Dninevada - : Operating and Service Manual

DNiNEVADA___________
Operating and Service Manual

©Copyright Fluke Corporation Service and Repair
Fluke Biomedical Please cali forfíMA number befare shipping
6920 Seaway Blvd. 1420 75th Street SW
Everett, WA 98203 Everett, WA 98203
Sales & Gustomer Servicié: 888-99FLUKE (888-993-5853) • 425-446-5560
775-883-3400 • 800-648-7952
http://www.fiukebiQmedical.com • [email protected]
DN1 NEVADA
INCORPORATED
IMPULSE 4000 OPERATING ANO SERVICE MANUAL
To order this manual, use Parí Number 9508-0242.
hrmware Versión LOO

Firmware Versión 1.02
Pírmware Versión 1.04
Copyright
DNI Nevada agraes to a limited copyright reléase that allows you to reproduce manuab and other printed materias for use in service trainíng programs and
other tcchnical publicatíons. If you woukl like other reprodactions or distributíons, submfr a writren request to DNI Nevada, Inc.
Standard Terms and Conditions

Refunds & Credits
Picase note that only serialized producís (producís labeled with a dístinct serial number) and accessories are eligiblc for partía! refund and/or credit.
Nonserializcd parts and accessory ítems (cables, canving cases, auxiliar}' modules, etc.) are not cligible for rctum or refund. In order to reccive a partía!
refund/credit of a product purchase price on a serialized product, the product must not have been damaged by the customer or by the common carnet
chosen by the customer to rctum the goods, and the product must be retumed complete (meaning all manuals, cables, accessories, etc.) within 90 days of
original purchase and in “á$ ncw” and reseilable condition. The Refarn Prcw&íWmust be foUowed to assure prompt refund/credit.
Restocking Charges ’X*'»
OnJy produces retumed within 90 days iraní the date of original purchase are cligible for refund/credit Producís retumed within 30 days of original purchase II
are subjcct to a mínimum restocking fee of 15%. Produces retumed in excess of 30 days rfter purchase, but prior to 90 days, are subíect to a mínimum
restocking fee of 20%. Addtóonal chatges for damage and/or missing parts and accessories will be applied to all retums. Producís not retumed within 90
days of purchase, or producís which are not in “as new” and reseilable condition, are not eligiblc for credit retum and will be retumed t the customer.
Retum Procedure
Evcry product retumed for refund/credit must be accompanicd by a Retum Material Authotization (RMA) number, to be obtained from our Order
Processing Dcpattmcnt. Al! ítems being retumed must be sent ffeight prepaid to our faetón- locatíon.
Certificatíon
This instrument was thoroughly tested and inspected and found to mecí DNI Nevada’s manufacturing spedfications when it was shipped from the fáctory.
Calibración measurements are traceable to the Natíonal Instituto of Standard* and Technalogy (NIST). Devices for which there are no NIST calíbration
standards are measured against in-house performance standards using accepted test procedüres.
Warranty
Warranty and Product Support
This irisrrument is warranted by DNI Nevada against defeets in materials and workmanship for one full year from the date of original purchase. During the
warranty period, we wffl repair or, at our optíon, replace at no charge a product that proves to be deféctíve, provided you retum the product, shípping
prepaid, to DNI Nevada, Inc_ This warramv does not apply if the product has been damaged by accidcnt or misuse or as the result of service or modificación
by other than DNI Nevada. IN NO EVENT SHALL DNI NEVADA BE HABLE FOR CONSEQUENTIAL DAMAGES.
Only serialized producís and their accessory ítems (those irems bearing a distinct serial number tag) are covcred under this onc—year warranty. PHYSICAL
DAMAGE CAUSEO BY MISUSE OR PHYSICAL ABUSE IS NOT COVERED UNDER THE WARRANTY. Items such as cables and nonserialized
modules are not covered under this warranty.
This warranty gives you speáfic legal rights, and you may also have other nghts which van’ from state to state, provínce to province, or country to country.
Ibis warranty is limited to repairing the instrument to DNI Nevada’s spedficanons.
When you retum an instrument to DNI Nevada, Inc^ for service, repair, or calíbration, we recommend using United Pared Service, Federal Express, or Air
Pared Pose We also recommend that you insure your shípmcnt forits actual replacement cost. DNI Nevada will not be responsable for lost shfrpments or
instmmcnts that are rcccivcd in damaged condition duc to improper packoging or liandling. AH warranty daim shipmcnts must be niade on a ffeight prepaid
basis. Also, in order to expedito your daim, piense. índude a properly completed copy of the Service Retum Form. Recalibratíon of instruments, which have a
recommended semiannua! calíbration frequeney, is not covered under the warranty.
Warranty Disclaimer
Sbould you dcct to have your instrument serviced and/or calibratcd by someone other than DNI Nevada, picase be advised that the original warranty
covering your product becomes void when the tamper-resistant Quality Seal is removed or broken without proper factor}’ authorizaéon. We strongly
recommend, thereforc, that you send your instrument to DNI Nevada for factory service and calíbration, espedaliy during the original warranty period.
In all cases, breaking the tamper-resístant Quality Seal should be avoided at al! cost, as this seal is the key to your original instrument warranty. In the event
that the seal must be biaben to gain interna! access to the instrument (eg^ in the case of a aistomer-ínstalled finnware upgrade), you must first contact DNI
Nevada’s technica! support department at 702-883-3400. You will be requked to provide us with the serial number for your instrument as well as a valid
reason for breaking the Quality Seal You should break this seal only afer you have recetved factor}7 authorization. Do not break the Quality Seal before you
have contacted us! Following these steps will help ensure that you wiH retain the original warranty on your instrument without intemiption.
WARNING
Unauthorized user modifications or applicarion beyond the published spedficatíons may resuk in eléctrica! shock hazards or improper operauon. DNI
«
MPULSE 4 0 0 0 OPERATING AND SERVICE MANUAL
Trademarks
and |hai,Mi...the tiadmiark s}nnboL0xin^.xtt^
”■■' :áWfe:ibbn■orflfe’t^^mimca'r«’tóe;dí¿^’püMi^érsütóstfsitít ^'ÚsüTg thc ftahícs ó¿iy foFctÍHoriáT piiqx>ses'andró thcbenefit of the tradcmárk owner
with no ¿ntcntion of improperly using that rtadeniark.
Companíes are listcd in alphabetical arder.
Thc foilowing are trademarks of Annstrong Medical Industries, Inc., 1 Jncolnshire, IHinois:
Chrts Clean®
The followíng are trademarks of Hewiett Packard, McMinnvíl’c, Oregon:
HP Codc Masrer ®
The followíng are trademarks of Laerda! Corporation, Armonk, New York:
Defib-Annefe, Hcart Start®
Thc followíng are trademarks of PhxTsia-T3antrok Rcdmond, Washington:
FAST-PATCH®, UFEPAK®
....
Table oí Contente
1 General Information
Safety Considerations................ ........................... -............... ................................ 1-1 ■
General.... ............................................................................................. . 1-1

