Dash Responder Operator's Manual Ver 1 Rev E

Contents

1

Intended Use and Functional Description

7

2

Controls and Indicators

8

3

Putting the Device into Operation and Performance Test

11

4

Manual Defibrillation

19

4.1

Defibrillator Application Guidelines

19

4.2

Non-Synchronized Defibrillation

20

4.3

Synchronized Defibrillation (Cardioversion)

29

5

Pacemaker

32

6

Device Setup

39

7

Battery-Power Operation

43

8

Test Discharge

49

9

Error Messages and System Information

51

10

Cleaning, Maintenance

52

11

Technical Specifications

55

12

Order Information

58

Appendix Index

59

Revision History This manual is subject to the GE Medical Systems Information Technologies change order service. The revision code, a letter that follows the document part number, changes with every update of the manual.

2002853-002-E

P/N / Revision

Date

Comment

2002853-002-A

2001-03

Initial Release

2002853-002-B

2001-06

ECO 067 221

2002853-002-C

2002-11

ECO 070 336

2002853-002-D

2004-01

ECO 075 782

2002853-002-E

2004-02

ECO 076 216

Dash Responder®

3

General Information

General Information

come with the Dash 2000, Dash 3000 and Dash

• The product Dash Responder® bears the CE mark

4000 patient monitors and with the ASU 3000

CE-0459 (notified body GMED), indicating its

charging unit. • The symbol

compliance with the provisions of the Council

means: Consult accompanying

Directive 93/42/EEC about medical devices and

documents. It indicates points which are of particular

fulfills the essential requirements of Annex 1 of this

importance in the operation of the device.

directive. The CE mark covers only the accessories listed in the chapter "Order Information".

• This manual reflects software version 1. • This manual is in conformity with the device

• The device complies with the electromagnetic immunity requirements of standard IEC 60601-12/EN 60601-1-2 "Electromagnetic Compatibility -

specifications and standards on safety of electromedical equipment valid at the time of printing. All rights are reserved for devices, circuits, tech-

Medical Electrical Equipment". • The radio-interference emitted by this device is within the limits specified in CISPR11/EN 55011, class B. • The device is designed to comply with IEC 60601 requirements. It has an internal power source and is

niques, software programs, and names appearing in this manual. • On request GE Medical Systems Information Technologies will provide a field service manual. • The GE Medical Systems Information Technologies quality management system complies with the

an MDD class IIb device.

standards DIN EN ISO 9001 and EN 46001.

•

Classified by Underwriters

ASSIFIED CL

C

R

US

Laboratories Inc. with respect to electric shock, fire, mechanical

and other specified hazards, only in accordance with UL 2601-1, CAN/CSA C22.2 No. 601.1, IEC 60601-1, and, if required, IEC 60601-2-27, IEC

• The safety information given in this manual is classified as follows: Danger indicates an imminent hazard. If not avoided, the hazard will result in death or serious injury.

60601-2-30, IEC 60601-2-34, IEC 60601-1-1. • Shock test: MIL-STD-810E 516.4 Procedure 1, ground equipment

Warning indicates a hazard. If not avoided, the hazard could result in death or serious injury.

• Drop test: IEC 68-2-32 • Vibration test:

Caution indicates a potential hazard. If not avoided, this

MIL 810E Cat. 10 and prEN 1789 • Leakage current:

hazard could result in minor personal injury or product/property damage.

insulation according to ANSI/AAMI ES 1 • This manual is an integral part of the device. It should always be kept near the device. Close observance of the information given in the manual is a prerequisite for proper device performance and correct operation and ensures patient and operator safety. Please note that information pertinent to several chapters is given only once. Therefore,

• To ensure patient safety, the specified measuring accuracy, and interference-free operation, we recommend to use only original GE Medical Systems Information Technologies components. The user is responsible for application of accessories from other manufacturers.

carefully read the manual once in its entirety. Also refer to the separate operator manuals that

4

Dash Responder®

2002853-002-E

General Information

• The warranty does not cover damage resulting from the use of unsuitable accessories and consumables from other manufacturers. • GE Medical Systems Information Technologies is responsible for the effects on safety, reliability, and performance of the device, only if -

assembly operations, extensions, readjustments, modifications, or repairs are carried out by GE Medical Systems Information Technologies or by persons authorized by GE Medical Systems Information Technologies,

-

the device is used in accordance with the instructions given in this operator's manual.

