Fairview Health Systems
There is audio with the Zoll online
learning section of this lesson.
Marcia Turner
MS, RN, Nursing Education Specialist
Fairview Health Systems
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Lesson Details
Target Audience
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This lesson is intended for Fairview employees that will be utilizing the R
Series Defibrillators in their scope of practice. It is assumed that the learner
has previously used the Zoll M Series.
Contact Hours
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Not Applicable
Estimated Duration
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The expected time to complete this learning activity is 30 minutes.
If you are unable to complete this during your scheduled work time, it may be
completed outside of work with prior approval from you supervisor. Any
overtime must be approved.
It is suggested that you complete a hands on review of the Zoll R series after
completing this lesson module.
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References and Contact
Information
References
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Zoll R Series Training Guide (August 2010)
R Series Quick Reference Guide (2010)
Print R Series Competency Checklist
Program Contact
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Marcia Turner, RN, MS, Nursing Education Specialist
mturner1@fairview.org
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Objectives
Upon completion of this lesson, learners will be able to:
• Identify the functionality of the new R Series features: CPR Help and
See Thru CPR.
• Identify the present selection of multifunction pads and their uses
with the Zoll R Series Models.
• Identify the proper procedure for visual and manual checks of the Zoll
R Series defibrillators.
• Demonstrate how to operate the Zoll R Series ALS and R Series Plus
defibrillators for defibrillation, synchronized cardioversion, and
pacing.
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Table of Contents
If you are viewing the lesson for the first time
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Click the Next button to begin the lesson
If you are returning to view a specific part of the lesson, click the
appropriate subject below
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The New Zoll R Series Models
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New Features: Real CPR Help and See-Thru CPR
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New Pads: OneStep Complete and OneStep Pediatric
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Compatible Electrodes
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Attaching an ECG Cable
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Other New R Series Features
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Testing of the New R Series Models
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Changing the R Series Plus to Manual Mode, ALS Full Functioning and Pacing Mode
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Completing the Zoll Online Training
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New R Series Models
There are two new R Series models: the ALS and the
Plus Models. Both models contain new features of Real
CPR Help and See-Thru CPR. Let’s begin learning about
the R Series ALS model.
Click the Next button to continue.
R Series ALS Model
R Series Plus Model
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R Series ALS Model
The R Series ALS model is similar to our present M Series in
appearance and function, however, it has the new features
of Real CPR Help and See-Thru CPR.
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R Series ALS Model
This machine will be utilized in higher acuity areas such as
ICU, PACU, ED and areas that have internal response to
codes with ALS trained staff.
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R Series Plus Model
The R Series Plus model looks and performs like an
AED. It also contains the features of Real CPR Help and
See-Thru CPR.
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R Series Plus Model
This model will be utilized in areas where the first
responders are BLS trained. It can quickly be transformed
into a full R Series ALS functioning model by changing it to
manual mode.
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New R Series Features
Real CPR Help
See-Thru CPR
As we discussed previously, the new R Series models have
Real CPR Help and See-Thru CPR. Let’s explore these
further. Click on the Real CPR Help picture above.
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Real CPR Help
Real CPR Help gives visual and audio cues to assist
compression quality . Click Next to continue.
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Real CPR Help
There are four mechanisms of real time CPR feedback: CPR
Index, Rate Prompt, Depth Prompt, and Idle Time Display.
Let’s learn more about the CPR Index. Click Next to
continue.
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CPR Index
The CPR Index is a visual representation of the quality of
compressions being performed.
It provides feedback after 8 good quality compressions in the
form of a filling hexagon. It takes 20-25 good quality
compressions before the index fully fills.
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Rate Prompt
The Rate Prompt is a visual and audible prompt that lets
the compressor know that compressions are less than 90
bpm.
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Rate Prompt
When the Rate Prompt is active, the CPR Index stops filling,
the Rate Prompt displays, and the metronome beeps at the
correct rate.
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Rate Prompt
Prompts will automatically stop when the compression
rate returns to 90 bpm.
There is one exception: the metronome beep prompt is continuous
despite compression rate with the R Series Plus model while in the AED
mode.
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Depth Prompt
The Depth Prompt is a visual and audible prompt to let the
compressor know that compressions are less than 2 inches
in depth.
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Depth Prompt
“Push
harder”
When the Depth Prompt is active, the CPR Index stops
filling, the Depth Prompt displays, and the audio prompt
states “Push harder.”
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Depth Prompt
Prompts will automatically stop when the compression
depth returns to 2 inches .
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Idle Time Display
The Idle Time Display is a visual prompt that displays after
compressions have been interrupted for more than 10
seconds. The time displays in minutes and seconds
(mm:ss).
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Idle Time Display
The display will disappear when compressions are fully
resumed. Let’s learn about the See-Thru CPR feature.
Click Next to continue.
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See-Thru CPR
See-Thru CPR is available on the R Series
ALS Model and the R Series Plus Model
(but only in the manual mode).
It displays a second tracing (FIL) that filters
out the CPR artifact from the ECG to allow
users to see a close approximation of a
patient’s underlying rhythm during CPR
compressions, reducing interruptions in
CPR.
