STEMI-2017/C2/Introduction-to-Kallows-Device/English

Topic: KALLOWS - Positioning ECG leads, BP cuff and SpO2 probe

Contributor Name: Jerry David, STEMI Team, Coimbatore

Reviewed by: Nancy Varkey, Spoken Tutorial Project, IIT Bombay

Keywords: STEMI Kit, NIBP, SpO2, ECG, Electrode, B.P cuff, Mobmon 12.0

VISUAL CUE	NARRATION
Show Slide Kallows STEMI Kit.	Hello and welcome to this tutorial on the Kallows STEMI Kit.
Learning Objectives	In this tutorial we will learn to - Position ECG leads, B.P. cuff & SpO2 Take an ECG and Check Blood Pressure and SpO2
Show Slide Hardware Requirements	To practise this tutorial, you will need the Kallows STEMI Kit.
Show Image	The STEMI Kit consists of An Android Tab in a metal casing Mobmon Device 12.0 Bluetooth B.P. monitor ECG electrodes SpO2 probe Wi-Fi Printer Power Strip
Show image	This is the Mobmon device.
Show image	It has a power button along with the charging port on the left side.
Show image	And the SpO2 and ECG ports on the back side.
Show image	This cable head has to be inserted into the ECG port on the Mobmon device.
Show image	After connecting, secure the connection with the screws provided on either sides.
Show image	Next, we will learn about the SpO2 probe.
Show image	This probe is made up of the following parts- Oximetry probe/cable Sensor
Show image	Let’s now see how to position the SpO2 probe.
Show image	Connect the oximetry probe/cable to the SpO2 connector on the Mobmon device.
Show image	This is how it should look when connected.
Show image	The patient's finger must be inserted right to the end of the sensor as shown in the figure.
Show image	While selecting a sensor site, priority should be given to an extremity free of - an arterial catheter, blood pressure cuff or intravascular infusion line.
Show image	The typical sites for oximetry probe connections are - For adults/ pediatrics: Finger, toe and pinna (top) or lobe of the ear. For infants: Foot or palm of the hand and the big toe or thumb.
Show images as per narration	Pls note: Reusable sensors may be used on the same site for a maximum period of 4 hrs, Make sure that the site is inspected routinely to ensure skin integrity. Do not use wet or damaged sensors. They may cause burns during the electro surgery or when applying other electrical device. Tissue damage/ burn can be caused by incorrect application or use of SpO2 sensor. Do not twist unnecessarily or use excessive force when using, connecting, disconnecting or storing the sensor. Loss of pulse signal can occur if the sensor is too tight or if there is excessive illumination from light sources such as surgical lamp, a bilirubin lamp or sunlight
NIBP CUFF PLACEMENT	Next, let’s learn how to position Blood Pressure cuff.
Show image	Connect the cuff connector to NIBP Connector of the Bluetooth device.
Show image	Measure the patient's limb and select the proper cuff size. As a general rule, cuff width should span approximately two - thirds of the distance between patient, elbow, shoulder. Wrap the NIBP cuff, preferably onto the left hand (on the brachial artery) of the patient as shown in the figure. The NIBP cuff must be wrapped tightly on the patient's limb for proper management.
	Press the Start button to activate Bluetooth BP Monitor.
Show the images as per narration	Pls note: Inaccurate measurements may be caused by incorrect application or use such as- Placing the cuff too loosely on the patient Using incorrect cuff size Not placing the cuff at the same level of the heart Leaky cuff or tube Excessive patient motion.
Show the images as per narration	Do not connect the SpO2 sensor and the B.P cuff to the same limb of the patient. This is to avoid nuisance alarms.
Show image	Make sure that while measuring the NIBP, the tube of the cuff is not blocked or tangled.
	Finally, let’s see how to position the ECG leads.
PATIENT PREPARATION	Quality ECG rhythm can be obtained with good skin preparation and proper electrode placement.
Show images as per narration one by one	The following must be done for good patient preparation- Clean electrode site and shave surface hair from chest Gently rub the skin with spirit to remove outer epidermal layer and skin becomes lightly red. Allow the electrode site to dry. Remove dry gel from electrode surface, if any. Place the electrodes on the flat non-muscular & non-hairy areas Use good quality (highly conductive) fresh gel. Apply sufficient quantity of gel on the electrode surface to establish good contact.
Show image	Note: Ensure that conductive portions of the electrodes, leads and cables do not come into contact with any other conductive parts. Do not use damaged electrode leads. Ensure that electrodes are not loosely applied. This will cause artifacts and will sound heart rate alarms, causing endless inconvenience.
Show image	This is how the electrodes should be placed. Electrode Placement RA Right intraclavicular area LA Left intraclavicular area V1 Fourth intercostal space at right border of sternum V2 Fourth intercostal space at left border of sternum V3 Fifth rib between V2 & V4 V4 Fifth intercostal space on left midclavicular line V5 Fifth intercostal left anterior axillary line V6 Fifth intercostal left midaxillary line RL Right lower abdominal quadrant just above inguinal ligament LL Left lower abdominal quadrant just above inguinal ligament
Show the image	Make sure the power cord and patient cable do not cross each other.
Show image	Switch on the Mobmon device by selecting power on/ off button on the side.
STEMI App to be shown here	Select ECG tab on the STEMI device to view the ECG, in the ECG live steam page.
Summary slide	Let us summarize. In this tutorial, we have learnt - how to position ECG leads, BP cuff and SpO2 probe. Take an ECG Check blood pressure and SPO2
Show STEMI INDIA slide	STEMI INDIA was set up as a ‘not for profit’ organisation primarily to reduce delays in accessing appropriate care for heart attack patients and reducing deaths due to heart attacks
Show Spoken Tutorial Project Slide	Spoken Tutorial Project, IIT Bombay is funded by NMEICT, MHRD, Govt. of India. For more details, please visit https://spoken-tutorial.org
Show THANK YOU slide	This tutorial has been contributed by STEMI INDIA and the Spoken Tutorial Project, IIT Bombay. This is Nancy Varkey signing off. Thanks for joining.

Contributors and Content Editors

Nancyvarkey, PoojaMoolya