GE Medical Systems Information Technologies, Inc. 8200 West Tower Avenue Milwaukee, WI 53223 USA Tel.:+1.414.355.5000 800.558.5120 (USA only) Fax: +1.414.355.3790 The authorized representative for GE Medical Systems Information Technologies Inc. in Europe is: GE Medical Systems Information Technologies GmbH Munzinger Str. 3 D-79111 Freiburg, Germany Tel. +49.761.45.43.0 Fax: +49.761.45.43.233 The country of manufacture appears on the device label. © GE Medical Systems Information Technologies, Inc., 2001 – 2002, 2004. All rights reserved.

2002853-002-E

Dash Responder®

5

General Information

For your notes

6

Dash Responder®

2002853-002-E

Intended Use and Functional Description

1 Intended Use and Functional Description The Dash Responder® is a lightweight, portable defibrillator. For full feature functionality, the Dash Responder® must be connected to a Dash 2000, Dash 3000 or Dash 4000 patient monitor for operation. Both devices are easily combined to form a powerful monitor-defibrillator system (Figure 1-1). The system is specially designed for use during patient transport within or outside the hospital. The Dash Responder® is available with or without transcutaneous pacemaker. Both versions are capable of delivering synchronized and non-synchronized shocks. In each case the defibrillator receives the control signal for synchronized defibrillation and for the demand mode of the pacemaker from the monitor. For defibrillation the user can choose among the following electrode types:

The Dash Responder® is powered from a rechargeable battery which is inserted into the device. A new, fully charged battery provides power for approx. 60 shocks with 360 Joules each or for approx. 5 hours of pacemaker operation at an average pulse rate and pacer output (75 ppm, 100 mA). The Dash Responder® will not operate unless equipped with the battery. The battery charges automatically when the system is connected to AC power and the devices are not turned on. When the devices are on, the battery will charge only when the devices do not require the full energy for operation. The Dash 3000 / 4000, when turned on, also charges the defibrillator battery while disconnected from AC power (see chapter 7 "Battery Power Operation").



adhesive pads,

A separate, optional charging unit (ASU 3000) is available for battery charging.



paddles (with integrated contact surfaces for children), and

This manual describes the Dash Responder® with integrated transcutaneous pacemaker.



internal electrodes.

Note In this manual, the Dash 2000, Dash 3000, and Dash 4000 patient monitors are generically DASH 3000

referred to as the patient monitor or simply the

patient monitor AC

Battery

Power

monitor.

Charging Status

Graph Go/Stop

NBP Go/Stop

Function

Trim Knob

Biocompatibility The parts of the product described in this operator

Silence Alarm

manual, including all accessories, that come in contact with the patient during the intended use,

Pacer On/Off Rate (ppm)

fulfill the biocompatibility requirements of the

Dash Responder transpor t defibrillator

1

Sync.

On/Off

2

Charge

3

Shock

Pacer Mode Output (mA)

applicable standards. If you have questions in this

Pacer Pause Charging Status

Energy select J(50 )

matter, please contact GE Medical Systems Information Technologies or its representatives.

Figure 1-1. Dash Responder® with Dash patient monitor

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Dash Responder®

7

Controls and Indicators

2 Controls and Indicators The Device 1

2

Te s

3

t

Pacer On/Off Rate (ppm)

Dash Responder transpor t defibrillator

Sync.

1

On/Off

2

Charge

3

Shock

Pacer Mode Output (mA) Pacer Pause

Energy Select J (50 Ω)

Charging Status

4

5

6

7

8

9

10

11 12 13 14 15

GE Medical Systems Information Technologies D-79111 Freiburg

Munzinger Str. 3

Dash Responder

Defib Test 50 Ω

CAUTION

Refer to equipment manual before connecting to these connectors

16

17

Figure 2-1. Controls and indicators of the Dash Responder®

8

Dash Responder®

2002853-002-E

Controls and Indicators

1

Button to unlock battery for removal

2

Monitor connector

3

Locking lever

4

Battery with "Test" button and charge level indication

5

6

7

8

10

Shock buttons to release the shock when adhesive or internal electrodes are connected (both buttons must be pressed simultaneously); the indicator lights up when the defibrillator is charged

button with indicator to enable and disable the synchronized operating mode (when the synchronized mode is enabled, the indicator is illuminated and goes off with each sync pulse)

