View source for STEMI-2017/C2/Introduction-to-Kallows-Device/English

<div style="margin-left:-0.035cm;margin-right:0cm;">Topic: KALLOWS - Positioning ECG leads, BP cuff and SpO2 probe</div>

<div style="margin-left:-0.035cm;margin-right:0cm;">Contributor Name: Jerry David, STEMI Team, Coimbatore</div>

<div style="margin-left:-0.035cm;margin-right:0cm;">Reviewed by: Nancy Varkey, Spoken Tutorial Project, IIT Bombay</div>

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



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|  '''''VISUAL CUE'''''
| '''''NARRATION'''''
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Kallows STEMI Kit.
|| Hello and welcome to this tutorial on the '''Kallows STEMI Kit.'''
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|| Learning Objectives
|| In this tutorial we will learn to - 
# <div style="margin-left:1.27cm;margin-right:0cm;">Position '''ECG '''leads, '''B.P. '''cuff & '''SpO2'''</div>
# <div style="margin-left:1.27cm;margin-right:0cm;">Take an '''ECG''' and </div>
# <div style="margin-left:1.27cm;margin-right:0cm;">Check Blood Pressure and '''SpO2'''</div>


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Hardware Requirements
|| To practise this tutorial, you will need the '''Kallows STEMI Kit.'''
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|| The '''STEMI Kit''' consists of 
* <div style="margin-left:1.27cm;margin-right:0cm;">An '''Android Tab''' in a metal casing</div>
* <div style="margin-left:1.27cm;margin-right:0cm;">'''Mobmon Device''' 12.0 </div>
* <div style="margin-left:1.27cm;margin-right:0cm;">'''Bluetooth B.P. monitor'''</div>
* <div style="margin-left:1.27cm;margin-right:0cm;">'''ECG electrodes'''</div>
* <div style="margin-left:1.27cm;margin-right:0cm;">'''SPO2 probe'''</div>
* <div style="margin-left:1.27cm;margin-right:0cm;">'''Wi-Fi Printer'''</div>
* <div style="margin-left:1.27cm;margin-right:0cm;">Power Strip</div>


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|| This is the''' Mobmon device.'''
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|| It has a '''power''' button along with the '''charging port''' on the left side.
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|| And the '''SpO2''' and '''ECG ports''' on the back side.
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|| This cable head has to be inserted into the '''ECG port '''on the '''Mobmon device.'''

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|| After connecting, secure the connection with the screws provided on either sides.
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|| Next, we will learn about the '''SpO2 probe.'''
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|| This '''probe''' is made up of the following parts-
# <div style="margin-left:1.27cm;margin-right:0cm;">'''Oximetry probe/cable'''</div>
# <div style="margin-left:1.27cm;margin-right:0cm;">'''Sensor'''</div>

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|| Let’s now see how to position the '''SpO2 probe.'''
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|| Connect the '''oximetry probe/cable''' to the '''SpO2 '''connector on the '''Mobmon device.'''
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|| This is how it should look when connected.
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|| The patient's finger must be inserted right to the end of the '''sensor''' as shown in the figure.
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|| While selecting a '''sensor''' site, priority should be given to an extremity free of -
# <div style="margin-left:1.27cm;margin-right:0cm;">an arterial catheter, </div>
# <div style="margin-left:1.27cm;margin-right:0cm;">blood pressure cuff </div>
# <div style="margin-left:1.27cm;margin-right:0cm;">or intravascular infusion line.</div>


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|| The typical sites for '''oximetry probe '''connections are -
* <div style="margin-left:1.27cm;margin-right:0cm;">For Adults/ Pediatrics: Finger, toe and pinna (top) or lobe of the ear.</div>
* <div style="margin-left:1.27cm;margin-right:0cm;">For Infants: Foot or Palm of the hand and the big toe or thumb.</div>


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|| 
|| '''Pls note: '''
* <div style="margin-left:1.27cm;margin-right:0cm;">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.</div>
* <div style="margin-left:1.27cm;margin-right:0cm;">Do not use wet or damaged sensors. They may cause burns during the electro surgery or when applying other electrical device.</div>
* <div style="margin-left:1.27cm;margin-right:0cm;">Tissue damage/ burn can be caused by incorrect application or use of SpO2 sensor</div>
* <div style="margin-left:1.27cm;margin-right:0cm;">Do not twist unnecessarily or use excessive force when using, connecting, disconnecting or storing the sensor.</div>
* <div style="margin-left:1.27cm;margin-right:0cm;">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 amp or sunlight</div>


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|| '''NIBP CUFF PLACEMENT'''
|| Next, let’s learn how to position '''Blood Pressure cuff.'''
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|| Connect the cuff connector to '''NIBP Connector '''of the '''Bluetooth device.'''
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|| 
# <div style="margin-left:1.27cm;margin-right:0cm;">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.</div>
# <div style="margin-left:1.27cm;margin-right:0cm;">Wrap the '''NIBP cuff''', preferably onto the left hand (on the brachial artery) of the patient as shown in the figure.</div>
# <div style="margin-left:1.27cm;margin-right:0cm;">The''' NIBP cuff''' must be wrapped tightly on the patient's limb for proper management.</div>


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|| Press the '''Start''' button to activate '''Bluetooth BP Monitor.'''
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|| Pls note: 

Inaccurate measurements may be caused by incorrect application or use such as-


* <div style="margin-left:1.27cm;margin-right:0cm;">Placing the '''cuff''' too loosely on the patient</div>
* <div style="margin-left:1.27cm;margin-right:0cm;">Using incorrect '''cuff size'''</div>
* <div style="margin-left:1.27cm;margin-right:0cm;">Not placing the '''cuff''' at the same level of the heart</div>
* <div style="margin-left:1.27cm;margin-right:0cm;">Leaky '''cuff''' or tube</div>
* <div style="margin-left:1.27cm;margin-right:0cm;">Excessive patient motion.</div>


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|| Do not connect the '''SpO2 sensor '''and the '''B.P cuff '''to the same limb of the patient.


