Updated 27/11/23

The new Viatom Checkme Pro vital signs monitor.

We are currently in the process of trialing a new type of lightweight monitoring equipment. Have a look at the video clips below to see how it works. It is currently in the Medical Sacs in Mobiles 1&2.

The Propaq LT

The Propaq LT (model 802LT0S) is a standalone device which can be used to monitor and record SpO2, pulse rate, blood pressure, respiration rate and ECG (electrocardiography). In addition to the ability to display ECG rhythms, the Propaq has several other advantages when compared to our current set of monitoring devices. It provides more accurate readings, has warning alarms to highlight abnormal readings, longer wires meaning a casualty can be monitored whilst wrapped up in a casualty bag, and the ability to take 'snapshot' recordings which can be analysed after the rescue or emailed on to the receiving hospital.

Please note - unlike the ECG monitors you may have seen the ambulance service using, the Propaq is not a defibrillator, and the ECG electrodes cannot be used to deliver a shock.

This page has four sections: How to Switch on and Set up the Propaq, Charging and Care, ECG rhythms and Default settings (alarm limits, etc.)

Switching on & Setting up

The Propaq can be used to monitor one or more vital signs simultaneously, depending upon which sensors you decide to attach. If you initially require only one vital sign, then later decide others could be useful, other components can be added later whilst the monitor is in use.

Switching on the monitor

Turn on by pressing the power button on the top (circled in red here).

The first screen

The first screen will ask if you would like to start a new patient or continue monitoring an existing patient.

NOTE: THE MANUFACTURERS HAVE SET THE DEFAULT CHOICE AS "START NEW PATIENT". IF DURING MONITORING YOU TURN OFF THE MONITOR TURN IT BACK ON AND SELECT THIS UNINTENTIONALLY, YOU WILL ERASE ALL THE READINGS FROM THE PATIENT YOU HAVE BEEN MONITORING.

Use the horizontal arrow keys to move the blue highlight to identify your choice.

Press the action button (the dot in the middle of the arrows) to say 'yes'.

For our purposes it is not necessary to input the patient's name, so this step is turned off by default.

The next screen to appear is the screen with large numbers. From this screen you can observe the heart rate, SpO2, blood pressure and respiratory rate readings when you have connected the leads.

Switching off the monitor

Start the shutdown process by pressing the power button on the top (see above). The shutdown screen will appear and you will be presented with four options:

Delete & shut down
Save & shutdown
Cancel (to return to the monitoring screen)
Setup

NOTE: THE DEFAULT OPTION IS DELETE & SHUT DOWN

If this is what you want, then just press the action button, if you want to save the data use the Right arrow key to move the blue cursor and press the Action button to select.

NOTE: If you select delete inadvertently, you will lose all the saved patient data. We have contacted the Company about this but they do not propose to alter the default to save at present.

Setting Up For Monitoring

SpO2

First connect the SpO2 cable. Make sure it clicks into place. You can slide the tab on the left of the cable by moving it to the right to lock the cable in place .

Place the SpO2 sensor on the patient's finger with the wire running over the top of the finger. Remember to make sure there is nothing which could interfere with the operation of the sensor such as dried blood or nail polish.

Within a few seconds of being connected to the patient the monitor should display SpO2 data in yellow (circled in red).

Beware - though more resistant to artifacts and poor perfusion than the stand alone monitoring equipment we use (SpO2, B/P), cold and movement can still result in false readings.

ECG and Respiratory Rate

Plug the ECG cable into the monitor.

We use gelled electrodes. Verify that the expiry date has not passed. Check that the gel is intact and has not dried out when you peel the backing sheet off the electrode. Out of date or dried electrodes can give false readings.

If you inadvertently put an electrode in the wrong place, ideally use a fresh one in the correct position. Do not detach and attempt to re-attach the ECG electrode you have just removed. They do not stick well on the second try and you usually lose some of the gel.

The ECG cable has three leads with coloured connectors: Red, Yellow and Green. Attach the connectors to the ECG electrodes before applying them to the casualty. Stick the electrodes to the patient in the following general positions:

RED lead on the casualty's RIGHT shoulder
YELLOW lead on the LEFT shoulder
GREEN lead at the bottom of the ribs on the casualty's left side.

NOTE: these are just general positions. Thus anywhere on the R arm including the right shoulder will do for the Red lead. Similarly, anywhere on the left arm including the left shoulder will do for the Yellow, and anywhere below and to the left of the heart (including the left thigh) will do for the Green.

Hairy individuals may have to have hair shaved from the electrode sites. If the casualty is sweaty do your best to dry the sites first.

When all leads are properly connected, confirm that the monitor displays the ECG waveform, heart rate, as well as any other patient data if the appropriate leads are connected.

Respiratory rate is monitored as part of the ECG monitoring. The machine senses chest movement via the ECG electrodes and changes in resistance caused by the lungs filling and emptying is used to calculate the rate. The respiratory rate is displayed (in purple) in the lower right corner (see above). Although very accurate when the patient is lying still, experience has shown that if the patient moves, respiratory monitoring is less accurate and can easily trigger an alarm. Therefore for now, respiratory monitoring will not come on by default.

As with the SpO2 sensor, ECG readings can be affected by movement. This is because the contraction of muscles creates electrical activity which the monitor picks up.

Blood Pressure

To take a blood pressure reading, take out and squeeze all the air from the cuff.

Applying the cuff

Position the patient’s arm away from the body so that cuff can be easily wrapped around the arm. Ensure the arm with the applied cuff is not in contact with the patient’s body or any other object as this could affect the reading.
Align the artery index marker over the brachial artery. The line of the brachial artery is illustrated in the figure below (which is from a collection of cigarette cards about first aid).
Apply the cuff approximately at the level of the middle of the upper arm overlying the biceps muscle. Do not put it on as far down as the elbow as this will interfere with the reading.NIBP Cuff Alignment
The cuff must fit snugly without being uncomfortably tight.
Keep the patient's arm by their side. In this position, the cuff will be at the same level as the heart.
The hose must be free of kinks and not pinched. It can be run up or down the body depending on which is most convenient. For example, if the casualty is in a Cas Bag, then run the hose upwards towards the shoulder.
Screw the hose connector onto the NIBP air connector on the top of the monitor.
Press the NIBP Start/Stop button to start a reading (bottom right on the display). You should be able to hear the pump inflate the cuff. Button

The horizontal bar moves from right to left to indicate the descending pressure in the cuff as the BP is measured. When finished the pressure will be displayed on the monitor as shown below.

It takes about a minute to do the first reading, so be patient. Unless there is an error, the result will appear on the screen in light blue. When you do further readings, the previous blood pressure will be displayed on the monitor as diamond-shaped marks superimposed on the moving pressure bar (see below). The right hand diamond is the most important for MR and indicates the previous systolic (upper number) blood pressure.

NOTE: Unlike the other readings which are taken continuously, to save power, the BP button must be pressed again to take a new blood pressure reading.

How To Change Screens, Take and View A Snapshot

Display screens

There is a choice of three screens

Screen 1 - Essential parameters in numeric format

Shows Heart rate, BP, SpO2, and respiratory rate (if switched on) in numeric format.

Screen 2 - ECG display

Shows the above data plus a display of the ECG

Screen 3 - Trends data

Shows the trends data. By default, this shows readings every five minutes. However, this can easily be changed by the user to anything from every minute to every 60 mintes.

How to change screens

Use the display button (circled in red) to cycle to the next configured display format.

Note: this button can also be used as a general "cancel" button to cancel the current control, setup or popup menu.

Snapshots

To capture a 21-second snapshot of the ECG, simply press the snapshot button. A snapshot captures data 14 seconds before and 7 seconds after pressing the Snapshot button.

If you see a change occur, press the snapshot button as soon as possible to capture the change. The monitor can store 20 snapshots. After 20 snapshots have been taken, each new snapshot replaces the oldest snapshot in the memory.

To review snapshots: select the Trends screen (Screen 3 - see above).

Highlight one of the results that includes a camera icon (see photo above) by using the up and down arrows t move the blue cursor then press the Action button to select.

The snapshot will now be displayed on the screen. The blue marker will move to the bottom of the screen. A dotted red line will appear down the centre of the waveform. This represents the point at which the snapshot was taken. Use the left and right arrows to move back or forwards in time through the waveform.

Once back at Base, snapshots can be downloaded and kept for training or review purposes or emailed on the the hospital.

The snapshot facility is very useful for establishing a baseline when you first arrive. Repeat the process if something changes.

To return to the monitoring screen press the Change the Screen button.

ECG Rhythms Relevant To LAMRT

Whilst there are dozens of ECG rhythms, for our purposes in LAMRT, we only need to recognise two basic rhythms:

The normal ECG, also called normal sinus rhythm (shown above) + its common variants (very slow and very fast)
Asystole (see below)

FROM THE POINT OF VIEW OF CLINICAL MANAGEMENT GET TO KNOW WHAT THE NORMAL LOOKS LIKE.

CONSIDER ANYTHING ELSE AS ABNORMAL, AND BE ON HEIGHTENED ALERT, PARTICULARLY IF THE PATIENT ALSO HAS CARDIAC SYMPTOMS.

There are two additional rhythms worth knowing:

Ventricular fibrillation
Ventricular tachycardia

Sinus Rhythm

This is the heart's normal rhythm when viewed on an ECG. If you only learn one rhythm this is the one to learn. There are several requirements for a rhythm to be considered normal:

Rate between 60-100 beats per minute (in adults) - the Propaq will tell you the rate.
Regular i.e. the R waves are equally spaced out across the screen
There is a "P" wave present for every "QRS" complex