RAD57&CO

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2008 Masimo Corporation

Includes a review on Carbon MonoxidePoisoning For Emergency Responders

Version 2.0F, 07.02.08

Monitoring CO Poisoning

with the Rad-57TM

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IMPORTANT NOTICE

This program is not meant as a substitute for a program orcourse of study in carbon monoxide recognition and treatment,or emergency medicine. This is for review only. Please refer to

your physician or local Medical Director for approved contentand medical protocols.

This program is not meant as a substitute for themanufacturers operator manual for the Masimo Rad-57. Pleaserefer to the manufacturer for complete operating instructions.

There are two versions of operating software that also includefaceplate changes. Please review slide 28 for key versiondifferences.

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Section 1

Review: Carbon Monoxide Poisoning For Emergency Responders

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Introduction

Carbon monoxide is the leading cause of poisoning in the UnitedStates for the last 100 years and is a common hazard to FirstResponders.

Until recently, the only way to reliably diagnose carbon monoxidepoisoning was to draw blood and check the carbon monoxide levels

in a lab. With the introduction of the Masimo Rad-57, testing forcarbon monoxide can now be done quickly and easily, allowing forprompt screening and treatment.

This training program covers carbon monoxide poisoningrecognition and treatment and the use of the Masimo Rad-57 Pulse

CO-Oximeter

TM

. As always, seek direction and approval from yourphysician or Medical Director prior to using this training program ora Masimo Rad-57.

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Definition

Carbon monoxide is a colorless, odorless,tasteless, toxic gas that, when inhaled, cancause serious physical problems and evendeath.

Carbon monoxide is often referred to asCO, which is its chemical symbol. Even atlow levels, carbon monoxide may cause long-term cardiovascular and neurologicaldisorders.

Carbon monoxide can be a serious andsometimes deadly threat to Firefighters and

EMS personnel. Firefighters have regularcontact with carbon monoxide at fire andrescue scenes, increasing their health risks.

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Incomplete combustion of any carbon-based material will produce carbonmonoxide. Closed or confined spaces are particularly hazardous. Commonsources are:

Automobiles, trucks, buses

Boats, campers

Gas heaters, furnaces, and hot water heaters

Gas-powered generators Small gasoline engines

Portable / space heaters

Barbecues / fireplaces

Cigarette smoke

Lanterns Methylene chloride (paint stripper)

Liver converts to CO

Structure / wildland fires

Common Sources

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Physiology

Carbon monoxide is inhaled and

passes from the lungs to the bloodwhere it binds with hemoglobin Produces carboxyhemoglobin

Affinity to hemoglobin is greater than 200 Xthat of oxygen

Reduces oxygen carrying capacity of blood

Alters release of remaining oxygen to cells

Acts as an intracellular toxin Poisons tissues and cells

Binds with myoglobin in muscle Interferes with heart and skeletal

muscle

Immediate threat to life Oxygen starvation Cardiac arrhythmias

Alters judgment, reasoning

Long-term health effects Central nervous system damage

Cardiovascular damage

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Signs and Symptoms

SpCO % Clinical Manifestations

0-4% None - Normal

5-9% Minor Headache

10-19%

Headache, Shortness of

Breath

20-29%Headache, Nausea,Dizziness, Fatigue

30-39%Severe Headache, Vomiting,Vertigo, ALOC

40-49% Confusion, Syncope,Tachycardia

50-59%Seizures, Shock, Apnea,Coma

60% -up Coma, Death

Koster LA, Rupp T.The Silent Killer, Recognizing and Treating Carbon

Monoxide Poisoning. JEMS. October 2005

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Treatment Considerations

Scene safety, protect yourself: Consider SCBA

Remove patient away from the poison!

ABCs (airway, breathing and circulation)

Check CO level with Pulse CO-Oximeter

High levels treated with 100% oxygen: Decrease half-life of CO in blood

Increase delivered oxygen in blood

Support ventilations as needed

Transport to closest, most appropriate facility

Consider hyperbaric treatment center:

Adults >25%, Pedi & Pregnant female >15% Neurologic compromise

Monitor vital signs and SpCO

Always follow local EMS protocols

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Suggested Triage Algorithm

Hampson NB, Weaver LK JEMS 2006

Measure SpCO

SpCO 0-3% SpCO >3%

No further medicalevaluation of SpCO

needed

Loss of consciousnessor neurological

impairment or SpCO>25% ?

Yes No

Transport on 100%oxygen for ED

evaluation. Considertransport to hospital

with hyperbaric chamber

SpCO >12 SpCO

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Half-Life

Half-life: The amount of time requiredto reduce the blood level of CO by50%. These are estimates for patientsthat otherwise are healthy. Age andhealth will impact the half-life of CO.

Breathing Room Air: Carbon Monoxidehalf-life in blood is ~ 240 minutes

High-flow oxygen (100%) via non-rebreather mask: Decreases CO Half-life in blood to 40-60 minutes

Hyperbaric Oxygen Treatment (HBOT)at 2.5 to 3 Atmospheres: Decreases COhalf-life in blood to 20 -24 minutes

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Understanding PPM & SpCO

PPM or Parts Per Million is theatmospheric concentration of the gas

PPM is common fireground safetymeasurement, often misleading as COforms in pockets

SpCO - noninvasive measurement of CO inthe blood

SpCO as measured by RAD-57 is a functionof PPM CO and total time of exposure of thepoison

Age, health and respiratory rate may be afactor

Even low PPM levels can lead to high SpCOif exposure is long enough, common in

overhaul

Even an exposure of 50 PPM for 60 minutesrequires assessment and possible medicaltreatment with oxygen

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Firefighter Risk

CO levels may be highest during the post-fire oroverhaul phase, search & rescue operationsand wildland firefighting

Periods that self-contained breathing apparatus(SCBA) are not worn or not functioning properly

CO poisoning is often unrecognized due to thepresence of exhaustion, heat stress, illness orinjuries

Studies have shown low levels of untreated COlead to central nervous system andcardiovascular disease

Moderate to high levels are immediate threats tohealth and safety, and cause cardiovascularinjury

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Section 2

Overview: Using the Rad-57 Pulse CO-Oximeter

Note: This is NOT intended to replace or act as a substitute for theOperators Manual. Please refer to the manufacturers Operator

Manual for complete information on the operation and safety of theRad-57 Pulse CO-Oximeter.

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RAD-57 Pulse CO-Oximeter

The Masimo RAD-57 is the worlds first and only Pulse CO-Oximeter Signal Extraction Technology (SET)

SpO2(oxygen saturation)

Pulse rate

Measure through motion and low perfusion

RainbowSET TechnologyAnalyzes 7+ wavelengths of light

Accurately measures carboxyhemoglobin (SpCO) levelsnoninvasively, in SECONDS!

PI (perfusion index, strength of arterial pulse)

Low Signal IQindicator (poor SpO2signal quality)

Continuous color-coded CO bar graph

Adjustable parameter alarms

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RAD-57 EMS Carry Case

Lightweight: 13 oz.

Small: 6.2 x 3.0 x 1.4

Portable: operates on 4 AAbatteries

Supplied with high-visibility,water-resistant protective case

Protective cover

Reference card holder

Department ID holder

Pen holder Spare battery pocket

Extra sensor pocket

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RAD-57 Operation / Powering Up

POWER Press to turn ON

Press and HOLD to turn OFF

Battery Indicator

4 Green LEDs

Each represents approximately 25%battery life

Use only Alkaline batteries

Do Not use rechargeable batteries

Battery Compartment

Located in back panel Holds 4 AA alkaline batteries

Operates 8-10 hours

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RAD-57 Operation / Startup Sequence

Place sensor on finger (relatively clean & dry) Press Power button

Verify All LEDs light up and a 1 second toneis heard*

Startup mode begins

All preset configurations are displayed

Scrolling zeroes 000 and flashesdashed lines

May take up to 25 seconds

Do not move sensor during startup

When complete reading is displayed

Begin patient monitoring

Defaults to pulse rate and oxygensaturation reading

PI bar graph displays strength ofarterial perfusion

* Refer to operators manual for additional verifications prior to patient monitoring.

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RAD-57 Operation / Sensor Placement

Sensor placement is veryIMPORTANT

When possible, use ring finger,non-dominant hand

Insert finger until the tip of fingerhits the STOP Block

Sensor should not rotate or movefreely on finger

LEDs (red light) should passthrough mid-nail, not cuticle

There is a top and bottom, cableshould be on top (nail side)

Optimal LED path

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RAD-57 Operation / Pulse Rate and Saturation

Display after Startup Oxygen Saturation on top in

Red

Pulse Rate on bottom in Green

Green PI scale, indicates

strength of arterial pulse

Low SIQ LED indicates poor

SpO2signal quality

Press Display to display %

carboxyhemoglobin

Press Bell to silence alarms

Display buttontoggles from

SpO2to SpCO

PI Scale

Low SIQ LED

Alarm Silence LED

Battery level

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RAD-57 Operation / Alarms

When parameter is violated, audible alarmwill sound, parameter will flash

Preset at factory:

Sp02(oxygen saturation)

Low: 90%

High: none

Pulse Rate

Low: 50

High: 140

SpCO (carboxyhemoglobin)

Low: none

High: 10%

Alarms adjust:

Press Mode/Enter twice Press Next key to scroll through

parameters

Use up and down keys to adjust

Changes remain until user restores tofactory defaults

Alarm Indicator(flashes)

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RAD-57 Operation / Measuring CO

Press Display button for SpCOreading

To scroll back to SpO2mode pressDisplay again

Carboxyhemoglobin displayed in % ontop

CO displayed on bottom confirmingmode

Real-time SpCO indicator continuouslyreads SpCO

Green: 1-3%

Yellow: 4-11%

Red: 12% and above

Confirm abnormal readings by takingseveral measurements on differentfingers and average the readings

Slow: Low SpCO Confidence

Fast: SpCO Alarm

CO label when SpCOis displayed

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RAD-57 Operation / Troubleshooting

Error Messages:

NO Cbl

Cable not seated properly into top of Rad-57

Defective cable

SEN OFF

Sensor off finger

Sensor misaligned

bAd CbL Defective cable

Replace cable

CbL

Incompatible cable

Connect appropriate cable

bAd SEN

Defective sensor Replace sensor

SEN

Unrecognized sensor

Connect appropriate sensor

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RAD-57 Operation / Troubleshooting

Will not power on

Check battery compartment Replace batteries

Continuous Startup mode (Scrolling zeroes 000 and flashes dashed lines)

Shield sensor from flashing lights,strobes or high ambient light with MasimoLight Shield*

Try other fingers

Single battery level indicator flashes (withaudible alarm)

Battery level too low

Replace batteries immediately

Err message

Return for service, Call 800-326-4890

Continuous Speaker Tone

Power down and remove batteries

Return for service, Call 800-326-4890

* Contact your Masimo sales rep to order a Masimo Light Shield.

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RAD-57 Operation / Light Shield Use

Face protrusion of light shield down, andinsert the end of the sensor into the hole

Ensure that sensor hits the back of the lightshield

Orient the sensor so the cable is coming outof the top of the hole while in the lightshield

Open the sensor by applying pressure fromthe top and bottom of the light shield

Insert finger until the tip of finger hits theSTOP Block

LEDs (red light) should pass through mid-

nail, not cuticle Orient the sensor so the cable is running

over the top of the patients hand

Optimal LED path

Apply pressure

to open sensor

Protrusion

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RAD-57 Operation / Improving Accuracy

The Rad-57 is designed with an accuracy of +/- 3 digitswith a range of 1% - 40% for one standard deviation (67%of patients)

Example: A reading of 10% could have a range from7% - 13%

Measurements may vary from reading to reading, even onthe same patient, within the accuracy specification

Proper probe placement may improve accuracy

If an abnormal level of CO is detected, always confirm bymeasuring other fingers and average

Flashing lights, strobes or high ambient light mayinterfere, use a Masimo Light Shield or other meansof shielding

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RAD-57 Operation / Contraindications

Small physiological changes and acceptable levels ofarterial perfusion along with correct sensor placementwill provide a stable CO reading. Inaccuratemeasurements may be caused by:

