CareCenter MD® Stress and Resting...

CareCenter MD® Stress and Resting ECG

User’s Guide

70-00533-02 A

CARECENTER MD™STRESS AND RESTING USER’S GUIDE

70-00533-02 A

Information in this document is subject to change without notice. Names and data used in the examples are fictitious unless otherwise noted.

Trademark Information

Cardiac Science, the Shielded Heart logo, Quinton, Burdick, HeartCentrix‚ and CareCenter MD are trademarks or registered trademarks of Cardiac Science Corporation. All other product and company names are trademarks or registered trademarks of their respective companies.

The Bluetooth® word mark and logos are registered trademarks owne by Bluetooth SIG, Inc. Any use of such marks by Cardiac Science Corporation is under license.

Copyright © 2011 Cardiac Science Corporation. All Rights Reserved.

Cardiac Science Corporation3303 Monte Villa Parkway Bothell, WA 98021, USA800.426.0337 (USA)[email protected]

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Contents

ContentsChapter 1: Introduction

Contact Information.............................................................................. 1-1Overview ............................................................................................... 1-2Features and options .............................................................................. 1-3Screen layouts ........................................................................................ 1-4

Chapter 2: Data Management

Patient Search tab .................................................................................. 2-2Search for a patient.......................................................................... 2-3

Overview tab.......................................................................................... 2-4Patient data list................................................................................ 2-5Recording list .................................................................................. 2-8Patient data ................................................................................... 2-12

To Confirm tab ................................................................................... 2-14Unassigned Recordings tab .................................................................. 2-15Orders tab............................................................................................ 2-16Custom tabs......................................................................................... 2-17

Chapter 3: ECG Acquisition

Test procedure programs........................................................................ 3-2Launch a default test procedure automatically........................................ 3-6Select a default test procedure manually ................................................. 3-7Select a default test procedure in Data management............................... 3-8Select the active patient.......................................................................... 3-9

Select the patient before starting an ECG acquisition ...................... 3-9Select the patient during an ECG acquisition .................................. 3-9Automatically open the search dialog............................................. 3-10Additional active patient options ................................................... 3-10

Select the ECG acquisition device ........................................................ 3-11Selecting a USB device .................................................................. 3-11Selecting a wireless device .............................................................. 3-11

Enter a comment ................................................................................. 3-12Measuring and entering blood pressure ................................................ 3-13

Start the blood pressure meter ....................................................... 3-13Enter blood pressure values manually ............................................ 3-13

Apply electrodes................................................................................... 3-14

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Contents

ECG filters........................................................................................... 3-17Enable a filter ................................................................................ 3-17Default filter settings ..................................................................... 3-18

Change the ECG representation........................................................... 3-19Change speeds ............................................................................... 3-19Change sensitivity.......................................................................... 3-19Resize the window......................................................................... 3-20Move the ECG waveform.............................................................. 3-20Change a lead ................................................................................ 3-20Select a view .................................................................................. 3-21Toggle views.................................................................................. 3-23Change the mode of representation ............................................... 3-23

Pediatric ECG...................................................................................... 3-24Pacemaker detection ............................................................................ 3-25Pacemaker impulses ............................................................................. 3-25Demo ECG ......................................................................................... 3-26Print the record.................................................................................... 3-27Save the record..................................................................................... 3-30

Chapter 4: Acquire a Resting ECG

Operating steps - overview ..................................................................... 4-2Controls for acquiring a Resting ECG.................................................... 4-3Detailed procedures ............................................................................... 4-4

Search for a patient or enter a new patient ....................................... 4-4Select the test procedure .................................................................. 4-4Apply the electrodes......................................................................... 4-4Start the acquisition for Resting ECG (automatically) ..................... 4-4Start the acquisition for Resting ECG (manually)............................ 4-5Review the recording ....................................................................... 4-5Print the record ............................................................................... 4-6Save the record ................................................................................ 4-6

Chapter 5: Acquire a Rhythm ECG

Operating steps - overview ..................................................................... 5-2Controls for acquiring a Rhythm ECG .................................................. 5-4Detailed procedures ............................................................................... 5-7

Search for a patient or enter a new patient ....................................... 5-7Select the test procedure .................................................................. 5-7Apply the electrodes......................................................................... 5-7Start the acquisition for Rhythm ECG (automatically) .................... 5-7

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Contents

Start the acquisition for Rhythm ECG (manually) .......................... 5-8Review the recording ....................................................................... 5-9Print the record ............................................................................. 5-11Save the record .............................................................................. 5-11

Chapter 6: Acquire a Stress Test ECG

Stress test displays .................................................................................. 6-2Stress test window ........................................................................... 6-2ECG panel ...................................................................................... 6-3Arrhythmia panel ............................................................................ 6-3Averaged Beat panel ........................................................................ 6-5Trend panel..................................................................................... 6-7Display elements ............................................................................. 6-9Warnings....................................................................................... 6-11

Operating steps - overview ................................................................... 6-15Stress test controls................................................................................ 6-17

Controls for acquiring a stress test ECG ........................................ 6-17Work load controls........................................................................ 6-20

Detailed procedures ............................................................................. 6-23Search for a patient or enter a new patient ..................................... 6-23Select the test procedure ................................................................ 6-23Apply the electrodes ...................................................................... 6-29Start the stress test ......................................................................... 6-30Start the exercise phase .................................................................. 6-31Start the recovery phase ................................................................. 6-33End the stress test .......................................................................... 6-33Review the record.......................................................................... 6-34Print the record ............................................................................. 6-34Save the record .............................................................................. 6-34

Chapter 7: Emergency ECG

Settings .................................................................................................. 7-2Recording type ................................................................................ 7-2Start option ..................................................................................... 7-2Age and gender................................................................................ 7-2Data management ........................................................................... 7-3Blood pressure device ...................................................................... 7-3

Operating steps - overview ..................................................................... 7-4Controls for acquiring emergency ECGs................................................ 7-5Detailed procedures ............................................................................... 7-7

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Contents

Select the test procedure .................................................................. 7-7Apply the electrodes......................................................................... 7-7Start the acquisition for an emergency ECG.................................... 7-8Stop the acquisition......................................................................... 7-8Save the recording ........................................................................... 7-8Assign the recording (after acquisition)............................................ 7-9Other functions ............................................................................... 7-9

Chapter 8: Displaying a Resting ECG Record

Displaying an ECG record ..................................................................... 8-2ECG window .................................................................................. 8-2Controls for reviewing ..................................................................... 8-3Indication bar.................................................................................. 8-4Controls for changing the view........................................................ 8-5Analysis Results ............................................................................... 8-6Measuring the ECG ........................................................................ 8-8Opening a record for comparison .................................................... 8-9

Measurement table view....................................................................... 8-11Measurement table in comparison ................................................. 8-13

Averaged beat view............................................................................... 8-14Individual views............................................................................. 8-15Superposition ................................................................................ 8-17Measuring the complex.................................................................. 8-17Wave margins................................................................................ 8-18QRS configuration ........................................................................ 8-18

Chapter 9: Displaying a Rhythm ECG Record

Displaying a Rhythm ECG record ......................................................... 9-2Rhythm ECG window..................................................................... 9-3Controls for reviewing ..................................................................... 9-4Indication bar.................................................................................. 9-5Analysis Results ............................................................................... 9-7Controls for changing the view........................................................ 9-9Display functions........................................................................... 9-10

ECG view ............................................................................................ 9-12Navigating in the ECG display ...................................................... 9-13

Rhythm view........................................................................................ 9-14Rhythm line .................................................................................. 9-15Beat classification in the ECG ....................................................... 9-16

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Contents

Chapter 10: Display a Stress Test ECG Record

Displaying the stress test ECG record .................................................. 10-2Controls for reviewing................................................................... 10-2Controls for changing the view...................................................... 10-3Indication bar................................................................................ 10-4Display functions .......................................................................... 10-5

ECG view ............................................................................................ 10-7Navigating in the ECG Display..................................................... 10-9

Rhythm View .................................................................................... 10-10Marking of the phases ................................................................. 10-11Actual time.................................................................................. 10-11ECG strip panel .......................................................................... 10-11Averaged Beat panel .................................................................... 10-12Trend panel................................................................................. 10-12Changing ECG parameters and view........................................... 10-12

ECG strip view .................................................................................. 10-13Selecting strips............................................................................. 10-13Viewing ECG strip...................................................................... 10-14Averaged Beat panel .................................................................... 10-14Trend panel................................................................................. 10-14

Trend view......................................................................................... 10-15Tab operation.............................................................................. 10-16

ST Trend view ................................................................................... 10-17Summary view ................................................................................... 10-19

Result table.................................................................................. 10-20Summary..................................................................................... 10-21

Chapter 11: Confirming Tests

Performing confirmation ..................................................................... 11-2Revoking confirmation ........................................................................ 11-3

Chapter 12: CareCenter MD Online

CareCenter MD Online overview ........................................................ 12-2CareCenter MD Online access............................................................. 12-3

Starting CareCenter MD Online................................................... 12-3Selecting the transmitting station .................................................. 12-3Exiting CareCenter MD Online.................................................... 12-4Showing the patient data ............................................................... 12-4

CareCenter MD Online display........................................................... 12-5Changing the ECG parameters...................................................... 12-5

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Contents

Changing the view......................................................................... 12-6Sending and receiving text messages ..................................................... 12-8

Transmitting messages................................................................... 12-8Receiving and replying to messages................................................ 12-8

Chapter 13: Backup and Restore

Backup CareCenter MD ...................................................................... 13-2Restore CareCenter MD ...................................................................... 13-3

Contents 70-00533-02 A6

1 Introduction

Contents

◆ Contact Information 1-1

◆ Overview 1-2

◆ Features and options 1-3

◆ Screen layouts 1-4

The Cardiac Science CareCenter MD is a personal computer-based system for acquisition and evaluation of 12-channel ECG both at rest and during exercise, in hospitals and physician offices. Please see the CareCenter MD™ Product Information and Safety guide for important safety information regarding this device.

Contact InformationCardiac Science provides customer service and technical support.

◆ To order additional product or accessories, contact Customer Care.

◆ For assistance with the product or installation, contact Technical Support.

Customer Care Technical Support800.426. 0337 (U.S.A.)

425.402.2000

[email protected]

800.426.0337 (U.S.A.)

425.402.2000

[email protected]

http://websupport.cardiacscience.com/webchat/

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Introduction

OverviewCareCenter MD is a diagnostic device capable of ECG monitoring; ST analysis and arrhythmia detection; generation, review, and storage of resting ECG and stress reports; interpretation of adult resting ECG; and select exercise device control.

There are two data acquisition devices, CareCenter MD (USB) which utilizes a USB connection to the computer and CareCenter MD (BT) which utilizes a wireless connection to a proprietary Bluetooth® data acquisition module.

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Features and options

Features and optionsThe system is available in Resting ECG or Stress and Resting ECG configurations. These features and options are available for both configurations of the system.

◆ Users—the system provides interlinking for a maximum of four concurrent users plus one server user. You can upgrade to add additional users. For information, contact your sales representative or Customer Care.

◆ Saving data and settings—when any user is logged in, the application creates a connection (user) for the server. All patient's data and records are saved in the database on this server.

The settings for the system are saved in the database. All users access the same settings. If the settings are changed in one of the networked computers, these changes become effective for all the other users after restarting the application.

◆ Updating data—listing of patient data and records are updated on the system workstations every 30 seconds.

◆ Data protection—the application has a locking mechanism that prevents users from editing the same record at the same time. If the network is down, this locking mechanism cannot connect the server and workstations. If the same record is edited, the application uses the most recent version when the network is restored.

◆ Re-analysis—if the test has not been saved, then the system re-analyzes the ECG test whenever age and gender are changed. For automatic re-analysis:

• USB—the acquisition device must remain connected to the system

• Wireless—the acquisition device must remain in acquisition modeNote: An optional re-analysis dongle eliminates the need to have the acquisition devices connected to the system. For information contact your sales representative or Customer Care.

◆ HL7 connectivity—HL7 is a connectivity option. This option requires a specialized dongle from Cardiac Science. For information, contact your sales representative or Customer Care.

◆ EMR connectivity—you can connect the application to your EMR partner through the Cardiac Science HeartCentrix product. For information, contact your sales representative or Customer Care.

◆ Database records—the system has a DB (database) replication feature that allows you to duplicate the database that exists on the server so that it also exists on the client. Using this option increases the amount of disk space required by the client. For more information, see the CareCenter MD™ System Setup Guide.

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Introduction

Screen layoutsThe application displays a control panel on the left and the main data area on the right. Use the control panel to select tests, select controls during a test, and select viewing options. The main data area displays patient data, device selection, the acquisition data and configuration details.

Figure 1-1: Example of screen layout

12

3

4

1 The task button—the function of this button changes according to the appropriate task in the workflow. This button corresponds to the F2 key.

2 Controls—use these controls to modify the test during acquisition or to select views when reviewing the recording.

3 Available tests—use these buttons to select the type of test or to select Data Management. You can make a selection using a keyboard shortcut, press:

Ctrl + <number>

Where <number> is the order of the test with the top test being 1. The order of these buttons is configurable.

4 Data area—this area displays patient information, acquisition data, data for reviewing the recording, or configuration details.

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2 Data Management

Contents

◆ Patient Search tab 2-2

◆ Overview tab 2-4

◆ To Confirm tab 2-14

◆ Unassigned Recordings tab 2-15

◆ Orders tab 2-16

◆ Custom tabs 2-17

This chapter describes the Data Management module.

The procedures in this manual assume Data Management is the default option. To change the default start option, see the CareCenter MD™ System Setup Guide.

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Data Management

Patient Search tabUse the Patient Search tab to find patient information.

Figure 2-1: Example of Patient Search tab

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Patient Search tab

Search for a patient

Use the Patient Search tab or the Patient… button to search for patient data. The system searches the database for the requested patient data using these fields:

◆ Patient number

◆ Last name

◆ First name

◆ Remarks

To search for patient data:

1. Choose a method to search for patient data:

• Select the Patient Search tab.

• Click Patient.... or press Ctrl + E.

• During a recording, click Select patient... or press F2.

2. In the Search screen, enter the search criteria in Search for.

You can enter the patient number, the patient’s first or last name or entries from Remarks.

If you enter partial information the system will search for that pattern. For example, enter 123 and the system will find patient numbers 1234 or 5123 or patients with 123 in the remarks.

* (asterisk) is a wild card that finds all entries.

3. Click Search or press Enter.

The system searches for patients with the given criteria and displays all the results.

4. Select the patient and click OK or press Enter.

If the patient does not display you can add a new patient, see Add a new patient on page 2-5.

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Data Management

Overview tabThe Overview tab displays patient data on the left and the ECG records on the right.

Figure 2-2: Example of the Overview tab

1 2

1 Patient data list2 Recording list

Configuration Options

Configure whether or not the Overview tab displays

• Select File | Options... | Database | Data management.

Configure the patient data fields that display

• Select File | Options… | Database | Patient Details.

Configure the patient data list columns

1. Right-click in the patient data list and select Configure Columns.

2. For each column to add or delete, choose a method:

– Click to select a column.

– Use the up and down arrow keys to select the column and press Enter.

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Overview tab

Patient data list

The patient data list always has one patient selected. You can choose the fields that display and the required field settings and change the name of the fields.

Add a new patientTo add a new patient:

1. Choose a method to add a new patient record:

• Select the new folder icon.

• Right-click in the patient data list and select New Patient.

• Select Patient | New Patient from the title bar.

• Click the New Patient button.

• Click New Patient in the patient search dialog box.

2. In the Patient Details dialog box, enter the patient information.Note: The Patient # must be unique. The system does not accept duplicate entries.

You must complete all fields that display an exclamation icon.

The system indicates invalid entries. All required entries must be complete and valid. Table 2-1 describes the default options.

3. Click OK to create the new patient record.

Note: The fields that display depend on the patient data configuration.

Table 2-1: Example of patient detail fields

Field Character limit Description

Patient number 18 Unique patient identification number

Last name 60 The patient’s last name

First Name 60 The patient’s first name

Date of Birth mm/dd/yyyy The patient’s date of birth

Gender -- The patient’s gender

• Male

• Female

Race -- The ethnicity of the patient

Height 3

(maximum height is 98 inches or 250 cm)

The height of the patient

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Data Management

Weight 3

(maximum weight is 661 pounds or 300 kg)

The weight of the patient

Department -- The department where the patient is located

Physician -- The name of the patient’s physician

Referring physician -- The name of the physician that referred the patient

Technician -- The name of the person that ran the tests

Attending Physician -- The name of the attending physician

Clinical Classification -- The classification of the cardiac disease in regard to severity and diagnosis

Table 2-1: Example of patient detail fields (continued)

Field Character limit Description

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Overview tab

Mark a patient data recordSelect a record or a set of records for editing, deleting, or opening by marking the data record.

Choose a method to mark a single record:

◆ Search for the record (see Search for a patient on page 2-3) and select the record, click Overview tab.

◆ Scroll up or down to locate the record and then click the record.

Choose a method to mark multiple records:

◆ To select a series of records press Shift and select consecutive records.

◆ To select individual records press Ctrl and select each record.

Edit patient detailsTo edit patient details:

1. Choose a method to select the record:

• Mark the record and click on the edit icon.

• Right-click the record and select Edit Patient Details.

• Mark the record and select Patient | Edit Patient Details.

2. Edit the patient record fields, and click OK or press Enter.

Delete patient data recordsTo delete patient data records:

1. Choose a method to select the record:

• Mark the record and click the delete icon.

• Right-click on the record and select Delete Patient(s).

• Mark the record and select Patient | Delete Patient(s).

2. Click Yes or press Enter to confirm the deletion.

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Data Management

Open a tabOpen a tab to display the patient data for a marked patient. If multiple tabs are open you can bring an open tab to the foreground.

To open a tab:

◆ Choose a method to open a patient tab:

• Mark the record and click on the open icon.

• Double-click the data record in the patient data list.

• Right-click the record and select Open File Card.

• Mark the record and select Patient | Open File Card.

To bring an open tab to the foreground:

◆ Click the title of the tab.

Recording list

The recording list is a tree structure. When the list is collapsed, the date, time, and test display. Expand the list or an individual entry to see the type of records, status of interpretation and confirmation.

◆ Records that are validated display with the comment: Confirmed.

◆ Records that have not been validated can be configured to display in red.

Figure 2-3: Example of recording list tree


Change the display settings for the test and recording list

• Select File | Options... | Database | Data management.

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Overview tab

You can perform these functions.

To... Do this...

Expand an entry

Choose a method:

• Click the + symbol.

• Select the test and press the right arrow key.

Expand all the entries Select the expand icon.

Collapse an entry

Choose a method:

• Click the - symbol.

• Select the test and press the left arrow key.

Collapse all the entries Select the collapse icon.

Open the recording Choose a method:

• Double-click the entry.

• Right-click the entry and select Open.

• Mark the entry and select Recording | Open.

• Mark the entry and press Enter.

Preview the recording Choose a method:

• Mark the entry and select the preview icon.

• Right-click the entry and select Preview.

• Mark the entry and select File | Print Preview....

Print the recording Choose a method:

• Mark the entry and select the print icon.

• Right-click the entry and select Print.

• Mark the entry and select File | Print.

Print (with format selection)

Note: Use Print (with format selection) to change from the default print format or change print parameters.

1. Choose a method to open the print format dialog box:

– Mark the recording and open the menu File | Print with format selection...

– Right-click the recording and select Print (with format selection).

2. In Print format, select the print format for the recording.

3. To preview the format, click Preview.4. To print, click Print.5. To save these settings as the default, click Save

as default.

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Data Management

Export recordingsYou can export recordings to an external medium or to another folder. The system automatically saves with the default file name format:

PPPP-YYYY-MM-DD-HH-MM-SS-TYPE.aed

Where:

◆ PPPP—the patient number

◆ YYYY-MM-DD—the date of the recording

◆ HH-MM-SS—the time of the recording

◆ TYPE—the type of recording

◆ .aed—the proprietary file format

To export the recordings:

1. Expand the recording list.

2. Choose a method to select the recording:

• Right-click the recording and select Export.

• Mark the recording and select Recording | Export.

