©2006 Medtronic Emergency Response Systems You’re Ready. LIFEPAK ® 1000 Defibrillator Orientation Guide

©2006 Medtronic Emergency Response Systems Your LIFEPAK  1000 defibrillator may not have all the settings or features (e.g. ECG monitoring) shown in this presentation. Please be familiar with the features available on your 1000 and how they are programmed. Additional information is provided in the notes section of this presentation. Refer to Operating Instructions for complete directions for use, indications, contraindications, warnings, precautions, and potential adverse events. Important User Instructions

©2006 Medtronic Emergency Response Systems Objectives  Review the operation and features of the LIFEPAK 1000 defibrillator including:  Electrode pad placement  AED and Manual mode  ECG monitoring  Pediatric patient  Battery  Troubleshooting  Maintenance

©2006 Medtronic Emergency Response Systems LIFEPAK 1000 Defibrillator  Uses:  AED therapy -For use only on patients in cardiopulmonary arrest  Manual defibrillation therapy -For the treatment of certain fatal arrhythmias  ECG monitoring -For the purpose of ECG rhythm recognition and heart rate monitoring

©2006 Medtronic Emergency Response Systems Basic Steps for Use  Establish that patient is in cardiac arrest  Turn on the 1000  Place electrodes  Follow screen messages and voice prompts

©2006 Medtronic Emergency Response Systems Electrode Placement  Remove clothing from patient’s chest  Remove excessive hair  Clean and dry the skin  Do not apply alcohol, tincture of benzoin, or antiperspirant to the skin

©2006 Medtronic Emergency Response Systems Electrode Placement  Press electrode firmly onto patient’s skin

©2006 Medtronic Emergency Response Systems Electrode Placement  Correct electrode position optimizes the amount of current flowing through the ventricles Correct electrode positionIncorrect electrode position

©2006 Medtronic Emergency Response Systems ECG Analysis  When an analysis occurs, the 1000 will prompt to clear the patient  Do not touch the patient during analysis  Make sure everyone is clear of the patient  Prompt:

©2006 Medtronic Emergency Response Systems Shock Advised!  The 1000 has detected a shockable ECG rhythm  The 1000 will charge automatically

©2006 Medtronic Emergency Response Systems Shock Advised!  Clear everyone from the patient or any equipment connected to the patient  Press the shock button  Prompt:

©2006 Medtronic Emergency Response Systems CPR Time  Start CPR prompt occurs immediately after shock is delivered  A text message and countdown timer appear for the remaining CPR time  At the end of CPR time, the 1000 automatically reanalyzes the heart rhythm  Prompts:

©2006 Medtronic Emergency Response Systems Shock Advised!  Repeat delivering shocks and providing CPR as directed until patient has return of spontaneous circulation or until advanced EMS provider arrive

©2006 Medtronic Emergency Response Systems No Shock Advised  The 1000 has determined the heart rhythm is not shockable  The 1000 will prompt to start CPR  Perform CPR until the patient has return of spontaneous circulation or the 1000 automatically reanalyzes the heart rhythm after the CPR Time interval is ended  Prompts:

©2006 Medtronic Emergency Response Systems Return of Spontaneous Circulation  Position the patient according to training if consciousness and/or signs of circulation and breathing return  Leave electrodes attached  Keep patient as still as possible  Electrodes may be connected to another LIFEPAK defibrillator

©2006 Medtronic Emergency Response Systems Manual Mode  Overrides the AED features  Provides responder-initiated charge, shock, and disarm functions

©2006 Medtronic Emergency Response Systems Basic Steps  Press the MENU key  Select YES to enter manual mode  ECG trace and HR appear on screen  Press CHARGE if heart rhythm is shockable  Press SHOCK when charge is complete  Press DISARM to remove an unwanted charge

©2006 Medtronic Emergency Response Systems Pediatric Patient  Use the 1000 with adult pads on children older than 8 years old or more than 55 lbs (25kg)  Use the 1000 with Infant/Child Reduced Energy Defibrillation Electrodes on children less than 8 years old or 55 lbs (25kg)

©2006 Medtronic Emergency Response Systems Pediatric Patient  With Infant/Child Electrodes, energy from the 1000 is reduced by a factor of 4  Approximately Joules is delivered if the1000 is set at Joules

©2006 Medtronic Emergency Response Systems Pediatric Patient  Basic Steps:  Remove Infant/Child Electrodes from package  Disconnect and remove any electrodes or cables from the 1000  Insert the Infant/Child Electrode connector directly into the 1000  Apply electrodes to patient’s chest  Follow voice prompts

©2006 Medtronic Emergency Response Systems Pediatric Patient  Infant/Child Electrodes are not compatible with manual defibrillation cables or QUIK-COMBO defibrillation cable (CAT )

©2006 Medtronic Emergency Response Systems Pediatric Patient  Place the Infant/Child Electrodes in the anterior-lateral position

©2006 Medtronic Emergency Response Systems Pediatric Patient  Alternate placement: anterior-posterior position

©2006 Medtronic Emergency Response Systems ECG Mode  Provides ECG display of the patient’s heart rhythm using a 3-wire cable  Basic steps:  Connect the ECG cable  Attach ECG electrodes to ECG cable  Apply ECG electrodes to patient’s chest  The 1000 displays the heart rhythm and heart rate in a Lead II configuration

©2006 Medtronic Emergency Response Systems ECG Mode  ECG electrode placement

©2006 Medtronic Emergency Response Systems ECG Mode  If a shockable rhythm is detected:  Follow voice and screen prompts  Remove ECG cable  Connect therapy cable  Apply therapy electrodes to chest  Prompt:

©2006 Medtronic Emergency Response Systems Battery  The 1000 is powered by a nonrechargeable lithium manganese dioxide battery pak  Battery pak fuel gauge indicates battery’s charge level  Fully charged battery: all green lights illuminated

©2006 Medtronic Emergency Response Systems Battery  Low battery: single steady green light  Empty battery: single flashing green light

©2006 Medtronic Emergency Response Systems Battery  The approximate level of charge in the battery appears on the readiness display when the 1000 is off  Battery low: battery symbol has one bar  Battery empty: battery symbol has no bars

©2006 Medtronic Emergency Response Systems Battery  The approximate level of charge in the battery appears on the screen when the 1000 is in use  Battery low: battery symbol has one bar  Battery empty: battery symbol has one bar flashing on and off  Prompt:

©2006 Medtronic Emergency Response Systems Troubleshooting Tips  Message: “Connect electrodes” “Check connector and electrodes”  Possible causes:  Electrodes are not adhered to the patient’s skin  Electrodes are disconnected from the 1000  Patient impedance measurement outside of range

©2006 Medtronic Emergency Response Systems Troubleshooting Tips  Message: “Connect electrodes” “Check connector and electrodes”  What to do  Firmly press electrode onto the skin  Check to be sure connector is completely inserted into the 1000  Clean, shave and dry the skin  Replace the electrode pads  If prompt continues, perform CPR until ALS arrives  Prompt:

©2006 Medtronic Emergency Response Systems Troubleshooting Tips  Message: “Motion detected, stop motion”  Possible causes:  Patient movement due to: breathing, CPR being performed during analysis, some internal pacemakers, vehicle motion, or electrical/radio frequency interference  What to do:  Check patient for normal breathing  Stop CPR during analysis  Stop vehicle during analysis  Move communication or other suspected devices away from 1000 when possible  Prompt:

©2006 Medtronic Emergency Response Systems Troubleshooting Tips  Message: “Replace battery”  Possible causes:  Battery pak has exceeded specified “on time” and/or energy discharges  What to do:  Continue to use during resuscitation  Obtain a replacement battery  Prompt:

