LIFEPAK 15 DEFIBRILLATOR and Monitorpptx

This PPT provide essential skills for operating lifepack 15 defib/ monitor.

1.                                     LIFEPAK  15          MONITOR  & DEFIBRILLATOR                                                                                       Prepared by : EL Shafee Ahmed Abaker MSc , PhD, CNE .

2. OBJECTIVEs:     At the end of this session, the participant's will be able to: Recognize the basic concepts related to Defibrillation, Cardioversion, Transcutaneous pacing . Identify the LIFEPAK 15 Monitor / Defibrillator  characteristic and its functions .

3. Outlines Introduction. Intended Use . Modes of Operation Defibrillation, Cardioversion . & Transcutaneous pacing. LIFEPAK 15 Monitor / Defibrillator  basic component’s and its functions.

4. INTRODUCTION:        The  LIFEPAK  15  Monitor / Defibrillator is a complete acute cardiac care response system designed for basic life support (BLS) and advanced life support (ALS) patient management protocols.      . 

5. Some LIFEPAK 15 monitor / defibrillator accessories are not interchangeable with accessories that are used with other LIFEPAK  monitor / Defibrillators

6. Intended Use ECG Monitoring. 12-Lead Electrocardiography SpO2 Monitoring. Noninvasive Blood Pressure Monitoring. Invasive Pressure Monitoring. End-Tidal CO2 Monitoring. Temperature Monitoring Automated External Defibrillation. Manual Defibrillation. Noninvasive Pacing.

7. Modes of Operation :       The LIFEPAK  15 Monitor / Defibrillator  has  six main operating modes.   1.  AED mode, for automated ECG analysis and a prompted treatment protocol for patient in cardiac arrest.    2.  Manual mode; for performing manual defibrillation.   3.  Synchronized cardioversion.   4.  Noninvasive pacing.   5.  ECG.   6.  Vital signs monitoring.

8. Other operating modes.  • Archive mode —for accessing stored patient information. • Setup mode —for changing default settings of the operating functions. • Demo mode —for simulated waveforms and trend graphs for demonstration purposes. • Service mode —for authorized personnel to perform diagnostic tests and calibrations

9. Defibrillation Defibrillation:  is a treatment for life-threatening  cardiac arrhythmias , specifically VF  and  pulseless V-Tach. A defibrillator delivers a dose of  electric current   to the   heart . this lead to   depolarizes  of the  heart muscle , ending the arrhythmia to enable the body's  natural pacemaker  in the   sinoatrial node   of the heart is able to re-establish normal  sinus rhythm .

10. Shock Energy according to AHA 2020 guidelines • Biphasic : Biphasic is more effective than older monophasic waveforms. Follow manufacturer recommendation (e.g., initial dose of 120 to 200 J); Second and subsequent doses should be equivalent and higher doses should be considered. • Monophasic : 360 J

11. C ardioversion synchronized electrical  cardioversion  is an electrical shock delivered in synchrony to the  cardiac cycle . cardioversion normally aims to end poorly perfusing  cardiac arrhythmias , such as  supraventricular tachycardia .

12. Noninvasive Pacing A noninvasive pacemaker is a device that delivers an electrical stimulus to the heart causing cardiac depolarization and myocardial contraction. The energy is delivered through large adhesive electrodes placed on the chest . Indications is of NIP for symptomatic bradycardia in patients with a pulse. Contraindications Noninvasive pacing is contraindicated for the treatment of ventricular fibrillation and asystole .

13. Demand and Nondemand Pacing Synchronous or demand pacemaker : Senses the client’s rhythm and paces only if the client’s intrinsic rate falls below the set pacemaker rate. Nondemand or fixed rate: Paces at a preset rate regardless of the client’s intrinsic rhythm

14.   AUTOMATED  EXTERNAL  DEFIBRILLATION   INDICATIONS: Cardiac arrest            Before using the defibrillator to analyse the patient ECG rhythm.  In AED mode, the LIFEPAK 15  monitor / defibrillator is not intende d for use on paediatric patients less than eight years old.