The system displays the Save As dialog box.

3. Browse to the appropriate location and click Save.

Import recordingsYou can import recordings from an external medium or from another folder.

To import recordings:

1. Select Recording | Import.

The system displays the Open dialog box.

Delete the recording Choose a method:

• Mark the entry and select the delete icon.

• Right-click the entry and select Delete.

• Mark the entry and select Recording | Delete.

To... Do this...


Configure the default export location or change the default structure of the file name

• Select File | Options... | General | Import / Export and change the appropriate settings.

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Overview tab

2. Browse to the location of the file to import and click Open.

The system displays the assignment dialog box, which displays the patient information contained in the recording. The information may vary depending on the settings in the original system.

If there is a conflict between the patient record being imported and the patient information that exists in the database, the system flags the information.

The system will search for this patient in the database. Select the correct patient:

3. Click OK to import the recording.Note: You cannot import a record that already exists in the database. If the record already exists in the database, the system displays an error.

If... Do this...

Patient information displays

1. Select Use in auto search to identify the fields to use in the database search.

The system displays a list of patients that match the auto search criteria.

2. Select the correct patient from the list.

Patient information displays that conflicts with existing information

1. Click the conflict icon.

The system prompts you to resolve the conflict.

2. Select the best choice to resolve the conflict.

You may need to enter additional information to distinguish the entry.

3. Select OK.

Note: Once the conflict is resolved, the system will resolve this type of conflict in the same way without prompts.

Patient fields are blank— existing patient

1. In the Search for field, enter search criteria which can be:

– patient number (or fragment)

– part of the patient name (first or last)

– field remarks (or fragment)

2. Click the Search or press Enter.

The system displays a list of patients that match the auto search criteria. For more information see Search for a patient on page 2-3.

3. Select the correct patient from the list.

Patient fields are blank— new patient

1. Click the New Patient button.

The New Patient dialog displays.

2. Enter the new patient details.

For more information, see Add a new patient on page 2-5.

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Data Management

Patient data

Each patient has a patient data tab. The patient data tab displays patient data, tests, and recordings. The title of the patient data tab is:

[Patient number] Patient last name, Patient first name.

The patient tab has these sub-tabs:

◆ Medication (default)◆ Indications◆ Symptoms◆ Previous diseases◆ Previous Therapies◆ Remarks◆ RelativesNote: To move between sub-tabs see Navigating in CareCenter MD in the System Setup Guide.

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Overview tab

Figure 2-4: Example of the patient data tab

To edit the patient data fields, choose a method:

◆ Click Edit to open Patient Details.

◆ Select Patient | Edit Patient Details.

1 234

5 6

1 Patient buttons on the control panel:

Patient... (search) New Patient Delete Patient

2 Patient tabs3 Patient information4 Edit patient button5 Patient data sub-tabs6 Recording list


Configure patient data sub-tabs

• Select File | Options... | Database | Patient details.

Note: The sub-tabs display at the end of the list.

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Data Management

To Confirm tabThe To Confirm tab displays a list of all records which have patients assigned, and have not been confirmed. Note: If the record does not have a patient assigned, it does not display on the To Confirm tab.

To confirm a recording from the To Confirm tab:

1. Search for the record:

a. Select the type of acquisition.

b. Select the time period for the acquisition.

2. Open the record.

3. Click Confirm to confirm the test.

To manage the records to confirm, right-click on the record and select the option. The options are:

◆ Open—opens the record

◆ Print—prints the recording in the standard print format

◆ Print (with format selection)—print the using a customized format

◆ Preview—print preview in the standard print format

◆ Export—copies the file to a remote location

◆ Delete—delete the recording

◆ Open file card for that patient—opens the tab for the patient assigned to the record


Configure whether or not the To Confirm tab displays

• Select File | Options... | Database | Data Management.

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Unassigned Recordings tab

Unassigned Recordings tabThe Unassigned Recordings tab displays a list of all tests for which no patient information has been entered. The test or recording information is stored on the Unassigned Recordings tab. At a later time you can add the test or recording to a current patient, or you can create a new patient and then add the test or recording.

To manage an unassigned recording, right-click on the record and select the option. The unassigned recording options are:

◆ Assign—assign the recording to a patient

◆ Open—open the unassigned recording

◆ Print—print the unassigned recording in the standard print format

◆ Print (with format selection)—print the unassigned recording using a customized format

◆ Preview—print preview in the standard print format

◆ Delete—delete the unassigned recordingNote: Cardiac Science recommends displaying the Unassigned Recordings tab. If the Unassigned Recordings tab does not display you cannot see or search for unassigned tests.


Configure whether or not the Unassigned Recording tab displays


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Data Management

Orders tabUse the Orders tab with the HL7 option to create, edit and execute orders.

To... Do this...

Create an order 1. Click the New Orders button or right-click on the orders list and select New Order.

2. In the Search for field of the Search screen, enter the search criteria.

You can enter the patient number, the patient’s first or last name or entries from Remarks.

If you enter partial information the system will search for that pattern. For example, enter 123 and the system will find patient numbers 1234 or 5123 or patients with 123 in the remarks.

* (asterisk) is a wild card that finds all entries.

3. Click Search or press Enter.

The system searches for patients with the given criteria and displays all the results.

4. Select the patient and click OK or press Enter.

If the patient does not display you can add a new patient, click New Patient and enter a new patient, see Add a new patient on page 2-5.

5. Enter the new order information and click OK or press Enter.

Open an order for edit Choose a method:

• Click Edit Order.

• Right-click on the record and select Edit Order.

Cancel an order • Right-click on the order and select Cancel Order.

View patient information for an order

Choose a method:

• Select Patient | Open File Card.

• Right-click on the order and select Open file card for that patient.

Modify the Orders tab • Select Settings | Configure this card.


Configure whether or not the Orders tab displays


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Custom tabs

Custom tabsYou can edit optional custom tabs. On a custom tab you can configure the display field, the order of the fields, and include sort information.

To Do this...

Create a custom tab 1. Select Settings | Add a new card.

2. Enter a name for the custom tab.3. Select the display and sort options for the custom tab.

Modify a custom tab • Select Settings | Configure this card.

Delete a custom tab • Select Settings | Remove this card.

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Data Management

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3 ECG Acquisition

Contents

◆ Test procedure programs 3-2

◆ Launch a default test procedure automatically 3-6

◆ Select a default test procedure manually 3-7

◆ Select a default test procedure in Data management 3-8

◆ Select the active patient 3-9

◆ Select the ECG acquisition device 3-11

◆ Enter a comment 3-12

◆ Measuring and entering blood pressure 3-13

◆ Apply electrodes 3-14

◆ ECG filters 3-17

◆ Change the ECG representation 3-19

◆ Pediatric ECG 3-24

◆ Pacemaker detection 3-25

◆ Pacemaker impulses 3-25

◆ Demo ECG 3-26

◆ Print the record 3-27

◆ Save the record 3-30

This chapter describes how to acquire an ECG.

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ECG Acquisition

Test procedure programsDuring the installation, the test type programs are set up. You may modify these programs or create new ones.

The acquisition device unlocks specific test procedures. You can only complete recordings for which you have the appropriate permissions.

Observe the instructions for the type of acquisition and options, as listed below. For more information see the System Setup Guide.

Table 3-1: Basic test types

Test type Settings

STAT ECG Type of acquisition:

Leads:

Duration:

ECG Interpretation:

Resting ECG

I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

Records ECG until stopped manually

yes

STAT Rhythm ECG Type of acquisition

Leads

Duration

ECG Interpretation

Rhythm ECG


ECG recording until stopped manually

yes

Resting 12 Type of acquisition:

Leads:

Duration:

ECG Interpretation:

Resting ECG


Automatic recording stop after 10 seconds

yes

Rhythm 12 Type of acquisition:

Leads:

Duration:

ECG Interpretation:

Rhythm ECG



yes

Treadmill Test Bruce

Type of acquisition:

Leads:

Duration:

Arrhythmia monitoring:

Stress protocol:

Stress Test


The complete test is acquired

yes

Bruce:

• Load start with 1.7 mph, 10% grade

• Increase by up to .9 mph, 2% grade

• Stage duration 3 minutes

• Stores a 10-second ECG strip at the end of every stage

• Blood pressure measurement at the end of every stage

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Test procedure programs

Treadmill Test Modified Bruce


Leads:

Duration:


Stress protocol:

Stress Test



yes

Modified Bruce:

• Load start with 1.7 mph, 0% grade

• Increase by up to .9 mph, up to 5% grade




Pharmacological Type of acquisition:

Leads:

Duration:


Stress protocol:

Stress Test



yes

Pharmacological Stress Test:

• No exercise device

• Stage duration varies

Bicycle Stress Test Standard


Leads:

Duration:


Stress protocol:

Stress Test



yes

WHO:

• Load start with 25 Watts

• Increase by 25 Watts


• Stores a 10-seconds ECG strip at the end of every stage


Table 3-1: Basic test types (continued)

Test type Settings

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ECG Acquisition

The system includes further investigation programs which are not set.

Table 3-2: Additional test types

Test type Settings

Resting 6 Type of acquisition:

Leads:

Duration:

ECG Interpretation:

Resting ECG

I II III aVR aVL aVF


No interpretation if less than 12 standard leads

Nehb Type of acquisition:

Leads:

Duration:

ECG Interpretation:

Resting ECG

I II III D A J



Frank Type of acquisition:

Leads:

Duration:

ECG Interpretation:

Resting ECG

I II III X Y Z



Rhythm 6 Type of acquisition:

Leads:

Duration:

ECG Interpretation:

Rhythm ECG

I II III aVR aVL aVF



Resting Dorsal Type of acquisition:

Leads:

Duration:

ECG Interpretation:

Resting ECG




Resting right precordial


Leads:

Duration:

ECG Interpretation:

Resting ECG

I II III aVR aVL aVF V1 V2 V3R V4R V5R V6R



Rhythm Dorsal Type of acquisition:

Leads:

Duration:

ECG Interpretation:

Rhythm ECG




Rhythm right precordial


Leads:

Duration:

ECG Interpretation:

Rhythm ECG




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Test procedure programs

Bicycle Stress Test Dorsal


Leads:

Duration:


Stress protocol:

Stress Test



yes

WHO:




• Stores a 10-seconds ECG strip at the end of every stage


Bicycle Stress Test right precordial


Leads:

Duration:


Stress protocol:

Stress Test



yes

WHO:






Table 3-2: Additional test types (continued)

Test type Settings


Configure test procedures • Select File | Options … |12 Lead ECG | Test procedures

Create or modify protocols • Select File | Options... | 12 Lead ECG | Protocols

To enable the procedures in Table 3-2

• Select File | Options... | 12 Lead ECG | Test procedures

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ECG Acquisition

Launch a default test procedure automaticallyDuring the installation, the Data Management module is preset as the default start option.

The system can be set to automatically launch the preset test procedure when the application starts.


Configure the default start option

1. Select File | Options… | General | Environment.

2. Select Start with test procedure and activate a test procedure as start option.

This test procedure is automatically launched for each test.

At the program start and after a record is saved, the system automatically changes to tab of the patient, for whom the record is saved.

3. To select a test, rather than automatically launching a test, in Start with module, select the Data management module.

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Select a default test procedure manually

Select a default test procedure manuallyYou can select the test procedures from the control panel on the left side of the display. The display sequence determines the keyboard shortcuts. The buttons are in order with the top position corresponding to Ctrl+1.

To manually select a test procedure, choose a method:

◆ Select Start and click the desired test procedure. ◆ Press the keyboard shortcut for the test.

Note: The tests that display depend on your configuration. If you add or remove buttons or change the order of the buttons, the keyboard shortcuts will change.

Table 3-3: Example of test procedure list

Test Button Keyboard shortcut

STAT ECG Ctrl+1

STAT Rhythm ECG Ctrl+2

Resting 12 Ctrl+3

Rhythm 12 Ctrl+4

Treadmill Test Bruce Ctrl+5

Treadmill Test Modified Bruce Ctrl+6

Pharmacological Stress Test Ctrl+7

Bicycle Stress Test Standard Ctrl+8


Reorder or set the keyboard shortcuts

• Select File | Options... | 12 Lead ECG | Test procedures

Note: Always save the changes to test procedures and then restart the system to ensure your changes take effect.

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ECG Acquisition

Select a default test procedure in Data managementWhen selecting a test procedure from Data management:

If... Then...

A patient tab is open When the test program launches, this patient's data is associated to the active patient.

The active patient is the one for whom the ECG recording is carried out. (The STAT ECG does not have an active patient.)

The Overview tab is open When the test program launches, the data marked in the patients list is associated to the active patient. The system prompts you to confirm this is the correct data.

1. To prevent the message from displaying again, select Don’t ask me again.

2. To reactivate messages select File | Options… | General | Environment, select Show disabled message boxes again.

If the record is saved after the acquisition of the ECG, the system associates the record to this patient.

After the change to the ECG record, the data of the active patient displays in the title bar of the program.

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Select the active patient

Select the active patientThe active patient is the patient for whom the current ECG record is saved and stored.

◆ If the test procedure is selected in the Data Management screen, the system automatically uses that patient as the active patient. See Select a default test procedure in Data management on page 3-8.

◆ If the test procedure is automatically launched, you must select the active patient during the ECG recording.

The title bar of the program shows the data of the active patient in the form:

[Patient number] Last name, First name Date of birth

Select the patient before starting an ECG acquisition

If possible, select the active patient before starting an acquisition.

If the active patient is unassigned, the system assigns the Select patient... function to the orange (main) button and to the F2 key. Note: The orange button and F2 are reassigned as you progress through the workflow.

◆ Click Select patient... or press F2. To search for a patient, see Search for a patient on page 2-3. The patient found during the search is used as the active patient, and thus for the ECG acquisition.

Select the patient during an ECG acquisition

You can select the active patient after the start of an acquisition.

To select the patient data during the acquisition:

1. Click Patient... or press Ctrl + E.

2. To select a different patient, click Search.

To search for patient data, see Search for a patient on page 2-3.


Configure the display of the main button. (If the button does not display.)

• Select File | Options… | 12 Lead ECG | ECG and select First step of the "Green Arrow" button is opening the patient search

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ECG Acquisition

Automatically open the search dialog

If you configure the system to return to a preset test rather than to Data Management , then you can configure the search dialog to display automatically. This function is always on for stress test acquisitions.

Additional active patient options

These additional options are available after you select the procedure:


Configure the system to prompt for the active patient

1. Select File | Options... | General | Environment and select a test procedure from Start with test procedure.

2. For each test type to prompt for the active patient:

a. Select File | Options... | 12 Lead ECG | Test procedures, and select the test procedure program.

b. Click the General tab and select At acquisition start, automatically ask for a patient.

Note: STAT and STAT Rhythm tests do not prompt for the active patient.

3. After you save a record for the active patient, select Continue and the system prompts for whether or not you want to carry out a further test procedure of this patient.

– To acquire another ECG, click Yes.

– To search another patient’s file, click No.

Menu Item Function

Show Patient Details To display and edit the details for the active patient, choose a method:

• Right-click Patient... and select Show Patient Details....• Select Patient | Show Patient Details....

Closing active Patient If you do not want to use the data of the active patient for the ECG acquisition, choose a method:

• Close the active patient.

• Right-click Patient... and select Close active Patient

• Select Patient | Close active Patient.

Select Patient Up to five patient tabs can be open in Data Management. The open patients are listed in the patient menu.

To select a patient whose tab is open, choose a method:

• Right-click Patient... and then select the patient from the list.

• Select Patient and then select the patient from the list.

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Select the ECG acquisition device

Select the ECG acquisition deviceYou must install and connect the acquisition devices to the system before using the devices for an acquisition. To install an acquisition device, see Getting Started or the CareCenter™ MD System Setup Guide.

Selecting a USB device

The system automatically searches for connected USB acquisition devices. If the system cannot find a USB acquisition device, or if the system finds several devices, the system displays the Device Selection dialog box.

◆ If the system cannot find an acquisition device, then the device list is empty and the Continue button is inactive, connect a USB acquisition device to the computer according to the CareCenter MD™ System Setup Guide:

◆ If the system finds several USB acquisition devices:

a. Click on the device that you want to use.

To scroll: click in the list and use the arrow keys to scroll to the device.

b. Click Continue or press F2.

Selecting a wireless device

The system does not search automatically for wireless acquisition devices. CareCenter MD displays all the wireless devices which are activated in File | Options...| Devices | CareCenter MD (BT). It does not matter whether these devices are on or off.

!Caution: Electrical shock

Touching an exposed battery has the risk of electrical shock. Always ensure the battery compartment for the wireless acquisition device is properly closed during use.

If the system cannot find a wireless acquisition device, or if the system finds several devices, the system displays the Device Selection dialog box.

◆ If the device list is empty, connect a wireless acquisition device according to the CareCenter MD™ System Setup Guide.

◆ If the system finds several devices:

a. Click on the device that you want to use.

To scroll: click in the list and use the arrow keys to scroll to the device.

b. Click Continue or press F2.

Note: Ensure the wireless acquisition device has enough battery charge to last for the entire acquisition session.

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ECG Acquisition

Enter a comment You can configure the comment box to open automatically at the start of an acquisition or at the end of an acquisition.

To manually enter comments during a test or acquisition:

1. Click Remarks or press F3.

The Comments tab opens.

2. Enter your comment.

Use the auto-type function for repeated terms.

If required, enter more information on the other tabs, or automatically display the information entered there.

3. To print comments, select Print comments.

4. To prevent comments from printing, clear Print comments.

5. Click OK.


Configure when the comment box displays for each test procedure

1. Select File | Options … |12 Lead ECG | Test procedures.

2. For each test procedure, click the General tab and choose the Comment box behavior.

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Measuring and entering blood pressure

Measuring and entering blood pressure

Start the blood pressure meter

If a blood pressure meter is connected, you can start the measurement manually.

◆ Click the blood pressure icon.

Enter blood pressure values manually

If a blood pressure meter is not connected, you can enter the measured values manually.

To manually enter a blood pressure:

1. Click on the blank blood pressure field or press Shift + F3.

If a blood pressure meter is connected, you can also enter the measured values manually.

• Click on the blank blood pressure field or press Shift + F3.

2. Enter the systolic and the diastolic value without separators.

It is not necessary to enter a diastolic value. Only systolic values under 350 are accepted.

The systolic value must be greater than the diastolic value.

3. Press Enter or click beyond the blood pressure field to close the input dialog box.

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ECG Acquisition

Apply electrodesFollow all safety precautions for the patient cable, see the Product Information and Safety guide.

Use only high-quality Cardiac Science-approved electrodes. Handle the electrodes with care to achieve good recording quality.

The ECG acquisition always starts with the electrode placement screen including the disturbance level indication and ECG preview. The electrode placement diagram shows the electrode positions. You can select the name of the points of application or the marking on the electrode cables.

◆ Apply the patient cable with no tension in the electrodes.

◆ For reusable electrodes, use a contact spray.

◆ For a resting ECG:

• Make sure that the patient lies comfortably and is relaxed.

The arms should have enough space to rest beside the patient. Holding the arms into the body can cause artifacts.

• Cardiac Science recommends placing a roll under the hollows of the knees of the patient.

!WARNING! Patient safety.

To prevent tripping, always ensure the patient belt allows freedom of movement. Use the belt loops to manage excess cable length. Before beginning the test, ensure there are no obstructions.

The system prompts you to apply the electrodes and displays an a electrode placement diagram. See Figure 3-1.

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Apply electrodes

Figure 3-1: Example of lead placement

To apply the electrodes from acquisition mode, with the acquisition device selected:

1. To toggle the electrode labeling (for NEHB only), select Site or Lead Wire Label.

2. To see the electrode placement scheme from another angle (side or back) click Turn.

3. Apply the electrodes to the patient.

• Always start with the right leg placement.• If an electrode is not applied the electrode position on-screen blinks. • The representation of an ECG lead starts as soon as the system recognizes the

electrodes are applied correctly.• The electrode fault detection begins working, when you apply the right leg and

two additional leads.4. Using the Electrode application display, try to improve the quality of the electrode

application, until all electrodes display in the adequate range. Note: Turning on a filter does not affect the display.

5. To assess the skin transmission impedance, select Impedance.

The system does not display ECG during the impedance measurement.

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ECG Acquisition

Note: You must select Electrode application before the system can start the acquisition.

6. Once all electrodes are applied, click the orange Start Auto button or press F2 to start acquiring the ECG or the stress test.

Note: The actual title of the orange button and the manual start controls are dependent on the workflow. Start Auto initiates a timed test, Start initiates an test that is not timed, and Start Test initiates a stress test.

• If the system displays electrode faults you can start the acquisition using the working electrodes, click Start Auto or Start to start the acquisition.– At least the right leg electrode and two additional limb electrodes must be

operational.

– If you start the ECG with an electrode fault, then the system does not display all channels. The display depends on the electrodes that are working properly.

Note: If the transmission is interrupted, the trace will stop displaying and the system indicates the error condition until the transmission is restored.


Configure the lead placements • Select File | Options | 12 Lead ECG | ECG.

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ECG filters

ECG filtersFilters can influence the ECG: therefore, avoid using filters when they are not required. The available filters are:

◆ Mains (AC Line) filter—inhibits disturbances coming from power supply lines, fluorescent lamps, as well as energy-intensive consumers.

These energy-intensive entities cause electromagnetic fields which spread in the room and can disturb ECG acquisition. Therefore, when selecting the location of the patient for the test, consider this influence and locate a place where the network disturbances are as low as possible.

Poor contact between electrode and body also has adverse effects on the acquisition. Ensure the electrodes are applied properly with good contact.

◆ EMG (Muscle Artifact) filter—acts against artifacts caused by muscle motions. For ECGs at rest, such artifacts are usually caused by having such a narrow space that patients hold their arms to their bodies. Ensure patients lie comfortably and calmly with enough space for their arms to rest at their sides.

◆ Baseline filter—prevents excessive excursion of the ECG waveform. Strong motions of the patient can adversely affect the stability of the ECG waveform.

Note: When filters are applied, pacer spikes may exhibit minor distortion which will appear as a small secondary spike immediately adjacent to the primary spike. This distortion does not affect the automatic interpretation algorithm.

Enable a filter

Any filters that are enabled display in the title bar of the ECG representation.

◆ E—EMG (Muscle Artifact) filter

◆ M—Mains (AC Line) filter

◆ B—Baseline filter

With every new acquisition, the filters are reset to the state preset for the test procedure.


Configure pre-selected settings separately for each test procedure

1. Select File | Options … | 12 Lead ECG | Test procedures.

2. Select the ECG tab and configure the filter settings.

Change the default filter settings


2. Select the ECG tab and configure the filter settings.

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ECG Acquisition

You can change the filter settings for an individual test:

Default filter settings

Table 3-4 lists the default filter settings.

To... Do this...

Enable the Mains (AC line) filter • Select Settings | Mains (AC Line) filter.

Enable the EMG (muscle Artifact) filter

• Click EMG filter or select Settings | EMG (Muscle Artifact) filter.

Enable the filter defaults (including the Baseline filter)

1. Select File | Options… | 12 Lead ECG | Test procedures.

2. Select the ECG tab and configure the settings.

Table 3-4: Default filter settings

Filter STAT ECG Resting ECG Rhythm ECG Stress Test

Mains (AC Line) filter On On Off On

EMG (Muscle Artifact) filter On Off Off On

Baseline filter On On On On

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Change the ECG representation

Change the ECG representationYou can change the speed, sensitivity, size and position of the ECG waveform.

Change speeds

To change the speed of the displayed ECG in the test:

1. Click the arrow to the left to decrease the speed.

2. Click the arrow to the right to increase the speed.

3. Alternatively:

a. Right-click in the ECG and select Speed.

b. Select the speed.

Default settings

Change sensitivity

To change the sensitivity of the displayed ECG in the test:

1. Click the down arrow to decrease the sensitivity.

2. Click the up arrow to increase the sensitivity.

3. Alternatively:

a. Right-click in the ECG and select Sensitivity.

b. Select the sensitivity.


With every new acquisition, the speed is reset to the state preset for the test procedure.

Configure the presets for each type of test procedure


2. Click the Display tab and set the presets.

Setting range [mm/s] Presetting [mm/s]

Multi-channel ECG 5, 10, 25, 50, 100, 200 25

Rhythm line 5, 10, 25, 50, 100 25

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ECG Acquisition

Default settings

Resize the window

To resize the window:

◆ Click the left arrows to enlarge the window.◆ Click the right arrows to shrink the window.

Move the ECG waveform

You can move each of the ECG waveforms in vertical direction and prevent the waveforms from writing into each other.

To move the waveform:

1. Click the inscription of the ECG waveform you want to move.

A ruler displays.

2. Click and drag the waveform up or down to the re-position the waveform.

3. Click beyond the ruler to hide it immediately, or right-click and select Hide ruler.

Otherwise, the ruler is automatically hidden after a short time.

4. To reset the original positions, with the ruler visible, right-click on one of the waveforms inscriptions and select Reset lead positions.

Change a lead

You can associate another lead to every ECG waveform or hide it completely.

To change a lead:

1. Right-click on the inscription of the ECG waveform to which you want to associate another lead or which you want to hide and select the lead to display.

2. Click the ellipsis to hide the waveform.

3. To close the window without changing the lead, click on the already selected entry or beyond the context menu in the ECG.

Setting range Presetting (mm/mV)

Multi-channel ECG 5, 10, 20 10

Rhythm line 5, 10 10

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Select a view

Different views are available to display the ECG waveforms in different arrangements. To define the views, they are divided into lines and columns.Note: Temporary changes made to the waveform views are not saved when moving between views. To save your preferences, set your preferences, exit, and then re-start the application.

Note: During a long ECG acquisition, when using a multi-column lead selection (for example 3x4) in the Rhythm Line Display, recordings of 30 minutes or more may result in a slight misalignment of the viewable sweep bar as the ECG waveform is refreshed. This occurs in the Rhythm Line Display only, not in the primary diagnostic ECG display. Reviewing and printing of ECG waveforms and stored ECGs are not affected. For long ECG recordings, select no more than 3 leads to display in the Rhythm Line Display.

To change the views:

◆ Right-click in the ECG representation and select the view.

By default, the structure is:

Column1 # column2 # column3 # column4

Where:

◆ Column1—all leads displayed in the first column one below the other.

◆ Column2—all leads displayed in the second column one below the other.

◆ Column3—all leads displayed in the third column one below the other.

◆ Column4 —all leads displayed in the fourth column one below the other.

See Figure 3-2.

Figure 3-2: Example of 1 column with 12 leads

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ECG Acquisition

Figure 3-3: Example of 2 columns with 6 leads



Change the available views, or configure views for each test procedure


2. Select procedure and then select the Lead Program tab.3. Modify the View selections.

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Toggle views

You can cycle through all views which consist of only one column and have the same number of leads.

◆ Click Refresh to toggle the views.

If you selected a 3-channel or a 6-channel representation, you can use the refresh in the header to switch to the other lead groups.

Change the mode of representation

The mode of representation affects only multi-column representations.

◆ Synchronous mode—the waveforms in the left column and the waveforms in the right column are written simultaneously.

◆ Sequential mode—the waveforms in the left column and the waveforms in the right column are written consecutively.

• Advantage—the waveform is overwritten only half as often. This allows longer viewing of the ECG.

• Disadvantage—the ECG within a column is updated only half as often.


The synchronous mode is the default.

Enable the sequential mode for each procedure and for every view


2. Select the Display tab.

In all representations which are displaying real-time ECG, you can select a multi-column view. To activate these views select the Sequential mode option.

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ECG Acquisition

Pediatric ECGFor patients 16 years and under, the program does not create diagnostics. Instead, the program creates a measurement table. In this table, the measurement values of the patient are compared with those from statistics distributed after Gauss. The tables use the same naming convention as the tables created by Andrè Davignon et al.

If the values of the patient are beyond this distribution, these are marked with asterisk (*).


Configure the pediatric ECG statistical distribution

1. Select File | Options… | 12 Lead ECG | ECG analysis.

2. In Table for pediatric ECG, select the gauss distribution for the table:

– None

– 2% to 98%

– 5% to 95%

Values beyond this distribution are marked with an asterisk (*)

Configure a default age and gender to use for analysis

• Select File | Options … | 12 Lead ECG | ECG analysis.

– To set the default age, select If DoB is missing, analyze with an age of and select the age.

– To set the default gender, select If gender is missing, analyze with and select the gender.

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Pacemaker detection

Pacemaker detectionThe settings for pacemaker detection can be changed during the ECG acquisition.

To change pacemaker detection:

1. Open Settings | Pacemaker detection...

2. Select the electrodes to be used for the detection.

3. Select whether the pacemaker should be replaced with 1 mV impulse.

Pacemaker impulsesImpulses delivered by pacemakers can be so narrow that it is not possible to display the original pulse. Therefore, the system shows a synthetic impulse exactly at the point of the ECG where the original impulse was detected.

The synthetic impulse is displayed on all channels and always with positive polarity.

Figure 3-5: Example of pacemaker impulses

The level of the synthetic impulse is 1 mV. By default, the width of the synthetic impulse is set to 8 ms.


Change the value of the synthetic impulse

1. Select File | Options... | Devices, and open CareCenter MD (BT) or CareCenter MD (USB).

2. Enter the desired width in the Pacemaker Impulse Width (ms) input box. The value must be between 2 ms and 16 ms.

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ECG Acquisition

Demo ECGAn internal ECG is saved in the acquisition devices.

To initiate a demo ECG:

1. Select File | Options... | Devices | CareCenter MD (BT) or CareCenter MD (USB).

2. Enable the check box Acquire Demo ECG.

The demo ECG can only be saved for a patient by the last name of Demo.

3. Create a patient, and enter at least the following data.

Last Name: Demo

Date of birth: e.g. 01.01.1980

Gender: male or female

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Print the record

Print the recordUse Print with Format selection to use other print formats or to set other printing parameters.

The TCR-1000 supports in-test print speeds of 5 mm/s and 25 mm/s. Cardiac Science-approved laser printers support in-test print speeds of up to 50 mm/s. Note: When a continuous rhythm test has a displayed speed greater than 25 mm/s, the TCR-1000 is limited to printing at 25 mm/s during in-test printing. To print the test to the TCR-1000 at 50 mm/s, Before or during the test, set the printer to a PDF writer (for example Bullzip PDF). When the PDF displays, select File | Print from the PDF and select the TCR-1000 printer.

To... Do this...

Preview the record in the standard print format

Choose a method:

• Click Preview.

• Press Ctrl + F.

• Select File | Print Preview....

Print the record in the standard format

Choose a method

• Click Print.

• Press Ctrl + P.

• Select File | Print.

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ECG Acquisition

Preview the record with selected print formats

1. Choose a selection method:

– Right-click Preview and select Dialog.

– Select File | Print with Format Selection....2. Select the print formats.

– Clear the formats that are neither printed, nor displayed.

– Select the formats to be printed or displayed.

3. To change the settings, click Print parameters.

a. Select the appropriate settings.

ECG—multi-channel ECG representation

Rhythm— single-channel rhythm representation below the multi-channel ECG

Averaged Beat

Vector loop

Full disclosure—Rhythm queue' in the rhythm ECG and in the exercise ECG

Grid

ECG line thickness

b. To use these settings as the standard format, click Save as default.

4. Click Preview to display the selected formats on the screen.5. Click Save as a default to use these formats as the default

formats (standard print format).

To... Do this...

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Print the record

Print the record after making the format selections

1. Choose a selection method:

– Right-click Print and select Dialog.

– Select File | Print with Format Selection....2. Select the print formats.

– Clear the formats that are neither printed, nor displayed.

– Select the formats to be printed or displayed.

3. To change the settings click on Print parameters.

a. Select the appropriate settings.

ECG—multi-channel ECG representation

Rhythm— single-channel rhythm representation below the multi-channel ECG

Averaged Beat

Vector loop

Full disclosure—Rhythm queue' in the rhythm ECG and in the exercise ECG

Grid

ECG line thickness

b. To use these settings as the standard format, click Save as default.

4. Click Print to print the selected formats.5. Click Save as a default to use these formats as the default

formats (standard print formats).

Change the standard format selection

1. Open File | Options… | 12 Lead ECG | Printing and select the type of test

2. Move the desired print formats to Used printing formats. 3. Select the print formats which you want to print as standard.4. To select the print formats for the test procedure, select File |

Options... | 12 Lead ECG | Test procedures on the Printing tab.

5. To change the printing parameters for a specific test procedure, enable Use different parameters.

To... Do this...

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ECG Acquisition

Save the recordAfter completion of the test, the final default workflow step is saving the test.

1. Click Save or press F2.

• If no active patient was selected, the system opens the search function automatically. Select the data as described in Search for a patient on page 2-3.

Before saving, the system displays a message with the data of the active patient.

• If the indicated patient data does not correspond with the real data, you have 3 seconds time to cancel the saving process.

– Click Cancel.

• If you find out that a wrong patient was selected, you can select a different patient as the active patient, select Patient | Select Patient.... If the age or the gender settings change due to the selection of another patient, the ECG is analyzed again. Note: If the test has not been saved, then the system re-analyzes the ECG test whenever age and gender are changed. For automatic re-analysis:


• Wireless—the acquisition device must remain in acquisition mode

– Click OK to confirm the repeated analysis of the ECG.

• As an alternative you can, click Save or press Shift + F12.2. If you do not want to save the record click Cancel or press Ctrl + X.

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4 Acquire a Resting ECG

Contents

◆ Operating steps - overview 4-2

◆ Controls for acquiring a Resting ECG 4-3

◆ Detailed procedures 4-4

This chapter describes how to acquire a resting ECG.

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Acquire a Resting ECG

Operating steps - overviewThe system uses the orange (main) button (or the F2 key) to perform a typical workflow. Use the orange button (or F2) to start and to save an automatic 10 seconds 12-channel ECG acquisition. Shaded steps are optional. For more information on each step see Detailed procedures on page 4-4.

Step Selection

1 Search for a patient or enter a new patient. Patient Search tab or Patient...

2 Select the test procedure. Resting 12 or Ctrl + <number>

Options If multiple acquisition devices are installed, select the device. Continue or press F2

If using a Bluetooth wireless device, power on the device.

3 Apply the electrodes:

• Incorrectly applied electrodes blink.

• The graphs indicate the hook up quality, check the ECG traces.

Options Enable the filter only if you cannot achieve sufficient acquisition quality.

EMG filter

Enter a remark. Remarks or press F3

Start a blood pressure measurement device or enter a blood pressure value manually.

Blood pressure icon or press Shift + F3

4 Start the acquisition.

Note: The button is active only if all electrodes are applied correctly.

Start Auto or press F2

Options Start an acquisition manually if the electrodes are not applied correctly.

Start Auto or press Ctrl + A

The system starts a timer which stops the record after 10 seconds. If you restart the timer within 10 seconds, the acquisition starts from the beginning.

Reset or press Ctrl + R

Start and stop the acquisition manually. Start or press Ctrl + SStop or press Ctrl + T

5 Review the recording.

Options Repeat the acquisition in manual or in automatic mode. Repeat or press Ctrl + SRepeat Auto or press Ctrl + A

Confirm the diagnosis.

The system adds your full name and the date and time to the diagnosis or to the remark.

Confirm or press Ctrl + B

Preview using the standard formats. Preview or press Ctrl + F

Print the recording in the standard format. Print or Ctrl + P

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Controls for acquiring a Resting ECG

Controls for acquiring a Resting ECG

6 Save the record. Save or press F2

Option Cancel without saving the record. Cancel or press Ctrl + X

Control Panel Option Description

Remarks or F3 Enter comments regarding the acquisition. See Enter a comment on page 3-12.

EMG filter Enables the EMG (muscle artifact) filter. See ECG filters on page 3-17.

Start or Ctrl + S Starts the acquisition manually and changes to manual acquisition. See Start the acquisition for Resting ECG (manually) on page 4-5.

You can start manual recording if electrode errors are indicated and the orange Start button is deactivated. See Apply electrodes on page 3-14.

Start Auto or Ctrl + A Starts automatic recording if electrode errors are indicated and the orange Start Auto button is deactivated. See Apply electrodes on page 3-14.

Stop or Ctrl + T Stops the acquisition. If the acquisition is stopped within10 seconds, the ECG is not analyzed.

Use this function if sudden disturbances occur.

Reset or Ctrl + R Restarts the automatic acquisition. The remaining time is set to 10 seconds, and the progress bar, to 0%.

Use this function if you see a passage which should not be saved during the acquisition.

Blood pressure icon

or

blank blood pressure field or Shift + F3

Corrects the blood pressure.

See Measuring and entering blood pressure on page 3-13.

Step Selection

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Detailed proceduresThis section contains detailed instructions for acquiring a Resting ECG.

Search for a patient or enter a new patient

To search for a patient, see Search for a patient on page 2-3. To enter a new patient Add a new patient on page 2-5.

Select the test procedure Note: If you add or remove buttons or change the order of the buttons, the keyboard shortcuts will change.

Select the test procedure, before applying the electrodes.

1. Click one of the resting test buttons or press the keyboard shortcut (Ctrl + 1 starts at the top of the list) or select Start and then select the test procedure:

• Resting 12 (default)

2. If multiple acquisition devices are enabled, select the device to be used for this test procedure and click Continue or press F2.Note: Each Bluetooth wireless device paired with this system displays on the selection screen; be sure to power on the wireless device you are using.

Apply the electrodes

Prepare the patient and apply the electrodes as described on Apply electrodes on page 3-14. If filters are necessary, see ECG filters on page 3-17.

Start the acquisition for Resting ECG (automatically)

Automatic recording is preset by default. The orange Start Auto button is active only if no electrode errors are indicated.

To start the acquisition:

◆ Click Start Auto or press F2.The system initiates the ECG acquisition, the orange button indicates the remaining time, and the progress bar indicates the elapsed time.

• The recording is stopped automatically after 10 seconds.

• If a disturbance occurs, the time is restarted. The remaining time is set to 10 seconds, and the progress bar, to 0 seconds.

If no active patient was selected, the patient search function opens automatically after the acquisition stops.

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Detailed procedures

Start the acquisition for Resting ECG (manually)

Manual acquisition is deactivated by default.

To start the acquisition manually:

1. Click Start or press F2.

Note: The Start button is active only if no electrode errors are indicated.

The system initiates the ECG acquisition. The recording runs until it is stopped manually. At the start, the progress bar displays. As soon as the progress bar has reached the right margin, you can save an ECG with 10-second of duration.

• If a disturbance occurs, the time is restarted. The progress bar is set to 0 seconds.• The heart rate display depends on the selected representation.

2. Click Stop or press F2.

The last 10 seconds are saved, and with 12-channel lead, also analyzed. Requirement is that the progress bar has reached 10 seconds.


Review the recording

After completion of the recording the record displays. When records are automatically analyzed; the main measurement values, the results of analysis, the averaged beat and the beat classification display.

Records are analyzed only when:

◆ Test procedure has 12-channel standard leads

◆ Acquisition duration at least 10 seconds

◆ Date of birth and gender of the active patient are first entered or changedNote: If the test has not been saved, then the system re-analyzes the ECG test whenever age and gender are changed. For automatic re-analysis:




Configure a manual acquisition as the default for a particular procedure

1. Select File | Options... | 12 Lead ECG | Test procedures.

2. In the General tab select the procedure and clear "Green arrow" button stops acquisition automatically after 10 seconds.

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As long as the electrodes are connected to the patient, the running ECG displays in the rhythm line. For more details, view more representations.

◆ Click the view buttons or select View and then select the representation.• ECG—ECG display, results of analysis and averaged beat

• Measurement Table—Measurement table, results of analysis and averaged beat

• Averaged Beat—Averaged beat, results of analysis and ECG

Also see Displaying an ECG record on page 8-2.

Controls for reviewing a resting ECGFunctions for checking the record.

Print the record

See Print the record on page 3-27.

Save the record

See Save the record on page 3-30.



Confirm or Ctrl + B Confirms the correctness of the diagnosis or the comment. See Chapter 11, Confirming Tests.

Note: After the record is confirmed, it cannot be changed.

Repeat or Ctrl + S Repeats the recording manually.

Repeat Auto or Ctrl + A Repeats the recording in automatic mode.

Blood pressure field or Shift + F3



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5 Acquire a Rhythm ECG

Contents


◆ Controls for acquiring a Rhythm ECG 5-4


This section describes how to acquire a Rhythm ECG.

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Acquire a Rhythm ECG

Operating steps - overviewThe system uses the orange (main) button (or the F2 key) to perform a standard workflow. Shaded steps are optional. Use the orange button (or F2) to record automatically, review, and save 30 seconds of a rhythm ECG.

For more information on each step see Detailed procedures on page 5-7.

Steps Selections

1 Search for a patient or enter a new patient. Patient Search tab or Patient...

2 Select the test procedure. Rhythm 12 or Ctrl + 4







EMG filter



Blood pressure icon or press Shift + F3


Note: The button is active only if all electrodes are applied correctly.

Start Auto or press F2

Options Start an acquisition if the electrodes are not applied correctly. Start Auto or press Ctrl + A

The system starts a countdown timer which stops the record after 30 seconds. Use Prolong to continue the acquisition and reset the countdown timer to 30.

Prolong or press Ctrl + R

Place a label and letter it. Marker press F4

Stop the multi-channel ECG and turn back to see events again and to print.

Freeze Frame or press F6

Save the last 10 seconds as an ECG strip. Save 10s or press F5

Save the continuous ECG as an ECG strip.

Click again to stop saving.

Start ECG strip

Print the continuous ECG.

Click again to stop printing.

Rhythm

Print the last 10 seconds as an ECG strip. 10sec ECG

You can start and stop the acquisition manually. Start or press Ctrl + SStop or press Ctrl + T

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Operating steps - overview

5 Review the recording.

Options To review, use these views: RhythmECGECG StripMeasurement TableAveraged Beat

Repeat the acquisition in manual or in automatic mode. Repeat or press Ctrl + SRepeat Auto or press Ctrl + A

Confirm the diagnosis. The system adds your full name and the date and time to the diagnosis or to the remark.



Print the recording in the standard format. Print or Ctrl + P


Options Cancel without saving the record. Cancel or press Ctrl + X

Steps Selections

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Controls for acquiring a Rhythm ECG




Start or Ctrl + S Changes to a manual acquisition. Use the manual recording to record longer than 30 seconds. See Start the acquisition for Rhythm ECG (manually) on page 5-8.

You can start manual recording if electrode errors are indicated and the orange Start button is deactivated. See Apply electrodes on page 3-14.

Start Auto or Ctrl + A Starts an automatic recording. You can start automatic recording if electrode errors are indicated and the orange Start Auto button is deactivated. See Apply electrodes on page 3-14.

Stop or Ctrl + T Stops the acquisition. You can stop the automatic recording earlier than 30 seconds.

Prolong or Ctrl + R Note: For automatic acquisitions only.

Extends the recording by another 30 seconds.

Marker or F4 Marks a place in the ECG which makes it easier to find at a later time.

To add or change marker labels, select File | Options… | 12 Lead ECG | Marker Labels.

To set a marker:

1. Click Marker or press F4.

The Info section displays heart rate information. The sequential numbers for the marks display in the Marker label field.

– To assign a specific name to the marker, overwrite the default entry.

– To use a default name, select one of the pre-defined labels.

2. To set the marker automatically and prevent the dialog box from displaying, select Don't show this dialogue again, set marker directly.

3. Save the mark with Set Mark.

The mark displays in the rhythm strip and in the multi-channel ECG.

Note: The point of time of the mark is decided by the click of the Marker button or the press of the F4 key, not the closing of the dialog box.

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Controls for acquiring a Rhythm ECG

Freeze Frame or F6 Stops the multi-channel ECG, while the rhythm channel and all measurement functions continue.

1. Click Freeze Frame or press F6.

When the recording is paused, you can turn back the standing ECG and save ECG strips, mark and print sections, and measure RR distances.

See ECG view on page 9-12.

2. Click Freeze Frame once more or press F6 again to let the ECG continue.

Save 10s or F5 Saves the last 10 seconds of an ECG strip. The main measurement values for the strip are indicated.

The system retrospectively saves the ECG strip which ends immediately with the mouse click. You can mark this ECG strip.

Note: Changing the default speed to 25 mm/second or faster, will not allow a full 10 second strip to appear in the window. If this situation occurs, the ECG trace may show a temporary overlap after Save 10s is clicked. This effect lasts only until the next sweep of the display. Stored ECGs are not affected.

See Editing the analysis for this ECG strip on page 9-8.

Start ECG strip Saves an ECG strip of maximum 30 seconds. You can mark or delete this ECG strip.

1. Click Start ECG strips.

The system starts saving the continuous ECG as an ECG strip.

2. During the saving click Stop ECG strip to stop the strip prematurely.

The main measurement values for the last 10 seconds of the strip are indicated.

Rhythm Enables continuous printing. When you click the button to start continuous printing, the button changes color and prompts Click to stop.

Note: You must manually stop continuous printing.

To print:

1. Click Rhythm.

The rhythm queue prints channels, depending on the print parameters. It can take several minutes until a complete page is printed.

2. To stop printing, click Printing (Click to Stop).


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Blood pressure

blank blood pressure field or Shift + F3

Measure the blood pressure values several times one after the other automatically, or enter them manually during the ECG session.

To be able to start the automatic measurement once more, the preceding measurement must be finished.

1. Click the blood pressure icon.


As soon as the blood pressure is automatically measured or entered manually, the value displays in the lower line for 1 minute. Within this time, the actual value can be corrected. No new value is added.

2. Correct the blood pressure values as long as they are displayed in the input box.

After that, the value in the lower line is deleted and shown as last measured value in the field of the upper line.

3. Add a new blood pressure value by clicking the blood pressure icon or by pressing Shift + F3.


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Detailed procedures

Detailed proceduresThis section contains detailed instructions on acquiring a rhythm ECG.

Search for a patient or enter a new patient◆ To search for a patient, see Search for a patient on page 2-3. ◆ To enter a new patient Add a new patient on page 2-5.



1. Click one of the rhythm test buttons or press the keyboard shortcut (Ctrl + 1 starts at the top of the list) or select Start and select the procedure (Rhythm 12 is the default).

2. If multiple acquisition devices are enabled, select the device to be used for this test procedure and click Continue or press F2.Note: Each Bluetooth wireless devices paired with this system displays on the selection screen; be sure to power on the wireless device you are using.



Start the acquisition for Rhythm ECG (automatically)

Automatic recording is preset by default. The orange Start Auto button is active only if no electrode errors are indicated.

To acquire a rhythm ECG automatically:

◆ Click Start Auto or press F2.The system initiates the ECG acquisition.

• The recording stops automatically after 30 seconds. • The orange button indicates the remaining time and the system indicates the time

which was already recorded.

• If a disturbance occurs, the recorded time continues. The remaining time is set to 30 seconds.

• The heart rate display depends on the selected representation.

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Start the acquisition for Rhythm ECG (manually)

Manual recording is deactivated by default.

To acquire a rhythm ECG manually:

1. Click Start or press F2.

Note: The button is only active if no electrode errors are indicated.

• The system initiates the ECG acquisition. The recording runs until it is stopped manually.

• The system indicates the elapsed time once the recording starts.

• In case of 12-channel lead, the acquisition can be analyzed if more than 10 seconds were acquired.

• The indication of the heart rate depends on the selected type of calculation.

2. Click Stop or press F2.

After you stop the recording, the system saves the last 10 seconds as an ECG strip, and analyzes the strip if the recording has all 12-channel leads. The strip is analyzed if the acquisition time has reached 10 seconds.



Change the acquisition length • Select File | Options... | 12 Lead ECG | Test procedures and on the General tab select Auto stop in (seconds).


Configure a manual acquisition as the default for a particular procedure

1. Select File | Options... | 12 Lead ECG | Test procedures,

2. In the General tab select the procedure and clear "Green arrow" button stops acquisition automatically after 10 seconds.

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Detailed procedures

Review the recording

After the acquisition is complete, the recording displays for confirmation.

If the records are automatically analyzed, the main measurement values, the results of analysis, the averaged beat and the beat classification are displayed. Records are automatically measured and analyzed only when:

◆ The test procedure has 12-channel standard leads

◆ The duration of the acquisition is at least 10 seconds

◆ Date of birth and gender of the active patient are first entered or changedNote: If the test has not been saved, then the system re-analyzes the ECG test whenever age and gender are changed. For automatic re-analysis:



As long as the electrodes are connected to the patient, the running ECG displays in the rhythm line.

You can view more representations to see more details.

◆ Click the review buttons or select View and select the display.• Rhythm—1-channel view of the whole ECG as "a rhythm queue" and multi-

channel ECG strip

• ECG—multi-channel ECG of the whole record results of analysis and averaged beat

• ECG Strip—multi-channel ECG, results of analysis and averaged beat of a strip

• Measurement Table —measurement results of analysis and averaged beat of a strip

• Averaged Beat—Averaged beat, results of analysis and ECG of a strip

See also Chapter 9, Displaying a Rhythm ECG Record.

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Controls for reviewing a rhythm ECGWhile you are reviewing the record, you can perform these functions.



Confirm or Ctrl + B Confirms the correctness of the diagnosis or the comment. For more information see Chapter 11, Confirming Tests.


Repeat or Ctrl + S Repeats the recording manually.

Repeat Auto or Ctrl + A

Repeats the recording in automatic mode.

Blank blood pressure field or Shift + F3



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Detailed procedures

Make a measurement in the ECG windowYou can make a measurement or create an ECG strip for analysis.

Print the record


Save the record

See Save the record on page 3-30.

Table 5-1: ECG window functions

To... Do this...

Make an RR or heart rate measurement

1. In the title bar click the ECG measurement tool. The system displays the marking lines.

2. Drag the marking line from the starting point for the RR distance and position it over the R spike of a beat.

3. Drag one of the other lines and position the line on another R spike.

4. To add or delete lines, right-click in the ECG and select the action.

5. To scroll the ECG, move a line to the left or right margin of the visible ECG.

Mark and edit an ECG strip of 10 seconds

1. In the title bar, click Select 10 seconds ECG.

2. Click in the ECG and drag the selected range to the desired position.

3. Click the Edit button.

The selected strip displays in grey in the time bar. Depending on the speed, the grey range can be greater or smaller than the visible range.

For more information see ECG view on page 9-12.

Mark and edit an ECG strip of any length

1. In the title bar, click Select variable length ECG.

2. Click in the ECG and drag the marker to select a strip.

As soon as the selected section is longer than 10 seconds, another mark appears and splits the selected section. The section on the right marks 10 seconds, which the system automatically measures and interprets.

3. To correct the beginning and the end of the selected strip: position the cursor on either margin, and drag to move the margin.

4. Click Edit and select the function.

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6 Acquire a Stress Test ECG

Contents

◆ Stress test displays 6-2


◆ Stress test controls 6-17


This chapter describes how to acquire a stress test ECG.

!WARNING! Patient injury.

In the event of a treadmill touch panel failure, use the system keyboard to control the treadmill.


In the event a failure prevents CareCenter MD from stopping the treadmill, the treadmill can be stopped manually. All treadmills controlled by CareCenter MD must have an emergency stop switch functionality.


Before using any stress test device, ensure the stress test device has been properly installed and that regular maintenance checks occur on the device.

!Caution: Stress device malfunction.

Faulty installation, sudden loss of power, damaged cables, or a faulty device can cause sudden changes in load or speed during the stress test. Monitor all patients when using a stress device.

!Caution: Misdiagnosis.

Entering erroneous parameters will result in erroneous readings or result in a premature end of the test. Be sure to enter the correct data.

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Acquire a Stress Test ECG

Stress test displaysThis section describes the stress test displays.

Stress test window

The stress test displays in a multi-panel window.

Figure 6-1: Example of the stress test screen

1234

1 ECG panel—as soon as an event occurs, it displays here

.2 Arrhythmia panel—as soon as an event occurs, it displays here

.3 Averaged Beat panel—once having calculated the first averaged beat, it

displays here and is updated every 10 seconds

.4 Trend panel—speed and grade or (load) values, heart rate, blood

pressure and ST rate are charted and updated every 10 seconds

.

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Stress test displays

ECG panel

The ECG panel displays the ECG waveforms.

Arrhythmia panel

The Arrhythmia panel displays events that occur during the test. You can disable the arrhythmia analysis at the beginning of the exercise program. The measurement program must be running to see arrhythmia events.

The ECG in the Arrhythmia panel is updated every 2.5 seconds. To change speed, sensitivity, channel position, or elevation of the ECG waveforms see Change the ECG representation on page 3-19.

The events in the Arrhythmia panel have this information:

◆ The phase in which the event started

◆ The start time of the eventNote: The system displays the phase for the beginning of the event. If the event is long and uninterrupted such as a bigeminal pulse, the displayed phase and beginning time will not change, as long as the bigeminal pulse continues. Therefore the bigeminal pulse can be marked for resting phase, although you have already come to the end of the test procedure.

◆ The name of the event


Configure the representation of the ECG waveforms


2. Select the test procedure (for example: Treadmill Test Bruce) from the list and open the Display tab.

3. Select the display (for example: Online ECG) and make your changes.

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The system displays these arrhythmia events:

◆ Asystole◆ Pause of one complex (1 beat pause)◆ Pause of two complexes (2 beat pause)◆ Long RR◆ Run◆ Couplet◆ Ventricular tachycardia◆ PVC◆ PAC◆ Multiple PAC◆ Bigeminy (Bigeminal pulse)

To... Do this...

Step through multiple arrhythmia events

• Right-click and select Previous event or Next event.

Exclude or include arrhythmia events during the stress test

• Select Settings | Arrhythmia detection....These settings are reset to their original state for the next stress test.


Configure which arrhythmia events to monitor


2. Select the test procedure (for example: Treadmill Test Bruce) from the list and open the Arrhythmia events tab.

– To exclude an arrhythmia event (the system will not display the detected event), clear the option.

– To include an arrhythmia event (the system displays the detected event), select the event.

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Averaged Beat panel

The Averaged Beat panel displays the measured ST rate and the ST raise in blue for the reference beat, and in black for the actual beat. The STmax lead corresponds with that of the Maximum ST value on page 6-10.

The averaged beat is updated every 10 seconds.

1. Click the lead name to jump to the next lead.

2. To view another lead, right-click on the lead inscription and select the lead.

3. To change the representation, right-click on the averaged beat and select the settings.

ST measuring point You can measure ST fixed at J+20ms, J+60ms, J+80ms or variable at J+1/8T and J+2/8T.

The variable ST measuring points adapt themselves to the length of the T wave.

◆ Right-click and select Measurement Point, and select the measurement point.

You can toggle the ST measuring point at any time during the test procedure. Also during later opening and viewing of the record, you can select another ST measuring point.

All analyses, summaries and printouts use the currently selected ST measuring point. See Basic settings for limit and target values on page 6-13 for how to change the basic setting.

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View You can select the type of view.

◆ Right-click and select View, and then select the representation.

1*1

1*2

2*1

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Reference beatThe reference beat can be hidden. If both the reference beat and the actual beat are displayed, these can be shown congruently or with small or great distance from each other.

◆ Right-click and select Reference Beat and select the representation.

Trend panel

The trend representation is updated every 10 seconds.

The colored time scale shows the times of the phases, in each case beginning with zero. The grey resting phase is followed by the red stress test phase and then by the yellow recovery phase.

To display the characteristics, place the mouse pointer on any point of time in the chart.

These trend measurement values display:

◆ Load and number of rotations (for a bicycle test)

◆ Speed and grade (for a treadmill test)

◆ Heart rate

◆ Blood pressure

3*4


Configure the basic settings of the Averaged Beat representation


2. Select the test procedure (for example Treadmill Test Bruce) from the list and open the Display tab.

3. Click on Small preview of the Averaged Beat and make your changes.

The ST values can be displayed in mm, mV or μV.

Change the measuring units of the ECG Amplitude

• Select File |Options … | 12 Lead ECG | ECG.

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◆ ST measured values of the two leads shown in the Averaged Beat panel

◆ METs values

If you change the Averaged Beat panel to the 3*4 view, the ST measurement values of both leads that were selected before continue to display.

You can display the trends of all parameters or a limited number of parameters.

◆ To change the trend measurements displayed, click Refresh.

All

Speed, Grade (for treadmill)

Load Rotations (for bicycle)

HR, and BP

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Display elements

!Caution: Data truncation.

If all display elements are selected for a stress test, some items will be truncated if the display is at the minimum screen resolution.

Heart rateAs soon as the electrodes are applied, the heart rate symbol blinks with every beat. When the patient reaches the heart rate target or limit, the heart rate symbol displays in red and the limit value (maximum permissible heart rate) and the percentage reached display.

You can configure the maximum value to be a fixed limit or the system can compute the maximum value as a function of the patient's age.

◆ To set the limit values before the stress test procedure, see Stress test parameters on page 6-25.

◆ To change the basic settings see, Basic settings for limit and target values on page 6-13.

The system always calculates the heart rate by averaging over 10 seconds. The default is: the value averaged for10 seconds.

Blood pressureThe system displays the blood pressure. When the pre-selected systolic or diastolic limits are reached, the values are indicated in red.

As the blood pressure is automatically measured or is entered manually, the value displays as the current value for one minute. Within this time, you can correct the blood pressure value. At the end of the minute, the value is cleared and displays as Last in the upper line of the blood pressure display. To enter a new value wait until the current value is blank.

Figure 6-2: Example of blood pressure display

During the ECG acquisition, you can measure the blood pressure values several times automatically one after the other (considering the one minute time delay), or enter them manually. The system starts the automatic measurement only after completion of the measuring process.

To enter a blood pressure value:

◆ Click the BP icon or the blank blood pressure field, or press Shift + F3.


1 Last measured value display2 Current value display

1

2

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Number of ventricular extrasystolesThe system indicates the number of premature ventricular contractions which have occurred in the last 60 seconds (PVC/min). The system updates the values every 10 seconds.

Measure of the perceived exertionThe input box for RPE values (rate of perceived exertion) is optional. The system expects RPE values based on the Borg scale, where 6 is no exertion and 20 is maximal exertion. The RPE entry is disabled by default.

To enter RPE values:

◆ Click to enter a value between 6 and 20 and press Enter.

Maximum ST valueFor all selected leads the system searches for the maximum ST value, and indicates the value together with the lead. When the patient reaches the limit value, the value displays in red.

You can display the maximum ST depression, the maximum ST elevation or the maximum amount of ST. By default, the maximum ST depression is enabled.

◆ To change the running test procedure, select Settings | ST....

Metabolic indexThe indication of METs values is optional. The METs entry is enabled by default.

Time in stageThe counter on the top line indicates the name of the stage and the time still remaining in the current stage. The Stop Load or Stop Belt and Hold functions also stop the count-down until the stage is resumed.

The lower line shows the time already elapsed in the stage.

Time in exercise phaseThe system displays the time elapsed in the exercise phase.

Stages in resting phase with treadmillBy default, the resting phase with treadmill stress test consists of the stages Laying, Sitting, Standing and Hyperventilating.

Stage1 2:00

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Pharmacological StagesBy factory selection, the pharmacological stress test consists of a resting phase and stages 1 through 6 in the exercise phase.

Warnings

During the exercise, the heart rate, the blood pressure values, the ST values, and the load values are monitored. To be monitored, the parameter must be activated in the test procedure data. For more information see Stress test parameters on page 6-25.

When an actively monitored parameter reaches the maximum ratings and destination values, the system indicates warning messages and repeats them every 2 minutes. The text of the message is entered in the Comments box. You can overwrite the message by changing the comments.Note: You must save to see the new comments.

When the warning appears:

◆ To stop the repeated warnings, select Do not warn again in the message.

◆ To save the last 10-seconds of ECG before the warning appeared, click Save 10s ECG.

◆ To close without saving, click Close.


Enable RPE 1. Select File | Options… | 12 Lead ECG | ECG.

2. In the Stress Settings group, select Use RPE.

Change basic ST values 1. Select: File | Options... | 12 Lead ECG | Test procedures.

2. Select the type of stress test and then select ST Options.

Disable METs 1. Select File | Options… | 12 Lead ECG | ECG.2. In the Stress options group, clear Use METs.3. Set the Use actual load or Use target load in the same

group when METs is enabled.

METs with bicycle stress test needs body weight, but with treadmill it does not.

Warning Description

HR > limit Heart rate too high— the value of the heart rate has exceeded the limit value shown.

BPsys > limit Systolic blood pressure value too high—the value of the systolic blood pressure has exceeded the limit value shown.

A corresponding warning displays for the diastolic blood pressure.

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BP decrease > limit Systolic pressure drop too high— compared with the preceding measurement, the value of the systolic blood pressure decreased by more than 20 mmHg.

This warning displays only in the exercise phase.

ST depression > limit

ST elevation > limit

ST depression too high—the value of the maximum ST depression has exceeded the limit value in one of the leads selected for monitoring.

By default, the maximum ST depression is enabled.

To configure the warnings for the maximum ST depression, the maximum ST elevation or the maximum amount of ST for the current test procedures, select Settings | ST....

The target load value has been reached The target load was reached.

PWC value accomplished at load Indicates the load in the stage when the patient has achieved a heart rate of 130, 150, or 170.

PWC (physical working capacity) is the load when patient achieves the heart rate of 130 (PWC130), 150 (PWC150), or 170 (PWC170).

Warning Description

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Basic settings for limit and target valuesYou can change the settings on these tabs:

Tab Settings

Heart Rate • Setting limits.

– To enable limits, select Enable.

• Setting the limiting formulas.

– To select an absolute value, select Absolute value and enter the value.

– Modify the formula for the maximum or the proportional extent of capacity utilization with geriatric-dependent and gender-dependent calculation and determine whether or not to use the limit value.

If the Display a message box when the limit is reached option is cleared, no warning displays. The setting also affects the Heart rate display element see Display elements on page 6-9.

• Modifying the training heart rate formula.

Blood Pressure • The systolic and the diastolic limit values.

If no value is selected, no warning is displayed. This applies also to the Blood pressure display element described in the Blood pressure on page 6-9.

• The value for the warning at drop of the systolic blood pressure value.

If no value is selected, no warning displays.

• If the Display a message box when the limit is reached option is cleared, no warning displays.

ST settings • The value of the ST elevation and the ST depression and the STmax and worst case settings.

If no value is selected, no warning displays. This applies also to the Maximum ST value display element Display elements on page 6-9.

• Whether or not the warning should be displayed at ST depression, ST elevation or with the amount of ST.

If the Display a message box when the limit is reached option is cleared, no warning displays.

• Select which ST measuring point to use.

• The channels that are searched for the maximum

• The channel selection for Averaged beats.

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Exercise Settings

• The protocol options.

• For bicycle stress test:

– The calculation method for the target load (Standard, Jones, Jones (without usage of weight), or Wassemann).

– Display a message when the destination value is reached.

If the option is cleared, no warning displays. This applies also to the Load display element described in Work load controls on page 6-20.

– Displays a message containing the load value when the patient reaches a heart rate of 130, 150, or 170.

You can select pro-rate the load value over the whole stage, otherwise the system reports the current load.

Note: PWC (physical working capacity) is the load when patient achieves the heart rate of 130 (PWC130), 150 (PWC150), or 170 (PWC170).

Tab Settings


Configure the messages • Select File | Options… | 12 Lead ECG | Test procedures and select the test procedure to change the values.

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Operating steps - overview

Operating steps - overviewBy default, the system is configured to perform a treadmill stress test with the Bruce exercise protocol without having to change settings. The system uses the orange (main) button (or the F2 key) to perform a standard workflow. Shaded steps are optional.

For more information on each step see Detailed procedures on page 6-23

Steps Selections

1 Search the data of the active patient or enter new patient data. Patient Search tab or Patient...

2 Select the test procedure.

The system displays an overview of all test procedure data:

• Check the patient's data.

• Check the limit for the annotations.

• Select another protocol or customize the selected protocol.

• Check the options for printing and blood pressure measurement.

Treadmill Test Bruce or Ctrl + 5






Continue or press F2


EMG filter


4 Start the Stress test.

The button becomes active only if all electrodes are applied correctly.

Start Test or press F2

Options Repeat the calculation of the average beat if the quality is insufficient (in the Averaged Beat panel).

Relearn

Place a label and letter it. Marker or F4

Stop the multi-channel ECG and turn back to see events again and to print.

Freeze Frame or F6

Save the last 10 seconds as an ECG strip. Save 10s or F5

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Options (continued)

Print the continuous ECG.

Click again to stop printing.

Rhythm

Print the last 10 seconds as an ECG strip. 10sec ECG

Print the averaged beat of the last 10 seconds. Averaged Beat

Start the blood pressure measurement for the resting phase or enter a blood pressure value manually.

Blood Pressure icon

or Shift + F3

5 Start the exercise phase.

Clickto increase the workload and , to de-crease it.

Switch to the next exercise stage or maintain the actual load stage as long as you like.

Start Exercise or press F2

Option Stop the treadmill at any time. Stop Belt

6 Start the recovery phase.

Otherwise the Recovery Phase will be started automatically by the protocol.

Start Recovery or F2

7 Enter a reason for the abort of the exercise phase. Stop exercise

Option Alternatively, resume the exercise.

8 End the Stress test. End Test

9 Review the ECG.

Options In the Summary view, enter your findings. RhythmECGECG StripTrendST-TrendSummary

Confirm the diagnosis.

The system adds your full name and the date and time to the diagnosis or to the remark.



Print the recording in the standard format. Print or press Ctrl + P

10 Save the record. Save or F2

Option Cancel without saving the record. Cancel or press Ctrl + X

Steps Selections

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Stress test controls

Stress test controlsThis section describes the controls and functions available during a stress test acquisition.

Controls for acquiring a stress test ECG

Use these controls when acquiring a stress test ECG:


Remarks Enter comments regarding the acquisition or the physician or user. See Enter a comment on page 3-12.


Marker or F4 Marks a place in the ECG which makes it easier to find at a later time. To add or change marker labels, select File | Options… | 12 Lead ECG | Marker Labels.

To add a marker to the ECG:

1. Click Marker or press F4.

The system displays time in phase, workload and heart rate information. The sequential numbers for the marks display in the Marker label field.

– To assign a specific name to the marker, overwrite the default entry.

– To use a default name, select one of the pre-defined labels.

2. To set the marker automatically and prevent the dialog box from displaying, select Don't show this dialogue again, set marker directly.

3. Save the mark with Set mark.

The mark displays in the rhythm strip and in the multi-channel ECG.

Note: The point of time of the mark is determined by the click of the Marker button or the press of the F4 key, not the closing of the dialog box.

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Freeze Frame or F6 Stops the multi-channel ECG display, while the rhythm channel and all measurement functions continue.

1. Click Freeze Frame or press F6.

When the recording is paused, you can turn back the standing ECG and save ECG strips, mark and print sections, and measure RR distances.

See Display functions on page 10-5.

2. Click Freeze Frame once more or press F6 again to let the ECG display continue.

Save 10s or F5 To save the last 10 seconds of an ECG strip:

1. Click Save 10s or press F5.

The system saves retrospectively the ECG strip which ends immediately with the mouse click.

The system displays information on the time in phase, workload, heart rate and blood pressure.

2. In the field Comment, enter a text or select one from a list of predefined texts.

3. Click Save 10s ECG.

The ECG strip is shown in color in the rhythm strip and in the multi-channel ECG.

Printing options

Note: To change the print format, speed, sensitivity and channels for these print options, select Settings | Print...

• For Rhythm select Parameters for continuous print• For 10secECG select Parameters for printing of 10sECG

Rhythm Enables continuous printing. When you click the button to start continuous printing, the button changes color and prompts Click to stop.


To print:

1. Click Rhythm.

The rhythm queue prints channels depending on the print parameters. It can take several minutes until a complete page is printed.

2. To stop printing, click Printing (Click to Stop).


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10sec ECG Prints the last 10 seconds of ECG in adjusted print format.

To print in multi-channel mode:

• Click 10secECG.

The system displays time in phase, workload and heart rate information.

– To enter a comment, click Comment and enter the text.

– To print, click Print.

Averaged Beat Prints the averaged beat.

To print:

• Click Averaged Beat.

The system prints the averaged beat computed from the last 10 seconds in 3x4 representation.

– To enter a comment, click Comment and enter the text.

– To print, click Print.



Change the standard print options

1. Select File | Options… | 12 Lead ECG | Test procedures.2. Select the stress test, then change Print during acquisition.

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Work load controls

Work load control in the treadmill stress test

Feature Description

The system indicates the value of the starting speed. The digits are grey when the treadmill is not running.

• Click to increase the load.

• Click to decrease the load.

The system indicates the value of the starting grade. The digits are grey when the treadmill is not running.

Click to increase the value.

Click to decrease the value.

Click Start Belt to start the treadmill.

Click to increase the speed.

Click to decrease the speed.

Click to increase the grade.

Click to decrease the grade.

The system indicates the protocol and the stage in the resting phase.

• Click Next to change to the next stage of the resting phase.

The Next button is active when the protocol is ready for the second stage in the resting phase.

• Use Select stage label... to open a selection box with all stages defined in the protocol for the resting phase. Click to select a different label.

The system indicates the protocol and the stage in the exercise phase.

1. To finish this stage and change to the next one, click Next.

2. To prolong the stage, click Hold.

The system changes the color of the Hold button.

The Time in stage indicates the remaining time. See Time in stage on page 6-10.

3. To stop the hold and continue, clicking Hold or Next again.

To stop the treadmill, click Stop Belt.

To quit the stress test prematurely, click End Test.

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Work load control in the bicycle stress test

Feature Description

The upper line shows the target value of the load. Below it, the load available at the bicycle is indicated. You cannot make changes when the load is off.

• Click to increase the load.

• Click to decrease the load.

The load values in the stage protocol of a bicycle stress test can be displayed as interpolated values. This function must be enabled.

The system indicates the protocol and the stage in the resting phase.

• Click Next to change to the next stage of the resting phase.

The Next button is active when the protocol is ready for the second stage in the resting phase.

• Use Select stage label to open a selection box with all stages defined in the protocol for the resting phase. Click to select a different label.

The system indicates the protocol and the stage in the exercise phase.

1. To finish this load stage and change to the next one, click Next.

2. To prolong the load stage, click Hold.

The system changes the color of the Hold button.

The Time in stage indicates the remaining time. See Time in stage on page 6-10.

3. To stop the hold and continue, clicking Hold or Next again.

To switch off the load, click Stop Load.

To switch on the load, click Start Load.

To quit the stress test prematurely, click End Test.

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Enable load display as interpolated values


2. Select Bicycle Stress Test. 3. Open the Exercise Settings tab, and select Interpolation of

reached load.

Note: Do not use this function, if the setting Always complete current stage on end of exercise is active.

Note: Ramped protocols are not interpolated. The actual value is displayed.

4. To see the interpolated load value, hold the mouse over the percentage pie chart.

5. To change the indication from percentage to wattage, click into the circle.

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Detailed procedures

Detailed proceduresThis section contains detailed procedures for acquiring stress tests.

Search for a patient or enter a new patient◆ To search for a patient, see Search for a patient on page 2-3.

◆ To enter a new patient, see Add a new patient on page 2-5.



◆ Click Treadmill Test Bruce or press the keyboard shortcut (Ctrl + 1 starts at the top of the list) or select Start | Bicycle Stress Test Standard and select the procedure.

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Device selectionThe device selection window displays if either no or several acquisition devices or exercise equipment are set.

To select the device

1. Select the devices.

• To select a device: click the device.

• To scroll: click in the list and use the arrow keys to scroll to the device.Note: Each Bluetooth wireless devices paired with this system displays on the selection screen; be sure to power on the wireless device you are using.

2. Click Continue or press F2.

You can continue only if an ECG acquisition device and an exercise device are set.

Device To set up the test:

ECG Acquisition device • Click on the device that you want to use.

For information on selecting the acquisition devices see the CareCenter MD™ System Setup Guide.

Treadmill or Bicycle • Click on the exercise equipment that you want to use.

If the list is empty, set one or several exercise equipment.

For information on connecting and configuring exercise equipment, see the CareCenter MD™ System Setup Guide.

Blood Pressure Meter • You can carry out the stress test if no blood pressure meter is set. In that case, the automatic blood pressure measurement is disabled.

• At the times set in the protocol, a request for manual blood pressure measurement displays.

• For more information connecting and configuring blood pressure meters, see the CareCenter MD™ System Setup Guide.

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Detailed procedures

Stress test parametersBefore the start of a stress test, the Stress Test Parameters display. Complete the fields to set the parameters for the stress test.

Patient Details Corrections to the patient's data are automatically entered in the patient's data tab. Ensure that size, weight, and age are entered.

Order Entry The medication entries from the patient’s data tab are displayed. Correct them if necessary. Text modifications automatically entered in the patient's data tab.

1 23

4 5

6 71 Patient Details2 Order Entry3 Workflow4 Annotations5 Protocol6 Print7 Blood pressure measurement

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Workflow The user that is logged displays as the technician. The Requesting Department is pre-populated from the Order information, if applicable.

To change the workflow:

1. Select a technician from the menu.

2. Select the Requesting Department from the menu.

Annotations You can select the messages that display and set the notification thresholds. The changes are used only for the current test procedure. For the next test procedure, the defaults are restored.

Protocol When you start a treadmill stress test or a bicycle stress test all applicable stress test protocols are available for selection.Note: When creating or modifying a bicycle exercise protocol for stress testing, the user should set the load values for Recovery to zero (0).

A stress test protocol is assigned to a test procedure in: File | Options… | 12 Lead ECG | Test procedures and select the stress test and then change the Exercise Settings.

To... Do this...

Enable warning messages • Select the option.

If the option is enabled, a warning message displays when the limit value is exceeded.

Change the threshold value • Click in the field and enter the new value or use the arrow keys to scroll the values.

Change the heart frequency percentage

• Click 100%.This toggles the Heart Rate field between absolute value and percentage.

To... Do this...

Use a different protocol • Select the protocol from the list.

If the list contains no suitable protocol, you can change a protocol.

Change the default protocol • Select: File | Options… | 12 Lead ECG | protocols.

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Detailed procedures

Print Select the printing options. The changes are used only for the current test procedure. For the next test procedure, the defaults are restored. The basic settings depend on the stress test protocol set.

For a treadmill stress test

Move the whole exercise protocol up or down

• Change the speed.

Increase or decrease the slope • Change the grade.

View the exact exercise protocol

• Point to any place in the protocol.

For a bicycle stress test

Move the whole load protocol up or down

• Change the start load.

Increase or decrease the slope • Change the end load.

View the exact load protocol • Point to any place in the protocol.

To... Do this...

Disable printing • Clear the printing options.

The rhythm queue prints one, two, or three channels. Depending on the printing parameters, it can take several minutes until a complete page is printed.

Print the averaged beat instead of 10-second ECG

• Select Averaged Beat.

To... Do this...

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Blood pressure measurement Select the blood pressure measurement options. Some options are available only if you use an automatic blood pressure meter.

If the automatic blood pressure measurement is disabled, the system prompts for whether or not manual measurement should display instead of the automatic measurement at the times set in the protocol.

To... Do this...

Disable the automatic blood pressure meter

• Clear Automatic BP measurement.

As soon as an automatic blood pressure measurement is completed, a confirmation dialogue with the measured values is displayed.

Disable the confirmation prompt during automatic blood pressure

• Clear Show confirmation dialogue.

Enable manual blood pressure measurement

• Select Prompt for manual BP measurement to activate this function.

If no blood pressure measurement is set in the protocol, this function is not available.


Edit the technician list • Select File | Options… | General | Technicians.

Edit the list of departments • Select File | Options... | General | Departments.

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Detailed procedures

Apply the electrodes◆ Click Continue or press F2. to continue with the stress test.

Prepare the patient and apply the electrodes as described on Apply electrodes on page 3-14. If filters are necessary, see ECG filters on page 3-17. In addition:

◆ Apply the arm electrodes on the back position above the scapula and the limb electrodes above the waist-line.

◆ Fix the electrode cables with an adhesive tape immediately near the electrode.

◆ If possible do not use EMG (muscle artifact) filter and Mains (AC line) filter.

◆ Familiarize patient with the process before you start the Stress Test.

Safety instructions for the treadmill stress testStart the treadmill walking belt on the lowest speed and grade settings. The patient stands on the side of the deck or straddles the walking belt. While holding the handles, the patient steps first with a foot onto the treadmill and then moves the other foot onto the treadmill.


Never start the treadmill if the patient is already standing on the belt. There is acute danger of falling and physical hazard.

For this equipment Use this procedure

Treadmill The start speed and the grade for the resting phase are automatically set. The treadmill is stopped.

1. Show the patient how the treadmill works.

2. Start the treadmill and vary speed and grade for a short time. 3. Stop the treadmill again.4. Explain the function of the emergency stop switch. 5. Show the patient how to mount the treadmill.

Bicycle The start load for the resting phase is automatically set.

1. Adjust the saddle height and the position of the handle bar.

2. Explain to the patient that he or she should pay attention to the indication for the speed range.

3. Let patient pedal for a short time.4. If necessary, increase or decrease the load to accustom the

patient to it.

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Start the stress test

!Caution: Patient injury

To prevent injury from the treadmill starting unexpectedly or at the wrong speed, always have the patient straddle or stand on the side of the treadmill until the treadmill is running at the correct speed. Never start the treadmill with the patient on the treadmill.

To start the stress test:

1. Click Start Test or press F2.

The button is only active if no electrode errors are indicated.

The system exits the electrode application scheme and changes to the resting phase of stress test.

The ECG is saved from the start of the stress test until the end.

2. If electrode errors are indicated and the orange Start Test button is disabled, you can still start the test.

a. Click Start Test or press Ctrl + S.

In this case, the analysis program is not available. The system displays a message.

b. Click Work without measurement.

3. Observe the system until the system indicates an averaged beat.

4. To repeat the averaged beat calculation if the quality of the indicated averaged beat is insufficient click Relearn.

If the signal is very distorted or if the electrodes are incorrect, the system displays an error message.

a. Check all 12 lead channels to improve the signal quality.

b. Click on Retry to restart the averaged beat calculation.

Alternatively, you can start the whole exercise without the measurement program. In this case, the system does not perform ST calculations. There is no arrhythmia analysis and no beat classification. The Arrhythmia and Averaged Beat panels remain empty.

5. If the gender and the age of the patient has not been entered, the system displays an error, click Edit patient data and retry.

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Detailed procedures

6. The stress test depends on the type of exercise equipment.

7. To measure the blood pressure in the resting phase, start the blood pressure meter or enter a blood pressure value using the keyboard.

See Display elements on page 6-9.

8. After the blood pressure displays, start the exercise phase.

Start the exercise phase

To start the exercise phase:

1. Click Start Exercise or press F2.

The system changes to the exercise phase of the Stress Test. The system executes the stress test protocol automatically.

• For a Treadmill—The treadmill is automatically accelerated until the speed of the first stage is reached. Inform the patient about the start of the treadmill.

• For a Bicycle—The start load for the first stage is automatically set.Note: To ensure all data is printed in the report, print the report only after the last step in the ramped protocol is completed.

At the times specified in the protocol:

• The system saves ECG strips of 10 seconds.

• The system measures the blood pressure.

The system indicates the start of the automatic blood pressure measurement by the rotating progress indication on the left of the BP field. As soon as an automatically measured blood pressure value is taken, the measurement is indicated in the New BP measurement dialog box and is saved automatically after 10 seconds.

For this equipment Do this...

Treadmill The start values for the resting phase are automatically set. When the treadmill is not running, the digits for speed and grade are grey.

To warm up the patient in the resting phase:

1. Start the treadmill.

2. Ask the patient to step on to the treadmill.

Follow the safety instructions for the treadmill.

3. If necessary, change speed and grade.

Bicycle The start load for the resting phase is automatically set.

To warm up the patient in the resting phase:

1. Ask the patient to start pedaling.

2. If necessary, change the load.

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a. To accept the indicated value and close the dialog box:

– In the automatic dialog box, click Save (auto in n). (Where n is the countdown timer.)

– In the manual dialog box, click Save.

b. To correct the values, click in the field and reenter the value.

c. To enter a remark, or select one from a list of predefined texts in the automatic or the manual blood pressure dialog box.

d. To stop the display of the automatic blood pressure measurement dialog box, select Don't show this dialogue again, save immediately.

e. To stop the system from taking automatic blood pressure measurements, select Do not measure BP automatically anymore.

The system prompts you to enter manual blood pressure measurements 45 seconds before the time that is set in the protocol.

f. To enter the measured blood pressure values manually, enter the value in the measurement box.

2. To change the settings for the automatic blood pressure measurement during the exercise:

a. Select Settings | BP....

b. To stop the display of the automatic blood pressure measurement dialog box, clear Show confirmation dialogue.

c. If the automatic blood pressure meter is disabled, select Prompt for manual BP measurement.

The system prompts you to enter the blood pressure manually.

3. To stop the treadmill at any time during the test:

a. Inform the patient that the treadmill will be slowing and stopping.

b. Click Stop Belt.

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Detailed procedures

Start the recovery phase

To stop the exercise:

◆ Click Start Recovery or press F2.The system changes to the recovery phase of the stress test.

• For a Treadmill—the speed and the slope are set to the values selected for recovery.

• For a Bicycle—the load is set to the value selected for recovery.

The system prompts you to enter an abort reason.

a. Click Stop exercise to enter the recovery phase and stop the test.

b. Click Resume exercise to go back into the exercise stage.

If the exercise phase is not stopped prematurely, the system automatically changes to the recovery phase.

End the stress test

!Caution: Patient injury

To prevent injury from the treadmill stopping suddenly, always inform the patient before stopping the treadmill.

◆ Click End Test or press F2.The stress test is finished. The ECG is displayed for review.


Add new entries to the list of abort reasons

• Select File | Options… | 12 Lead ECG | Abort Reasons.

Allow the current stage to complete and then move to the recovery phase


2. Select the test procedure. 3. Select the Exercise Settings tab and select Always

complete current stage on end of exercise under protocol. Note: When the system prompts for an abort reason, click Stop and the end of the stage.

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Review the record

After completion of the stress test the record is displayed for review.

As long as the electrodes are connected to the patient, the running ECG is displayed in the rhythm line.

For more details, you have more representations.

◆ Click one of the view buttons or select View and select a view. • Rhythm—representation as shown above

• ECG—complete ECG, multi-channel, averaged beat and trend

• ECG Strip—ECG strip, averaged beat and trend

• Trend—trend charts and complete multi-channel ECG

• ST Trend—trend charts, averaged beat and complete multi-channel ECG

• Summary—result table, ECG strip, averaged beat and trend

Also see Chapter 10, Display a Stress Test ECG Record.

Print the record


Save the record

After completion of the test, the final default workflow step is saving the test.

1. Click Save or press F2.

Before saving, the system displays a message with the data of the active patient.

If the patient data does not correspond with the real data, you have three seconds to cancel the saving process.

• Click Cancel.

2. If you find out that a wrong patient was selected, you can select a different patient as the active patient, select Patient | Select patient....

For bicycle stress tests, the target load is not recomputed.

3. Alternatively, you can click Save or press Shift + F12.

4. If you do not want to save the record click Cancel or press Ctrl + X.

The system prompts you to:

a. Save—save the record for the active patient.

b. Don’t Save—discard the record. No data is saved. The program returns to the Stress Test Parameters screen.

c. Cancel—cancel the process, to continue viewing the record.

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7 Emergency ECG

Contents

◆ Settings 7-2


◆ Controls for acquiring emergency ECGs 7-5


This chapter describes how to acquire an emergency ECG. The system includes the STAT ECG (Resting 12 Lead ECG) and STAT Rhythm ECG. You can start an emergency ECG without entering patient information. The emergency ECG displays until you stop the recording.

When the emergency ECG is not assigned to a patient when it is saved, it appears on the Unassigned Recordings tab. For more information on recordings see Test procedure programs on page 3-2.

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Emergency ECG

SettingsUse these settings to configure the emergency ECG. While you can change these settings at any time, they are usually configured just once after the installation.

Recording type

The system is configured for both the STAT ECG (Resting Emergency ECG) and the STAT Rhythm ECG test procedure. The Rhythm test procedure allows you to record the ECG for a long time. During the recording or later you can select multiple ECG strips for analysis or interpretation.

Start option

You can configure the system to always start with an emergency test procedure.

Age and gender

The automatic analysis program requires the age and gender of the patient in order to calculate measurement values and perform the interpretation. Because this data may not be available for the emergency ECG, the recording includes no analysis unless you configure a default age and gender.


Allow only a single emergency procedure

• Select File | Options... | 12 Lead ECG | Test procedures clear the STAT ECG or STAT Rhythm ECG option.


Change the start up default to the emergency test procedure

1. Select File | Options... | General | Environment.

2. Select Startup with test procedure.3. Select the emergency test procedure. (STAT ECG or STAT

Rhythm ECG).


Set a default age and gender 1. Select File | Options... | 12 Lead ECG | ECG analysis.

2. Select age and gender for use in the analysis program.

Note: The output of Analysis Results uses the default gender and age for diagnosis.

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Settings

Data management

You can perform an emergency ECG without selecting an existing patient. In order to display the recording, the Unassigned Recording tab must be displayed.

Blood pressure device

All test procedures can use the automatic blood pressure device. If your system is connected to the automatic blood pressure device, you can use it in emergency test procedures.

!WARNING! Delay in analysis.

If your blood pressure device is not ready for use, you can not start the emergency recording.

For using the blood pressure device in emergency test procedure, select File | Options... | Devices the page for connected device (e.g. SunTech® Tango®+).

Select to enable for the emergency test procedure where the external device should be used.


Enable the Unassigned Recording tab

1. Select File | Options... | Database | Data management.

2. Drag the Unassigned recordings tab to the Used tab pages column.

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Emergency ECG

Operating steps - overviewThe system uses the orange (main) button (or the F2 key) to perform a standard workflow. Use the orange button (or F2) to start and save a STAT ECG acquisition. Shaded steps are optional.

Steps Selections

1 Select the test procedure. STAT ECG or STAT Rhythm ECG







EMG filter



Blood pressure meter or press Shift + F3


The button is active only if all electrodes are applied correctly.

Start or press F2

Options Start an acquisition if the electrodes are not applied correctly. Start or press Ctrl + S

Auto Resting ECG: Start the automatic timer if the acquisition is still in progress. The acquisition starts from the beginning, the previous acquisition is deleted.

Reset or press Ctrl + R

Auto Rhythm ECG: Prolong an acquisition in progress. The acquisition is extended by 30 seconds (The previous acquisition is included.)

Prolong or press Ctrl + R

4 Stop the acquisition manually. Stop or press Ctrl + T

5 Review the acquisition.

Options Repeat the recording in manual or in automatic mode. Repeat or press Ctrl + SRepeat Auto or press Ctrl + A

Confirm the diagnosis. The system adds your full name and the date and time to the diagnosis or to the remark.




Cancel without saving the record. Cancel or press Ctrl + X

7 Print the recording in the standard format. Print or Ctrl + P

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Controls for acquiring emergency ECGs

Controls for acquiring emergency ECGsTable 7-1 lists the functions available for the STAT ECG and STAT Rhythm ECG. To change the ECG display (sensitivity, recording speed, number of channels, channel position) see Change the ECG representation on page 3-19.

Table 7-1: Emergency ECG controls

Control Panels Option Function


Stop or Ctrl + T Stops the recording. You can stop the recording at any time, however, the analysis program (measurement and interpretation) needs at least 10 seconds of ECG data.

Reset or Ctrl + R Note: Resting ECG only

Restarts the automatic recording time if you had started the acquisition using Start Auto.

EMG Filter Enables the EMG muscle artifact filter. For more information see ECG filters on page 3-17.

For STAT Rhythm ECG only:

Prolong or Ctrl + R Note: Rhythm ECG only.

Prolongs the recording time if you had started the acquisition using Start Auto. The remaining time is reset to 30 seconds.

Marker or F4 Marks distinctive points within the ECG. See Controls for acquiring a Rhythm ECG on page 5-4.

Freeze Frame or F6 Stops or starts the display of multi channel ECG. See Controls for acquiring a Rhythm ECG on page 5-4.

Save 10s or F5 Saves the last 10 seconds of ECG as strip. The main measurement values are calculated and displayed. See Controls for acquiring a Rhythm ECG on page 5-4.

Start ECG strip Saves a strip with a maximum length of 30 seconds. You can label or delete this strip later. See Controls for acquiring a Rhythm ECG on page 5-4.

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Emergency ECG

Rhythmor

Printing (Click to stop)

Starts or stops continuous printing. When you click the button to start continuous printing, the button changes color and prompts Click to stop.

The system prints selected channels base on the user settings.


10sec ECG Prints the last 10 seconds of ECG in adjusted print format.

Table 7-1: Emergency ECG controls

Control Panels Option Function

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Detailed procedures

Detailed proceduresThis section contains detailed instructions on acquiring an emergency ECG.

Select the test procedureNote: If you have selected a patient in data management, this patient is NOT used for emergency ECG.

Note: If you add or remove buttons or change the order of the buttons, the keyboard shortcuts will change.

1. Choose a method to select the test procedure:

• Click the STAT ECG or STAT Rhythm ECG button.

• Press the appropriate keyboard shortcut. (Ctrl + 1 starts at the top of the list) or select Open and select the procedure.

• Select Start and then select the emergency ECG procedure.

2. If multiple acquisition devices are enabled, select the device to be used for this test procedure and click Continue or press F2.Note: Each Bluetooth wireless device paired with this system displays on the selection screen; be sure to power on the wireless device you are using.

Identifying the recordingThe system automatically generates an identification for the recording and displays it in the indication bar. The identifier consist of the term #STAT# and the date and time when the test procedure was started.

To change the patient identification:

◆ Click on the automatically generated name and enter a short description.

If you know the name of the patient, enter the patient name, however, this entry is not entered in the database, rather it is intended to assist in assigning the recording to a patient at a later time.

Assigning the recording (prior to acquisition)When performing an emergency ECG, any patient data entered for the test is replaced with the #STAT# identifier and a time stamp. Use the time stamp on printed reports to correlate to a specific patient. To assign the patient after the acquisition, see Assign the recording (after acquisition) on page 7-9.



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Emergency ECG

Start the acquisition for an emergency ECG

Choose a method to start the acquisition:

◆ Click the Start button or press F2.◆ To acquire exactly 10 seconds of ECG, click Start Auto button.

After 10 seconds the ECG can be analyzed, printed and saved. (For Rhythm Emergency ECG, the Start Auto button starts a 30 second recording.)Note: You cannot start the acquisition when Impedance is running.

Stop the acquisition

To stop the acquisition:

1. Acquire at least 10 seconds of undisturbed ECG.

2. To stop an acquisition, click the Stop button or press F2.

The last 10 seconds will be analyzed (if gender and age are available).Note: If the test has not been saved, then the system re-analyzes the ECG test whenever age and gender are changed. For automatic re-analysis:



3. If you started the acquisition using Start Auto you can stop it early: click Stop or press Ctrl + T.

To evaluate the ECG:

• For STAT ECG see Review the recording on page 4-5.

• For STAT Rhythm ECG see Review the recording on page 5-9.

Save the recordingNote: Always save the emergency ECG before printing.

To save the recording:

◆ Click the Save button or press F2. You have up to 3 seconds to cancel the save.

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Detailed procedures

Assign the recording (after acquisition)

You can assign the patient before or after the acquisition. In order to assign the recording to a patient, the patient must exist in the application database.

All recordings that have not been assigned to a patient display in Data Management on the Unassigned recordings tab.

To assign a patient:

1. Click Data management.

2. Select the Unassigned recordings tab.

For more information see Unassigned Recordings tab on page 2-15.

3. If the patient exists in the database, right-click a recording and select Assign or double-click the recording and use Search for to locate the patient.

4. To create a patient, double-click a recording and click New Patient.

For more information see Search for a patient on page 2-3.Note: Demographic information may not display in the first emergency ECG report on a new patient.

Other functions

You can view, print, or delete the recording.

To view, print, or delete the recording:

1. Click Data management.

2. Select the Unassigned recordings tab.

For more information see Unassigned Recordings tab on page 2-15.

3. Right-click a recording and select the function.

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Emergency ECG

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8 Displaying a Resting ECG Record

Contents

◆ Displaying an ECG record 8-2

◆ Measurement table view 8-11

◆ Averaged beat view 8-14

This chapter describes the Resting ECG view.

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Displaying a Resting ECG Record

Displaying an ECG recordOpen the recordings as described in Recording list on page 2-8.

ECG window

The title bar of the program shows the test procedure, the recording date and time as well as the patient's data.

Analyzed records display in a multi-panel window. To configure how the panels display, see Controls for changing the view on page 8-5.

Figure 8-1: Example of Resting ECG View

12

1 Buttons for toggling of speed and sensitivity, button for enlarging the multi-channel ECG surface and for indication of the enabled filters

2 Analysis Results panel includes measurements, diagnosis, and summary sections

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Displaying an ECG record

Controls for reviewing

Control panel Option Function


Confirm or Ctrl + B Confirms the correctness of the diagnosis or the comment:


See Chapter 11, Confirming Tests.

Compare... or Ctrl + O To compare the current record with another record for this patient:

• Click the Compare... or select View | Compare...See Opening a record for comparison on page 8-9.

Print or Ctrl + P See Print the record on page 3-27.

Preview or Ctrl + F See Print the record on page 3-27.

Save or Shift + F12 Closes the record and saves the changes.

Close or Ctrl + X Closes without saving changes.

If there are changes in the record the system prompts you whether or not to save.

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Indication bar

You can customize and save the indication of main measurement values and frontal vectors in the header. The indication of heart rate, blood pressure values, main measurement values and frontal vectors apply to an (analyzed) section.

The settings are saved and are preserved while opening other records.

To customize the indication bar from the view:

1. Right-click the indication bar and select Customize....

The system displays the customize dialog box.

2. To display a value in the header, select the check box, to hide the value in the header, select the check box to remove the mark.

Selection Example Description

HR Heart rate always refers to the actual ECG strip.

The system always calculates the heart rate by averaging over 10 seconds.

BP The blood pressure value applies to the actual time of the ECG strip.

This value is also used in the Analysis Results panel.

Main measurement values Includes all of the main measurements.

The main measurement values (for analyzed ECG strips) of the averaged beat display.

These values are also used in the Analysis Results panel and in connection with the indication of the enlarged averaged beat.

P P-duration

PR PR-interval

QRS QRS-duration

QT QT-interval

QTc Corrected QT-interval

Where: QTc = QT/ RR

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Controls for changing the view

Use the view buttons to change the arrangement within multi-split panel window.

Frontal vectors Includes all of the frontal vectors.

The frontal vectors of the P wave, the QRS complex and the T wave are also taken from the Analysis Results panel.

P P-wave vector

QRS QRS complex vector

T T-wave vector

Include vector length If you have selected a vector to display, you can specify the length of the individual frontal vectors (in mm, μV or mV).



Set the units for the vector • Select File | Options… | 12 Lead ECG | ECG | Units

Icon Option Function

Measurement Table Displays the values of the averaged beat of this strip in every lead.

• Click Measurement Table or select View | Measurement Table.

See Measurement table view on page 8-11.

Averaged Beat Displays the enlarged averaged beat of this strip in every lead:

• Click Averaged Beat or View | Averaged Beat.

Now you can measure averaged beat and correct the wave margins.

See Averaged beat view on page 8-14.

Enlarge Maximizes the current view

• Click the enlarge arrow button.

The system maximizes the current view.

Reduce Minimizes the current view:

• Click the reduce arrow button.

The system returns to the multi-split screen window.

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Analysis Results

To obtain interpreted results, the system requires a test that includes at least the leads: I, II, and V1 to V6. For a measurement, the acquisition must include leads I and II. The Resting 12 test procedure fulfils these conditions for interpretation.

The system also requires a recording with at least 10 seconds of disturbance-free ECG and patient information with at least age and gender. Age and gender may be default values.

If the system cannot analyze the data, the system displays the Summary items only.

The Analysis Results section displays these measurement values and interpretations:

◆ Heart Rate

◆ Main measurement values

◆ Angle and amplitude of the waves as well as position type

◆ Indexes

◆ QT dispersion

◆ Rhythm and diagnosis resultsNote: See Rhythm line on page 9-15 for descriptions of the characters used within the Rhythm diagram. See the Hannover ECG System HES© Physician’s Guide for more information about the ECG analysis program.


Configure the display • Select: File | Options… | 12 Lead ECG | ECG analysis and configure:

– Indication of the results of analysis in a different language

– Indication of the position types

– A simple or detailed diagram of the rhythm line

– Indication of the indexes

– Indication of the interference voltage

– Indication of the QT dispersion for all leads or for chest wall leads

– Indication of the table with pediatric ECG

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Editing the analysis for this ECG stripYou can modify the generated analysis, or add comments to the analysis.Note: You cannot modify the analysis when the system is comparing records or if the record has been confirmed.

To modify the analysis:1. Click on Diagnosis or Summary to modify the automatically generated text.

2. To insert a remark: • Enter text directly in the window.• To select pre-defined text, click Insert... and select the text.

Default terms for Rhythm, Atrial, Ventricular and Others categories are defined and you can add or change entries.

3. Click OK to complete the modification.

Resizing the Analysis ResultsYou can change the size of the Analysis Results window.


Change or add to the list of terms

• Select File | Options... | 12 Lead ECG | Diagnosis statements

To... Do this...

Increase the size • Click the enlarge arrows

Decrease the size • Click the reduce arrows

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Measuring the ECG

You can make a measurement.

Table 8-1: ECG functions

To... Do this...

Make a measurement 1. Click in the ECG.

The system displays the marking lines.

2. Drag the red line into position. 3. Drag the green line into position.

The system displays the measurement values. The time interval is always a positive value. The amplitude is given with algebraic sign.

Calculation:

Amplitude = green horizontal cursor - red horizontal cursor

Note: If the green line is below the red line, the amplitude is a negative value.

Simultaneously move both measurement markers

1. Move the pointer in between both vertical measurement markers.

The pointer changes into a double arrow.

2. Drag both markers to the desired position.

Hide the measurement markers

• Click the X in the measurement values dialog box.

The box and the measuring cursors are hidden.

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Opening a record for comparison

You can compare multiple ECG records.

To compare records:

1. Open a record.

2. Click Compare... or select View | Compare.... and select the record for comparison from the list.

3. Click OK.

The record opened for comparison displays below the already opened one.

Figure 8-2: Example of comparison

1

2

3

1 Record opened for comparison2 Button for closing of the comparative record3 Heart rate, blood pressure and main measurement values

apply to the record displayed in the upper window

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• The title bar of the program shows the unchanged data of the first opened record as well as the patient's data.

• The title bar of the comparative record indicates the date and time of the comparative record.

• Commenting, confirming, printing and blood pressure always apply to the record opened first.

• You cannot edit or print the comparison record. For example, you cannot enter comments, or change the blood pressure information.

4. To open another record for comparison, click Compare....

Each comparison record displays below the previously opened record.

5. To view the list of available comparative records:

• On the comparison record title bar, click the down arrow. You can select a record which replaces the current comparison record (i.e., which is not displayed additionally).

6. Instead of the ECG, you can display a comparison of the measurement tables and the averaged beats.


• Click Averaged Beat or select View | Averaged Beat.

7. Click X to close the comparative record.

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Measurement table view

Measurement table viewAs with the ECG view, the measurement table can be also displayed as a maximized view. To change the views see Controls for changing the view on page 8-5.

Figure 8-3: Example of the measurement table view

1

2

1 Measurement table2 Averaged beat

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For each of 12 leads, the measurement table contains these measurement values:

You can change to other views:

◆ To see the waveforms, click ECG or select View | ECG and display the options.See Displaying an ECG record on page 8-2.

◆ To view the enlarged averaged beat in every lead, to measure it and to correct the wave margins, open representation of the averaged beat.a. Click Averaged Beat or select View | Averaged beat.


Range Measurements

QRS range • Amplitude and duration of the Q, R and S waves

• Amplitude ratio between Q and R

• Amplitude ratio between R and S

• Area of the QRS range

ST and T range • ST value

• positive amplitude value of T

• negative amplitude value of T

• area of the ST and T range

P range • The first extreme value of the P amplitude

(if another extreme value is found, this is indicated, in addition)

• area of the P wave

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Measurement table view

Measurement table in comparisonIf a comparative record is open, you can compare the measurement tables of both records.

Figure 8-4: Example of measurement table comparison

Instead of the measurement table, you can display a comparison of the ECG and the averaged beat.◆ Click ECG or select View | ECG and display options.◆ Click Averaged Beat or select View | Averaged Beat.

1

2

1 Using Enlarge, the table was stretched to full window width 2 The comparative record shows table and results of analysis

at the same time

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Averaged beat viewAs with the ECG view, the Averaged Beat can display as a maximized view. To change the views see Controls for changing the view on page 8-5.

Figure 8-5: Example of Averaged beats

To toggle the leads view:

1. Right-click on one of the complexes and select the parameter to modify.

2. In the submenu, select the entry.

3. To change the zoom factor, click or in the title bar.

1

2

1 Enlarge the respective beat by double click 2 Three-channel small preview of ECG strip

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Averaged beat view

Individual views

Choose a method to change the individual view:

◆ Double-click a lead to show only this lead.

◆ Right-click and select View | 1*1 to display only the marked lead.

Figure 8-6: Example of individual view

1 2

31 Automatically computed and manually corrected wave

points over 12 leads2 Measurement values of the P wave, the QRS and the T wave

over all 12 leads 3 QRS measurement values of this lead (corresponds to

measurement values in the QRS range in the table)

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Changing the lead

Figure 8-7: Example of lead buttons

◆ Click one of the buttons.

The button S toggles the superposition view.

◆ Right-click and select Leads | <lead>

Changing the zoom factor◆ Click or in the title bar.

◆ Right-click and select Zoom | <zoom factor>.

Changing speed or sensitivity◆ Right-click and select Speed | <speed>.

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Averaged beat view

Superposition

To show all leads in a cascaded format, right-click and select View | Superposition.

Figure 8-8: Example of Superposition

Measuring the complex

See Measuring the ECG on page 8-8.

1 23

1 The selected lead is highlighted with a bold line in the average beat rate

2 In the Superposition representation, an especially exact correction of the wave points is possible

3 Temporal distance and amplitude difference between both red and green measuring lines

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Wave margins

The wave margins ascertained by the system are marked by red marks. From the difference between these marks, the main measurement values P, P Q, QRS and QT as well as the values of QTc derived from them are determined.

Locate the wave margin table of the displayed lead on the upper of the screen. You can correct the wave margins by moving the marks.

1. Click on the mark and drag it to the desired position.

As soon as you have moved a mark, new values from the changed wave margins are entered on the bottom line.

2. Click OK to accept the new values.

The manually ascertained values are taken over in the upper line and marked with MAN. From now on, the system uses only these values.

The AUTO | MAN button is a changeover switch.

3. Click on MAN if you want to clear the manual values and display the automatically ascertained values again.

You can toggle between the manually and the automatically ascertained values.

QRS configuration

Locate the QRS configuration of the displayed lead in the QRS display on the upper right of the screen. The recognized waves are given in their order:

The measurement values to the waves are given in the table at the lower edge of the QRS display. These values are an extract from the Measurement table view on page 8-11.


Change the QRS units • Select File | Options… | 12 Lead ECG | ECG | Units.

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9 Displaying a Rhythm ECG Record

Contents

◆ Displaying a Rhythm ECG record 9-2

◆ ECG view 9-12

◆ Rhythm view 9-14

This chapter describes the Rhythm ECG view.

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Displaying a Rhythm ECG Record

Displaying a Rhythm ECG recordOpen the records as described in Recording list on page 2-8.The ECG and Rhythm views give an overview of the entire recording. The ECG Strip, Measurement Table and Average Beat views apply to a section within the recording.

To... Do this...

Change the view • Select View | <view setting>.

Save your settings • Select View and enable Use current view as default.

The saved view is the opening screen when you access a rhythm record.

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Displaying a Rhythm ECG record

Rhythm ECG window

The title bar of the program displays the test procedure, the recording date and time as well as the patient's data. The records are displayed in a multi-panel window:

Figure 9-1: Example of Rhythm ECG window

1

23

1 Analysis Results panel shows results of analysis of the selected strip

2 Average beat panel rate computed by the analyzer from the ECG of the selected strip

3 Multi-channel ECG of the whole record

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Control panel Option Function


Confirm or Ctrl + B Confirms the correctness of the diagnosis or the comment.


For more information see Chapter 11, Confirming Tests.

Compare... or Ctrl + O To compare the current record with a former record for this patient:

• Click the Compare... or select View | Compare...See Opening a record for comparison on page 8-9.



Save or Shift + F12 Closes the record and saves the changes.

Close or Ctrl + X Closes without saving changes.

If there are changes in the record the system prompts you whether or not to save.

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Indication bar

You can customize and save the indication of main measurement values and frontal vectors in the header. The indication of heart rate, blood pressure values, main measurement values and frontal vectors apply to an (analyzed) section.

To customize the indication bar from the view:

1. Right-click the indication bar and select Customize....

The system displays the customize dialog box.

2. Display or hide a value in the header.

• Select the check box to display the value.

• Clear the check box to hide the value.


HR Heart rate always refers to the ECG strip. The selected tab indicates the time of the ECG strip.

For analyzed records, the system always calculates the heart rate by averaging over 10 seconds.

BP The blood pressure value applies to the selected ECG strip.

Main measurement values Includes all of the main measurements.

The main measurement values (for analyzed ECG strips) of the averaged beat display.

These values are also used in the Analysis Results panel and in connection with the indication of the enlarged averaged beat.

P P-duration

PR PR-interval

QRS QRS-duration

QT QT-interval

QTc Corrected QT-interval

Where: QTc = QT/ RR

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Frontal vectors Includes all of the frontal vectors.

The frontal vectors of the P wave, the QRS complex and the T wave are also taken from the Analysis Results panel.

P P-wave vector

QRS QRS complex vector

T T-wave vector

Include vector length If you have selected a vector to display, you can specify the length of the individual frontal vectors (in mm, μV or mV).



Set the units for the vector • Select: File | Options… | 12 Lead ECG | ECG | Units.

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Analysis Results

To obtain interpreted results, the system requires a test that includes at least the leads: I, II, and V1 to V6. For a measurement, the acquisition must include leads I and II. The Rhythm 12 test procedure fulfils these conditions for interpretation.

The system also requires a recording with at least 10 seconds of disturbance-free ECG and patient information with at least age and gender. Age and gender may be default values.

If the system cannot analyze the data, the system displays the Summary only.

The Analysis section displays these measurement values and interpretations:

◆ Heart Rate

◆ Main measurement values

◆ Angle and amplitude of the waves as well as position type

◆ Indexes

◆ QT dispersion

◆ Rhythm line and diagnosis statementsNote: See Rhythm line on page 9-15 for descriptions of the characters used within the Rhythm diagram. See the Hannover ECG System HES© Physician’s Guide for more information about the ECG analysis program.


Configure the display • Select: File | Options… | 12 Lead ECG | ECG analysis and configure:

– Indication of the results of analysis in a different language

– Indication of the position types

– A simple or detailed diagram of the rhythm line

– Indication of the indexes

– Indication of the interference voltage

– Indication of the QT dispersion for all leads or for chest wall leads

– Indication of the table with pediatric ECG

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Editing the analysis for this ECG stripYou can modify the generated analysis, or add comments to the analysis.Note: You cannot modify the analysis when the system is comparing records or if the record has been confirmed.

To modify the analysis:

1. Click on Diagnosis for this ECG strip or Summary to modify the automatically generated text.

2. To insert a remark:

• Enter text directly in the window.

• To select pre-defined text, click Insert... and select the text.

Default terms for Rhythm, Atrial, Ventricular and Others categories are defined and you can add or change entries.

3. Click OK to complete the modification.

Resizing the Analysis ResultsYou can change the size of the Analysis Results panel.


Change or add to the list of terms

• Select File | Options... | 12 Lead ECG | Diagnosis statements.

To... Do this...

Increase the size • Click the enlarge arrows

Decrease the size • Click the reduce arrows

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Use the view buttons to change the arrangement within multi-panel window.


Rhythm Displays an overview of the whole record with a 1- channel ECG.

• Click Rhythm or select View | Rhythm.

See Rhythm view on page 9-14.

ECG Displays an overview of the whole record (multi-channel).

• Click the ECG button or select View | ECG.


ECG Strip Displays the saved strips (one strip per tab).

• Click ECG Strip or select View | ECG Strip and select the display options.

Measurement Table Displays the values of the averaged beat of this strip in every lead.


See Measurement table view on page 8-11.

Averaged Beat Displays the enlarged averaged beat of this strip in every lead.

• Click Averaged Beat or View | Averaged Beat.

Now you can measure averaged beat and correct the wave margins.


Enlarge Maximizes the current view.

• Click the enlarge arrow button.

The system maximizes the current view.

Reduce Minimizes the current view.

• Click the reduce arrow button.

The system returns to the multi-split screen window.

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Display functions

Table 9-1 describes the functions available from the ECG view and Rhythm view.

Table 9-1: Rhythm control functions

To... Do this...

Change the line spacing (line height)

Note: Rhythm view only.

1. Position the cursor exactly between two lines.

2. Drag the line to the correct height.

The system controls the minimum line height.

The maximum line height depends on the length of the recording.

Change leads 1. Position the pointer on a lead name.

2. Right-click and select the lead from the menu.

Change the waveform position

1. Position the pointer on the lead name.

2. Drag the line to re-position the waveform.








1. In the title bar, click the Select 10 seconds ECG icon.



The selected ECG strip displays in grey in the time bar or the rhythm strip. Depending on the speed, the grey range can be greater or smaller than the visible range.

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1. In the title bar, click the Select variable length ECG. icon.





Select a strip Use the strips for the evaluation of the rhythm record. There is a tab for every saved strip.

1. To see the strips one after the other, click the right and left arrows.

2. Position the pointer on the tab to see the printing state and the name of the strip.

The system displays the start time as the tab label.

Edit a strip 1. Right-click on a tab or click on a strip in the ECG view and select Edit.

2. Enter a short, clear name or edit the existing name and click Save.

3. To print or preview this strip, click Print and select ECG or Averaged Beat.

To change the printing format and the parameters select Settings | Print....


To... Do this...

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ECG viewThe ECG view shows the ECG in the main display as a multi-channel representation. To navigate in the whole record, see Navigating in the ECG display on page 9-13. To change the number of channels visible at the same time or to change the lead order, right-click and select from the menu.

To change the display characteristics, see Change the ECG representation on page 3-19.

You can mark sections of at least 10 seconds in length.

Figure 9-2: Example of ECG view

1

2 31 Display the whole multi-channel ECG (by moving) in this display2 The ECG slider control3 The ECG time bar. The black frame symbolizes the position of the

ECG visible in proportion to the whole record

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ECG view

Navigating in the ECG display

The rectangular frame (see item 3 in Figure 9-2) symbolizes the position of the ECG that is visible.

Choose a method to change the position of the visible ECG:

◆ Drag the slider on the ECG time bar.

◆ To move the ECG continuously, click the ECG slider control and move the control element to the left or to the right.

Moving the ECG slider, moves the ECG in proportion.

◆ Click on any place on the time bar to position the multi-channel ECG to this time.

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Rhythm viewThe Rhythm view shows the rhythm strips in the main display. The beginning times of every ECG line are indicated to the left of the rhythm strip. The times apply to the start of the recording. The lead names display in every line.

Figure 9-3: Example of Rhythm view


Configure display channels 1. Select File | Options... | 12 Lead ECG | Test procedures.2. Select the rhythm procedure.3. Select Display | ECG rhythm.

If the lead in the rhythm line is changed during the acquisition, then these settings are overwritten.

1 2

3

4

51 Tab for the selection of a strip2 Heart rate, blood pressure and main measurement values

of the currently selected section3 The actual ECG strip in the rhythm strip highlighted in red4 Multi-channel ECG of the currently selected strip5 Scroll bar to navigate in the ECG strip

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Rhythm view

Rhythm line

A rhythm statement displays in the analysis section. The QRS complexes found are represented in a rhythm diagram below this line by characters.

In addition, the QRS are also marked in the ECG rhythm line in the lower edge of the printout. These characters can differ from the markings of the QRS complexes in the above-mentioned rhythm diagram.

According to the settings, the complex types are symbolized by the following characters:

ECG line

Rhythm diagram

Simple Complex

Dominant N1 + +

Dominant with abnormal P and T wave N1 + o

Dominant with abnormal P wave N1 + p

Dominant with abnormal T wave N1 + t

Dominant with base line variation N1 + b

Dominant with abnormal RR interval N1 + r

Dominant at 10-seconds margin N1 + i

Extrasystole type 1 V1 V 2



Aberrant A A A

Disturbed complex X X X

Pacemaker P P P


Configure the display of the rhythm diagram

1. Select File | Options... | 12 Lead ECG | ECG analysis.

2. For Create rhythm diagram, select:

– No—to hide the rhythm diagram

– Simple—to show the simple diagram

– Complex—to show the complex diagram

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Beat classification in the ECG

In the resting ECG and in the exercise ECG, the beat types can be indicated in the ECG. In the rhythm ECG, the beat classification can be indicated only for saved sections.

Marking in the ECG

Used in

Rest Stress

Dominant N1

Dominant 2 N2 --

Dominant undetermined N3 --

Extrasystole T1 V1

Extrasystole T2 V2

Extrasystole T3 V3

Extrasystole T4 V4 --

to

Extrasystole T20 V20 --

Further extrasystoles V21 --

SVES S --

Escape Systole E --

Aberrant A

Complex with disturbance X

Pacemaker complex P

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10 Display a Stress Test ECG Record

Contents

◆ Displaying the stress test ECG record 10-2

◆ ECG view 10-7

◆ Rhythm View 10-10

◆ ECG strip view 10-13

◆ Trend view 10-15

◆ ST Trend view 10-17

◆ Summary view 10-19

This chapter describes the stress test views.

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Display a Stress Test ECG Record

Displaying the stress test ECG recordOpen the tests and records as described in Recording list on page 2-8.

The title bar of the program shows the test procedure, the recording date and time as well as the patient's data.




Confirm or Ctrl + B Confirms the correctness of the diagnosis or the comment:


For more information see Chapter 11, Confirming Tests.

Compare... or Ctrl + O To compare the opened record with an former record of the patient:

• Click the Compare... or select View | Compare...For more information see Opening a record for comparison on page 8-9.



Save or Shift + F12 Saves the changes.

The record is closed. The changes you have carried out are saved.

Close or Ctrl + X Closes without saving changes:

If changes were carried out in the record, the system prompts you again to Save or Don't save.

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Displaying the stress test ECG record


Use the view buttons to change the arrangement within multi-split panel window.


Rhythm Displays an overview of the whole record with a 1- or 2-channel ECG.

• Click Rhythm or select View | Rhythm.

See Rhythm View on page 10-10.

ECG Displays an overview of the whole record (multi-channel).

• Click the ECG button or select View | ECG and select the display option.


ECG Strip Displays the saved strips (usually one section per exercise stage).

• Click ECG Strip or select View | ECG Strip and select the display option.

See ECG strip view on page 10-13.

Trend Displays the charts of workload, heart rate and ST values.

• Click Trend or select View | Trend.

See Trend view on page 10-15.

ST-Trend Displays the average beats with ST measurement.

• Click ST-Trend or select View | ST-Trend.

See ST Trend view on page 10-17.

Summary Displays the result table and summary.

• Click Summary or select View | Summary and select the display option.

See Summary view on page 10-19.

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Indication bar

!Caution: Data truncation.

If all display elements are selected for a stress test, some items will be truncated if the display is at the minimum screen resolution.

Field or option Description

The displayed heart rate refers always to the actual time.

The actual time is indicated farther on the right.

The displayed blood pressure value applies to the actual time. The time of the measurement can be a maximum of 1 minute before the actual time.

The displayed double product of heart rate x blood pressure value applies to the actual time.

The system indicates the name of the actual stage and the time in the actual stage.

For a treadmill stress test The system indicates the grade of the treadmill during the

actual exercise phase.

The system indicates the speed of the treadmill during the actual exercise phase.

For a bicycle stress test The load values of the actual load stage are indicated.

The system indicates the actual time as the total time elapsed in the exercise phase. If the cursor is placed in the recovery phase, the total time of the exercise phase displays here.

In recovery, the system displays a time, as soon as the cursor is in the recovery phase. The time since end of the exercise is indicated.

Stage 4

0:15Grade

20.0%

Speed

5.6 mph

Exercise

15:15

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Displaying the stress test ECG record

Display functions

Table 10-1 describes the functions available from the ECG view and Rhythm view.

If enabled the metabolic index displays during the recording.

If enabled the RPE (rate of perceived exertion) display during the recording.

Field or option Description


To... Do this...

Change the line spacing (line height)

Note: Rhythm view only.

1. Position the cursor exactly between two lines.

2. Drag the line to the correct height.

The system controls the minimum line height.

The maximum line height depends on the length of the recording.

Change leads 1. Position the pointer on a lead name.

2. Right-click and select the lead from the menu.

Change the waveform position

1. Position the pointer on the lead name.

2. Drag the line to re-position the waveform.







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1. In the title bar, click the Select 10 seconds ECG icon.



The selected strip displays in grey in the time bar or the rhythm strip. Depending on the speed, the grey range can be greater or smaller than the visible range.


1. In the title bar, click the Select variable length ECG. icon.





Select a strip Use the strips for the evaluation of the test record. There is a tab for every saved strip.

1. To see the strips one after the other, click the right and left arrows.

2. Position the pointer on the tab to see the printing state and the name of the strip.

The system displays the start time as the tab label.

Edit a strip 1. Right-click on a tab or click on a strip in the ECG and select Edit.

2. Enter a short, clear name or edit the existing name and click Save.

3. To print or preview this strip, click Print and select ECG or Averaged Beat.

To change the printing format and the parameters select Settings | Print....


To... Do this...

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ECG view

ECG viewIn the main display, the ECG displays in multi-panel representation. Using the elements described in this section, you can navigate across the whole record.

To change the number of the channels visible at the same time and the lead order, right-click in the display. Changing the sensitivity / speed, moving lead positions, changing leads and changing the view is described in Change the ECG representation on page 3-19.

To mark sections, you can select between 10 seconds and any length.

To change the view:

1. Select View | ECG.

2. Select the view orientation:

• ECG and Averaged Beat and Trend (See Figure 10-1 upper screen)

• ECG and Averaged Beat and Trend (widescreen) (See Figure 10-1 lower screen)

3. To save your setting, select View | Use current view as default.

From now on, the saved view is used as opening screen on opening a stress test record.

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Figure 10-1: Example of ECG views

1

2 3

23

4

4

1 ECG strip panel— ECG strip reflects the saved 10 second strip for the selected tab

2 Average beat panel—Average beat rate at the actual time (on the bottom left)

3 Trend panel—The actual time is synchronized in the trend window, in the average beat rate and in the ECG window

4 Time bar with marking of the currently selected strip (red) and all saved strips (blue)

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ECG view

Navigating in the ECG Display

The rectangular frame in the time bar symbolizes the position of the ECG visible on top within the whole record.

Choose a method to change the position of the visible ECG:

◆ Drag the slider on the ECG time bar.

◆ To move the ECG continuously, click the ECG slider control and move the control element to the left or to the right.

Moving the ECG slider, moves the ECG in proportion.

◆ Click on any place on the time bar to position the multi-channel ECG to this time.

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Rhythm ViewThe rhythm view shows the rhythm strips in a multi-panel window.