11

Pacer Mode button to select the pacer operating mode (fixed rate, demand)

12

Pacer Pause button to suspend delivery of pacer pulses (without changing the pacer settings)

Charging Status indicator solid yellow: battery charging solid green: battery charged blinking yellow: charging error (replace battery) flashing green: battery conditioning program active

13

button with indicator to turn the pacemaker on and off (when the pacemaker is enabled, the indicator is illuminated and goes off with each delivered pacer pulse)

14

Output (mA) button to change the pacer output current

15

Rate (ppm)

16

Contacts for test discharge (possible only with adapter lead for adhesive defibrillation pads)

17

Connector for exchange of the defibrillation electrodes (switch off the device before exchanging the electrodes!)

Sync.

button to turn the defibrillator on and off (indicator is illuminated when the device is turned on) On/Off

Energy Select

buttons to select the defibril-

lation energy 9

button to initiate defibrillator charging Charge

Pacer On/Off

button to change the pacer rate

Explanation of Symbols Used on the Device Consult accompanying documents Caution, High Voltage Buttons to deliver the defibrillation shock Type CF signal input: highly insulated, suitable for intracardiac application, defibrillation-proof Battery

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Dash Responder®

9

Electrode Types

Electrode Types

Disposable Adhesive Pads Disposable adhesive pads are used both for defibrillation and for pacing. These electrodes are self-adhesive and pregelled. They are connected by means of a cable and may remain attached to the patient for up to 24 hours. Paddles

Figure 2-2. Disposable adhesive pads (external defibrillation, pacing)

APEX

CHARGE SHOCK 3 2

Electrodes for Internal Defibrillation Electrodes for internal defibrillation consist of a contact spoon (a, Figure 2-4), a handle b and a counter nut c. The spoon must match the size of the heart and have full contact with the myocardium. There is a choice of 3 different spoon sizes. The electrodes as well as their connection cable must be sterilized before each use. For internal defibrillation, either two spoon electrodes are used or one spoon electrode and an "external counter electrode" (d, Figure 2-4) which is placed under the patient and in the immediate vicinity of the heart. Defibrillator charging and release of the defibrillation shock are initiated with buttons on the device.

Figure 2-3. Paddle

a

There are two types of paddles: one is placed on the apex, the other on the sternum. For delivery of the defibrillation shock, the paddles are placed directly on the body surface. Before use, however, an ample amount of electrode gel must be spread onto the paddles. There is a Shock button on each of the electrodes: The Shock button on the Apex paddle is used to initiate defibrillator charging; afterwards the defibrillation shock is triggered by pushing both Shock buttons simultaneously. A smaller contact surface for defibrillation of children is integrated in the paddles (see "Defibrillation of Children" in section 4.2).

c b

For order numbers, please refer to chapter 12 "Order Information".

d

Figure 2-4. Electrode for internal defibrillation

10

Dash Responder®

2002853-002-E

Putting the Device into Operation and Performance Test

3 Putting the Device into Operation and Performance Test Safety Information (some of the safety statements refer to the combined system of the ® Dash Responder and the patient monitor) Danger

Warning

Explosion Hazard - The device is not designed

Shock Hazard - Do not fail to observe the

for use in areas of medical locations where an

following warnings. Otherwise the lives of the

explosion hazard may occur. An explosion hazard

patient, the user and bystanders are in danger.

may result from the use of flammable anesthetics,

− The Dash Responder® is a high-voltage electrotherapy device and must be handled by qualified and specially trained personnel. Improper use of the device can endanger life. Always follow the instructions given in the operator's manual.

skin cleansing agents and disinfectants. Also, it is not permitted to operate the defibrillator in an oxygen-enriched environment or in the presence of flammable substances (gas) or anesthetics. Oxygenation in the vicinity of the defibrillation electrodes must be strictly avoided. Temporarily interrupt the oxygen supply.

− Before using the device, the operator must ascertain that it is in correct working order and operating condition. In particular, all connectors, electrodes as well as sensors and probes must be checked for signs of damage. Damaged parts must be replaced immediately, before use. − When disconnecting the device from AC power, remove the plug from the AC power source first,, before disconnecting the cable from the device. Otherwise there is a risk of coming in contact with line voltage by inadvertently introducing metal parts in the sockets of the power cord. − As a general rule, utmost caution is advised for intracardiac application of medical technical devices. Great care must be exercised to prevent that conductive parts (connectors, electrodes, transducers) connected to the isolated patient signal input come in contact with other grounded conductive parts, as this could bridge the patient's isolation and cancel the protection provided by the isolated input.

2002853-002-E

Dash Responder®

11

Putting the Device into Operation and Performance Test

Warning

Warning

Electrically conductive contact with parts connected to the heart (pressure transducers, metal tube connections and cocks, guide wires, electrode catheters and the metal parts of syringes) must be avoided at all cost. When using devices intracardially, observe these guidelines: - always wear isolating rubber gloves; - parts with a conductive connection to the heart must be isolated from ground; - do not use tube fittings and stopcocks made of metal, if possible; - when connecting the heart catheter, observe these guidelines: - the connection must be isolated - all electrodes must be attached to the patient and secured against inadvertent disconnection or they must be isolated and protected against inadvertent contact (otherwise electrodes that become disconnected could bring the patient in contact with ground). For devices used intracardially, the annual Technical Inspections are mandatory. − During intracardiac application, a defibrillator and a pacemaker, both checked for proper functioning, must be readily available.

− The device must only be connected to a properly installed wall outlet with a non-fused earthed wire. If this type of wall outlet is not available, the device must be operated on battery power (ambulance or device battery). − Devices may be connected to other devices or to parts of systems only when it has been made certain that there is no danger to the patient, the operators, or the environment as a result. In those instances where there is any element of doubt concerning the safety of connected devices, the user must contact the manufacturers concerned or other informed experts as to whether there is any possible danger to the patient, the operator, or the environment as a result of the proposed combination of devices. Standards IEC 60601-1-1/EN60601-1-1 must be complied with in all cases. − The device is suitable for application in a humid environment provided the regulations concerning drip-proof equipment of IEC 60601/EN 60601 are strictly observed. However, do not defibrillate patients in a very moist or wet environment, unless absolutely necessary. Always dry the defibrillation electrodes and connection cables prior to defibrillation.

− Ensure that there are no conductive connections between the patient and bystanders during defibrillation.

12

Dash Responder®

2002853-002-E

Putting the Device into Operation and Performance Test

Warning − Equipment Failure - Magnetic and electrical fields are capable of interfering with the proper performance of the device. For this reason make sure that all external devices operated in the vicinity of the defibrillator comply with the relevant EMC requirements. X-ray equipment, MRI devices, radio systems, and cellular telephones are possible sources of interference as they may emit higher levels of electromagnetic radiation. Keep the defibrillator away from these devices and verify the defibrillator performance before use. − Equipment Failure - Similarly, the defibrillator may disturb equipment operating in its vicinity when charging or delivering the shock. Verify the performance of these devices before use. − Suffocation Hazard - Dispose of the packaging material, observing the applicable wastecontrol regulations. Keep the packaging material out of children's reach.

Literature Medical Device Directive of August 2, 1994 EN 60601-1: 1990 + A 1: 1993 + A 2: 1995 Medical electrical equipment. General requirements for safety. EN 60601-1-1: 9/1994 + A1: 12/1995 General requirements for safety. Requirements for the safety of medical electrical systems. IEC-Publication 513/1994: Fundamental aspects of safety standards for medical equipment.

Caution − Equipment Damage, Shock Hazard - Devices intended for emergency application must not be exposed to low temperatures during storage and transport to avoid moisture condensation at the application site. Wait until all moisture has vaporized before using the device. − Equipment Damage - Exercise great care when using HF surgery equipment on the patient at the same as the defibrillator. As a general rule, the distance between the ECG and defibrillation electrodes and the HF surgery electrodes should not be less than 15 cm. If this is not ensured, disconnect the electrodes and transducer leads while using the HF surgery device. − Equipment Damage - Avoid defibrillating repeatedly into open air, because the device temperature may increase to an inadmissible level due to the internal safety discharges. − Equipment Damage - Do not discharge the defibrillator with the electrodes shorted together.

