Operating Instructions - Aimcardio quest manual.pdfintraventricular conduction block, pre-excitation syndrome and ischemic heart disease. Records stored and used during the life of

QUEST®Exercise Stress System

Part No. 071-0717-00 Rev. F

Operating Instructions

Copyright © 2004 Quinton Cardiology, Inc. All rights reserved.

Quinton Cardiology, Inc.3303 Monte Villa ParkwayBothell, Washington 98021-8969

(800) 777-1777 (608) 764-1919

Authorized Representativeper MDD 93/42/EEC

MDSSBurckhardtstrasse 1

D-30163 Hannover, Germany

Table of Contents

Intended Use ..........................................................................................................vWarnings, Cautions & Notices ......................................................................... viiDefinitions of Symbols Used ............................................................................... xi

Chapter 1 General Information .....................................................................1-1General Description ..................................................................................... 1-1Interpretive Analysis Program for Resting ECGs ........................................ 1-2Safety Features ............................................................................................. 1-3Using Multiple Electrical Apparatus ........................................................... 1-4Microshock and the Electrically Susceptible Patient ................................... 1-4

Chapter 2 Getting Started ...............................................................................2-1Setting Up Equipment .................................................................................. 2-1Turning the Power On and Off .................................................................... 2-1Setting System Calendar & Clock ............................................................... 2-2Loading Recording Paper ............................................................................ 2-4

Chapter 3 Keyboard and Displays ................................................................3-1Keyboard ...................................................................................................... 3-1Display Objects ............................................................................................ 3-2

Chapter 4 Patient Preparation........................................................................4-1Prepare the Patient for Exercise Stress Testing ........................................... 4-1Prepare the Patient for Blood Pressure Monitoring ..................................... 4-4Prepare the Patient for Resting ECG ........................................................... 4-4

Chapter 5 Indications and Test Termination..............................................5-1Deciding to Perform an Exercise Stress Test ............................................... 5-1Terminating an Exercise Stress Test ............................................................ 5-3

Chapter 6 Exercise Stress Tests: Getting Ready .........................................6-1Choosing the Environment .......................................................................... 6-2Preparing for Exercise Stress Tests .............................................................. 6-2Entering Patient Data ................................................................................... 6-7Acquiring a Supine ECG ........................................................................... 6-13Acquiring a Baseline ECG ......................................................................... 6-13Acquiring Labeled ECG Reports ............................................................... 6-14Selecting the Protocol ................................................................................ 6-15Using a Treadmill ...................................................................................... 6-15Using a Bike ............................................................................................... 6-17

Chapter 7 Exercise Stress Tests: Warm-up, Exercise and Recovery........7-1Operating in Warm-up Phase ....................................................................... 7-1Operating in Exercise Phase ........................................................................ 7-4Operating in Recovery Phase ....................................................................... 7-7

QUEST Operating Instructions i

Chapter 8 Emergency Procedures................................................................. 8-1Emergency Equipment Checklist ................................................................. 8-1Using a Defibrillator .................................................................................... 8-1

Chapter 9 Acquiring a Resting ECG ............................................................ 9-1Outline of a Resting ECG ............................................................................ 9-1Choosing the Environment .......................................................................... 9-1Preparing for Resting ECG .......................................................................... 9-2Running a Resting ECG ............................................................................... 9-4Change User Settings for Current Test ........................................................ 9-5

Chapter 10 Configuring the System............................................................. 10-1Customizing User Setup ............................................................................ 10-1Customizing ECG User Setup ................................................................... 10-3Configuring System Setup ......................................................................... 10-5Configuring Post Study Users .................................................................... 10-7Configuring Network Settings ................................................................... 10-8Configuring Quest for use with a Mouse ................................................... 10-9

Chapter 11 Managing Patient Data .............................................................. 11-1Sorting Tests .............................................................................................. 11-2Test Storage ............................................................................................... 11-2Editing Tests .............................................................................................. 11-5Printing Tests ............................................................................................. 11-7Moving, Copying and Deleting Tests ........................................................ 11-8Exporting Final Report Data ...................................................................... 11-9

Chapter 12 Protocol Usage ............................................................................. 12-1Using Exercise Stress Protocols ................................................................. 12-1Customizing Protocols ............................................................................... 12-2Programming a Ramp Protocol .................................................................. 12-8Protocol Descriptions ................................................................................. 12-9

Chapter 13 Sample Printouts......................................................................... 13-1Resting 3-Channel ECG ............................................................................. 13-2Resting 3-Channel + Rhythm ECG ........................................................... 13-3Resting 6-Channel ECG ............................................................................. 13-4Resting 3-Channel Rhythm Strip ............................................................... 13-5Pretest 3-Channel Supine ECG .................................................................. 13-6Pretest 3-Channel + Rhythm Supine ECG ................................................. 13-7Pretest 6-Channel Supine ECG .................................................................. 13-8Pretest 3-Channel + Rhythm Baseline ECG .............................................. 13-93-Channel Rhythm Strip .......................................................................... 13-104-Channel Rhythm Strip .......................................................................... 13-116-Channel Rhythm Strip .......................................................................... 13-12Exercise Phase 12-Lead ECG(3-Channel + Rhythm Format) ................................................................ 13-1312 Lead - HR/BP Graph ........................................................................... 13-1412 Lead - Single Lead S-T Graph ............................................................ 13-1512 Lead - 12 Lead S-T Graph .................................................................. 13-16

ii QUEST Operating Instructions

12 Lead - Side by Side Averages ............................................................. 13-1712 Lead - Overlaid Averages ................................................................... 13-18Freeze Print .............................................................................................. 13-19Arrhythmia Report Printout ..................................................................... 13-20Maximum Exercise ECG ......................................................................... 13-21Recovery Phase 12-Lead ECG(3-Channel + Rhythm Format) ................................................................ 13-22Average Complex Automatic Printout ..................................................... 13-23Final Report Test Summary with Narrative(Summary and S-T Segment Analysis) .................................................... 13-24Final Report Average Complex Summary ............................................... 13-25Final Report Average Complex (by Time) .............................................. 13-26Final Report Trends Graph ...................................................................... 13-27Final Report S-T Trends Graph ............................................................... 13-28Exercise Stress Test Report ..................................................................... 13-29

Chapter 14 Maintenance and Service ...........................................................14-1Inspecting for Damage ............................................................................... 14-1Cleaning and Disinfecting QUEST ............................................................ 14-2Performance Testing .................................................................................. 14-2Moving the QUEST Cart ........................................................................... 14-3Moving the Treadmill ................................................................................ 14-3Storing QUEST .......................................................................................... 14-4Annual Safety Inspection ........................................................................... 14-4Voltages and Fuses .................................................................................... 14-5EMC Declaration Tables ............................................................................ 14-5Technical Data ........................................................................................... 14-8

Chapter 15 Troubleshooting ..........................................................................15-1Troubleshooting Unit Problems ................................................................. 15-1Troubleshooting Trace Problems ............................................................... 15-5Recognizing and Reducing ECG Artifacts ................................................ 15-8

Index .................................................................................................................IN-1Glossary ............................................................................................................ G-1References ......................................................................................................... R-1

QUEST Operating Instructions iii

iv QUEST Operating Instructions

Intended Use

WARNING: This device is intended for use by only trained medical personnel with specific knowledge in exercise stress testing and ECG monitoring. All tests must be conducted under the direct supervision of a qualified physician. Complications of exercise testing can include acute myocardial infarction, ventricular fibrillation or death. Medical personnel involved with testing should be familiar with cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS).

WARNING: This device is NOT intended for unattended or continuous patient monitoring or for use in operating rooms. It is intended for short-term monitoring of ECG waveforms in exercise stress applications. There are no audible or visible alarms.

WARNING: Whenever conducting an exercise stress test carefully evaluate the patient’s condition with regard to contraindications.

CAUTION: (United States units only) Federal law restricts this device to sale by or on the order of a physician.

This device is intended for use inside a medical facility.