This is to avoid nuisance alarms.
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|| Make sure that while measuring the '''NIBP,''' the tube of the '''cuff''' is not blocked or tangled.



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|| Finally, let’s see how to position the '''ECG leads.'''
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|| '''PATIENT PREPARATION'''
|| Quality '''ECG''' rhythm can be obtained with good skin preparation and proper electrode placement.
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|| 

Follow the instructions given in the narration
|| The following must be done for good patient preparation-
# <div style="margin-left:1.27cm;margin-right:0cm;">Clean '''electrode''' site and shave surface hair from chest</div>
# <div style="margin-left:1.27cm;margin-right:0cm;">Gently rub the skin with spirit to remove outer epidermal layer and skin becomes lightly red. </div>
# <div style="margin-left:1.27cm;margin-right:0cm;">Allow the '''electrode''' site to dry.</div>
# <div style="margin-left:1.27cm;margin-right:0cm;">Remove dry '''gel''' from '''electrode''' surface, if any.</div>
# <div style="margin-left:1.27cm;margin-right:0cm;">Place the '''electrodes''' on the flat non-muscular & non-hairy areas</div>
# <div style="margin-left:1.27cm;margin-right:0cm;">Use good quality (highly conductive) fresh '''gel'''. </div>
# <div style="margin-left:1.27cm;margin-right:0cm;">Apply sufficient quantity of gel on the '''electrode''' surface to establish good contact.</div>


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|| Note: 
# <div style="margin-left:1.27cm;margin-right:0cm;">Ensure that conductive portions of the </div>
## <div style="margin-left:2.54cm;margin-right:0cm;">'''electrodes, leads '''and''' cables '''</div>


do not come into contact with any other conductive parts.
# <div style="margin-left:1.27cm;margin-right:0cm;">Do not use damaged '''electrode leads'''.</div>
# <div style="margin-left:1.27cm;margin-right:0cm;">Ensure that '''electrodes''' are not loosely applied. This will cause artifacts and will sound heart rate alarms, causing endless inconvenience.</div>


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|| Show image
|| This is how the '''electrodes''' should be placed.



{| style="border-spacing:0;width:8.334cm;"
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
| align=center| '''Electrode'''
| align=center| '''Placement'''
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
| align=center| RA
|| Right intraclavicular area
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
| align=center| LA
|| Left intraclavicular area
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
| align=center| V1
|| Fourth intercostal space at right border of sternum
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
| align=center| V2
|| Fourth intercostal space at left border of sternum
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
| align=center| V3
|| Fifth rib between V2 & V4
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
| align=center| V4
|| Fifth intercostal space on left midclavicular line
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
| align=center| V5
|| Fifth intercostal left anterior axillary line
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
| align=center| V6
|| Fifth intercostal left midaxillary line
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
| align=center| RL
|| Right lower abdominal quadrant just above inguinal ligament
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
| align=center| LL
|| Left Lower abdominal quadrant just above inguinal ligament
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|}

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|| Make sure the power cord and patient cable do not cross each other.
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|| Show image
|| Switch on the '''Mobmon device''' by selecting power '''on/ off '''button on the side.
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|| STEMI App to be shown here
|| Select '''ECG tab '''on the '''STEMI device '''to view the '''ECG''', in the '''ECG''' live steam page.
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|| 
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|| Let us summarize.
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|| Let us summarize.
|| In this tutorial, we have learnt -
* <div style="margin-left:1.27cm;margin-right:0cm;">how to position '''ECG leads, BP cuff '''and''' SpO2 probe.'''</div>
* <div style="margin-left:1.27cm;margin-right:0cm;">Take an''' ECG'''</div>
* <div style="margin-left:1.27cm;margin-right:0cm;">Check '''blood pressure '''and''' SPO2'''</div>


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|| Show STEMI INDIA slide
|| '''STEMI INDIA'''
* <div style="margin-left:1.058cm;margin-right:0cm;">was set up as a ‘not for profit’ organisation</div>
* <div style="margin-left:1.058cm;margin-right:0cm;">primarily to reduce delays in accessing appropriate care for heart attack patients</div>
* <div style="margin-left:1.058cm;margin-right:0cm;">and reducing deaths due to heart attacks</div>


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|| Show Spoken Tutorial Project Slide
|| Spoken Tutorial Project, IIT Bombay <span style="background-color:#ffffff;">is funded by NMEICT, MHRD, Govt. of India.</span>


For more details, please visit http://spoken-tutorial.org
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|| Show THANK YOU slide
|| This tutorial has been contributed by
* <div style="margin-left:1.058cm;margin-right:0cm;">STEMI INDIA</div>
* <div style="margin-left:1.058cm;margin-right:0cm;">and the Spoken Tutorial Project, IIT Bombay.</div>

This is Nancy Varkey signing off. Thanks for joining.
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