í
Safety Symbols ............................................................................................. 1-1
Battery Charger...... ................................................................................ 1-1
Defibrillators.................................... ................................ ..................... . 1-1
Automatic Defibrillators................. ............................. . 1-1
Connecting the Defibrillator to the Impulse 4000............................. ........... 1-2
Discharging the Defibrillator.
Discharging the Automatic Defibrillator............................................ . 1-3
Intemal Paddles .............................................................................................. 1-4
Safety Information ................................................................................................ 1-4
Introduction and Features...................................................................................... 1-5
Impulse 4000 Instrument Specifications...................................................... . 1-6
Defibrillator Measurement......... .............................................................. 1-6
Transcutaneous Pacemaker Measurement.................................................. 1-8
Autosequence Test....... ............................................................................... 1-11
Defibrillator Tests........... ................. .......................... ............... . 1-11
Pacemaker Tests................................................................................ 1-11
¿f ECG Waveforms.....____________ ________ -—.—...................................... 1-12

<í:
Manikin Interface....... ................................. ................................................. 1-15
Training Scenaños ......................... . 1-15
Calendar/Clock ........................................................................... 1-15
Data Interfaces............................. ...................................................... 1-15
General Specifications for the Impulse 4000..................................... 1-16
Standard Accessories1-17
£ Optional Accessories................................................................. 1-17
Defibrillation-Only (50-Q) Electrode Adapters................... 1-17

í-
i Extemal Transcutaneous Pacer-Only (50-Q)
Electrode Adapters....................................................... 1-17
Combinatíon Defibrillator/Extemal Transcutaneous Pacer