Under the supervision of a qualified physician, QUEST may be used to monitor patients during exercise stress testing. Suggested uses1 include:

● Diagnosis of potential coronary heart disease

● Evaluation of patient physical performance

● Post infarction assessment

● Cardiac rehabilitation

● ECG monitoring specifically for cardiac performance during drug-induced stress (i.e, heart rate stimulants) in lieu of an exercise ergometer

Exercise stress testing poses a small but definite risk to the patient. Therefore observe the following considerations:

1. The procedure must be performed under the supervision of a qualified physician.

2. The patient must demonstrate appropriate indications.

3. The overseeing physician must carefully consider any contraindications.

4. The medical personnel must observe proper technique and safety precautions.

QUEST Operating Instructions v

5. The procedure must be performed at a site with accessible heart defibrillator and emergency cardiac medications.

Please note that the overseeing physician must demonstrate clinical competence. He or she should be aware of diagnostic accuracy and the criteria used to assess a “positive,” “negative” or “indeterminate” result. The overseeing physician should demonstrate these and other qualifications according to the guidelines found in the Position Statement on Clinical Competence in Exercise Stress testing from the American College of Physicians Board of Regents2, the American College of Cardiology Board of Trustees, and the American Heart Association Steering Committee.3

This equipment does not provide an interpretation of the exercise results but compiles data for evaluation by a physician.

Under the supervision of a qualified physician trained in the subject of ECG interpretation QUEST can also be used to record the electrical activity of the heart for the purpose of correlating the resultant waveforms with the health of the heart muscle tissue structures.

This equipment produces a 12 lead (view) electrocardiogram which can be used as a first step for assessment of patients with cardiac arrhythmias, intraventricular conduction block, pre-excitation syndrome and ischemic heart disease. Records stored and used during the life of the patient can assist physicians in the diagnosis and natural history of heart related illnesses (such as coronary artery disease).

This equipment is not designed to produce a definitive interpretation nor exhaustive evaluation of the patient’s heart but rather provide an effective beginning for evaluation of patients with heart abnormalities.

vi QUEST Operating Instructions

Warnings, Cautions & Notices

Warnings

WARNING: This device is intended for use by only trained medical personnel with specific knowledge in exercise stress testing and ECG monitoring. All tests must be conducted under the direct supervision of a qualified physician. Complications of exercise testing can include acute myocardial infarction, ventricular fibrillation or death. Medical personnel involved with testing should be familiar with cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS).

WARNING: This device is NOT intended for unattended or continuous patient monitoring or for use in operating rooms. It is intended for short-term monitoring of ECG waveforms in exercise applications. There are no audible or visible alarms.

WARNING: Whenever conducting an exercise stress test carefully evaluate the patient’s condition with regard to contraindications.

WARNING: Explosion hazard. Do NOT use in the presence of flammable anesthetics.

WARNING: Electrical shock hazard. Do NOT contact unit or patient during defibrillation. Otherwise, serious injury or death could result.

WARNING: NEVER position defibrillator paddles very close to or over ECG electrodes. Remove all chest electrodes (V-Leads or C-Leads) from a patient before defibrillation to allow proper paddle placement. Severe burns may result from improper placement of defibrillator paddles. Before using any defibrillator, consult the operating instructions for that equipment.

WARNING: For proper grounding, use only the provided, 3-conductor, hospital-grade power cord.

WARNING: The auxiliary AC outlets labeled “AUXILIARY 115V/0.25A” are not general purpose outlets. Only connect equipment that has been approved by Quinton Cardiology, Inc., or your local representative or dealer.

WARNING: Plug the power cord from the monitor into the outlet labeled “MONITOR AC” on the back panel of the QUEST unit. Failure to use this outlet may expose the patient to leakage currents that exceed acceptable limits for medical equipment as defined by EN 60601-1-1.

QUEST Operating Instructions vii

WARNING: Do not use BNC QRS pulse output for synchronized cardioversion.

WARNING: Consult all instructions accompanying your treadmill or bike before conducting an exercise stress test.

WARNING: Possible hazard due to broken glass. Take care while unpacking the monitor. Glass components may have shattered during shipping.

WARNING: It is recommended that unpacking and setup of QUEST be done by two people. There is a risk of personal injury if the equipment is dropped or tipped.

WARNING: Do not contact the COM2 or COM3 input/output ports and simultaneously touch the patient. There is a possible risk of exposure to dangerous currents.

WARNING: Treadmill deck can move up and down. Movement can create pinch points and lift objects. Keep objects out of treadmill path.

WARNING: Do not press the treadmill Stop key while the patient is still walking on the belt except in an emergency such as if the patient falls. Unexpected deceleration may make the patient lose his or her balance.

WARNING: The tilt/swivel platform of the monitor can create pinch points. Be careful to keep your hands away from the platform while tilting the monitor.

WARNING: Do not let clothing or cables become entangled in the treadmill. Route the patient cable over the railings, away from moving parts like the walking belt and treadmill deck. Serious injury and equipment damage can result.

WARNING: The monitor does not contain any serviceable parts. Dangerous high voltages are present inside. Refer all servicing to authorized service personnel.

WARNING: Even though Burdick supplies and accessories are manufactured according to strict quality standards, some patients may experience an allergic reaction to disposable electrodes or tape.

WARNING: NEVER place any object or chair on the treadmill walking belt. Serious personal injury could result from objects that are thrown or tipped due to treadmill movement.

WARNING: The Zip drive and/or network card provided with QUEST have been specially configured for the QUEST system. Use of any other Zip drive and/or network card could result in harm to the user, the patient, and the equipment.

viii QUEST Operating Instructions

WARNING: Position the Quest away from other equipment. If it is necessary to use the Quest adjacent to or stacked with other equipment, then observe the Quest to verify normal operations.

WARNING: Use of accessories or cables other than those specified, with the exception of Burdick accessories and cables sold by Quinton Cardiology, Inc. as replacement parts for internal components, may result in increased emissions or decreased immunity of the Quest.

Cautions

CAUTION: (United States units only) Federal law restricts this device to sale by or on the order of a physician.

CAUTION: Hazardous voltage. To reduce the risk of electrical shock, do not attempt to remove the cover under any circumstances. Refer servicing to a qualified technician.

CAUTION: The unit must be operated within the range of line voltage and frequency specified on the rating plate.

CAUTION: Although the QUEST system is designed to minimize the effect of RF interference, the presence of strong EMI fields generated by electronic, surgical or diathermy instruments close to the unit or patient may cause ECG trace noise or ECG input overload conditions.

CAUTION: To avoid scratching or damaging the monitor, never touch it with anything other than your finger tips. The rare exception to this is the calibration procedure. To calibrate the monitor, use the tip of a pencil or something made from plastic. Never use sharp or pointed objects. Do not use the point of a pen; ink will stain the TouchScreen membrane.

CAUTION: Failure to properly terminate communication with the PC card can result in loss or damage to tests and/or the PC card.

CAUTION: Blood pressure monitoring during an exercise stress test is consistent with guidelines published for exercise testing. Blood pressure readings should be taken at periodic intervals before, during and after the exercise test evaluation.

CAUTION: The Quest requires special precautions regarding EMC. Install and use the Quest according to the guidelines of the EMC declaration tables.

CAUTION: Portable and RF communications equipment may affect the Quest. Always observe the recommended separation distances as defined in the EMC declaration tables.

QUEST Operating Instructions ix

Notices

NOTICE: Computer generated ST Measurements and other computer-assisted calculations are valuable tools when used properly. However, no automated measurements are completely reliable and measurements should be reviewed by a qualified physician before treatment, or non-treatment, of any patient.

NOTICE: Computer assisted interpretation is a valuable tool when used properly. However, no automated interpretation is completely reliable and interpretations should be reviewed by a qualified physician before treatment, or non-treatment, of any patient.

NOTICE: The monitor has a separate power switch which does not interrupt power supplied to QUEST.

NOTICE: Waveforms displayed on the QUEST screen are not intended to be used for diagnostic purposes. Use displayed waveforms to assess signal quality only.

NOTICE: Average Complex waveforms are computer-generated averages of representative beats found during analysis. Do not base interpretation on Average Complex waveforms. For diagnosis, refer only to waveforms obtained in unprocessed rhythm or 12-lead recordings.

NOTICE: For best signal quality, do not use electrodes after the expiration date on the package and never mix electrode types or brands.

NOTICE: Disposal of equipment and accessories should be carried out in accordance with local ordinances. Contact your local waste management officials for more information.

NOTICE: Readings from automatic blood pressure devices may not be completely reliable. When readings are questionable, perform manual blood pressure readings and consult the operating instructions that came with your automatic blood pressure unit.

x QUEST Operating Instructions

Definitions of Symbols Used

Attention. Carefully read and follow accompanying instructions.

Danger! High voltage.

Hazardous voltage.

Meets or exceeds Council Directive 93/42/EEC, MDD, Class IIb.

Complies with the EMC/Radiocommunications requirements set out by the Australian Communication Authority under Radiocommunications Act, 1992.

Defibrillation-Protected Type CF Equipment.

Equipotential connection.

