Philips HeartStart M5066A Owner's Manual

HeartStart Defibrillator OWNER’S MANUAL Guid e to Set U p, O peration , Mai ntenan ce, an d Acce ssories M5066 A Editi on 7
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Phil ip s Me dic al Sy ste ms Th e Hear tSta r t Defibr ill ator M 5066A Pads Car tridge Han dle . Pul l the handl e to tur n on the Hea rtStart a nd r e mo v e the car trid ge’ s hard cover . Ready Light. Th is g r ee n li gh t tells you the readin ess of the Hea rtStart. Blin ki ng: st and by mo de (rea dy for use) Solid: in use Off: needs att enti on (Heart Start “chir ps” a nd i-but ton fl ashe s) On/Of f Button . Pr ess th is gr ee n butt on to tur n on the Hea rtStart. T o tu rn o ff the Hea rtStart, pr ess the g r ee n butt on agai n and hold it down fo r one (1) seco nd. Inf o rma t io n Bu tt on . This bl ue “ i-b utto n” fl ashe s whe n it has i nfo rm atio n you ca n ac ces s by pressin g it. It also flash es at the begi nnin g of a patie nt car e pause whe n CP R coac hi ng is e nabl ed. Caut ion Lig ht. This t riangula r ligh t flashe s during r h ythm analysis and is on w hen a sho ck is advi sed , as a r eminde r that no one sho uld be t ouchi ng t he pati ent. Shock Bu tton . When ins tr ucted by the HeartStart to deli v er a sh oc k, pr es s th is fl ashi ng orang e but ton . Inf ra r e d (I R ) Communic atio ns P or t. This specia l lens, or “ey e , ” is used to tran sfer He art Star t data directly to or fr om a co mputer . Speak er . When t he de vi ce i s being u sed, its voice ins tructions come from th is spe ak er . Beep er . The Hea rtStart “ch irp s” thr o ugh thi s beeper t o al ert y ou when i t need s at t ention. SMAR T Pads Car tridge . Th is disposa ble car tridge co ntains sel f- adhe si ve pads with at tach ed cab le . Sho wn wi th adult p ads cartrid ge. SMAR T Pads Car tridge La tc h. Slid e the la tch to the righ t to relea se the pads c ar tridg e for r epl acem ent. Batte r y . The non- r echa rgeab le batte r y is ins ert ed in a r ece s s on the bac k of the Hea rtStart. A B C D E F G H I J K L top top C B D E G F H A fro nt v ie w I B A back vie w K L K L
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Phil ips Medi cal Syste ms Hear tStar t Def ibr illator M5066A QUICK REFERENC E
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Phil ips Medi cal Syste ms Hear tStar t M5066A Automated Exter nal Def ibr illator Ed ition 7 IMPOR T A NT NO T E: It is impo rta nt to un derst and that su r vival r ates for sudde n cardiac arrest are directly rela ted to how s oon v ictim s receive treatm ent. For eve r y minu te o f delay , the c han ce o f sur vi val decl ines by 7% to 1 0%. Defib rillati on can not assu r e sur viva l. In so me vi ctims, th e unde rlying proble m causin g the cardiac a rr est is sim ply not sur viv able d espite a n y availab le care . OWNER’S MA NUAL
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Phil ips Medi cal Syste ms HEARTSTA RT M5066A About this e ditio n The informa tion in this g uide applies to the mod el M5066A He artStart Defib ri llator . Its techn ical cont ents apply to all m odels in the He artSt ar t HS1 family of de fibrilla tors, inc ludi ng th e HeartS tart, th e HeartSta rt OnS ite, and the Hea rtStart Fir st A id De fi bril la tor . This inform ation is sub ject to chan ge. Please con tact Phili ps at www .m edical. philips .com/he art star t or conta ct your lo cal Ph ilips represent ative for informatio n on re visions. Edi tio n h isto ry Editio n 7 Publi cation date: J ul y 2007 Publi cation #: M506 6-91901 Assembl y #: 0118 72-0007 Printed in th e U.S.A. Cop yright © 2007 Ph ilips Electronics Nor th America C orp . No part of this pub licat ion ma y be rep r oduc ed, transm itted, tra nscri bed, stored in a retrieval syste m or tran slat ed into an y huma n or co mp uter la ngua ge i n any fo rm by a ny me ans with out the c onsen t of the cop yright hol der . Unau thori zed copying o f this publica tion ma y not onl y infr inge cop yright but also r educ e the ability of P hilip s Medica l Sys tems t o provide accu rate and up- to-d ate i nf orm atio n to us ers and ope rator s alik e . Auth ori ze d EU r epr esen ta tiv e Phili ps Med izin Syst eme B oeblin gen Gm bH Hewlet t-Pack ard Strasse 2 71034 Boebl ing en, German y ( 49) 7031 463-2254 CA UT IO N : F ederal la w (US A) restrict s this de vice to sal e by or on t he or der of a ph ysician. The Ph ilips Hear tSt ar t Defibr illator i s des igned to be use d only wit h Philips- appro ved accesso ries. The H ear tStar t may perform improperly if non- app r oved a ccess ories are used . De vice tra cki ng In t he U.S.A., this device is subj ect to track ing requ iremen ts by th e ma nufact urer an d di stri butor s. If th e defi brillato r has be en so ld, donat ed, lost , sto len, expo rte d, or destroy ed, notif y Philips Medi cal Syst ems o r your di stribut or . De vice m anuf actur e r The H ear tStar t D efibr illator is manuf actured by Phili ps Med ical S ystems , Seat tle, W a shing ton, US A. Patents Thi s prod uct is ma nuf act ured an d so ld und er on e or mor e of t he f ollo wi ng Un ited St ates pa tents : US604721 2, US6 317635, US5892046, US58 91049, US635678 5, US5 650750, US6553257, US59 02249, US628732 8, US6 662056, US5617853, US59 51598, US627238 5, US6 234816, US6346014, US62 30054, US629957 4, US5 607454, US5803927, US57 35879, US574990 5, US5 601612, US6441582, US58 89388, US577396 1, US6 016059, US6075369, US59 04707, US586879 2, US5 899926, US5879374, US56 32280, US580046 0, US6 185458, US5611815, US65 56864, US560745 4, and other pa te nts p endi ng.
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Phil ips M edica l Syst ems i CONTENT S 1 Introduction to the H eartStart Desc riptio n ...... ..... ..... ...... ..... ...... ........ ..... ...... ..... ...... ..... ...... ..... ...... ........ ..... ...... ... 1-1 Sud den Cardiac Arres t ..... ..... ...... ..... ..... ...... ........ ..... ...... ..... ...... ..... ...... ........ ..... . 1-1 Indic ations f or Use ... ...... ..... ...... ..... ...... ..... ........ ...... ..... ...... ..... ...... ..... ........ ...... ... 1-1 Train ing and practi ce ..... ..... ...... ..... ...... ..... ...... ..... ..... ......... ..... ...... ..... ..... ...... ..... . 1-2 Natio nal an d local req uiremen ts . ...... ..... ........ ...... ..... ...... ..... ...... ........ ..... ...... ... 1- 2 For mo re inf ormatio n . ........ ...... ..... ...... ..... ...... ..... ........ ...... ..... ...... ..... ..... ...... ..... . 1-2 2 Setting up the HeartS tart Packa ge cont ents .... ..... ...... ..... ...... ..... ..... ...... ..... ........ ...... ..... ...... ..... ...... ..... ...... ... 2-1 Sett ing up the Hea rtStar t . ........ ..... ...... ..... ...... ..... ..... ...... ........ ...... ..... ..... ...... ..... . 2- 1 Recom mende d access ories .. ...... ..... ..... ...... ........ ..... ...... ..... ...... ..... ...... ..... ........ . 2-3 3 Using th e HeartStart Overvie w . ...... ..... ........ ...... ..... ...... ..... ...... ..... ...... ........ ..... ...... ..... ...... ..... ..... ...... ...... 3-1 STEP 1 : PULL t he green handle . ..... ..... ...... ........ ..... ...... ..... ...... ..... ...... ........ ..... . 3-2 STEP 2 : PLACE the pads .... ...... ..... ...... ..... ........ ...... ..... ...... ..... ...... ..... ........ ...... ... 3-3 STEP 3 : PRES S the Sho ck butto n ... ..... ...... ..... ........ ...... ..... ...... ..... ...... ..... ...... ... 3-3 Treat ing inf ant s and chil dren ..... ..... ..... ...... ..... ........ ...... ..... ...... ..... ...... ..... ...... ... 3-4 When emergenc y medi cal ser vices arri ve . ........ ..... ...... ..... ...... ........ ..... ...... ... 3-6 4 After using the HeartStart After each u se ... ...... ..... ........ ...... ..... ...... ..... ...... ..... ........ ...... ..... ...... ..... ..... ...... ..... . 4- 1 Hea rtStart da ta sto rage ... ..... ........ ...... ..... ...... ..... ..... ...... ..... ......... ..... ..... ...... ..... . 4-1 5 Mai ntaini ng t he H eartStart Routi ne Mai ntenan ce ..... ..... ...... ..... ...... ..... ...... ..... ........ ...... ..... ...... ..... ..... ...... ..... . 5-1 Perio dic chec ks .... ..... ...... ........ ...... ..... ..... ...... ..... ...... ........ ..... ...... ..... ...... ..... ...... ... 5-1 Clea ning t he Heart Start ..... ...... ..... ...... ..... ...... ..... ..... ......... ..... ...... ..... ..... ...... ..... . 5-2 Dis posing o f the He artSta rt .... ..... ...... ........ ..... ...... ..... ...... ..... ...... ..... ........ ...... ... 5-2 Tro ublesho oting ti ps ... ...... ..... ...... ..... ..... ......... ..... ..... ...... ..... ...... ..... ...... ........ ..... . 5-2
Ph ilip s M edica l Sy ste ms ii HEARTSTA RT M5066A APPEND ICES A Accessori es for the HeartStart B Gloss ary of term s C Gl ossa ry of sy mbol s/cont rols D Warni ngs a nd preca utions E T echn ica l info rm ation F Configuration G Testing and troubleshooting H Additional technica l i nformatio n required for European conformity
Phil ips Medi cal Syste ms 1-1 1 1 Int rodu cti on to th e He ar tS tar t Descri ption The Hear tStart Defibril lator M5066A is pa rt of the Philips Hear tStar t HS1 fa mily of defibri llators. Sm all, light we ight, and batter y p ow ered, it is designe d for sim ple and r e liabl e oper atio n. Sudde n Cardia c Arrest The Hear tS tar t is used t o treat th e most com mon caus es o f sudde n cardi ac a rr est (SC A), i ncludin g ventricular fibrilla tion (V F). SC A is a co ndition that o ccurs w hen the hear t un expecte dly stops pum ping. SC A can occu r to anyone – infant, ch ild, adu lt, male or fema le – anywhere , at any tim e. Many vict ims of SC A do not ha ve wa rni ng sig ns or symp tom s. VF is a chao tic q uiv eri ng of the hea rt muscl e that pr ev ents it fr o m pump ing bloo d. The only e ffective treat ment for VF is d efibrilla tion. The Hear tSta rt treats VF by sen ding a shock across th e hear t, so it ca n sta rt b eatin g regula rly again . Unless this is su ccessful w ith in the f irst few minute s afte r the h eart stops beatin g, the victim is not likely to sur vive . In dic ati ons for Us e The Hear t Star t s hould be us ed to treat som eone you thin k m a y be a vict im o f SCA. A person in SCA: • doe s not r espond when s hak en, a nd • is not breathing normally . If in do ubt, app ly the pa ds. Follow t he voice in structio ns for each step in using the defib rillato r .
1-2 Phil ips Medi cal Syste ms HEARTSTART M5066A T ra ining a nd pra ctice The HeartS tart is one part of a w ell- desi gned eme rge ncy r espon se pla n. An y emerg ency re spons e plan sh ould be und er the ov ersi ght of a ph ysicia n and sho uld incl ude tra inin g in car dio pulmo nary resus citat ion (CPR ). Philip s r ecommend s that y ou trai n on the de vi ce yo u will be using. Several natio nal and local organi zations o ffer comb ined CP R/defib rillator t raining. Contac t y our P hil ips r ep res ent ati ve, or v isit us on-li ne at www .medical. philips.co m, for information abou t training programs in your area. NO T E: T r aining acc esso ries are available fr om Ph ilips f or practici ng use of the HeartStart. S ee Appendi x A for in format ion on or deri ng acc essor ies. Nation al a nd lo cal r equi r ements Chec k wi th your loc al hea lth depar tm ent to see if the re are any nat ional or loc al requiremen ts about own ing and using a defib rillator . For more informati on Conta ct y our loca l Ph ilips r epresent ative f or additio nal informat ion about th e Hea rtS tar t. T hey will be happy to answer a ny quest ions you may hav e and to pro vide you with copies of t he clinica l sum maries of several key studie s usin g Philips a utomat ed external defibr illators . * Y ou c an also find the clin ical summari es onl ine at www .medica l.philip s.com/ hear tsta rt . T e chnical informat ion abo ut all Philips Hear tSta rt auto mated externa l defib rillato rs is also availab le on line, in the T ec hnic al Reference Guide f or He ar tS tar t Defib rillators. * Clinical summ aries also includ e Heartstream F or eRunner and FR2 D efibrillators.
