internal current-limiting ECG cables specified or supplied by ZOLL. For continued safety and EMI performance, use only the line cord supplied by ZOLL. Dispose of battery packs in accordance with national, regional and local regulations.
Software License ZOLL Medical Corporation Attn: Tracking Coordinator 269 Mill Road Chelmsford, MA 01824-4105 Fax: (978) 421-0025 Telephone: (978) 421-9655 Notification of Adverse Events As a health care provider, you may have responsibilities under the Safe Medical Devices Act (SMDA), for reporting to ZOLL Medical Corporation, and possibly to the FDA, the occurrence of certain events. These events, described in 21 CFR Part 803, include device-related death and serious injury or illness.
CHAPTER 1 GENERAL INFORMATION Service The R Series does not require periodic recalibration or adjustment. Appropriately trained and qualified personnel should, however, perform periodic tests of the defibrillator to verify proper operation. If a unit requires service, contact the ZOLL Technical Service Department. For customers In the U.S.A. For customers outside the U.S.A. Telephone: 1-800-348-9011 1-978-421-9655 Call the nearest authorized ZOLL Medical Corporation representative.
The ZOLL Serial Number For customers Return the unit to In the U.S.A. ZOLL Medical Corporation 269 Mill Road Chelmsford, MA 01824-4105 Attention: Technical Service Department (SR number) Telephone: 1-800-348-9011 In Canada ZOLL Medical Canada Inc. 1750 Sismet Road, Unit #1 Mississauga, ON L4W 1R6 Attention: Technical Service Department (SR number) Telephone: 1-866-442-1011 In other locations The nearest authorized ZOLL Medical Corporation representative.
CHAPTER 1 GENERAL INFORMATION 1–24 www.zoll.com 9650-0904-01 Rev.
Chapter 2 Product Overview Defibrillator Controls and Indicators 1 ON OFF 2 3 3 4 9 Front Right Left 7 5 6 8 15 11 ? 10 Top Rear SpO2 13 14 12 9650-0904-01 Rev.
CHAPTER 2 PRODUCT OVERVIEW Table 2-1. 2–2 R Series Unit Features Item Description 1 Front panel Includes the display screen and primary controls. 2 Handle Integrated carrying handle. 3 External paddle well Holds paddles when not in use. Allows defib self-test when paddles are stowed in their respective wells. 4 Beeper Emits R-wave detection beeps, defib charge Ready tones, and alarm tones. 5 USB host connector (Optional) (Reserved for future use — do not connect to any equipment.
Defibrillator Controls and Indicators The Front Panel The front panel of the R Series device includes the display screen, softkeys, battery indicator, AC power indicator, Code Readiness indicator, SHOCK button, and control panel. The control panel configuration varies slightly depending on the model and whether the unit is in AED mode or Manual mode. See Figure 2-1 and Figure 2-2.
CHAPTER 2 PRODUCT OVERVIEW Table 2-2 describes the controls and indicators that appear on the front panel. Display screen Battery indicator AC power indicator Code Readiness indicator LEAD ANALYZE CHARGE SIZE ALARM SUSPEND ENERGY SELECT RECORDER ON OFF Mode Selector PACER OUTPUT mA 4:1 RATE ppm Pacer door is open NIBP Button (optional) Figure 2-2. Table 2-2.
Defibrillator Controls and Indicators Table 2-2. R Series Controls and Indicators (continued) Control or Indicator Description CHARGE Button Displays in Manual mode only. Charges the defibrillator to the selected energy. In addition to the CHARGE button on the front panel, there is one located on the apex paddle handle.
CHAPTER 2 PRODUCT OVERVIEW Table 2-2. R Series Controls and Indicators (continued) Control or Indicator Description NIBP Button (optional) Allows you to start single, auto, or STAT non-invasive blood pressure measurements as described in the option insert Non-Invasive Blood Pressure (part number 9650-0914-01). Your unit has this button only if you ordered this configuration.
Defibrillator Controls and Indicators ECG Rate and Depth Indicators SpO2 values and alarm indicator (optional) SpO2% CPR Idle Time CPR Index (R Series Plus Only) IDLE 0:00 CPR ECG I x1 Depth Rate 99 NIBP 120 80 • size • selected lead • alarm indicator • heartbeat indicator Ɔ PPI 72 mmHg NIBP values and alarm indicator (optional) CO2 values and alarm indicator (optional) Elapsed time Softkey labels Messages Trace 1 I 100 CO2 RR 35 13 11:24 Options Heart rate (beats per minute) mmHg Tr
CHAPTER 2 PRODUCT OVERVIEW Patient Cables and Connectors The back of the unit includes a set of connectors for patient cables. Sync In/ Marker Out/ ECG Out Figure 2-4. NIBP (optional) EtCO2 (optional) ECG SpO2 (optional) OneStep Cable Patient Cable Connectors Connector Description OneStep Cable For connecting paddles or ZOLL hands-free therapy and pacing electrodes using either OneStep or OneStep Pacing cables. ECG For connecting 3- or 5-lead ECG cable or OneStep Pacing cable’s ECG cable.
Defibrillator Controls and Indicators ECG Connector OneStep Pacing Cable OneStep Cable Figure 2-5. OneStep Cables OneStep Cable Manager (Optional) As an option, the OneStep Cable Manager is available to store and organize cables. OneStep Cable Manager Cable Caddy Figure 2-6. 9650-0904-01 Rev.
CHAPTER 2 PRODUCT OVERVIEW Power Cord The AC power cord is used to operate the R Series unit when battery power is not being used. An additional extension cord is available for use when the cable organizer accessory is attached to the unit. The extension cord plugs into the main AC power cord as shown below. External Paddles (Manual Mode Only) Paddles are defibrillation-proof Type BF equipment. The external paddles on the R Series device are used for defibrillation and synchronized cardioversion.
Defibrillator Controls and Indicators Attach the OneStep cable from the R Series unit to the connector at the base of the apex paddle. 1. Align OneStep cable as shown. Figure 2-8. 2. Insert OneStep cable into APEX paddle. Attaching the OneStep Cable to the APEX Paddle OneStep cable connected to APEX paddle Figure 2-9.
CHAPTER 2 PRODUCT OVERVIEW Pediatric-size electrodes are built into the paddle assembly beneath the standard electrode plates. The user must manually adjust energy settings to pediatric levels consistent with their institution’s protocols. PEDI button To expose the pediatric plate, press the PEDI button at the top of the paddle, then slide the Adult plate upward. Before replacing the Adult plate, be sure to clean the pediatric plate and surrounding area thoroughly.
Common Tasks The following table summarizes some of the more common softkeys. Softkey Action Next Item Moves the highlighting down to the next item in a vertical list. Next Field Moves the highlighting down to the next item in a horizontal list. Prev Item Moves the highlighting up to the previous item in a vertical list. Next Digit Moves the highlighting to the right in a series of letters or digits. Prev Digit Moves the highlighting to the left in a series of letters or digits.
CHAPTER 2 PRODUCT OVERVIEW To install a battery pack: 3P/ 3P/ 1. Place the end of the battery pack opposite the tab into the end of the compartment closest to the front of the unit. 2. Lower the tabbed end of the battery pack into the compartment and press down on the tabbed end until it locks into place. ? ? Figure 2-14. Installing a Battery Pack Adjusting Display Brightness (Manual Mode Only) To adjust brightness: 1. Turn the Mode Selector to ON. 2. Press the Manual Mode softkey.
Common Tasks The right-most softkey is labeled MORE when there are more than six items on the code marker list. Press the MORE softkey to see the next set of Code Markers displayed above the softkeys. Separate code marker lists are maintained for DEFIB and PACER modes, thereby enabling the display of appropriate code markers for each particular protocol. (For information on configuring these code marker lists, refer to the R Series Configuration Guide.
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Chapter 3 Automated External Defibrillator (AED) Operation ZOLL hands-free therapy electrodes are a defibrillation-protected Type BF patient connection. WARNING! Use only One-Step Pediatric electrodes to defibrillate patients under 8 years of age in AED mode. Use of adult electrodes with pediatric patients can result in the delivery of excessive energy doses. This chapter describes the recommended method of operation in AED Mode.
CHAPTER 3 AUTOMATED EXTERNAL DEFIBRILLATOR (AED) OPERATION The R Series defibrillator is capable of analyzing a patient’s ECG rhythm in two different ways. The first mode of analyzing is automatic; the other mode of analyzing is user activated analysis and is initiated by pressing the ANALYZE softkey. Automatic and user activated analysis of a patient’s ECG can be performed only when: • Hands-free therapy electrodes are connected, and making good contact with the patient. • Mode Selector is turned to ON.
AED Operation Connect the hands-free therapy electrodes to the OneStep cable if not already connected. hands-free therapy electrodes connector OneStep cable 1 2 When connecting a OneStep electrode to the OneStep cable, push the two connectors together until the latch clicks, as shown. Latch When disconnecting the OneStep electrode and OneStep cable, press down the latch with your thumb as shown.
CHAPTER 3 AUTOMATED EXTERNAL DEFIBRILLATOR (AED) OPERATION 2. Roll the pad smoothly from the applied edge to the other, being careful not to trap any air pockets between the gel and skin. Pad Note: Skin If it is not possible to place the “BACK” pad on the patient’s back, the pads should be placed in the standard apex-sternum positions. Effective defibrillation will result, but pacing will usually be less effective.
AED Operation • Shock 2 - 150 joules • Shock 3 - 200 joules The default energy selections for pediatric patients are: • Shock 1 - 50 joules • Shock 2 - 70 joules • Shock 3 - 85 joules After the third shock, all subsequent shocks are delivered at the same energy as the third shock in both Adult and Pediatric modes. 2 Analyze WARNING! Do not analyze the patient ECG during patient movement. A patient must be motionless during ECG analysis. Do not touch the patient during analysis.
CHAPTER 3 AUTOMATED EXTERNAL DEFIBRILLATOR (AED) OPERATION When a nonshockable rhythm is detected, the unit displays a NO SHOCK ADV. message. Immediately begin chest compressions and continue other treatment per protocol. NO SHOCK ADV. ECG 150J SEL. Manual Mode Analyze NO SHOCK ADVISED If the patient’s rhythm is shockable, the unit displays a SHOCK ADVISED message. The defibrillator begins charging automatically to the preconfigured energy setting and displays a CHARGING message.
AED Operation Once the unit is charged to the selected energy, the SHOCK button illuminates and the PRESS SHOCK message is announced and displayed. Note: Rhythm analysis does not continue after the defibrillator is charged and ready once a decision to shock has been made. The R Series unit will not automatically disarm the defibrillator if the patient’s rhythm reverts to a non-shockable rhythm before the shock has been delivered.
CHAPTER 3 AUTOMATED EXTERNAL DEFIBRILLATOR (AED) OPERATION Repeat Analysis After performing CPR for the configured period of CPR, the unit will restart ECG analysis automatically. Note: Reanalysis of the ECG rhythm is inhibited for 3 seconds after a shock. Continue Patient Care Continue patient care according to medical protocols. Operating Messages The unit uses both audio and visual prompts to present critical information to operators. The following information describes the unit default configuration.
AED Operation SHOCK ADVISED/ XXXJ READY This message is displayed when a shockable ECG rhythm has been detected and the selected energy is ready to be delivered. PRESS SHOCK This message is displayed and announced when the ECG analysis has determined that a shock is advised and the selected energy is ready to be delivered. SHOCKS: XX This message displays the number of shocks that have been delivered by the unit since it was powered on. It resets to 0 after the unit has been off for more than 10 seconds.
CHAPTER 3 AUTOMATED EXTERNAL DEFIBRILLATOR (AED) OPERATION ELAPSED TIME When enabled, this feature indicates the elapsed time since the unit was first turned on. It is displayed in the lower left corner. The elapsed time is displayed in MM:SS format up to 99:59. If the unit is on for over 100 minutes, the elapsed time will roll over to 0. The elapsed time will be maintained for up to 10 seconds after power down.
Switching to Manual Mode Operation When changing from AED mode to Manual mode, the current selected energy level is maintained. Note: 9650-0904-01 Rev. K To transfer back to AED mode from Manual mode, power down the unit for more than 10 seconds and then power it back up.
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Chapter 4 Manual Defibrillation Paddles are a defibrillation-protected Type BF patient connection. ECG leads are a defibrillation-protected Type CF patient connection. Emergency Defibrillation Procedure with Paddles WARNING! To avoid risk of electrical shock, do not allow electrolyte gel to accumulate on hands or paddle handles. When defibrillating with paddles, use your thumbs to operate the SHOCK buttons in order to avoid inadvertent operator shock.
CHAPTER 4 MANUAL DEFIBRILLATION Begin CPR Following Local Medical Protocols Request additional assistance. 1 Select ON AED ON OFF The unit beeps 4 times to indicate that it has passed the power on self test, and the green AED label and the ON mode selector light up on the front panel. Press the Manual Mode softkey on the front panel of the unit to enter the Manual mode of operation. The message CONFIRM MANUAL MODE and the Confirm softkey will be displayed.
Emergency Defibrillation Procedure with Paddles If medical protocol allows, you may select a different energy level using the up and down arrow buttons. One pair is located on the front panel of the unit; the other pair is located on the sternum paddle. ANALYZE CHARGE or or ENERGY SELECT Note: Neonatal and pediatric defibrillator energy levels should be selected based on sitespecific protocols. The selected energy level is shown as DEFIB XXXJ SEL. on the display. ECG DEFIB 120J SEL.
CHAPTER 4 MANUAL DEFIBRILLATION Sternum Apex Rub the paddles against the skin to maximize the paddle-to-patient contact. WARNING! Do not permit gel to accumulate between the paddle electrodes on the chest wall (gel bridge). This could cause burns and reduce the amount of energy delivered to the heart. If using defibrillator gel pads, make sure that the size of the pad is large enough to cover the entire paddle electrode area.
Autoclavable External Paddles After charging to the selected energy, the charge indicator on the apex paddle lights. A distinctive charge ready tone sounds, and the message DEFIB XXXJ READY is displayed. The defibrillator is now ready to discharge. 3 Deliver Shock WARNING! Warn all persons in attendance of the patient to STAND CLEAR prior to defibrillator discharge. Do not touch the bed, patient, or any equipment connected to the patient during defibrillation. A severe shock can result.
CHAPTER 4 MANUAL DEFIBRILLATION Emergency Defibrillation Procedure with Hands-Free Therapy Electrodes ZOLL hands-free therapy electrodes are a defibrillation-protected Type BF patient connection. ECG leads are a defibrillation-protected Type CF patient connection. Determine the Patient’s Condition Following Local Medical Protocols Verify: • Unconsciousness. • Absence of breathing. • Absence of pulse. Begin CPR Following Medical Protocols Request additional assistance.
Emergency Defibrillation Procedure with Hands-Free Therapy Electrodes When disconnecting the OneStep electrode and OneStep cable, press down the latch with your thumb as shown. Latch If defibrillation electrodes are not making good contact with the patient’s skin, the unit issues the messages CHECK PADS and POOR PAD CONTACT and does not allow delivery of energy. If a short circuit exists between the electrodes, the unit issues the message DEFIB PAD SHORT.
CHAPTER 4 MANUAL DEFIBRILLATION 1 Select ON AED ON OFF The unit beeps 4 times to indicate that it has passed the power on self test, and the green AED label and the ON mode selector light up on the front panel. Press the Manual Mode softkey on the front panel of the unit to enter the Manual mode of operation. The message CONFIRM MANUAL MODE and the Confirm softkey will be displayed. Press the Confirm softkey to enter the Manual mode of operation.
Emergency Defibrillation Procedure with Hands-Free Therapy Electrodes If medical protocol allows, you may select a different energy level using the ENERGY SELECT buttons on the front panel. ANALYZE CHARGE ENERGY SELECT The selected energy level is shown as DEFIB XXXJ SEL. on the display. ECG DEFIB 120J SEL.
CHAPTER 4 MANUAL DEFIBRILLATION To increase or decrease the selected energy after you have pressed the CHARGE button, use the defibrillator ENERGY SELECT buttons. Caution Changing the selected energy while the unit is charging or charged causes the defibrillator to disarm itself. Press the CHARGE button again to charge the unit. After charging to the selected energy, the SHOCK button on the front panel lights. A distinctive charge ready tone sounds and the DEFIB XXXJ READY is displayed.
Autoclavable Electrodes • Molded Autoclavable Internal handles with integrated electrode spoons • Autoclavable Internal Handles with removable internal defibrillation electrodes When these internal handles are used, the R Series defibrillator can operate only in Manual mode even if the unit supports Advisory mode. When an internal handle set is connected to the R Series, it automatically limits energy output to a maximum of 50 joules.
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Chapter 5 Advisory Defibrillation ZOLL hands-free therapy electrodes are a defibrillation-protected Type BF patient connection. When the Mode Selector is turned to ON, the unit is in Manual mode, and hands-free therapy electrodes are used, the R Series can identify shockable rhythms using its built in ECG analysis capability.
CHAPTER 5 ADVISORY DEFIBRILLATION Advisory Defibrillation Procedure Determine the Patient’s Condition Following Local Medical Protocols Verify: • Unconsciousness. • Absence of breathing. • Absence of pulse. Begin CPR Following Local Medical Protocols Request additional assistance. Prepare Patient Remove all clothing covering the patient’s chest. Dry chest if necessary. If the patient has excessive chest hair, clip or shave it to ensure proper adhesion of the electrodes.
Advisory Defibrillation Procedure Note: If the unit has been configured not to confirm the transition from AED mode to Manual mode, the unit will immediately enter Manual mode. The control buttons for Manual mode light up on the front panel and the unit displays DEFIB 120J SEL on the monitor.
CHAPTER 5 ADVISORY DEFIBRILLATION 2 Press ANALYZE Button WARNING! Keep patient motionless during ECG analysis. Do not touch the patient during analysis. Cease all movement via stretcher or vehicle before analyzing the ECG. Press the ANALYZE button to begin the analysis of the patient’s ECG rhythm and to determine if a shockable rhythm is present.
Advisory Defibrillation Procedure Note: When a nonshockable rhythm is detected, the R Series does not prevent the user from manually defibrillating the patient. When a shockable rhythm is detected (ventricular fibrillation or wide-complex tachycardia with heart rate > 150), one of the following occur: • Units with the automatic charge option enabled automatically charge to the preconfigured or user selected energy setting.
CHAPTER 5 ADVISORY DEFIBRILLATION Once the unit is charged to the selected energy, the SHOCK button illuminates and the PRESS SHOCK message is displayed. Simultaneously, the monitor displays the energy level to which the defibrillator is charged, DEFIB XXXJ READY. Note: Rhythm analysis does not continue after the defibrillator is charged and ready once a decision to shock has been made.
Advisory Function Messages Advisory Function Messages SELECT DEFIB MODE Displayed if any of the buttons on the right side front panel (SHOCK, ANALYZE, CHARGE, ENERGY SELECT) are pressed while in Data Transfer mode. To enable the defibrillator in Manual mode, press the Exit Transfer softkey, or quickly turn the Mode Selector to OFF and then ON. SELECT PADS Displayed if the ANALYZE button is pressed while the device is operating in any ECG lead other than “PADS.
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Chapter 6 Synchronized Cardioversion Note: This option is only available in Manual mode. Paddles are a defibrillation-protected Type BF patient connection. ECG leads are a defibrillation-protected Type CF patient connection. WARNING! Only skilled personnel trained in Advanced Cardiac Life Support and familiar with equipment operation should perform synchronized cardioversion. The precise cardiac arrhythmia must be determined before attempting defibrillation or cardioversion.
CHAPTER 6 SYNCHRONIZED CARDIOVERSION Marker indicates each detected R wave during synchronization Verify that markers are clearly visible on the monitor and their location is appropriate and consistent from beat to beat. If necessary, use the LEAD and SIZE buttons to establish settings that yield the most consistent Sync marker pattern. The synchronized cardioversion procedure for ZOLL hands-free therapy electrodes is identical to that for paddles with the exception of the SHOCK button location.
Synchronized Cardioversion Procedure If therapy electrodes are not making good contact with the patient’s skin, the unit issues the messages CHECK PADS and POOR PAD CONTACT and does not allow delivery of energy. If a short circuit exists between the electrodes, the unit issues the message DEFIB PAD SHORT. An ECG LEAD OFF condition prevents synchronized discharge if leads are selected as the ECG source.
CHAPTER 6 SYNCHRONIZED CARDIOVERSION Verify that the markers are clearly visible on the monitor and their location is appropriate and consistent from beat to beat. If necessary, use the LEAD and SIZE buttons to establish settings that yield the best display. A SYNC XXXJ SEL. message appears on the display. If DEFIB XXXJ SEL. appears, press the Sync On/Off softkey. (If your unit supports Remote Sync, you must also press the Sync softkey.) Two quick beeps sound. ECG SYNC 120J SEL.
Remote Synchronized Cardioversion Procedure The defibrillator is now ready to deliver therapy. 3 Deliver SHOCK WARNING! Warn all persons in attendance of the patient to STAND CLEAR prior to defibrillator discharge. Verify that no one is in contact with the patient, monitoring cable or leads, bed rails, or any other potential current pathways. Verify that the ECG waveform is stable and that Sync markers appear over each R-wave.
CHAPTER 6 SYNCHRONIZED CARDIOVERSION Determine the Patient’s Condition and Provide Care Following Local Medical Protocols Prepare Patient Prepare the patient as described in “Prepare Patient” on page 6-2. Follow the instructions provided with the external monitoring device to prepare the patient for ECG monitoring and synchronization with a separate defibrillator.
Remote Synchronized Cardioversion Procedure View the ECG trace on the remote device’s display. Verify that Sync markers appear with each R-wave. The Sync markers will appear as described in the remote device’s user manual. WARNING! Verify the ECG waveform is stable and that a Sync marker appears only with R-waves. If Sync markers are not present on the remote device display, or do not appear to be nearly simultaneous with each R-wave, do not proceed with synchronized cardioversion.
CHAPTER 6 SYNCHRONIZED CARDIOVERSION Once the energy is delivered, the display simultaneously shows XXXJ DELIVERED and DEFIB XXXJ SEL. After approximately 5 seconds, the XXXJ DELIVERED message disappears and the DEFIB XXXJ SEL. message remains to indicate the selected energy level. If additional countershocks are necessary, readjust the energy level as necessary, press the Sync On/Off, and then the Remote Sync softkeys and repeat.
Chapter 7 Real CPR Help Real CPR Help is defibrillation-proof Type BF equipment. WARNING! The Real CPR Help function is fully functional only when using adult CPR electrodes. Do not use Adult CPR electrodes with patients under 8 years of age. WARNING! Use only Pediatric CPR electrodes with patients under 8 years of age. The use of Pediatric CPR electrodes enables the R Series unit to display Idle Time and Compression Rate and Depth measurements.
CHAPTER 7 REAL CPR HELP • CPR Idle Time Display • CPR Rate Metronome • Voice prompts • Chest Compressions Waveform display • FULLY RELEASE display prompt (if configured) Real CPR Help Field Whenever OneStep CPR, or OneStep Complete electrodes are connected to the R Series defibrillator, the unit illuminates the Real CPR Help field in the upper center portion of the display. This field includes the indicators described in the next sections.
Real CPR Help Field Compression Release Bar (R Series Plus/Adult only) If the CPR Dashboard is configured On, the Compression Release Bar shows the release of the chest compression by the rescuer. When the release of the chest is properly administered (fully released), the bar will fill all the way to the top. This feature is unavailable while using Pediatric CPR electrodes. CPR Dashboard CPR Depth Rate CPR Index 1.
CHAPTER 7 REAL CPR HELP Fully Release prompt The R Series unit can be configured to display the text prompt, FULLY RELEASE, which reminds rescuers to lift (fully release) their hands from the patient’s chest during compressions to allow full recoil. This feature is unavailable while using Pediatric CPR electrodes. By default, the FULLY RELEASE text prompt is not enabled.
Chapter 8 See-Thru CPR (R Series Plus Only) The See-Thru CPR feature is only available in R Series Plus models. WARNING! The See-Thru CPR filter works only when the R Series defibrillator is monitoring CPR in Manual mode. The See-Thru CPR filter stops if: — The unit is in pace mode. — Patient impedance is invalid. — OneStep CPR electrodes or OneStep Complete electrodes are no longer detected. The See-Thru CPR filter will not remove all CPR artifact.
CHAPTER 8 SEE-THRU CPR (R SERIES PLUS ONLY) of asystole or low amplitude PEA, the residual artifact seen after filtering may look like fine ventricular fibrillation. Because the filtered ECG signal may contain residual chest compression and/or filtering artifacts, a rescuer should always follow the standard procedure of stopping CPR to assess the patient’s ECG rhythm before determining treatment. Using See-Thru CPR (R Series Plus Only) To use See-Thru CPR • The R Series unit must be monitoring CPR.
Using See-Thru CPR (R Series Plus Only) The following figure shows a patient in Fine VF. It is difficult for a rescuer to discern this rhythm during CPR compressions. When the CPR filter turns on, the Fine VF rhythm becomes more obvious.
CHAPTER 8 SEE-THRU CPR (R SERIES PLUS ONLY) The following figure shows a patient in VF, which, during compressions, is slightly more difficult to discern. When viewing this ECG, it is possible to view the underlying rhythm as the filter is able to reject all of the CPR artifact.
Using See-Thru CPR (R Series Plus Only) The following figure shows a patient in PEA, which could easily be mistaken for Fine VF because enough of the compression artifact leaks through to distort this signal. When the CPR filter turns on, the PEA is still not obvious because of the left over ripples from the CPR signal. About 14 seconds into this chart, the rhythm changes to asystole, which could easily be mistaken for coarse VF.
CHAPTER 8 SEE-THRU CPR (R SERIES PLUS ONLY) The following figure shows a patient with an organized rhythm where See-Thru CPR effectively filters out artifact created by CPR. SinusRhythm Raw ECG Raw ECG • | Filter ON Filtered ECG Filtered ECG CPR 0:00 CPR 0:12 SinusRhythm Raw ECG Raw ECG • | Filter OFF • | Filter ON Filtered ECG Filtered ECG CPR 0:12 CPR 0:24 SinusRhythm Raw ECG Raw ECG • | Filter OFF Filtered ECG Filtered ECG CPR CPR 0:24 0:36 12.5 mm/sec, 5 mm/mV 8–6 www.zoll.
Chapter 9 Noninvasive Temporary Pacing (Optional) Note: This is an optional feature and is only available in Manual mode. When ZOLL hands-free therapy electrodes are used, the patient connection is considered to be defibrillation-protected Type BF. ECG leads are a defibrillation-protected Type CF patient connection. WARNING! To avoid risk of electrical shock, do not touch the gelled area of the hands-free therapy electrodes while pacing. Therapy electrodes should be replaced periodically.
CHAPTER 9 NONINVASIVE TEMPORARY PACING (OPTIONAL) Noninvasive Temporary Pacing R Series defibrillators with the pacer option contain a VVI demand pacemaker – a safe and effective design for Noninvasive Temporary Pacemakers. Proper demand pacing requires a reliable, high quality surface ECG signal.
Noninvasive Temporary Pacing Therapy Electrode Application WARNING! Poor adherence and/or air under the therapy electrodes can lead to the possibility of arcing and skin burns. 1. Apply one edge of the pad securely to the patient. 2. Roll the pad smoothly from the applied edge to the other, being careful not to trap any air pockets between the gel and skin. Pad Skin 3.
CHAPTER 9 NONINVASIVE TEMPORARY PACING (OPTIONAL) Press the Manual Mode softkey on the front panel of the unit to enter the Manual mode of operation. The message CONFIRM MANUAL MODE and the Confirm softkey will be displayed. Press the Confirm softkey to enter the Manual mode of operation. If the Confirm softkey is not pressed within 10 seconds, the unit will revert back to semiautomatic operation.
Noninvasive Temporary Pacing Observe the pacing stimulus marker on the display or stripchart ( well-positioned in diastole. ) and verify that it is Pacing Stimuli 4 Set Pacer Output Increase PACER OUTOUT until stimulation is effective (capture); the output mA value is displayed. The pacer output increments and decrements by a value of 2 mA on the display when the knob is turned.
CHAPTER 9 NONINVASIVE TEMPORARY PACING (OPTIONAL) To avoid mistaking muscular response to pacing stimuli for arterial pulsations, use ONLY the following locations for palpating pulse during pacing: • femoral artery • right brachial or radial artery Effective pacing The following ECG traces illustrate typical examples of effective pacing. Large T wave Negative R wave Pacer Markers Inverted T wave/ absence of P waves Widened, positive QRS, (which looks like an ectopic beat).
Noninvasive Temporary Pacing 4:1 Mode OFF PACER OUTPUT mA 4:1 RATE ppm Pressing and holding the 4:1 button temporarily withholds pacing stimuli, thereby allowing you to observe the patient’s underlying ECG rhythm and morphology. When depressed, this button causes pacing stimuli to be delivered at ¼ of the indicated ppm setting.
CHAPTER 9 NONINVASIVE TEMPORARY PACING (OPTIONAL) Special Pacing Applications Noninvasive Temporary Pacing can be performed in the Cardiac Catheterization Lab either for emergency pacing or standby pacing. For pacing in X-ray and fluoroscopic applications, ZOLL pro-padz® radiolucent hands-free therapy electrodes may be used. Noninvasive Temporary Pacing can be performed in the Operating Room using ZOLL pro-padz sterile hands-free therapy electrodes.
Special Pacing Applications 1 Select ON AED ON OFF The unit beeps 4 times to indicate that it has passed the power on self test, and the green AED label and the ON mode selector light up on the front panel. Press the Manual Mode softkey on the front panel of the unit to enter the Manual mode of operation. The message CONFIRM MANUAL MODE and the Confirm softkey will be displayed. Press the Confirm softkey to enter the Manual mode of operation.
CHAPTER 9 NONINVASIVE TEMPORARY PACING (OPTIONAL) Press the Async Pacing On/Off softkey Note: If the pacer output is set to 8 mA or higher, pacing stimuli begin immediately at the set rate. The display shows “ASYNC PACE” to indicate that asynchronous pacing has been activated. The annotation “ASYNC PACE” is also printed on the stripchart when activated by the RECORDER button, and printed on the corresponding summary report. To return to demand pacing, press the ASYNC Pacing On/Off softkey again.
Chapter 10 ECG Monitoring Note: This option is only available in Manual mode. ECG leads are a defibrillation-protected Type CF patient connection. The R Series products can be used for either short- or long-term ECG monitoring. R Series products have built-in circuitry to prevent damage to their ECG monitoring circuits during defibrillation. Monitoring electrodes, however, can become polarized during defibrillator discharge, causing the ECG trace to briefly disappear from the screen.
CHAPTER 10 ECG MONITORING Caution ECG electrodes embedded in OneStep Pacing and Complete resuscitation pads produce non-standard ECG monitoring lead vectors, designated P1, P2 and P3. While ECG signals acquired from these leads are appropriate for ECG rhythm assessment and determining electrical capture during pacing, they should not be used for ECG morphological evaluations. Attach conventional ECG electrodes for diagnostic purposes.
Monitoring Electrodes Attachment 3-lead configuration RA 5-lead wire configuration LA RA LA V LL 3-lead set RL 3-lead cable LL 5-lead cable Note: Lead sets and lead cables are different accessories and are not interchangeable. For 5-lead monitoring, use a 5-lead cable. Note: 3-lead cables are available with and without ESU noise suppression. Monitoring Electrodes Attachment Attach snap-on leads to electrodes and check for good contact between the electrode and the lead termination.
CHAPTER 10 ECG MONITORING Apply the ECG electrodes firmly to the patient’s skin, pressing around the entire perimeter of the electrodes. Plug the patient cable connector into the black ECG input connector (located on the rear panel of the instrument). If you are using a 3-lead set that is connected to a OneStep Pacing cable, plug the red connector into the red OneStep cable input connector on the device, and plug the connector (that is black inside) into the black ECG input connector on the device.
Monitoring the Patient’s ECG Monitoring the Patient’s ECG Set the Controls Set the Mode Selector to ON. The unit beeps 4 times to indicate that it has passed the power on self test, and the green AED label and the ON switch light up on the front panel. Press the Manual Mode softkey on the front panel of the unit to enter the Manual mode of operation. The message CONFIRM MANUAL MODE and the Confirm softkey will be displayed. Press the Confirm softkey to enter the Manual mode of operation.
CHAPTER 10 ECG MONITORING WARNING! Implanted pacemakers may cause the heart rate meter to count pacemaker pulses during incidents of cardiac arrest or other arrhythmias. Pacemaker patients should be carefully observed. Check the patient's pulse; do not rely solely on heart rate meters. Dedicated pacemaker detection circuitry may not detect all implanted pacemaker spikes; patient history and physical exam are important in determining the presence of an implanted pacemaker.
5-Lead Monitoring Changing from 3-Lead Monitoring To change from 3-lead to 5-lead monitoring, simply disconnect the 3-Lead ECG patient cable (or OneStep Pacing cable ECG connector) and connect the 5-lead ECG cable. Refer to the beginning of this section for appropriate preparations (i.e., placing electrodes, attaching electrodes, setting the controls, etc.). If any ECG lead becomes disconnected during monitoring, an ECG LEAD OFF message appears on the display.