Power on (QUEST and treadmills).

Power off (QUEST and treadmills).

Alternating Current (AC).

Heart Rate Detection.

Input/Output Connection.

Monitor Screen Contrast.

Stop Function.

Start.

Increase Grade.

Decrease Grade.

QUEST Operating Instructions xi

Increase Speed.

Decrease Speed.

Power on (er800S model bike).

Power off (er800S model bike).

Power on (Rehcor model bike).

Power off (Rehcor model bike).

External communications on (Rehcor model bike); required for operation with QUEST.

External communications off (Rehcor model bike).

xii QUEST Operating Instructions

Chapter 1 General InformationCongratulations on your purchase of a top quality QUEST® Exercise System.

By listening to our customers, we have designed the QUEST system to suit your specific needs, incorporating features that health-care professionals like yourself have requested.

Your business is important to us. If you would like any further information or if you have any questions, contact your local representative or call Burdick Customer Service Department at (800)777-1777 or (608) 764-1919.

General Description

Figure 1-1The QUEST System

QUEST is a comprehensive exercise stress tolerance testing system. It is specifically designed to be the most intuitive system available. Critical information is kept readily accessible with minimal operator interaction. This allows you to conduct most of the test right from the touch-sensitive monitor while remaining focused on the welfare of the patient.

NOTE: Your QUEST system is intended for use with Quinton Cardiology, Inc. -approved supplies; its reliability and performance are directly affected by the supplies you use.

QUEST Operating Instructions 1-1

Chapter 1 General Information

With QUEST you may:

1. View your patient’s ECG with confidence that ectopic beats and ST levels are continuously evaluated using the highest quality signal processing algorithms.

2. Configure custom test protocols.3. Perform exercise stress tests with an attached treadmill or bike. 4. Select final reports which best accommodate your procedures.5. Acquire resting (supine) ECG printouts.6. Save final reports digitally for future referral.

Interpretive Analysis Program for Resting ECGs

About the program

QUEST is available with an interpretive analysis program for resting ECGs. This program is widely respected as one of the most accurate available today. It was developed by Prof. Peter MacFarlane of the University of Glasgow who has been involved in computerized ECG interpretation since its inception in the 1960s.

The ECG Interpretation Criteria Physician’s Guide is included with the Operating Instructions. This guide outlines the criteria used by the analysis program.

Features of the interpretive analysis program

● DEVELOPED IN A HOSPITAL ENVIRONMENT The interpretive program was developed by the University of Glasgow Division of Cardiovascular and Medical Sciences, Section of Cardiology based in the Royal Infirmary, Glasgow, Scotland. Unlike many products which are developed with the aid of outside consultants, this program was developed in the environment for which it is intended.

● USES AGE, GENDER AND RACE DATA EXTENSIVELYMore than 500 measurements, plus the patient’s age, gender, clinical classification and medications are factored into each analysis. Several criteria for abnormalities are age, race and gender dependent. Race, for example is key in identifying hypertrophy and T-wave abnormalities.

● PRODUCES CLEAR REASON STATEMENTSReasons appending abnormalities are given in conversational language. For example, wording like, “High voltages in limb leads,” is used rather than, “R in I > 1.4 mV.”

● USES CLINICAL HISTORYThe program is the first to use clinical class as an integral part of analysis just as a physician would consider clinical class in his or her evaluation.

1-2 QUEST Operating Instructions

Safety Features

● UNDER CONTINUOUS DEVELOPMENT & ENHANCEMENTThe program has been clinically tested against more than 80,000 ECGs and is continuously under development.

● ACCURATELY DETECTS NORMAL ECGsNormal ECGs are easily identified and sorted so the physician may quickly verify results.

Safety Features

WARNING: Electrical shock hazard. Do NOT contact unit or patient during defibrillation. Otherwise, serious injury or death could result.

WARNING: NEVER position defibrillator paddles very close to or over ECG electrodes. Remove all chest electrodes (V-Leads or C-Leads) from a patient before defibrillation to allow proper paddle placement. Severe burns may result from improper placement of defibrillator paddles. Before using any defibrillator, consult the operating instructions for that equipment.

QUEST is certified to comply with recommendations in IEC 601-1 and 601-2-25 safety standards.

A 3-conductor, hospital-grade power cable is included. The DB-15 style patient cable provides electrical isolation from earth ground. This conforms to IEC safety, pinout and mechanical requirements.

This symbol on the patient module indicates it is classified as defibrillation-protected, Type CF equipment.

This symbol which appears on the rear panel indicates that this equipment meets the requirements of Council Directive 93/42/EEC, MDD, Class IIb.

These units have been tested for electromagnetic compatibility in accordance with IEC 601-1-2 and comply with CISPR-11 and 801. The immunity failure criterion for the device is, “interference with the ECG trace that would result in misdiagnosis, loss of ergometer control or sustained erratic heart rate detection.” While the device passes the relevant standards, it may exhibit evidence of interference when subjected to electrostatic discharges, high voltage transients or high voltage surges, as defined in IEC 801-2, IEC 801-4 and IEC 801-5. The interference from a single event may manifest itself as a sharp noise spike on the ECG trace and/or display. The clinician will distinguish such noise spikes from the ECG waveforms, hence there is little risk of misdiagnosis. In the unlikely situation that the equipment is placed in an environment where such interference events are common, either the equipment or the interference source should be moved.


Chapter 1 General Information

Using Multiple Electrical ApparatusUse caution when monitoring patients who must be protected from very small electrical currents. Susceptible patients include patients with cardiac catheters or pacemakers. Consult a qualified technician before using multiple electrical apparatus in this patient environment.

The patient leads are electrically isolated from ground and the device meets the most stringent IEC and/or ANSI/AAMI medical standards for leakage currents.

However, a potential hazard may occur if the enclosure leakage currents from multiple pieces of equipment combine and are inadvertently routed directly to a patient’s heart via a catheter or pacemaker lead. Only equipment which is certified to meet, or otherwise complies with, IEC and ANSI/AAMI medical standards should be used in this environment. Use of certified equipment does not, however, completely eliminate this possible hazard. If you are unsure about the equipment you are using, consult a certified Biomedical Electronics Technician who can inspect and evaluate your facility.

Another potential hazard may occur if two devices near a patient are powered from different circuits. If the grounds of the two circuits are at different potentials, which can occur under certain fault conditions, then a ground loop can exist between the enclosures of the two devices. If devices must be powered from separate circuits in the vicinity of a susceptible patient, then the grounding lugs on the devices should be electrically connected via an equipotential cable. Please consult the QUEST Setup Guide, part number 086501, for more detailed information.

Microshock and the Electrically Susceptible PatientPatients who have a direct, conductive, electrical path to the heart, such as a conductive catheter or pacemaker lead through a breached chest, are at risk for microshock. A patient in this situation is “electrically susceptible.” Microshock may theoretically occur if electrical current, which can be below the level of perception, is directly conducted into the heart. There is a slight risk that this can cause fibrillation. For this reason, medical equipment standards require very low levels of leakage currents.

The main QUEST electronics box and patient module connection meet the most stringent requirements for leakage currents suggested by either the American Association for the Advancement of Medical Equipment (AAMI) or the International Electrotechnical Commission (IEC) medical standards for patient-connected equipment. The monitor is a commercial-grade device, so, to maintain the electrical safety requirements for the QUEST as a medical system, the monitor is supplied by an isolation transformer. The QUEST is configured to meet the full safety requirements for EN 60601-1-1, Safety Requirements for Medical Electrical Systems, only if the monitor is supplied power from the “MONITOR AC” power outlet on the QUEST back panel. Do NOT plug the monitor into a wall outlet.


Chapter 2 Getting StartedSetting Up Equipment

QUEST is supplied with an Equipment Setup Guide. Before operating QUEST, ensure that the unit has been installed according to the setup instructions. Make sure that the treadmill or bike is set up according to the operating instructions for that equipment then connect it as required to QUEST.

Turning the Power On and Off

QUEST Power

NOTICE: The monitor has a separate power switch which does not interrupt power supplied to QUEST.

The power switch is located on the right side of the unit when the keyboard is directly in front of you. To turn on the unit, press this switch to the On position ( ). After a short powerup sequence, the Pretest screen is displayed. If the display is blank, make sure that the monitor is turned on.

To save energy, turn QUEST off at the end of the day. Make sure that no tests are running, all the desired reports have been printed or saved and the Pretest screen is displayed. Turn the unit off by pressing the power switch to the Off position ( ).

