Selling Stress 運動平板培訓完整版

SellingStress

運動平板培訓

運動心電圖的應用范圍冠心病的輔助診斷多支血管病變的病人確定犯罪血管從冠心病人中選擇高危病人進行PTCA和CABG心肌梗死病人有無存活心肌或缺血心肌心肌梗死病人出院前運動處方的制定冠心病人介入治療或CABG后再狹窄的判定評估冠心病病人預后心臟病內(nèi)外科治療療效評定評定心臟功能，安排病人活動量體育療法運動處方的制定運動員體力狀態(tài)的鑒定飛行員體檢運動試驗的原理運動測試心電圖用于冠心病診斷未能確認確認病人的身體狀況測驗會記錄運動及藥物對心臟影響過程中的心電圖評估的指標

傳統(tǒng)上采用ST段的壓低或抬高（預示心肌缺血）運動前的危險因素和最大運動級量也是強有力的診斷依據(jù)運動級量由以下參數(shù)來體現(xiàn):最大運動時間，最大負荷，最大代謝當量（MET）或最大心率及心率和血壓的乘積運動試驗的類型標準運動試驗-跑臺試驗運動超聲心動圖(StressEcho)用心臟超聲顯示心臟壁的運動核醫(yī)學運動測試（Nuclearstresstesting）核醫(yī)學影像掃描確認血流的特點鉈,Cardiolite藥物學平板試驗

潘生丁，腺苷，多巴酚安運動試驗檢測CAD機制通過運動提高心率增加心肌耗氧量，檢測冠狀動脈供血情況，如冠狀動脈明顯狹窄，運動達到一定負荷量時，冠狀血流量不能相應增加，既發(fā)生心肌缺血反映。運動試驗陽性心電圖改變解釋ST段下降：代表心內(nèi)膜下心肌損傷ST段抬高：冠脈血流暫時中斷T波高聳：內(nèi)膜下心肌缺血強陽性（ST段下降≥0.20mV），多支病變。陽性標準運動中或運動后發(fā)作心絞痛運動中或運動后發(fā)生缺血型ST段下降≥0.10mV,≥1mm。運動中或運動后發(fā)生ST段急性損傷型抬高≥0.20mV。運動中或運動后發(fā)生AMI。運動誘發(fā)缺血型T波高聳。運動誘發(fā)血壓急劇下降。運動試驗終止相對指征發(fā)生缺血型ST段下降≥0.10mV胸痛加重血壓顯著升高或下降快速心律失常，如AVRT、PSVT、AF、Af出現(xiàn)束支阻滯、W-P-W,不能區(qū)分真、假陽性突然發(fā)生緩慢竇性心律失常、傳導阻滯、停搏運動試驗終止絕對指征發(fā)作心絞痛，急性冠脈閉塞達到目標心率心電圖出現(xiàn)陽性指征血壓下降伴全身反應、面色蒼白、出冷汗病人要求終止試驗嚴重心律失常如室速、室顫儀器設備故障假陽性發(fā)生的主要原因高血壓患者左心室肥厚左束支阻滯植物神經(jīng)紊亂綜合癥處于更年期的人群（女性更為突出）冠狀動脈心肌橋預激綜合征運動試驗的技術及程序運動試驗的階段運動前階段皮膚處理及電極貼放運動前ECG協(xié)議運動階段運動協(xié)議恢復階段運動舒緩階段連續(xù)實時ECG監(jiān)護最后報告階段最后報告的準備、確認、及發(fā)出病人準備正確的皮膚處理=好的測試高質量的皮膚處理及電極放置的目的是獲得好的信噪比（阻抗）高質量的皮膚處理減少肌顫偽差減少基線漂移確保高質量的打印輸出及數(shù)據(jù)噪聲:運動試驗-一個多噪音的環(huán)境噪音的類型低頻噪音:基線漂移高頻噪音:肌電偽差50-Hz噪音:來自電源解決方案高質量的預處理及電極放置;立方曲線校正漸量修正技術去除肌電偽差高質量的預處理及電極放置;無扶手;屏幕及記錄儀濾波直接數(shù)字采集;消除電源干擾運動前階段手動控制階段ECG協(xié)議典型階段仰臥位站位深呼吸目的:獲得靜息基線ECG數(shù)據(jù),與運動ECGs作比較運動階段自動運行運動協(xié)議,增加跑臺的速度及梯度.運動系統(tǒng)預先設置標準的運動協(xié)議:Bruce(modifiedBruce)BalkeNaughtonRampprotocolsDrugprotocols運動階段臨床醫(yī)生觀察ST改變,心律失常(異常事件),最大心率,血壓,以及運動終止時的生命體征恢復階段手動控制恢復階段,監(jiān)護12-leadECGs約8-10分鐘,觀察心率失常及ST段的變化.終止運動的根據(jù):身體狀態(tài)ECG變化達到最大目標心率HR和BP異常最后報告階段最后報告階段包括:回顧全部運動過程總結ST段變化趨勢心律失?；仡櫞鎯υ\斷數(shù)據(jù)最后報告的診斷心率:最大HR,最大預測HR,目標HR血壓(收縮壓升高)率壓積(HRx收縮壓)功能性(運動負荷的承受能力)-由于運動量大小和氧耗量成平行關系,故氧耗量可作運動量的計量單位.用METS代謝當量評估氧耗量.1個MET=每公斤體重每分鐘耗氧3.5毫升(靜息狀態(tài)下).限制型病人-6METSor更低無癥狀病人-7to11METS健康型病人-12to15METS耐久性運動員-16to20METS最后報告的診斷生命體征及癥狀ECG反應-ST段的變化ST段水平或下斜型壓低1.0毫米或更多–非正常四種類型的有關冠狀動脈疾病的ST段改變ST段抬高緩慢上斜型ST段壓低水平ST段壓低下斜型ST段壓低目前市場上的平板種類GEMarquette-Case8000,Max-1,Max-Personal,T2000treadmill,CardiosysQuinton-Q4500,Q710,Q55/65andST65/55SchillerCS-200,AT-10and60;BurdickQuestOther-CambridgeHeart,Mortara,Esaote,Siemens平板客戶關心的問題內(nèi)科醫(yī)師/臨床醫(yī)生(心臟病專家,內(nèi)科醫(yī)生)首先考慮病人的安全,可信賴的平板試驗及精確的報告