2002853-002-E

Dash Responder®

13

Putting the Device into Operation and Performance Test

Connecting the Defibrillator to the Monitor DASH 3000 patient monitor AC

Note

Battery

Power

Charging Status

Turn off the Dash Responder® before connecting

Graph Go/Stop

NBP Go/Stop

it to or disconnecting it from the patient monitor.

Function

Trim Knob

• Before you can connect the Dash Responder® to Silence Alarm

the monitor, you will have to open the locking device by swinging the lever a (Figure 3-1) to the front as far as it will go. Since the lever a is protected against opening inadvertently, push it towards the back first (1, b), then fold it out (2, b).

a Te

• Place the monitor on top of the Dash Re-

st

sponder® such that the connector is flush with the corresponding socket in the monitor (c).

Pacer On/Off Rate (ppm)

Dash Responder transpor t defibr illator

Sync.

1

On/Off

2

Charge

3

Shock

Pacer Mode Output (mA) Pacer Pause

Charging Status

Energy select J(50 )

• Push the lever a to the rear until you hear it click into place (d). 2

b

Caution Equipment Damage - Do not open the locking lever unless the system is located on a solid

1

surface. Otherwise the connector for the monitor may wedge and become damaged.

c

d

Figure 3-1. Connecting the Dash Responder® to the Dash patient monitor

14

Dash Responder®

2002853-002-E

Putting the Device into Operation and Performance Test

Power Supply The Dash Responder® is powered from a rechargeable battery. When the battery is missing or discharged, the defibrillator and pacemaker will not function. Dash Responder transpor t defibrillator

1

Sync.

On/Off

2

Charging Status

Figure 3-2. Charging Status indicator solid yellow: battery charging solid green: battery charged blinking yellow: charging error (replace battery) flashing green: battery conditioning program active

The Dash Responder® is an emergency device and must always be ready for use. For this reason, you must ensure that the defibrillator battery is always charged or that a charged battery is readily accessible at all times. When the Dash Responder® is connected to the monitor, the battery charges automatically as soon as the system is connected to AC power. The lights up to yellow Charging Status indicator indicate that the battery is charging (Figure 3-2). Also refer to chapter 7 "Battery Power Operation".

Reconnect the system to AC power as soon as possible after battery power operation or recharge the battery immediately with the separate charging unit. There is no risk of overcharging the battery.

Note

Caution

− When the "Low Battery" message appears, you can still deliver 5 shocks with 360 Joules each. − The defibrillator including the pacemaker will not function, when the battery is discharged or missing.

To ensure that the Dash Responder® will always

2002853-002-E

function properly in an emergency, do not disconnect the monitor-defibrillator system from AC power for more than 10 days.

Dash Responder®

15

Putting the Device into Operation and Performance Test

Turning On the Defibrillator • Press the On/Off button (Figure 3-3) to turn the device on. The defibrillator emits a short audio signal to confirm that it was turned on. Then the display shows the following information in that order:

Dash Responder transpor t defibrillator

1

Sync.

On/Off

that the self-test is running and of 2  indication the test results (detailed error description)

Charging Status



device name and software version,



copyright



indication of discharged battery, if applicable

Then the standard display appears, showing the defibrillation energy value (the value displayed is the energy for the 1st defibrillation shock in the Autosequence mode, also refer to section 4.2 "Non-Synchronized Defibrillation").

Figure 3-3. On/Off button

200 J

Automatic Device Shutdown

Figure 3-4. Standard display with indication of the selected defibrillation energy (1st shock in Autosequence mode)

16

You can enable an automatic device shutdown routine that turns off the device when it is not operated for 5 minutes and neither the defibrillator nor the pacer are on. If the pacemaker is on and paused, the device switches off after 20 minutes. In both situations a message will appear which informs the user that the device is about to shut down. If this message is not acknowledged, the device will turn off after another 30 seconds. You acknowledge the message by pressing any of the buttons (press the button again, to activate the corresponding function). The automatic device shutdown routine has been implemented to prevent the battery from discharging when the device is not in use. The routine can be enabled and disabled from the setup menu (chapter 6).