CHAPTER 10 ECG MONITORING If Display Filtered ECG in Trace1 is configured, the unit displays the filtered ECG in Trace1. You can then switch between filtered and unfiltered ECG using the Enable/Disable Filt ECG softkey. With the unfiltered ECG displayed in Trace1, the user of the R Series unit can also enable the display of the filtered ECG in Trace2 or Trace3. Adding Traces to Be Displayed The screen can display up to three traces simultaneously.
Alarms Alarms Setting Alarm Limits Unless configured otherwise, heart rate alarms are preset at 30 bpm (bradycardia) and 150 bpm (tachycardia). Refer to the R Series Configuration Guide for details on setting power-up alarm limits. To set alarm parameters: 1. Press the Alarms softkey to view the Alarm Set screen and softkeys.
CHAPTER 10 ECG MONITORING Heart Rate Alarm Limits The heart rate is displayed in the upper right-hand corner of the screen. Unless configured otherwise, heart rate alarms are preset at 30 bpm (bradycardia) and 150 bpm (tachycardia). The low heart rate alarm limit range is 20 bpm to 100 bpm. When the unit is monitoring a patient’s heart rate via ECG, the range for the high heart rate alarm limit is 60 to 280 bpm with a default setting of 150 bpm.
Alarms If a second, different alarm occurs after you suspend an alarm tone, you can suspend the alarm tone for that second parameter by pressing and releasing the ALARM SUSPEND button again. The unit behaves the same as described above for the first alarm. Suspending a second alarm does not alter the timing or processing of the previously suspended alarm. Silencing Alarm Tones To silence the alarm tone, press and hold down the ALARM SUSPEND button for between 1 and 3 seconds.
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Chapter 11 Event Records and Reports Note: This option is only available in Manual mode. The R Series defibrillator records important event information during operation. You can retrieve this information in various forms: • Summary Report — Summary report allows you to store and later retrieve important ECG and event information. You can print summary report information in various formats. For more information about Summary Report and how to print a report, refer to the Summary Report section below.
CHAPTER 11 EVENT RECORDS AND REPORTS • ECG rhythm analysis is initiated. • VF alarm is triggered. • Parameter alarm is triggered. • Mode Selector is turned to PACER (after entering Manual mode). Note: Diagnostic bandwidth recordings are not included in Summary Report. The unit stores and prints summary information in chronological order. The memory allocated for summary data can hold up to 350 defibrillation or 350 recorder-activated events.
Summary Report Defibrillation Event Format The summary report function records 6 seconds of pre-shock and 9 seconds of post-shock patient ECG data. Also recorded are joules selected, joules delivered, Sync if active (includes Sync markers), ECG lead, ECG size, patient current, defib impedance, actual time and date. The date/time printed on the top of the strip corresponds to the ECG data occurring 6 seconds before the event. Figure 11-2. Defibrillation Event Format (Pre-Shock) Figure 11-3.
CHAPTER 11 EVENT RECORDS AND REPORTS Pacer Mode Selected Format The summary report function records 6 seconds of pre-pace patient ECG data. Also recorded are the ECG lead, ECG size, patient's heart rate, pace rate, pace current, time and date. The date/time printed on the top of the strip corresponds to the ECG data occurring 6 seconds before the event. Figure 11-4. Pacer Mode Selected Format After establishing a paced rhythm, turning the recorder on briefly records the paced rhythm for later reports.
Summary Report Heart Rate Alarm Activated Format The summary report function records 6 seconds of pre-alarm patient ECG. Also recorded are the ECG lead, ECG size, patient's heart rate, actual event time, and date. The date/time printed on the top of the strip corresponds to the ECG data occurring 6 seconds before the event. If the pacer is on during this event, the pacing rate and pacing current are also recorded. Figure 11-6.
CHAPTER 11 EVENT RECORDS AND REPORTS Recorder On Format The summary report function records 6 seconds of patient ECG prior to turning on the recorder. Also recorded are the ECG lead, ECG size, patient's heart rate, actual event time, and date. The date/time printed on the top of the strip corresponds to the ECG data occurring 6 seconds before the event. If the pacer is on during this event, the pacing rate and current are also recorded. If async pace is active, the annotation ASYNC PACE is recorded.
Summary Report Note: If the first two segments are shockable, only two asterisks appear on the stripchart, and the third segment is not analyzed. Figure 11-9. Analyze Format In addition, the ECG rhythm analysis report can include the following annotations: Annotation Description POOR PAD CONTACT The hands-free therapy electrodes are improperly connected. ANALYSIS HALTED A fault condition occurred, or the operator pressed the ANALYZE button again. NOISY ECG Excessive noise was detected.
CHAPTER 11 EVENT RECORDS AND REPORTS Printing a Partial Summary Report To print a partial summary report: 1. Press the Report Data softkey, then press Print Chart. 2. Press the Print Range softkey. 3. Use the First Event, Prev. Event, Next Event and Last Event softkeys to locate the event from which printing will start (all subsequent events are also printed). 4. Press the Print softkey. The unit prints all records from the selected item to the most recent.
Erasing Summary Report and Full Disclosure Erasing Summary Report and Full Disclosure Summary information can be erased either manually or automatically. Manual Erasure You can manually erase summary records and full disclosure data from memory in preparation for collecting data for a new patient. Note: When the event summary memory and full disclosure memory are filled, data recording stops. You must erase the records to continue recording.
CHAPTER 11 EVENT RECORDS AND REPORTS Related Messages 11–10 Message Description CHECK RECORDER The paper supply in the stripchart printer is exhausted. DISK FORMAT REQ. The internal flash memory disk file system has been corrupted. Follow the procedure in the previous section, “Formatting the Disk.” DO NOT POWER OFF Do not remove power (both battery and AC) while the unit is erasing reports or formatting the disk. ERASING REPORT The unit is erasing the selected report data.
Chapter 12 File Transfer This chapter describes procedures for transferring files from the R Series defibrillator to an external system, such as a personal computer or handheld device. It also explains how to remove, install and erase a Compact Flash card. Note: The USB and Wi-Fi capabilities that are included in this chapter are only available if you have the R Series Plus model. The file transfer option is only available when you are in Manual mode.
CHAPTER 12 FILE TRANSFER To retrieve and review event files, you need one of the following software packages installed on the receiving equipment: • ZOLL CodeNet Central software • ZOLL RescueNet Code Review software To retrieve and review maintenance files, you need ZOLL Defib Dashboard software installed on the receiving equipment. R Series defibrillators use the Microsoft Windows file structure for stored records.
Transferring a Full Disclosure File to a Compact Flash Card To remove a compact flash card: Press the release button and pull the card out of the slot. Figure 12-2. Removing a Compact Flash Card Transferring a Full Disclosure File to a Compact Flash Card Make sure that a compact flash card is installed in the slot on the left side of the device. To transfer data to a compact flash card: 1. Turn the Mode Selector to ON. 2. Press the Manual Mode softkey.
CHAPTER 12 FILE TRANSFER Transferring Device Check and Activity Log Files to a Compact Flash Card Make sure that a compact flash card is installed in the slot on the left side of the device. To copy the Device Check or Activity Log to a CF card: 1. Turn the Mode Selector to ON. 2. Press the Manual Mode softkey. Note: If the CONFIRM MANUAL MODE message displays, press the Confirm softkey to enter the Manual mode of operation. 3. Press the Report Data softkey. 4. Press the Transfer Mode softkey. 5.
Transferring Full Disclosure Files Through Wi-Fi (R Series Plus Only) To transfer data through the USB port: 1. Turn the Mode Selector to ON. 2. Press the Manual Mode softkey. Note: If the CONFIRM MANUAL MODE message displays, press the Confirm softkey to enter the Manual mode of operation. 3. Press the Report Data softkey. 4. Press the Transfer Mode softkey. 5. Press the More softkey. 6. Press the Enable USB softkey. The R Series is now in USB Transfer Mode. 7.
CHAPTER 12 FILE TRANSFER Note: Enable Report ID must be enabled in System Configuration mode for the report screen to appear (See the R Series Configuration Guide). If Enable Report ID is set to No, then the screen will not be displayed and the report will be sent immediately. 7. To send the report, press the Send Report softkey. The R Series is now in Wi-Fi Transfer Mode and a status text message box appears in the middle of the screen and describes the status of the file being sent.
Transferring Device Check and Activity Log Files Through Wi-Fi (R Series Plus Only) Note: If the CONFIRM MANUAL MODE message displays, press the Confirm softkey to enter the Manual mode of operation. 3. Press the Report Data softkey. 4. Press the Transfer Mode softkey. 5. Press the More softkey. 6. Press the Defib History to Wi-Fi softkey. The R Series is now in Wi-Fi Transfer Mode and a status text message box appears in the middle of the screen and describes the status of the files being sent.
CHAPTER 12 FILE TRANSFER TRANSFER FAILED Invalid Wi-Fi configuration Error Number: N Contact Network Administrator The transfer failed because the Wi-Fi configuration was illegal. N indicates one of following error codes: N = 1: Local Static IP settings Action: If running in Static IP mode, make sure that the relevant static IP addresses are not 0.0.0.0.
Transferring Device Check and Activity Log Files Through Wi-Fi (R Series Plus Only) TRANSFER FAILED Invalid Wi-Fi configuration Error Number: N Contact Network Administrator (cont.) N = 8: The Defib Upload Server's Username / Password are blank within the Full Disclosure and Defib History server configuration items Data COMM II only) Action: If Full Disclosure Transfer Mode is set to Server, make sure that the Username (Full Disclosure) and Password (Full Disclosure) entries are valid.
CHAPTER 12 FILE TRANSFER TRANSFER FAILED Network Error: Unknown [-7002] Action: Make sure that no illegal characters are used for the SSID names. TRANSFER FAILED Wi-Fi Network Not Found Contact Network Administrator The R Series could not associate with a Wi-Fi network. Action: 1) Make sure that the configuration values for the SSID names are correct. 2) Make sure that the R Series unit is within range of the wireless server. 3) Contact the Network Administrator for assistance.
Transferring Device Check and Activity Log Files Through Wi-Fi (R Series Plus Only) TRANSFER FAILED Unsupported Wi-Fi Card Verify Installation of Wi-Fi Card The card installed in the CF slot is not an R Series Data COMM or Data COMM II card. TRANSFER FAILED Authentication Error The encryption passphrase/key is incorrect. Action: Make sure that the correct Wi-Fi card is properly installed in the unit. Action: Contact the Network Administrator for assistance.
CHAPTER 12 FILE TRANSFER 12–12 www.zoll.com 9650-0904-01 Rev.
Chapter 13 Maintenance Defibrillator equipment must be maintained to be ready for immediate use. The defibrillator should be tested daily. The R Series defibrillator gives you two readiness testing options: • Automatic • Manual Note: Both automatic and manual test results are automatically recorded to internal memory. Maintenance Frequency Visual Inspection Once per day, inspect Code Readiness indicator.
CHAPTER 13 MAINTENANCE Routine Procedures Daily Visual Inspection Equipment Ensure that the unit is clean (with no fluid spills) and free of visible damage. Inspect all cables, cords, and connectors for good condition (no cuts, fraying or bent pins). Check that the paddle surfaces are clean and free of electrolyte gel and other contaminants.
Manual Defibrillator Testing Code Readiness Test The R Series defibrillator performs Code Readiness tests automatically to verify its integrity and readiness for emergency use. These tests verify the following: • Battery — Verifies that the battery state of charge is sufficient for at least one hour of continuous monitoring and ten shocks at maximum energy.
CHAPTER 13 MAINTENANCE If a LOW BATTERY message appears during testing, the battery is close to depletion and should be replaced or recharged. Before you begin 1. Connect the R Series to AC mains. 2. Do one of the following: • Connect unopened OneStep electrodes to the OneStep cable, (Unopened OneStep electrodes act as a test port. The test port capability no longer functions once the electrode package is opened and electrodes are deployed.
Manual Defibrillator Testing 9. Press paddles firmly into their wells and using your thumbs, simultaneously press and hold the SHOCK buttons (one on each paddle) until the shock is delivered. The unit displays the message 30J TEST OK and prints a stripchart indicating 30J TEST OK and the delivered energy. If the message 30J TEST FAILED appears, contact appropriate technical personnel or the ZOLL Technical Service Department.
CHAPTER 13 MAINTENANCE 4. When the Ready tone sounds, press the SHOCK button on the front panel until the shock is delivered. The unit displays the message 30J TEST OK and displays a shock count of 1. If the message 30J TEST FAILED appears, contact appropriate technical personnel or the ZOLL Technical Service Department. Pacer Testing 1. Turn the Mode Selector to ON. 2. Press the Manual Mode softkey.
Manual Defibrillator Testing • 10 mm ±1.0 mm high Code Readiness Log Each automatic and manual defibrillation test result is stored in internal non-volatile memory, the Code Log. A total of 1000 Code Readiness test records can be stored in internal memory. When the Code Readiness Log is full, the oldest records are erased on a first-in-first-out (FIFO) basis. The Code Readiness Log can be transferred to an external computing device (see “Transferring Files to an External Device” on page 12-1).
CHAPTER 13 MAINTENANCE 5. To print a specific test, use the Prev Test and Next Test softkeys to select the test, then press Print Test, or press Print Test Log to print the log of all of the tests. Code Readiness Test Log Date: 10 NOV 06 00:01:03 Battery: OK 30J Self Test: OK Type: Automatic OneStep Cable: OK Defib: OK Pace: OK ECG: OK AC Power: Connected Print Test Log 13–8 Print Test Prev Test Next Test Figure 13-1. Code Readiness Test Log Print Display Figure 13-2.
Manual Defibrillator Testing Setting Time and Date To set the unit’s time and date: 1. Turn the Mode Selector to ON. 2. Press the Manual Mode softkey. Note: If the CONFIRM MANUAL MODE message displays, press the Confirm softkey to enter the Manual mode of operation. 3. Press the Options softkey. 4. Press More. 5. Press Set Clock. The month field will be highlighted. Set Time May Prev Field Figure 13-4. 02, 08 Inc Value 16 Dec Value : Next Field 37 Enter and Return Set Time Screen 6.
CHAPTER 13 MAINTENANCE ZOLL recommends cleaning the device, paddles, and cables with a soft damp cloth using the approved cleaning agents. The external printer parts should be cleaned with a damp, soft cloth only. Do not immerse any part of the defibrillator (or its accessories) in water. Do not use ketones (such as acetone or MEK) on the defibrillator. Do not sterilize the defibrillator. Avoid using abrasives (including paper towels) on the display window.
Manual Defibrillator Testing 3P/ 3P/ Figure 13-6. Inserting the Paper and Closing Printer Door After the paper is loaded, press the RECORDER button to resume printing. Note: To ensure you have loaded the paper properly, check to make sure the arrows printed on the red, grid side of the paper point upward. Cleaning the Print Head To clean the recorder print head, perform the following steps: 1. Press the release button, and allow the printer door to open (see Figure 13-5); then remove any paper. 2.
Operator’s Checklist for R Series Product Recommended checks and procedures to be performed daily or weekly, depending on Automatic Test configuration. 1. Condition Date ______________________________________________ Location ____________________________________________ Unit Serial Number ___________________________________ Remarks Unit clean, no spills, clear of objects on top, case intact 2. Hands-free Therapy electrodes 1 set preconnected / 1 spare 3.
Chapter 14 Troubleshooting The troubleshooting information provided in this chapter is intended for use by nontechnical medical personnel during device operation. This chapter answers many of the common problems or questions that may arise during operation. If trouble persists after consulting this guide, contact the appropriate technical personnel or ZOLL Technical Service Department. Refer to the R Series Plus/BLS Service Manual for more detailed troubleshooting information.
CHAPTER 14 TROUBLESHOOTING Symptom Recommended Action 3. Pad Expired; Replace Pads Check the expiration date on OneStep electrodes, and replace them if they are expired. 4. Poor Pad Condition; Replace Pads OneStep electrode condition sensor indicates that the electrode gel has dried or aged beyond its specifications. The electrodes may no longer provide optimal therapy. Replace therapy electrodes.
Monitor Symptom Recommended Action 6. Noisy ECG, artifact, wandering baseline • Consider 1 – 21Hz filter bandwidth (see R Series Configuration Manual). • Prepare the patient’s skin prior to electrode attachment. • Check for proper adhesion of electrodes to patient. • Reduce or eliminate ECG artifact due to electrode or patient cable movement. Route cables so that they don’t pull on electrodes or swing excessively. • Ensure patient is motionless.
