1. MACS CPAP System Self Guided Tour

2. Program Objectives This program is a self guided tour of the MACS CPAP System. At the end of this tour you will be able to: zDescribe the main operating features of MACS zIdentify the controls and connections zDescribe the patient circuit zSet-up MACS for patient operation zDefine various clinical environments for CPAP application zClean and maintain the MACS

3. Features and Controls – Rear Panel Driving Gas Input zConnection for 50 psi oxygen source gas zAlways use a high flow gas source (pressure take-off) that can provide 55 + 15 psi pressure at a minimum of 40 L/min

4. Features and Controls – Rear Panel Air Entrainment zAmbient air is entrained for internal gas mixing zExternal housing contains air filter zAir filter replacement is part of the preventative maintenance

5. Features and Controls – Front Panel CPAP Control zAdjusts the CPAP from 0 to 20 cm H 2 O zAutomatic sensitivity zFlow adjusts automatically to meet patient demand up to 140 L/min zOxygen concentration is maintained at set % Oxygen control

6. Features and Controls – Front Panel % Oxygen Control zDelivered oxygen choice y 65% y 100% zSets the spontaneous breath oxygen concentration

7. Features and Controls – Front Panel Pressure Gauge zShows pressure in patient circuit at the output of MACS zGives an indication of patient effort

8. Features and Controls – Front Panel Circuit Connection 1 zConnection for the large bore hose of the patient circuit

9. Features and Controls – Front Panel Circuit Connection 2 zPatient circuit small hose connection zConnects to the expiratory valve on the patient circuit

10. Patient Circuit Patient circuit is a disposable, single limb system; zBoth hoses attach to the front of MACS zPatient end connects for clinical intervention y Directly to an endotracheal tube (invasive) y Resuscitator face mask (noninvasive) zUse 90 degree elbow to connect bacteria filter for operator protection

11. Patient Circuit Use only Airon Corporation patient circuits; zCalibration of the CPAP control is based upon the Airon patient circuit zUsing other manufacturers circuits may cause y errors in pressure delivery y high expiratory flow resistance y interference with CPAP sensitivity y increased oxygen usage

12. Program Objectives MACS CPAP System self guided tour, objectives completed so far: þDescribe the main operating features of MACS þIdentify the controls and connections þDescribe the patient circuit With an understanding of MACS’s capabilities, let’s look at patient application.

13. Patient Application Initial Set-up zAttach Airon patient circuit to MACS zAttach a high pressure oxygen hose to the rear of MACS zAttach this hose to the oxygen source

14. Patient Application Set % Oxygen Control zSet % Oxygen control to the desired oxygen level zAll breaths receive set oxygen level + 10% zOxygen tank time doubles with 65% zCaution - with rapid, large tidal volumes on 100% oxygen, the actual delivered percentage might be slightly less than 100%

15. Patient Application Start CPAP zTurn on oxygen source zAttach patient breathing circuit to the patient using either a mask or endotracheal tube zAdjust the CPAP control to the level desired zIf the patient is not attached to the circuit, or there is a large leak, a high flow of gas will occur

16. Patient Application Monitor patient zAssess per your protocol y patient breathing rate y comfort y oxygenation y CO 2

17. Clinical Issues Pediatric Support zMACS is safe for pediatric - adult patients zUse the lowest possible settings zMonitor closely for patient synchrony

18. Clinical Issues Providing nebulized medications zA medication nebulizer may be placed between the patient connection and the patient zPatient will inhale medication during every breath and exhale back out through patient circuit  Filters may be added for personnel safety

19. Clinical Issues CO 2 Monitoring zAny type of CO 2 analyzer may be used zInline style analyzers should be place between the patient circuit connection and the patient zPlace the sampling tube of sidestream analyzers under the patient mask

20. Clinical Issues Altitude Operation zMACS can be used for air transports in unpressurized cabins up to 15,000 feet z Pressure settings will not change as altitude changes

21. Patient Safety Patient Safety Features zInternal Safety Pressure Release – limits circuit pressure to 40 cm H 2 O zAnti-Suffocation System – in the event of device malfunction, an internal valve will allow ambient air to enter the patient circuit

22. Cleaning and Maintenance zClean MACS between patients using a soft cloth and a mild detergent / disinfectant zDo not immerse MACS in water zPatient circuit is disposable, single use application and should not be cleaned, disinfected or reused zMACS should receive preventative maintenance every 2 years

23. Program Objectives MACS CPAP System self guided tour completed; you should now be able to: þDescribe the main operating features of MACS þIdentify the controls and connections þDescribe the patient circuit þSet-up MACS for patient operation þDefine various clinical environments for CPAP application þClean and maintain MACS Next Step – consider reviewing the MACS Case Study and completing the competency evaluation

24. Contact Information Thank you for you interest in the MACS CPAP System For more information visit www.macs-cpap.comwww.macs-cpap.com or call Airon Corporation at 888-448-1238