Dash Responder®

2002853-002-E

Putting the Device into Operation and Performance Test

Setup Note Enter your own settings in the column at the far right (with date and signature).

Menu / Parameter

Explanation

DEVICE SETUP

general device settings

The device has a configuration menu which allows you to customize a number of the settings to suit your requirements. These settings will be retained. The table shows all device settings for which customer defaults can be selected, as well as the factory defaults. This manual describes a defibrillator where the factory defaults are active. In chapter 6 "Defibrillator Setup" you will find instructions on setting up the defibrillator. The same chapter explains how to adjust the contrast, activate the backlighting, select the language and how to restore the factory defaults.

Factory Defaults

Adjustment Range

User Setup

DISPLAY SETUP BCKLIT

backlighting of the display

medium value

min. to max.

CONTR

contrast

medium value

min. to max.

ALARM

volume of audio alarms and audio signals high

low, medium, high

SHUTD

automatic device shutdown after 5 or 20 minutes

off

on/off

LANGUAGE

selection of the language

English

FACT SETT.

restores the factory settings

DEFIB SETUP

defibrillator settings

LEVEL 1, 2, 3

energy levels for the automatic energy sequencing

PACER SETUP

pacemaker settings

RATE

default pacer rate

SERVICE MODE

for equipment servicing and battery conditioning

BATT.COND

battery conditioning program

SERVICE TOOLS

for equipment servicing

COMP TEST

component test

2002853-002-E

200 J, 200 J, 360 J

150 to 360 J per shock

60 ppm

30 to 200 ppm

Dash Responder®

17

Putting the Device Into Operation and Performance Test

Performance Test A performance test must be carried out before each use.

200 J

The performance test includes 

Figure 3-5. Standard display when device is ready for operation

 

a visual inspection of the device, the cables and the electrodes for signs of mechanical damage, verification of the functional readiness of the device, delivery of a test discharge.

After power-up, the Dash Responder® runs automatic self-tests. If malfunctions are identified, an error message will be displayed (see chapter 9 "Error and System Messages"). In this situation, do not put the device into service. In all other cases you will see the standard display (Figure 3-5) and the device is ready for use. Now verify that the defibrillation shock is correctly delivered by triggering a test discharge (chapter 8 "Test Discharge"). If the delivered energy of the test discharge is not within the specified limits, a defibrillation is possible all the same (it is the user's decision whether or not to employ the defibrillator). However, the device must be immediately checked and repaired by a service technician.

Audio Signals The table below gives an overview of the different audio signals emitted by the device.

18

defibrillator charging (charging tone)

beep while defibrillator charges

defibrillator charged

charging tone + superimposed alternating tone until discharge

general alert

beep

tone alerting to inadmissible button operation

beep

Dash Responder®

2002853-002-E

Manual Defibrillation / Defibrillator Application Guidelines

4 Manual Defibrillation 4.1 Defibrillator Application Guidelines Observe the following guidelines to ensure successful and safe defibrillation. Otherwise the lives of the patient, the user and bystanders are in danger. Warning

Warning

− Defibrillating a patient with normal heart rhythm may induce ventricular fibrillation. − Position the patient flat on a hard surface where he is electrically insulated. The patient must not be allowed to come into contact with metal parts, e.g., bed or litter, to prevent unwanted pathways for the defibrillation current which may endanger the assistants. For the same reason, do not position the patient on wet ground (rain, accident in swimming pool). Do not allow the defibrillation electrodes to come into contact with other electrodes or metal parts which are in contact with the patient. The patient's chest must be dry, because moisture can cause unwanted pathways for the defibrillation current. When using flammable skin cleansing agents, wait until they have completely dried. − The operator and all assistants must be briefed regarding the preparations for and execution of defibrillation. All tasks must be clearly assigned. Immediately prior to the shock - interrupt heart massage and artificial respiration, - disconnect tube connections, and - warn bystanders. − Ensure that there are no conductive connections between the patient and other persons during defibrillation.