Treadmill Power

The power switch for the treadmill is located in the front on the left side, as you face the treadmill. To turn the power on, press the switch to the On position ( ). To turn the power off, press the switch to the Off position ( ).

Bike Power

The power switch for the bike is located in the back of the bike in the area below the bike seat.

er800S model: Turn the power on by depressing the green button to the On position ( ). The green button will be illuminated when the power is on. Turn the power off by depressing the green button to the Off position ( ).

Rehcor model: Turn the power on by flipping the switch to the On position ( ). Turn the power off by flipping the switch to the Off position ( ).

NOTE: In order for the Rehcor bike to communicate with the QUEST system, the external communications switch must be set to the On position ( ).


Chapter 2 Getting Started

Setting System Calendar & Clock1. The first screen displayed after QUEST is turned on and powers

up is the Pretest screen. From this screen, press [Change System Selections]. The System Selections screen is displayed.

Figure 2-1The System

Selections Screen

2. Press [System Setup]. The System Setup screen is displayed.

Figure 2-2System Setup Options


Setting System Calendar & Clock

3. Press [Change Time] to access Time Entry window.

4. Press the screen key with the desired time format, 12 Hour or24 Hour.

The format is selected when the key has focus or appears highlighted.

5. Use the keyboard to type the correct time.

Use a colon ( : ) to separate the hour and minute entries.

If 12 Hour format is selected, type “AM” or “PM.”

6. To accept changes you have made, press [Set Time]. The System Setup screen is displayed.

NOTE: If you press [Close] instead, only format changes will be saved.

7. To access Date Entry window, press [Change Date].

8. Use the keyboard to type the correct date.

NOTE: Type the date in the format which is currently highlighted in the list at the bottom of the screen. Pay attention to what character separates the day, month and year entries. The original QUEST default is the “ / ” character.

9. To accept the changes you have made, press [Set Date]. The Setup Selections screen is displayed.

NOTE: If you press [Close] instead, only format changes will be saved.

10. Turn the QUEST power switch off and then back on again. Changes made to the System Calendar and Clock do not take effect until the QUEST has been restarted.


Chapter 2 Getting Started

Loading Recording Paper

NOTE: Damage caused by using unapproved recording paper may void your warranty.

NOTE: The printer is pre-adjusted at the factory. Do not try to make adjustments.

Use only Burdick thermally responsive ECG recording paper to obtain the best trace quality. The following ECG papers are recommended:

Assurance™, permanent trace, Z-fold. Thermal image integrity guaranteed for 25 years when stored in accordance with manufacturer’s specifications.

Standard trace, Z-fold. Thermal image integrity guaranteed for 5 years when stored in accordance with manufacturer’s specifications.

● Open the paper compartment door by pulling the left edge and sliding the door out to the left.

● Remove old paper or cardboard from compartment keeping paper if desired.

● Remove paper from a new package.

You may leave the bottom sheet of cardboard under the stack of paper. This makes placing the paper into the compartment easier.

● Place the paper into the compartment so that it lies flat with the red grid showing.

The edge of the paper that has printing on it should be closest to the keyboard.

● The paper compartment holds up to 1 1/2 packs of paper. If you wish, place the remainder from the old pack on top of the new paper. A red stripe appears on the paper when approximately 20 sheets remain at the end of a stack of paper.

● Lift the top sheet of the new stack of paper and lay it to the right.

● Slide the door back into place.

● Lay the top sheet of paper back over the door so that the printed side is up.

A black mark can be seen in the lower left corner of the page. Paper should be aligned parallel to the edge of the door.


Chapter 3 Keyboard and DisplaysKeyboard

The QUEST features a full, alphanumeric keyboard as well as six dedicated Ergometer Control keys. The keys and their functions are described below.

Figure 3-1The QUEST Keyboard

F

G

H

I

J

KLM

N

O

P

Q

R

A B C E

D

Key

A StartStarts the connected treadmill or toggles the Start/Stop mode of the connected bike (er800S model only).

B SpeedIncrease and decrease treadmill speed.

NOTE: These keys are disabled when a Bike protocol is in effect.

C Grade/WattsIncrease and decrease the slope of the treadmill deck or the Watts setting of the bike.

DNumbers1 through 0

Used for text entry such as blood pressure readings.

E Stop

Stops the treadmill, toggles the Start/Stop mode of the bike (er800S model), or stops resistance to the bike (Rehcor model).

Whenever a patient is walking on the treadmill belt, use this key only in an emergency such as if the patient falls because the treadmill speed decreases very quickly.

F Backspace Moves cursor one character to the left, deleting character previously in that position.

G Home Moves cursor to beginning of text entry line.


Chapter 3 Keyboard and Displays

Display ObjectsObjects are items appearing on the display that have a specific function. QUEST objects include screens, windows, lists, numeric keypads, text entry boxes and TouchScreen keys.

NOTE: When an object appears lighter than the rest, or gray, this means that the object is not available. An object may be unavailable if:

✔ QUEST is not in the appropriate mode. For example, the function may have been disabled in the System Setup window.

✔ Your version of QUEST does not support the object’s function.

H Enter

Selects objects with focus.

In the special case of the Comments text entry object for the Final Report, this key is used to move the cursor to the beginning of a new line.

I End Moves cursor to end of text entry line.

J Arrow Move focus within lists and move the cursor within text entry lines.

K Delete Moves cursor one character to the right, deleting character previously in that position.

L InsertToggles text entry overwriting. When off, typed characters overwrite previously typed text. When on, typed characters are inserted at the cursor pushing previously typed text to the right.

M Alt

Selects Hot Keys.

Object labels have one letter underlined. This underlined letter indicates the “Hot Key” which means that the corresponding keyboard key may be used to select the object.

For example, the [Enter Patient Data] key may be selected by holding down and pressing the key.

N ControlAccesses special text characters on the keyboard if available. These characters are blue on the keyboard.

O Shift Used in text entry to type capital letters.

P Caps Lock Toggles capital letter text entry. When on, the small light is on and text is entered as capital letters.

Q Tab Moves focus to next object on the display.

R Help Accesses on-line help guide (if available).

Key

PÜ


Display Objects

To indicate which object is active or selected, QUEST gives the object “focus.” This means the objects appears outlined or highlighted on the display. The keyboard key, , is used to move focus. Holding down and pressing

moves focus back to the previous object.

QUEST uses a process called Logistep™ to guide you through standard procedures. As you operate QUEST, focus is given to the TouchScreen key, or other object, for the next step which typically follows.

Screens

Screens occupy the full monitor. In this manual, the names of screens and of windows are written in bold, italic letters. The first screen which appears when you turn QUEST on is Pretest.

Screens contain all the objects and user information needed for a group of related functions. For example, from the Pretest screen you can preview ECG waveforms, access the Patient Demographic Entry window and begin an exercise stress test.

Figure 3-2An Example of a Screen



TouchScreen Keys

TouchScreen keys respond when you touch the monitor. In this manual, the names of TouchScreen keys are typed in bold letters between brackets. For example, the key below is the [Enter Patient Data] key.

Hot Keys

Hot Keys are keyboard keys which select objects that are displayed on the screen.

Some object labels have one underlined letter. This underlined letter indicates the corresponding keyboard key that, when used in conjunction with the key, selects the object.

NOTE: The word “alt” is underlined on the key. This helps remind you that this key is used with the underlined Hot Keys.

For example, to select [Enter Patient Data] using the keyboard, hold down and simultaneously press the key.

Windows

Windows are small display areas which contain objects and information for a particular function. Windows overlay screens and are displayed only while in use. An example of a window is the Patient Demographic Entry window.

Figure 3-3An Example of a Window

Most windows contain a [Close] button. This button is used to close thewindow without making any changes or saving data. This provides you witha means of closing a window which was opened unintentionally.

PÜ


Display Objects

Lists

Lists are special windows that list several choices from which a selection is made. Choices are diaplayed in alphabetical order.

Figure 3-4An Example of a List

Use the [Up Scroll Arrow] or [Down Scroll Arrow] keys to highlight the desired item. When the desired item is highlighted, select it by pressing [Select].

If the item you need is not displayed in the list, press the [Text] key. This will give you access to a text entry box where you can type a new item that is not available in the list.

[Up Scroll Arrow]

[Down Scroll Arrow]



Numeric Keypads

Numeric keypads are objects that are used to enter numeric data. An example of a numeric keypad is found in the Blood Pressure Entry window.

Figure 3-5An Example of aNumeric Keypad

Use the numeric TouchScreen keys [0] through [9] to type numeric values.

Use the [ < — ] key to erase one character to the left of the cursor with each press of the key.

Special keys such as the [ / ], [ : ] and [ . ] allow you to type separators in different numeric entries. For example, for blood pressure values, press [ / ] to accept the Systolic entry and move focus to the Diastolic value.

Press [Enter] to accept entries. Press [Clear] to erase all entries.

Press [Start] to begin Automatic Blood Pressure measurement. Press [Stop] to end ABP measurement.

NOTE: Alternatively, the keyboard can be used to enter BP values manually: First, type the systolic value and press to move to the diastolic entry. Then, type the diastolic value and press to accept both entries.

Text Entry Boxes

Text entry boxes are objects which accept text. When they have focus, these boxes display a cursor, a vertical line, at the insertion point.

An example of an active text entry box with a cursor is shown below.


Chapter 4 Patient PreparationWARNING: Even though Burdick supplies and accessories are manufactured according to strict quality standards, some patients may experience an allergic reaction to disposable electrodes or tape.

The attending physician is responsible for obtaining the patient’s medical history including their symptoms and any past medical problems. A thorough evaluation of the patient includes recognition of contraindications to performing an exercise test.

Prepare the Patient for Exercise Stress TestingApply electrodes before entering patient data into QUEST. This allows time for the electrodes to adhere and improves conductivity.

1. Take special care with skin preparation.

NOTE: For good electrode contact, you must abrade the skin at electrode sites as well as shave any hair which might be present. Poor skin preparation can result in ECG artifact as described in “Baseline wander” on pg. 15-8. Such artifact is NOT caused by the equipment.

✔ If any hair is present, shave hair from electrode sites using a safety razor like the one provided with the QUEST accessories (see Figure 4-1 for electrode locations).

✔ Cleanse electrode sites with warm, soapy water to remove oil.

✔ Lightly abrade skin at electrode sites using a skin rasp or a gauze pad. The goal is to remove the top layer of epidermis so the electrodes can make proper contact with the skin. The skin will redden but should not bleed.

NOTE: For best signal quality, do not use electrodes after the expiration date on the package and never mix electrode types or brands.

2. Place disposable, stress electrodes according to Figure 4-1, “Exercise Stress Lead Placement” on pg. 4-2. As you apply electrodes, press down on the outside foam area first to avoid squeezing the gel out.


Chapter 4 Patient Preparation

Figure 4-1Exercise Stress Lead

Placement

1 623

45

8

109

7

Key

AHA IEC

1 V1 C1Fourth intercostal space at right margin of sternum.

2 V2 C2Fourth intercostal space at left margin of sternum.

3 V3 C3 Midway between 2 and 4.

4 V4 C4Fifth intercostal space at junction of left midclavicular line.

5 V5 C5At horizontal level of position V4 at left anterior axillary line.

6 V6 C6At horizontal level of position V4 at left midaxillary line.

7 RA R Beneath right clavicle.

8 LA L Beneath left clavicle.

9 RL N In line with 7.

10 LL F In line with 8 and 4.


Prepare the Patient for Exercise Stress Testing

3. Insert the patient module into the pocket of the patient module belt.

NOTE: Use the belt extension on patients for whom the patient module belt is not large enough.

4. Put the belt and patient module on the patient. Route the main cable on the patient module up and under the belt.

Figure 4-2Patient Module Cable routing

5. Attach leads to electrodes with stress clips.

✔ Open stress clip by pinching with thumb and forefinger.

✔ Connect clip to metal button on top of pad.

6. Adjust lead wires so that tension is minimal. Make “stress loops” (see Figure 4-3) and tape them to the patient’s chest and abdomen. Stress loops minimize electrode movement and ECG artifact.

Figure 4-3Stress Loop

7. Position the belt and patient module so the patient will be comfortable but so that the electrode connections will not be disturbed. To avoid entanglement, route the cable and the Patient Module away from the patient’s legs and the equipment.



8. In cases where electrode and cable movement is a factor, such as with obese patients, take steps to keep the electrodes in place. This can be accomplished by having the patient put on a stretchy shirt or by wrapping an elastic bandage around the patient’s torso.

Prepare the Patient for Blood Pressure Monitoring

CAUTION: Blood pressure monitoring during an exercise stress test is consistent with guidelines published for exercise testing. Blood pressure readings should be taken at periodic intervals before, during and after the exercise test evaluation.

1. Using a manual or automatic sphygmomanometer place the blood pressure cuffs on the patient’s arm.

2. Enter blood pressure readings as the patient moves through the exercise stress testing sequence. You may either enter the readings through the testing screens in QUEST using the [BP] key or you may manually record the readings on the recording paper.

Prepare the Patient for Resting ECGApply electrodes before entering patient information into the QUEST. This allows time for the electrodes to adhere and improves conductivity.

To minimize muscle artifact, make sure your patient is comfortable and relaxed. Assure your patient that there is no danger or pain involved, and that his or her cooperation will assist in producing a valuable diagnostic record.

Make the patient comfortable on a cot or padded table which is large enough to support arms and legs. The patient’s arms should rest at his or her sides and the legs should lie flat, not touching one another. Use a pillow to support the patient’s head. Also, try to avoid factors like cold drafts which could cause discomfort. Leaving the chest and electrode sites exposed, cover your patient with a blanket to prevent shivering.

Correct electrode placement is critical for an accurate GRI analysis of test results. For limb sites, choose fleshy areas, not ankles or wrists (see Figure 4-4). Refer to the “Resting ECG Lead Placement and Coding Chart” on pg. 4-7 for details on correct standard lead placement.

1. If the patient has oily or sweaty skin, or has recently applied lotion to their skin, clean the sensor sites with warm soapy water. Dry the sensor sites completely before applying sensors.


Prepare the Patient for Resting ECG

2. When applying sensors to sites with a lot of hair, the following techniques may improve contact:

✔ Use the thumb and forefinger to spread the hair before applying the sensor to the skin.

✔ If the sensor does not adhere well, it may be necessary to shave the site.

NOTE: In some cases skin irritation can occur from site preparation and sensor electrolyte solutions.

3. Place disposable, snap-type electrodes on prepared skin sites. Press down on the outside foam area first as you apply electrodes to avoid squeezing the gel out.

Figure 4-4Disposable Limb electrode on

Arm

4. Place the Patient Module in a position that is convenient and comfortable for the patient.

5. Attach leads to electrodes with stress clips.

✔ Open stress clip by pinching with thumb and forefinger.

✔ Connect clip to metal button on top of pad.

6. Adjust lead wires so that tension is minimal. Make sure that lead cables follow the contours of the patient’s body and lie flat, and that no strain is placed on the electrodes.

✔ Leads on arm electrodes should point downward toward feet.

✔ Leads on legs should point upward toward chest.

Large loops can pick up AC interference from the air. To avoid interference, roll excess cable into a coil (see Figure 4-5) and tape the coil to the patient’s chest and abdomen.



Figure 4-5Lead Cable Arrangement CORRECT INCORRECT


Prepare the Patient for Resting ECG

Resting ECG Lead Placement and Coding Chart

PLACEMENT OF THELIMB SENSORS

PLACEMENT OF THE CHEST SENSORS

LEAD CODING AND MEASUREMENTS

V1

V6V2

V3 V4 V5

LEAD ILEAD IILEAD III

LA-RALL-RALL-LA

LEADSENSORS

CONNECTED / MEASURED

aVRaVLaVF

RA and (LA-LL)LA and (RA-LL)LL and (RA-LA)

LEADSENSORS


V1V2V3V4V5V6

V1 and (LA-RA-LL)V2 and (LA-RA-LL)V3 and (LA-RA-LL)V4 and (LA-RA-LL)V5 and (LA-RA-LL)V6 and (LA-RA-LL)

LEADSENSORS


AHA COLOR CODELEAD

RLLLRALAV1V2V3V4V5V6

BAND LABEL

GREENRED

WHITEBLACKBROWNBROWNBROWNBROWNBROWNBROWN

REDYELLOWGREENBLUE

ORANGEVIOLET

Fourth intercostal space at right margin of sternum

C1Fourth intercostal space at left margin of sternum

C2Fifth intercostal space at junction of left midclavicular line

C4Midway between position C2 and position C4

C3At horizontal level of position C4 at left anterior axillary line

C5At horizontal level of position C4 at left midaxillary line

C6

C1

C6C2

C3 C4 C5

RA

RL LL

LAI

aVR aVL

aVF

II

III

(R) (L)

(N) (F)