報告格式

測量的準確度臨床標準

心電信號描記質量平板客戶關心的問題?技術員(平板技術員,

心電圖技術員,護士)Interfacewiththepatientandequipment.Featurestomaketheirjobeasierandfaster.Ease-of-use ThroughputFamiliaritywithequipmenttheycurrentlyuseFinalreportsthewaythephysicianwantsthem.平板客戶關心的問題?CardiologyManager,AdministratorInterfacewiththeotherhospitaldepartments.Clinicalissuesremainapriority.However,informationaccessanddepartmentefficienciesarebecomingapriority.ProcessefficienciesClinicaldecisionsupportInformationaccess,electronicpatientrecord.平板客戶關心的問題?IS/HISAdministratorsInthenetworkedhealthcaresystems,theISadministratorislookingforeaseofintegrationintothenetworkandallresultantbenefitsCompletepatientmedicalrecordDataintegrationintoenterprise-networkinformationsystemDeviceconnectivityintoinformationsystemWhatistheExerciseTestingSystemSale?ThestresssalecanoftenbeaREPLACEMENTSALE.TwotypesofstresssalesinthehospitalmarketSaletoalong-timeGEMarquettestresscustomerSaletoacurrentQuintoncustomerorSchilleruserStrategy-profilewhatstressequipmentiscurrentlyintheaccount,andreplaceitwiththeappropriateGEMarquettestressdevice.MAXPersonal-FundamentalSystemDesignedforModularity12SLAnalysis-Adult/Pediatric,withbatteryoperationMUSECVcompatibleviamodemtransmissionRemoteQuerytoMUSECVFullvarietyoffinalreports,editinginRecovery,LinkedMediansreportCubicSpline,IncrementalUpdatingAM5digitalacquisitionmodule,InterLeaddesignAutomaticarrhythmiadetectionMAXPersonal-FundamentalSystemDesignedforModularityPrice-System$9,050-$9,450-Ergometer$9,800-Treadmill,CartPrice-Options$0-12SL$1,000-Computer-Assist-12SL$1,500-Computer-Assist-12SL-CubicSplineIntroduced-Winter1995MAX1-IntuitiveTechnologyforDiverseRequirements12SLAnalysis-Adult/PediatricMUSECVcompatibleviadiskettePharmacologicReportOptionFullvarietyoffinalreports,editinginRecovery,LinkedMediansreportCubicSpline,IncrementalUpdatingAM5digitalacquisitionmodule,InterLeaddesignAutomaticarrhythmiadetectionFullinterfacingtoperipheraldevicesMAX1-IntuitiveTechnologyforDiverseRequirementsPrice-System$11,900-Basic$12,900-DualFloppy-MUSEPrice-Options$750-12SL$250-Pharmacologic$1,000-CombinedIntroduced-Spring1989ClinicalDecisionSupport-FRFalgorithm-accuracyofinterpretationWaterfallDisplay-quick,ischemicassessmentStressSerialPresentation-confirmclinicalchanges15leadstress,ST/HRIndex,arrhythmiaanalysisWorkflowEfficiency-GettingStartedCBTTipsTutorial,CompetencyListReporting,Post-TestReviewToolsCASE8000-CardiacAssessmentSystemforExercise-Outcomes,InformationAccess-Bi-DirectionalMUSEconnectivity-networkconnectivity,Web-enabledforcompletecardiovascularMUSErecordatpoint-of-careADT,ordersdownloadRemote,WANaccessCASE8000-CardiacAssessmentSystemforExercisePrice-System$17,500-15“MonitorPrice-Options12SL-$750FullDisclosure-$1,000RemoteViewing-$800StoragetoLocalNetwork-$200MUSENetworkInstallation-$1,000Introduced-Spring1999CASE8000-CardiacAssessmentSystemforExerciseClinicalExpertise

ExerciseECGAlgorithms-Today12SLECGAnalysisProgramIncrementalMedianUpdatingCubicSplineSTMeasurementsDirectDigitalAcquisitionArrhythmiaAnalysis2023/11/8SellingStressEMEA983612SLECGAnalysisProgramWhatisit?Computerprogramforanalyzingsimultaneouslyacquired12-leadECGs.acquiredon12leads,sampled500Hz,50/60adapaivefilters,incrementalmedianupdatng,accurateQRSmeasurements,interpretiveprogramforrhythmandmorphology.Benefits?Experts:savestime,secondopinion,reducesvariabilityofreadingsLessexperienced:secondopinion,educationalfeedback,addedreadabilityIncrementalMedianUpdatingAlsocalledRepresentativeBeatDeterminationSignalAveragingWhatisit?1976CASE-noise-rejection,signalenhancingalgorithmforECGsQRSdetectionfordominanttemplateBeatAlignment-matchesincoming/dominantbeatCorrelation-80%accept;less80%rejectectopicMedianUpdate-incrementalrevision10mv/1/16BenefitsMaintainsaccuratemedianmorphologyReal-time,beat-by-beatmedianupdatingCubicSplineWhatisit?enhancedalgorithmforremovingbaselinerollinECGtracings.mathematicalprogramthatuses3beatstoestimatebaselineroll,whichissubsequentlysubtractedtoyieldstraigthenedECGwithnowaveformphasedistortion.Benefits?Straigthensbaseline,cleansECGevenwithartifactUsesnoaggressivefiltering,sofullfideltityQRSEliminateserrorsinmeasurementsfrommoreaggressivefiltering.STSegmentMeasurementsWhatisit?ElectronicSTsegmentmeasurementusingtraditionalclinicalapproachEstablishEpoint(onset),Jpoint(latestoffset)anduser-selectedpost-Jpointthenelectronicallymeasure.Benefits?Avoicserrorsoffixed-timeintervalmeasurementsEnhancesaccuracyofSTmeasurementsUser-adjustedpost-JlocationDirectDigitalAcquisitionWhatisit?Activepatientcabledoesanalog-to-digitalconversionatthepatient.Benefits?EliminatesanalogcablenoisefromcablemovementandgivescleanersignalregardlessofcablelengthAllowsformodularpatientcabledesign.easydisconnectlowercostcablereplacementQuintonQ4500-FeaturesandClaimsTilt-andswivelmonitorMuscleartifactandbaselinewanderfiltersOversizesoft-touchexercisedevicecontrols“Customize”in-testandfinalreportsPre-editduringrecoveryQ412automaticBPQuick-prep“gun”QuintonQ4500-TakeawaysNointerpretiverestingECGanalysisNo12-leadsinfinalreport:tabularsummary,averagebeat,worstcasemedians,cannedstatements,interpretationChallengetoprogramDoesn’tshowworstcaseleadonthescreenDifficulttouse;severalmenusdeepQuintonQ4500-vs.MAX-1Push12SLinterpretiveECGAnalysisprogramPresentvarietyoffinalreports-previewreportFocusonease-of-usePointtocomparativemediancomplexes;scanforworstcaseSTPushCubicspline,incrementalmedianupdating,LinkedMediansPre-editinRecoveryMUSEconnectivityQuintonQ710Exercise&RestingECGSystem-FeaturesandClaims2screens-exerciseCRtandECGLCDpreviewscreenAdaptivedigitalfiltersformuscleartifact/baselinewanderRestingECGisHP’sinterpretiveECGalgorithmStatreportwithsinglekeyRemotestartbuttonandleadqualityonpre-ampmoduleQuintonQ710-Takeaways2distinctlydifferentanalysisandmeasurementalgorithmtechniquesforRestingandStressECGapplications.poorperformance:inaccurateHRonscreen;invalidatesfinalreport.only3secondsECGdataonscreenwithnomediancomplexes.notmechanicallyrobustnoautoarrhythmiadocumentation.CanbereplacedbyQ4500whencustomerhasproblemsQuintonQ710-vs.MAX-PE12SLgivesbestanalysisandmeasurementalgorithmtechniquesinbothrestingECGandstressECGapplications-consistencyofdataandinterpretationEase-of-useofinterfaceMUSEconnectivityandRemoteQueryfull8seconddisplaywithmediancomplexesQuintonMedTrackST55,ST65-FeaturesandClaimsNewHyperdriveSystem,brushlessmotorNewsoftstartQuietthroughouttestWeightcapacity400lbs0.8to9.6mphandupto25%gradeQuintonMedTrackST55,ST65-vs.MarquetteT2000BrushlessDCmotor0mphstartQuietthroughouttestWeightcapacity450lbs0to13.5mphandupto25%gradeEmergencyStopButtonandfront/siderailsstandard60‘lengthBettervalueBurdickQuest-FeaturesandClaimsReports:12-lead,summary,median,ectopicsummaryDisconnectpatientmodule.PCCMCIAcardforupgradesT-600TreadmillDiskettestorage(10reports)

BurdickQuest-Features&ClaimsIntuitiveTouchScreentechnologyfastandeasyLogistepfornextstepwith“Return”key.3,4,6traceformats3yearwarranty,1-yearonpatientcables.$18,500withtreadmillBurdickQuest-TakeawaysNorestingECGapplicationNotmechanicallyrobustPassivefrontend;passivecablewithprocessinginchassisT-600treadmillordinaryRedesigningwriter;hadbeenswap-outfromEclipsecartsThirdpartyserviceBurdickQuest-vs.Max-112SLECGAnalysisprogram-restingandstressECGapplication.Easy-to-usefunctionalkeystogothroughphases.Easeoftrimknobcontrol-Noerrorsinstresstestsequence.FullcomplementoffinalreportsInterleadandActivefrontend.SchillerCardiovitAT-10LaptopdesignFullsizereportsCustomscreensandreportsSpirometryoptionFreelifetimesoftwareupdatesSTsegment12-leadbargraphFulldisclosurerestingECG$12,995-$13,400packageSchillerCardiovitAT-60HospitalgradeCustomscreensandreportsVectorcardiographyoptionInternalfloppydriveoptionSpirometryoptionFreelifetimesoftwareupdates12-channelreportprinting$15,995-$16,95packageSchillerCardiovitAT-10/60-TakeawaysNoworstcaseSTscanNeedtopscreen;alptopscreenimpossibletoreadPreteststageonly1minute;sopreteststagesdonepriortostartingtestNoVEcounterAv