1. Copyright © 2000 Agilent Technologies, Inc.
PRESENTER’S NOTES
THE HEARTSTREAM FR2 AED TRAINING TOOLKIT “Buttonology” Slide Presentation
Copyright © 2000 Agilent Technologies, Inc.

2. The Heartstream FR2 Semi-Automatic External Defibrillator

3. Heartstream FR2 AED Responding to Sudden Cardiac Arrest
This is a course in the operation, maintenance, and troubleshooting of the Heartstream FR2 AED.
It is assumed that you are proficient in CPR and Basic Life Support.
Refer to the Heartstream FR2 User’s Guide for complete information.

4. Sudden Cardiac Arrest (SCA)
Abrupt loss of heart pump function
Death certain without rapid treatment
Sudden Cardiac Arrest (SCA) is a leading cause of death in the United States and many countries throughout the world.
Currently fewer than 5% of the victims of SCA survive.
When SCA strikes, the victim rapidly becomes unconscious, has no breathing or detectable pulse.
If SCA is not reversed, death is certain.

5. The Heart Pump: A Series of Events...
An electrical event…
Stimulates a mechanical event…
Results in rhythmic and coordinated pumping action of the heart
Main Pumping
Chambers
There are two components to normal heart function, electrical and mechanical.
Electrical:
Special fibers send electrical impulses in a coordinated, organized way throughout the heart.
This electrical activity is shown on an electrocardiogram (ECG or EKG).
Mechanical:
Electrical impulses stimulate heart contractions, causing the heart to pump blood--first to the lungs to receive oxygen, and then out to the rest of the body.
As a result of this coordinated electrical and mechanical heart function, the normal heart pumps with regularity and is associated with a pulse.

6. SCA: Heart in Chaos  Ventricular Fibrillation
Abnormal; irregular, very fast heart rhythm
Heart can’t pump blood effectively
Victim: Unconscious  Not breathing spontaneously  No pulse
Only definitive treatment: Defibrillation
Ventricular fibrillation (VF) is the most common SCA rhythm, although other rhythms are possible (ventricular tachycardia, pulseless electrical activity, and asystole).
A fibrillating heart is a quivering mass, analogous to a “bag of worms.” It is beating very rapidly, without the coordinated electrical conduction and pumping properties of a healthy heart.
The signs of SCA are unconsciousness and absence of pulse and breathing (or the presence of agonal respirations).
The only treatment that can allow the heart to reset itself to a more coordinated rhythm (and pulse) is defibrillation. Conceptually, defibrillation is similar to “rebooting” a frozen computer.

7. Defibrillation Electric shock to the heart
Stops uncoordinated activity
Allows coordinated heart rhythm and pumping action to resume
Only effective treatment for ventricular fibrillation
Defibrillation is an electric shock delivered across the heart.
The goal of defibrillation is to stop VF, allowing a coordinated rhythm and pumping action to resume.
Defibrillation is the only effective treatment for ventricular fibrillation.

8. Heartstream FR2 AED Heartstream FR2 AED is Easier than CPR
Low maintenance
Safe and effective
Heartstream FR2 AED automatically
Prompts the user
Interprets heart rhythm
Advises “Shock” only if needed
The leading-edge technology used in the Heartstream FR2 automatic external defibrillator (AED) results in simplicity of use. Many people find that learning to use the FR2 is easier skill than mastering CPR. The FR2 requires virtually no maintenance, and is a safe and effective treatment for SCA.
The Heartstream FR2 automatically guides the user through voice and screen prompts, interprets the heart rhythm, and prompts the user to deliver a defibrillation “shock,” only if a shock is needed.

9. “Chain of Survival” Rapid, coordinated response improves outcome
The American Heart Association (AHA) “Chain of Survival” is an ideal coordinated response model.
There are four links in the chain, all of which should be activated quickly for the best outcome. The chain is only as strong as its weakest link.
Early access (call for help, including mobilizing a defibrillator to the scene)
Early cardiopulmonary resuscitation (CPR) (provide CPR until the FR2 arrives, and as part of AED care)
Early defibrillation (now provided by you)
Early advanced life support (the Paramedics and other EMS personnel)
Early Access
Early
CPR
Early
Defibrillation
Early
Advanced Care

10. Role of CPR Integral component of AED use CPR circulates oxygen ...
Prolongs heart’s electrical activity
Minimizes brain damage
… but defibrillation is the definitive treatment
CPR is performed until the AED is at the patient’s side.
Because multiple shocks may be necessary, CPR is performed at intervals to circulate oxygen during emergency care.
CPR helps to prevent brain damage by circulating oxygen to the brain. CPR is also thought to prolong the heart’s electrical activity, allowing more time for the AED to arrive.
Early defibrillation, however, is the only truly definitive first-line treatment for sudden cardiac arrest.

11. Role of the AED Provider
Recognize emergency
Activate EMS/ emergency response
Verify SCA
Access the Heartstream FR2 AED
Attach Heartstream FR2 AED and follow prompts
Provide BLS/CPR as indicated
Recognize that there is an emergency situation.
Call or have bystander call for EMS emergency response.
Check that the patient has suffered sudden cardiac arrest (SCA).
Attach the pads and turn on FR2, follow prompts .

12. Heartstream FR2 AED Operation

13. Using the Heartstream FR21 2 3
Heartstream FR2 use is as simple as turning the AED on, applying the pads to the patient’s bare chest, and pressing the shock button when prompted.

14. Verify SCA Assess ABC’s Not breathing Unconscious No detectable pulse
Before using the Heartstream FR2, it is important to verify that the patient is in cardiac arrest.
Cardiac arrest is indicated when the patient is unconscious, not breathing (or with agonal respirations) and has no detectable pulse.
The steps for determining when it is appropriate to use the FR2 are the same steps you learned for CPR.
It is important to activate EMS or the appropriate emergency plan as soon as you determine the patient is unconscious.
If the patient has a pulse, Heartstream FR2 use is not indicated.

15. Turn On AED Push the green On/Off button
Voice and screen prompts begin
Data collection starts
Turn on the Heartstream FR2 as soon as it is at the side of the patient and you have verified SCA.
Turning on the FR2 tarts the voice and screen prompts that will guide the rescuer.
Provided a Data Card is inserted, the FR2 immediately begins to record important event and patient information when powered on. Voice recording also starts if an ECG/Event/Voice Data Card is inserted.

16. Apply Pads Apply pads as shown on icons Plug in pads connector
When prompted, bare the patient’s chest by ripping or cutting the clothing.
If there is excessive chest hair, you may need to clip or shave the chest. Do so quickly to reduce hair to a stubble in the pad application areas.
If the chest is sweaty or wet, dry it with a towel or other absorbent material.
Look at the pad icons to ensure proper pad placement.
Peel the pads away from the paper backing by grasping the pad at the point where the cable is connected to the pad.
Grasp the pad by the edges. Avoid touching the gel portion of the pad. Adhesive gel may tear gloves. Use caution when handling pads.
Press pads firmly, including edges, to patient’s chest.
When the pads are placed, plug the pads connector into the socket by the flashing light.

17. Pads Location Pad on patient’s right Below collar bone
Right of sternum
Pad on patient’s left
On rib cage
Below breast
Wrapped towards back
The right pad should be placed just below the collarbone and to the right of the sternum.
The left pad should be placed over the ribs and below the left breast. The lateral edge should wrap around patient’s side to the mid-axillary line.
It may be necessary to lift the breast to place the left pad properly.

18. Rhythm Analysis Automatic decision-making process
Don’t touch patient during analysis
Outcome of analysis
Shock advised
No shock advised
After placing the pads and plugging in the connector, the Heartstream FR2 will automatically analyze the patient’s heart rhythm.
It is important that rescuers and bystanders do not touch or move the patient during analysis, to minimize artifact.
The FR2 will indicate if a shock is advised or if no shock is indicated.
It may seem like a long time to “stand by” while the FR2 is analyzing, however analysis only takes a few seconds.

19. Deliver Shock Before shock button is pushed Verbal clear Visual clear
Push shock button when advised and follow prompts
The AED operator is responsible for keeping all persons (including the operator) from touching the patient when a shock is delivered. Visually and verbally “clear” the patient before delivering a shock. Scan the patient from head to toe to make sure no one is touching the patient while loudly stating “clear,” “stand clear,” or a similar statement.
After clearing the patient, press the lighted orange button to deliver the shock.
Following shock delivery, the Heartstream FR2 will immediately begin to re-analyze the patient’s heart rhythm. Continue to follow FR2 prompts.

20. Pause for CPR Fill bar shows progress through pause
Heartstream FR2 AED will prompt you at completion “Analyzing...”
The Heartstream FR2 will automatically pause after three consecutive shocks to allow rescuers to perform one minute of CPR.
During a CPR pause, the FR2 will indicate on the screen and with voice prompts that it is “timed out” so that CPR can be provided.
The fill bar gives rescuers a visual timer, indicating how much of the CPR pause interval has elapsed.
At the completion of the pause, the FR2 will alert the user by stating, “Analyzing...do not touch the patient.”
The FR2 will also show on the screen the elapsed time since the unit was turned on, and the total number of shocks delivered. The patient’s ECG will be displayed on the model 3860.

21. No Shock Advised Heartstream FR2 continues to monitor ECG
Provide BLS/CPR as indicated
Heartstream FR2 will advise when analysis is needed
Voice and screen prompts inform you when the Heartstream FR2 determines that no shock is advised.
When No Shock is advised, the FR2 will prompt the rescuer to check airway breathing and pulse. Provide BLS/CPR care as indicated.
The FR2 continues to monitor ECG data while the rescuer provides appropriate care to the patient.
If the FR2 detects a potentially shockable rhythm, it will automatically shift to analyzing mode and advise the rescuer not to touch the patient.
While the FR2 is monitoring, it is important that CPR (if necessary) be provided according to AHA guidelines of 100 compressions per minute. Check the pulse after each minute of CPR.
The FR2 will periodically prompt the rescuer to check airway, breathing, and pulse, and to resume CPR if needed. The time taken for patient assessment (at least 10 seconds recommended) also allows the FR2 to assess the patient’s heart rhythm without CPR artifact.

22. Heartstream FR2 AED Troubleshooting

23. Troubleshooting “APPLY PADS. PLUG IN CONNECTOR.”
Possible cause: Pads and/or pads connector are not firmly attached.
Sample corrective action: Press pads firmly to patient’s bare chest and insert connector.
The Heartstream FR2 provides precise visual and audible prompts to guide the operator through potential troubleshooting actions.
The prompts are specific to the error condition. For example, the prompt, “Apply pads. Plug in connector,” indicates that the defibrillation pads may not be properly applied, are touching each other, or are not connected to the FR2.
If the prompt continues, replace the pads.

24. Troubleshooting “PRESS PADS FIRMLY TO PATIENT’S BARE CHEST.”
Possible cause: Incomplete pad contact with the skin.
Sample corrective action: Prep skin, press entire pad onto the chest.
This prompt indicates that the pads are connected to the FR2, but that they are not contacting the skin adequately.
If good contact cannot be obtained by pressing the pads firmly to the chest, disconnect the pads from the FR2, remove them from the patient’s chest, and dry the skin or shave any excessive hair from the contact area. Then apply a new set of pads and connect them to the FR2.

25. Troubleshooting “REPLACE PADS.”
Possible cause: Pads, cable, or connector damage or short.
Sample corrective action: Replace the pads.
If the FR2 is unable to analyze the heart rhythm and calculate impedance, it will prompt you to replace the pads. Disconnect the connector from the FR2 and remove the pads from the patient’s chest. Then apply a new set of pads and connect them to the FR2.

26. Troubleshooting “ANALYZING INTERRUPTED.”
Possible cause: Patient is being moved or jostled
Sample corrective action: Stop CPR; do not touch patient.
Excessive movement of the patient or the transport environment may interfere with successful rhythm analysis.
Do not administer CPR during rhythm analysis.
Be sure that no one is touching the patient during rhythm analysis.
Avoid moving the patient during rhythm analysis. If the patient is being transported, it may be necessary to stop the vehicle to permit the FR2 to analyze the heart rhythm and make a shock or no-shock decision.

27. Heartstream FR2 Other Considerations

28. Other Considerations Implanted pacemakers or defibrillators
Wet surfaces
Metal surfaces
Medication patches
Children
Implanted pacemakers or defibrillators -
The FR2 is capable of analyzing heart rhythms in the presence of implanted pacemakers. However, the FR2 may not detect all shockable rhythms.
If a shock is advised despite the presence of an implanted defibrillator or pacemaker, follow the FR2 Prompts.
Try to avoid placing the FR2 pads directly over implanted pacers or defibrillators.
Wet or metal surfaces - FR2 can be used on wet surfaces (with both fresh and salt water) and metal surfaces that are wet or dry.
Medication patches - Remove any medication patches from the patient’s chest and wipe the area clean.
Children - Do not use the FR2 on patients under 8 years of age.
Trauma and hypothermia - Local protocols vary for the AED treatment provided to victims of trauma or hypothermia. Consult your physician medical director or local regulatory agency for treatment protocols.

29. Heartstream FR2 Data Collection and Management
The Heartstream FR2 is designed to simplify data collection and management.
Summary data for an incident is automatically recorded in internal memory by the Heartstream FR2 while you are using it.
This information can be reviewed by removing and reinstalling the battery, then selecting REVIEW INCIDENT from the menu. Summary information includes the elapsed time of FR2 use and the number of shocks delivered during the incident.

30. Event Storage and Review
Data storage
Data card
Data review
Download data from Data Card to computer
The Heartstream FR2 optionally uses a compact Data Card to record more detailed code information. The Data Card is placed arrow face up into the Data Card tray, which is inserted into the FR2.
If the Data Card is installed when the FR2 is turned on, data recording is automatic.
Each Data Card can record approximately 4 hours of event and ECG data, or 30 minutes with voice recording.
Once the Data Card’s data storage capacity is full, no further recording occurs. After an event, replace the Data Card with an empty card to return the FR2 to service. Send the event Data Card to the appropriate location for post-event review.
Be sure to reinstall the Data Card tray, even if no Data Card is used. The tray helps seal the FR2 against moisture and dirt.
CodeRunner is the software program that allows Heartstream FR2 data to be transferred into a variety of reports for patient tracking and quality assurance and review activities.

31. Heartstream FR2 Maintenance
The Heartstream FR2 requires minimal physical maintenance. The Status Indicator window and Battery Insertion Test make maintenance quick and easy.
Agilent Technologies recommends that the FR2 be checked periodically. Different intervals may be appropriate depending upon the environment in which the FR2 is used, and the requirements of your program medical director and/or organizational policies.
Refer to Chapter 4 of the FR2 User’s Guide for additional maintenance information.

32. Maintenance Temperature Cleaning
The FR2 is designed to be operated in temperatures of 32 to 122o F (0 to 50o C) and 0 to 95% relative humidity. Standby temperatures 32 to 109o F (0 to 43o C) and 0 to 75% relative humidity. Special procedures may be necessary to maintain proper environmental conditions.
The outside of the Heartstream FR2, including the defibrillator pads connector port, can be cleaned with a soft cloth dampened in one of several appropriate cleaning agents, listed in the User’s Guide. Do not immerse the Heartstream FR2 in fluids.
Make sure a battery (or the Training & Administration Pack) and a Data Card tray are installed when cleaning the Heartstream FR2, to keep fluids out of the device.

