Presentation on theme: "Monitoring CO Poisoning with the Rad-57TM"— Presentation transcript:
1Monitoring CO Poisoning with the Rad-57TM Includes a review on Carbon Monoxide Poisoning For Emergency RespondersVersion 2.0F,
2IMPORTANT NOTICEThis program is not meant as a substitute for a program or course of study in carbon monoxide recognition and treatment, or emergency medicine. This is for review only. Please refer to your physician or local Medical Director for approved content and medical protocols.This program is not meant as a substitute for the manufacturer’s operator manual for the Masimo Rad-57. Please refer to the manufacturer for complete operating instructions.There are two versions of operating software that also include faceplate changes. Please review slide 28 for key version differences.
3Review: Carbon Monoxide Poisoning For Emergency Responders Section 1Review: Carbon Monoxide Poisoning For Emergency Responders
4IntroductionCarbon monoxide is the leading cause of poisoning in the United States for the last 100 years and is a common hazard to First Responders.Until recently, the only way to reliably diagnose carbon monoxide poisoning was to draw blood and check the carbon monoxide levels in a lab. With the introduction of the Masimo Rad-57, testing for carbon monoxide can now be done quickly and easily, allowing for prompt screening and treatment.This training program covers carbon monoxide poisoning recognition and treatment and the use of the Masimo Rad-57 Pulse CO-OximeterTM. As always, seek direction and approval from your physician or Medical Director prior to using this training program or a Masimo Rad-57.
5DefinitionCarbon monoxide is a colorless, odorless, tasteless, toxic gas that, when inhaled, can cause serious physical problems and even death.Carbon monoxide is often referred to as “CO”, which is its chemical symbol. Even at low levels, carbon monoxide may cause long- term cardiovascular and neurological disorders.Carbon monoxide can be a serious and sometimes deadly threat to Firefighters and EMS personnel. Firefighters have regular contact with carbon monoxide at fire and rescue scenes, increasing their health risks.
6Common SourcesIncomplete combustion of any carbon-based material will produce carbon monoxide. Closed or confined spaces are particularly hazardous. Common sources are:Automobiles, trucks, busesBoats, campersGas heaters, furnaces, and hot water heatersGas-powered generatorsSmall gasoline enginesPortable / space heatersBarbecues / fireplacesCigarette smokeLanternsMethylene chloride (paint stripper)Liver converts to COStructure / wildland fires
7PhysiologyCarbon monoxide is inhaled and passes from the lungs to the blood where it binds with hemoglobinProduces carboxyhemoglobinAffinity to hemoglobin is greater than 200 X that of oxygenReduces oxygen carrying capacity of bloodAlters release of remaining oxygen to cellsActs as an intracellular toxinPoisons tissues and cellsBinds with myoglobin in muscleInterferes with heart and skeletal muscleImmediate threat to lifeOxygen starvationCardiac arrhythmiasAlters judgment, reasoningLong-term health effectsCentral nervous system damageCardiovascular damage
8Signs and Symptoms SpCO % Clinical Manifestations 0-4% None - Normal 5-9%Minor Headache10-19%Headache, Shortness of Breath20-29%Headache, Nausea, Dizziness, Fatigue30-39%Severe Headache, Vomiting, Vertigo, ALOC40-49%Confusion, Syncope, Tachycardia50-59%Seizures, Shock, Apnea, Coma60% -upComa, DeathKoster LA, Rupp T.The Silent Killer, Recognizing and Treating Carbon Monoxide Poisoning. JEMS. October 2005
9Treatment Considerations Scene safety, protect yourself:Consider SCBARemove patient away from the poison!ABC’s (airway, breathing and circulation)Check CO level with Pulse CO-OximeterHigh levels treated with 100% oxygen:Decrease half-life of CO in bloodIncrease delivered oxygen in bloodSupport ventilations as neededTransport to closest, most appropriate facilityConsider hyperbaric treatment center:Adults >25%, Pedi & Pregnant female >15%Neurologic compromiseMonitor vital signs and SpCO®Always follow local EMS protocols
10Suggested Triage Algorithm Measure SpCOSpCO 0-3%SpCO >3%No further medical evaluation of SpCO neededLoss of consciousness or neurological impairment or SpCO >25% ?YesNoTransport on 100% oxygen for ED evaluation. Consider transport to hospital with hyperbaric chamberSpCO >12SpCO <12Transport on 100% oxygen for ED evaluationSymptoms of CO exposure?No further evaluation of SpCO needed. Determine source of CO if nonsmokerHampson NB, Weaver LK JEMS 2006
11Half-LifeHalf-life: The amount of time required to reduce the blood level of CO by 50%. These are estimates for patients that otherwise are healthy. Age and health will impact the half-life of CO.Breathing Room Air: Carbon Monoxide half-life in blood is ~ 240 minutesHigh-flow oxygen (“100%”) via non- rebreather mask: Decreases CO Half- life in blood to minutesHyperbaric Oxygen Treatment (HBOT) at 2.5 to 3 Atmospheres: Decreases CO half-life in blood to minutes
12Understanding PPM & SpCO PPM or “Parts Per Million” is the atmospheric concentration of the gasPPM is common fireground safety measurement, often misleading as CO forms in pocketsSpCO - noninvasive measurement of CO in the bloodSpCO as measured by RAD-57 is a function of PPM CO and total time of exposure of the poisonAge, health and respiratory rate may be a factorEven low PPM levels can lead to high SpCO if exposure is long enough, common in overhaulEven an exposure of 50 PPM for 60 minutes requires assessment and possible medical treatment with oxygen
13Firefighter RiskCO levels may be highest during the post-fire or “overhaul” phase, search & rescue operations and wildland firefightingPeriods that self-contained breathing apparatus (SCBA) are not worn or not functioning properlyCO poisoning is often unrecognized due to the presence of exhaustion, heat stress, illness or injuriesStudies have shown low levels of untreated CO lead to central nervous system and cardiovascular diseaseModerate to high levels are immediate threats to health and safety, and cause cardiovascular injury
14Section 2 Overview: Using the Rad-57 Pulse CO-Oximeter Note: This is NOT intended to replace or act as a substitute for the Operators Manual. Please refer to the manufacturer’s Operator Manual for complete information on the operation and safety of the Rad-57 Pulse CO-Oximeter.
15RAD-57 Pulse CO-Oximeter The Masimo RAD-57 is the world’s first and only Pulse CO-OximeterSignal Extraction Technology (SET®)SpO2 (oxygen saturation)Pulse rateMeasure through motion and low perfusionRainbow® SET TechnologyAnalyzes 7+ wavelengths of lightAccurately measures carboxyhemoglobin (SpCO) levels noninvasively, in SECONDS!PI (perfusion index, strength of arterial pulse)Low Signal IQ® indicator (poor SpO2 signal quality)Continuous color-coded CO bar graphAdjustable parameter alarms
16RAD-57 EMS Carry Case Lightweight: 13 oz. Small: 6.2” x 3.0” x 1.4” Portable: operates on 4 “AA” batteriesSupplied with high-visibility, water-resistant protective caseProtective coverReference card holderDepartment ID holderPen holderSpare battery pocketExtra sensor pocket
17RAD-57 Operation / Powering Up Press to turn ONPress and HOLD to turn OFFBattery Indicator4 Green LED’sEach represents approximately 25% battery lifeUse only Alkaline batteriesDo Not use rechargeable batteriesBattery CompartmentLocated in back panelHolds 4 “AA” alkaline batteriesOperates 8-10 hours
18RAD-57 Operation / Startup Sequence Place sensor on finger (relatively clean & dry)Press “Power” buttonVerify All LED’s light up and a 1 second tone is heard*Startup mode beginsAll preset configurations are displayedScrolling zeroes 0 – 0 – 0 and flashes dashed linesMay take up to 25 secondsDo not move sensor during startupWhen complete reading is displayedBegin patient monitoringDefaults to pulse rate and oxygen saturation reading“PI” bar graph displays strength of arterial perfusion* Refer to operator’s manual for additional verifications prior to patient monitoring.
19RAD-57 Operation / Sensor Placement Optimal LED pathSensor placement is very IMPORTANTWhen possible, use ring finger, non-dominant handInsert finger until the tip of finger hits the STOP BlockSensor should not rotate or move freely on fingerLED’s (red light) should pass through mid-nail, not cuticleThere is a top and bottom, cable should be on top (nail side)
20RAD-57 Operation / Pulse Rate and Saturation Display after StartupOxygen Saturation on top in RedPulse Rate on bottom in GreenGreen PI scale, indicates strength of arterial pulseLow SIQ LED indicates poor SpO2 signal qualityPress “Display” to display % carboxyhemoglobinPress “Bell” to silence alarmsPI ScaleLow SIQ LEDAlarm Silence LEDDisplay button toggles from SpO2 to SpCOBattery level
21RAD-57 Operation / Alarms When parameter is violated, audible alarm will sound, parameter will flashPreset at factory:Sp02 (oxygen saturation)Low: 90%High: nonePulse RateLow: 50High: 140SpCO (carboxyhemoglobin)Low: noneHigh: 10%Alarms adjust:Press “Mode/Enter” twicePress “Next” key to scroll through parametersUse up and down keys to adjustChanges remain until user restores to factory defaultsAlarm Indicator(flashes)
22RAD-57 Operation / Measuring CO Slow: Low SpCO ConfidenceFast: SpCO AlarmPress “Display” button for SpCO readingTo scroll back to SpO2 mode press “Display” againCarboxyhemoglobin displayed in % on top“CO” displayed on bottom confirming modeReal-time SpCO indicator continuously reads SpCOGreen: 1-3%Yellow: 4-11%Red: 12% and aboveConfirm abnormal readings by taking several measurements on different fingers and average the readingsCO label when SpCO is displayed
23RAD-57 Operation / Troubleshooting Error Messages:“NO Cbl”Cable not seated properly into top of Rad-57Defective cable“SEN OFF”Sensor off fingerSensor misaligned“bAd CbL”Replace cable“CbL”Incompatible cableConnect appropriate cable“bAd SEN”Defective sensorReplace sensor“SEN”Unrecognized sensorConnect appropriate sensor
24RAD-57 Operation / Troubleshooting Will not power onCheck battery compartmentReplace batteriesContinuous Startup mode (Scrolling zeroes 0 – 0 – 0 and flashes dashed lines)Shield sensor from flashing lights, strobes or high ambient light with Masimo Light Shield*Try other fingersSingle battery level indicator flashes (with audible alarm)Battery level too lowReplace batteries immediately“Err” messageReturn for service, CallContinuous Speaker TonePower down and remove batteries* Contact your Masimo sales rep to order a Masimo Light Shield.
25RAD-57 Operation / Light Shield Use Optimal LED pathFace protrusion of light shield down, and insert the end of the sensor into the holeEnsure that sensor hits the back of the light shieldOrient the sensor so the cable is coming out of the top of the hole while in the light shieldOpen the sensor by applying pressure from the top and bottom of the light shieldInsert finger until the tip of finger hits the STOP BlockLED’s (red light) should pass through mid- nail, not cuticleOrient the sensor so the cable is running over the top of the patient’s handApply pressureto open sensorProtrusion
26RAD-57 Operation / Improving Accuracy The Rad-57 is designed with an accuracy of +/- 3 digits with a range of 1% - 40% for one standard deviation (67% of patients)Example: A reading of 10% could have a range from 7% - 13%Measurements may vary from reading to reading, even on the same patient, within the accuracy specificationProper probe placement may improve accuracyIf an abnormal level of CO is detected, always confirm by measuring other fingers and averageFlashing lights, strobes or high ambient light may interfere, use a Masimo Light Shield or other means of shielding
27RAD-57 Operation / Contraindications Small physiological changes and acceptable levels of arterial perfusion along with correct sensor placement will provide a stable CO reading. Inaccurate measurements may be caused by:Incorrect sensor placementElevated levels of methemoglobinIntravascular dyes such as indocyanine green or methylene blueAbnormal hemoglobin levelsLow arterial perfusionLow arterial oxygen saturation levelsElevated Total Bilirubin levelsMotion artifact
28RAD-57 Version Differences Faceplate design changes (see image)SpCO button displays value for 10 secondsUpon Startup all LEDs flash, dashed lines, scrolling zeroes, followed by flash dashed linesAlarm settings revert back to factory settings upon power offSpCO bar graph changes color at 10% and 20%Version 2Faceplate design changes (see image)Display button allows user to scroll through modes (SpO2, SpCO and PI)PI can be displayed as a numeric valueUpon Startup all LEDs flash, device presents all configurations, then scrolling zeroes and flash dashed linesAlarm settings are retained after power offSpCO bar graph changes color at 3% and 12%
29ResourcesFor more information on carbon monoxide poisoning and the Masimo Rad-57or callMasimo Corporation40 ParkerIrvine, CA 92618All Rights ReservedMasimo