Incorrect sensor placement

Elevated levels of methemoglobin Intravascular dyes such as indocyanine green or

methylene blue

Abnormal hemoglobin levels

Low arterial perfusion

Low arterial oxygen saturation levels

Elevated Total Bilirubin levels

Motion artifact

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RAD-57 Version Differences

Version 1 Faceplate design

changes (see image)

SpCO button displays

value for 10 seconds

Upon Startup all LEDs

flash, dashed lines,

scrolling zeroes, followedby flash dashed lines

Alarm settings revert

back to factory settings

upon power off

SpCO bar graph changes

color at 10% and 20%

Version 2 Faceplate design changes

(see image)

Display button allows userto scroll through modes(SpO2, SpCO and PI)

PI can be displayed as anumeric value

Upon Startup all LEDsflash, device presents allconfigurations, thenscrolling zeroes and flashdashed lines

Alarm settings areretained after power off

SpCO bar graph changescolor at 3% and 12%

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Resources

For more information on carbon monoxide poisoning and the Masimo Rad-57

www.masimo.comor call 800-326-4890

www.Firerehab.com

www.firegrantshelp.com

www.emsgrantshelp.com

www.naemse.org

www.naemt.org

www.iaff.orgwww.carbonmonoxidekills.com/

www.epa.gov/iaq/pubs/coftsht.html

www.carbon-monoxide-poisoning.com

www.nlm.nih.gov/medlineplus/carbonmonoxidepoisoning.html

www.emedicinehealth.com/carbon_monoxide_poisoning/article_em.htm

www.osha.gov/OshDoc/data_General_Facts/carbonmonoxide-factsheet.pdf

www.cdc.gov/co/

www.bt.cdc.gov/disasters/carbonmonoxide.aspwww.postgradmed.com/issues/1999/01_99/tomaszewski.htm

Masimo Corporation40 Parker

Irvine, CA 92618

949-297-7000

All Rights Reserved
http://www.masimo.com/http://www.firerehab.com/http://www.firegrantshelp.com/http://www.emsgrantshelp.com/http://www.naemse.org/http://www.naemt.org/http://www.iaff.org/http://www.carbonmonoxidekills.com/http://www.epa.gov/iaq/pubs/coftsht.htmlhttp://www.carbon-monoxide-poisoning.com/http://www.nlm.nih.gov/medlineplus/carbonmonoxidepoisoning.htmlhttp://www.emedicinehealth.com/carbon_monoxide_poisoning/article_em.htmhttp://www.osha.gov/OshDoc/data_General_Facts/carbonmonoxide-factsheet.pdfhttp://www.cdc.gov/co/http://www.bt.cdc.gov/disasters/carbonmonoxide.asphttp://www.postgradmed.com/issues/1999/01_99/tomaszewski.htmhttp://www.postgradmed.com/issues/1999/01_99/tomaszewski.htmhttp://www.bt.cdc.gov/disasters/carbonmonoxide.asphttp://www.cdc.gov/co/http://www.osha.gov/OshDoc/data_General_Facts/carbonmonoxide-factsheet.pdfhttp://www.osha.gov/OshDoc/data_General_Facts/carbonmonoxide-factsheet.pdfhttp://www.osha.gov/OshDoc/data_General_Facts/carbonmonoxide-factsheet.pdfhttp://www.emedicinehealth.com/carbon_monoxide_poisoning/article_em.htmhttp://www.nlm.nih.gov/medlineplus/carbonmonoxidepoisoning.htmlhttp://www.carbon-monoxide-poisoning.com/http://www.carbon-monoxide-poisoning.com/http://www.carbon-monoxide-poisoning.com/http://www.carbon-monoxide-poisoning.com/http://www.carbon-monoxide-poisoning.com/http://www.epa.gov/iaq/pubs/coftsht.htmlhttp://www.carbonmonoxidekills.com/http://www.iaff.org/http://www.naemt.org/http://www.naemse.org/http://www.emsgrantshelp.com/http://www.firegrantshelp.com/http://www.firerehab.com/http://www.masimo.com/

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