(50-íl) Electrodo Adapters 1-17
Adapter (Pacemaker Plug-ln) Modules.................. . 1-18
Instrument Familiarity 1-19

2 Installation
Unpacking and Inspection.................................................................... ................. 2-1
Claims........... ................ .. ............................. ....................... ..................................2-1
Warranty Repair.............. ........................... ............................... ............... ..............2-1
Connecting the Printer .......................................................................................... 2-1
RS-232 Serial Port Setup................................. ............................... ........................2-2
Maníkín Connection.................................... ................................ ........................... 2-2
High-Level ECG Output Port.............. .................................................................... 2-2
3 Operating Instructions
Power-Up and Initialization............................................................ . 3-1
Main Menú Structure ...... .......... ....................... .............................. 3-1
Testíng a Defibrillator................... ..........................-............................ . 3-2
Defibrillator Testíng Theory............................ ..................... .........................3-2
Available Energy Rangos....... .............. ................................................ 3-2
Measuring Defibrillator Energy Output.........................................................3-2
Self-Test Feature.............................................................. ............................... 3-3
Printing Mea su reme nt Data ............. 3-4
Testíng Semi- and Fully Automatic Defibrillators ...................... 3-4
Viewing Waveform Output........ ....................................................... . 3-5
Real-Time Waveform Output.............. . 3-5
Time-Expanded Waveform Playback................................................ 3-5
Testíng Defibrillator Cardioversion ............................................................... . 3-6
Cardioversion Testíng Theory, Measurement Techo ¡que

and Parameters..................................................................... 3-6
Cardioversion Delay Time....... .................... .................. 3-6
Selecting the Stimulus Waveform............................................... 3-6
Conducting the Cardioversion Test............................................. 3-7
Self-Test Feature ................................ . 3-8
Printing Measurement Data........ ......... ........................................................ . 3-8
Viewing Waveform Output 3-8
Testíng Defibrillator Máximum Energy .............................................. 3-9
Conducting the Máximum Energy Test.............................................. .......... 3-9
..v Seif-Tesí. Feature3*9
Printing Measurement Data......................................................... 3-9

Adaptar (Pacemaker Plug-ln) Modules - Optional.....................................3-12
Connecting the Pacemaker to the Impulse 4000 ......................... ............ 3-12
Conducting the Manual Pacemaker Test.......................................... ......... 3-13
Measuring Pulse Parameters................ .......................... ......... ......... .3-13
Self-Test Feature................. ....................................................... 3-14
Viewing Real-Time Waveform Output............ ..................................... 3-14
Measuring the Refractory Periods.......... ..............................................3-15
Conducting a Demand Mode Test..................................................... 3-17
Generatíng ECG Waveforms................................................................................. 3-19
Selecting the ECG Waveform...................3-19
Transvenous Paced Feature......... ....................................................... 3-20
ECG Waveform Parameters Table...................................................... 3-21
Generatíng ECG Performance Waveforms....................................... 3-24
Manual Performance Mode................ . 3-24
Automated Performance Sequence Mode................................. 3-24
Reference Lead 3-24
ECG Performance Waveform Parameters Table 3-25
R-Wave Detector Testing........................................................... 3-26
Autosequence Test ........................................................................... 3-27
Running Autosequences ...... ...................................................................... 3-27
Sample Printouts for the Hewfett Packard Model

Codemaster XL+ Defibríllator.............................................. 3-29
Sample Printouts for the Hewlett Packard Model

Codemaster XL+ Pacemaker .............................................. 3-30
Factory-lnitialized Autosequence Table - Defibrillator............ 3-32
Factory-lnítialized Autosequence Table - Defibrillator Data for