CHAPTER 14 TROUBLESHOOTING Recorder Symptom Recommended Action 1. CHECK RECORDER message • Recorder out of paper. • Remove paper, check paper type, check recorder for paper jam, and reload paper. • Recorder door is open. • Paper is loaded upside down. 2. Recorder makes stuttering sound when activated. • Check recorder for paper jam. 3. Light or poor quality printing • Ensure correct paper is in use. • Ensure paper is installed grid side against recorder print head.
Defibrillator Symptom Recommended Action 4. Patient on “Standby” pacing gets paced intermittently. • Ensure proper ECG electrode or OneStep Pacing/ Complete electrode connection and placement. If ECG lead wire comes off, pacer will automatically pace asynchronously. • Check ECG cable for damage. • Patient R-to-R interval varying. Pace rate close to patient’s heart rate. • Verify rate is set appropriately. 5. Heart rate display reads 0 with proper pacing capture displayed on ECG trace.
CHAPTER 14 TROUBLESHOOTING 14–6 Symptom Recommended Action 4. Energy does not discharge when the SHOCK button(s) is pressed. • 60 or 120 seconds (user configurable) have elapsed in Manual mode since initial charge ready. Energy was internally discharged. • Device is in Sync mode or Remote Sync mode and no QRS complex is detected. • Energy internally discharged because energy selection was changed during charge or after the device was ready.
Defibrillator Symptom Recommended Action 8. CHECK PADS or ATTACH PADS message • Verify proper OneStep cable / hands-free therapy electrode connection by disconnecting and reconnecting the OneStep cable and hands-free therapy electrodes. • Ensure proper contact of hands-free therapy electrodes and that the patient does not have excessive hair beneath the electrodes. • OneStep cable is defective. If message persists, disconnect OneStep cable from therapy pads, and plug cable into test connector.
CHAPTER 14 TROUBLESHOOTING AC Charger Symptom Recommended Action 1. The Battery indicator is alternately illuminating green and yellow. • • • • Verify battery is installed. Turn unit ON to identify the fault condition. Replace battery pack with a fully charged battery pack. If problem persists, replace battery pack, unplug device from AC mains for more than 10 seconds and plug device back into AC mains. 2. LOW BATTERY message appears • Verify that the AC Power Indicator is illuminated.
Appendix A Specifications This section describes the specifications for the R Series Defibrillator as well as the ECG rhythm analysis algorithm. • • • • • • “Defibrillator Specifications” on page A-2 “Battery Pack Specifications” on page A-6 “IEC 60601-1-2 Specifications” on page A-7 “R Series Rectilinear Biphasic Waveform Characteristics” on page A-13 “Clinical Trial Results for the Biphasic Waveform” on page A-25 “ECG Rhythm Analysis Algorithm Accuracy” on page A-29 9650-0904-01 Rev.
APPENDIX A SPECIFICATIONS Defibrillator Specifications General Size (height • width • length) 8.2 in. • 10.5 in. • 12.5 in. with handle or 10.0 in. without handle 20.8 cm • 26.7 cm • 31.7 cm with handle or 25.4 cm without handle Weight 13.6 lb (6.17 kg) with OneStep cable and battery pack 15.2 lb (6.
Defibrillator Specifications Messages ERASING REPORT, INSERT CARD, REPLACE BATTERY, LOW BATTERY, PERFORM CPR, NOISY ECG, RETRY ANALYSIS, CHECK PATIENT, ANALYSIS HALTED, PRESS ANALYZE, NO SHOCK ADV.
APPENDIX A SPECIFICATIONS Automatic Defibrillator Test Verifies defibrillator charging and discharging without removing paddles from storage wells or with OneStep cable connected to the Test Port or OneStep electrodes. Defibrillation advisory Evaluates electrode connection and patient ECG to determine if defibrillation is required.
Defibrillator Specifications Heart rate accuracy ±5% Heart rate alarm Screen icon indicates activated/deactivated status. User selectable. Tachycardia: 60 to 280 beats per minute Bradycardia: 20 to 100 beats per minute Tall T-wave Rejection < 0.8 mV Heart Rate Averaging The R Series averages the interval between the last 5 detected beats. On startup, the R Series averages the rate between detected beats once two beats are detected, until a full 5 beats have been received.
APPENDIX A SPECIFICATIONS Printing method High-resolution, thermal array print head Printout modes Manual or automatic; user-configurable Data card Type Compact flash card Sync in / Marker out / ECG out Sync In Marker Out 0-5 V (TTL Level) pulse, active high, 5 to 15 msec in duration, no closer than 200 ms apart. Energy transfer begins within 25 ms of the leading edge of the external sync pulse.
IEC 60601-1-2 Specifications IEC 60601-1-2 Specifications This section provides specification tables for the R Series as per IEC 60601-1-2. Electromagnetic Emissions Declaration Guidance and manufacturer’s declaration — electromagnetic emissions for the R Series. The R Series is intended for use in the electromagnetic environment specified below. The customer or user of the R Series should ensure that it is used in such an environment.
APPENDIX A SPECIFICATIONS Electromagnetic Immunity Declaration (EID) Guidance and manufacturer’s declaration — electromagnetic immunity for the R Series. The R Series is intended for use in the electromagnetic environment specified below. The customer or user of the R Series should ensure that it is used in such an environment.
IEC 60601-1-2 Specifications EID for Life-Support Functions Guidance and manufacturer’s declaration – electromagnetic immunity – for life-supporting equipment and systems. The life-support functions a of the R Series are intended for use in the electromagnetic environment specified below. The customer or user of the R Series should ensure that it is used in such an environment.
APPENDIX A SPECIFICATIONS Recommended Separation Distances from RF Equipment for the R Series Life-Support Functions Recommended separation distances between portable and mobile RF communications equipment and the R Series. The life-support functions a of the R Series are intended for use in the electromagnetic environment in which radiated RF disturbances are controlled.
IEC 60601-1-2 Specifications EID for Non–Life-Support Functions Guidance and manufacturer’s declaration – electromagnetic immunity – for non– life-supporting equipment and systems. The non–life-support functions a of the R Series are intended for use in the electromagnetic environment specified below. The customer or user of the R Series should ensure that it is used in such an environment.
APPENDIX A SPECIFICATIONS Recommended Separation Distances from RF Equipment for the R Series Non–Life-Support Functions Recommended separation distances between portable and mobile RF communications equipment and the R Series. The non–life-support functions a of the R Series are intended for use in the electromagnetic environment in which radiated RF disturbances are controlled.
R Series Rectilinear Biphasic Waveform Characteristics R Series Rectilinear Biphasic Waveform Characteristics Table A-1 shows the characteristics of the R Series Rectilinear Biphasic® waveform when discharged into 25 ohm, 50 ohm, 100 ohm, 125 ohm, 150 ohm and 175 ohm loads at the maximum energy setting of 200 joules. Table A-1. R Series Rectilinear Biphasic Waveform Characteristics 200 J discharged into 25 50 100 125 150 175 Maximum initial current 31.4 A 30.4 A 19.7 A 19.4 A 16.7 A 15.
APPENDIX A Table A-2. Selected Energy SPECIFICATIONS Delivered Energy at Every Defibrillator Setting into a Range of Loads Load 25 50 75 100 125 150 175 Accuracy* 150 J 107 J 164 J 180 J 183 J 188 J 184 J 179 J ±15% 200 J 142 J 230 J 249 J 253 J 269 J 261 J 260 J ±15% * For all energy levels, accuracy is equal to either ±15% or 3 joules, whichever is greater.
R Series Rectilinear Biphasic Waveform Characteristics 30 20 10 0 2 4 6 8 10 12 A 0 -10 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -20 -30 ms Figure A-2. Rectilinear Biphasic Waveform at 150 Joules 30 20 10 0 2 4 6 8 A 0 -10 10 12 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -20 -30 ms Figure A-3. 9650-0904-01 Rev.
APPENDIX A SPECIFICATIONS 25 20 15 10 5 0 2 4 6 8 10 12 A 0 -5 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -10 -15 -20 -25 ms Figure A-4. Rectilinear Biphasic Waveform at 100 Joules 25 20 15 10 5 0 2 4 6 8 A 0 -5 10 12 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -10 -15 -20 -25 ms Figure A-5. A–16 Rectilinear Biphasic Waveform at 85 Joules www.zoll.com 9650-0904-01 Rev.
R Series Rectilinear Biphasic Waveform Characteristics 25 20 15 10 A 5 0 0 2 4 6 8 10 12 -5 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -10 -15 -20 ms Figure A-6. Rectilinear Biphasic Waveform at 75 Joules 25 20 15 10 A 5 0 0 2 4 6 8 -5 10 12 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -10 -15 -20 ms Figure A-7. 9650-0904-01 Rev.
APPENDIX A SPECIFICATIONS 20 15 10 5 0 2 4 6 8 10 12 A 0 -5 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -10 -15 -20 ms Figure A-8. Rectilinear Biphasic Waveform at 50 Joules 15 10 5 0 2 4 6 8 A 0 -5 10 12 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -10 -15 ms Figure A-9. A–18 Rectilinear Biphasic Waveform at 30 Joules www.zoll.com 9650-0904-01 Rev.
R Series Rectilinear Biphasic Waveform Characteristics 15 10 5 0 2 4 6 8 10 12 A 0 -5 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -10 -15 ms Figure A-10. Rectilinear Biphasic Waveform at 20 Joules 10 8 6 4 2 0 2 4 6 8 A 0 -2 10 12 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -4 -6 -8 -10 ms Figure A-11. 9650-0904-01 Rev.
APPENDIX A SPECIFICATIONS 8 6 4 2 0 2 4 6 8 10 12 A 0 -2 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -4 -6 -8 ms Figure A-12. Rectilinear Biphasic Waveform at 10 Joules 8 6 4 2 0 2 4 6 8 A 0 -2 10 12 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -4 -6 -8 ms Figure A-13. A–20 Rectilinear Biphasic Waveform at 9 Joules www.zoll.com 9650-0904-01 Rev.
R Series Rectilinear Biphasic Waveform Characteristics 8 6 4 2 0 2 4 6 8 10 12 A 0 -2 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -4 -6 -8 ms Figure A-14. Rectilinear Biphasic Waveform at 8 Joules 8 6 4 A 2 0 0 2 4 6 8 10 12 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -2 -4 -6 ms Figure A-15. 9650-0904-01 Rev.
APPENDIX A SPECIFICATIONS 6 4 2 0 2 4 6 8 10 12 A 0 -2 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -4 -6 ms Figure A-16. Rectilinear Biphasic Waveform at 6 Joules 6 4 2 0 2 4 6 8 A 0 -2 10 12 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -4 -6 ms Figure A-17. A–22 Rectilinear Biphasic Waveform at 5 Joules www.zoll.com 9650-0904-01 Rev.
R Series Rectilinear Biphasic Waveform Characteristics 5 4 3 2 1 0 2 4 6 8 10 12 A 0 -1 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -2 -3 -4 -5 ms Figure A-18. Rectilinear Biphasic Waveform at 4 Joules 5 4 3 2 A 1 0 0 2 4 6 8 -1 10 12 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -2 -3 -4 ms Figure A-19. 9650-0904-01 Rev.
APPENDIX A SPECIFICATIONS 4 3 2 1 0 2 4 6 8 10 12 A 0 -1 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -2 -3 -4 ms Figure A-20. Rectilinear Biphasic Waveform at 2 Joules 2.5 2 1.5 1 0.5 0 2 4 6 8 A 0 -0.5 10 12 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -1 -1.5 -2 -2.5 ms Figure A-21. A–24 Rectilinear Biphasic Waveform at 1 Joule www.zoll.com 9650-0904-01 Rev.
Clinical Trial Results for the Biphasic Waveform Clinical Trial Results for the Biphasic Waveform The efficacy of the ZOLL Rectilinear Biphasic waveform has been clinically verified during a study of defibrillation of Ventricular Fibrillation (VF) and Ventricular Tachycardia (VT). A feasibility study was performed initially for defibrillation of VF/VT (n=20) on two separate groups of patients to ensure waveform safety and energy selection.
APPENDIX A SPECIFICATIONS Successful defibrillation with rectilinear biphasic shocks was achieved with 58% less delivered current than with monophasic shocks (14±1 amperes versus 33±7 amperes, p=0.0001). The difference in efficacy between the rectilinear biphasic and the monophasic shocks was greater in patients with high transthoracic impedance (greater than 90 ohms).
Clinical Trial Results for the Biphasic Waveform The total efficacy of consecutive rectilinear biphasic shocks was significantly greater than that of monophasic shocks. The following table displays the Kaplan-Meier (product-limit) "survival" curves for each of the two waveforms. As all patients begin in the failure mode, the estimated life-table probabilities refer to the chance of still being in failure after the kth shock (k=1,2,3,4): Table A-3.
APPENDIX A SPECIFICATIONS Recommended Anterior/Posterior Placement Back/ Posterior Front/ Apex Place the front (apex) pad on the third intercostal space, mid clavicular line on the right anterior chest. The back/posterior pad should be placed in the standard posterior position on the patient’s left as shown. A–28 www.zoll.com 9650-0904-01 Rev.
ECG Rhythm Analysis Algorithm Accuracy ECG Rhythm Analysis Algorithm Accuracy Sensitivity and specificity are expressions of ECG rhythm analysis algorithm performance when compared to ECG interpretation by a clinician or expert. Sensitivity refers to the algorithm’s ability to correctly identify shockable rhythms (as a percentage of the total number of shockable rhythms).
APPENDIX A SPECIFICATIONS Table A-5. Clinical Performance Results (Pediatric Patients) Rhythms Sample Size (9 second records) Shockable (49 patients) Performance Goals Observed Performance 90% One-sided Lower Confidence Limit Sensitivity Coarse VF 42 >90% 100.0% 93.1% Rapid VT 79 >75% 100.0% 96.3% Nonshockable (155 patients) Specificity NSR 208 >99% 100.0% 98.6% AF, SB, SVT a, heart block, idioventricular, PVCs 348 >95% 99.4% 98.2% 29 >95% 100% 90.
Appendix B R Series Accessories The following accessories are compatible for use with R Series products. To order any of these items, contact your local ZOLL representative.
APPENDIX B R SERIES ACCESSORIES Internal autoclavable handles, with switch 8011-0501-01 Molded autoclavable internal handles, no switch 8011-0140-XX Molded autoclavable internal handles, with switch 8011-0141-XX Cables REF OneStep Cable (100-240V, 50/60Hz) 8009-0749 OneStep Pacing Cable (100-240V, 50Hz) 8009-0750 AAMI 3-Lead Wire ECG Patient Cable 8000-0025-02 (6’) 8000-0025 (12”) AAMI 3-Lead Wire ECG Patient Cable, ESU 9500-000693 IEC 3-Lead ECG Patient Cable 8000-0026 AAMI 5-Lead Wire
LNOP DC-12 LNOP Adult Reusable Direct Connect 12’ Cable 8000-0296 EtCO2 Sensors and Cables REF CAPNOSTAT 5 CO2 Sensor and Cable 8000-0312-01 SPU Pediatric/Adult Airway Adapter 8000-0260-01 SPU Neonatal/Pediatric Airway Adapter 8000-0261-01 Reusable Adult Airway Adapter 8000-0262-01 Reusable Neonatal/Pediatric Airway Adapter 8000-0263-01 SPU Pediatric/Adult Airway Adapter with Mouthpiece 8000-0265-01 CAPNO2mask, Large Adult 8000-0761 CAPNO2mask, Standard Adult 8000-0760 CAPNO2mask, Pediat
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Appendix C Wi-Fi Radio Module Information If this defibrillator contains an optional low power Wi-Fi radio module, it transmits information between the defibrillator and a wireless network (infrastructure mode). The module complies with the following standards: • Part 15 of the FCC Rules.
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R Series ® ALS Operator’s Guide 9650-0912-01 Rev.
The issue date for the R Series Operator’s Guide ALS (REF 9650-0912-01 Rev. K) is December 2013. If more than 3 years have elapsed since the issue date, contact ZOLL Medical Corporation to determine if additional product information updates are available. Copyright © 2013 ZOLL Medical Corporation. All rights reserved.
Table of Contents Chapter 1 General Information Product Description ............................................................................................................ 1-1 How to Use This Manual..................................................................................................... 1-2 Operator’s Guide Updates .................................................................................................. 1-3 Unpacking ...............................................................
TABLE OF CONTENTS Chapter 2 Product Overview Defibrillator Controls and Indicators.................................................................................... 2-1 The Front Panel .......................................................................................................... 2-3 Display Screen ............................................................................................................ 2-5 Patient Cables and Connectors .....................................................