©2006 Medtronic Emergency Response Systems Data Management  Every time the 1000 is used it digitally saves patient data that can be transferred to a PC equipped with a Medtronic LIFENET ® system product  The 1000 provides an infrared method to transfer data

©2006 Medtronic Emergency Response Systems Maintenance  Daily Auto Test  The 1000 performs automatic tests daily at 3:00 AM  OK symbol visible: AED is ready for use  Daily Auto Test will test for low or replace battery conditions  Battery gauge on the readiness display updates every day

©2006 Medtronic Emergency Response Systems Maintenance  Self-test  Each time the 1000 is manually turned on, it performs internal self-tests to check that the internal electrical components and circuits work properly  Also indicates a low or replace battery condition

©2006 Medtronic Emergency Response Systems Maintenance  If the 1000 requires service, the wrench symbol appears  If the wrench is visible, remove the 1000 from service and contact authorized service personnel

©2006 Medtronic Emergency Response Systems After-use Care  After the 1000 has been used:  Clean foreign substances from the 1000  Replace electrodes  Replenish supplies as needed  Check battery symbol for battery status and replace battery if low  Download patient data per local protocol

©2006 Medtronic Emergency Response Systems Routine Maintenance  The 1000 is easy to maintain  On a periodic basis check the following:  OK symbol is visible  Battery gauge level  Use-by date on electrode pads is not passed  Other emergency supplies stored with the 1000 are present (e.g., face masks, gloves, razors, etc.)  Damage to or foreign substances on the 1000

©2006 Medtronic Emergency Response Systems Recommended Corrective Actions  Wrench symbol visible: contact authorized service personnel  Battery symbol visible: replace if low battery indicated  Use-by date passed: replace electrode packet  Supplies missing: replenish as needed  Damage noted: contact authorized service personnel  Foreign substance visible: clean with damp sponge or cloth with recommended cleaning agents

©2006 Medtronic Emergency Response Systems cprMAX ™ Technology  cprMAX technology is designed to allow resuscitation protocols to maximize the quantity of CPR administered during treatment  Consistent with 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care 1 and the European Resuscitation Council Guidelines for Resuscitation  Know which features are programmed by your Medical Director 1American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2005; 112 (Supplement IV). 2 European Resuscitation Council Guidelines for Resuscitation Resuscitation 2005; 67S1.

©2006 Medtronic Emergency Response Systems Summary  The LIFEPAK 1000 defibrillator is designed to be the most powerful BLS tool for emergency medical services (EMS) and patients:  Indicated for use on patients of all ages  Utilizes ADAPTIV™ biphasic technology  Includes manual mode capability  Incorporates fuel gauge indicators for battery  Includes cprMAX technology

©2006 Medtronic Emergency Response Systems LIFEPAK and LIFENET are registered trademarks of Medtronic Emergency Response Systems, Inc. ADAPTIV, cprMAX, CODE-SUMMARY, REDI-PAK and QUIK-COMBO are trademarks of Medtronic Emergency Response Systems, Inc. ©2006 Medtronic Emergency Response Systems, Inc. MIN / CAT You’re Ready. Always. Refer to Operating Instructions for complete directions for use, indications, contraindications, warnings, precautions, and potential adverse events.

©2006 Medtronic Emergency Response Systems The following slides are only to be used if a pulse check has been selected in the setup option.

©2006 Medtronic Emergency Response Systems Pulse Prompt  You may be prompted to check for a pulse after every shock or no shock advised decision or only after a no shock advised.

©2006 Medtronic Emergency Response Systems Check for Pulse  YES and NO soft keys appear on the screen  If patient does not have a pulse, press the NO soft key and CPR time begins  Prompt:

©2006 Medtronic Emergency Response Systems Check For Pulse  If patient has pulse, press the YES soft key  The 1000 will prompt the user to provide rescue breaths, if needed  The 1000 enters a continuous monitoring state  Prompts: