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Zoll R Series DefibrillatorseLearning

There is audio with the Zoll online learning section of this lesson.

Marcia Turner MS, RN, Nursing Education Specialist Fairview Health Systems

Fairview Health Systems

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Navigating the Lesson

Moving Forward• Click the Next button in the lower right corner of the screen to proceed to the

next slide in the lesson.

Viewing a Previous Slide• Click the Back button in the lower right corner of the screen to move back one

slide in the lesson.

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Lesson DetailsTarget Audience• This lesson is intended for Fairview employees that will be utilizing the R

Series Defibrillators in their scope of practice. It is assumed that the learner has previously used the Zoll M Series.

Contact Hours• Not Applicable

Estimated Duration• The expected time to complete this learning activity is 30 minutes. • If you are unable to complete this during your scheduled work time, it may be

completed outside of work with prior approval from you supervisor. Any overtime must be approved.

• It is suggested that you complete a hands on review of the Zoll R series after completing this lesson module.

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References and Contact Information

References• Zoll R Series Training Guide (August 2010) • R Series Quick Reference Guide (2010)• Print R Series Competency Checklist

Program Contact • Marcia Turner, RN, MS, Nursing Education Specialist• mturner1@fairview.org

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Upon completion of this lesson, learners will be able to:• Identify the functionality of the new R Series features: CPR Help and

See Thru CPR.• Identify the present selection of multifunction pads and their uses

with the Zoll R Series Models.• Identify the proper procedure for visual and manual checks of the Zoll

R Series defibrillators.• Demonstrate how to operate the Zoll R Series ALS and R Series Plus

defibrillators for defibrillation, synchronized cardioversion, and pacing.

Objectives

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Table of ContentsIf you are viewing the lesson for the first time• Click the Next button to begin the lesson

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

• The New Zoll R Series Models

• New Features: Real CPR Help and See-Thru CPR

• New Pads: OneStep Complete and OneStep Pediatric

• Compatible Electrodes

• Attaching an ECG Cable

• Other New R Series Features

• Testing of the New R Series Models

• Changing the R Series Plus to Manual Mode, ALS Full Functioning and Pacing Mode• Completing the Zoll Online Training

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R Series ALS Model R Series Plus Model

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

Click the Next button to continue.

New R Series Models

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

R Series ALS Model

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R Series ALS Model

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

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R Series Plus Model

The R Series Plus model looks and performs like an AED. It also contains the features of Real CPR Help and See-Thru CPR.

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R Series Plus Model

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

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Real CPR Help See-Thru CPR

New R Series Features

As we discussed previously, the new R Series models have Real CPR Help and See-Thru CPR. Let’s explore these further. Click on the Real CPR Help picture above.

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Real CPR Help gives visual and audio cues to assist compression quality . Click Next to continue.

Real CPR Help

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

Real CPR Help

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

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

CPR Index

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Rate Prompt

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

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Rate Prompt

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

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Rate Prompt

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

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Depth Prompt

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

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Depth Prompt

When the Depth Prompt is active, the CPR Index stops filling, the Depth Prompt displays, and the audio prompt states “Push harder.”

“Push harder”

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Depth Prompt

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

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Idle Time Display

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

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Idle Time Display

The display will disappear when compressions are fully resumed. Let’s learn about the See-Thru CPR feature. Click Next to continue.

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See-Thru CPR is available on the R Series ALS Model and the R Series Plus Model (but only in the manual mode).

It displays a second tracing (FIL) that filters out the CPR artifact from the ECG to allow users to see a close approximation of a patient’s underlying rhythm during CPR compressions, reducing interruptions in CPR.

See-Thru CPR

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

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

See-Thru CPR

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Quick Review

Let’s do a quick review of the content we just learned.

Click the host, Quinn, to begin.

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Quick Review

When does the Rate Prompt display? Click on the correct answer.

B. When compressions are greater than 90 bpm.

C. When the caregiver needs to take a lunch break.

A. When compressions are less than 90 bpm.

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Quick Review

Correct!

Click Next to continue.

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Quick Review

Good try! That was not the answer I was looking for.

Click Next to continue.

The correct answer is A: when compressions are less than 90 bpm.

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Quick Review

When the Depth Prompt displays, what does the audio prompt say?Click on the correct answer.

A. “Push faster.”

B. “Push harder.”

C. “Feed me.”

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Quick Review

Yes! That’s it!

Click Next to continue.

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Quick Review

I’m sorry, that is incorrect.

Click Next to continue.

The correct answer is B: “Push harder.”

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Quick Review

True or False: See-Thru CPR is meant to take the place of human assessment.Click on the correct answer.

A. True

B. False

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Quick Review

Great Work!

Click Next to continue.

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Quick Review

That is not correct.

Click Next to continue.