DefíbrillatorIPacer 3-34
Factory-lnitialized Autosequence Table - Pacer Data for

DefibrillatorIPacer ..............t.*...................,............................ 3-35
Programming Custom Autosequences...................................................... 3-42
Making Defibrillator Autosequences ......................................... 3—43
Making Defibrillator/Pacer Autosequences............................... 3-43
Making Pacer Autosequences................................................... 3-44
Viewing Autosequences ............................................................................... 3-45
Printing Autosequences 3-45
_................... Initiaifizing Autosequences 3-45......................
Autosequence Test Options Table 3-46
vi
IMPULSE 4000 OPERATING AND SERVICE M
Using Trainíng Scenarios................................ ............... .............. ........... 3-47
Interactíve Defibrillator Trainíng................................................... . 3-49
Emergency Ventricular Defibrillation.......................... ........... . 3-49
Electiva Cardioversion .................................................................. «... 3-49
Interactíve Transcutaneous Pacemaker Trainíng.............. .......... . 3-50
medTester interface.................. ........................ ................................ .............. 3-52
Using the Impulse 4000 with the medTester............................ 3-52
Utílities. .......................................................... ............................................. 3-53
View Angle................................................ ........................... . 3-53
Clock..................___________ ............................... .............................. ..... 3-53
Battery......................................................................................................... 3-54
Baud Bate ......................................................... ................... 3-55
Calibration.................................... ...... .......... ........................... 3-55
Diagnostics...................................... 3-55
Serial Port Operation.......................................................................................... 3-56
Baud Bate ........................................... ................................................ 3-56
XON/XOFF............................................... .....................------- ------.......------- 3-57
Serial Printing of Test Data ....................................................................... 3-57
Remote Commands ........................................ ................................... 3-57
Introduction......................................................................................... 3-57
Command Syntax ................................................................ 3-58
Responsos to Commands............................................................... 3-58
Error Responsos................................................................................. 3-59
Specíal Commands........................................................................... 3-59
instrument Identification Commands........................... ..................... 3-59
Global Variable Setup Commands ................................................... 3-60
General Purpose Command ................................................ 3-61
Defibrillator Measurement Commands................... 3-61
Pacemaker Measurement Commands................................................3-63
Waveform Commands........................................................................ 3-64
Utílities and Diagnostics......................... 3-66
4 TEST AND CALIBRATION
Introduction, 4-1
■ Füncííonai ¡..v 44'
Calibration 4-2
5 The ory oí Opera ti oh
6 Technical Information
Part Number References for the Impulse 4000 ............................................. ..... 6-1
Impulse 4000 Final Assembly Component List............ ....................................... 6-3
Impulse 4000 Main Printed Circuit Board Component Locator......... 6-8
Impulse 4000 Main Printed Circuit Board Schematic..........................................6-9
Impulse 4000 Main Printed Circuit Board Component List............. 6-29
Impulse 4000 Load Printed Circuit Board Component Locator...... 6-50
Impulse 4000 Load Printed Circuit Board Schematic ..................... 6-51
Impulse 4000 Load Printed Circuit Board Component List............. 6-53
Impulse 4000 Display Printed Circuit Board Component Locator.. 6-58
Impulse 4000 Display Printed Circuit Board Schematic ................. 6-59
Impulse 4000 Display Printed Circuit Board Component List......... 6-63
7 Modules
j-
MPULSE 4000 OPERATING ANO SERVICE MANUAL
List oí lllustrations
1 General Information
Instrument Familiarity 1-19
3 Operating Instructions
Main Menú Structure .............................................. ...................................... 3-1
Exampie oí a Prínted Report with a Header (Testing a Defíbrillator)3-4
Waveform Output from an Oscilloscope (Testing a Defibríllator)..... 3-5
Waveform Output from an Oscilloscope

(Testing an Extemal Transcutaneous Pacemaker)................. 3-14
ECG Waveform Parameters Table................................................... 3-21
ECG Performance Waveform Parameters Tab/e.............................. 3-25
R-Wave Detector 3-26
Sampie Printouts for the Hewlett Packard Model

Codemaster XL+ Oefibrillator................................. 3-29
Sampie Printouts for the Hewlett Packard Model

Codemaster XL+ Pacemaker 3-30
Factory-lnitialized Autosequence Table - Defibrillator................. 3-32
Factory-initialized Autosequence Table - Defibrillator Data for

DefibrillatorlPacer.»..^.,,.»...^.^^^...........,^............—...,.3-34
Factory-lnitialized Autosequence Table - Pacer Data for

DefíbrillatoriPacer
Autosequence Test Options Table...............................

un
Sampie printout (Using Training Scenaríos)...................................
flattery Status Table........................................................................
5 Theory Of Operation
Impulse 4000 Overview Circuit Block Diagram................................ 5-2
IMPULSE 4000 OPERATIHG ANO SERVICE MANUAL
6 Technical Information
Impulse 4000 Main Printed Circuit Board Component Locator......................... 6-8
Impulse 4000 Main Printed Circuit Board Schematic — 10 sheets .. 6-9
Impulse 4000 Load Printed Circuit Board Component Locator........................6-50
Impulse 4000 Load Printed Circuit Board Schematic —1 sheet.......................6-51
Impulse 4000 Display Printed Circuit Board Component Locator .. 6-58
impulse 4000 Display Printed Circuit Board Schematic — 2sheets 6-59