15. AED  - PROCEDURE: Verify that the patient in cardiopulmonary arrest (pulseless, unconscious and not breathing) Press 'ON' Prepare the patient for electrode placement . Connect the electrodes to the therapy cable and confirm cable connection to the defibrillator. Apply the electrodes to the patient's chest in the anterior-lateral position. Press ' ANALYZE" to initiate the analysis. Stop CPR . (Moving the AED during analysis may affect the ECG signal resulting in an inappropriate SHOCK   or NO SHOCK ADVISED   decision)

16. Cont.... 7.  Continue to follow the screen messages and voice prompts provided by the AED .   Shock Advised. 8.  When charging is complete, the available energy is displayed. The STAND CLEAR , PUSH SHOCK BUTTON . Everyone away from patient. 9.  When the button is pressed, the ENERGY DELIVERED message occurs indicating that the energy transfer was completed.(within 60 seconds) 10.  After a shock is delivered the ' START CPR'(30:2). 11. When the CPR countdown time ends the PUSH ANALYZE prompts occur. (These prompt repeat every 20 seconds until press ANALYZE)

17. NO SHOCK ADVISED: If the AED detects a nonshockable rhythm , the NO SHOCK ADVISED After NO SHOCK ADVISED , the START CPR prompts occur. When the CPR countdown time ends, the PUSH ANALYZE prompt  occur. Switching from AED Mode to Manual Mode: Press ENERGY SELECT one time, and press PACER / CHARGE    Set up , continue Manual Mode,        -  AED/ Direct        - AED / Confirmed -  Select ' YES ' to enter Manual Mode.       -  AED / Passcode        

18. MANUAL  DEFIBRILLATION:     The LIFEPAK 15 monitor / defibrillator provides manual defibrillation using adult and paediatric  QUICK – COMBO pacing /defibrillation/ECG.     It is also capable of providing intra-operative direct defibrillation and synchronized cardioversion with the internal paddles accessory.

19. MANUAL  DEFIBRILLATION  PROCEDURE:   Verify the patient is in cardiac arrest.    Press ' ON'    Identify the electrode & prepare the skin.    Connect the therapy electrodes to the therapy cable and confirm cable connection to the defibrillator.    Apply therapy electrode to the patient in anterior-lateral / anterior –posterior position.    Confirm the desired energy is selected or Press ENERGY SELECT or rotate SPEED DIAL to select desired energy.    Press CHARGE.    Confirm ECG rhythm requires defibrillation. Confirm available energy.

20. Cont...    Press Shock button on the defibrillator , standard paddles to discharge energy to the patient. For standard paddles, apply firm pressure with both paddles to the chest, and press both paddle buttons simultaneously to discharge energy  to the patient.    Start CPR according to protocol. To activate the ,Press CPR at any time.   At the end of CPR, Observe the patient and the ECG rhythm, if an additional shock is necessary, repeat the procedure.

21. SYNCHRONIZED CARDIOVERSION PROCEDURE:     Press ' ON'    Attach patient ECG cable and ECG electrodes.    Select  II  or Lead with greatest QRS Complex amplitude.    Press  'SYNC ' Button.    Observe the  ECG rhythm . Confirm that a triangle sense marker appears near the middle of each QRS complex.    Connect the therapy electrodes to the therapy cable and confirm cable connection to the defibrillator.    Prepare the patient's skin    Press  ENERGY SELECT.    Press CHARGE.    Observe the patient and ECG rhythm. Repeat procedure.

22. Front View

23. BASIC  ORIENTATION: Front View: Area 1:    1. 'ON'                    -  Turns ON or OFF. LED illuminated when 'ON'   2.ENERGY SELECT -  Increase  or Decrease the energy   3.CHARGE              -  Charge the defibrillator in Manual Mode    CPR                        -  Controls CPR metronome. LED illuminated &                                              active    ANALYZE               -  Activates Shock Advisory system'    LEAD                      -  Changes ECG lead.    SIZE                        -  Changes ECG size.    SYNC                      - Activate Synchronized mode.

24. Back view:   Paddle retainers   Paddle test contacts   Standard paddle wells   USB Port cover   System connection   Auxiliary power   Power adopter warning   Battery Pins.