Chapter 5 Synchronized Cardioversion Synchronized Cardioversion Procedure ............................................................................. 5-2 Determine the Patient’s Condition and Provide Care Following Local Medical Protocols .................................................................................................................. 5-2 Prepare Patient ........................................................................................................... 5-2 1 Select DEFIB .......
TABLE OF CONTENTS Special Pacing Applications................................................................................................ 8-7 Standby Pacing ........................................................................................................... 8-7 Asynchronous Pacing ................................................................................................. 8-7 Pediatric Pacing ....................................................................................................
Transferring a Full Disclosure File to a Compact Flash Card ........................................... 11-3 Transferring Device Check and Activity Log Files to a Compact Flash Card ................... 11-3 Transferring Files Through the USB Port (Optional)......................................................... 11-4 Transferring Full Disclosure Files Through Wi-Fi (Optional)............................................. 11-5 Transferring Device Check and Activity Log Files Through Wi-Fi (Optional).........
TABLE OF CONTENTS R Series Rectilinear Biphasic Waveform Characteristics .................................................A-13 Clinical Trial Results for the Biphasic Waveform ..............................................................A-25 Randomized Multicenter Clinical Trial for Defibrillation of Ventricular Fibrillation (VF) and Ventricular Tachycardia (VT) ...................................................................
Chapter 1 General Information Product Description The ZOLL® R Series® products combine a defibrillator, ECG display, advanced monitoring capabilities, and Noninvasive Transcutaneous Pacing (NTP) with communication, data printing and recording capabilities in a single lightweight portable instrument. The unit has been designed for all resuscitation situations and its small, compact, lightweight design makes it ideal for accompanying patients during transport.
CHAPTER 1 GENERAL INFORMATION Real CPR Help® requires the use of OneStep™ CPR electrodes or OneStep Complete electrodes. When using these pads, the displayed ECG waveforms can be adaptively filtered, using the See-Thru CPR® feature, to reduce the artifact caused by chest compressions. The R Series is a Code-Ready® defibrillator.
Operator’s Guide Updates Operator’s Guide Updates An issue or revision date for this manual is shown on the front cover. If more than three years have elapsed since this date, contact ZOLL Medical Corporation to determine if additional product information updates are available. All users should carefully review each manual update to understand its significance and then file it in its appropriate section within this manual for subsequent reference.
CHAPTER 1 GENERAL INFORMATION Symbol Description Type B patient connection. Type BF patient connection. Type CF patient connection. Defibrillator-proof type BF patient connection. Defibrillator-proof type CF patient connection. Fusible link. Equipotentiality. Alternating current (AC). ,I 2. 45 2% )/. Direct current (DC). Contains lithium. Recycle or dispose of properly. R EC Y C LE ,I )/. Keep away from open flame and high heat. Do not open, disassemble, or intentionally damage.
Symbols Used on the Equipment Symbol Description Return to a collection site intended for waste electrical and electronic equipment (WEEE). Do not dispose of in unsorted trash. Date of manufacture. Use by. Latex-free. Do not reuse. Do not fold. Not sterile. Nonionizing electromagnetic radiation from Wi-Fi during data transfer. Manufacturer. Authorized representative in the European Community. Serial Number. Catalogue number. Consult instructions for use. Prescription only. 9650-0912-01 Rev.
CHAPTER 1 GENERAL INFORMATION Symbol Description Maximum energy. Test port. Conventions This guide uses the following conventions: Within text, the names and labels for physical buttons and softkeys appear in boldface type (for example, “Press the SHOCK button or the Code Marker softkey”). This guide uses uppercase italics for audible prompts and for text messages displayed on the screen (for example, CHECK PATIENT).
Defibrillator Function In manual mode, the unit can also be used for synchronized cardioversion of certain atrial or ventricular arrhythmias. A qualified physician must decide when synchronized cardioversion is appropriate. The advisory function should be used to confirm ventricular fibrillation or wide complex ventricular tachycardia (greater than 150 beats per minute) in patients meeting the three conditions indicating lack of circulation (listed above).
CHAPTER 1 GENERAL INFORMATION External Pacemaker (Optional) Some R Series products include an optional transcutaneous pacemaker consisting of a pulse generator and ECG-sensing circuitry. Noninvasive transcutaneous pacing (NTP) is an established and proven technique. This therapy is easily and rapidly applied in both emergency and nonemergency situations when temporary cardiac stimulation is indicated. The output current of the pacemaker is continuously variable from 0 to 140 mA.
External Pacemaker (Optional) • Suppression of tachycardia. Increased heart rates in response to external pacing often suppress ventricular ectopic activity and might prevent tachycardia. WARNING! This device must not be connected to internal pacemaker electrodes. Pacemaker Complications Ventricular fibrillation does not respond to pacing and requires immediate defibrillation. Therefore, the patient’s dysrhythmia must be determined immediately, so that you can employ appropriate therapy.
CHAPTER 1 GENERAL INFORMATION Pediatric Pacing Pacing can be performed on pediatric patients weighing 55 lb. (25 kg) or less using ZOLL pediatric hands-free therapy electrodes. Prolonged pacing (in excess of 30 minutes), particularly in neonates, can cause burns. Periodic inspection of the underlying skin is recommended.
Intended Use — NIBP Intended Use — NIBP The ZOLL R Series NIBP option is indicated for the non-invasive measurement of arterial blood pressure for resting patients in critical care and in-hospital transport.
CHAPTER 1 GENERAL INFORMATION Paddles and Electrodes The R Series will defibrillate, cardiovert, and monitor ECG using either defibrillation paddles or hands-free therapy electrodes. The pacer version of the R Series will pace using ZOLL hands-free therapy electrodes. ENERGY SELECT, CHARGE and SHOCK controls are located on the paddles and front panel. When using hands-free therapy electrodes, you must use the controls on the front panel of the unit.
Code-Ready System You can charge the battery by either of the following methods: • Internal charging — plug the R Series into an AC power supply to automatically begin charging the installed battery pack. The front panel battery indicator operates as follows: When the indicator is: Note: It means: Steady yellow Battery is charging Steady green Battery is charged Alternating yellow and green No battery is installed or a battery charging fault has been detected.
CHAPTER 1 GENERAL INFORMATION Warnings General Federal (U.S.A.) law restricts this defibrillator to use by or on the order of a physician. Only appropriately trained, skilled personnel who are familiar with equipment operation should perform emergency defibrillation. The prescribing physician should determine what training, such as Advanced Cardiac Life Support (ACLS) or Basic Life Support (BLS) certification, is appropriate.
Warnings ECG Analysis, Defibrillating, Pacing and CPR Prior to attempting synchronized cardioversion, ensure the ECG signal quality is good and that sync markers are displayed above each QRS complex. Do not use the unit in advisory mode during patient movement. A patient must be motionless during ECG rhythm analysis. Do not touch the patient during analysis. If transporting the patient, cease all movement before beginning ECG analysis.
CHAPTER 1 GENERAL INFORMATION Do not use the unit near or within standing water. Electrical safety might be compromised when the defibrillator is wet. Never discharge the unit with the defibrillation electrodes or paddles shorted together or in open air. Do not discharge the defibrillator except as indicated in the instructions. Discharge the defibrillator only when defibrillation electrodes or paddles are properly applied to the patient.
Warnings To ensure patient safety, connect the R Series only to equipment with galvanically isolated circuits. Use only high-quality ECG electrodes. ECG electrodes are for rhythm acquisition only; you cannot use ECG electrodes for defibrillation or pacing. Do not use therapy or ECG electrodes if the gel is dried, separated, torn or split from the foil; patient burns may result from using such electrodes. Poor adherence and/or air pockets under therapy electrodes can cause arcing and skin burns.
CHAPTER 1 GENERAL INFORMATION Cautions If the unit is to be stored longer than 90 days, remove the battery pack. Do not sterilize the defibrillator, or its accessories unless the accessories are labelled as sterilizable. Do not immerse any part of the defibrillator in water. Do not use ketones (such as acetone or MEK) on the defibrillator. Avoid using abrasives (including paper towels) on the display window.
FDA Tracking Requirements FDA Tracking Requirements U.S. Federal Law (21 CFR 821) requires the tracking of defibrillators. Under this law, owners of this defibrillator must notify ZOLL Medical Corporation if this product is • received • lost, stolen, or destroyed • donated, resold, or otherwise distributed to a different organization If any such event occurs, contact ZOLL Medical Corporation in writing with the following information: 1.
CHAPTER 1 GENERAL INFORMATION Software License Note: Read this Operator’s Guide and License agreement carefully before operating any of the R Series products. Software incorporated into the system is protected by copyright laws and international copyright treaties as well as other intellectual property laws and treaties. This software is licensed, not sold. By taking delivery of and using this system, the Purchaser signifies agreement to and acceptance of the following terms and conditions: 1.
The ZOLL Serial Number When requesting service, please provide the following information to the service representative: • Unit serial number • Description of the problem • Department using the equipment and name of the person to contact • Purchase order to allow tracking of loan equipment • Purchase order for a unit with an expired warranty • Sample ECG or other stripcharts demonstrating the problem (if available and applicable), less any confidential patient information.
The first two characters of the date-of-manufacture code give the last two digits of the year (for example, “06” appears for products manufactured in 2006). The last character of the date-of-manufacture code gives the month in which the product was manufactured. The month appears in the form of a single alphanumeric character: “A” for January, “B” for February, “C” for March, and so on through “L” for December.
Chapter 2 Product Overview Defibrillator Controls and Indicators 1 SHOCK LEAD ANALYZE CHARGE SIZE ALARM SUSPEND ENERGY SELECT RECORDER MONITOR DEFIB OFF PACER OUTPUT mA 4:1 RATE ppm 2 3 3 4 9 Front Left Right 7 8 56 15 11 10 ? Top Rear SpO2 13 14 12 9650-0912-01 Rev.
CHAPTER 2 PRODUCT OVERVIEW Table 2-1. 2–2 R Series Unit Features Item Description 1 Front panel Includes the display screen and primary controls. 2 Handle Integrated carrying handle. 3 External paddle well Holds paddles when not in use. Allows defib self-test when paddles are stowed in their respective wells. 4 Beeper Emits R-wave detection beeps, defib charge Ready tones, and alarm tones. 5 USB host connector (Optional) (Reserved for future use — do not connect to any equipment.
Defibrillator Controls and Indicators The Front Panel The front panel of the R Series device includes the display screen, softkeys, battery indicator, AC power indicator, Code Readiness indicator, SHOCK button, and control panel. The control panel configuration varies slightly depending on the model. See Figure 2-1.
CHAPTER 2 PRODUCT OVERVIEW Table 2-2. R Series Controls and Indicators (continued) Control or Indicator Description Mode Selector Selects the mode of operation (available options depend on model): • • • • OFF — Unit is powered off.
Defibrillator Controls and Indicators Table 2-2. R Series Controls and Indicators (continued) Control or Indicator Description 4:1 Button (optional) This button is used to determine a patient’s underlying ECG rhythm. While depressed, this button causes pacing stimuli to be delivered at ¼ of the indicated ppm setting. When the button is released, normal pacing resumes.
CHAPTER 2 PRODUCT OVERVIEW ECG Rate and Depth Indicators CPR Idle Time SpO2 values and alarm indicator (optional) SpO2% NIBP values and alarm indicator (optional) NIBP 120 80 Depth Rate Elapsed time Softkey labels Ɔ PPI 72 mmHg CO2 RR 35 13 11:24 Options Heart rate (beats per minute) Messages Trace 1 I 100 CO2 values and alarm indicator (optional) CPR ECG I x1 IDLE 0:00 99 • size • selected lead • alarm indicator • heartbeat indicator CPR Index mmHg Trace 2 II Trace 3 III Mode/Me
Defibrillator Controls and Indicators Patient Cables and Connectors The back of the unit includes a set of connectors for patient cables. Sync In/ Marker Out/ ECG Out Figure 2-3. NIBP (optional) EtCO2 (optional) ECG SpO2 (optional) OneStep Cable Patient Cable Connectors Connector Description OneStep Cable For connecting paddles or ZOLL hands-free therapy and pacing electrodes using either OneStep or OneStep Pacing cables.
CHAPTER 2 PRODUCT OVERVIEW ECG Connector OneStep Pacing Cable OneStep Cable Figure 2-4. OneStep Cables OneStep Cable Manager (Optional) As an option, the OneStep Cable Manager is available to store and organize cables. OneStep Cable Manager Cable Caddy Figure 2-5. 2–8 The R Series with the Optional OneStep Cable Manager (Side View) www.zoll.com 9650-0912-01 Rev.
Defibrillator Controls and Indicators Power Cord The AC power cord is used to operate the R Series unit when battery power is not being used. An additional extension cord is available for use when the cable organizer accessory is attached to the unit. The extension cord plugs into the main AC power cord as shown below. External Paddles Paddles are defibrillation-proof Type BF equipment. The external paddles on the R Series device are used for defibrillation and synchronized cardioversion.
CHAPTER 2 PRODUCT OVERVIEW Attach the OneStep cable from the R Series unit to the connector at the base of the apex paddle. 1. Align OneStep cable as shown. Figure 2-7. 2. Insert OneStep cable into APEX paddle. Attaching the OneStep Cable to the APEX Paddle OneStep cable connected to APEX paddle Figure 2-8.
Working with Menus Pediatric-size electrodes are built into the paddle assembly beneath the standard electrode plates. The user must manually adjust energy settings to pediatric levels consistent with their institution’s protocols. PEDI button To expose the pediatric plate, press the PEDI button at the top of the paddle, then slide the Adult plate upward. Before replacing the Adult plate, be sure to clean the pediatric plate and surrounding area thoroughly.
CHAPTER 2 PRODUCT OVERVIEW The following table summarizes some of the more common softkeys. Softkey Action Next Item Next Field Moves the highlighting down to the next item in a vertical list. Prev Item Moves the highlighting up to the previous item in a vertical list. Next Digit Moves the highlighting to the right in a series of letters or digits. Prev Digit Moves the highlighting to the left in a series of letters or digits. Inc Inc Digit Increases the highlighted value or digit.
Common Tasks Common Tasks Follow the instructions in the subsequent sections for: • “Replacing a Battery Pack” on page 2-13. • “Adjusting Display Brightness” on page 2-13. • “Using Code Markers” on page 2-14. Replacing a Battery Pack 3P/ 3P/ To remove a battery pack, press the tab on the end of the battery pack inward, and lift the battery pack out of the compartment. ? ? Figure 2-12. Removing a Battery Pack To install a battery pack: 3P/ 3P/ 1.
CHAPTER 2 PRODUCT OVERVIEW 2. Press the High Bright or Low Bright softkey to select high and low brightness. Note: Brightness level affects battery run time. Selecting high bright will cause the battery charge to be depleted at a faster rate than when selecting low bright. Using Code Markers Pressing the CODE MARKER softkey causes the unit to display a preconfigured list of clinical actions.
Chapter 3 Manual Defibrillation Paddles are a defibrillation-protected Type BF patient connection. ECG leads are a defibrillation-protected Type CF patient connection. Emergency Defibrillation Procedure with Paddles WARNING! To avoid risk of electrical shock, do not allow electrolyte gel to accumulate on hands or paddle handles. When defibrillating with paddles, use your thumbs to operate the SHOCK buttons in order to avoid inadvertent operator shock.
CHAPTER 3 MANUAL DEFIBRILLATION Begin CPR Following Local Medical Protocols. Request additional assistance. 1 Select DEFIB Turn the Mode Selector to DEFIB. The unit automatically defaults to 120 joules or the preconfigured first shock energy selection. 1 RECORDER MONITOR DEFIB OFF PACER Note: Defibrillator PADDLES are selected as the ECG source when the instrument is turned to MONITOR or DEFIB with paddles connected to the OneStep cable.
Emergency Defibrillation Procedure with Paddles The selected energy level is shown as DEFIB XXXJ SEL. on the display. ECG DEFIB 120J SEL. 00:01 Options Code Marker Param Report Data Alarms Sync On/Off If you have configured Shocks 1, 2, and 3 to escalating energy levels (see the R Series Configuration Guide for instructions), the R Series automatically sets the energy to the preconfigured Energy Level: Shock 1, 2, 3 setting at power-up and after each of the first two shocks.
CHAPTER 3 MANUAL DEFIBRILLATION WARNING! Do not permit gel to accumulate between the paddle electrodes on the chest wall (gel bridge). This could cause burns and reduce the amount of energy delivered to the heart. If using defibrillator gel pads, make sure that the size of the pad is large enough to cover the entire paddle electrode area. The paddles may be used for ECG monitoring in emergency situations when time does not allow connection of standard ECG monitoring electrodes.