IEC COLOR CODELEAD

NFRL

C1C2C3C4C5C6

LOCATION LABEL

RIGHT LEGLEFT LEG

RIGHT ARMLEFT ARM

CHESTCHESTCHESTCHESTCHESTCHEST

REDYELLOWGREENBROWNBLACKVIOLET

LEAD ILEAD IILEAD III

L-RF-RF-L

LEADSENSORS


STANDARD LIMB LEADS

aVRaVLaVF

R and (L-F)L and (R-F)F and (R-L)

LEADSENSORS


AUGMENTED LIMB LEADS

C1C2C3C4C5C6

C1 and (L-R-F)C2 and (L-R-F)C3 and (L-R-F)C4 and (L-R-F)C5 and (L-R-F)C6 and (L-R-F)

LEADSENSORS


CHEST LEADS

AHASTANDARD LIMB LEADS

AUGMENTED LIMB LEADS

CHEST LEADS

IEC

Fourth intercostal space at right margin of sternum

V1Fourth intercostal space at left margin of sternum

V2Fifth intercostal space at junction of left midclavicular line

V4Midway between position V2 and position V4

V3At horizontal level of position V4 at left anterior axillary line

V5At horizontal level of position V4 at left midaxillary line

V6

AHA

IEC

LOCATION

RIGHT LEGLEFT LEG

RIGHT ARMLEFT ARM

CHESTCHESTCHESTCHESTCHESTCHEST

BAND

BLACKGREEN

REDYELLOWWHITEWHITEWHITEWHITEWHITEWHITE


Chapter 5 Indications and Test TerminationDeciding to Perform an Exercise Stress Test

In addition to the following guidelines4, always consult current literature and research regarding proper technique and evaluation of exercise stress testing.

Indications

1. Evaluation of chest pain.

2. Screening for ischemic heart disease in at-risk asymptomatic males.

3. Evaluating dysrhythmias.

4. Determining functional capacity.

5. Generating an exercise prescription.

6. Aid in establishing the severity or prognosis of ischemic heart disease to stratify those who need additional intervention, that is, angioplasty or coronary artery bypass graft.

NOTE: These last three applications of exercise stress testing are of higher risk to the patient.

7. Estimating antiarrhythmic therapy.

8. Evaluating antianginal or antihypertensive therapy.

9. Evaluating a patient after myocardial infarction for risk stratification.

Contraindications

Never conduct an exercise stress test under the following conditions:

1. Acute myocardial infarction in progress or recent complicated myocardial infarction.

2. A recent significant change in the resting ECG suggesting infarction or other acute cardiac event.

3. Unstable or atypical angina.

4. Rapid ventricular or atrial dysrhythmias.

5. History suggesting medicine toxicity such as with digoxin, diuretics, sedatives or psychotropic agents.

6. Uncompensated congestive heart failure.

7. Severe aortic stenosis or left ventricular outflow tract obstruction (hypertrophic cardiomyopathy—IHSS).

8. Suspected or known dissecting aneurysm.

9. Active myocarditis or cardiomyopathy.


Chapter 5 Indications and Test Termination

10. Active thrombophlebitis.

11. Recent embolic disease, either systemic or pulmonary, within the past three months.

12. Current or recent infectious episodes.

13. Uncooperative patient.

Use caution under any of the following conditions:

1. Conductive disturbances:

First- or second-degree atrioventricular block.

Bundle-branch block.

Preexcitation syndromes (Wolff-Parkinson-White syndrome).

2. Controlled dysrhythmias.

3. Known coronary artery disease.

4. Use of certain medications:

Beta blockers

Diuretics

Digoxin

Calcium channel blockers

Nitrates

Antihypertensive agents

5. Clinically severe hypertension.

6. Congenital heart disease.

7. Other conditions:

Severe anemia.

Fixed-rate pacemakers.

Marked obesity.

Moderate to severe pulmonary disease.

Intermittent claudication.

Neuromuscular, musculoskeletal, orthopedic or arthritic disorders that would prevent treadmill walking.


Terminating an Exercise Stress Test

Terminating an Exercise Stress TestTerminate the test immediately under the following conditions:

1. Acute myocardial infarction or suspicion of myocardial infarction.

2. Onset of progressive angina.

3. Decrease of systolic blood pressure with increasing workload accompanied by signs or symptoms indicating poor left ventricular function and poor cardiac output.

4. Serious dysrhythmias.

5. Signs of poor perfusion including pallor, cyanosis or cold, clammy skin.

6. Central nervous system symptoms including ataxia, vertigo, visual or gait problems and confusion.

7. Technical problems with monitoring the ECG or mechanical problems such as motor failure.

8. Patient requests to stop.

The physician may decide to terminate the test under the following conditions:

1. Pronounced ECG changes from baseline, including more than 2 mm of horizontal or downsloping ST-segment depression or 2 mm of ST-segment elevation.

2. Progressive or increasing chest pain.

3. Pronounced fatigue or shortness of breath.

4. Wheezing.

5. Leg cramps or intermittent claudication.

6. Hypertensive response (systolic blood pressure greater than 260 mmHg or diastolic blood pressure greater than 115 mmHg).

7. Less serious dysrhythmias such as supraventricular tachycardia.

8. Exercise-induced bundle branch block that cannot be distinguished from ventricular tachycardia.


Chapter 5 Indications and Test Termination


Chapter 6 Exercise Stress Tests: Getting ReadyOutlined below are the basic steps of a traditional exercise stress test. Some of the steps are optional and are performed at the discretion of the overseeing physician.

NOTE: The user can press Stop at any time during the test sequence to immediately terminate the procedure.

Figure 6-1Outline of an

Exercise Stress Test

[Print Baseline ECG][Print Baseline ECG]

[End [End Test]est] [Sa[Save ve Test Data]est Data]


Chapter 6 Exercise Stress Tests: Getting Ready

NOTE: Test data is automatically saved if power supply is interrupted during the test or if the test is terminated prior to being printed or saved.

Choosing the Environment

WARNING: Explosion hazard. Do NOT use in the presence of flammable anesthetics.

CAUTION: Although the QUEST system is designed to minimize the effect of RF interference, the presence of strong EMI fields generated by electronic, surgical or diathermy instruments close to the unit or patient may cause ECG trace noise or ECG input overload conditions.

QUEST is a high fidelity instrument which responds to the minute voltages of the heart. Since it is such a sensitive instrument, take care to avoid interference which can be produced by AC signals. To minimize interference, locate the ECG monitor and patient away from power cords and other electrical devices.

Preparing for Exercise Stress TestsDo NOT operate QUEST if:

✔ You are using an ergometer and the treadmill or bike are not responding to user controls or are not functioning as expected.

✔ ECG data is not continually refreshed on the display at any time while the patient is connected.

✔ The heart rate measurement is not updating or is grossly inaccurate.

The physician is responsible for evaluating the patient, selecting the proper protocol for testing, supervising and terminating a test and for the recovery of the patient.


1. Ensure exercise equipment and power cables are connected according to the guidelines outlined in the QUEST Setup Guide.

2. Apply leads to your patient according to the guidelines in Chapter 4.

3. Press the power switch on the right side of the QUEST unit to put it in the On position ( ). The Pretest screen (see Figure 6-2) is displayed after a short powerup sequence.


Preparing for Exercise Stress Tests

NOTE: If you have run an exercise stress test with another patient, make sure the Pretest screen is displayed before connecting a new patient. If you do not press [Next Test] between patients, printouts will be mislabeled.

Figure 6-2The Pretest Screen

A B D GF I

Q P O N M L K J

HC E

R

Key

A [BP] Accesses Blood Pressure Entry window.

B Heart RateDisplays current patient heart rate. If an arrhythmia event is detected, the word “Ectopic” is displayed below the heart rate.

C[Arrhythmia Detection is ON/OFF]

Toggles the detection of arrhythmias for the Final Report.

D Phase Displays the current phase of the test.



4. With the belt on the patient and the Patient Module in the pocket, connect the Patient Module cable. Insert the connector into the Patient Module, arrow-side-up, until you hear it “click” into place.

E[Arrhythmia Print is ON/OFF]

NOTE: [Arrhythmia Detection] must be ON in order to use this option.

Toggles the printing of detected arrhythmias during the Pretest phase.

When the [Arrhythmia Print is ON/OFF] key is set to ON, a 10-second ECG is printed whenever ectopic beats are detected. Unless you wish to have these print throughout the test, make sure that [Arrhythmia Print is ON/OFF] is set to OFF.

F ProtocolDisplays current protocol which will be used in Warmup, Exercise and Recovery phases of the test.

G Workload

Displays the current treadmill or bike values.