The correct answer is B: False.

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Quick Review

That concludes our quick review for this section. I will resume our review later in the lesson.

Click Next to continue.

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

New Pads: OneStep Complete and OneStep Pediatric

OneStep Complete OneStep Pediatric

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OneStep Complete

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

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OneStep Complete

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

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OneStep Complete

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

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

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

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

Opening the Pads

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Applying the Pads

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

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Applying the Pads

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

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OneStep Pediatric PadsUse with pediatric patients 0-8 years and/or <25 kg. These pads presently do not allow for Real CPR Help and See-Thru CPR features in the new R Series models.

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OneStep Pediatric PadsECG leads are NOT internal in the pad.

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

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

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

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

first.

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OneStep Pad Connections

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

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

• Pro Padz• Pedi Padz• Paddles and Internal Handles

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

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Pro Padz

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

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Pedi Padz

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

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Paddles and Internal Handles

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

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Paddles and Internal Handles

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

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

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Quick Review

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

Click the host, Quinn, to begin.

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Quick Review

When opening the OneStep Complete, you should use scissors.Click on the correct answer.

B. False.

A. True.

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Quick Review

Correct!

Click Next to continue.

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Quick Review

Good try! That was not the answer I was looking for.

Click Next to continue.

The correct answer is B: False.

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Quick Review

When placing the OneStep Complete using anterior/posterior placement, which pad should you place first?Click on the correct answer.

A. Back pad

B. Front pad

C. It doesn’t really matter as long as they both are on the patient.

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Quick Review

Yes! That’s it!

Click Next to continue.

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Quick Review

I’m sorry, that is incorrect.

Click Next to continue.

The correct answer is A: Back Pad

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Quick Review

True or False: Pro Padz, Pedi Padz, paddles and internal handles are all compatible with the R Series. However, they do not allow for the use of the Real CPR Help and See-Thru CPR features. Click on the correct answer.

A. True

B. False

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Quick Review

Great Work!

Click Next to continue.

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Quick Review

That is not correct.

Click Next to continue.

The correct answer is B: False.

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Quick Review

That concludes our quick review for this section. Please continue on with the lesson. Enjoy!

Click Next to continue.

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When using the OneStep Complete and OneStep Pediatric Pads:

Attaching an ECG Cable

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

Attaching an ECG Cable

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

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

Click Next to learn about testing the R Series models.

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Auto Test Visual Inspection Manual Test

Done daily automatically by the machine at 2AM

To be done with daily crash cart check on the

days the unit is open

To be done weekly with crash cart check and after

resolving any code readiness issues to

restore green check in the code ready indicator

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Testing of the R Series Models

Let’s begin by learning about the Auto Test. Click Next to continue.

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

Adult Units Peds Units

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

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

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Ensure the defibrillator is:

• Clean and free of visible damage• Cables are in good condition • Connector pins are not bent • Paper tray has enough paper• Defibrillator is plugged into AC power • The green check mark appears in the code ready

indicator

Visual Inspection

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Manual Defibrillator Self-Test

1. The defibrillation cable must be connected to the OneStep Complete Pads (adult units) or machine testing port (peds units) on the side of the machine.

2. Turn the machine to defib mode (in the R Series Plus machine you must first put in the manual mode).

3. Select 30J as the energy level.4. Click CHARGE.5. Click SHOCK.6. Watch for the words TEST OK on the front of the screen

and on the print out.

Complete the following:

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We’re now going to talk about changing the R Series Plus to Manual and Pacing modes.

Click Next to continue.

Changing R Series Plus to Manual Mode

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Step 1: Turn the machine on.

Step 2: Press the Manual Mode soft key.

Changing R Series Plus to Manual Mode and Full ALS Functioning

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Step 3: Press the Confirm soft key.

Changing R Series Plus to Manual Mode and Full ALS Functioning

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Changing R Series Plus to Pacing Mode

Once the machine is in manual mode, you can perform pacing operations by moving the dial to Pacing.

You can adjust the rate and mA by using the lower control area.

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Completing Zoll On Line Training• Please read the next few slides prior to beginning this

process so you know what lies ahead.

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

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• Complete the rest of the registration form.

• Click on Advanced Life Support. • Click Submit.

Completing Zoll On Line Training

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

Completing Zoll On Line Training

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• Once into the Zoll training site, complete the module entitled “Getting Started”

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

Completing Zoll On Line Training

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• Click here to begin the login process:

• Click here if you’ve previously logged in and created your user id and password:

Initial Zoll Training Site

Zoll Training Site

Completing Zoll On Line Training

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Please complete the test in the LMS to document your learning. Click here to complete an evaluation of this learning activity.

Thank you for completing this lesson. You are on your way to becoming an expert in the Zoll R Series Models! Congratulations!

Conclusion and Evaluation