ZOLL Medical Corporation Sales Training

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ZOLL Medical CorporationSales Training
M Series 12 Lead
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12-lead ECG
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Agenda

• Introduction
• What is a 12-lead?
• Features and Benefits
• Demonstration
• In-Service
• Hands-on

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FACTS

• AMI ( Acute Myocardial Infarction ) is THE
  leading cause of death in the US
• 1.1 MILLION people have an MI annually
• 439,000 women
• 668,000 Men
• Approx 500,000 will die
• Costs for CAD ( Coronary Artery Disease ) in the
  US in 2001 were 298 billion
• NRMI ( National Registry Myocardial Infarction)
  Database

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Indications for the 12-lead ECG

• Chest Pain
• Stroke
• Dysrhythmias
• Post-Resuscitation
• Following Emergency Cardioversion
• Suspected Electrolyte Disturbances
• For Asystole confirmation
• PEA ( Pulseless Electrical Activity) to identify
  cause

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12-Lead ECG KNOWLEDGE

• Ischemia
• Lack of oxygenation
• ST depression or T inversion
• Injury
• Prolonged ischemia
• ST elevation
• Infarct
• Death of tissue
• May or may show in Q wave

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ST Segments
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12-lead ECG
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12-lead Electrode Placement

• V1- Right parasternally,4th Intercostal space
• V2 - Left parasternally, 4th intercostal space
• V3 - Directly between V2 and V4
• V4 - 5th intercostal space,left mid clavicular
  line
• V5 Directly between V4 and V6
• V6 Left midaxillary line , same plane as V4

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12-Lead ECG KNOWLEDGE

• Inferior Wall
• Leads II, III, aVF
• Left Leg

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12-Lead ECG KNOWLEDGE

• Lateral Wall
• Leads I and aVL
• Left Arm

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12-Lead ECG KNOWLEDGE

• Septal Wall
• Leads V1, V2
• Along sternal borders

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12-Lead ECG KNOWLEDGE

• Septal Wall
• V3, V4
• Left anterior chest

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12-Lead ECG KNOWLEDGE

• Lateral Wall
• Leads V5 and V6
• Left lateral chest

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12-Lead ECG KNOWLEDGE

• The three ECG subsets
• Non diagnostic no ST or T wave abnormalities
• Suspicious for ischemia ST depression or T wave
  inversion
• Suspicious for injury ST elevation

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12-Lead ECG KNOWLEDGE

• Whats the Value of a12-Lead?
• Provides baseline ECG before treatment
• Early and rapid identification of AMI
• Triage to correct facility
• Cath Lab or Thrombolytics
• Quicker diagnosis
• Reduced time to triage / treatment in hospital
• Improved patient care

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M Series with 12-lead ECG option

• Features and Benefits

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12-Lead ECG KNOWLEDGE

• Description
• Simultaneous 12-lead ECG acquisition, storage,
  display, transmission and analysis
• Uses GE Medical Systems 12SL analysis program
• Interface with MUSE for direct transmission of
  12-lead ECG records from defibrillator to
  hospital MUSE system.

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12-Lead ECG UNDERSTANDING

• Key Differentiators
• AHA Class I recommendation
• GE 12SL Gold Standard for analysis
• Direct transmission to MUSE
• Bluetooth Wireless Options
• Module to Interlink to RescueNet Code Review
• Fax and email
• Bluetooth Activation Pod Kit
• Fax or MUSE

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The GE 12SL PROGRAM

• Background
• Validated on clinically correlated Gold
  Standard databases
• Annually evaluated by a group of over 50 top
  consulting Cardiologists and physicians from
  around the world ( ECG Analysis seminar)
• Detailed Physicians Guide explains the ECG
  Analysis morphology ( obtained from GE)

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12SL PROGRAM

• KEY Points
• Worldwide name recognition (Analysis by 12SL)
• Introduced in 1980 and consistently enhanced
• Most independently validated algorithm in the
  scientific literature
• Adult Pediatric programs available
• Published statement of Validation Accuracy
• Established value and is now the Standard of Care

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Sensitivity

• Refers to recognition
• If the test always recognizes the disorder,
  sensitivity would be 100
• False negatives are failures of sensitivity
• A false negative occurs when the condition
  exists but the test fails to find it

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Specificity

• Refers to the number of diagnoses confirmed
• If the diagnosis were corroborated every time the
  test identifies it, it would be 100 specific
• False positives are failures in specificity
• A false positive occurs when the test indicates
  the disease is present, when in fact it is not

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GE 12SL PROGRAM

• Infarction
• Sensitivity 65 ( refers to recognition)
• Specificity 98 ( refers to diagnostic accuracy)
• Overall 74 sensitivity for Chest Pain Patients
• clearly adequate for first line screening of
  patients with chest pain by paramedics or in the
  ER.
• specificity is superior to that of the
  trained electrocardiographer

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12-Lead ECG KNOWLEDGE

• 12-lead Summary Reports
• 4x3 Prints 10 seconds of 12-lead ECG in four
  staggered 2.5 second segments (default)
• 4x3 Median Prints single median beat for each
  of the 12 leads as computed by 12SL algorithm
• 2x6 Prints all 12-lead ECG data recorded during
  first 5 second interval. Inhibits printing of
  the 12SL analysis and lead II rhythm strip
• Measurement Matrix Prints measurements for each
  segment of each lead. This option must be
  changed in the configuration menu.

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M-Series ECG Filters

• Normal Monitoring Bandwidth is 0.5 to
  30/40 Hz ( Frequency Response)
• Diagnostic 12-lead monitoring is done at 0.05 to
  150 Hz ( AAMI standard ( American Association of
  Medical Instrumentation)
• Diagnostic 12-lead can also be done at 0.05 to
  40Hz ( to reduce noise)

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Features and Benefits

• Integrated in the M Series
• Easy to Use
• Recorder Button automatically provides 4x3
  printout
• 12-lead Acquisition Button Provides 4x3,
  Interpretation and Measurements
• Faster 12-lead print-out v LP12
• Prints the first 3 lead groups after 2.5 seconds
• LP12 waits 10 seconds and then prints 12-lead
  report

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Features and Benefits

• One-Step Patient Cable
• Ease of Configuration
• 12SL Analysis Implementation
• Fast Acquisition
• Compressed ECG pre transmission

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Features and Benefits

• Fax/Modem Card 12-lead Transfer today
• Wireless coming in Oct 2003
• 12-lead ECG compression
• LP12 Physio sends raw ECG data
• M Series compresses before we send
• MAY help transmission speeds!!
• Preconfigured telephone numbers
• Saves time / easy /Auto redial
• Manual dial option ( Buried in LP12 configuration)

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Why ZOLLs 12-lead?

• Key Points
• GE Medical Systems 12SL Analysis Program
• Rapid 12-lead Acquisition
• ECG compression for transmission
• Transmission capabilities of M Series
• 12SL Best in Class v other ECG Programs
• Cost-effective pricing
• Connectivity options ie MUSE

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12-lead ECG APPLICATION

• 12-lead Demo

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M Series 12-lead

• Being prepared
• Review Operators Guide
• Review 12-lead Monitoring Insert
• Understand electrode placement
• V1 4th intercostal space at right sternal margin
• V2 4th intercostal space at left sternal margin
• V4 5th intercostal space on left midclavicular
  line
• V3 Between V2 and V4
• V5 Left anterior axillary line at horizontal
  level of V4
• V6 Left midaxillary line at horizontal level of
  V4

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Demo Tips

• Configure the device to automatically transmit
  after a 12-lead
• Have a 12-lead simulator
• Pre-connect all leads to the simulator
• Have the M Series already in 12-lead monitor mode
• Configure to come up in Lead II
• Do not enter in the age, gender or ID
• Explain how M Series 12-lead begin to print out
  after the first 2.5 seconds on the Leads I , II ,
  III
• LP12 waits 10 seconds before print out
• Explain how ZOLL compresses the data
• V-Pak electrode samples

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M Series 12-lead

• Have the proper equipment!
• 12-lead cables!!!!!!!!!!!!!!!
• 12-lead simulator
• Fresh batteries
• Pre-attached leads
• Configure M Series for desired operation
• Carry a spare modem card and cables
• TEST THE TRANSMISSION IN ADVANCE

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12-Lead ECG KNOWLEDGE

• Basic Operation - 12-Lead Acquisition
• Attach electrodes
• Turn selector switch to MONITOR
• Press 12 LEAD soft key to enter 12-lead menu
• Acquire, Settings, PT Info, Alarms is displayed
• Press ACQUIRE to begin 12-lead acquisition (takes
  10 seconds)
• Wait for ACQUISITION COMPLETE message before
  patient movement allowed
• Transmission screen will automatically be
  displayed after acquisition if configured
• To print only Press and hold PRINT for 3 seconds

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• 12 Lead Miscellaneous

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12-lead Accessories

• Modem Extension Cable Revision B (Dec 02)
• Connects to Ositech King of Hearts or Viking
  Cellular Ready modems only
• Does not fit the older Viking Modem cards
• Part 8000-0086
• Xtreme Pak
• Comes with modem cable built in to plate
• See Bulletin 52802 for all Part
• Sales Bulletin 55302 /52602 for details

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M Series 12 Lead Opportunities

• Adding 12 lead increases ASP and gets you to
  quota faster
• 7,395.00 is like selling two defibrillators
  instead of one

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Qualifying Questions

• Is 12-lead currently in your scope of practice?
• What is your current protocol for AMI assessment
  in your department?
• What 12-lead devices do you currently use?
• Are you transmitting 12-leads? If so, where to?
• Once in the ER, how long does it take before a
  12- lead ECG is taken?
• Whats your average on scene time?
• Do you have a 24 / 7 Cath lab in your area?

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Troubleshooting 12-lead

• Do they prep the skin before applying the ECG
  electrodes to the patient?
• Were the electrodes pre-attached potentially
  drying out the electrodes?
• Is there proper lead placement?
• Check for placement on boney prominences or for
  correct lead placement.
• Do they place the limb leads on the chest or
  limbs?
• Check to make sure the ER does the same
  placement.
• If they transmit, do they have drop out areas?
• If they get a fax busy signal, does the ER have a
  dedicated fax machine?
• Have they programmed their M Series with the
  appropriate fax numbers and cell phone?

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12-lead ECG UNDERSTANDING

• 12-lead In-Service