Phil ips Medi cal Syste ms 2-1 2 2 S ett ing up the He ar tStar t Package content s Che ck the cont ent s of the HeartSta rt Def ibri llator M5066A bo x to be su r e it contai ns: • 1 Hear tS tar t D efibrill at or • 1 batt ery M5070A • 1 Adul t SMAR T Pads Cartri dge M50 71A, conta ining one s et of a dhesive d efibrilla tion pads • 1 Ow ner ’ s M anu al • 1 Qu ic k Re f er en ce Guid e T rai ning materi als and opti on al a ccess ories fo r t he HeartSt art ar e al so a v ailabl e fr om Philips. S ee Appendix A for a descrip tion o f these i tems. Sett ing up the Hea rtS tart Sett ing-up the Hear tSta rt Defibr illator i s sim ple and qui ck. 1. Remo v e th e He artStart fr om its pac ka ging. 2. R emo v e a new SMA R T Pads Ca rtr i dg e fr om it s pac ka g e. * * T o replace a used ca rtridge or insert a differ ent cartridge, first loca te the latch at t he top edge of t he defibrillator , and slide it to t he side. The pads cartridge will be relea sed. Lift out the ca rtridge and re place as described in steps 2 and 3.
2-2 Phil ips Medi cal Syste ms HEARTSTART M5066A 3. In sert the cartri dge in to th e ca rtrid ge wel l on th e f r ont of the de fib ri lla tor . It shoul d click into place when p roperly sea ted. The green PULL h andle should be al l the wa y do wn. NO TE: T o pre v ent the pad s’ adhe siv e g el fr om drying out, do no t op en the ha r d co v er or fil m seal of th e cartri dge unt il y ou nee d to use the pads. 4. Rem ov e the batt er y from its pack aging. I nstall it in the ba tter y com par tmen t on the b ack of the defibrilla tor . 5. The Hear tSta rt will au toma tically ru n a se lf-test when the batte ry is inse rte d. Pr ess the S hock but ton wh en ins truct ed. Whe n the self-t es t is o v er , the defib rillato r will repo rt the resu lt, an d tell you to p ush the green O n/Off butt on in c ase of an emerge nc y . ( Do not push the green button un less this is an actual emergency. ) Then the defib rillato r will turn o ff and go to st andby mo de. The green R eady lig ht w ill be b linkin g to s how t he Hea rt Star t is re ady for u se . * NO TE: Alwa ys stor e th e Hea rtSta r t with a p ads ca rtrid ge and a battery in stal led , so it wi ll be r ead y to use an d can perf orm d ail y self -tes ts. * As long as a battery is installed, turning the H eartStar t “ off ” puts it into standb y mode, which means that it is r eady f or use. 55 l b s / 25 k g 55 l b s / 25 k g
2-3 Phil ips Medi cal Syste ms 2 6. Pla ce t he defib rillator in t he carr y ca se, pressing it firmly into p lace . Inse rt the Quic k Reference G uide, * fa ce u p , in the cl ear pla stic wi ndow on t he i ns ide of the c ase. If you pur c h ased a spar e SMAR T Pads Cartridge or an Infant /Chi ld Pads Cart ridge , pla ce it in the storag e area in t he ca se . NO T E: Do not s tore anythin g in t he defib rillator carr y ca se tha t it is not design ed to acco mmodate . St or e all object s in their int ended loca tion in the case . 7. Sto r e the Hea rtStart in acc or danc e with y our s ite’ s emergen cy r esp onse protocol. T y pica ll y , th is will be in a high -traffic area tha t is easy to acce ss, convenient for check ing the Ready light periodic ally , and eas y to hear the alarm c hirp if the batter y p ower gets low o r the d efibrilla tor needs at tentio n. Idea ll y , the HeartSt art s hould be stor e d ne ar a tel ephon e, so th e Emer genc y Res ponse T eam or Emergenc y Medi cal Se r vi ces can be al erted as fas t as pos sible in t he e vent o f a p ossible SC A. I f poss ible , keep t he sp ar e S MAR T Pads Cart ridge a nd o ther acce ssories with the de fibrilla tor – in the ca rry ca se if on e is u sed – for q uick a cces s whe n ne eded . In ge nera l, tr e at th e H eartS tart as yo u woul d a n y p iec e of el ectr onic e quipm ent, suc h as a comput er . Be sur e to s tore the defibrilla tor according t o its specific ation s. See Append ix E for details . As long a s a b atter y an d a p ads ca rtrid ge are inst alled , the gr een Ready light sh ould be blin king to show that the He ar tStar t has pas sed its most r ece nt self-t es t and is the r ef or e re ady to use. NO T E: If you h a ve a tra ining pads car tridg e, it is reco mmende d that y ou sto r e it separ ate ly fr om t he HeartSt art, so the traini ng pa ds canno t be conf use d wit h the r egul ar pads in an emerge ncy . * The illustra tion on the cov er of the Quick Ref erence Guide is a 3-step guide t o using th e HeartStart. Detailed illustrated dir ections ar e inside, for r eference in an emergency , or if yo u are hea ring impair ed or using the HeartStart where it is har d to hear the v oice instructions .
2-4 Phil ips Medi cal Syste ms HEARTSTART M5066A Recommended a ccessories It is al wa ys a goo d ide a to have a spare batt er y and a spare p ads set . Ot her th ings that ar e us eful to k eep wi th th e HeartSta rt incl u de: • sci ssors — for c utting t he victim’ s c lothes if ne eded • dis posa ble gloves — to protec t the u ser • a dis posab le razo r — to shav e the chest if hair pr events good pads conta ct • a pocket m ask or fa ce shie ld — to p rotect the user • a towel or absor bent wipe s — t o dr y the vic tim' s ski n for go od pa ds conta ct Philips h as a Fast Respon se Kit with a ll thes e items. Se e Appendix A for detail s. If you may need to def ibrillate an inf ant or a child un der 25 k g (55 p oun ds ) or 8 yea rs old, it is r ec ommend ed t hat y ou or der t he Infant/ Chi ld SMAR T Pad s C artridge, a vailabl e separate l y . W hen the Infa nt/Child Pa ds Car tridge is inst alled in the Hea rtS tar t, the Hea rt Star t au tomat ically reduces th e d efibrilla tion ene rgy to an energ y l e v el more appropriate for infants and children. In a ddition, if optio nal C PR coac hing is selec ted, the Hear tS tart pr ovides co aching appropriat e for infants and chil dr en. Di r ect ions f or usin g the Infant /Chi ld SMAR T Pads ar e pr ov ided in Cha pt er 3, “Us ing th e He artSta r t . ”
Phil ips Medi cal Syste ms 3-1 3 3 Using t he Hear tS tar t IM POR T ANT NO TE: Be sure to read the R emi nd ers se cti on a t th e en d o f this cha pter as we ll as t he wa rni ngs a nd pr ecautio ns in Appe ndix D . Ov erview If you t hink s omeone is in S C A, act quick ly and c almly . If s omeon e el se is availa ble , ask hi m or her to ca ll for emerge ncy med ical ass istanc e while you g et the Hea rtS tar t. If you are al one , f oll o w these s tep s: • Ca ll y our eme rgency se rv ices provider . • Qui ckly ge t the H ear tStar t a nd brin g it to the victim’ s si de . If the re is any dela y in gett ing the defib rillator , c heck the pati ent a nd pe rform car di opulmonary r esusc itat ion (CPR) if nee ded until the H eartStart is a vailabl e. • If the patie nt is an infan t or child, first pe rform CPR, the n call for emerge ncy me dical services (EMS) bef or e yo u ap ply the HeartStart. See speci al se ction on t r eati ng infan ts and chi ldre n on pag e 3-5. • Check the imme diat e env ir o nmen t for flammable gase s. Do not us e the HeartSt art in th e pr es ence o f flam mable ga ses, su ch as an o xygen tent . Ho w ev er , it i s saf e to use the He artSta rt on som eone w ea ri ng an o xyg en mask . There are th ree basic s teps to u sing t he defib rillator t o treat som eone wh o may be in s udde n ca rdi ac arre st : 1. PUL L up the handle o n the S MAR T Pads Ca rtridg e. 2. PLA CE the pa ds o n the p atie nt’ s bare ski n . 3. PRESS the flas hing S hock but ton if instr uct ed. The following pages provide d etails about e ach s tep.
3-2 Phil ips Medi cal Syste ms HEARTSTART M5066A STEP 1 : PULL the green handle T urn on th e Hear tS tar t by pu lli ng th e SMA R T Pad s Car t ridg e’ s green hand le . * Rem ov e the hard cover from the p ads ca rtrid ge and s et i t aside . Rem ain c alm and follow the He ar tStar t’ s inst ruction s. The Hear t Star t sta rts by di recting you to remove all clothe s from the p atien t’ s che st. If nece ssary , rip or cut off the clothi ng to bar e th e person ’ s chest * Y ou can also turn on the HeartStart Defibrillator b y pres sing the gr een On/Off butto n. 55 l b s / 25 k g
3-3 Phil ips Medi cal Syste ms 3 STEP 2 : PLA CE the pads Pul l t he t ab at t he to p of t he pa ds cartri dge to peel of f the fi lm s eal. I nsid e ar e tw o adhe siv e pa ds on a plast ic li ner . Remov e the pad s fr om the cart ridg e. P eel on e pad o ff th e li ner . Pla ce the pad on the pati ent ’ s bar e sk in, exactly as shown in the pict ure on the pad . Press the p ad down firmly . Then repeat this w ith the o ther pad. B e sur e the pads ha v e bee n remo v ed fr o m the li ner befo r e plac ing the m. Where to plac e pads on adults and children over 25 kg/55 pounds or 8 ye ar s ol d (anteri or-ant erior). Where to place pads on infants or children under 25 kg/55 pounds or 8 y ears old (anter ior-posterior).
3-4 Phil ips Medi cal Syste ms HEARTSTART M5066A STEP 3 : PR ESS the Shock button As soon as t he H ear tSt art det ects tha t the pa ds are a ttach ed t o th e pa tien t, it beg ins ana lyzin g the pa tien t’ s he ar t rhythm. I t te lls you that no one sh ould be touc hing the pat ient , a nd t he Cautio n l igh t be gins f lash ing a s a r emin de r . If a shock is needed: The Ca ution li ght goes fr om flas hing to solid , the oran ge Sh ock but ton sta rts flashing , and th e defi bril lato r tell s y ou to pr ess th e flash ing or ange but to n. Bef or e y ou pre ss t he but to n, ma k e sur e n o on e is t ou chin g the pat ient . Whe n y ou pr es s th e Shock button, th e defi bri lla tor t ells y ou that the sho ck h as been deli v er e d. The n the Hea rtStart tel ls you it is s af e to to uch the patie nt, inst ruc ts y ou t o begin CP R, an d in v ites y ou to pre ss the fla shing b lue i-but ton f or CPR Coach ing if desired. If a shock is not needed: The Hear t Star t t ells you i t is safe to to uch the p atien t an d inst ruc ts you t o perf orm CP R if nee ded. (If CPR is no t neede d – for exam ple, if th e patie nt is mov ing or r eg aini ng consc ious ness – fo llow y our local pr o tocol unt il em erge ncy medi cal pers on nel arr iv e .) Th en the HeartStart inv ite s y ou to pr es s th e flash i ng blu e i-b utt on for CPR Coa ching , i f desir e d. For CPR Coaching: Pr ess the flas hing blue i-bu tton d uring th e fir st 30 seco nds of th e pa tien t care paus e to acti vat e CPR Coachi ng. * (If the Inf ant/Chi ld SMAR T Pads Cartridg e is inser ted, CPR C oaching will p r ovide c oaching for infan t/child CPR.) When t he pause is ov er , the de fibrilla tor tells you to stop CPR, so it ca n anal yze the pat ient’ s heart r h yth m. T he moti on ca used b y CPR can int erf er e with anal ys is, s o be s ur e to sto p a ll mo ti on wh e n in str uc te d. * The default configuration for the HeartStar t pro vides CPR Coaching when you press the i-button in this situation; ho we v er , the default setting can be r ev ised by y our Medical Dir ector using P hilips softwar e a va ilable separa tely . See Appendix F f or mor e informat ion.