For treadmill, these are speed in mph (miles per hour) or kmh (kilometers per hour) and %grade. For bike these are speed in rpm (rotations per minute) and Watts.

H User Displays current User selection.

I[Change System Selections]

Accesses the System Selections screen.

J [Start Exercise] Advances to Exercise phase.

K [Start Warmup] Advances to Warmup phase.

L[Print Additional ECGs]

Accesses the Additional ECG Selection list.

M[START Rhythm Print]

Begins a continuous Rhythm strip. Press this key again to stop printing.

N[Print Baseline ECG]

Acquires a 12-lead ECG labeled “BASELINE ECG.” This ECG is used as a baseline for S-T analysis throughout the test.

O[Print Supine ECG]

Acquires a 12-lead ECG labeled “SUPINE ECG.”

P[Enter Patient Data]

Accesses the Patient Demographic Entry window.

Q[Change Test/Display Setup]

Accesses the Test/Display Setup Selection window.

R Message BoxDisplays informational messages and prompts. If there is more than one message, they will be scrolled every 10 seconds.

Key


Preparing for Exercise Stress Tests

5. Make sure the Patient Module cable is also connected to the jack labeled PATIENT ECG located on the back of the unit.

6. Verify that the proper User is selected (item “H” in Figure 6-2). If you would like to use a customized User Setup or for more information on Users, see “Customizing User Setup” on pg. 10-1.

7. To make changes to the display or test setup, press [Change Test/Display Setup]. Any changes made will remain in effect for the current test only. Permanent changes must be made through the System Setup, User Setup or Protocol Programming screen.

Change Test/Display Setup

Figure 6-3The Change Test/Display

Setup Window

B

C

E

F

K

L

M

O

J

H

N

G

D

P

I

A

Key

ACurrent Protocol

Displays currently active protocol

B[Change Protocol]

Press to display the Protocol Selection window.



C[Pacemaker Enhancement is ON/OFF]

Press to toggle Pacemaker Enhancement function on and off. This button defaults to OFF at the start of each test.

When the Pacemaker Enhancement function is enabled, QUEST places a spike on the display and on the printout whenever a pacemaker pulse is detected.

NOTE: The QUEST Heart Rate Meter, Line Filter, S-T Analysis, and ECG Morphology can all be negatively affected by the presence of a pacemaker. To avoid confusion, it is best to enable the Pacemaker Enhancement function when testing a patient who wears a pacemaker. This ensures that the printouts clearly show the presence of a pacemaker.

DS-T MeasurementPoint

Displays the currently selected S-T measurement point.

E[Adjust QRS MeasurementPoints]

Press to display the QRS Measurement Point Adjustment window.

F[Change Display Gain]

Press to display the Display Gain Selection window.

G[Change Display Format]

Press to display the Display Selections window.

H[Change Writer Settings]

Press to display the Writer Selections window.

NOTE: If you select the Stable filter (a .67Hz filter) in the Writer Selections window, the heart rate display on the screen and the printout will be delayed by 1.02 seconds for the entire time the filter is on. The first 1.02 seconds will show no lines on the screen and printout. Once the filter is turned off, the screen and printout will skip 1.02 seconds of heart rate data to return to a real time representation.

I[Auto BP is ON/OFF]

Press to toggle Automatic Blood Pressure (Auto BP) on and off. ABP is measured as programmed in the Protocol screen.

J[BP Prompt is ON/OFF]

NOTE: This option is not available when (Auto BP) is ON.

Press to toggle the BP prompts. When on, BP prompts occur as programmed in the Protocol screen.

K[RPE Prompt is ON/OFF]

Press to toggle the RPE prompts. When on, RPE prompts occur as programmed in the Protocol screen.

L[12 Lead is ON/OFF]

Press to toggle the automatic 12-lead printouts as programmed in the Protocol screen.

M[Rhythm is ON/OFF]

Press to toggle the automatic rhythm printouts as programmed in the Protocol screen.

N[Average Complex is ON/OFF]

Press to toggle the automatic average complex printouts as programmed in the Protocol screen.

Key


Entering Patient Data


NOTE: Test data is automatically saved if power supply is interrupted during the test or if the test is terminated prior to being printed or saved.

After applying leads to your patient, enter patient data.

Patient data directly affects both the QUEST analysis and the physician’s analysis of the patient’s ECG. For example, target heart rate is automatically calculated using Age. For Bike protocols, patient weight is used to calculate METs. As a minimum, it is recommended that you enter the patient’s last name and ID number.

NOTE: When you have finished entering patient demographics, press [Save] to accept the data you have entered and return to the Pretest screen.

1. In Pretest, press [Enter Patient Data] to access the Patient Demographic Entry window.

Figure 6-4The Patient Demographic

Entry Window

2. The Last Name text entry box has focus and there is a cursor at the insertion point. If this object does not have focus, you can touch the object on the monitor to select it.

3. Type the patient’s last name and press .

4. Type the patient’s first name and press .

5. Type the patient’s identification number and press .

O [Close]Press to close the Test/Display Setup window. Any changes are applied.

PAnalog Outputs

Press to display the current Analog Output settings. Press the appropriate screen key to select a different setting.

Options for each output (O1, O2, O3, O4) are: Lead I, II, III, aVR, aVL, aVF, V1 through V6, Speed/Revolutions, Grade/Watts, and Heartrate.

Key



6. Type the patient’s date of birth. Age and Age Format are automatically filled in. Press .

NOTE: The patient’s date of birth (D.O.B.) must be entered in the format specified in System Setup. An example of the format to use is displayed on the D.O.B. object.

7. Type in the maximum heart rate for the patient. If this field is left blank, QUEST automatically calculates the maximum heart rate using the formula, [220 - (patient’s age)]. Press .

8. Press to view the list of options for race. Select the appropriate race entry and press . The display returns to Patient Demographic Entry window and the Gender button is highlighted.

9. Press to view the list of options for gender. Select the appropriate gender from the list and press . The display returns to Patient Demographic Entry window and the BP button is highlighted.

10. Press or touch the BP (Blood Pressure) object to activate the Blood Pressure Entry window.

Figure 6-5The Blood Pressure Entry

Window

C

D

F

I

A

G

H

B

E

Key

ANumeric[0] through [9]

Use these keys or the keyboard to type the numeric blood pressure values.

B[Up Arrow] & [Down Arrow]

Press to increase and decrease numeric blood pressure values.

C [ < — ] Press to erase one character to the left of the cursor.



11. Enter the patient’s baseline blood pressure reading.

NOTE: If using an automatic blood pressure recording device refer to the operating instructions for the device to obtain proper blood pressure readings.

12. Type the patient’s systolic blood pressure reading and press the TouchScreen key, [ / ]. Then type the diastolic value and press

. The display returns to Patient Demographic Entry window.

NOTE: Alternatively, the keyboard can be used to enter BP values manually: First, type the systolic value and press to move to the diastolic entry. Then, type the diastolic value and press to accept both entries.

13. Enter the patient’s height and press .

14. Enter the patient’s weight and press .

15. Press to view the list of options for Medicine 1. Select the appropriate medicine from the list or press [Text] to access the text entry object and type a different selection; press .The display returns to Patient Demographic Entry window.

16. If appropriate, select or enter a second medication for Medicine 2.

17. If appropriate, enter additional medications:

✔ Press to access the Additional Medications window.

✔ Press to view the list of options. Select the appropriate medicine from the list or press [Text] to access the text entry object and type a different selection; press . Repeat as

D [Enter]Press to accept both entries, save any changes you have made in this window and return to Patient Demographic Entry.

E [Close]Press to cancel editing the blood pressure values and return to Patient Demographic Entry. No changes for blood pressure are saved.

F [ / ]After typing the Systolic value, press this to accept the entry and move focus to the Diastolic value.

G [Clear] Press this to clear both blood pressure values.

H [Start]NOTE: This option is only available when an Automatic Blood Pressure monitor is selected in the System Setup.

Press this to start measuring BP using the automatic BP unit.

I [Stop]NOTE: This option is only available when an Automatic Blood Pressure monitor is selected in the System Setup.

Press this to stop measuring BP using the automatic BP unit.

Key



necessary for Medication 4, Medication 5, and Medication 6.

✔ When finished entering additional medications, press [Close].

NOTE: This list may be edited in User Setup.

18. Press to view the list of options for Clinical Class 1. Select the appropriate clinical class from the list or press [Text] to access the text entry object and type a different selection; press

.The display returns to Patient Demographic Entry window.