25. BATTERIES:   Battery power using two Lithium – ion batteries or with auxiliary power using the AC Power Adopter.   It is not interchangeable with other LIFEPAK 15 Defibrillator.   Routinely inspect batteries for damage  or Leak.

26. HOME SCREEN Heart symbol                 -   Message area Alarms limits                  -   NIBP Time                                -    IP1 Blue tooth icon             -     IP2 Battery Indicator          -     ETCO2 Selected energy            -     SPO2 / SPCO ECG lead / Size              -    Heart Rate Channel – 1                   -    Alarm Indicator.

27. Navigating the Home Screen

28. Change the displayed ECG lead using the LEAD button

29. 8.   ELECTRODE  &  PADDLE PLACEMENT    Patient Skin Preparation:          -  Remove all clothing from the patient's chest.          -  Remove  excessive chest hair as much as possible.          -  Clean and dry the skin with towel or gauze.          -  Do not use alcohol, tincture or antiperspirant to prep the skin. 2 . Placement of electrodes  - 'Anterior –Lateral Placement'         Place the Apex paddle lateral to the patient's left nipple in the midaxillary line and other paddle placed below the right clavicle.   Anterior – Posterior Placement:        Place the paddle below the nipple and other paddle placed behind the heart in the intrascapular area.

30. 3.  ECG  -  MONITORING: 1 ,   Selecting ECG Lead:          Press 'Lead' If any ECG lead currently appears on the home screen the lead changes to Paddles.        Lead:     Paddles         I        II  -  Select       III     AVR     AVL     AVF   II,  CO2   I, II, III  & AVR, AVL, AVF   

31. 2 .   Changing ECG ' Size'   :  'Press  Size'           0.25           0.5           1.0  -   Select           1.5           2.0           2.5           3.0           3.5           4.0

32. 4.  Monitoring  Using Paddle Accessories:           Monitor ECG Using Paddles, can use either 'QUIK – COMBO' therapy electrodes (or) standard paddles. Placement:    'Anterior – Lateral Placement' Procedure:  -  Press 'ON Prepare the patient's skin Apply the standard paddles or therapy electrodes in the anterior        Lateral position. Connect the therapy electrodes to the therapy cable. Select the 'Paddles 'lead.

33. ECG  -  Monitoring  Procedure: Press 'ON' Attach the ECG cable to the green connector on the monitor. Identify the appropriate electrode sites on the patient . Prepare the patients skin for electrodes application Apply ECG electrodes. Select the desired ECG lead on the monitor screen. If necessary, adjust ECG size for accurate heart rate counting. Press 'Print' to obtain an ECG Printout.

34. Colour Coding for ECG Leads:    Limb Leads:                               Precordial  Leads:          RA   -  White                     V1   -  Red    (4th (R)intercostal space)          LA   -   Black                    V2  -  Yellow  (4th (L) intercostal space          RL   -  Green                     V3  -  Green (Direct b/w V2 & V4)          LL   -   Red                        V4  -   Blue   (5th intercostal space           C   -   Brown                    V5  -   Orange  (Left anterior axillary line)                                                     V6  -   Violet (Left midaxillary line)

35. Monitoring SPO2 & SPCO:       Parameter            SPO2 Volume  -    Sensitivity        -   Normal Averaging Time -  8 seconds Monitoring   NIBP: Indications:   - HTN & Hypotension   -  Shock   -  Major fluid imbalance

36. MEMORY CAPACITY:     The total capacity is 360 minutes of continuous ECG, 90 minutes of continuous data from all channels or 400 single waveform events.  The maximum memory capacity for a single patient includes up to 200 single waveform reports and 90 minutes of continuous ECG.

37. CONCLUSION:            The  LIFEPAK 15 Monitor / Defibrillator  is a complete acute cardiac care response designed for basic life support and Advanced life support patient management protocols. This device used for all accessories in a single device. It is mainly used in ER and OR, ICU for manage the patient with any critical condition and safe the patient life.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  

38. REFERENCE:   Physio- Control, Manual  of LIFEPAK 15 Monitor / Defibrillator Operating Instructions, 2021 Publication. Australia.