3-5 Phil ips Medi cal Syste ms 3 T reat ing infants and childr en W A RNING: Most card iac arrests in child ren ar e not ca used by hear t proble ms. When r espond ing to cardia c arrest in an infa nt or child : • Provide in fant/child CPR while a bystan der c alls EMS and brings the Hea rtS tar t. • If no bystande r is available , provide 1 -2 minut es of CPR be fore calling E MS and r e tri ev ing the Hea rtStart. • If y ou witn es se d th e ch ild 's col la ps e, ca ll EM S imm edia tely and then get th e Hea rtS tar t. Altern atively , follow your local protocol . If the patient is unde r 55 pounds or 8 years old, and you have an Infant/Child P ads Car t ri dge: • Remo v e th e Infan t/ Child Pads Cartridge fr om i ts pac kage. * • Locat e th e la tch at th e to p edge of the de fibr illa tor , and slid e it to the side . The pads ca rt ridge will be released . Remov e the ol d cartridg e . • Ins tall the new ca rt ridge: slid e the bo ttom end of th e car t ridge into t he recess, the n press in th e car tridge un til the lat ch clicks int o place . Be su r e the green h andle is presse d down firm ly . Th e Hear tStar t w ill tell you th at Infan t/Child pads ha ve been inser ted, th en it will turn off to be ready for use. • Pu ll the gree n handl e to sta rt th e rescue . • Remo v e all clo thi ng f r om t he up per bo dy , to b ar e bo th the c hest a nd t he back . Plac e one pa d in the cen te r of the ch est be twe en th e nippl es, and the oth er in th e ce nter of the b ack (ant eri or -po ste rior) . Wit h the In fant /Chi ld P ads Ca rtridge i ns erted, th e He artSta rt automa tic all y re du ces the de fibri lla tion energy fr om the adul t dos e of 150 joule s to 50 J o ules † and pr ovides optio nal in fant/c hil d CPR Coach ing . Plac e the pad s exac tly as sho wn on th e illus tration on t he pads . * Philips r eco mmends that t he HeartStart be stor ed wit h an adult pads cartridge insta lled, as pediat ric car diac ar rest is not co mmon. † This low er energy lev el ma y not be effe ctive f or t rea ting an adult.
3-6 Phil ips Medi cal Syste ms HEARTSTART M5066A If the patient is under 55 pounds or 8 ye ar s ol d, but yo u do NO T have an Infant/Child P ads Cartr idge: • DO NO T DEL A Y TREA TM ENT . • Remo v e all clot hing fr om the tors o , to bare both the ches t and the bac k. • Appl y the H eartStart usi ng the adu lt pad s cartrid ge, but pla ce one pad i n the cen ter of t he ch est bet w e en the nip pl es, and the ot her i n the center of the back (ante rior -posteri or). If the patient is over 55 pounds or 8 y ears old, or if you are not sure of the exact we ight or ag e: • DO NO T DEL A Y TREA TM ENT . • Remo v e all clot hing fr om the chest . • Appl y the H eartStart usi ng the adu lt pad s cartridge, and place the pad s as illust rated on th e pads (a nterior -a nterior) . Make sure the p ads do not ove rlap or touc h each ot her . Wh en em er gen c y m ed ic al s er v ic es arr ive When Eme rgency Medi cal S er vi ces (EMS) pe rso nnel ar riv e t o ca r e fo r t he pat ient , the y m a y dec id e to appl y another def ibri lla to r to all ow monito rin g of the patien t. The SMAR T Pa ds should be removed fr om the pati ent prio r to using anoth er defibr illat or . EMS personne l ma y wan t a summar y of the last -use data * stored in the He artSt art. T o hear the su mmary data , ho ld do wn t he i- butto n unti l the Hea rtS tar t beep s. NO T E: Aft er the E MS team removes th e SMA R T Pa ds fr om the pati ent, re mo v e the use d pads cartridge, and i nsert a new pad s cartri dge bef or e r etur ni ng the Hea r t Start to service, t o be su r e it is r ead y f or us e. * See Chap ter 4, “After using the HeartStart ” f or de tails about data storage.
3-7 Phil ips Medi cal Syste ms 3 Reminders • Remo v e an y medi cin e patch es and r esi dual adhesi ve fr om th e pati ent’ s che st bef or e a ppl ying the pa ds. • Do no t all ow th e p ads to conta ct o the r el ect r ode s or meta l parts th at ar e in con tact w ith the p atien t. • A void placin g the pads directly over an implan ted pacem aker o r defibri llato r . A notic eable lum p with a surg ical scar shou ld indicat e the posi tion of an implan ted devi ce . • If the pads do n ot st ick well, c heck t hat t he pa ds adh esive ha s not dried ou t. Each pad has a la yer of ad hesi v e gel. If the ge l is not st icky t o the touc h, re plac e the pads with a new set . • K ee p th e pat ient st ill and keep any movem ent aroun d th e pati ent t o a minim um d uri ng rh ythm analy sis . Do not tou ch the patie nt or the pads while the Caution light is on so lid or f lashin g. If t he Hea rtS tar t is un able to anal yze due to ele ctrica l “no ise” ( ar tifact) , it wil l tell you to stop a ll m ov emen t and re mi nd you not to touch th e patie nt. If th e artifact conti nues for mo r e than 30 se cond s, the Hear tS tart will paus e brief ly to a llow you to dea l with the sour ce of t he noi se, th en r esume a nal ysi s. • The He artStart wil l not del iv er a shoc k unle ss y ou pr es s the fl ashi ng oran ge Shoc k butto n. I f you do not pr es s the Sh ock but ton withi n 30 seco nds after the def ibrillato r tells you to , it will disarm its elf, and (for the f irst CPR int erval) giv e a r emi nder to mak e su r e emerge ncy me dical services ha ve be en called, th en begin a CPR inter v al. This is desig ned to min imize interrupt ion of CPR and help ensu re ongo ing p atie nt s uppo rt. • Whi le waiting f or you to press th e Shock butt on, the He ar tStar t will cont in ue to analy ze th e hea rt rh yt hm. If the pati e nt’ s rhy thm changes bef or e y ou pr ess the S hock butt on, and a s ho ck is no lo nger need ed, the defib rillator w ill di sarm a nd tell y ou a shock is no t advis ed. • If for any r eason you wan t to turn off th e defi brilla tor d uring a us e, y ou can pr es s the On/O ff button – holding i t dow n for at least one second – to return th e device to s tandby m ode .
Phil ips Medi cal Syste ms HEARTSTART M5066A Notes
Phil ips Medi cal Syste ms 4-1 4 4 After using the Hear t Star t After e ach use 1. Chec k th e o utsi de o f the Hear t Star t for sign s of d ama ge, dir t, or conta mination . If y ou see sign s of damage , cont act Philips for tec hnical suppo rt . If th e de fibrilla tor is d irty or co ntam inated , clean it ac cording t o the gui delin es in Chap ter 5, “M aint aining t he He artStart. ” 2. Ins er t a new SMA R T Pa ds car tr idge in to th e Hear tSt ar t. Chec k sup plies and accesso ries for damage and expiratio n dates . Replace any us ed, dama ged or expi r ed item s. For di rec tio ns o n c hangi ng t he pads and r ep lacin g t he ba tt er y , ple ase se e Chap ter 2, “Sett ing up th e HeartSta rt. ” The sin gle-use pads mu st be r eplac ed aft er being used. 3. Unles s y ou r pr otoc ol r e quir es that t he batte ry r e main i nstal le d, r emov e the batte ry for fi v e seco nds, then reinstall it to run t he bat ter y inse rt ion se lf-test to ch eck th e oper at ion of th e defi bril lato r . * Wh en th e te st is comp lete , check that th e green Read y light is blink ing. 4. Ret urn the Hea rtStart to its stor ag e loca ti on so i t wil l be re ady f or use when need ed. Hear tSta rt da ta st orage The Hear tSta rt auto matica lly stores d ata about its la st c linical use in its in ternal memory . The s tor ed data c an be co nv enientl y tr ansf er r ed t o a per sonal comp uter or a handheld com puter runn ing t he appropriate a pplicatio n in th e Philip s HeartStart Ev ent Re view data m anag ement softwa r e sui te. Ev ent Re vie w so ftwar e is for use by trained perso nnel only . Inform ation abo ut Hear tSta rt E v ent Review is a vailabl e online at www .medical. philips.co m/goto/eventreview . * If yo u lea ve the battery in the HeartStar t after us ing the defibrillator , then transfer the last-use data to a computer running HeartStart Event Re vie w softwar e, the software will calculate the local date and time of the device use . Howe v er , if y ou r emov e t he battery prior t o transfer ring the data, t he softwa re will only s how elaps ed time.
4-2 Phil ips Medi cal Syste ms HEARTSTART M5066A Follow your lo cal protocol w ith regard to prompt data trans fer for medi cal review af ter using th e He artStart. * Details ab out da ta trans fer and timi ng are provided in Event Revi ew do cumen tat ion. The i nf ormati on autom ati cal ly st or ed b y th e HeartSta rt includes a sum mar y of last -use da ta an d deta iled dat a abou t its last c linical use . Y ou can g et a voic e summ ar y of information about the last u se of the defib rillator by hold ing the i- butt on d own until it b eeps onc e. The Hea rtSta rt will te ll y ou ho w man y sho ck s wer e de liv ered and h ow long it ha s been si nce it w as turned on. Summ ar y data ar e a vailabl e anytime the de fibrillato r is rea dy for use (the batter y a nd pa ds are install ed, and th e defibrilla tor is not turne d on) or while it is ac tually in use . Remo vi ng th e bat tery erase s th e summary data for the la st use. Las t-u se dat a stor ed in in te rnal memo ry i ncl ud e: • ECG recordings ( a maximum of 15 min utes followin g p ad s applic ation † ) • the HeartSt art’ s status (enti r e inci dent ) • the Heart Start’ s rh y thm anal ys is decis ions (enti r e incid en t) • th e elap sed tim e a ssoci ated w ith st ored e vents (en tir e in cident ) * The HeartStart automaticall y stor es infor mation about its last clinical use in it s intern al memory for at least 30 da ys, so the data can be downlo aded to a computer running appr opriate Ev ent Review softwar e. (If the battery is remov ed dur ing this period, the defibrillator r etains the files . When the batter y is reinsta lled, the last-use ECG reco rdin g will be k e pt in defibrillator memory for an ad ditional 30 da ys .) After t his time, the last- use ECG r ecor dings will automatically be erased to pr epar e for a futur e u se . † If ECG recor dings from a pre vious use ha ve not been erased, the maximum time for ne w ECG reco rdi ngs ma y be less.
Phil ips Medi cal Syste ms 5-1 5 5 Maintaining the Hear t Star t Routine M aintenance The Hear tSta rt is ver y si mple to ma intain . The defibri llator p erforms a self- test ever y day . In a ddition , a bat ter y i nser ti on se lf- test i s ru n wh enever a ba tter y is install ed in the device . The defib rillator’ s ex tensive autom atic self-t est features elim inate th e nee d for any m anual ca libration . The Hear tSta rt has n o use r - serviceab le parts. WARN ING: E lectr ic al shoc k h azard. Do n ot op en th e He artSta rt, r emo v e its co v ers , or atte mpt re pair . Ther e ar e no user - servicea ble co mponent s in the Hea rtS tar t. If repair is requ ire d, retu rn the Hear tSt ar t to Phili ps for ser vice . Rem inder s: • Do no t lea ve the He ar tSta rt withou t a pad s car tr idge ins talle d; the defib rillator w ill sta rt chirpin g and th e i-bu tton will sta rt flashing . For dir ections on changi ng th e pads cartri dge, see C hap ter 2 , “Setti ng up the Hea rtS tar t. ” • The H ear tStar t ru ns d aily self- tests. As lo ng as the green Ready light is blinkin g, it is not nec essar y to te st the defib rillator by initia ting a bat ter y ins ertion sel f-te st. Thi s uses battery pow e r and risk s drai ning t he batte ry pr emat ur el y . Pe r i o d ic c h ec k s Othe r t han the ch ecks r e comme nded a fte r e ach u se of the He artSt art, maint enance is limit ed to periodic ally checki ng the followin g: • Check the gr een Re ady li ght. If the gr een Rea dy l ight is no t bli nking , see T r ou bles hooti ng Tip s, belo w . • Rep lace a n y use d, dam aged or exp ir ed sup plies a nd ac cessorie s • Ch eck th e ou tside of the defib rillat or . If you see cracks o r othe r signs of damag e, cont act Philip s for techn ical suppor t.