− Electric Shock Hazard - Turn off the device before exchanging the defibrillation electrodes; exchanging the electrodes on a charged defibrillator initiates an internal safety discharge. − Pacemaker Patients - Defibrillating a patient with an implanted pacemaker is likely to impair the pacemaker function or cause damage to the pacemaker. For this reason - select the smallest energy level possible for the application, - do not apply the defibrillation electrodes in the vicinity of the pacemaker electrodes, - have an external pacemaker at hand, - check the implanted pacemaker for proper functioning as soon as possible after the shock. − Ineffective Defibrillation Shock - If a second defibrillator is used on the patient, the electrodes of the Dash Responder (paddles, pads) must be removed. Otherwise much of the defibrillation shock will be dispersed via the Dash Responder and the shock will be ineffective.

Caution Equipment Damage - Disconnect transducers and devices that are not defibrillation-proof from the patient before delivering the shock.

− Before delivering the shock, verify that the charged and selected energies are the same.

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Dash Responder®

19

Manual Defibrillation / Non-Synchronized Defibrillation

4.2 Non-Synchronized Defibrillation Using Disposable Defibrillation Pads

GE Medical Systems Information Technologies D-79111 Freiburg

Munzinger Str. 3

Dash Responder



Use pads before their expiration date.



Do not reuse the pads.



A pair of pads may remain attached to the patient for up to 24 hours and withstands up to 50 shocks of 360 J each.



Use electrodes 919 202 94 for adults and electrodes 919 202 95 for children.



Shave the application points; this improves conductivity and makes removal of the pads easier. STERNUM: right sternal edge at the level of the 2nd intercostal space, APEX: left axillary line at the level of the 5th intercostal space (Figure 4-3).

Figure 4-2. Connecting the electrode



Place the pads on the patient such that the connectors point to either side of the patient and that the cables are not hindering patient treatment.

STERNUM electrode and connector



The electrodes are pregelled; therefore, do not use additional contact cream or gel.



Do not use pads, if the gel is dry.

CAUTION

Defib Test 50 Ω

Refer to equipment manual before connecting to these connectors

Figure 4-1. Connecting the adapter lead

Danger Shock Hazard - Always switch off the device before connecting the adapter lead and the defibrillation pads.

• Connect the adapter lead to the device (Figure 4-1). APEX electrode and connector

Figure 4-3. Application points for adhesive pads (anterior – anterior) (dashed application points for pacemaker patients)

20

• Press the connector of the cable on to the electrode contact pin until you hear it click into place (Figure 4-2).

Dash Responder®

2002853-002-E

Manual Defibrillation / Non-Synchronized Defibrillation

Warning Risk of Skin Burns / Equipment Damage - Do not attach the pads over

• Rub the patient's chest dry. • Peel off the backing from each pad. • Press the pads carefully on the appropriate sites, observing the APEX and STERNUM labels (Figure 4-3).

− sternum or clavicle − nipples − implanted pacemaker or defibrillator devices.

• Before delivering the shock, check that the pads are firmly seated.

• Turn on the device.

/Off

2

Charge

Shock

3

Energy Select J (50Ω)

The device defaults to the Autosequence mode. In this mode the defibrillator automatically sequences the defibrillation energy levels configured for the first three shocks. The level for the 3rd shock is maintained for all subsequent defibrillations. The Autosequence mode is selected

b

a Figure 4-4. Buttons to select energy (a) and to initiate defibrillator charging (b)

360 J



when the device is turned off and on again



when you exit the setup menu



when you remove the electrode connector (17, Figure 1-1).

The factory set Autosequence energy levels are the values recommended by AHA/ERC for ventricular fibrillation and pulseless tachycardia. 1st shock with 200 J 2nd shock with 200 J 3rd and all subsequent shocks with 360 J. If you do not want to use the Autosequence mode, you can choose any of the available energy values with the Energy Select buttons (a, Figure 4-4): 2 – 5 – 7 – 10 – 20 – 30 – 50 – 100 – 150 – 200 300 – 360 Joules.

Figure 4-5. Indication of selected energy

• Do not touch the patient any more and warn all those present. Warning Damage to Myocardium - Please note that

• Initiate defibrillator charging with the Charge button (b, Figure 4-4).

children require less energy for successful ventricular defibrillation than adults. For the first defibrillation shock delivered to babies and small children, select an energy of approx. 2 J/kg body weight. For subsequent shocks, the energy may be increased to 4 J/kg body weight.

2002853-002-E

Dash Responder®

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