Figure 10-2: Example of Rhythm view

1 23

1 Marking of the actual time (time of the average beat rate and marking in the trend window - here in exercise phase 5:53)

2 Details in the indication bar apply to the actual time3 Multi-channel ECG of the selected and marked ECG strip (here

in rest at 1:50)

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Rhythm View

Marking of the phases

The system indicates the beginning times of each ECG line in the left margin of the rhythm window. The times always apply to the beginning of a phase.

The background color of this time bar marks the phase in the record:

◆ grey—resting phase

◆ red—exercise phase

◆ yellow—recovery phase.

The same color coding is on the bottom of the tabs and in the footer of the trend chart.

Actual time

The actual time is marked with a vertical line in the ECG.

The Averaged Beat panel shows the phase and the actual time on the bottom left.

The Trend panel draws a blue vertical line which indicates the whole time (not the time per phase).

◆ To change the actual time, choose a method:

• in the rhythm display by moving the vertical sliders

• in the ECG display by horizontal moving of the cursor

• in the header by clicking a tab

The other panels are synchronized to the new time.

ECG strip panel

The ECG strip currently marked in red (corresponds to the marked tab) is shown in a multi-channel ECG display on the top right panel.

Use all functions which are available in the multi-channel display, such as:

◆ change sensitivity and speed

◆ change the view

◆ hide and move channels

◆ change channels

◆ measure waveforms

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Averaged Beat panel

The averaged beat is indicated at the actual time. The time indicated on the bottom left corresponds to the time of the vertical marking in the rhythm display.

◆ You can change these functions by right-clicking:

• the speed and sensitivity

• the zoom factor (sensitivity, speed and background grid are changed proportionally)

• the ST measuring point for acquisition

• the view

• the distance of the reference beat

For more information see Averaged Beat panel on page 6-5.

Trend panel

In the Trend panel, the actual time is marked by a vertical blue line.

Position the mouse pointer in the trend panel to show the numerical measurement values at the place of the mouse pointer.

1. To exclude a measurement, right-click and select the measurement to exclude.

2. Click refresh in the header, to view different groups of measurement values.

Changing ECG parameters and view

To change the ECG parameters and view

1. Right-click in the ECG and select Speed, Sensitivity, or other function.

2. You can also use the buttons on the header to change the parameters or view.

3. Choose an option for ECG event labels:

• Label the rhythm lines with the beat classification

• Show arrhythmia events

• Hide the labels

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ECG strip view

ECG strip view

Figure 10-3: Example of ECG Strip view

Selecting strips

Use the ECG strips for the evaluation of the exercise record. For every saved strip, there is a tab.

To select the strips:

1. To see the strips one after the other, click the forward/backward arrows.

2. To see the printing state and name of the strip, position the mouse pointer on the tab.

3. Click the tab to open the ECG display of a strip.

21

3

1 Using the arrow buttons, you can see the sections (strips) one after the other

2 By clicking the tab you can open to the ECG of the related strip3 ECG strip selected with the marked tab

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Viewing ECG strip

In the large multi-channel ECG display, the system shows the selected ECG strip.

If you gave a name on saving, it is indicated on the upper left of the display.

Use the standard functions for multi-channel ECG display:

◆ change sensitivity and speed

◆ change the view

◆ change or hide channels

◆ change channel positions

◆ measure waveforms

Right-click to select the beat types or the arrhythmia results.

Averaged Beat panel

The averaged beat is indicated at the actual time. The time indicated on the bottom left corresponds to the time of the selected ECG strip.

◆ You can change these functions by right-clicking:

• the speed and sensitivity

• the zoom factor (sensitivity, speed and background grid are changed proportionally)

• the ST measuring point for acquisition

• the view

• the distance of the reference beat

For more information see Averaged Beat panel on page 6-5.

Trend panel

In the Trend panel, the actual time is marked by a vertical blue line.

Position the mouse pointer in the trend panel to show the numerical measurement values at the place of the mouse pointer.

1. To exclude a measurement, right-click and select the measurement to exclude.

2. Click refresh in the header, to view different groups of measurement values.

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Trend view

Trend viewNote: To see the exact values for the Exercise time, Speed, Grade (or Load), and METs, use the mouse to trace the graph.

Figure 10-4: Example of Trend view

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Tab operation

Use the tabs as described in Selecting strips on page 10-13 to see the ECG strip at the end of each stage and to mark the respective time in the charts.

In each case, the four charts show a group of measurement values.

1. Right-click in each of four charts and select the parameters to exclude from the indication.

2. To indicate the values computed in every 10-second section (unsmoothed waveform) right-click in both ST charts and clear Display smoothed ST-Values.

3. To see the change of the ST values during the acquisition right-click in both ST charts and select Display ST Value relation to reference.

The whole multi-channel ECG in the upper window can be used for scrolling of the record or to control the marked sections.

4. Right-click to change Speed, Sensitivity, Sheet or the ECG event labels.

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ST Trend view

ST Trend viewECG windows and trend chart are synchronized. The use of the tabs and the multi-channel ECG corresponds to the Trend panel on page 10-14.

The main window indicates the actual averaged beat. A slider for changing of the actual time is at the bottom of the screen.

Figure 10-5: Example of ST Trend

You can change the display of the Averaged Beat panel:

To... Do this...

Change speed, sensitivity, zoom, ST measuring point, view, referenced beat, or to display an isoelectric line

• Right-click and select the option from the menu.

Position the isoelectric line vertically

• Position the mouse pointer a little bit above or below the isoelectric line and move both complexes together in vertical direction.

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The Trend panel charts show the workload trend and the ST trends. You can change the display of the ST Trend panel:

Correct the ST measurement value

• Position the mouse cursor near the isoelectric line and correct the ST measurement value.

Move the actual time • Use the horizontal scroll bar.

• Keep the buttons right or left pressed to display the average beats continuously in 10-seconds steps.

ECG windows and trend chart are updated.

To... Do this...

Change the ST values in the lower Trend chart

• Click the refresh button in the header.

Reposition the window based on time

• Click on any time to position the blue cursor on this time.

ECG window and averaged beat are updated.

Move the actual time • Click on the blue line and move the actual time with pressed mouse button.

ECG window and averaged beat are updated.

Exclude the parameters from the indication

• Right-click and select the parameters to exclude.

To indicate the values computed in every 10-second strip (unsmoothed waveform)

• Right-click and clear the Display smoothed ST-Values.

To see the change of the ST values during the acquisition

• Right-click and select the Display ST Value relation to reference.

To... Do this...

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Summary view

Summary viewThe Summary view shows a multi-panel window consisting of:

◆ result table

◆ summary of the most significant exercise data

◆ ECG strip, Averaged Beat, Trend

The heights of the summary panels can be customized by moving the horizontal separators.

To change the view select, View | Summary | Summary or View | Summary | Summary (widescreen).

Figure 10-6: Example of Summary screens

12 3

1 Button to insert predefined terms or boilerplates2 Blood pressure values can be edited afterwards (by clicking in the box)3 The table is not delimited horizontally in the view Summary (widescreen)

CareCenter MD 1.0 70-00533-02 A 10-19


Result table

You can change the display of the result table.

To... Do this...

To display the whole width of the table

• Click the expand icon.

For every exercise stage, at least one line with beginning time, beginning workload, heart rate, ST value and reason of the change-over displays.

Further lines are generated only if these events exist:

– blood pressure measurement (automatic or manual)

– saving or printing a strip

To see saved or printed strips

Saved and printed strips are marked with icons.

• Double-click the icon.

Change the channel for ST values

The channel with Worst-case or the lead V2 is used by default.

• Right-click box ST () in the header and select the desired channel

The tab for the currently selected section is highlighted in yellow by. The ECG strip window and the Averaged beat window are assigned to this time.

Edit the blood pressure values 1. Click on an existing blood pressure value and enter the corrected value.

2. To complete the input press Enter or click on another value.

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Summary view

Summary

Summary information is configured for all stress tests.

Free text and pre-defined text can be entered in the Summary.


Change summary information 1. Select File | Options... | 12 Lead ECG | ECG.

2. Change the settings in Stress Settings, Summary.

For bicycle stress tests, enable the calculation of the Target Load

• Select File | Options... | 12 Lead ECG | Test procedures | <selected stress test> | Exercise Settings. The calculation requires the input of size and weight of the patient.

Define the target heart rate • Select File | Options... | 12 Lead ECG | Test procedures | <selected stress test> | Heart Rate.

For bicycle stress tests, define the output of PWC values is defined

• Select File | Options... | 12 Lead ECG | Test procedures | <selected stress test> | Exercise Settings.

CareCenter MD 1.0 70-00533-02 A 10-21


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11 Confirming Tests

Contents

◆ Performing confirmation 11-2

◆ Revoking confirmation 11-3

Use the confirmation function to enter comments and validate the test.

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Confirming Tests

Performing confirmationConfirming or validating the test places a confirmation mark on the test. The confirmation mark includes the date and full username of the user that confirmed the test.

The system adds the confirmation mark to:

◆ The Remarks dialog box

◆ The Analysis Results window

◆ The Findings section on the printout

If the confirmation fails, verify:

◆ The confirming user is logged into the system as an active user

◆ The password is correct

◆ The user has privileges to confirm the test

For more information about integrated security, see the System Setup Guide.

To confirm a test:

1. Click Confirm or press Ctrl + B.

2. To save and close the report after the confirmation, select Immediately save and close the test on confirm.

3. Click Confirm.Note: You must have the appropriate privileges to confirm a test.

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Revoking confirmation

Revoking confirmationUse the revoke confirmation function to reset a confirmed test to modify it (for example, to add a remark, conclusion, or measurement). You can revoke a test if it is a test that you have confirmed and your privilege allows you to reset your own tests or if you have unlimited rights to reset tests.

To revoke a confirmation:

1. Click Revoke confirmation or press Ctrl + B.

Note: You must have the appropriate privileges to revoke the confirmation of a test.

2. Click Revoke confirmation for this test.

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Confirming Tests

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12 CareCenter MD Online

Contents

◆ CareCenter MD Online overview 12-2

◆ CareCenter MD Online access 12-3

◆ CareCenter MD Online display 12-5

◆ Sending and receiving text messages 12-8

Use the online feature, to quickly transfer the ECG acquisition from one or more workstations (acquiring stations) in the network to other workstations (observing stations).

You can view several acquiring workstations at the same time by adjusting the CareCenter MD Online window to remain in the foreground (on top of opened applications).

!WARNING! Patient safety.

When viewing multiple workstations, using CareCenter MD Online, take care to keep patient screens in the same order or orientations, so that you do not confuse data from multiple patients.

!Caution: Patient safety.

CareCenter MD Online is not intended as a remote patient monitor. CareCenter MD Online is for reference only.

!Caution: Misdiagnosis.

Electronic transmission errors may distort the ECG. A physician must check and confirm every measurement result and diagnosis. Use under clinical supervision only.

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CareCenter MD Online

CareCenter MD Online overviewCareCenter MD Online requires:

◆ A network installation with the transmitting and the receiving computers in the network with the system database.

◆ The transmitting workstation (acquiring workstation) that acquires the ECG using a system acquisition device.

◆ The receiving workstation (observing workstation) must have a CareCenter MD Online license. This can be a local dongle (CareCenter MD Online) or a multi-user license in the network dongle.

◆ For each workstation where CareCenter MD Online can review records, you must enable the workstation. Both the server and the workstations must have CareCenter MD Online enabled.

Figure 12-1 is an example of a CareCenter MD online reviewer sending a text message.

Figure 12-1: Example of CareCenter MD Online viewing screen

1 2 34

1 Online icons2 Online ECG viewing area3 Text message area4 Pre-defined messages


Enable the workstation for CareCenter MD Online

• Select File | Options... | 12 Lead ECG | ECG and then select Allow CareCenter MD Online clients to view this workstation.

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CareCenter MD Online access

CareCenter MD Online accessFrom CareCenter MD Online, you can select the transmitting station, configure the view and send messages between the transmitting and receiving workstations.

Starting CareCenter MD Online

To start the program:

1. Double-click the CareCenter MD Online icon on the desktop or select Start | Programs | CareCenter MD | CareCenter MD Online.

2. If the system prompts you, log in with username and password or through integrated security from CareCenter MD. See the System Setup Guide.

3. Click the pin in front icon to keep the CareCenter MD Online in the foreground, that is, always on top of all running applications.

4. Click the un-pin icon to deactivate the always-on-top-function.

This may prevent you from seeing the ECG acquisitions.

Selecting the transmitting station

The available transmitting stations display as buttons above the ECG field. A button displays as soon as CareCenter MD launches on the workstation; it does not matter which ECG test was opened.

1. Click the button for the transmitting workstation.

When you select a workstation, the button is activated and changes color to orange. To disconnect from the transmitting workstation, click the button again.

2. To send messages to the transmitting workstation, click Message. (See Transmitting messages on page 12-8).

When ECG acquisition starts, the selected lead program displays in the header of the ECG window. The system also displays:

• The name of the workstation

• The name of the selected test procedure

• The patient's number, name and age

• The heart rate, exercise workload, and time in phase

The transmitting workstation, indicates the receiving workstation by displaying a message button labeled with the name of the receiving workstation.

Displaying a message button is NOT an acknowledgement that the ECG is being monitored.

CareCenter MD 1.0 70-00533-02 A 12-3


Exiting CareCenter MD Online

To close CareCenter MD Online from the reviewing workstation:

◆ Click Exit. When the workstation stops transmitting the ECG, the button for the workstation is disabled, to indicate the workstation is not being viewed. Note: Remote users should exit CareCenter MD Online before the local user logs out of CareCenter MD and logs in as another user.

Showing the patient data

During an ECG acquisition, use the Patient button to view the patient's data. Only the selected fields display. You can change or correct patient's data in CareCenter MD only. You cannot change patient data in CareCenter MD Online.

For more information on patient data see Edit patient details on page 2-7.

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CareCenter MD Online display

CareCenter MD Online displayYou can change how CareCenter MD Online displays the acquisitions.Note: The display settings are not saved in CareCenter MD Online.

Changing the ECG parameters

In the header, the selected lead program is indicated on the left.

Table 12-1: Changing ECG Parameters

To... Do this...

Change the speed • Click to decrease the speed or click to increase the speed.

• Alternatively, right-click in the ECG and select Speed and then select the speed.

Change the sensitivity • Click to decrease the sensitivity or click to increase the sensitivity.

• Alternatively, right-click in the ECG and select Sensitivity and then select the sensitivity.

Change or hide a lead Note: These changes are not saved.

1. Right-click on the inscription of the lead to change or to hide.

2. To change a lead, select the lead to display from now on.

3. To hide the lead, select the ellipsis.4. To exit without changing a lead, select the

marked entry or click outside the menu in the ECG.

Move a lead position Note: To prevent channels from being overwritten, you can only move leads vertically. The changed position is not saved.

1. Left-click the inscription of the lead position.

A scale appears.

2. While holding down the mouse key, move the waveform up or down to the desired position.

The ruler is automatically hidden after a short time.

3. To immediately hide the ruler, left-click beyond the ruler, or right-click and select Hide ruler.

Restoring lead positions Note: You can restore the original positions of all leads. You cannot restore the leads individually.

1. Display the ruler.

2. Right-click on the lead inscriptions and select Reset lead positions.

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Changing the view

Different views are available for the representation of the ECG. To configure the views see Select a view on page 3-21. The view options display as:

Column1 # column2 # column3 # column4

Where:

◆ Column1—all leads displayed in the first column one below the other

◆ Column2—all leads displayed in the second column one below the other

◆ Column3—all leads displayed in the third column one below the other

◆ Column4 —all leads displayed in the fourth column one below the other

To change the view:

◆ Right-click in the ECG representation and select the view.

Examples of viewsFor 3-channel and 6-channel representations, use the refresh icon in the header to switch to the other lead groups.

Figure 12-2: Example of 1 column with 12 leads

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CareCenter MD Online display



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Sending and receiving text messagesCareCenter MD Online and CareCenter MD can receive and transmit text messages. Each message opens in its own window.

!Caution: Incomplete or inaccurate data.

When using CareCenter MD Online, ensure text message boxes are positioned so the boxes not to overlap and obscure data.

Transmitting messages

To transmit a message from CareCenter MD Online to CareCenter MD:

1. Click Message.

The system opens a dialog box indicating name of the workstation where the message will be sent. (This is the workstation from which you are receiving the ECG.)

2. Click in the text box and enter a message.

3. To add pre-defined text, click one of the buttons containing auto-text.

4. To send the message, click Send message.

5. To close the message window, click Close.

Receiving and replying to messages

As soon as CareCenter MD Online starts and an acquiring workstation is selected, this workstation can receive a message. See Selecting the transmitting station on page 12-3. The text message dialog box indicates the name of the workstation where the message originated.

To reply to a text message:

1. Choose a method to reply to a text message:

• Click in the text box to write an answer.

• Click one of the pre-defined text buttons to enter that text.

2. To send the message, click Send message.

3. To close the window without sending a reply, click Close.


Configure pre-defined auto text for transmitting and receiving messages


2. Select the CareCenter MD Online tab.3. Configure the text.

You can configure separate text for transmitting and receiving workstations.

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13 Backup and Restore

Contents

◆ Backup CareCenter MD 13-2

◆ Restore CareCenter MD 13-3

You can backup and restore the CareCenter MD database.

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Backup and Restore

Backup CareCenter MDFollow your facilities policies and procedures for backing up the system. Cardiac Science recommends backing up the CareCenter MD database on a regular basis. When the backup files are up-to-date it makes restoring the system easier.

The system creates backup files. The default backup file location is C:/CCMD-backup.

To backup CareCenter MD:

1. Select Start | All Programs | CareCenter MD | Backup CareCenter MD Database.

The system runs the backup scripts and writes the backup file. When the backup is complete it prompts you to press any key.

2. Press a key on the keyboard.

The system closes the backup window.

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Restore CareCenter MD

Restore CareCenter MDUse the restore function to restore data to the CareCenter MD server. The clients will be updated when they connect to the server. Before restoring a system, ensure that no CareCenter MD clients have logged in. If a CareCenter MD client is logged in it can affect the data that is restored. For more information or for help in restoring the database, contact Cardiac Science Technical Support.

!Caution: Possible loss of data.

Contact your IT department or Cardiac Science Technical support before beginning a restore process. Restoring data incorrectly can lead to loss of data.

!Caution: Possible loss of data.

Restoring data to the CareCenter MD server requires deleting data from the CareCenter MD clients. Data for all CareCenter MD instances will match the restored data.

To restore CareCenter MD:

1. On each CareCenter MD client where you will restore the database:

a. Close CareCenter MD.

b. Open a DOS command prompt window (cmd.exe) and enter:

cd c:\program files\carecenter md\

Note: This is the default location of the s05main.exe application. If you have changed the default location, then adjust the pathname accordingly.

c. In the command prompt window, enter:

s05Main.exe -dbcreate

The system prompts you to delete the database.

d. Select Yes.

e. In the User Management window, select Close.

f. Close the command prompt window.

2. On the CareCenter MD server:

a. Close CareCenter MD.

b. Open a DOS command prompt window (cmd.exe) and enter:

cd c:\program files\carecenter md\backup

Note: This is the default location of the ccmdrestore.exe application. If you have changed the default location, then adjust the pathname accordingly.

c. In the command prompt window enter:

ccmdrestore

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Backup and Restore

d. In the User Management window, select Close.

The system prompts you to press any key.

e. Press Enter.

f. Close the command prompt window.

The system restores the files from the last backup.

3. Restart the CareCenter MD server.

4. Restart the CareCenter MD clients.

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For Sale in US OnlyCardiac Science Corporation • 3303 Monte Villa Parkway, Bothell, WA 98021 USA • 425.402.2000 • US toll-free 800.426.0337 • Fax: 425.402.2001 • [email protected] and Customer Care (US and International) • 425.402.2000 • US toll-free 800.426.0337 • Fax: 425.402.2001 • [email protected] Technical Support • (US) Fax: 425.402.2022 • [email protected]• http://websupport.cardiacscience.com/webchat/ • (International) [email protected]

Cardiac Science, the Shielded Heart logo, Quinton, Burdick, HeartCentrix‚ and CareCenter MD are trademarks of Cardiac Science Corporation. Copyright ©2011 Cardiac Science Corporation. All Rights Reserved.

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