5-2 Phil ips Medi cal Syste ms HEARTSTART M5066A Cleaning the H ear tStar t The outsi de o f the Hea rt Star t an d its carr y ca se c an be clea ned w ith a soft clot h damp ened in so ap y water , chl orine bleac h (2 table spoons per qua r t or liter of water ), or amm onia- base d clean ers . Rem inder s: • Do not u se isopr opyl (rubbing) alcohol , st r ong so lv en ts such as ace tone or acetone-based cleaners, abrasive materials, or enzymatic cleaners to clean your He ar tSta rt. • Do not im mers e the Hear tSta rt in fluids or all ow fluids to spill onto it. Do not st erilize the d efibrillat or or its acces sories. Dispo sing of the Hear tStar t The Hear tSta rt an d its acce ssori es sh ould be dis pose d of in ac cordan ce with local reg ul ati on s. T r oubl eshootin g t ips The Hear tStar t ’ s green Ready light is your guide to kn owing if the defibri llato r is rea dy for us e . • If the R eady ligh t is blinki ng: The Hear tS tar t has pa ssed th e b atter y inser tion self-t est and the last p eriodic self- test a nd is t herefor e r eady for u se . • If the R eady li ght is solid : The Hear tSta rt is in u se or running a se lf-test . • If the R eady li ght is off, the Hear tSt art is c hirping, a nd th e i-b utton i s flashi ng : A self-te st err or has occur r ed, the r e is a pr ob lem with th e pads or th e batt er y power is low . Press the i-butt on for in struction s. • If t he Re ady l ight is of f but th e Hea rtSta rt is not chirpi ng and th e i-b utton is not fl ashing: th ere is no ba tter y inse rte d, the batt er y is deple ted, o r the defib rillator n eeds rep air . Ins ert/replac e batte ry and ru n the self-te st. As lon g as th e He artSta rt passes t he se lf -te st, you can be assur ed it is r eady for u se . More detaile d testi ng and troublesh ooting info rmation is a vai lable in Appendi x G.
Phil ips Medi cal Syste ms A-1 A A Acce sso r ies fo r the He ar t Sta r t Access ori es * for th e Hea rt Start Defibr illato r a vailab le separa tely from your Philips representative o r on- line at www .medical.p hilips .com/hea rt start includ e: • Batte ry (spar e recomme nded ) [REF: M5070A] •P a d s • Ad ul t S MAR T Pads Cart ri dg e ( sp ar e r ecom men de d) [R EF : M5 0 71A ] • Inf ant/Chi ld SMAR T P a ds Cartridg e [REF: M5072A] • Ca rry Ca ses • Stand ar d carr y case , with pa ramedic’ s scis sors and r oom for spare pa d cartrid ge a nd ba tt ery [REF : M507 5A] • Sli m carr y ca se, w ith p aramedic ’ s sc issors [ REF: M5076A] • Plast ic waterproof ha rdshell carr y case [REF: YC ] • Fast Respon se Ki t (p ouch c ontaini ng a pock et m ask, a dispos ab le raz or , 2 pairs of gloves, a pair of paramed ic’ s scis sors, and an absorbe nt wipe) [REF: 68-P CHA T] • Data Mana gement Soft war e • HeartStart Conf igur e PD A s o ftwar e [REF : 989803 143041] • HeartStart C aseCa ptu r e PD A softwar e [ REF: 989 80314305 1] • HeartStart Rev ie w Expr ess Connect [R EF: 861311 opt ion A01] • HeartStart Eve nt Re view , single P C lice nse [REF : M3834A] • HeartStart Ev ent Re vie w , organi zati on-wid e l icense [RE F: 98 98031 41811] • HeartStart Ev ent R e vie w P ro , singl e PC l ic ense [REF: 8612 76 opt ion A01 ] • HeartStart Ev ent R ev ie w Pr o , thr ee-PC l ic ense [REF: 861 276 opt ion A02 ] • He ar tStar t Event Review Pro , organiz ation-wid e license [REF: 861276 opt ion A03] • I nfra red cab le for us e wi th He art St ar t Event R eview so ftw are [RE F: ACT -IR ] • He artS tar t Defibr illator Quic k Reference [RE F: M5066- 97800 ] * Certain accessories r equir e a pr escription in the United States.
A-2 Phil ips Medi cal Syste ms HEARTSTART M5066A • T rain ing • Adult T raining Pa ds Cartridg e [REF : M5073A] • Adult T raining Re plac ement P ads [REF : M5093A] • Adult P ads Pla cemen t Guide [REF: M5090A] • Inf ant/Ch ild T ra ining Pa ds Cartridg e [REF : M5074A] • Inf ant/C hild T ra ini ng Replac ement P ads [R EF: M509 4A] • Inf ant/Ch ild Pad s Place ment Gu ide [REF: 98980313 9281 ] • HeartSt art HS1 and FR2 Ins truct or's T raini ng T oolki t, NTS C [REF: M5066-8 9100] or P AL [REF: M5066-89 101] • HeartStart T rai ner [R EF: M50 85A] • Intern al M anik in Ad apt er [REF: M508 8A] • Exte rnal Man ikin Ada pter , 5 pack [REF: M5089A]
Phil ips Medi cal Syste ms B-1 B BG l o s s a r y o f t e r m s The terms lis ted in this Glossar y are defin ed in the context of the Philips Hea rtS tart De fibrilla tor and its use . AED Au tomated e xternal defibril lator (a s emi-au tomatic defibrillat or). AE D mode T he stan da rd tr e atment mod e fo r the He artSt art Def ibr illa tor . It pr ovide s v oi ce instru cti ons g uid ing t he r e scue r thr o ugh a ppl ying t he ad hesiv e pads, wait ing for rh y thm anal ys is, and deliv e ring a sho ck if nee ded . anal ys is See “SM AR T an alys is. ” arr h y thmia An unh eal th y , often ir r egul ar , beatin g of the heart. artifac t Elect rica l “n oise ” caus ed b y s our ce s s uch a s m uscl e mo v eme nts, CPR, pat ient tran spor t, or st atic el ectrici ty tha t ma y inter fere with rhythm analys is. bat ter y The seal ed li thiu m m ang anes e d ioxide ba tter y used to power t he Hear tStar t Defib rillat or . It is pro vide d in a pack tha t fits int o a compar tme nt on the b ack of the defibr illator . Cautio n ligh t A trian gular light on the fr ont of the HeartStart Defi bril lato r that flashe s dur ing rh y thm anal ysi s an d i s on sol id when a s hock is advi sed, as a r e mind er n ot t o tou ch the patie nt. confi guration The s etting s for a ll opera ting op tions of the Hear tSt art Defi brillator , includin g tr ea tment pr otocol. The fac tory defaul t configu rati on c an be m odif ied by autho ri zed perso nnel using HeartS tart Ev ent Re vi ew so ftwar e. CPR Car d iopulmo nary re susci tation. A tech nique f or pr oviding arti ficial r espir ation an d heart c ompr es sions. CPR C oaching Basic verbal instructio ns for perform ing c ar diopulm onar y re suscit ation, in cluding hand plac ement, r escue br e athin g, c ompr ess ion depth and ti ming , pr o vi ded by th e HeartStart wh en the fl ashing bl ue i-bu tt on is pr essed during th e fir st 30 seco nds of a pati en t car e pause. defib rillation T e rmination of cardiac fibrilla tion by applying elect rical ener gy . ECG El ect r o ca rdi og ram, a r ec or d of t he elec tr ical r h y thm of th e heart as det ecte d through defib rillati on pads .
B-2 Phil ips Medi cal Syste ms HEARTSTART M5066A fibrilla tion A dist urbance of the norma l hea rt rh ythm t hat result s in chaotic , dis organ ized activ ity tha t cann ot effecti vely pump bloo d. V entric ular fib rillation (fibrill ation in the l ow er c hamber s of the hea rt) is as sociat ed wi th sud den c ar diac ar r es t. HeartSta rt Even t Rev ie w A suit e of data manag ement so ftwar e a ppli cati ons f or use b y trai ned per sonnel to re view a nd an alyze He art Star t De fibr illator pa tien t use and by auth orized person nel to alter Hear tStar t co nfigura tion. In formatio n is available fr om Philip s Medic al System s on the inte rnet at http:/ /www .medica l.philips .com /g oto / eventreview . i-but ton A blue “in format ion” bu tton on the front of th e Hear tSta r t Defib rillat or . If the i-bu tton is p r esse d du ring t he 30 se conds i t fl ashe s duri n g a pat ient car e pau se, the HeartStart pro vid es CPR Coac hing ; * if th e i- but ton i s pr essed when i t i s fl ashi ng and the Hea rt Star t is chir ping, the He ar tSta rt provides troub leshoo ting gu idance . At other tim es, if the i-but ton is pressed and he ld until it bee ps once , the Hear tS tart pro vide s summ ar y inform ation a bout it s las t clinic al use and d e vice statu s. When the i- button is on soli d (not flashi ng), it ind icate s the use r may safely tou ch t he pati ent. in fr ar e d communic ations A me thod o f sen ding i nformation using a sp ecial p ar t of th e ligh t spec trum. I t is used to transm it informati on between the Hear tStar t D efibrillat or and a co mputer run ning HeartS tart Ev ent Re vi ew softwa r e. NSA “ No Shock Advi sed, ” a deci sio n made b y the HeartSta rt Defi brilla tor t hat a shoc k is not need ed, base d on anal ys is of the p atie nt’ s heart rh y thm. NSA pause A paus e pr ovided by the He ar tStar t Defib rillator follow ing an NSA deci sion. The paus e can be confi gur ed to a “st andar d” NSA paus e or a “SMAR T” NSA paus e. During a sta ndard NSA paus e the defibr illator p erforms n o ba ckground monit oring of patie nt rhythm. Durin g a SMA R T NSA p ause , the defib rillator conduc ts bac kgr ou nd moni tor ing and, if it dete cts an arti fact-fr e e shoc kabl e rh ythm, will e xit th e pa use and begin rh ythm analysis. If the Hear tSt art detec ts artifac t such as that cr eated by CPR, or if the us er pr ess es the i -butto n fo r CPR Coachi ng d uring a SMAR T NSA paus e, the defib rill ator wi ll no t exit the pau se f or rh ythm a nalysis in order t o allow C PR to be com pleted unint errupted. non-s hocka ble rh y thm A hear t rh ythm tha t the Hear tSt art De fibrilla tor dete rmines is no t appr opriat e for defib rillation . On/O ff b utton A green b utton locat ed on the fro nt of t he He art Star t De fibr illator . Pressing the On/O ff butt on whe n the defibri llator is in standby mode t urns th e defib rillato r on; pressing an d holding the On/O ff button for one s econd wh en the de fibrillato r is on turns th e defibr illator off an d disa rms the def ibrillato r . In addition , pr essi ng the * Pressing the i-button for CPR Coaching d uring a SMAR T NSA pause turns off backgr ound monitor ing.
B-3 Phil ips Medi cal Syste ms B On/Of f but to n sto ps the ba tt ery in sertion se lf -te st th at automa ti cal ly run s when a batte ry is ins ert ed. pads Se e “SM AR T p ads. ” pa tient care pa use A d efine d pau se to all ow pa tient a sse ssme nt, tre atmen t, a nd/or CPR . See “NSA pause” and “pr otocol pause. ” per iodic se lf- tes ts D ail y , w ee kly , and monthl y tests autom atic all y cond ucte d b y th e HeartS tart Defib rillat or when it is in its stan dby mode . The tests m onito r many k ey func tions and pa rameter s of the defibr illat or , includi ng batte ry ca paci ty , pads cartridge readiness , and t he st ate of its in ternal circuitr y . protoco l A sequ ence o f opera tions performe d by t he He artS tar t De fibrilla tor to direct pati en t ca r e in the AED m ode. pr ot ocol pause A pa use pr ov ide d by the Hea rtStart Def ibr illa tor af te r a sho ck ser ies, d uring wh ich the r e spond er can a dmin ist er C PR. The d ef ibri llator doe s not c onduc t bac kgr oun d moni tor ing of the pati ent’ s heart rh y thm dur ing th is pau se. Read y light A green LED s howing the re adin ess for u se of the Hear tS tart Defib rillat or . A blinkin g Ready ligh t mean s the defib rillator i s ready for use; a solid Read y light mean s the defibri llator is being used. rh y thm a naly si s See “S MAR T analy sis. ” Shoc k butt on An or ange butt on with a l ight ning bol t sy mbol on it, loca te d on the fr ont of the Hea rtS tar t Def ibrilla tor . T he Sh ock button flash es wh en a shock is a dvise d. Y ou must press the b utto n for the sh ock to be deli vered. shockabl e rh y thm A he art rhythm that the Heart Start D efibrillator de termines is app r opriate for defib rillation, suc h as v entricu lar fibrillation an d some ventricular ta ch ycardias associa ted with sudden ca rdiac arrest. sho ck seri es in ter val A conf igurab le int er val be tween shocks , used by th e Hea rtS tar t D efibrill ator to dec ide if th e shoc ks ar e par t of the sa me shoc k se ri es. SMAR T a naly si s T he pr oprietary alg ori thm u sed b y the He artSta rt Defib ril lat or to anal yz e the pati ent’ s heart rh yt hm and dete rmi ne whe ther the rh yt hm is sho ckabl e. SMAR T bip ha si c wavefor m The pate nted, l ow-ene rgy defib rillati on sh ock wa vef orm used by the Hea rtS tar t Defib rillat or . It is an im pedan ce-com pensa ted bi phasic wav eform. Us ed wit h the Adult SMA R T P ads, it delivers 150 Joul es, nomi nal, in to a 50 oh m loa d; used with the Infa nt/ Child SMAR T Pad s, it d eliv er s 50 Jo ules , nomi nal, in to a 50 ohm loa d. SMAR T NSA paus e See “NSA paus e. ” SMA R T Pads The adhe sive pads, supp lied i n a car tridg e, used with t he He art Star t De fibrilla tor . Pulling the handle o n the c ar tridge t urns on the d efibrilla tor and open s the
B-4 Phil ips Medi cal Syste ms HEARTSTART M5066A cartr idge. The pad s ar e ap pli ed t o the p ati ent’ s bar e ski n and us ed t o de te ct the patie nt’ s hear t rhythm a nd to transfer the defib rillation shock . Only H ear tStar t SMA R T Pads can be used with the Hea rtS tar t Defib rillat or . standb y mode The o peratin g mo de of the H eart Star t De fibrilla tor wh en a batter y h as be en ins tal led, and the uni t is tu rned off and r ead y for use when ne eded . Sho wn b y blinkin g green R EAD Y light. stan dard NSA p aus e See “NSA paus e. ” s udde n ca rdi ac arre st (SC A) The sud den sto ppin g o f t he hea rt’ s pum pi ng r hythm, ac comp an ied by lo ss of consc ious ness , abse nce of r espi ratio n, and lack of a puls e. wa vef orm See “SM AR T biph asic wa vef orm. ”
Phil ips Medi cal Syste ms C-1 C C Gl ossar y of symbols/controls sym bol descri ption Pads cartrid ge ha ndl e. Gre en. Pulling t he ha ndle turns on the de fibrilla tor and open s pads car tridge for u se. Refer to operating ins tructio ns. On/Of f butt on. Gr een. Pr essing the On/ Off butto n when the de fibrilla tor is in standby m ode tu rns the defibrilla tor on; pr essing and holdi ng th e On/Off but ton for one seco nd when t he defib rillator is on turn s the de fibrillato r off and disarms the defibril lator . In add ition, pr essi ng the On/ Of f butt on st op s th e bat tery ins ertio n se lf- test tha t autom atica lly runs w hen a ba tter y is inser te d. Information butt on (i-button). Blue . Pressing t he i-but ton while it is flashing dur ing a patient care pause provides CP R Coachin g; pressing it while it is f lashing and the defibril lator is chir ping pr ov ides troubleshooting gu idance. P r essing it unt il it bee ps at other t imes pro vid es summary i nformat ion about the defibr illat or’ s last clinic al use and de vice st atu s. Cautio n light. Flashes d uring rh y thm an alysis, a nd is o n but not fla shin g when a shoc k is advi sed, as a r eminder not to touch th e pat ient . Shock butt on. Oran ge. Flashes when the de fibrilla tor is char ged. If a sho ck is needed , the def ibrillat or directs the user t o pr es s the Sh oc k button to de liv e r a shoc k to the pati en t. Defib rillat ion protecti on. Def ibrilla tion protec ted, ty pe BF p ati ent c onnec tion . Meets the requirements o f the European me dical device d ire ctives 93/ 42/EEC . Indicates that this device is optimize d f or Guidelines 2005. PU LL
C-2 Phil ips Medi cal Syste ms HEARTSTART M5066A Cer tified by the Canad ian Standards A ssociation. Reference o rd er num ber . Expirat ion date . Lith iu m ma nganes e dio xi de b att ery . One batt ery in package. Do n ot c rus h the ba ttery . Do not expose th e bat tery to high hea t or open flames . Do no t incine rate th e batt er y . Do no t muti late the ba tter y or op en the batter y case . Cl ass 9 misc ell an eou s da nge r ou s good s . (S ymbo l re quir ed on outer packag ing by frei gh t carr ie r re gula tions to ide ntify shipm ents cont aini ng li thiu m batteri es. ) Insta ll the batt er y in the defib rillator be fore the date (MM -YY YY) s how n on th e assoc iat ed la bel . Do not expose to moisture. Handle with care. sym bol descri ption
C-3 Phil ips Medi cal Syste ms C This sid e up . T r ansportati on r equir ements ( ref er to asso ciated thermometer symbol). Storage requirements (refer to asso ciated therm ometer symbol). Envir onmen tal (temperature and r elative humidity) requirements. Thes e pad s a r e disp osab le a nd ar e for s ingl e pat ient u se only . Car tridge conten ts: one set of two d efibrillation p ads. Sto r e the p ads at t emp eratur es bet wee n 0° a nd 43 ° C (32° a nd 110° F ). Thi s pr oduct is not steri le. This product does not contain natural rubber latex. Meets t he requirement s of the European elec tr omagnet ic co mpatibility d ir e ct iv e 89/ 3 36/ EE C. Pads intende d f or use on infant or child under 8 y ears or 55 pounds (25 K g). Expirat ion (see associ ated date code). sym bol descri ption N O N - S T E R I L E L A T E X
C-4 Phil ips Medi cal Syste ms HEARTSTART M5066A Serial number . Lot numb er . Fe de ral la w (U SA) r estr ic ts thi s de vi ce to s ale by or on the or d er of a ph ysic ian. Dispose o f in accordance with your coun try's r equirements. Pri nte d on re cy cl ed pa p er . sym bol descri ption
Phil ips Medi cal Syste ms D-1 D D W ar nings and precautions It is impor t ant to underst and how to use you r Hea rtS tar t D efibrill ator sa fely . Pleas e r e ad thes e warning s and pr ecaution s c ar efu lly . A wa rning de scr ibes so met hing that c ould caus e seri ous pe rson al inj ury or death. A pr ecaut i on d escribe s some thi ng that could caus e minor pers on al injury , dam age t o the Hear tS tar t, loss of data stored in th e Hea rt Star t, o r les s cha nce o f succ essful de fibrilla tion. NO T E: The Hear tSt ar t Defi brillato r is d esigned to b e use d only w ith Ph ilips- approv ed acce ssories. The Hear tStar t ma y perform im pr operly if non- app r o v ed acc ess ories a r e us ed . Wa r n i n g s flamm able gases If the H eartStart i s use d to giv e a shoc k i n the pr esen ce of fl ammabl e gas es su ch as in an o xyge n ten t, the r e is a ri sk of expl osi on. Mov e supplement al o xy gen and oxygen d elivery devic es a wa y fr om the defi brillat ion pads. ( Howe ver , it is sa fe to use t he HeartSta rt on someo ne w eari ng an o xyge n mask. ) batt ery The HeartSt art M5070A batte ry is not rech arge able. Do no t tr y to re char ge, open, crush , or burn the batte r y , or i t ma y expl ode or catch fire. flu ids Do no t let fluid s get in to the He art Star t. Avoid spill ing any flu ids on th e Hear tS tar t or it s acc essor ies. Sp illing f luids in to th e H ear tStar t m a y dam age i t or cause a fire or sh ock h azard. Do no t steriliz e th e He artS tar t o r its a ccesso ries. access ori es Us ing dam age d or expir ed equipmen t or acc esso ries ma y caus e th e HeartSta rt Defib rillator to pe rform improperly , a nd/or injure the patient or t he user . pati ent handli ng P e rfo rming CPR or o therwi se han dli ng or mov ing th e pati en t whi le t he Hea rtStart is anal yz ing he art rh ythm can caus e an incor r ec t or del a y ed anal y s is. If the Hea rtS tar t tells you a shock is ad vise d whil e you are h andlin g or m oving the pat ient , stop th e vehic le or CPR and keep th e pati ent a s still as po ssibl e for at leas t 15 se cond s. This will give the Hear t Start tim e to re confir m the analys is befo re tellin g you to press t he Sh ock b utton . cell pho nes Th e Hear tStar t can work correctly when i t is fairly close to equipm ent like emerge ncy two-wa y radios and ce ll phones. Norma ll y , u sing a cell phone nea r the pat ient sh ou ld not caus e a problem f or th e Hea r tStar t. Howev er , it is best t o keep suc h equipm ent onl y as clos e as necess ary to the pati en t and the HeartStart.
D-2 Phil ips Medi cal Syste ms HEARTSTART M5066A pad s Do not allo w the pad s to cont act ot her elect r ode s or met al parts tha t ar e in con tact w ith the p atien t. Precautions de vic e handli ng The He artStart was desi gned to be stur dy and r eli able for man y diff er ent u se condi tio ns. How ev er , handling the Heart Start too r ou ghl y can da mage it or its acce ssor ies a nd wi ll inva lidat e th e w arrant y . Ch eck the He ar tSt ar t and acc esso ries re gul arl y f or damage, accor din g to dir ec tion s. ma intena nce Improp er m ainte nance may dam age the Hea rtS tar t o r cau se i t to func tion imp r operly . M aintai n the Hear tSta rt acco rding to directio ns. skin burn s D o not let th e pa ds tou ch e ach o the r o r othe r e lec tr odes, l ead wir es , dr essings , medic ine pa tches , e tc. Suc h conta ct c an c ause el ect rica l ar cing a nd s kin burns duri ng a shock and ma y also div ert th e elec tri cal cur r en t a wa y fr om the pati ent’ s heart. During a shoc k, a ir pock ets betw een th e sk in an d pad s c an cau se s kin burns . T o help pr event air po ck e ts, mak e sur e pads stick w el l to th e ski n. Do not use dried out pads becau se they will not provide good co ntact with the skin . patie nt ha ndling Before del ivering a shock, it is im por tan t to di scon nect t he pat ient f ro m o ther medic al elec tr ical equ ip ment, such as blo od-f lo w mete rs, th at ma y not inco rpora te defi brilla tion p rotectio n. In additio n, m ak e s ure the pad s are n ot in cont act with meta l obje cts suc h as a bed frame or str etc her .
Phil ips Medi cal Syste ms E-1 E E T ec hni cal infor m at ion HeartSt art Defibril lat or spec ific atio ns The s pecific ations provided in the following ta bles a re nomin al va lues. Addit ional in form at ion c an b e foun d in the T echni cal Refe rence Manual for He artSta rt Auto mated Exter nal De fibrillato rs, lo cated online at ww w .me dical .philips.co m. Ph ysical Environm enta l catego r y specif ications siz e 2.80” H x 7. 40” D x 8.30” W (7.1cm H x 19cm D x 21cm W). weigh t Approximately 3.3 lb s (1.5 k g) wit h batte r y and pads c art ridge in stalle d. cate gor y s pecifica tions tempe rat ure an d relative hu midity Op eratin g (batte ry and p ads ca rt ridge in stalled ): 32° to 122° F (0° to 50° C) 0% to 95% RH (non-co ndensi ng). Stan dby (ba tter y and pads c artridg e ins talled): 50° to 109° F (10° to 43° C) 10% to 75% RH (non-c onden sing ). Stora ge /shi ppi ng ( with batte ry and pads cartr idge) : -4° to 140 ° F (- 20° to 60° C) f or u p to 2 da ys 0% to 85% RH (non-co ndens ing) alt itude Operate s at 0 t o 1 5,000 f eet; can be st or ed at up t o 8 ,500 f eet, in stan dby mode. sh ock/ drop ab use tole rance Withs tan ds 1 met er dr op to an y edg e, corn er , or sur face. vibr ati on Operating : meet s EN1789 random, r oad ambu lanc e. Standb y: mee ts EN1789 s w ept sin e, r oad ambula nc e.
E-2 Phil ips Medi cal Syste ms HEARTSTART M5066A Co ntrols and ind icato rs seali ng Drip pro of per EN6052 9 class IP x1. Solid Obj ects per EN 60529 clas s IP2x. ESD/EMI (rad iated an d imm unity ) See El ectr omagneti c Conf ormi ty ta bles . cate gor y s pecifica tions cate go ry spe cification s controls G re en SMA R T Pads ca rtri dge handle Gre en On/Off but ton Blue i -but ton Ora nge S hock but ton ind icators Re ady ligh t: gr een; blin ks when th e defibrilla tor is in standby mo de (ready for use) ; solid w hen the de fibrillato r is b eing u sed. i-but ton: blue, flashes when inf orma tion is a vail abl e, o n solid du ring pat ient care pause. Cautio n light: flash es whe n the defibr illator is analyzin g, com es on solid w hen the def ibrillat or is r eady to del iver a shock . Shoc k butt on: ora nge , flas hes w hen the de fibrillato r is c harged and rea dy to deliver a shoc k. audio sp eak e r Pro vi des v oic e pr om pts and war ning to nes du rin g norma l use. bee per Provides chir ps when troub lesh ooti ng i s ne eded .
E-3 Phil ips Medi cal Syste ms E De fibr illa ti on Wa ve form cate gor y s pecifica tions wa vef orm parameters B iphasic truncate d exponential. Wa veform parameters a re automati cally ad justed as a fu nction of patient defibr illation impe dance . In t he d iagram a t left, D is t he durati o n of ph ase 1 and E i s t he durati on of pha se 2 of the wa vefor m, F is t he in terphase delay (500 µs), and Ip is t he pea k current. The H eartStart d eliv ers sho cks to l oad impe dance s fr om 25 to 18 0 o hms. The du ration of each phase o f the w a v eform is dyn amically a djusted based o n del iv ered charge , in order to compen sate for patient imped ance variatio ns, as sho wn be lo w: adult d efibrill ation loa d phase 1 phase 2 peak del iv ered r esi stance ( Ω ) duration (ms) duration ( ms) curr ent (A) energy (J) 25 2. 8 2. 8 65 128 50 4. 5 4. 5 40 150 75 6. 25 5.0 30 155 100 8.0 5. 3 24 157 12 5 9. 65 6.4 21 159 150 1 1.5 7 . 7 18 160 175 1 2.0 8 . 0 16 158 pedia tric defib rillation (using M5072 A infa nt/ child r educ ed-en ergy de fibri llator pad s) loa d phase 1 phase 2 peak del iv ered r esi stance ( Ω ) duration (ms) duration ( ms) curr ent (A) energy (J) 25 4. 1 2. 8 28 35 50 5. 1 3. 4 20 46 75 6. 2 4. 1 15 52 100 7.2 4. 8 12 54 125 8.3 5. 5 10 56 150 9.0 6. 0 9 57 175 9.0 6. 0 8 55
E-4 Phil ips Medi cal Syste ms HEARTSTART M5066A ene rgy * (pe diatric d oses in dicated ar e based on C DC gro wt h charts for t he 50th per centile we ight s for bo ys.) Using HeartStart Adult SMAR T Pads: 150 J nomi nal ( ± 15%) in to a 50 oh m load . Usin g Hea rt Start Infant /Child SMAR T Pa ds: 50 J nom inal ( ± 15%) int o a 5 0 ohm load. Sa mple p ediatric ene rgy dos es: age energy d ose ne wborn 14 J/kg 1 y ear 5 J/ kg 2 − 3 year s 4 J/kg 4 − 5 year s 3 J/kg 6 − 8 year s 2 J/kg * National Center for Health Statisti cs in collaboratio n with the Nationa l Center for Chroni c Di sease Prevention and Heal th Promotio n. CDC gr o w th cha rts: w e ight -f o r-ag e perc ent il es, r e vise d and corrected November 28, 20 00. Atlanta, GA : Cent ers for Diseas e Control and Prevention © 2000. cha rge cont r ol C ontr olled by Pat ient An alys is Sys tem f or aut omate d ope rat ion. “charge com plet e” indi cator Sh ock bu tto n fla she s, au dio to ne s ound s. sho ck-to-s hock cyc le time < 20 secon ds, typi cal, inclu ding analysi s. pati en t car e pause-t o-shock ti me Quick Sho ck. 8 sec onds , typi cal, fr om end of pati en t car e paus e to sho ck de liv ery . disarm (AED mo de) O nce c harged, t he defibrillat or will disarm if : • the patie nt’ s heart rh ythm chang es to non -shoc kable rh yt hm, • a shock is not delivered with in 30 se conds afte r the d efibrillat or has charg ed fo r shoc k del iv ery , • th e On/Off but ton is pressed an d held down for at least on e (1) secon d to turn o ff the defibr illator , • the adhesiv e pads ar e r emov e d fr om the patien t or the pad s cartridg e is disc onnec ted fr om the d efibrilla tor , • th e bat ter y is re moved or is com plete ly dep leted o r • the impedanc e betw ee n pads is out of rang e. adult s hock deliver y vector Via adhes iv e pads pl aced in the anteri or -an terio r (Lead II) posit ion. infant/ child sh ock deliver y vector Via adhes iv e pads typical ly placed in the ant eri or -post erior posi tion . cate gor y s pecifica tions
E-5 Phil ips Medi cal Syste ms E ECG analysis system cat eg o ry sp ecific ations func tion Eval uates impe danc e of adhe siv e pads for pr oper co ntact with th e pati ent’ s skin, and ev aluat es the ECG r h ythm and sign al q uali ty t o det ermine if a shock is appr opriate. sh ockable rhythms V entr icular fibril lation (VF) a nd some ventricula r tach ycardia s assoc iated with a lack o f ci r culatio n, inclu ding ve nt ricular f lutter and p olymorp hic ventri cular tach ycard ia ( VT) . Th e HeartS tart use s m ulti ple par amete rs to det ermi ne if a rh ythm is shockable . NO T E: For patient saf ety reasons, some ver y lo w-amplitude or low-freque ncy rhythms may not be i nterpr eted as shoc kable VF rhythms. Al so, some VT rhythms usually associated with circulation will not be interprete d as shockable rh ythms . non-sho ckabl e rh y thms SMAR T Analysi s is desig ned to d etect non -sho ckable rh yt hms as defi ned by AHA/AAMI DF-80. See foll owi ng tabl e. On de tect ion of an y non-sho ckabl e rh y thm, the HeartSt art pro mpt s user to perfo rm CPR i f neede d. pacem ak er d etecti on Pacemak er artifact is re mov ed fr om the signal for r h yth m anal ys is. ar tifa ct detect ion If ele ctri cal “nois e” (ar tifa ct) is dete cted wh ich inter feres with accura te rh yth m analys is, analysis will be de la yed unt il the ECG sig nal is clean. ana lysis protoc ol D epe ndin g on resul ts of an alys is, ei ther prepa res for sh ock del iver y o r pr ovi des a pause. F or detai ls of pr ot ocol , see Ap pendi x F , “Confi gurat ion. ”
E-6 Phil ips Medi cal Syste ms HEARTSTART M5066A ECG analysis performance rhythm class ECG test samp le a size meets AHA r ecommend ations b for adult defibrill ation obser ved 90% one-sided performance lower c onfidence limit shoc kab le rh ythm — ventricular fibri llation 300 sen sitiv ity >90 % (meets AAMI DF80 re quir e ment) (87%) shoc kab le rh ythm — ventricular tach ycardia 100 sen sitiv ity >75 % (meets AAMI DF80 re quir e ment) (67%) non-s hockab le r h ythm — nor ma l si nus r h yth m 300 s pecif ici ty > 99% (meets AAMI DF80 re quir ement ) (97%) non-s hockab le r h ythm — asyst ole 100 s pecif ici ty > 95% (meets AAMI DF80 re quir e ment) (92%) non-shockable rhythm — all o ther non-sho cka ble rh ythms c 450 s pecif ici ty > 95% (meets AAMI DF80 re quir e ment) (88%) a. From Philips M edical Systems H ear tstr eam ECG rhy thm d atabases. b. American H eart Associatio n (AHA) AE D T ask F or ce, Subcommit tee on AED Saf ety & Efficacy . Automatic External Defibr illators f or Pu blic Access U se: Recommend ations for Spec ifying and Re porting A rrh ythmia Analysis Algor ithm P erformance , Incorporati on of New W aveforms, and Enhancing Safety . Circu latio n 1997; 95:1677-1 682. c. Supra v entricular tac hy cardia (SVT) is specifical ly included in the non- sh ocka b l e rh ythm cla ss , in acc o rda nce wit h AH A r eco mme ndations b and the AAMI standa rd DF80.
E-7 Phil ips Medi cal Syste ms E Acc ess ori es sp ecif icat ion s Batt e ry M5070A Hea rtSt ar t Adult SMAR T Pads M 5071A and Infant /Chil d SMAR T Pads M5072A catego r y specif ications batt er y type 9 VDC , 4.2 Ah, lithium ma ngane se dioxide . Dispo sable , long-life p rimar y cell. ca paci ty When new , a minim um of 200 shoc ks or 4 h ours of oper ati ng time at 77° F (25° C ). (IEC 60 601-2- 4 2002 ) shelf life (prior t o inse rt ion) A mi nim um of 5 y e ars f r om date o f ma n ufac tu re when sto r ed and ma inta ined according to dir ect ions provided in this Owner ’ s Manual . stan dby lif e (afte r inse rt ion) T ypi cally , 4 years w hen s tored an d main tained accordin g to di r ect ions provided in this Owner’ s Manual . trai ning lif e Supp orts 10 hours of use in trai ning mod e. catego r y specif ications adult p ads Dis posable , adh esive defib rillation pads wit h a no minal act iv e surf ace area of 8 5 cm 2 each, pr ovided in a snap -in cartridge with an inte grat ed 54” ( 137.1 cm), ty pical, c able. infa nt/child pad s Disp osable , adhe siv e def ibrillatio n pads w ith a no minal acti v e surfac e area of 85 cm 2 each , pr ov ide d in a s nap-i n ca rtridge with a n int egr ated 40 inch ( 101. 6 cm), typic al, cabl e. Car tridge in corpor ates t eddy bear icon on cover of sea l for ready id enti fi cati on . defibri llatio n pad re qui rem en ts Use onl y HeartSt art Adult SMAR T Pads M5071A or Infant /Chi ld SMAR T Pads M5072 A with the He art Star t Def ibrillato r .
E-8 Phil ips Medi cal Syste ms HEARTSTART M5066A Envir onmen tal c onsidera tions By co mplying w ith you r natio nal regu lations regarding di spos al of e lectric , ele ctr o nic, and ba ttery waste, yo u can mak e a positi v e cont ri butio n to our shar e d envi r onm ent. Suc h w aste can int r odu ce harm ful e le ment s i nto t he environ ment as a whol e and ma y a lso en danger hum an hea lth . produ ct in formation defibril lator T he defibril lator conta ins elect r onic com ponent s. Do not dis pose of it as unsorted muni ci pal w aste. Colle ct s uch e lec tr oni c wa ste separ atel y and di spos e of it at an app r opriate recycl ing facility accordin g to yo ur coun tr y's regulati ons. batte ry T he bat ter y ce lls co ntain chem icals . The chemis tr y us ed in each batt er y is iden tified by a symbo l on the lab el; symbols are defin ed in the defib rillator User 's Guid e/ Instr uct ions for U se/Own er' s Manu al . Recyc le th e batte ry at an appropriate recyc ling fa cility . pads The u sed pads ma y be c ontami nate d wi th bo dy tis sue, fl uid, or bloo d. Cut them off and d ispose of the m as infectio us w aste . Recyc le th e remainin g car tridg e compo nents at an appr o priat e r ecycl ing fac ilit y in acco r dance wit h local re gul at ion s.
Phil ips Medi cal Syste ms F-1 F FC o n f i g u r a t i o n Ov erview The Ph ilips H ear tStar t D efibri llator co mes wit h a f actor y default config uration desi gne d to meet t he ne eds of mo st u sers. Thi s c on figur ati on c an onl y be chan ged by an aut hori zed per son using HeartSt art Configu re PD A soft war e or Ev ent Re vie w s oftwar e. This softwa r e is fo r use by trained personn el. Info rmat ion abou t HeartSta rt data manage men t pro du cts is a v aila ble online at http:// www .m edical. philips.co m/goto/ ev entre view . Dev ice opt ions The f ollowing table incl udes t he featu r es o f Hea rt Start De fibrilla tor op eration that are not rela ted to pati ent trea tme nt. para meter sett ings default defa ult desc ription speak er v olum e 1, 2, 3, 4 , 5, 6, 7, 8 8 The v olu me of th e He ar tStar t ’ s sp eaker is se t to 8, highes t. auto s end perio dic self-test (PST) data On , Off On Enab les th e perio dic s elf-tes t data to b e br oad cas t thr ough the de vi ce's in frar e d da ta port. ECG out dat a On, Off On Enabl es the ECG data to be br o adca st thr o ugh the de v ic e's i nfrar ed dat a port.
F-2 Phil ips Medi cal Syste ms HEARTSTART M5066A Patient treatment pr otocol opti ons para meter sett in gs default defaul t descri pti on “call E MS” voice re mi nde r ti mi ng • At po w er o n ( when the us er tu rns on the Hear tS tar t) • At po w er on and at the sta rt of th e f irst pati e nt car e pa use • A t the star t of the fir st pa ti ent ca r e pau se •N o r e m i n d e r At the star t of the first pati e nt ca r e paus e Provides a voice remind er to make su r e em erge ncy me dical s er vices have been call ed, at the st art of the fir st patient car e pause. shoc k s eries 1, 2, 3, 4 1 The automa tic proto col pause for C PR is ac tiv ate d each ti me a sho ck is del iv er ed . * During t he pr o toco l pa use, t he HeartSta rt do es not perf orm rh yt hm anal ysis . The l engt h o f t he pr ot ocol p ause aft er a shoc k ser ies is com plete d is dete rmined by the pr otocol pause time r s etti ng . sh ock se ries inter va l (minut es) 1.0 , 2.0, ∞ (infin ity) 1.0 A deliv er e d shock must o ccur wi thi n 1 minu te of the pr ev iou s shoc k to be count ed a s part o f t he c urr ent s hoc k ser ies. NO TE: This parameter is only applicable when the s hoc k series is not conf igure d to the default 1 shock. * A sho ck series begins when a shock is deliver ed af ter the HeartStart is turned on. A new s hock series b egins after a pr otocol pause. If shock series is configur ed for 2 or more, a n ew shock series also begins if the t ime since the pre vious shock exceed s the shock s eries interval setting.
F-3 Phil ips Medi cal Syste ms F pr ot ocol pause timer (minut es) 0.5, 1. 0, 1.5, 2.0, 2 .5, 3.0 2.0 A 2-min ute pr otocol pa use fo r CPR auto matic ally start s after voice ins truction is given when a shock ser ies is com plet ed. A fter the prot ocol pause, the def ibr illat or r et urns to rh ythm a nalysis. If th e use r presses th e i-b utton for opti onal CPR coach ing, the Hea rtStart pro vi des coac hing for 5 cy cle s of CPR, starting and e nding wi th c ompr e s sions , when t he CPR C oa chin g par amete rs ar e al so s et t o the ir d efa ult va lues . Th e numb er o f CPR cycle s var ies for othe r pro toc ol pau se ti mer and CPR Coachi ng para meter se tti ngs. Note: Because the pr otocol pause ends upon completion of a CPR cyc le in or der to maximiz e the benef it s of CPR, the actual duration of the pause may differ slight ly fr om the ti mer setti ng. NS A pa use ty pe • Stan dard NS A paus e: HeartSta rt doe s not perf or m rh y thm an aly sis during the NSA pau se . • SMAR T NSA pause: Hear tSt ar t con- ducts b ackground moni tori ng duri ng the SMAR T NSA paus e. If a po te n- tiall y shoc kabl e rh ythm is detected, Hear tSt ar t ter mi- na tes th e SM AR T NSA pa use a nd res um es rhyt hm ana lysi s. SMAR T NS A pau se During a SMAR T NSA pause, the defibri lla tor c onducts backg r ound monitor ing. If a pot enti ally shockabl e rh yth m is de tected in a motion less pati ent, the d efibrilla tor te rminates the SMAR T NSA pause a nd re sumes rh ythm a nalysis. N O TE : If t he Hear tSta r t d etec ts C PR in pro gress or i f the responder has pressed the i-button for CPR Coaching, the SMAR T NSA pause wi ll be converte d to a standard NSA pause . During the standard NSA pause , the de f i brillator does not perform rhyt hm analysis . para meter sett in gs default defaul t descri pti on
F-4 Phil ips Medi cal Syste ms HEARTSTART M5066A NSA pause timer (minut es) 0.5, 1. 0, 1.5, 2.0, 2 .5, 3.0 2.0 A 2-minute N SA pause f or CPR auto matic ally start s after voice ins truction is gi v en when no shock is advised (NSA). * If th e use r presses th e i-b utton for opti onal CPR coach ing, the Hea rtStart pro vi des coac hing for 5 cy cle s of CPR, starting and e nding wi th c ompr e s sions , when t he CPR C oa chin g par amete rs ar e al so s et t o the ir d efa ult va lues . Th e numb er o f CPR cycle s var ies for othe r N SA pa use tim er and CP R Co achi ng parameter settings. Note: Because the NSA pause ends upon completion of a CPR c ycle in order to maximize the benef its of CP R, the actual duration of the pause may di ff er slightly from the ti mer se tting . CPR promp t • CP R1: In struc ts th e user to be gin C PR. •C P R 2 : I n s t r u c t s t h e user th at it is safe to to uch the pati e nt and to begi n CPR. •C P R 3 : I n s t r u c t s t h e user to be gin C PR and to press th e i-button for CPR Co achi ng. •C P R 4 : I n s t r u c t s t h e user th at it is safe to to uch the pati en t, to begin CPR, a nd to press the i -butto n for CPR Coac hing. CPR4: Instructs t he use r that it is saf e to touch the patie nt, to begi n CPR, and to p ress th e i-button for CPR Coac hing. The CPR r eminder voice ins tructions pro v ided at t he begi nning of a pa use inte rval a ssu r es th e u ser that i t i s s af e to to uch t he pa tien t, i nst ruc ts t he user to begi n CPR, and in vi tes the user to pres s the i- butto n f or guid ance in th e bas ic st ep s of CP R . Note: CPR Coaching is available onl y with the CPR3 and CPR4 sett ings . para meter sett in gs default defaul t descri pti on * If the shock seri es is conf igured t o 2 or mor e, and a shock has been d eliver ed as part of a s eries, the leng th of the firs t NSA pause within that shock series is determined by the pr otocol pause timer s etting. Otherwise, the length of an NSA pause is determ ined by t he NSA pause timer setting.
F-5 Phil ips Medi cal Syste ms F CPR Coac hing adu lt ventila tion instru ction Y es, No Y es Opt ional CPR Coaching incl udes r escu e br ea ths at th e rate de term ined by the CPR Coaching compression :v entilation ratio f or adults when an adul t pa ds cartridg e is ins talled. NO TE: i f t his p ar a met er is c onf igur ed to NO, CPR Coachi ng will alw ays be compressions-only when an a dult pads car tr idge is installed. CPR Coac hing infa nt/child ventila tion instru ction Y es, No Y es Opt ional CPR Coaching incl udes r escu e br ea ths at th e rate de term ined by the CPR Coaching compression :v entilation ratio f or infants an d childr e n when an infan t/ ch ild pads cart ridge is insta lled. NO TE: i f t his p ar a met er is c onf igur ed to NO, CPR Coachi ng will alw ays be compressions-only when an infant/child pads car tridge is inst alled. CPR Coac hing com pression :v entila tion ratio • 30: 2 adu lt and 30:2 infan t/child • 30: 2 adu lt and 15:2 infan t/child • 15: 2 adu lt and 15:2 infan t/child 30:2 ad ult an d 30:2 infan t/ child If th e use r presses th e i-b utton for opti onal CPR C oaching d uring a pro tocol pau se or NSA pau se, the HeartSta rt pro vi des coac hing in basic CPR fo r cycl es of 30 compr e ssions and 2 v entila tions for adults , ch ildren, and infant s. Paus es begin and end wit h com pr e ss ion s. para meter sett in gs default defaul t descri pti on
Phil ips Medi cal Syste ms HEARTSTART M5066A Notes
Phil ips Medi cal Syste ms G-1 G G T esting and troubl eshooting Te s t i n g As long as a b atter y i s i nstalled, the Hear tS tar t Def ibrill ator a utoma tically t ests itsel f ev ery day and aler ts you if it finds a problem . The self-te st include s pads readiness test ing. In additio n, it ru ns a pa ds self -test e ach t ime a pads c ar tridge is inse rted. It ale rt s you if it finds a proble m. S ee the T ec hnical Ref erence Manual, a vailabl e online at ww w .m edic al.philips .com, for a detaile d discussio n of the self - test s. Y o u can also t est the defib rillat or at any time by r e mo ving th e bat tery for fiv e seco nds the n r einst alling it . This te st takes abo ut one mi nute . Becaus e the b atter y inse rtion self-tes t is very de tailed an d uses batt er y power , runni ng it more often than nece ssary wi ll d rain the batt ery pr em atur el y . It is r e commend ed t hat y ou r un the batt er y inser tio n self -test o nly: • whe n the defibril lator is first pu t into ser vice . • af ter each ti me th e defi bri lla tor i s used to tr eat a pati ent. • w hen th e ba tte ry is repla ced . • when the defib rilla tor ma y ha v e been d amaged . If y ou need to use the de fibrillator in a n emergen cy while y ou ar e running a batt ery sel f-t es t, pull th e SMAR T Pads c artrid ge handl e to st op the test and to t ur n on th e Hear tS tar t for us e. T r oubl eshootin g The Hear tSta rt ’ s g reen R eady lig ht is the signa l that tells you if t he d efibrill ator is ready for u se. The defibr illator also u ses ch irps and the i-butt on flas hes to aler t you to a pro blem . Recommended action duri ng an emergency If f or an y r eason the He artSta rt does not t urn on when y ou pu ll th e SMA R T Pads cartridge hand le, pr ess th e On/Off but ton. If th at do es no t tu rn on the d efib rillator , rem ov e th e ba tter y and repla ce i t with a new ba tter y i f a vailable and press the On/O ff but ton to turn on the d efibrilla tor . I f
G-2 Phil ips Medi cal Syste ms HEARTSTART M5066A no s par e battery is a v ailab le, r e mov e the in sta lled ba ttery fo r fiv e second s, then reinser t it a nd run a batter y in ser tion self- test. If th e prob lem co ntinue s, do no t us e the Hea rt Star t. A tten d to the p ati ent, pro vidin g CPR if neede d, un til Emerg ency Me dical S er vices Personn el arrive . T ro ubl eshootin g while th e Heart Star t is in u se (g r een Ready l ig h t is so lid ) Hea rtStart t el ls y ou : poss ible cau se recom mended a ction ... to re plac e the b attery imme diatel y The batt ery is ne arly depl et ed. The defib rillator will tu rn off if a ne w batt er y is not inse rt ed. Replac e th e batte r y wi th a ne w bat tery imm ed ia t ely . ... th er e i s no c art ridge ins talled, and ... to inser t a pads car tridge • The pads cartrid ge has bee n re moved . • The pads cartrid ge has bee n damage d. Insert a new pads cartridge. ... to pr e ss t he pads fi rml y to the s kin ... to mak e sure th e pad s ha ve b een r emo v ed fr om the l iner ... the pad s should not be touc hing the patie nt’ s clothi ng. • The pad s ar e not pr o perl y a ppl ied to th e patie nt. • The pads ar e not mak ing go od conta ct with the pati en t's bar e ches t beca use o f mo i stur e or exce ssive hair . • The pad s ar e touc hing each o ther . • The pads ma y not ha ve bee n r emov ed fro m the liner or ma y be on the p ati ent’ s clot hing. • Mak e sur e t hat the pad s ar e s ticki ng com plete ly t o the patie nt’ s skin. • If the pad s are n ot s tic king , dr y t he pa tient' s che st and s ha ve or clip any ex cessive che st hair . • Re positio n the pads. • Mak e sur e the pads ar e no t on th e lin er or the pa tien t’ s clot hing . If the voice ins truction co ntinues after yo u do thes e thin gs , insert another pads car tridge . ... to inser t n ew pads c artridg e The pad s ca rtridg e has bee n open ed an d the p ads pe eled o ff the liner , b ut the pad s ha v e no t been suc ces sful ly attac hed to the pa tien t. The r e ma y be a probl em wit h the pad s ca rt rid ge . Re place the da maged pads cart ridge . Pull up th e handl e on th e cartrid ge cov er , a nd r e plac e pad s on pa tien t with ne w pads to co ntin ue with the re sc ue .
G-3 Phil ips Medi cal Syste ms G ... to sto p al l moti on • The pati en t is be ing mo v ed or jost led. • The en vir onment is dry and mov e me nt ar ound the patie nt is causi ng stat ic elect ricity to inte rfe r e with ECG anal ysis. • Radio or elec tr ical so ur ce s are interferin g with ECG an alysis. • Sto p CP R; do no t to uch the p atie nt. Minimi ze pa tien t mot ion. If the pa tient is b eing tr anspo rt ed, sto p the v ehicle. • Re sponde rs and bysta nders sh ould mini mize moti on, par ticu larly in dr y env ir on ment s t hat c an genera te stat ic el ectr ic ity . • Check for possible causes of rad io and e lec tric al i nter f er enc e and tur n them off or remove them fro m the area . ... th e sho ck wa s not delivered • The pads ma y not be maki ng go od conta ct with the pa tie nt’ s skin. • The pads ma y be touc hing ea ch other . • Th e pads m a y be da mage d. • P ress the pads firm ly to t he p atien t's ches t. • M ake su r e t he adh esi ve pad s are cor r ect ly pos i tion ed o n t he pati en t. • Replace t he pads if ne cessary . ... the sho ck button was no t press ed Shoc k has been adv ise d but the sho ck butto n ha s no t bee n pr ess ed wit hin 30 second s. When next pr o mpted , pr es s th e Sho ck button t o de liv e r sh ock. Hea rtStart t el ls y ou : poss ible cau se recom mended a ction
G-4 Phil ips Medi cal Syste ms HEARTSTART M5066A T roublesho otin g while th e Hear tS tart is no t in use (g r een R eady li gh t is not on) beha vior possib le cau se re co mmende d actio n chirp s or i-but ton f la shes • The bat tery pow e r is lo w or the SMA R T Pads cart ri dg e nee d s to be re pla ce d. • The defibri lla tor ma y ha ve been tur ned off witho ut a pads cartri dge inst alled, o r the install ed pad s cartrid ge ma y not ha v e its har d cover in pla ce . • T he t rai ning pa ds car tri dg e ha s be en left in the d efibrilla tor . • The defibri llato r has been st or ed outs ide th e r ec ommend ed tempe ratu r e rang e. • The defibri lla tor has dete cted an erro r during a self-test or cannot perf or m a s elf -t est, or the Sh ock butto n is damage d. • Press the bl ue i-button. Replace the battery or pads cartrid ge if ins tru ct ed. • Mak e sur e the pads ca rtrid ge is proper l y in stalle d with the ha rd cover in place . (See Ch apter 5, “Mainta ini ng the HeartStart, ” for directio ns on i nstallin g the pads ca rtri dge. ) • Re move th e tr ainin g pad s car t ridg e and re plac e it with an Adult or Infa nt/Child Pads Ca rtri dge. • Remov e th e batt ery for fiv e seco nd s then r einsta l l it to sta rt th e batte ry inser tion self -test. I f it fails , inser t a new batt er y to repeat th e test . If i t fails agai n, do n ot us e th e defibri llato r . I f it passes, st ore the d ef ibr ill at or with in t he recommen ded te mperature rang e. • Cont act Philips for ser vic e if ne eded . no chirp ing and/o r i-but ton doe s not f lash • The b atter y is m issing o r comple tely deplet ed. • The defibri lla tor ma y ha ve been physically da maged. Re move the batte r y for five seco nds then r einsta ll it to sta rt the batt ery ins ert ion self-te st. If it fails, in ser t a new bat tery a nd re peat the test. If it fails again, do no t u se the d efibrill ator . Con tact Philip s for ser vice.
Phil ips Medi cal Syste ms H-1 H H Additional technical inf or mation required f or European conformity Electromagne tic con formity Guidanc e and man uf actur e r’ s dec larati on: Th e HeartSt art is in tend ed f or u se i n the elect romagn etic environm ent spe cifi ed in th e tab les b elow . Th e c ustom er or u ser of the Hear tSta rt shou ld assure tha t it is used in such an environm ent. Elec tr omagnet ic emissi ons emis sions te st comp liance ele ctr o magneti c en vi r onment – g uida nce RF CISPR 1 1 Gr oup 1 Clas s B The He artSta rt uses RF ener gy onl y for its i nte rnal f unct ion. Ther efor e, i ts R F emis si ons ar e ve ry low and a r e n ot li k e ly to caus e any inte rf er enc e in nea rb y elec tr on ic equ ipment . The H ear tStar t i s suitab le for use in al l establis hmen ts, includi ng dome stic esta blishm ents and th ose directly conne cted to the pub lic lo w-v olt age po w er suppl y net w ork that suppl ie s bui ldin gs us ed fo r dome sti c pur poses .
H-2 Phil ips Medi cal Syste ms HEARTSTART M5066A Elec tr omagnetic immunity imm unit y test IEC 60 601 tes t le vel comp liance level elec troma gnet ic envi r onme nt - guidanc e elect rosta tic di scha rge (ESD) IEC 61000-4 -2 ± 6 kV contac t ± 8 kV air ± 6 kV c ont act ± 8 kV ai r Ther e ar e no specia l r equi r ement s with r e spec t to ele ctr ostatic disch arge. a power frequ enc y (50/60 Hz) magneti c field IEC 61000-4 -8 3 A/m 3 A /m Pow er f r equen cy magn et ic fiel ds shou ld be at lev els cha racte ristic of a typica l locatio n in a typica l com mercial/hos pital e nvir onme nt. Ther e ar e no speci al r equir emen ts fo r non-co mmer c ial /non-hos pit al env ir o nmen ts. radiated RF IEC 61000-4 -3 10 V/ m 80 MHz to 2.5 GHz 20 V/m P ortable an d mob ile RF comm unicat ions equip ment should be used no c los er to an y part of the Hea rt Start , inc luding cables, t han is absolut el y necess ary . b,c The recomme nded s eparation distance s for various transmitters and the AED are s hown in t he f ollo wing ta ble. Inte rference may occu r in t he vicin ity o f eq uipme nt ma rked wit h the following symbo l: NO TE 1. At 80 MHz and 800 MHz, th e higher fr equency r ange applies. NO TE 2. These guidelines ma y not apply in all sit uations. Electr omag netic pr opagation i s affected by absorption a nd ref lection fr om struc tures, o bjects and people. a. Gener ally , AED s are somet imes suscep tible to interference gen erated by patien t and/or r espo nder moti on in environment s in whi ch a high static e lectric field is pre sent (e.g., lo w humidity , syntheti c carpe ts, etc.). As a saf ety me asur e , Philips AED s incorpor ate a patented method to sense possible c orruption of the ECG si gnal by such interference and to r espond by directing the user to sto p all motion . In these cases, it is important to minimize movement in th e vicinity of the patie nt during rh ythm anal ysis in ord er to ensure th at the signal b eing anal yzed accurate ly r efl ects the patie nt’ s underlyin g heart rh ythm. b. The I SM (indust rial, scient ific and me dial) bands bet ween 150 k Hz and 80 MHz are 6,76 5 MHz to 6,795 MH z; 13,553 M Hz to 13,56 7 MHz; 26,957 M Hz to 27,283 MHz; and 40,66 M Hz to 40, 70 MHz . c. Fi eld str engths fr om fi x ed tr ansmitte rs, suc h as b ase statio ns f or r adio ( cellu lar/cor dless ) tele phones and land mobile r adi o s, amateur radio , AM and FM radio broadcast, and TV br oadcast cannot be pre dicte d th eoreti call y wit h accurac y . T o asses s the e lectr omag netic en vi ro nm e nt due to fixed RF transmi tters, an elec tromagnetic si te sur v ey should be con sidered. If the measured field strength in the lo cati on in wh ic h t he Hear tStar t is used ex ceeds t he applicabl e RF co mpliance level above , the Hear tStart shou ld be o bserved to verify normal o perat i on. If abnormal performance i s obser ved, additional measures ma y be necessar y , such as re-orien ting or relocatin g the H ear tStart.
H-3 Phil ips Medi cal Syste ms H Reco mm end ed s epa ra tion dis ta nces be tw e en po rtabl e and mob il e RF co mm uni ca tio ns eq ui pme n t an d th e Hea rtSt art The He artSt art is inte nded for use i n an elec tr omagneti c en vi r onme nt in which ra diat ed R F di stur ba nces ar e co ntr ol led . T he cus tomer or the u ser of the HeartSt art can he lp pr ev ent el ectr omagnet ic i nte rf er ence b y m ainta i ning a minim um d istanc e betw e en portable and mobi le RF com muni cati ons equ ipment (tr ansmi tters ) and t he HeartSt art as r ecomm end ed b elo w , ac cor ding t o the maxi mum o ut put po w er o f t he c ommun icat ions equi pm ent. separa ti on di stanc e acc or din g to fr equency of tran smit te r (m) rated maxi mu m out put power of transmitter (W ) 80 MHz to 800 MHz d = 0.6 √ P 800 M Hz to 2.5 GHz d = 1.15 √ P 0. 01 0. 06 0. 115 0.1 0.1 9 0.3 6 1 0. 6 1. 15 10 1. 9 3. 64 100 6. 0 11. 5 For transm itters rated at a max imum output power no t listed a bov e, t he recommende d separation distance d in met ers (m) can be determi ned us ing th e equa tion appli cabl e to the fr equenc y of the tra nsm itte r , whe r e P is the maxi m um output po wer rat ing of the trans mi tter i n wat ts (W) accor din g to th e tran sm itte r ma nuf actu r er . NO TE 1. At 80 MHz and 800 MHz, t he separation distance f or the higher fr equency range a pplies. NO TE 2. The ISM (industrial, scientific and medial) bands betw een 150 kHz a nd 80 MHz are 6,765 MHz to 6,795 MHz; 13,553 MHz to 13,567 MHz; 26, 957 MHz to 27,283 MH z; and 40,66 MHz to 40, 70 MHz. NO TE 3. An additional fa ctor of 10/3 is used in calculating the r ecommend ed separation d istance for transmitters in the ISM freq uency bands betw een 150 kHz an d 80 MHz and in t he fr equency range 80 MHz t o 2.5 GHz to decr ease the lik elihood that mo bile/portable communic ations equipment could cause interfer ence if it is inadv ertently bro ught into patient ar eas. NO TE 4. These guidelines may no t apply in all situations. Elec trom agnetic propagation is affected b y absorption and ref lection fr om struc tures, o bjects and people.
H-4 Phil ips Medi cal Syste ms HEARTSTART M5066A Impor tant warnings and reminders • Do not allo w the pad s to cont act ot her el ect r ode s or met al parts tha t ar e in con tact w ith the p atien t. • Be fore deliv erin g a shock, it is impor tant to d isconnec t the patie nt from oth er medic al elect ric al equ ipm ent, such as blood -fl ow meter s, th at ma y not incorpo rate defi brillati on protectio ns. In addition , make sure the pads are not in co ntact w ith m etal o bjects suc h as a b edfra me or stretch er . • Check supp lie s, acce ssori es, pac kagi ng, a nd s par es for damage a nd e xpir ati on dating . Environm ental c ons ider ation s • The defib rillat or cont ains e lectronic c ompo nents . Dispo se o f it at an appropriat e recycling faci lity . • Th e ba tter y cells co ntai n che micals. Recy cle t he ba tter y at an appropria te recycling f acility . • The us ed pads ma y be contami na ted. Cut them off and di spos e of them proper ly . Rec ycle th e remai ning ca r trid ge comp on ents at a n approp riate recycling f acility . Shoc k cycle timin g The Heart Star t Qu ick Shoc k feature allo ws it to d eliver a shock within 8 secon ds, typi cal, f ollowin g th e prom pt en ding a CP R In ter val . From shoc k to s hoc k, th e Hea rtS tar t takes <2 0 seconds, ty pica l, inc luding ana lysis. After 1 5 shocks, th e HeartStart ta k es <30 s econds from ana ly zing to r eady- to-shoc k. Aft er 200 s hock s, the Hear tSta rt takes <4 0 seco nds fr om in itia l power - on to ready-t o-shock .
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PO WER T O SA VE A LIFE Phili ps Medical Systems is par t of Ro ya l Philips Electr onics Philips Me dical Sys tem s Uni t ed S t ates Philips Medical System s 2301 Fifth Av enue , Suite 200 Seattle, W A, USA 98121 (800) 263-3342 Cana da Philips Medical System s 281 Hillmount Road Markham, Onta rio L6C 2S3 (800) 291-6743 Europe, M iddle Ea st, a nd Africa Philips Medizin Systeme Boebling en GmbH Cardiac and Monitoring Syst ems Hewlett-Packa rd Strass e 2 71034 Boeblingen, German y 49 7031 463 2254 Lati n Amer i ca Philips Medical System s 1550 Sawg rass Corporate Park wa y , Suite 300 Sunrise, FL 33323, USA (954) 835-2660 Asi a Pa cif ic Philips Electro nics H ong K o n g Ltd. 30th Floor , Hopew ell Cent re 17, K ennedy Road, W a nchai Hong K ong (852) 2821 5888 REF: M5066-91 901