33. Automatic Selftests Selftests Automatic Comprehensive
Test result displayed in Status Indicator window
Automatic, comprehensive self-tests increase the user’s confidence that the Heartstream FR2 is ready for use when needed.
Various critical and non-critical functions are automatically checked, including the high energy waveform delivery circuits. Calibration specifications are also verified.
The FR2 automatically checks itself daily, weekly, and monthly. The user can also manually initiate the most comprehensive test possible (the battery insertion test).
Results of these tests are displayed in the “Status Indicator” window in the upper right corner of the FR2. The user simply views the Status Indicator to determine that the device is ready to go. The FR2 does not require on-site service.

34. Status Indicator Status Indicator signals Ready for use:
Use not advised; troubleshoot:
Do not use; change battery:
When the Status Indicator shows a flashing or solid red “X,” the Heartstream FR2 may not be ready for use. The “X” may be accompanied by audible “chirping” (similar to a smoke detector), so that the operator has both a visual and audible cue that the device needs attention.
Corrective action for a flashing or solid red “X” is a battery insertion selftest.
The FR2 also helps the user to troubleshoot the problem with precise audible and visual prompts, such as “Low Battery, Replace Battery Now.”

35. Battery Insertion Selftest
Run the battery insertion selftest
If status indicator doesn’t display flashing black hourglass
If a problem is suspected
After use or training
Battery insertion selftest is initiated by
Removing and re-installing battery
If there is a flashing or solid red “X,” if a problem is suspected, or after use or training, perform a battery insertion selftest. Initiate a battery insertion selftest by removing and re-installing the existing battery.
During portions of the automatic test, the screen flashes and blinks, and buttons light up.
After the automatic portion of the test is complete, the interactive test begins. The interactive test allows the user to verify the correct operation of the screen, buttons, and speaker.
A battery insertion selftest is initiated any time a battery is inserted into the device, except when the FR2 is attached to a patient or in training mode.
The selftest may be terminated at any time by pressing the On/Off button.

36. Battery Insertion Selftest
Battery insertion selftest results
Status indicator
Display screen
Passed
Interactive selftest begins
Failed
Install new battery; perform battery insertion selftest
If second selftest fails, take FR2 AED out of service
At the completion of the automatic portion of the battery insertion selftest, the display screen displays the outcome of the testing. The Status Indicator will also reflect readiness for use.
If the FR2 fails a battery insertion selftest, install a new battery and perform a second selftest. If the second test fails, notify Agilent Customer Service.

37. SMART Battery in a Small Package
Description: 12 VDC, 4.2 Ah; lithium; disposable, recyclable
Shelf life prior to installation: Typically, 5 years from date of manufacture*
Capacity when new: Minimum of 300 shocks or 12 hours of operating time at 77° F (25° C)
Installed shelf life (standby): Typically, 5 years*
* when stored under standby environmental conditions
The Heartstream FR2 is powered by a small, non-rechargeable (disposable), lithium manganese dioxide battery.
The FR2 battery has a shelf life of 5 years. When installed in the unit, the FR2 battery typically lasts more than 4 fours in standby mode (during which time it does frequent and comprehensive self-testing), or delivers a minimum of 300 shocks, or provides 12 hours of continuous monitoring.
Always carry a spare battery. Insert the battery firmly when installing it in the FR2; the battery will “click” in place when properly installed.

38. Heartstream FR2 Review

39. 1 2 3 Heartstream FR2 AED Use Review Heartstream FR2 operation.
FR2 use is as simple as turning the AED on, applying the pads to the patient’s bare chest, and pressing the shock button when prompted.