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See-Thru CPR
See-Thru CPR does not replace human
assessment; it is meant to be a tool in the
process.
See-Thru CPR does not work in the
advisory/analyze mode.
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Quick Review
Let’s do a quick review of the content we just learned.
Click the host, Quinn, to begin.
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Quick Review
When does the Rate Prompt display?
Click on the correct answer.
A. When compressions are less than 90 bpm.
B. When compressions are greater than 90 bpm.
C. When the caregiver needs to take a lunch
break.
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Quick Review
Correct!
Click Next to continue.
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Quick Review
Good try! That was not the
answer I was looking for.
The correct answer is A: when compressions
are less than 90 bpm.
Click Next to continue.
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Quick Review
When the Depth Prompt displays, what
does the audio prompt say?
Click on the correct answer.
A. “Push faster.”
B. “Push harder.”
C. “Feed me.”
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Quick Review
Yes! That’s it!
Click Next to continue.
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Quick Review
I’m sorry, that is incorrect.
The correct answer is B: “Push harder.”
Click Next to continue.
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Quick Review
True or False: See-Thru CPR is meant to
take the place of human assessment.
Click on the correct answer.
A. True
B. False
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Quick Review
Great Work!
Click Next to continue.
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Quick Review
That is not correct.
The correct answer is B: False.
Click Next to continue.
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Quick Review
That concludes our quick review
for this section. I will resume
our review later in the lesson.
Click Next to continue.
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New Pads: OneStep Complete and
OneStep Pediatric
There are some new pad options for use with the Zoll R Series
models. Let’s learn more. Click on the OneStep Complete
Pad picture to continue.
OneStep Complete
OneStep Pediatric
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OneStep Complete
The OneStep Complete Pad is for use on older children
and adults. Real CPR Help and See-Thru CPR are available
when using the OneStep Complete Pads by utilizing a new
censor attached to the pad.
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OneStep Complete
ECG leads are internal in the pad. It is not necessary to
put leads on to perform pacing or urgent synchronized
cardioversion UNLESS you are using anterior/anterior
placement.
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OneStep Complete
The OneStep Compete Pads sense to charge at intervals of
120, 150, and 200 Joules consecutively for defibrillation.
If a different Joule setting is desired, adjust it by using the
energy select arrow key for initial and subsequent shocks.
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Opening the Pads
Step 1: Open the electrode
package by grasping the blue ring
and white tab marked OPEN HERE.
Step 2: Pull away from each other
so that the electrodes are
displayed as in the picture.
Note: Do not use a scissors to
open the pads!
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Applying the Pads
Anterior/Posterior placement is recommended. Place
the back pad on first. Then place the front pad with the
sensor on the sternum between the nipples.
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Applying the Pads
If using anterior/anterior placement, rotate the apex
electrode 180 degrees. With this placement, the ECG
display may be slightly different and should not be used
for diagnostic purposes. Use the ECG cable for pacing
with this electrode placement.
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OneStep Pediatric Pads
Use with pediatric patients 0-8 years and/or <25 kg.
These pads presently do not allow for Real CPR Help and SeeThru CPR features in the new R Series models.
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OneStep Pediatric Pads
ECG leads are NOT internal in the pad.
Switch to Pedi Padz to perform pacing or urgent synchronized
cardioversion and add an ECG cable.
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OneStep Pediatric Pads
The OneStep Pediatric Pads sense to charge at intervals of 50,
70, and 85 Joules consecutively for defibrillation.
If a different Joule setting is needed based on the patient’s weight and AHA
guidelines, 2 J per kilo, adjust it by using the energy select arrow key for initial
and subsequent shocks.
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Applying Pediatric Pads
Apply pads as shown on package placing the back pad on first.
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OneStep Pad Connections
Both the OneStep Complete Pad and the OneStep
Pediatric Pad attach the same way to the multifunction
cable on the R Series Models.
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Compatible Electrodes
There are other compatible electrodes that can be utilized
with the R Series Models, however, none of them allow for
the use of the new features Real CPR Help and See-Thru
CPR.
• Pro Padz
• Pedi Padz
• Paddles and Internal Handles
Let’s look at each of these to see how they are used with
the R Series models. Click Next to continue.
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Pro Padz
You can use these for elective synchronized cardioversion
along with 3 lead ECG cables in older pediatric patients or
adults. The energy selection must be adjusted manually
when using these pads.
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Pedi Padz
You can use these for elective synchronized cardioversion
and pacing along with 3 lead ECG cable in pediatric
patients under 15kg in weight. Energy selection must be
adjusted manually when using these pads.
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Paddles and Internal Handles
Paddles and Internal Handles will only be utilized in
selected areas by special request. You cannot use these
with the R Series Plus Model unless the machine is set in
manual mode.
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Paddles and Internal Handles
Paddles will initially sense to charge at 120 Joules and
internal handles to 10 Joules when used with the R Series
ALS model.
If different Joule settings are needed, adjust by using the energy select arrow
key for initial and subsequent shocks.
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Quick Review
We are back for another Quick Review with your favorite
host, Quinn.
Click the host, Quinn, to begin.
