Document Sample
12-Lead ECG KNOWLEDGE - ZOLL Powered By Docstoc
					M Series…
12 Lead

            ZOLL Medical Corporation
                      Sales Training
12-lead ECG

•   Introduction
•   What is a 12-lead?
•   Features and Benefits
•   Demonstration
•   In-Service
•   Hands-on
• AMI ( Acute Myocardial Infarction ) is THE leading cause
  of death in the US
• 1.1 MILLION people have an MI annually
    – 439,000 women
    – 668,000 Men
    – Approx 500,000 will die
• Costs for CAD ( Coronary Artery Disease ) in the US in
  2001 were $298 billion

NRMI ( National Registry Myocardial Infarction) Database
      Indications for the 12-lead ECG
•   Chest Pain
•   Stroke
•   Dysrhythmias
•   Post-Resuscitation
•   Following Emergency Cardioversion
•   Suspected Electrolyte Disturbances
•   For Asystole confirmation
•   PEA ( Pulseless Electrical Activity) to identify cause
12-Lead ECG                           KNOWLEDGE

  • Ischemia
     – Lack of oxygenation
     – ST depression or T inversion
  • Injury
     – Prolonged ischemia
     – ST elevation
  • Infarct
     – Death of tissue
     – May or may show in Q wave
            ST Segments
                  HORIZONTAL AXIS

                                 SEGME NT


            INTERV AL      QRS
                        INTERV AL
                                      INTERV AL
12-lead ECG
12-lead Electrode Placement

              •V1- Right parasternally,4th
              Intercostal space
              •V2 - Left parasternally, 4th
              intercostal space
              •V3 - Directly between V2 and V4
              •V4 - 5th intercostal space,left
              mid clavicular line
              •V5 – Directly between V4 and V6
              •V6: Left midaxillary line , same
              plane as V4
12-Lead ECG               KNOWLEDGE

• Inferior Wall

   – Leads II, III, aVF
      • Left Leg
12-Lead ECG           KNOWLEDGE

• Lateral Wall

  – Leads I and aVL
     • Left Arm
12-Lead ECG                 KNOWLEDGE

• Septal Wall

  – Leads V1, V2
  – Along sternal borders
12-Lead ECG                  KNOWLEDGE

• Septal Wall

  – V3, V4
     • Left anterior chest
12-Lead ECG                 KNOWLEDGE

• Lateral Wall

  – Leads V5 and V6
     • Left lateral chest
12-Lead ECG                                  KNOWLEDGE

•    The three ECG subsets

    1. Non diagnostic: no ST or T wave

    2. Suspicious for ischemia: ST
       depression or T wave inversion

    3. Suspicious for injury: ST elevation
    12-Lead ECG                               KNOWLEDGE

• What’s the Value of a12-Lead?
  – Provides baseline ECG before treatment
  – Early and rapid identification of AMI
  – Triage to correct facility
     • Cath Lab or Thrombolytics
  – Quicker diagnosis
  – Reduced time to triage / treatment in hospital
  – Improved patient care
M Series with 12-lead ECG option

       Features and Benefits
12-Lead ECG                                  KNOWLEDGE

• Description:
  – Simultaneous 12-lead ECG acquisition, storage,
    display, transmission and analysis
  – Uses GE Medical Systems 12SL™ analysis program
  – Interface with MUSE® for direct transmission of 12-
    lead ECG records from defibrillator to hospital MUSE
12-Lead ECG                                         UNDERSTANDING

• Key Differentiators
  –   AHA Class I recommendation
  –   GE 12SL = Gold Standard for analysis
  –   Direct transmission to MUSE
  –   Bluetooth Wireless Options
       • Module to Interlink to RescueNet Code Review
           – Fax and email
       • Bluetooth Activation Pod Kit
           – Fax or MUSE
         The GE 12SL PROGRAM

• Background
  – Validated on clinically correlated “Gold Standard”
  – Annually evaluated by a group of over 50 top consulting
    Cardiologists and physicians from around the world (
    ECG Analysis seminar)
  – Detailed Physician’s Guide explains the ECG Analysis
    morphology ( obtained from GE)
                 12SL PROGRAM

• KEY Points :
  – Worldwide name recognition (Analysis by 12SL)
  – Introduced in 1980 and consistently enhanced
  – Most independently validated algorithm in the scientific
  – Adult & Pediatric programs available
  – Published statement of “Validation & Accuracy”
  – Established value and is now the Standard of Care

• Refers to recognition
• If the test always recognizes the disorder,
  sensitivity would be 100%
• False negatives are failures of sensitivity
  – A false negative occurs when the condition exists
   but the test fails to find it

• Refers to the number of diagnoses confirmed
• If the diagnosis were corroborated every time the
  test identifies it, it would be 100% specific
• False positives are failures in specificity
   – A false positive occurs when the test indicates the disease is
     present, when in fact it is not
               GE 12SL PROGRAM

• Infarction
   – Sensitivity 65% ( refers to recognition)
   – Specificity 98% ( refers to diagnostic accuracy)
   – Overall 74% sensitivity for Chest Pain Patients

   – “… clearly adequate for first line screening of patients with
     chest pain by paramedics or in the ER”.
   – “ … specificity is superior to that of the trained
12-Lead ECG                                                 KNOWLEDGE

• 12-lead Summary Reports

  – 4x3: Prints 10 seconds of 12-lead ECG in four staggered 2.5 second
    segments (default)
  – 4x3 Median: Prints single median beat for each of the 12 leads as
    computed by 12SL algorithm
  – 2x6: Prints all 12-lead ECG data recorded during first 5 second interval.
    Inhibits printing of the 12SL analysis and lead II rhythm strip
  – Measurement Matrix: Prints measurements for each segment of each
    lead. This option must be changed in the configuration menu.
            M-Series ECG Filters

• Normal Monitoring Bandwidth is 0.5 to
30/40 Hz ( Frequency Response)

• Diagnostic 12-lead monitoring is done at 0.05 to
150 Hz ( AAMI standard ( American Association
of Medical Instrumentation)

• Diagnostic 12-lead can also be done at 0.05 to
40Hz ( to reduce noise)
             Features and Benefits

• Integrated in the M Series
• Easy to Use
   – Recorder Button automatically provides 4x3 printout
   – 12-lead Acquisition Button Provides 4x3, Interpretation and
   – Faster 12-lead print-out v LP12
       • Prints the first 3 lead groups after 2.5 seconds
       • LP12 waits 10 seconds and then prints 12-lead report
         Features and Benefits

• One-Step Patient Cable
• Ease of Configuration
• 12SL Analysis Implementation
  – Fast Acquisition
  – Compressed ECG pre transmission
             Features and Benefits
• Fax/Modem Card 12-lead Transfer today
   – Wireless coming in Oct 2003
• 12-lead ECG compression
   – LP12 Physio sends raw ECG data
   – M Series compresses before we send
   – MAY help transmission speeds!!
• Preconfigured telephone numbers
   – Saves time / easy /Auto redial
   – Manual dial option ( Buried in LP12 configuration)
             Why ZOLL’s 12-lead?

• Key Points
  –   GE Medical Systems 12SL Analysis Program
  –   Rapid 12-lead Acquisition
  –   ECG compression for transmission
  –   Transmission capabilities of M Series
  –   12SL Best in Class v other ECG Programs
  –   Cost-effective pricing
  –   Connectivity options ie MUSE
12-lead ECG      APPLICATION

    • 12-lead Demo
                   M Series 12-lead
• Being prepared
  – Review Operators Guide
  – Review 12-lead Monitoring Insert
  – Understand electrode placement
     •   V1: 4th intercostal space at right sternal margin
     •   V2: 4th intercostal space at left sternal margin
     •   V4: 5th intercostal space on left midclavicular line
     •   V3: Between V2 and V4
     •   V5: Left anterior axillary line at horizontal level of V4
     •   V6: Left midaxillary line at horizontal level of V4
                           Demo Tips
•   Configure the device to automatically transmit after a 12-lead
•   Have a 12-lead simulator
•   Pre-connect all leads to the simulator
•   Have the M Series already in 12-lead monitor mode
     – Configure to come up in Lead II
•   Do not enter in the age, gender or ID#
•   Explain how M Series 12-lead begin to print out after the first 2.5
    seconds on the Leads I , II , III
     – LP12 waits 10 seconds before print out
•   Explain how ZOLL compresses the data
•   V-Pak electrode samples
                    M Series 12-lead
• Have the proper equipment!
   – 12-lead cables!!!!!!!!!!!!!!!
   – 12-lead simulator
        • Fresh batteries
   –   Pre-attached leads
   –   Configure M Series for desired operation
   –   Carry a spare modem card and cables
12-Lead ECG                                                  KNOWLEDGE

• Basic Operation - 12-Lead Acquisition

   – Attach electrodes
   – Turn selector switch to MONITOR
   – Press 12 LEAD soft key to enter 12-lead menu
       • Acquire, Settings, PT Info, Alarms is displayed
   – Press ACQUIRE to begin 12-lead acquisition (takes 10 seconds)
   – Wait for ACQUISITION COMPLETE message before patient movement
   – Transmission screen will automatically be displayed after acquisition if
   – To print only: Press and hold PRINT for 3 seconds
12 Lead – Miscellaneous
              12-lead Accessories
• Modem Extension Cable Revision B (Dec 02)
   – Connects to Ositech King of Hearts or Viking Cellular Ready
     modems only
   – Does not fit the older Viking Modem cards
   – Part # 8000-0086
• Xtreme Pak
   – Comes with modem cable built in to plate
   – See Bulletin 52802 for all Part #

   – Sales Bulletin # 55302 /52602 for details
    M Series 12 Lead Opportunities

• Adding 12 lead increases ASP and gets you to
  quota faster
• $7,395.00 is like selling two defibrillators instead
  of one
              Qualifying Questions
• Is 12-lead currently in your scope of practice?
• What is your current protocol for AMI assessment in your
• What 12-lead devices do you currently use?
• Are you transmitting 12-leads? If so, where to?
• Once in the ER, how long does it take before a 12- lead ECG is
• What’s your average on scene time?
• Do you have a 24 / 7 Cath lab in your area?
              Troubleshooting 12-lead
•   Do they prep the skin before applying the ECG electrodes to the patient?
•   Were the electrodes pre-attached potentially drying out the electrodes?
•   Is there proper lead placement?
•   Check for placement on boney prominences or for correct lead placement.
•   Do they place the limb leads on the chest or limbs?
•   Check to make sure the ER does the same placement.
•   If they transmit, do they have drop out areas?
•   If they get a fax busy signal, does the ER have a dedicated fax machine?
•   Have they programmed their M Series with the appropriate fax numbers and cell
12-lead ECG                    UNDERSTANDING

        • 12-lead In-Service

Shared By: