Technology Offering

Objective

The goal of our presentation is to equip your sales team

with the three most important concepts possible:

1. Masimo’s new products are compelling and easy to introduce to

target customers.

2. It will be easy to prove and demonstrate – to move the sales

process forward.

3. The sales team can achieve their numbers by selling the new

Masimo offering.

Oxygenation

• Objective: to ensure adequate oxygenation of the patient’s arterial blood.

• Methods:

• (1) Pulse oximetry (non-invasive estimation of hemoglobin saturation)

• (2) Arterial blood gas analysis for oxygen partial pressure (PaO2).

Recommendations: Assessment of oxygenation should be done whenever possible by pulse oximetry,

with blood gas analysis being employed when necessary for more critically ill patients.

Ventilation

Objective: to ensure that the patient’s ventilation is adequately maintained.

Methods: (1) Observation of thoracic wall movement or observation of breathing bag movement

when thoracic wall movement cannot be assessed.

(2) Auscultation of breath sounds with an external stethoscope, an esophageal

stethoscope, or an audible respiratory monitor. (Acoustic Respiration )

(3) Capnography (end-expired CO2 measurement)(4) Arterial blood gas analysis for carbon dioxide partial pressure (PaCO2)

(5) Respirometry (tidal volume measurement)

Recommendations:

Qualitative assessment of ventilation is essential as outlined in either 1 or 2 above, and capnography

is recommended, with blood gas analysis as necessary

Guidelines for anesthesia monitoring for Dogs and Catsfrom the American College of Veterinary Anesthesiologists

Masimo Mission:

Improving Patient Outcomes and Reducing the Cost of Care . . .

. . . by Taking Noninvasive Monitoring to New Sites and New Applications

AAHA Guidelines for anesthesia for dogs and cats in cludes Pulse Oximeter on the list of monitoring tools that should be used wh en administering anesthesia.

Masimo SET• Masimo’s breakthrough technology is capable of obtaining accurate and

reliable oxygenation and heart rate in the presence of patient movement and

low perfusion caused by drugs like Alpha 2 agonists.

• 140+ clinical publications over 15+ years have confirmed Masimo SET is the

Gold Standard.

• First to receive FDA clearance for accuracy during motion & low perfusion

• Utilized in 20 out of the 28 accredited Veterinarian University Programs

More about SET

• In addition to motion, SET technology provides

a 10 fold increase in reading low perfusion.

• Using Alph2’s (DexDormator, Xylazine etc) and

Propoflo cause peripheral perfusion reduction.

• Use Masimo with all drugs, especially “alpha 2

drugs” unsurpassed clinical superiority

Challenges with Non-Masimo SET®

Pulse Oximetry Technologies

• In well-perfused patients who are not moving…– Most pulse oximeters work similarly

• But unreliable when needed most– Patient movement

– Low perfusion (many critical care patients)

• Clinical impact– False alarms

– Increased workload

– Alarm fatigue

– Delayed response may lead to compromised care and poor outcomes

– Limited ability to provide accurate measurements to aid clinicians in diagnosis / prognosis

– Patient disturbance

Masimo SET: the Proven Gold Standard in Pulse Oximetry

Why is Masimo SET the best SpO2 technology

delivering on the need for accurate monitoring

during motion and low perfusion?

Sensitivity vs. Specificity

Sensitivity – The ability to detect true positives/alarms

Specificity – The ability to reject false positives/alarms

• Masimo has the highest sensitivity & specificity

• Other technologies have attempted to decrease false alarms at the

expense of missing more true events

• Missed true events compromises patient safety

• Evaluations of performance must place much emphasis on sensitivity

& specificity

Sensitivity & SpecificityMasimo SET: Accurate Monitoring, Reduce False Alarms

Independent study comparing Masimo SET vs Nellcor 600 and GE’s “TruSat” technology1:

Missed Event Sensitivity False Alarm Specificity

Masimo SET 1/40 97.5% 6/120 95.0%

Nellcor N600 17/40 57.5% 34/120 71.5%

GE-D/O TruSat 33/40 17.5 21/120 82.5%

1 Nitin Shah, M.D., Laverne Estanol, M.S. Anesthesiology, 2006 Long Beach VA Medical Center, UC Irvine Medical Center, Long Beach,

California Comparison of Three New Generation Pulse Oximeters During Motion and Low Perfusion in Volunteers

• All Pulse oximeters miss desaturations

• All Pulse oximeters have False Alarms

• Masimo with SET technology is more accurate with fewer false alarms.

Approaches to Reduce False Alarms with

Conventional and “Next Generation” Pulse Oximetry

• “Dynamic” / automatically increased averaging times*

– Falsely low SpO2 values are mixed with normal SpO2 values

• Value holding or freezing

– Displaying numbers when the signal is corrupted by motion

• Extended alarm delays

– “Sat Seconds” can delay alarm notification by up to 100

seconds*

• Implications

– False alarm and true alarm notifications can be delayed

– If SpO2 or pulse rate are changing

• Can result in missed patient events

* Nellcor N-600x operator’s manual

Masimo SET In the field

“Recent development of the Radical-7 pulse oximeter (masimo.com ) employs new algorithm software that allows more reliable readings of SpO2 in case of motion, pigmentation, hypotensive, and vasoconstrictive stage in animals.”

Jeff Ko , D.V.M., M.S. Diplomate A.C.V.A. Professor, Anesthesia

Department of Veterinary Clinical Sciences Purdue University, School of Veterinary Medicine

What are veterinarians saying about Masimo?

“PVI tells you when you need fluid, it tells whether your fluid administration is effective or therapeutic and if it’s not, it actually is indirectly indicating that you need to adjust anesthetic protocol.

What are veterinarians saying about Masimo?

“The traditional methods for monitoring fluid responsiveness during surgery are inadequate. The PVI is a better method and can be obtained from the Masimo pulse oximeter. “

William W. Muir III DVM, MS, PhD, DACVA, DACVECC

Selection that fits your needs

“ Masimo’s equipment works consistently and gives th e entire staff a lot more peace of mind with consistent, accurate readings and minimal drop-off alarms.”— Bob Klostermann, DVM

Unique Post-Op Oxygenation monitoring application using TFI on Ventral Tail

Perfusion Index (PI)

Perfusion Index= PI is a numerical value that indicates the strength of the signal. PI is a relative number which will vary by monitoring sites.

Low = <0.5

Good = >0.5

Perfusion Index, or PI -is a relative assessment of the pulse strength at the monitoring site.

How to use PI?Use PI during sensor placement to evaluate the quality of the application site. A high PI reading means great signal strength.

How does PI work?The ratio of the pulsatile vs. non-pulsatile amounts of blood at any particular site corresponds to PI at that site.

During sensor placement, how I can tell if the sensor site is a good one?.How do clinicians trouble shoot over the phone? They can now.

Signal IQ

Signal IQ:

Low

Good

Signal IQ (SIQ): A visual indicator of the oximeters confidence level in the displayed arterial oxygen saturation and pulse rate measurements.

Why SIQ?Masimo SET will continue to report accurate oxygen saturation and pulse rate during motion and low perfusion, even when plethysmographic waveform becomes corrupt and other bedside oximeters read erroneously or freeze.

How do I use Signal IQ?•Use SIQ to be sure that valid O2

saturation and pulse rate readings are displayed during motion and low perfusion. •Use SIQ in the presence of environmental interference like sunlight, florescent lights or ceiling fans.

How can we tell the oximeter picking up a good signal on this patient?How do clinicians trouble shoot over the phone?

Features: Lightweight, convenient handheld Ideal for spot check monitoring or continuous monitoring Audible and visual alarm for High/Low saturation, pulse rate, sensor-off and low battery Perfusion Index, FastSat, Signal IQ displays plus APOD Up to 72 hours of trending memory Long battery life: up to 48 hours on four AA batteries Optional protective boot cover with built in tabletop stand

The Power of Masimo SET in the palm of your hand.

Competitors

Nellcor N-65VSAT Handheld Pulse Oximeter

Nonin - 2500A Vet Handheld Pulse Oximeter

SurgiVet® V1030 Hand Held Pulse Oximeter

Features:Masimo SET® pulse oximetry: proven accurate during motion and low perfusion in Over 100 independent clinical studies.1,2 The accuracy of Masimo SET oximetry has been linked to improved care and reduced medical errors.3 Compact, lightweight design with extended battery life for transport applications. Large LED color display is easy to read at a distance. Up to 8 hours of continuous battery life (RECHARGABLE)

Competitors

OxiMax™ N-560™ Pulse Oximeter Smiths Medical SurgiVetV3304 Tabletop Pulse Oximeter

The best patient safety choice today and tomorrow

Features :Masimo SET is clinically proven to be the highest sensitivity and specificity pulse oximeter in the worldPerfusion Index (PI) with trending capability indicates arterial pulse signal strength and may be used as a diagnostic tool during low perfusionPleth Variability Index (PVI): captures vital thoracic pressure changes that may compromise normal cardiac function affecting systemic circulation Signal IQ® waveform for signal identification and quality indication during excessive motion and low signal to noise situations Detachable portable hand-held for patient transport

Select OEM Partners

Masimo is the leading Read-Through Motion and Low Perfusion pulse oximetry solution in physiological

monitors

Before We Move On….Program my number in your phone : National Account Manager - Ian Quinn 949-689-8082 and iquinn@masimo.com

Director Animal Health - Kevin Allen – 714-376-6805 and kallen@masimo.com

NEW CONTACT - Distribution Resource Manager – Jeff Goeggel - (949) 633-8014 JGoeggel@masimo.com

Before going into facility memorize 2 or 3 Masimo Bu llet Points

Practice introduction question(s)

Progress with a smooth transition using sales tools and clinical supporting materials

A few points to remember before asking for the sale :

1. Masimo provides accurate technology when measuring pulse O2 with improved contact/lead points to avoid missed/frozen readings

2. Masimo provides a money back guarantee on their units

Marketing Materials

30 Second Elevator Speech

Target AccountsAnyone using Alpha 2 agonist drugs like DexDormator, Xylazine and Propoflo as they cause peripheral perfusion reduction. Masimo Pulse oximetry can read to 1/10th the perfusion compared with conventional offering for unsurpassed clinical superiority

Anyone performing Dental Procedures!!! Every Masimo monitor comes with a new transflectance sensor that works great under the base of the tail, allowing for more room in the mouth when performing dental procedures.

Anyone performing Emergency and Critical Care Servi ces!!! This is when motion and low perfusion can cause conventional pulse to fail or read falsely low. Masimo’s measure through motion and low perfusion is reliable when it matters most.

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