19. If appropriate, select a second classification in Clinical Class 2 selection (see instructions for Clinical Class 1 selection).

20. Press to view the list of physician names. Select the name of the overseeing physician from the Physician selection list or press [Text] to access the text entry option; press .The display returns to Patient Demographic Entry window and the Technician button is highlighted.


21. Press to view the list of technician names. Select your name from the Technician selection list or press [Text] to access the text entry option; press .The display returns to Patient Demographic Entry window and the Department button is highlighted.


22. Press to view the list of department names. Select the name of your department from the Department selection list or press [Text] to access the text entry option. Type the name of the department and press the tab key. Type the department number. Press .The display returns to Patient Demographic Entry window.

NOTE: The list of department names may be edited in User Setup.

23. Press [Save] to save changes and return to Pretest.



Detailed List of Patient Demographic Items

There are three kinds of objects in the Patient Demographic Entry window:

1. Text Entry Boxes

2. Lists

3. Numeric Keypad (the Blood Pressure Entry window)

The table below describes the contents of each of these objects. For text entry objects, the kind of information accepted and the maximum number of characters are listed next to the object name. For lists, the contents are given.

NOTE: If you skip an item in this window, QUEST generally leaves the item blank. Default values other than “blank” are indicated in the table below.

Last Name Up to 20 alphanumeric characters.

First Name Up to 20 alphanumeric characters.

Id(Identification)

Up to 20 alphanumeric characters.

D.O.B.(Date of Birth)

Up to 20 alphanumeric characters. Must be typed in the format specified in System Setup. An example of the appropriate format is displayed.

AgeUp to 3 numeric characters.

If you type a value for Age that does not agree with the calculated age from D.O.B., D.O.B. is cleared.

Age Format Years (default)

Maximum Heart Rate

Up to 3 numeric characters; range = 0 to 250.

If this field is left blank, QUEST automatically calculates the maximum heart rate using the formula, [220 - (patient’s age)].

Race

blankCaucasianBlackOrientalOther RaceUnknown

GenderblankFemaleMale

BP(Blood Pressure)

Blood Pressure Entry window.

Enter the systolic blood pressure reading and press [Enter] or [Tab], then enter the diastolic value and press [Enter]; or press [Start] and measure BP by using the automatic BP unit.

For both values, the range = 0 to 250.

Height Up to 3 numeric characters. Range = 0 - 244 cm or 0 - 96 in.

WeightUp to 3 numeric characters. Range = 0 - 227 kg or 0 - 500 lb.

Used to calculate METs for Bike protocols.



Medicine 1 and

Medicine 2

blankAmiodaroneBeta BlockerDigitalisDisopyramideDiureticLidocaineNo MedicationOther AntiarrhythmicOther MedicationProcainamidePsychotropicQuinidineSteroidUnknown

This list is user-configurable and may contain additional entries.Select from the list or press [Text] to access the space for typing a different selection.

Additional Medications

Medication 3Medication 4Medication 5Medication 6

For each field, press Enter to access the medication entry window. Select from the list (see row above) or press [Text] to access the space for typing a different selection.

Clinical Class1and

Clinical Class2

blankNormalUnknownMyocardial InfarctionMyocardial IschemiaHypertensionCongenital Heart DiseaseRheumatic heart DiseasePericarditisRespiratory DiseaseImplanted PacemakerEndocrine DiseasePulmonary EmbolismPost Cardiac SurgeryCardiomyopathyOther

This list is user-configurable and may contain additional entries.Select from the list or press [Text] to access the space for typing a different selection.

Physician Select from the list or press [Text] to access the space for typing a new selection.

TechnicianSelect from the list or press [Text] to access the space for typing a new selection.

DepartmentSelect from the list or press [Text] to access the space for typing a new selection. Press [Tab] and type in the department number.


Acquiring a Supine ECG

Acquiring a Supine ECGIn Pretest, press [Print Supine ECG] to immediately print a 12-lead ECG report. This test is labeled “SUPINE ECG.”

Tips for Acquiring Supine ECGs

You will obtain high-quality resting ECGs when your patient is relaxed. Assure your patient that acquiring a resting ECG is not dangerous or painful. Tell your patient that his or her cooperation will assist in producing a valuable diagnostic record.

Make the patient comfortable on a cot or padded table which is large enough to support arms and legs. The patient’s arms should rest at his or her sides and the legs should lie flat, not touching one another. Use a pillow to support the patient’s head. Also, try to avoid factors like cold drafts which could cause discomfort. Leaving the chest and electrode sites exposed, cover your patient with a blanket to prevent shivering.

Acquiring a Baseline ECG

NOTE: It is important that a Baseline ECG be acquired. This record, which is acquired before the Exercise phase of the test, is used by QUEST to obtain a baseline reference for Median Complexes and S-T Analysis. Even if a Hyperventilating or Supine ECG is obtained, a Baseline ECG is still required.

1. Have the patient stand comfortably with hands at his or her sides.

2. In Pretest, press [Print Baseline ECG] to immediately print a 12-lead ECG report labeled “BASELINE ECG.”



Acquiring Labeled ECG ReportsYou may print 12-lead reports that are labeled to match your procedures. For example, if you commonly obtain ECG reports while your patient is hyperventilating, you may obtain reports which are labeled “Hyperventilation ECG” on the printout. Select the appropriate label in the Additional ECG Selection window.


1. In Pretest, press [Print Additional ECGs] to access the Additional ECG Selection window.

Figure 6-6The Additional ECG

Selection Window

2. Highlight the name of the desired report label and press [Select].


Selecting the Protocol

Selecting the Protocol

NOTE: The attending physician is responsible for selecting the proper protocol.

1. In Pretest, press [Change Test/Display Setup] to access the Test/Display Setup Selection window.

2. Press [Change Protocol]. The Protocol Selection list is displayed.

3. Select the desired protocol and press [Close] to return to the Test/Display Setup Selection window.

NOTE: If you select a Ramp protocol, you will advance to the Ramp Protocol Display window. You must enter ramping values each time you select the Ramp protocol.

4. Press [Close] to return to the Pretest screen.

Using a Treadmill

WARNING: NEVER place any object or chair on the treadmill walking belt. Serious personal injury could result from objects that are thrown or tipped due to treadmill movement.

Push the power switch for the treadmill to the On position ( ).

Stopping the Treadmill in an Emergency

WARNING: Do not press the treadmill Stop key while the patient is still walking on the belt except in an emergency such as if the patient falls. Unexpected deceleration may make the patient lose his or her balance.

There are two ways to stop the treadmill in an emergency situation such as if the patient falls or experiences a dangerous arrhythmia:

1. Press the “Stop” key, , on the QUEST keyboard.

2. Press the Emergency Stop switch on the treadmill (if installed).



Putting the Patient on the Treadmill


WARNING: Treadmill deck can move up and down. Movement can create pinch points and lift objects. Keep objects out of treadmill path.

WARNING: Do not let clothing or cables become entangled in the treadmill. Route the patient cable over the railings, away from moving parts like the walking belt and treadmill deck. Serious injury and equipment damage can result.

NOTE: When using the treadmill keep in mind that unexpected changes in speed and elevation can cause the patient to trip or fall. Always use proper exercise stress testing protocols and communicate anticipated treadmill changes to the patient.

1. Make sure the treadmill walking belt is NOT moving and is at its lowest elevation.

2. Help your patient onto the foot boards of the treadmill but NOT ONTO THE BELT and have him or her grasp the handrails.

Some patients may be comfortable straddling the belt by placing his or her feet on the foot boards located to either side of the walking belt. Other patients may prefer to stand to one side of the belt on one of the foot boards.

3. Start the treadmill by pressing the green Start key, . The walking belt begins to move at 0.6 mph (1.0 kmh).

4. In Pretest press [Start Warmup] to access the Warmup screen.

If the current protocol is programmed for a treadmill speed in the Warmup phase, the walking belt begins to move at this speed.

If no speed is programmed, the walking belt continues to move at 0.6 mph (1.0 kmh).

5. Have the patient step onto and stride on the slowly moving belt.

6. If desired, you may manually increase the speed using the Increase Speed key, as the patient becomes accustomed to the motion.

7. Encourage the patient to use the handrails for balance only. A light, relaxed grip will improve the ECG signals by reducing artifacts caused by muscle tension.

8. Continue operating in the Warmup phase according to the instructions in the next section.


Using a Bike

Using a Bike


1.

Documents

Operating Instructions - Aimcardio quest manual.pdfintraventricular conduction block, pre-excitation syndrome and ischemic heart disease. Records stored and used during the life of