Slide 1

Applying Pediatric PadsApply pads as shown on package placing the back pad on first.

46R Series ALS ModelR Series Plus Model

There are two new R Series models: the ALS and the Plus Models. Both models contain new features of Real CPR Help and See-Thru CPR. Lets begin learning about the R Series ALS model.

Click the Next button to continue.New R Series Models

6Lesson DetailsTarget AudienceThis lesson is intended for Fairview employees that will be utilizing the R Series Defibrillators in their scope of practice. It is assumed that the learner has previously used the Zoll M Series.

Contact HoursNot Applicable

Estimated DurationThe expected time to complete this learning activity is 30 minutes. If you are unable to complete this during your scheduled work time, it may be completed outside of work with prior approval from you supervisor. Any overtime must be approved.It is suggested that you complete a hands on review of the Zoll R series after completing this lesson module.

2References and Contact InformationReferencesZoll R Series Training Guide (August 2010) R Series Quick Reference Guide (2010)Print R Series Competency Checklist

Program Contact Marcia Turner, RN, MS, Nursing Education Specialistmturner1@fairview.org

3Upon completion of this lesson, learners will be able to:Identify the functionality of the new R Series features: CPR Help and See Thru CPR.Identify the present selection of multifunction pads and their uses with the Zoll R Series Models.Identify the proper procedure for visual and manual checks of the Zoll R Series defibrillators.Demonstrate how to operate the Zoll R Series ALS and R Series Plus defibrillators for defibrillation, synchronized cardioversion, and pacing.

Objectives

4Table of ContentsIf you are viewing the lesson for the first timeClick the Next button to begin the lesson

If you are returning to view a specific part of the lesson, click the appropriate subject below

The New Zoll R Series Models New Features: Real CPR Help and See-Thru CPR New Pads: OneStep Complete and OneStep Pediatric Compatible Electrodes Attaching an ECG Cable Other New R Series Features Testing of the New R Series Models Changing the R Series Plus to Manual Mode, ALS Full Functioning and Pacing Mode Completing the Zoll Online Training5Quick Review

Correct!Click Next to continue.27The R Series ALS model is similar to our present M Series in appearance and function, however, it has the new features of Real CPR Help and See-Thru CPR.R Series ALS Model

7R Series ALS Model

This machine will be utilized in higher acuity areas such as ICU, PACU, ED and areas that have internal response to codes with ALS trained staff.

8Completing Zoll On Line TrainingPlease read the next few slides prior to beginning this process so you know what lies ahead.

On one of the next slides, youll click on a link to create a user id (for example: bjones6) and a password (possibly your LMS access password so it is easy to remember) so you can enter the Zoll training site.

7777R Series Plus Model

This model will be utilized in areas where the first responders are BLS trained. It can quickly be transformed into a full R Series ALS functioning model by changing it to manual mode.

1010Real CPR HelpSee-Thru CPR

New R Series FeaturesAs we discussed previously, the new R Series models have Real CPR Help and See-Thru CPR. Lets explore these further. Click on the Real CPR Help picture above.

11There are four mechanisms of real time CPR feedback: CPR Index, Rate Prompt, Depth Prompt, and Idle Time Display. Lets learn more about the CPR Index. Click Next to continue.

Real CPR Help

13

The CPR Index is a visual representation of the quality of compressions being performed.

It provides feedback after 8 good quality compressions in the form of a filling hexagon. It takes 20-25 good quality compressions before the index fully fills.

CPR Index

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Rate PromptThe Rate Prompt is a visual and audible prompt that lets the compressor know that compressions are less than 90 bpm.

15Rate PromptWhen the Rate Prompt is active, the CPR Index stops filling, the Rate Prompt displays, and the metronome beeps at the correct rate.

16Rate Prompt

Prompts will automatically stop when the compression rate returns to 90 bpm. There is one exception: the metronome beep prompt is continuous despite compression rate with the R Series Plus model while in the AED mode.

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Depth PromptThe Depth Prompt is a visual and audible prompt to let the compressor know that compressions are less than 2 inches in depth.

18Depth PromptWhen the Depth Prompt is active, the CPR Index stops filling, the Depth Prompt displays, and the audio prompt states Push harder.

Push harder

19

Depth PromptPrompts will automatically stop when the compression depth returns to 2 inches .

20Idle Time DisplayThe Idle Time Display is a visual prompt that displays after compressions have been interrupted for more than 10 seconds. The time displays in minutes and seconds (mm:ss).

21Idle Time DisplayThe display will disappear when compressions are fully resumed. Lets learn about the See-Thru CPR feature. Click Next to continue.

22See-Thru CPR does not replace human assessment; it is meant to be a tool in the process.

See-Thru CPR does not work in the advisory/analyze mode.

See-Thru CPR

24Quick ReviewLets do a quick review of the content we just learned.

Click the host, Quinn, to begin.

25Quick Review

When does the Rate Prompt display? Click on the correct answer. B. When compressions are greater than 90 bpm.C. When the caregiver needs to take a lunch break.A. When compressions are less than 90 bpm.26

There are some new pad options for use with the Zoll R Series models. Lets learn more. Click on the OneStep Complete Pad picture to continue.

New Pads: OneStep Complete and OneStep Pediatric

OneStep CompleteOneStep Pediatric36 OneStep CompleteThe OneStep Complete Pad is for use on older children and adults. Real CPR Help and See-Thru CPR are available when using the OneStep Complete Pads by utilizing a new censor attached to the pad.

37OneStep CompleteECG leads are internal in the pad. It is not necessary to put leads on to perform pacing or urgent synchronized cardioversion UNLESS you are using anterior/anterior placement.

38 OneStep CompleteThe OneStep Compete Pads sense to charge at intervals of 120, 150, and 200 Joules consecutively for defibrillation. If a different Joule setting is desired, adjust it by using the energy select arrow key for initial and subsequent shocks.

39Step 1: Open the electrode package by grasping the blue ring and white tab marked OPEN HERE.

Step 2: Pull away from each other so that the electrodes are displayed as in the picture.

Note: Do not use a scissors to open the pads!

Opening the Pads

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40

Applying the PadsAnterior/Posterior placement is recommended. Place the back pad on first. Then place the front pad with the sensor on the sternum between the nipples.

4141Applying the PadsIf using anterior/anterior placement, rotate the apex electrode 180 degrees. With this placement, the ECG display may be slightly different and should not be used for diagnostic purposes. Use the ECG cable for pacing with this electrode placement.

4242

OneStep Pediatric PadsECG leads are NOT internal in the pad.

Switch to Pedi Padz to perform pacing or urgent synchronized cardioversion and add an ECG cable.

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OneStep Pediatric PadsThe OneStep Pediatric Pads sense to charge at intervals of 50, 70, and 85 Joules consecutively for defibrillation.

If a different Joule setting is needed based on the patients weight and AHA guidelines, 2 J per kilo, adjust it by using the energy select arrow key for initial and subsequent shocks.

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OneStep Pad ConnectionsBoth the OneStep Complete Pad and the OneStep Pediatric Pad attach the same way to the multifunction cable on the R Series Models.

47

Compatible ElectrodesThere are other compatible electrodes that can be utilized with the R Series Models, however, none of them allow for the use of the new features Real CPR Help and See-Thru CPR. Pro PadzPedi PadzPaddles and Internal Handles

Lets look at each of these to see how they are used with the R Series models. Click Next to continue.

48

Pro PadzYou can use these for elective synchronized cardioversion along with 3 lead ECG cables in older pediatric patients or adults. The energy selection must be adjusted manually when using these pads.

49Pedi PadzYou can use these for elective synchronized cardioversion and pacing along with 3 lead ECG cable in pediatric patients under 15kg in weight. Energy selection must be adjusted manually when using these pads.

50Paddles and Internal HandlesPaddles and Internal Handles will only be utilized in selected areas by special request. You cannot use these with the R Series Plus Model unless the machine is set in manual mode.

51Paddles and Internal HandlesPaddles will initially sense to charge at 120 Joules and internal handles to 10 Joules when used with the R Series ALS model.

If different Joule settings are needed, adjust by using the energy select arrow key for initial and subsequent shocks.

52Quick ReviewWe are back for another Quick Review with your favorite host, Quinn.

Click the host, Quinn, to begin.

53Quick Review

When opening the OneStep Complete, you should use scissors.Click on the correct answer. B. False.A. True.

54When using the OneStep Complete and OneStep Pediatric Pads:

Attaching an ECG Cable

64When using the Pro Padz, Pedi Padz, Internal Pads and Paddles, use the 3 lead adapter cable and attach as shown. The pad adaptor is attached to the back side of the connection.

Attaching an ECG Cable

65

Other New R Series FeaturesThe battery is lighter and has a power indicator allowing you to view the remaining run time. To view the remaining run time, you would press the icon.

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Other New R Series FeaturesThe printer now loads from the top of the machine. Press the top button to open and load the paper.

Click Next to learn about testing the R Series models.

67Auto TestVisual InspectionManual TestDone daily automatically by the machine at 2AMTo be done with daily crash cart check on the days the unit is openTo be done weekly with crash cart check and after resolving any code readiness issues to restore green check in the code ready indicator boxTesting of the R Series ModelsLets begin by learning about the Auto Test. Click Next to continue.

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Auto TestFor the Auto Test to occur, the defibrillation cable needs to be connected to the OneStep Complete pads (adult units) or the machine testing port on the side of the machine (peds units).

Adult UnitsPeds Units

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Auto TestThe Auto Test automatically checks the battery, therapy electrodes (if attached), circuitry, cables, printer function, shock, and AC power.

If the Auto Test fails, it displays a red X and test log results on the screen front identifing the problem. If the problem is not easily correctable contact your biomed department.

70Ensure the defibrillator is:

Clean and free of visible damageCables are in good condition Connector pins are not bent Paper tray has enough paperDefibrillator is plugged into AC power The green check mark appears in the code ready indicator

Visual Inspection

71Manual Defibrillator Self-TestThe defibrillation cable must be connected to the OneStep Complete Pads (adult units) or machine testing port (peds units) on the side of the machine. Turn the machine to defib mode (in the R Series Plus machine you must first put in the manual mode).Select 30J as the energy level.Click CHARGE.Click SHOCK.Watch for the words TEST OK on the front of the screen and on the print out.

Complete the following:

72Were now going to talk about changing the R Series Plus to Manual and Pacing modes.

Click Next to continue.Changing R Series Plus to Manual Mode

7373Step 1: Turn the machine on.

Step 2: Press the Manual Mode soft key.

Changing R Series Plus to Manual Mode and Full ALS Functioning

7474Step 3: Press the Confirm soft key.Changing R Series Plus to Manual Mode and Full ALS Functioning

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Changing R Series Plus to Pacing ModeOnce the machine is in manual mode, you can perform pacing operations by moving the dial to Pacing.You can adjust the rate and mA by using the lower control area.

7676Complete the rest of the registration form. Click on Advanced Life Support. Click Submit.

Completing Zoll On Line Training7878You will be brought to the following screen. You can now enter your user ID (bjones6) and password you just created to get into the Zoll training site.

Completing Zoll On Line Training7979Once into the Zoll training site, complete the module entitled Getting Started

Once completed, do the test in the LMS and you will have completed your LMS Zoll R Series defibrillator training module.

Completing Zoll On Line Training8080Click here to begin the login process:

Click here if youve previously logged in and created your user id and password:

Initial Zoll Training SiteZoll Training Site

Completing Zoll On Line Training8181Please complete the test in the LMS to document your learning. Click here to complete an evaluation of this learning activity.Thank you for completing this lesson. You are on your way to becoming an expert in the Zoll R Series Models! Congratulations!

Conclusion and Evaluation82