Autoclavable External Paddles 3 Deliver Shock WARNING! Warn all persons in attendance of the patient to STAND CLEAR prior to defibrillator discharge. Do not touch the bed, patient, or any equipment connected to the patient during defibrillation. A severe shock can result. Do not allow exposed portions of the patient’s body to come into contact with metal objects, such as a bed frame, as unwanted pathways for defibrillation current may result. Apply a force of 10 - 12 kilograms (22 - 26.
CHAPTER 3 MANUAL DEFIBRILLATION Emergency Defibrillation Procedure with Hands-Free Therapy Electrodes ZOLL hands-free therapy electrodes are a defibrillation-protected Type BF patient connection. ECG leads are a defibrillation-protected Type CF patient connection. Determine the Patient’s Condition Following Local Medical Protocols Verify: • Unconsciousness. • Absence of breathing. • Absence of pulse. Begin CPR Following Medical Protocols Request additional assistance.
Emergency Defibrillation Procedure with Hands-Free Therapy Electrodes When disconnecting the OneStep electrode and OneStep cable, press down the latch with your thumb as shown. Latch If defibrillation electrodes are not making good contact with the patient’s skin, the unit issues the messages CHECK PADS and POOR PAD CONTACT and does not allow delivery of energy. If a short circuit exists between the electrodes, the unit issues the message DEFIB PAD SHORT.
CHAPTER 3 MANUAL DEFIBRILLATION 1 Select DEFIB Turn the Mode Selector to DEFIB. The unit automatically defaults to 120 joules or the preconfigured first shock energy selection. 1 RECORDER MONITOR DEFIB OFF PACER PADS are selected as the ECG source when the instrument is turned to MONITOR or DEFIB and paddles are not connected to the OneStep cable. You may select any of the other ECG leads by pressing the front panel LEAD button.
Emergency Defibrillation Procedure with Hands-Free Therapy Electrodes The selected energy level is shown as DEFIB XXXJ SEL. on the display. ECG DEFIB 120J SEL. 00:01 Options Param Code Marker Report Data Alarms Sync On/Off If you have configured Shocks 1, 2, and 3 to escalating energy levels (see the R Series Configuration Guide for instructions), the R Series automatically sets the energy to the preconfigured Energy Level: Shock 1, 2, 3 setting at power-up and after each of the first two shocks.
CHAPTER 3 MANUAL DEFIBRILLATION 3 Deliver Shock WARNING! Warn all persons in attendance of the patient to STAND CLEAR prior to defibrillator discharge. Do not touch the bed, patient, or any equipment connected to the patient during defibrillation. A severe shock can result. Do not allow exposed portions of the patient’s body to come into contact with metal objects, such as a bed frame, as unwanted pathways for defibrillation current may result.
Chapter 4 Advisory Defibrillation ZOLL hands-free therapy electrodes are a defibrillation-protected Type BF patient connection. When the Mode Selector is turned to DEFIB and hands-free therapy electrodes are used, the R Series can identify shockable rhythms using its built in ECG analysis capability.
CHAPTER 4 ADVISORY DEFIBRILLATION Advisory Defibrillation Procedure Determine the Patient’s Condition Following Local Medical Protocols Verify: • Unconsciousness. • Absence of breathing. • Absence of pulse. Begin CPR Following Local Medical Protocols Request additional assistance. Prepare Patient Remove all clothing covering the patient’s chest. Dry chest if necessary. If the patient has excessive chest hair, clip or shave it to ensure proper adhesion of the electrodes.
Advisory Defibrillation Procedure When used with OneStep Pediatric electrodes, the default energy selections for pediatric patients are: • Shock 1 - 50 joules • Shock 2 - 70 joules • Shock 3 - 85 joules WARNING! Use only OneStep Pediatric electrodes to defibrillate patients under 8 years of age in Advisory mode. Use of adult electrodes, or pediatric electrodes other than OneStep Pediatric electrodes, can result in the delivery of excessive energy doses.
CHAPTER 4 ADVISORY DEFIBRILLATION Press the ANALYZE button to begin the analysis of the patient’s ECG rhythm and to determine if a shockable rhythm is present. ECG ANALYZING ECG 00:01 Options Param Code Marker Report Data Alarms Sync On/Off An ANALYZING ECG message is displayed for 6 to 12 seconds while the patient’s ECG is analyzed. Once the analysis is completed, the unit indicates whether or not a shock is advised. The analysis normally consists of three consecutive 3-second ECG rhythm analyses.
Advisory Defibrillation Procedure • Units with the automatic charge option disabled will alternately display the messages SHOCK ADVISED and PRESS CHARGE. Press the CHARGE button. Regardless of the analysis result, the user can control the defibrillator manually. For example, the user can defibrillate the patient even if the advisory function issues a NO SHOCK ADV. message. SHOCK ADVISED ECG DEFIB 120J SEL.
CHAPTER 4 ADVISORY DEFIBRILLATION Once the unit is charged to the selected energy, the SHOCK button illuminates and the PRESS SHOCK message is displayed. Simultaneously, the monitor displays the energy level to which the defibrillator is charged, DEFIB XXXJ READY. Note: Rhythm analysis does not continue after the defibrillator is charged and ready once a decision to shock has been made.
Advisory Function Messages Advisory Function Messages SELECT DEFIB MODE Displayed if the ANALYZE button is pressed, but the unit is not in the DEFIB mode. Turn the Mode Selector to DEFIB to enable the defibrillator and advisory capability. SELECT PADS Displayed if the ANALYZE button is pressed while the device is operating in any ECG lead other than “PADS.” Press the LEAD button until “PADS” is selected. REMOVE SYNC Displayed if the ANALYZE button is pressed while the device is in Sync mode.
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Chapter 5 Synchronized Cardioversion Paddles are a defibrillation-protected Type BF patient connection. ECG leads are a defibrillation-protected Type CF patient connection. WARNING! Only skilled personnel trained in Advanced Cardiac Life Support and familiar with equipment operation should perform synchronized cardioversion. The precise cardiac arrhythmia must be determined before attempting defibrillation or cardioversion.
CHAPTER 5 SYNCHRONIZED CARDIOVERSION Marker indicates each detected R wave during synchronization Verify that markers are clearly visible on the monitor and their location is appropriate and consistent from beat to beat. If necessary, use the LEAD and SIZE buttons to establish settings that yield the most consistent Sync marker pattern. The synchronized cardioversion procedure for ZOLL hands-free therapy electrodes is identical to that for paddles with the exception of the SHOCK button location.
Synchronized Cardioversion Procedure If therapy electrodes are not making good contact with the patient’s skin, the unit issues the messages CHECK PADS and POOR PAD CONTACT and does not allow delivery of energy. If a short circuit exists between the electrodes, the unit issues the message DEFIB PAD SHORT. An ECG LEAD OFF condition prevents synchronized discharge if leads are selected as the ECG source.
CHAPTER 5 SYNCHRONIZED CARDIOVERSION A SYNC XXXJ SEL. message appears on the display. If DEFIB XXXJ SEL. appears, press the Sync On/Off softkey. (If your unit supports Remote Sync, you must also press the Sync softkey.) Two quick beeps sound. ECG SYNC 120J SEL. 00:01 Options Param Code Marker Report Data Alarms Sync On/Off Unless otherwise configured, the unit automatically exits Sync mode after each shock and when the Mode Selector is moved to MONITOR, PACER or OFF.
Remote Synchronized Cardioversion Procedure 3 Deliver SHOCK WARNING! Warn all persons in attendance of the patient to STAND CLEAR prior to defibrillator discharge. Verify that no one is in contact with the patient, monitoring cable or leads, bed rails, or any other potential current pathways. Verify that the ECG waveform is stable and that Sync markers appear over each R-wave.
CHAPTER 5 SYNCHRONIZED CARDIOVERSION Determine the Patient’s Condition and Provide Care Following Local Medical Protocols Prepare Patient Prepare the patient as described in “Prepare Patient” on page 5-2. Follow the instructions provided with the external monitoring device to prepare the patient for ECG monitoring and synchronization with a separate defibrillator. 1 Select DEFIB Turn the Mode Selector to DEFIB.
Remote Synchronized Cardioversion Procedure WARNING! Verify the ECG waveform is stable and that a Sync marker appears only with R-waves. If Sync markers are not present on the remote device display, or do not appear to be nearly simultaneous with each R-wave, do not proceed with synchronized cardioversion. 2 Charge Defibrillator Press the CHARGE button on the front panel or, if using paddles, on the apex paddle handle.
CHAPTER 5 SYNCHRONIZED CARDIOVERSION Once the energy is delivered, the display simultaneously shows XXXJ DELIVERED and DEFIB XXXJ SEL. After approximately 5 seconds, the XXXJ DELIVERED message disappears and the DEFIB XXXJ SEL. message remains to indicate the selected energy level. If additional countershocks are necessary, readjust the energy level as necessary, press the Sync On/Off, and then the Remote Sync softkeys and repeat.
Chapter 6 Real CPR Help Real CPR Help is defibrillation-proof Type BF equipment. WARNING! The Real CPR Help function is fully functional only when using adult CPR electrodes. Do not use Adult CPR electrodes with patients under 8 years of age. WARNING! Use only Pediatric CPR electrodes with patients under 8 years of age. The use of Pediatric CPR electrodes enables the R Series unit to display Idle Time and Compression Rate and Depth measurements.
CHAPTER 6 REAL CPR HELP • CPR Idle Time Display • CPR Rate Metronome • Voice prompts • Chest Compressions Waveform display • FULLY RELEASE display prompt (if configured) Real CPR Help Field Whenever OneStep CPR, or OneStep Complete electrodes are connected to the R Series defibrillator, the unit illuminates the Real CPR Help field in the upper center portion of the display. This field includes the indicators described in the next sections.
Real CPR Help Field Compression Release Bar (Adult only) If the CPR Dashboard is configured On, the Compression Release Bar shows the release of the chest compression by the rescuer. When the release of the chest is properly administered (fully released), the bar will fill all the way to the top. This feature is unavailable while using Pediatric CPR electrodes. CPR Dashboard CPR Depth Rate CPR Index 1.
CHAPTER 6 REAL CPR HELP By default, the FULLY RELEASE text prompt is not enabled. This feature is unavailable while using Pediatric CPR electrodes. CPR Voice Prompts (Adult only) The R Series unit can be configured to issue voice prompts related to the depth of chest compressions as feedback to rescuers performing CPR. Two voice prompts are available for this purpose: • Push Harder • Good Compressions When chest compressions are detected but their depth is consistently less than 1.5 or 2 inches (3.
Chapter 7 See-Thru CPR (Optional) WARNING! The See-Thru CPR filter works only when the R Series defibrillator is monitoring CPR. The See-Thru CPR filter stops if: — The unit is in pace mode. — Patient impedance is invalid. — OneStep CPR electrodes or OneStep Complete electrodes are no longer detected. The See-Thru CPR filter will not remove all CPR artifact. Always stop CPR to verify the patient’s ECG rhythm before making treatment decisions.
CHAPTER 7 SEE-THRU CPR (OPTIONAL) Because the filtered ECG signal may contain residual chest compression and/or filtering artifacts, a rescuer should always follow the standard procedure of stopping CPR to assess the patient’s ECG rhythm before determining treatment. Using See-Thru CPR To use See-Thru CPR • The R Series unit must be monitoring CPR. • OneStep CPR or OneStep Complete electrodes must be attached to the unit.
Using See-Thru CPR The following figure shows a patient in Fine VF. It is difficult for a rescuer to discern this rhythm during CPR compressions. When the CPR filter turns on, the Fine VF rhythm becomes more obvious. FineVF Raw ECG Raw ECG • | Filter ON Filtered ECG Filtered ECG CPR 0:00 CPR 0:12 FineVF Raw ECG Raw ECG • | Filter OFF • | Filter ON Filtered ECG Filtered ECG CPR 0:12 CPR 0:24 FineVF Raw ECG Raw ECG • | Filter OFF Filtered ECG Filtered ECG CPR CPR 0:24 0:36 12.
CHAPTER 7 SEE-THRU CPR (OPTIONAL) The following figure shows a patient in VF, which, during compressions, is slightly more difficult to discern. When viewing this ECG, it is possible to view the underlying rhythm as the filter is able to reject all of the CPR artifact.
Using See-Thru CPR The following figure shows a patient in PEA, which could easily be mistaken for Fine VF because enough of the compression artifact leaks through to distort this signal. When the CPR filter turns on, the PEA is still not obvious because of the left over ripples from the CPR signal. About 14 seconds into this chart, the rhythm changes to asystole, which could easily be mistaken for coarse VF.
CHAPTER 7 SEE-THRU CPR (OPTIONAL) The following figure shows a patient with an organized rhythm where See-Thru CPR effectively filters out artifact created by CPR. SinusRhythm Raw ECG Raw ECG • | Filter ON Filtered ECG Filtered ECG CPR 0:00 CPR 0:12 SinusRhythm Raw ECG Raw ECG • | Filter OFF • | Filter ON Filtered ECG Filtered ECG CPR 0:12 CPR 0:24 SinusRhythm Raw ECG Raw ECG • | Filter OFF Filtered ECG Filtered ECG CPR CPR 0:24 0:36 12.5 mm/sec, 5 mm/mV 7–6 www.zoll.
Chapter 8 Noninvasive Temporary Pacing (Optional) When ZOLL hands-free therapy electrodes are used, the patient connection is considered to be defibrillation-protected Type BF. ECG leads are a defibrillation-protected Type CF patient connection. WARNING! To avoid risk of electrical shock, do not touch the gelled area of the hands-free therapy electrodes while pacing. Therapy electrodes should be replaced periodically. Consult electrode directions for specific recommendations.
CHAPTER 8 NONINVASIVE TEMPORARY PACING (OPTIONAL) Noninvasive Temporary Pacing R Series defibrillators with the pacer option contain a VVI demand pacemaker – a safe and effective design for Noninvasive Temporary Pacemakers. Proper demand pacing requires a reliable, high quality surface ECG signal.
Noninvasive Temporary Pacing 2. Roll the pad smoothly from the applied edge to the other, being careful not to trap any air pockets between the gel and skin. Pad Skin 3. Ensure that hands-free therapy electrodes are making good contact with the patient’s skin and are not covering any part of any other ECG electrodes. 4. If using OneStep Pacing electrodes or OneStep Complete electrodes, select ECG lead P1, P2, or P3; otherwise, select an appropriate ECG lead.
CHAPTER 8 NONINVASIVE TEMPORARY PACING (OPTIONAL) The pacer rate increments or decrements by a value of 2 ppm on the display when the knob is turned. OFF PACER OUTPUT mA 4:1 RATE ppm Observe the pacing stimulus marker on the display or stripchart ( well-positioned in diastole. ) and verify that it is Pacing Stimuli 4 Set Pacer Output Increase PACER OUTOUT until stimulation is effective (capture); the output mA value is displayed.
Noninvasive Temporary Pacing 5 Determine Capture It is important to recognize when pacing stimulation has produced a ventricular response (capture). Determination of capture must be assessed both electrically and mechanically in order to ensure appropriate circulatory support of the patient. Electrical capture is determined by the presence of a widened QRS complex, the loss of any underlying intrinsic rhythm, and the appearance of an extended, and sometimes enlarged, T-wave.
CHAPTER 8 NONINVASIVE TEMPORARY PACING (OPTIONAL) 6 Determine Optimum Threshold The ideal pacer current is the lowest value that maintains capture — usually about 10% above threshold. Typical threshold currents range from 40 to 80 mA. Location of the hands-free therapy or OneStep therapy electrodes affects the current required to obtain ventricular capture.
Special Pacing Applications Special Pacing Applications Noninvasive Temporary Pacing can be performed in the Cardiac Catheterization Lab either for emergency pacing or standby pacing. For pacing in X-ray and fluoroscopic applications, ZOLL pro-padz® radiolucent hands-free therapy electrodes may be used. Noninvasive Temporary Pacing can be performed in the Operating Room using ZOLL pro-padz sterile hands-free therapy electrodes.
CHAPTER 8 NONINVASIVE TEMPORARY PACING (OPTIONAL) RECORDER button, and printed on the corresponding summary report. To return to demand pacing, press the Async Pacing On/Off softkey again. The display returns to “PACE.” ASYNC PACE 00:01 Options 50 mA Param 70 PPM Code Marker Report Data Alarms Async Pacing On/Off Pace stimuli are also delivered asynchronously whenever there is an ECG LEAD OFF condition. Due to the lead off condition, no ECG waveforms will be displayed when pacing by this method.
Chapter 9 ECG Monitoring ECG leads are a defibrillation-protected Type CF patient connection. The R Series products can be used for either short- or long-term ECG monitoring. R Series products have built-in circuitry to prevent damage to their ECG monitoring circuits during defibrillation. Monitoring electrodes, however, can become polarized during defibrillator discharge, causing the ECG trace to briefly disappear from the screen.
