70-00533-02 A User’s Guide CareCenter MD® Stress and Resting ECG
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.
Contents Contents Chapter 1: Introduction Contact Information.............................................................................. 1-1 Overview ............................................................................................... 1-2 Features and options .............................................................................. 1-3 Screen layouts ........................................................................................
Contents ECG filters........................................................................................... 3-17 Enable a filter ................................................................................ 3-17 Default filter settings ..................................................................... 3-18 Change the ECG representation........................................................... 3-19 Change speeds ...............................................................................
Contents Start the acquisition for Rhythm ECG (manually) .......................... 5-8 Review the recording ....................................................................... 5-9 Print the record ............................................................................. 5-11 Save the record .............................................................................. 5-11 Chapter 6: Acquire a Stress Test ECG Stress test displays ...................................................................
Contents Select the test procedure .................................................................. 7-7 Apply the electrodes......................................................................... 7-7 Start the acquisition for an emergency ECG .................................... 7-8 Stop the acquisition......................................................................... 7-8 Save the recording ...........................................................................
Contents Chapter 10: Display a Stress Test ECG Record Displaying the stress test ECG record .................................................. 10-2 Controls for reviewing................................................................... 10-2 Controls for changing the view...................................................... 10-3 Indication bar................................................................................ 10-4 Display functions ............................................................
Contents Changing the view......................................................................... 12-6 Sending and receiving text messages ..................................................... 12-8 Transmitting messages................................................................... 12-8 Receiving and replying to messages................................................ 12-8 Chapter 13: Backup and Restore Backup CareCenter MD ......................................................................
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.
Introduction Overview CareCenter 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.
Features and options Features and options The 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.
Introduction Screen layouts The 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. 1 2 4 3 Figure 1-1: Example of screen layout 1 2 3 The task button—the function of this button changes according to the appropriate task in the workflow.
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. CareCenter MD 1.
Data Management Patient Search tab Use the Patient Search tab to find patient information. Figure 2-1: Example of Patient Search tab 2-2 70-00533-02 A CareCenter MD 1.
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. 2. 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.
Data Management Overview tab The Overview tab displays patient data on the left and the ECG records on the right. 2 1 Figure 2-2: Example of the Overview tab 1 2 Patient data list 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.
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 patient To add a new patient: 1. 2. 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.
Data Management Table 2-1: Example of patient detail fields (continued) Field Character limit Description Weight 3 The weight of the patient (maximum weight is 661 pounds or 300 kg) 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 C
Overview tab Mark a patient data record Select 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.
Data Management Open a tab Open 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.
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.
Data Management To... Do this... 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. Export recordings You 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.
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: If.
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 ◆ Relatives Note: To move between sub-tabs see Navigating in CareCenter MD in the System Setup Guide.
Overview tab 1 3 5 2 4 6 Figure 2-4: Example of the patient data tab 1 Patient buttons on the control panel: 2 3 4 5 6 Patient... (search) New Patient Delete Patient Patient tabs Patient information Edit patient button Patient data sub-tabs Recording list To edit the patient data fields, choose a method: ◆ Click Edit to open Patient Details. ◆ Select Patient | Edit Patient Details. Configuration Options Configure patient data subtabs • Select File | Options... | Database | Patient details.
Data Management To Confirm tab The 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.
Unassigned Recordings tab Unassigned Recordings tab The 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.
Data Management Orders tab Use 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.
Custom tabs Custom tabs You 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. CareCenter MD 1.
Data Management 2-18 70-00533-02 A CareCenter MD 1.
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 detecti
ECG Acquisition Test procedure programs During 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.
Test procedure programs Table 3-1: Basic test types (continued) Test type Treadmill Test Modified Bruce Settings Type of acquisition: Stress Test Leads: I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 Duration: The complete test is acquired Arrhythmia monitoring: yes Stress protocol: Modified Bruce: Pharmacological • Load start with 1.7 mph, 0% grade • Increase by up to .
ECG Acquisition The system includes further investigation programs which are not set.
Test procedure programs Table 3-2: Additional test types (continued) Test type Settings Type of acquisition: Stress Test Bicycle Stress Test Dorsal Leads: I II III aVR aVL aVF V4 V5 V6 V7 V8 V9 Duration: The complete test is acquired Arrhythmia monitoring: yes Stress protocol: WHO: • Load start with 25 Watts • Increase by 25 Watts • Stage duration 2 minutes • Stores a 10-seconds ECG strip at the end of every stage • Blood pressure measurement at the end of every stage Type of acquisition: Str
ECG Acquisition Launch a default test procedure automatically During 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. Configuration Options 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.
Select a default test procedure manually Select a default test procedure manually You 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.
ECG Acquisition Select a default test procedure in Data management When 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.
Select the active patient Select the active patient The 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.
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. Configuration Options 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.
Select the ECG acquisition device Select the ECG acquisition device You 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.
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.
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.
ECG Acquisition Apply electrodes Follow 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.
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. 4. • Always start with the right leg placement. • If an electrode is not applied the electrode position on-screen blinks.
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.
ECG filters ECG filters Filters 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.
ECG Acquisition You can change the filter settings for an individual test: 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.
Change the ECG representation Change the ECG representation You can change the speed, sensitivity, size and position of the ECG waveform. Configuration Options 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 1. Select File | Options… | 12 Lead ECG | Test procedures. 2. Click the Display tab and set the presets. Change speeds To change the speed of the displayed ECG in the test: 1.
ECG Acquisition Default settings Setting range Presetting (mm/mV) Multi-channel ECG 5, 10, 20 10 Rhythm line 5, 10 10 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.
Change the ECG representation 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.
ECG Acquisition Figure 3-3: Example of 2 columns with 6 leads Figure 3-4: Example of 4 columns with 3 leads Configuration Options Change the available views, or configure views for each test procedure 3-22 70-00533-02 A 1. Select File | Options… | 12 Lead ECG | Test procedures. 2. Select procedure and then select the Lead Program tab. 3. Modify the View selections. CareCenter MD 1.
Change the ECG representation 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.
ECG Acquisition Pediatric ECG For 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 (*).
Pacemaker detection Pacemaker detection The 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 impulses Impulses delivered by pacemakers can be so narrow that it is not possible to display the original pulse.
ECG Acquisition Demo ECG An 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. 3-26 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 70-00533-02 A CareCenter MD 1.
Print the record Print the record Use 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 Scienceapproved 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 TCR1000 is limited to printing at 25 mm/s during in-test printing.
ECG Acquisition To... Do this... 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.
Print the record To... Do this... Print the record after making 1. Choose a selection method: the format selections – 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 Acquisition Save the record After 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.
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. CareCenter MD 1.
Acquire a Resting ECG Operating steps - overview The 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.
Controls for acquiring a Resting ECG Step Selection 6 Save the record. Option Save or press F2 Cancel without saving the record. Cancel or press Ctrl + X Controls for acquiring a Resting ECG 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.
Acquire a Resting ECG Detailed procedures This 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.
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. 2.
Acquire a Resting ECG 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.
5 Acquire a Rhythm ECG Contents ◆ Operating steps - overview 5-2 ◆ Controls for acquiring a Rhythm ECG 5-4 ◆ Detailed procedures 5-7 This section describes how to acquire a Rhythm ECG. CareCenter MD 1.
Acquire a Rhythm ECG Operating steps - overview The 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.
Operating steps - overview Steps Selections 5 Review the recording. Options To review, use these views: Rhythm ECG ECG Strip Measurement Table Averaged Beat Repeat the acquisition in manual or in automatic mode. Repeat or press Ctrl + S Repeat Auto or press Ctrl + A Confirm the diagnosis. The system adds your full name and the Confirm or press Ctrl + B date and time to the diagnosis or to the remark. Preview using the standard formats.
Acquire a Rhythm ECG Controls for acquiring a Rhythm ECG 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 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.
Controls for acquiring a Rhythm ECG Control Panel Option Description 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.
Acquire a Rhythm ECG Control Panel Option Description Blood pressure 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. blank blood pressure field or Shift + F3 1. Click the blood pressure icon. See Measuring and entering blood pressure on page 3-13.
Detailed procedures Detailed procedures This 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. 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.
Acquire a Rhythm ECG If no active patient was selected, the patient search function opens automatically after the acquisition stops. Configuration Options Change the acquisition length • Select File | Options... | 12 Lead ECG | Test procedures and on the General tab select Auto stop in (seconds). 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.
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.
Acquire a Rhythm ECG Controls for reviewing a rhythm ECG While you are reviewing the record, you can perform these functions. Control Panel Option Description Remarks or F3 Enter comments regarding the acquisition. See Enter a comment on page 3-12. Confirm or Ctrl + B Confirms the correctness of the diagnosis or the comment. For more information see Chapter 11, Confirming Tests. Note: After the record is confirmed, it cannot be changed. Repeat or Ctrl + S Repeats the recording manually.
Detailed procedures Make a measurement in the ECG window You can make a measurement or create an ECG strip for analysis. 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.
Acquire a Rhythm ECG 5-12 70-00533-02 A CareCenter MD 1.
6 Acquire a Stress Test ECG Contents ◆ Stress test displays ◆ Operating steps - overview 6-15 ◆ Stress test controls 6-17 ◆ Detailed procedures 6-23 6-2 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. WARNING! Patient injury. In the event a failure prevents CareCenter MD from stopping the treadmill, the treadmill can be stopped manually.
Acquire a Stress Test ECG Stress test displays This section describes the stress test displays. Stress test window The stress test displays in a multi-panel window. 1 2 3 4 Figure 6-1: Example of the stress test screen 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 .
Stress test displays ECG panel The ECG panel displays the ECG waveforms. Configuration Options Configure the representation of the ECG waveforms 1. Select File | Options… | 12 Lead ECG | Test procedures. 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. Arrhythmia panel The Arrhythmia panel displays events that occur during the test.
Acquire a Stress Test ECG 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 • Exclude or include arrhythmia • events during the stress test Right-click and select Previous event or Next event. Select Settings | Arrhythmia detection....
Stress test displays 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.
Acquire a Stress Test ECG View You can select the type of view. ◆ Right-click and select View, and then select the representation. 1*1 1*2 2*1 6-6 70-00533-02 A CareCenter MD 1.
Stress test displays 3*4 Configuration Options Configure the basic settings of the Averaged Beat representation 1. Select File | Options … | 12 Lead ECG | Test procedures. 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.
Acquire a Stress Test ECG ◆ 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 6-8 70-00533-02 A CareCenter MD 1.
Stress test displays 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 rate As 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.
Acquire a Stress Test ECG Number of ventricular extrasystoles The 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 exertion The 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.
Stress test displays Pharmacological Stages By factory selection, the pharmacological stress test consists of a resting phase and stages 1 through 6 in the exercise phase. Configuration Options 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.
Acquire a Stress Test ECG Warning Description 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.
Stress test displays Basic settings for limit and target values You 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.
Acquire a Stress Test ECG Tab Settings 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.
Operating steps - overview Operating steps - overview By 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...
Acquire a Stress Test ECG Steps Options (continued) 5 Selections Print the continuous ECG. Rhythm Click again to stop printing. 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 Start the exercise phase. or Shift + F3 Start Exercise or press F2 Clickto increase the workload and , to de-crease it.
Stress test controls Stress test controls This 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: Control Panel Option Description Remarks Enter comments regarding the acquisition or the physician or user. See Enter a comment on page 3-12. EMG filter Enables the EMG (muscle artifact) filter. See ECG filters on page 3-17.
Acquire a Stress Test ECG Control Panel Option Description 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.
Stress test controls Control Panel Option 10sec ECG Description 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.
Acquire a Stress Test ECG 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.
Stress test controls 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.
Acquire a Stress Test ECG Configuration Options Enable load display as interpolated values 1. Select File | Options... | 12 Lead ECG | Test procedures. 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.
Detailed procedures Detailed procedures This 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. 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.
Acquire a Stress Test ECG Device selection The device selection window displays if either no or several acquisition devices or exercise equipment 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.
Detailed procedures Stress test parameters Before the start of a stress test, the Stress Test Parameters display. Complete the fields to set the parameters for the stress test. 1 2 4 5 6 7 1 2 3 4 5 6 7 3 Patient Details Order Entry Workflow Annotations Protocol Print Blood pressure measurement 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.
Acquire a Stress Test ECG 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. To... Do this...
Detailed procedures For a treadmill stress test For a bicycle stress test To... Do this... 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. • 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.
Acquire a Stress Test ECG 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.
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.
Acquire a Stress Test ECG 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.
Detailed procedures 6. The stress test depends on the type of exercise equipment. 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.
Acquire a Stress Test ECG 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.
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.
Acquire a Stress Test ECG 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.
7 Emergency ECG Contents ◆ Settings 7-2 ◆ Operating steps - overview 7-4 ◆ Controls for acquiring emergency ECGs 7-5 ◆ Detailed procedures 7-7 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.
Emergency ECG Settings Use 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.
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. Configuration Options Enable the Unassigned Recording tab 1. Select File | Options... | Database | Data management. 2. Drag the Unassigned recordings tab to the Used tab pages column. Blood pressure device All test procedures can use the automatic blood pressure device.
Emergency ECG Operating steps - overview The 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. Options STAT ECG or STAT Rhythm ECG If multiple acquisition devices are installed, select the device. Continue or press F2 If using a Bluetooth wireless device, power on the device.
Controls for acquiring emergency ECGs Controls for acquiring emergency ECGs Table 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 Remarks or F3 Enter comments regarding the acquisition. See Enter a comment on page 3-12. Stop or Ctrl + T Stops the recording.
Emergency ECG Table 7-1: Emergency ECG controls Control Panels Option Rhythm or Printing (Click to stop) Function 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. Note: You must manually stop continuous printing. 10sec ECG 7-6 70-00533-02 A Prints the last 10 seconds of ECG in adjusted print format. CareCenter MD 1.
Detailed procedures Detailed procedures This section contains detailed instructions on acquiring an emergency ECG. Select the test procedure Note: 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. 2. Choose a method to select the test procedure: • Click the STAT ECG or STAT Rhythm ECG button. • Press the appropriate keyboard shortcut.
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.
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.
Emergency ECG 7-10 70-00533-02 A CareCenter MD 1.
8 Displaying a Resting ECG Record Contents ◆ Displaying an ECG record ◆ Measurement table view 8-11 ◆ Averaged beat view 8-14 8-2 This chapter describes the Resting ECG view. CareCenter MD 1.
Displaying a Resting ECG Record Displaying an ECG record Open 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.
Displaying an ECG record Controls for reviewing Control panel Option Function Remarks or F3 Enter comments regarding the acquisition. See Enter a comment on page 3-12. Confirm or Ctrl + B Confirms the correctness of the diagnosis or the comment: Note: After the record is confirmed, it cannot be changed. 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...
Displaying a Resting ECG Record 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.
Displaying an ECG record Selection Example Description 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).
Displaying a Resting ECG Record 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.
Displaying an ECG record Editing the analysis for this ECG strip You 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.
Displaying a Resting ECG Record 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.
Displaying an ECG record 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. 3 1 2 Figure 8-2: Example of comparison 1 2 3 CareCenter MD 1.
Displaying a Resting ECG Record • 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.
Measurement table view Measurement table view As 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. 1 2 Figure 8-3: Example of the measurement table view 1 2 CareCenter MD 1.
Displaying a Resting ECG Record For each of 12 leads, the measurement table contains these measurement values: 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 value • positive amplitude value of T • negative amplitude value of T • area of the ST and T range • The first extreme value of the P amplitude ST and T range P range (if another extreme value is found,
Measurement table view Measurement table in comparison If a comparative record is open, you can compare the measurement tables of both records. 1 2 Figure 8-4: Example of measurement table comparison 1 2 Using Enlarge, the table was stretched to full window width The comparative record shows table and results of analysis at the same time 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.
Displaying a Resting ECG Record Averaged beat view As 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. 1 2 Figure 8-5: Example of Averaged beats 1 2 Enlarge the respective beat by double click Three-channel small preview of ECG strip To toggle the leads view: 8-14 1. Right-click on one of the complexes and select the parameter to modify. 2. In the submenu, select the entry. 3.
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. 1 2 3 Figure 8-6: Example of individual view 1 2 3 CareCenter MD 1.
Displaying a Resting ECG Record 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 | Changing the zoom factor ◆ Click or in the title bar. ◆ Right-click and select Zoom | . Changing speed or sensitivity ◆ 8-16 Right-click and select Speed | . 70-00533-02 A CareCenter MD 1.
Averaged beat view Superposition To show all leads in a cascaded format, right-click and select View | Superposition. 1 2 3 Figure 8-8: Example of Superposition 1 2 3 The selected lead is highlighted with a bold line in the average beat rate In the Superposition representation, an especially exact correction of the wave points is possible Temporal distance and amplitude difference between both red and green measuring lines Measuring the complex See Measuring the ECG on page 8-8. CareCenter MD 1.
Displaying a Resting ECG Record 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.
9 Displaying a Rhythm ECG Record Contents ◆ Displaying a Rhythm ECG record ◆ ECG view 9-12 ◆ Rhythm view 9-14 9-2 This chapter describes the Rhythm ECG view. CareCenter MD 1.
Displaying a Rhythm ECG Record Displaying a Rhythm ECG record Open 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 | . 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.
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: 1 2 3 Figure 9-1: Example of Rhythm ECG window 1 2 3 CareCenter MD 1.
Displaying a Rhythm ECG Record Controls for reviewing Control panel Option Function Remarks or F3 Enter comments regarding the acquisition. See Enter a comment on page 3-12. Confirm or Ctrl + B Confirms the correctness of the diagnosis or the comment. Note: After the record is confirmed, it cannot be changed. 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...
Displaying a Rhythm ECG record 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.
Displaying a Rhythm ECG Record Selection Example Description 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).
Displaying a Rhythm ECG record 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.
Displaying a Rhythm ECG Record Editing the analysis for this ECG strip You 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.
Displaying a Rhythm ECG record Controls for changing the view Use the view buttons to change the arrangement within multi-panel window. Icon Option Function 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. See ECG view on page 9-12. ECG Strip Displays the saved strips (one strip per tab).
Displaying a Rhythm ECG Record 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.
Displaying a Rhythm ECG record Table 9-1: Rhythm control functions To... Do this... Mark and edit an ECG strip of any length 1. In the title bar, click the Select variable length ECG. icon. 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.
Displaying a Rhythm ECG Record ECG view The 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.
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.
Displaying a Rhythm ECG Record Rhythm view The 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. Configuration Options Configure display channels 1. Select File | Options... | 12 Lead ECG | Test procedures. 2. Select the rhythm procedure. 3. Select Display | ECG rhythm.
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.
Displaying a Rhythm ECG Record 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.
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. CareCenter MD 1.
Display a Stress Test ECG Record Displaying the stress test ECG record Open 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. Controls for reviewing Control Panel Option Description Remarks or F3 Enter comments regarding the acquisition. See Enter a comment on page 3-12.
Displaying the stress test ECG record Controls for changing the view Use the view buttons to change the arrangement within multi-split panel window. Icon Option Function 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. See ECG view on page 10-7.
Display a Stress Test ECG Record 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.
Displaying the stress test ECG record Field or option Description If enabled the metabolic index displays during the recording. If enabled the RPE (rate of perceived exertion) display during the recording. Display functions Table 10-1 describes the functions available from the ECG view and Rhythm view. Table 10-1: 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.
Display a Stress Test ECG Record Table 10-1: Rhythm control functions To... Do this... Mark and edit an ECG strip of 10 seconds 1. In the title bar, click the Select 10 seconds ECG icon. 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 or the rhythm strip. Depending on the speed, the grey range can be greater or smaller than the visible range. Mark and edit an ECG strip of any length 1.
ECG view ECG view In 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, rightclick 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.
Display a Stress Test ECG Record 4 1 2 3 3 2 4 Figure 10-1: Example of ECG views 1 2 3 4 10-8 70-00533-02 A ECG strip panel— ECG strip reflects the saved 10 second strip for the selected tab Average beat panel—Average beat rate at the actual time (on the bottom left) Trend panel—The actual time is synchronized in the trend window, in the average beat rate and in the ECG window Time bar with marking of the currently selected strip (red) and all saved strips (blue) CareCenter MD 1.
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.
Display a Stress Test ECG Record Rhythm View The rhythm view shows the rhythm strips in a multi-panel window. 1 3 2 Figure 10-2: Example of Rhythm view 1 2 3 10-10 70-00533-02 A Marking of the actual time (time of the average beat rate and marking in the trend window - here in exercise phase 5:53) Details in the indication bar apply to the actual time Multi-channel ECG of the selected and marked ECG strip (here in rest at 1:50) CareCenter MD 1.
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.
Display a Stress Test ECG Record 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.
ECG strip view ECG strip view 1 2 3 Figure 10-3: Example of ECG Strip view 1 2 3 Using the arrow buttons, you can see the sections (strips) one after the other By clicking the tab you can open to the ECG of the related strip ECG strip selected with the marked tab 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.
Display a Stress Test ECG Record 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.
Trend view Trend view Note: 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 CareCenter MD 1.
Display a Stress Test ECG Record 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.
ST Trend view ST Trend view ECG windows and trend chart are synchronized. The use of the tabs and the multichannel 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...
Display a Stress Test ECG Record To... Do this... 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. The Trend panel charts show the workload trend and the ST trends. You can change the display of the ST Trend panel: To...
Summary view Summary view The 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). 1 2 3 Figure 10-6: Example of Summary screens 1 2 3 CareCenter MD 1.
Display a Stress Test ECG Record 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.
Summary view Summary Summary information is configured for all stress tests. Free text and pre-defined text can be entered in the Summary. Configuration Options Change summary information 1. Select File | Options... | 12 Lead ECG | ECG. 2. Change the settings in Stress Settings, Summary. Select File | Options... | 12 Lead ECG | Test procedures | | Exercise Settings.
Display a Stress Test ECG Record 10-22 70-00533-02 A CareCenter MD 1.
11 Confirming Tests Contents ◆ Performing confirmation 11-2 ◆ Revoking confirmation 11-3 Use the confirmation function to enter comments and validate the test. CareCenter MD 1.
Confirming Tests Performing confirmation Confirming 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.
Revoking confirmation Revoking confirmation Use 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.
Confirming Tests 11-4 70-00533-02 A CareCenter MD 1.
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).
CareCenter MD Online CareCenter MD Online overview CareCenter 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.
CareCenter MD Online access CareCenter MD Online access From 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.
CareCenter MD Online 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.
CareCenter MD Online display CareCenter MD Online display You 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 • • Change the sensitivity • • Change or hide a lead Click to decrease the speed or click to increase the speed.
CareCenter MD Online 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.
CareCenter MD Online display Figure 12-3: Example of 2 columns with 6 leads Figure 12-4: Example of 4 columns with 3 leads CareCenter MD 1.
CareCenter MD Online Sending and receiving text messages CareCenter 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.
13 Backup and Restore Contents ◆ Backup CareCenter MD 13-2 ◆ Restore CareCenter MD 13-3 You can backup and restore the CareCenter MD database. CareCenter MD 1.
Backup and Restore Backup CareCenter MD Follow 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.
Restore CareCenter MD Restore CareCenter MD Use 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.
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. 13-4 3. Restart the CareCenter MD server. 4. Restart the CareCenter MD clients. 70-00533-02 A CareCenter MD 1.
For Sale in US Only Cardiac Science Corporation • 3303 Monte Villa Parkway, Bothell, WA 98021 USA • 425.402.2000 • US toll-free 800.426.0337 • Fax: 425.402.2001 • info@cardiacscience.com Orders and Customer Care (US and International) • 425.402.2000 • US toll-free 800.426.0337 • Fax: 425.402.2001 • care@cardiacscience.com Technical Support • (US) Fax: 425.402.2022 • techsupport@cardiacscience.com• http://websupport.cardiacscience.com/webchat/ • (International) internationalsupport@cardiacscience.
