Physio Control LIFEPAK 20, Manual

Page: 99 / 227

Therapy
4-26 LIFEPAK 20e Defibrillator/Monitor Operating Instructions
The LIFEPAK 20e defibrillator/monitor has an integrated pulse oximeter that can be used in
conjunction with a noninvasive pacemaker to help confirm capture. To confirm capture, compare
the pulse rate measured by the oximeter to the set pacing rate of the pacemaker.
Noninvasive Pacing Procedure
ECG monitoring during pacing must be performed with the ECG electrodes and patient ECG
cable. Pacing therapy electrodes cannot be used to monitor ECG rhythm and deliver pacing
current at the same time. Be sure to place the therapy electrodes in the proper locations as
described in the pacing procedure. Improper electrode placement may make a difference in the
capture threshold.
To pace, perform the following:
1 Press
ON
.
2 Connect the patient ECG cable, apply ECG electrodes to the ECG cable and patient, and
select Lead I, II, or III. To receive the best monitoring signal, ensure there is adequate space
between the ECG electrodes and the therapy electrodes.
3 Identify the QUIK-COMBO electrode sites on the patient. For pacing, use either the anterior-
lateral or anterior-posterior position (refer to page 4-3 ).
4 Prepare patient's skin for electrode application as described in Step 3 of the Defibrillation
Procedure.
5 Apply QUIK-COMBO electrodes to the patient.
6 Connect the therapy electrodes to the therapy cable.
7 Press
PACER
. Confirm the LED illuminates, indicating that the power is on.
Note: If the
REMOVE TEST PLU G
message appears, disconnect test plug and connect
therapy electrodes to QUIK-COMBO therapy cable.
8 Observe the ECG rhythm. Confirm that a triangle sense marker appears near the middle of
each QRS complex. If the sense markers do not appear or are displayed in the wrong location
(for example, on the T-wave)
,
select another lead. (It is normal for the sense marker location
to vary slightly on each QRS complex.)
9 Press
RATE
or rotate the Speed Dial to select the desired pacing rate.
Note: The
RATE
button changes the rate in 10 pulse per minute (ppm) increments; the
Speed Dial changes the rate in 5 ppm increments.
10 Press
CURRENT
or rotate the Speed Dial to increase current until electrical capture occurs.
For each delivered pacing stimulus, the
PACER
indicator flashes off and a positive pace
marker displays on the ECG waveform.
11 Palpate the patient's pulse or check blood pressure and compare the SpO
2
pulse rate with the
set pacing rate to assess for mechanical capture. Consider use of sedation or analgesia if
patient is uncomfortable.
Note: The
CURRENT
button changes the current in 10 mA increments; the Speed Dial
changes the current in 5 mA increments.
Note: To change rate or current during pacing, press
RATE
or
CURRENT
, and then rotate
the Speed Dial.
Note: To interrupt pacing and view the patient's intrinsic rhythm, press and hold the
PAUSE
button. This causes the pacer to pace at 25% of the set rate. Release the
PAUSE
button to resume pacing at the set rate.
12 To stop pacing, reduce current to zero or press
PACER
.
Note: To defibrillate and stop noninvasive pacing, press
ENERGY SELECT
or charge the
defibrillator. Pacing automatically stops. Proceed with defibrillation.