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Quick Review
When opening the OneStep Complete, you
should use scissors.
Click on the correct answer.
A. True.
B. False.
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Quick Review
Correct!
Click Next to continue.
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Quick Review
Good try! That was not the
answer I was looking for.
The correct answer is B: False.
Click Next to continue.
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Quick Review
When placing the OneStep Complete using
anterior/posterior placement, which pad should
you place first?
Click on the correct answer.
A. Back pad
B. Front pad
C. It doesn’t really matter as long as they
both are on the patient.
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Quick Review
Yes! That’s it!
Click Next to continue.
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Quick Review
I’m sorry, that is incorrect.
The correct answer is A: Back Pad
Click Next to continue.
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Quick Review
True or False: Pro Padz, Pedi Padz, paddles and
internal handles are all compatible with the R
Series. However, they do not allow for the use
of the Real CPR Help and See-Thru CPR
features.
Click on the correct answer.
A. True
B. False
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Quick Review
Great Work!
Click Next to continue.
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Quick Review
That is not correct.
The correct answer is B: False.
Click Next to continue.
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Quick Review
That concludes our quick review
for this section. Please continue
on with the lesson. Enjoy!
Click Next to continue.
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Attaching an ECG Cable
When using the OneStep Complete and OneStep Pediatric
Pads:
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Attaching an ECG Cable
When using the Pro Padz, Pedi Padz, Internal Pads and
Paddles, use the 3 lead adapter cable and attach as
shown. The pad adaptor is attached to the back side of
the connection.
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Other New R Series Features
The battery is lighter and has a power indicator allowing
you to view the remaining run time. To view the
remaining run time, you would press the
icon.
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Other New R Series Features
The printer now loads from the top of the machine.
Press the top button to open and load the paper.
Click Next to learn about testing the R Series models.
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Testing of the R Series Models
Auto Test
Visual Inspection
Manual Test
Done daily automatically
by the machine at 2AM
To be done with daily
crash cart check on the
days the unit is open
To be done weekly with
crash cart check and after
resolving any code
readiness issues to
restore green check in
the code ready indicator
box
Let’s begin by learning about the Auto Test. Click Next to
continue.
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Auto Test
For the Auto Test to occur, the defibrillation cable needs to be
connected to the OneStep Complete pads (adult units) or the
machine testing port on the side of the machine (peds units).
Adult Units
Peds Units
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Auto Test
The Auto Test automatically checks the battery, therapy
electrodes (if attached), circuitry, cables, printer function,
shock, and AC power.
If the Auto Test fails, it displays a red X and test log results on
the screen front identifing the problem. If the problem is not
easily correctable contact your biomed department.
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Visual Inspection
Ensure the defibrillator is:
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Clean and free of visible damage
Cables are in good condition
Connector pins are not bent
Paper tray has enough paper
Defibrillator is plugged into AC power
The green check mark appears in the code ready
indicator
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Manual Defibrillator Self-Test
Complete the following:
1.
2.
3.
4.
5.
6.
The defibrillation cable must be connected to the
OneStep Complete Pads (adult units) or machine testing
port (peds units) on the side of the machine.
Turn the machine to defib mode (in the R Series Plus
machine you must first put in the manual mode).
Select 30J as the energy level.
Click CHARGE.
Click SHOCK.
Watch for the words TEST OK on the front of the screen
and on the print out.
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Changing R Series Plus to
Manual Mode
We’re now going to talk about changing the R Series Plus
to Manual and Pacing modes.
Click Next to continue.
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Changing R Series Plus to Manual
Mode and Full ALS Functioning
Step 1: Turn the machine on.
Step 2: Press the Manual Mode soft key.
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Changing R Series Plus to Manual
Mode and Full ALS Functioning
Step 3: Press the Confirm soft key.
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Changing R Series Plus to
Pacing Mode
Once the machine is in manual mode, you can perform
pacing operations by moving the dial to Pacing.
You can adjust the rate and mA by using the lower control
area.
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Completing Zoll On Line Training
• Please read the next few slides prior to beginning this
process so you know what lies ahead.
• On one of the next slides, you’ll click on a link to create a
user id (for example: bjones6) and a password (possibly
your LMS access password so it is easy to remember) so
you can enter the Zoll training site.
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Completing Zoll On Line Training
• Complete the rest of the
registration form.
• Click on Advanced Life Support.
• Click Submit.
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Completing Zoll On Line Training
• You will be brought to the following screen. You can now
enter your user ID (bjones6) and password you just
created to get into the Zoll training site.
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Completing Zoll On Line Training
• Once into the Zoll training site, complete the module
entitled “Getting Started”
• Once completed, do the test in the LMS and you will have
completed your LMS Zoll R Series defibrillator training
module.
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Completing Zoll On Line Training
• Click here to begin the login process:
• Click here if you’ve previously logged in
and created your user id and password:
Initial Zoll
Training Site
Zoll Training
Site
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Conclusion and Evaluation
Thank you for completing this lesson. You
are on your way to becoming an expert in
the Zoll R Series Models! Congratulations!
Please complete the test in the LMS to document your
learning. Click here to complete an evaluation of this
learning activity.
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