CHAPTER 9 ECG MONITORING Caution ECG electrodes embedded in OneStep Pacing and Complete resuscitation pads produce non-standard ECG monitoring lead vectors, designated P1, P2 and P3. While ECG signals acquired from these leads are appropriate for ECG rhythm assessment and determining electrical capture during pacing, they should not be used for ECG morphological evaluations. Attach conventional ECG electrodes for diagnostic purposes.
Monitoring Electrodes Attachment 3-lead configuration RA 5-lead wire configuration LA RA LA V LL 3-lead set RL 3-lead cable LL 5-lead cable Note: Lead sets and lead cables are different accessories and are not interchangeable. For 5-lead monitoring, use a 5-lead cable. Note: 3-lead cables are available with and without ESU noise suppression. Monitoring Electrodes Attachment Attach snap-on leads to electrodes and check for good contact between the electrode and the lead termination.
CHAPTER 9 ECG MONITORING Plug the patient cable connector into the black ECG input connector (located on the rear panel of the instrument). If you are using a 3-lead set that is connected to a OneStep Pacing cable, plug the red connector into the red OneStep cable input connector on the device, and plug the connector (that is black inside) into the black ECG input connector on the device.
Monitoring the Patient’s ECG Monitoring the Patient’s ECG Set the Controls Set the Mode Selector to MONITOR, then press the LEAD button until the desired lead configuration is selected. The selected lead is indicated at upper right of the display. LEAD SIZE ALARM SUSPEND RECORDER MONITOR OFF If the unit displays the ECG LEAD OFF, POOR LEAD CONTACT, or CHECK PADS message, inspect the ECG electrodes or therapy electrodes, lead wires, and cables for proper connections.
CHAPTER 9 ECG MONITORING CPR IDLE 0:00 SpO2% x1 PADS Depth Rate 99 ECG Ɔ PPI 72 NIBP mmHg ----ECG --CO2 RR Pace Marker mmHg ----MONITOR Options Param Code Marker Report Data Alarms Test Log To disable detection of pacemaker spikes: 1. Press the Param softkey. 2. Press ECG. 3. Press Disable Pacer Detect. To re-enable detection of pacemaker spikes: 1. Press the Param softkey. 2. Press ECG. 3. Press Enable Pacer Detect.
5-Lead Monitoring Changing from 5-Lead ECG Monitoring To change from 5-lead monitoring to 3-lead monitoring, you must power off the unit for at least 10 seconds, remove the 5-lead cable, connect the 3-lead cable, then power on the unit again. If you fail to shut the unit off for at least 10 seconds, the unit displays the ECG LEAD OFF message after you disconnect the 5-lead wire cable, even if leads from a 3 lead ECG cable are properly attached to the patient.
CHAPTER 9 ECG MONITORING If optional physiological monitoring parameters are installed in the unit, the operator can select applicable traces to appear in the second or third position. To select the display for the second or third trace: 1. Press the Options softkey, then press Traces. 2. Press Trace 2 or Trace 3 to select the position. 3. Press the softkey for the parameter or other waveform to display in the selected position (or Off to clear that position).
Alarms To set alarm parameters: 1. Press the Alarms softkey to view the Alarm Set screen and softkeys.
CHAPTER 9 ECG MONITORING When the unit is monitoring a patient’s heart rate via ECG, the range for the high heart rate alarm limit is 60 to 280 bpm with a default setting of 150 bpm. When the unit is monitoring a patient’s pulse rate via pulse oximetry (SpO2), however, the unit automatically lowers the upper limit for the high heart rate alarm to 235 bpm. The unit restores the original high heart rate alarm limit when ECG monitoring resumes.
Alarms Silencing Alarm Tones To silence the alarm tone, press and hold down the ALARM SUSPEND button for between 1 and 3 seconds. The alarm tone stops, the unit displays the alarm’s bell icon in inverse video with an “X” across it, and the value of the alarm parameter remains highlighted. (If you press the ALARM SUSPEND button again, alarm processing is reactivated.) The alarm tone will not sound again as long as the physiological parameter’s value remains out of range.
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Chapter 10 Event Records and Reports The R Series defibrillator records important event information during operation. You can retrieve this information in various forms: • Summary Report — Summary report allows you to store and later retrieve important ECG and event information. You can print summary report information in various formats. For more information about Summary Report and how to print a report, refer to the Summary Report section below.
CHAPTER 10 EVENT RECORDS AND REPORTS • Parameter alarm is triggered. • Mode Selector is turned to PACER. Note: Diagnostic bandwidth recordings are not included in Summary Report. The unit stores and prints summary information in chronological order. The memory allocated for summary data can hold up to 350 defibrillation or 350 recorder-activated events. All event data remains in memory and is accessible until data is manually erased or until the preconfigured time interval has elapsed.
Summary Report Defibrillation Event Format The summary report function records 6 seconds of pre-shock and 9 seconds of post-shock patient ECG data. Also recorded are joules selected, joules delivered, Sync if active (includes Sync markers), ECG lead, ECG size, patient current, defib impedance, actual time and date. The date/time printed on the top of the strip corresponds to the ECG data occurring 6 seconds before the event. Figure 10-2. Defibrillation Event Format (Pre-Shock) Figure 10-3.
CHAPTER 10 EVENT RECORDS AND REPORTS Pacer Mode Selected Format The summary report function records 6 seconds of pre-pace patient ECG data. Also recorded are the ECG lead, ECG size, patient's heart rate, pace rate, pace current, time and date. The date/time printed on the top of the strip corresponds to the ECG data occurring 6 seconds before the event. Figure 10-4. Pacer Mode Selected Format After establishing a paced rhythm, turning the recorder on briefly records the paced rhythm for later reports.
Summary Report Heart Rate Alarm Activated Format The summary report function records 6 seconds of pre-alarm patient ECG. Also recorded are the ECG lead, ECG size, patient's heart rate, actual event time, and date. The date/time printed on the top of the strip corresponds to the ECG data occurring 6 seconds before the event. If the pacer is on during this event, the pacing rate and pacing current are also recorded. Figure 10-6.
CHAPTER 10 EVENT RECORDS AND REPORTS Recorder On Format The summary report function records 6 seconds of patient ECG prior to turning on the recorder. Also recorded are the ECG lead, ECG size, patient's heart rate, actual event time, and date. The date/time printed on the top of the strip corresponds to the ECG data occurring 6 seconds before the event. If the pacer is on during this event, the pacing rate and current are also recorded. If Async pace is active, the annotation ASYNC PACE is recorded.
Summary Report Note: If the first two segments are shockable, only two asterisks appear on the stripchart, and the third segment is not analyzed. Figure 10-9. Analyze Format In addition, the ECG rhythm analysis report can include the following annotations: Annotation Description POOR PAD CONTACT The hands-free therapy electrodes are improperly connected. ANALYSIS HALTED A fault condition occurred, or the operator pressed the ANALYZE button again. NOISY ECG Excessive noise was detected.
CHAPTER 10 EVENT RECORDS AND REPORTS Printing a Partial Summary Report To print a partial summary report: 1. Press the Report Data softkey, then press Print Chart. 2. Press the Print Range softkey. 3. Use the First Event, Prev. Event, Next Event and Last Event softkeys to locate the event from which printing will start (all subsequent events are also printed). 4. Press the Print softkey. The unit prints all records from the selected item to the most recent.
Erasing Summary Report and Full Disclosure Erasing Summary Report and Full Disclosure Summary information can be erased either manually or automatically. Manual Erasure You can manually erase summary records and full disclosure data from memory in preparation for collecting data for a new patient. Note: When the event summary memory and full disclosure memory are filled, data recording stops. You must erase the records to continue recording.
CHAPTER 10 EVENT RECORDS AND REPORTS 10–10 Message Description DISK FORMAT REQ. The internal flash memory disk file system has been corrupted. Follow the procedure in the previous section, “Formatting the Disk.” DO NOT POWER OFF Do not remove power (both battery and AC) while the unit is erasing reports or formatting the disk. ERASING REPORT The unit is erasing the selected report data. FORMATTING DISK The internal flash memory disk is being formatted. www.zoll.com 9650-0912-01 Rev.
Chapter 11 File Transfer This chapter describes procedures for transferring files from the R Series defibrillator to an external system, such as a personal computer or handheld device. It also explains how to remove, install and erase a Compact Flash card.
CHAPTER 11 FILE TRANSFER Wi-Fi (Optional) The R Series has an optional Wireless Ethernet function that transfers data files using the IEEE 802.11 protocol (Wi-Fi). This includes a ZOLL R Series Data COMM Card or ZOLL R Series Data COMM II card, and a protective guard that must be installed on the unit.
Transferring a Full Disclosure File to a Compact Flash Card To remove a compact flash card: Press the release button and pull the card out of the slot. Figure 11-2. Removing a Compact Flash Card Transferring a Full Disclosure File to a Compact Flash Card Make sure that a compact flash card is installed in the slot on the left side of the device. To transfer data to a compact flash card: 1. Turn the Mode Selector to MONITOR. 2. Press the Report Data softkey. 3. Press the Transfer Mode softkey. 4.
CHAPTER 11 FILE TRANSFER 2. Press the Report Data softkey. 3. Press the Transfer Mode softkey. 4. Press the More softkey. 5. Press the Defib History to Card softkey. The message TRANSFERRING DATA is displayed. All data is transferred to the installed CF data card. Note: Do not remove the CF card while files are transferring. Corruption may result on the data card. When all files are transferred, the message DATA TRANSFERRED is displayed. You can now remove the CF card from the R Series unit.
Transferring Full Disclosure Files Through Wi-Fi (Optional) Transferring Full Disclosure Files Through Wi-Fi (Optional) Before you begin, ensure the Wi-Fi card is properly seated with the name R Series Data COMM or Data COMM II facing up in the compact flash slot. Make sure that the Wi-Fi guard has been attached. To transfer data through Wi-Fi: 1. Turn the Mode Selector to MONITOR. 2. Press the Report Data softkey. 3. Press the Transfer Mode softkey. 4. Press the Report to Wi-Fi softkey. 5.
CHAPTER 11 FILE TRANSFER Note: If you are out of the range of an access point, the data will not be transferred and the message Wi-Fi Network Not Found is displayed. Press the Return softkey to return to the previous menu and try again. TRANSFER FAILED Full Disclosure Not Sent DATA TRANSFER MODE Return To exit Wi-Fi/DataTransfer Mode, press the Return softkey and then the Exit Transfer softkey or switch the Mode Selector to OFF.
Transferring Device Check and Activity Log Files Through Wi-Fi (Optional) Related Wi-Fi Messages Informational Message Description INITIALIZING NETWORK A transfer has been initiated. CONNECTING TO THE NETWORK The association with the host network is being established. CONNECTING TO SERVER The unit is connecting to a remote system. TRANSFER IN PROGRESS The data transfer is in progress. WAITING FOR SERVER RESPONSE The unit is waiting for the final acknowledgment from a remote system.
CHAPTER 11 FILE TRANSFER N = 6: Missing required configuration data for Network Profile 1 with Enterprise Authentication selected (Data COMM II only) Action: Check the following: If Authentication Protocol is set to PEAP, make sure that the following are configured: • User Identity • User Password If Authentication Protocol is set to TLS, make sure that the following are configured: • User Identity • Private Key Password • Client Certificate N = 7: Missing required configuration data for Network Profile 2 w
Transferring Device Check and Activity Log Files Through Wi-Fi (Optional) TRANSFER FAILED Network Error: General Errror Number: NNNN Contact Network Administrator The transfer failed because of a general network Wi-Fi error. NNNN may indicate one of the following error codes: N = 7004 N = 7010 N = 7011 N = 7015 N = 7016 Action: Install another Data COMM card. N = 7500 N = 7501 N = 7502 N = 7503 N = 7504 N = 7505 N = 7506 N = 7507 Action: Install another Data COMM II card.
CHAPTER 11 FILE TRANSFER TRANSFER FAILED Network Error: DNS Contact Network Administrator The DNS request has failed. TRANSFER FAILED Full Disclosure Service Not Available Contact Network Administrator The option to accept full disclosure files is not enabled on the server. TRANSFER FAILED Defib History Service Not Available Contact Network Administrator The option to accept Defib History files is not enabled on the server.
Chapter 12 Maintenance Defibrillator equipment must be maintained to be ready for immediate use. The defibrillator should be tested daily. The R Series defibrillator gives you two readiness testing options: • Automatic • Manual Note: Both automatic and manual test results are automatically recorded to internal memory. Maintenance Frequency Visual Inspection Once per day, inspect Code Readiness indicator.
CHAPTER 12 MAINTENANCE Routine Procedures Daily Visual Inspection Equipment Ensure that the unit is clean (with no fluid spills) and free of visible damage. Inspect all cables, cords, and connectors for good condition (no cuts, fraying or bent pins). Check that the paddle surfaces are clean and free of electrolyte gel and other contaminants.
Manual Defibrillator Testing Code Readiness Test The R Series defibrillator performs Code Readiness tests automatically to verify its integrity and readiness for emergency use. These tests verify the following: • Battery — Verifies that the battery state of charge is sufficient for at least one hour of continuous monitoring and ten shocks at maximum energy.
CHAPTER 12 MAINTENANCE If a LOW BATTERY message appears during testing, the battery is close to depletion and should be replaced or recharged. Before you begin 1. Connect the R Series to AC mains. 2. Do one of the following: • Connect unopened OneStep electrodes to the OneStep cable, (Unopened OneStep electrodes act as a test port. The test port capability no longer functions once the electrode package is opened and electrodes are deployed.
Manual Defibrillator Testing 8. Press paddles firmly into their wells and using your thumbs, simultaneously press and hold the SHOCK buttons (one on each paddle) until the shock is delivered. The unit displays the message 30J TEST OK and prints a stripchart indicating 30J TEST OK and the delivered energy. If the message 30J TEST FAILED appears, contact appropriate technical personnel or the ZOLL Technical Service Department.
CHAPTER 12 MAINTENANCE The messages CHECK PADS and POOR PAD CONTACT appear alternately. The pace alarm sounds, and the Clear Pace Alarm softkey flashes. 6. Reconnect the OneStep cable, and press the Clear Pace Alarm softkey. The messages CHECK PADS and POOR PAD CONTACT disappear, and the alarm tone stops. Recorder Check 1. Check the printer for an adequate supply of paper, then press the RECORDER button. 2. Press and hold the SIZE button for at least 2 seconds.
Manual Defibrillator Testing Code Readiness Test Log Date: 10 NOV 06 00:01:03 Battery: OK 30J Self Test: OK Type: Automatic OneStep Cable: OK Defib: OK Pace: OK ECG: OK AC Power: Connected Print Test Log Print Test Prev Test Next Test Figure 12-1. Code Readiness Test Log Print Display Figure 12-2. Code Readiness Test Log Figure 12-3. Code Readiness Test Report 9650-0912-01 Rev.
CHAPTER 12 MAINTENANCE Setting Time and Date To set the unit’s time and date: 1. Set the Mode Selector to MONITOR. 2. Press the Options softkey. 3. Press More. 4. Press Set Clock. The month field will be highlighted. Set Time Oct Prev Field Figure 12-4. 14, 06 Inc Value 16 Dec Value : Next Field 37 Enter and Return Set Time Screen 5. Press the Inc Value or Dec Value softkeys to select the appropriate month. 6.
Manual Defibrillator Testing Do not immerse any part of the defibrillator (or its accessories) in water. Do not use ketones (such as acetone or MEK) on the defibrillator. Do not sterilize the defibrillator. Avoid using abrasives (including paper towels) on the display window. Take special care to clean the defibrillation paddles after each use. The buildup of gel can interfere with ECG monitoring through the paddles, can adversely effect energy delivery and may reduce operator safety.
CHAPTER 12 MAINTENANCE 3P/ 3P/ Figure 12-6. Inserting the Paper and Closing Printer Door After the paper is loaded, press the RECORDER button to resume printing. Note: To ensure you have loaded the paper properly, check to make sure the arrows printed on the red, grid side of the paper point upward. Cleaning the Print Head To clean the recorder print head, perform the following steps: 1. Press the release button, and allow the printer door to open (see Figure 12-5); then remove any paper. 2.
Operator’s Checklist for R Series Product Recommended checks and procedures to be performed daily or weekly, depending on Automatic Test configuration. 1. Condition Date ______________________________________________ Location ____________________________________________ Unit Serial Number ___________________________________ Remarks Unit clean, no spills, clear of objects on top, case intact 2. Hands-free Therapy electrodes 1 set preconnected / 1 spare 3.
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Chapter 13 Troubleshooting The troubleshooting information provided in this chapter is intended for use by nontechnical medical personnel during device operation. This chapter answers many of the common problems or questions that may arise during operation. If trouble persists after consulting this guide, contact the appropriate technical personnel or ZOLL Technical Service Department. Refer to the R Series Service Manual for more detailed troubleshooting information.
CHAPTER 13 TROUBLESHOOTING Symptom Recommended Action 3. Pad Expired; Replace Pads Check the expiration date on OneStep electrodes, and replace them if they are expired. 4. Poor Pad Condition; Replace Pads OneStep electrode condition sensor indicates that the electrode gel has dried or aged beyond its specifications. The electrodes may no longer provide optimal therapy. Replace therapy electrodes.
Recorder Symptom Recommended Action 6. Noisy ECG, artifact, wandering baseline • Consider 1 – 21Hz filter bandwidth (see R Series Configuration Manual). • Prepare the patient’s skin prior to electrode attachment. • Check for proper adhesion of electrodes to patient. • Reduce or eliminate ECG artifact due to electrode or patient cable movement. Route cables so that they don’t pull on electrodes or swing excessively. • Ensure patient is motionless.
CHAPTER 13 TROUBLESHOOTING Pacer 13–4 Symptom Recommended Action 1. CHECK PADS message • Ensure therapy electrodes are connected to the OneStep cable. • Ensure electrode gel is not dry. Replace therapy electrodes if necessary. • Ensure good electrode-to-patient contact. • Check integrity of OneStep cable by plugging into test connector. CHECK PADS should disappear. 2. No stimulus marker ( ) is present on the ECG trace. • Ensure unit is in PACER mode.
Defibrillator Defibrillator Symptom Recommended Action 1. Excessive artifact detected when using paddles as ECG source. • • • • • • • Ensure “PADDLES” is selected. Firmly press paddles against patient skin. Use gel on paddles. Clean paddle surface. Check and clean between adult and pediatric shoe. Check cable for damage. Use ECG electrodes. 2. Defibrillator will not charge (energy • Ensure that SHOCK button(s) on paddles or front panel level does not increment on are not stuck on. display).
CHAPTER 13 TROUBLESHOOTING 13–6 Symptom Recommended Action 6. Unable to SHOCK when in Remote Sync mode • Ensure REMOTE SYNC is displayed in place of the ECG waveform and that REMOTE SYNC XXXJ SEL. is displayed. • Ensure that a remote device conforming with the Sync In/Marker Out specifications in Appendix A is properly connected. • Ensure that Sync markers appear with each R-wave on the remote device’s display.
AC Charger Symptom Recommended Action 11. No 30J TEST OK message is displayed when performing a manual defibrillator self-test. • Check to make sure unit is set to 30 joules. • If testing with OneStep electrodes, make sure that the OneStep cable patient connector is firmly inserted into the electrode connector. Ensure the OneStep electrode package is sealed. • If testing with the Test Port, make sure the OneStep cable is firmly inserted into the Test Port.
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Appendix A Specifications This section describes the specifications for the R Series Defibrillator as well as the ECG rhythm analysis algorithm. • • • • • • “Defibrillator Specifications” on page A-2 “Battery Pack Specifications” on page A-6 “IEC 60601-1-2 Specifications” on page A-7 “R Series Rectilinear Biphasic Waveform Characteristics” on page A-13 “Clinical Trial Results for the Biphasic Waveform” on page A-25 “ECG Rhythm Analysis Algorithm Accuracy” on page A-29 9650-0912-01 Rev.
APPENDIX A SPECIFICATIONS Defibrillator Specifications General Size (height • width • length) 8.2 in. • 10.5 in. • 12.5 in. with handle or 10.0 in. without handle 20.8 cm • 26.7 cm • 31.7 cm with handle or 25.4 cm without handle Weight 13.6 lb (6.17 kg) with OneStep cable and battery pack 15.2 lb (6.
Defibrillator Specifications Messages ERASING REPORT, INSERT CARD, REPLACE BATTERY, LOW BATTERY, PERFORM CPR, NOISY ECG, RETRY ANALYSIS, CHECK PATIENT, ANALYSIS HALTED, PRESS ANALYZE, NO SHOCK ADV.
APPENDIX A SPECIFICATIONS Automatic Defibrillator Test Verifies defibrillator charging and discharging without removing paddles from storage wells or with OneStep cable connected to the Test Port or OneStep electrodes. Defibrillation advisory Evaluates electrode connection and patient ECG to determine if defibrillation is required.
Defibrillator Specifications Heart rate accuracy ±5% Heart rate alarm Screen icon indicates activated/deactivated status. User selectable. Tachycardia: 60 to 280 beats per minute Bradycardia: 20 to 100 beats per minute Tall T-wave Rejection < 0.8 mV Heart Rate Averaging The R Series averages the interval between the last 5 detected beats. On startup, the R Series averages the rate between detected beats once two beats are detected, until a full 5 beats have been received.
APPENDIX A SPECIFICATIONS Printing method High-resolution, thermal array print head Printout modes Manual or automatic; user-configurable Data card Type Compact flash card Sync in / Marker out / ECG out Sync In Marker Out 0-5 V (TTL Level) pulse, active high, 5 to 15 msec in duration, no closer than 200 ms apart. Energy transfer begins within 25 ms of the leading edge of the external sync pulse.
IEC 60601-1-2 Specifications IEC 60601-1-2 Specifications This section provides specification tables for the R Series as per IEC 60601-1-2. Electromagnetic Emissions Declaration Guidance and manufacturer’s declaration — electromagnetic emissions for the R Series. The R Series is intended for use in the electromagnetic environment specified below. The customer or user of the R Series should ensure that it is used in such an environment.
APPENDIX A SPECIFICATIONS Electromagnetic Immunity Declaration (EID) Guidance and manufacturer’s declaration — electromagnetic immunity for the R Series. The R Series is intended for use in the electromagnetic environment specified below. The customer or user of the R Series should ensure that it is used in such an environment.
IEC 60601-1-2 Specifications EID for Life-Support Functions Guidance and manufacturer’s declaration – electromagnetic2 immunity – for life-supporting equipment and systems. The life-support functions a of the R Series are intended for use in the electromagnetic environment specified below. The customer or user of the R Series should ensure that it is used in such an environment.
APPENDIX A SPECIFICATIONS Recommended Separation Distances from RF Equipment for the R Series Life-Support Functions Recommended separation distances between portable and mobile RF communications equipment and the R Series. The life-support functions a of the R Series are intended for use in the electromagnetic environment in which radiated RF disturbances are controlled.
IEC 60601-1-2 Specifications EID for Non–Life-Support Functions Guidance and manufacturer’s declaration – electromagnetic immunity – for non– life-supporting equipment and systems. The non–life-support functions a of the R Series are intended for use in the electromagnetic environment specified below. The customer or user of the R Series should ensure that it is used in such an environment.
APPENDIX A SPECIFICATIONS Recommended Separation Distances from RF Equipment for the R Series Non–Life-Support Functions Recommended separation distances between portable and mobile RF communications equipment and the R Series. The non–life-support functions a of the R Series are intended for use in the electromagnetic environment in which radiated RF disturbances are controlled.
R Series Rectilinear Biphasic Waveform Characteristics R Series Rectilinear Biphasic Waveform Characteristics Table A-1 shows the characteristics of the R Series Rectilinear Biphasic™ waveform when discharged into 25 ohm, 50 ohm, 100 ohm, 125 ohm, 150 ohm and 175 ohm loads at the maximum energy setting of 200 joules. Table A-1. R Series Rectilinear Biphasic Waveform Characteristics 200 J discharged into 25 50 100 125 150 175 Maximum initial current 31.4 A 30.4 A 19.7 A 19.4 A 16.7 A 15.
APPENDIX A Table A-2. Selected Energy SPECIFICATIONS Delivered Energy at Every Defibrillator Setting into a Range of Loads Load 25 50 75 100 125 150 175 Accuracy* 150 J 107 J 164 J 180 J 183 J 188 J 184 J 179 J ±15% 200 J 142 J 230 J 249 J 253 J 269 J 261 J 260 J ±15% * For all energy levels, accuracy is equal to either ±15% or 3 joules, whichever is greater.
R Series Rectilinear Biphasic Waveform Characteristics 30 20 10 0 2 4 6 8 10 12 A 0 -10 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -20 -30 ms Figure A-2. Rectilinear Biphasic Waveform at 150 Joules 30 20 10 0 2 4 6 8 A 0 -10 10 12 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -20 -30 ms Figure A-3. 9650-0912-01 Rev.
APPENDIX A SPECIFICATIONS 25 20 15 10 5 0 2 4 6 8 10 12 A 0 -5 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -10 -15 -20 -25 ms Figure A-4. Rectilinear Biphasic Waveform at 100 Joules 25 20 15 10 5 0 2 4 6 8 A 0 -5 10 12 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -10 -15 -20 -25 ms Figure A-5. A–16 Rectilinear Biphasic Waveform at 85 Joules www.zoll.com 9650-0912-01 Rev.
R Series Rectilinear Biphasic Waveform Characteristics 25 20 15 10 A 5 0 0 2 4 6 8 10 12 -5 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -10 -15 -20 ms Figure A-6. Rectilinear Biphasic Waveform at 75 Joules 25 20 15 10 A 5 0 0 2 4 6 8 -5 10 12 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -10 -15 -20 ms Figure A-7. 9650-0912-01 Rev.
APPENDIX A SPECIFICATIONS 20 15 10 5 0 2 4 6 8 10 12 A 0 -5 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -10 -15 -20 ms Figure A-8. Rectilinear Biphasic Waveform at 50 Joules 15 10 5 0 2 4 6 8 A 0 -5 10 12 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -10 -15 ms Figure A-9. A–18 Rectilinear Biphasic Waveform at 30 Joules www.zoll.com 9650-0912-01 Rev.
R Series Rectilinear Biphasic Waveform Characteristics 15 10 5 0 2 4 6 8 10 12 A 0 -5 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -10 -15 ms Figure A-10. Rectilinear Biphasic Waveform at 20 Joules 10 8 6 4 2 0 2 4 6 8 A 0 -2 10 12 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -4 -6 -8 -10 ms Figure A-11. 9650-0912-01 Rev.
APPENDIX A SPECIFICATIONS 8 6 4 2 0 2 4 6 8 10 12 A 0 -2 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -4 -6 -8 ms Figure A-12. Rectilinear Biphasic Waveform at 10 Joules 8 6 4 2 0 2 4 6 8 A 0 -2 10 12 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -4 -6 -8 ms Figure A-13. A–20 Rectilinear Biphasic Waveform at 9 Joules www.zoll.com 9650-0912-01 Rev.
R Series Rectilinear Biphasic Waveform Characteristics 8 6 4 2 0 2 4 6 8 10 12 A 0 -2 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -4 -6 -8 ms Figure A-14. Rectilinear Biphasic Waveform at 8 Joules 8 6 4 A 2 0 0 2 4 6 8 10 12 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -2 -4 -6 ms Figure A-15. 9650-0912-01 Rev.
APPENDIX A SPECIFICATIONS 6 4 2 0 2 4 6 8 10 12 A 0 -2 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -4 -6 ms Figure A-16. Rectilinear Biphasic Waveform at 6 Joules 6 4 2 0 2 4 6 8 A 0 -2 10 12 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -4 -6 ms Figure A-17. A–22 Rectilinear Biphasic Waveform at 5 Joules www.zoll.com 9650-0912-01 Rev.
R Series Rectilinear Biphasic Waveform Characteristics 5 4 3 2 1 0 2 4 6 8 10 12 A 0 -1 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -2 -3 -4 -5 ms Figure A-18. Rectilinear Biphasic Waveform at 4 Joules 5 4 3 2 A 1 0 0 2 4 6 8 -1 10 12 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -2 -3 -4 ms Figure A-19. 9650-0912-01 Rev.
APPENDIX A SPECIFICATIONS 4 3 2 1 0 2 4 6 8 10 12 A 0 -1 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -2 -3 -4 ms Figure A-20. Rectilinear Biphasic Waveform at 2 Joules 2.5 2 1.5 1 0.5 0 2 4 6 8 A 0 -0.5 10 12 25 Ohm 50 Ohm 75 Ohm 100 Ohm 125 Ohm 150 Ohm 175 Ohm 200 Ohm -1 -1.5 -2 -2.5 ms Figure A-21. A–24 Rectilinear Biphasic Waveform at 1 Joule www.zoll.com 9650-0912-01 Rev.
Clinical Trial Results for the Biphasic Waveform Clinical Trial Results for the Biphasic Waveform The efficacy of the ZOLL Rectilinear Biphasic waveform has been clinically verified during a study of defibrillation of Ventricular Fibrillation (VF) and Ventricular Tachycardia (VT). A feasibility study was performed initially for defibrillation of VF/VT (n=20) on two separate groups of patients to ensure waveform safety and energy selection.
APPENDIX A SPECIFICATIONS Successful defibrillation with rectilinear biphasic shocks was achieved with 58% less delivered current than with monophasic shocks (14±1 amperes versus 33±7 amperes, p=0.0001). The difference in efficacy between the rectilinear biphasic and the monophasic shocks was greater in patients with high transthoracic impedance (greater than 90 ohms).
Clinical Trial Results for the Biphasic Waveform The total efficacy of consecutive rectilinear biphasic shocks was significantly greater than that of monophasic shocks. The following table displays the Kaplan-Meier (product-limit) "survival" curves for each of the two waveforms. As all patients begin in the failure mode, the estimated life-table probabilities refer to the chance of still being in failure after the kth shock (k=1,2,3,4): Table A-3.
APPENDIX A SPECIFICATIONS Recommended Anterior/Posterior Placement Back/ Posterior Front/ Apex Place the front (apex) pad on the third intercostal space, mid clavicular line on the right anterior chest. The back/posterior pad should be placed in the standard posterior position on the patient’s left as shown. A–28 www.zoll.com 9650-0912-01 Rev.
ECG Rhythm Analysis Algorithm Accuracy ECG Rhythm Analysis Algorithm Accuracy Sensitivity and specificity are expressions of ECG rhythm analysis algorithm performance when compared to ECG interpretation by a clinician or expert. Sensitivity refers to the algorithm’s ability to correctly identify shockable rhythms (as a percentage of the total number of shockable rhythms).
APPENDIX A SPECIFICATIONS Table A-5. Clinical Performance Results (Pediatric Patients) Rhythms Sample Size (9 second records) Shockable (49 patients) Performance Goals Observed Performance 90% One-sided Lower Confidence Limit Sensitivity Coarse VF 42 >90% 100.0% 93.1% Rapid VT 79 >75% 100.0% 96.3% Nonshockable (155 patients) Specificity NSR 208 >99% 100.0% 98.6% AF, SB, SVT a, heart block, idioventricular, PVCs 348 >95% 99.4% 98.2% 29 >95% 100% 90.
Appendix B R Series Accessories The following accessories are compatible for use with R Series products. To order any of these items, contact your local ZOLL representative.
APPENDIX B R SERIES ACCESSORIES Internal autoclavable handles, with switch 8011-0501-01 Molded autoclavable internal handles, no switch 8011-0140-XX Molded autoclavable internal handles, with switch 8011-0141-XX Cables REF OneStep Cable (100-240V, 50/60Hz) 8009-0749 OneStep Pacing Cable (100-240V, 50Hz) 8009-0750 AAMI 3-Lead Wire ECG Patient Cable 8000-0025-02 (6’) 8000-0025 (12”) AAMI 3-Lead Wire ECG Patient Cable, ESU 9500-000693 IEC 3-Lead ECG Patient Cable 8000-0026 AAMI 5-Lead Wire
LNOP DC-12 LNOP Adult Reusable Direct Connect 12’ Cable 8000-0296 EtCO2 Sensors and Cables REF CAPNOSTAT 5 CO2 Sensor and Cable 8000-0312-01 SPU Pediatric/Adult Airway Adapter 8000-0260-01 SPU Neonatal/Pediatric Airway Adapter 8000-0261-01 Reusable Adult Airway Adapter 8000-0262-01 Reusable Neonatal/Pediatric Airway Adapter 8000-0263-01 SPU Pediatric/Adult Airway Adapter with Mouthpiece 8000-0265-01 CAPNO2mask, Large Adult 8000-0761 CAPNO2mask, Standard Adult 8000-0760 CAPNO2mask, Pediat
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Appendix C Wi-Fi Radio Module Information If this defibrillator contains an optional low power Wi-Fi radio module, it transmits information between the defibrillator and a wireless network (infrastructure mode). The module complies with the following standards: • Part 15 of the FCC Rules.
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