IMPULSE 4000 OPERAT1NG AND SERVICE MANUAL
Abbreviatioris
NOTE: This cokimn alpnabctizeci
A ampere
BPM beats per minute
°C degrees Celsius (centigrade)
"F degrees Fahrenheit
DMM digital multimeter
ECG electrocardiograph or electrocardiogram
Hz hertz
in inch
J joule
k kilo— (103)
kHz kilo hertz
kíl kilohm
m -meter
micro— (10-6)
pA microampere
Ps microsecond
m milli- (10-3)
inA milliampere
mm millimeter
ms millisecond
mV millivolt
£2 ohm
pacer pacemaker
P-P peak—to—peak
Ib pound
PPM pulses per minute
PQRST Refers to portion of the ECG waveform
s second
V volt
xi
Chapter 1
General Information
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Cbapter 1 - General Information
SAFETY CONSIDERATIONS
General
This instrument and its related documentaron must be reviewed for familiarizaron with safety
markings and instructions befare operation.
Safety Symbols
This is the instruction manual symbol; the instrument is marked with this symbol when it
A is necessary for you to refer to the instruction manual.
WARNING! The “WARNING? sigo denotes a hazard. It calis attention to a procedure, practice,
or the like, which, ¡f not correctly performed or adhered to, could result in personal injury. Do not
proceed beyond a “WARNING? sign until the indicated conditions are fully understood and met.
CAUTION: The “CAUTION? sign denotes a hazard. It calis attention to an operatíng

procedure, practice, or the like, which, if not correctly performed or adhered to, could result in
damage to or destruction oí part or all of the instrument. Do not proceed beyond a “CAUTION? sign
until the indicated conditions are fully understood and met.
Battery Charger
Use only (he specified battery charger supplied by DNI Nevada with this instrument. Make sure the
battery charger is rated for your power source. The power source should be compatible with the
input voltage and current ratíngs printed on the battery charger.
Defibrillators
Defibrillators deliver hígh-voltage shocks to a patient in order to stop a life-threatening heart
condition. The defibrillator pulse is potentíally dangerous. Do not touch the Impulse 4000 paddle
contacts or the defibrillator paddles when discharging (firing) a defibrillator. Always follow the
devíce manufacturéis safety protocois of the defibrillator, such as holding both paddles correctly
and pushíng the buttons on both paddles simultaneously. Under no circumstances should you
touch the conductive metal contacts on the defibrillator paddles. Never try to defeat the safety
features of a defibrillator.
Automatic Defibrillators
Automatic defibrillators discharge automatically when they detect a life-threatening heart condition
that requires defibrillation. The Impulse 4000 simulates a wide range of cardiac arrhythmias to test
the defibrillator. If the Impulse 4000 has been set to output a ventricular fibrillation or a rapid
ventricular tachycardia wavefarm, the automatic defibrillator will discharge after it detects the
waveform and determines that defibrillation is necessary. The fully automatic defibrillator warns you
that it is about to discharge.
Always
Impulse 4000 with the correct electrode adapters. Do not touch the Impulse 4000 paddle contacts
or the defibrillator connections continué^ on the next page
1-1
Cbapter 1 - General Infarmation
SAFETY CONSIDERATIONS - cont/nued
Automatic Defibrillators - continued

During automatic sequences of defibrillator tests, the Impulse 4000 outputs the vermicular
fibrillation waveform automatically. Therefore, be aware of this fact and heed the defibrillators
audible warnings, so that you are ready for the pending defibrillator discharge.
Connecting the Defibrillator to the Impulse 4000

1. Select the proper Impulse 4000 electrode adapters (see the Optional Accessories section in
Chapter 1) for the defibrillator to be tested. An electrode adapter consists of a connector to the
defibrillator cable, a banana plug, and a plástic insulating cover. Ensure that the banana plug is
in the center of the plástic cover.
2. Place the banana plug portion of the electrode adapter into the center of each of the
Impulse 4000 defibrillator paddle contacts.
3- Fit the plástic cover so it completely covers the metal of each of the Impulse 4000 defibrillator
paddle contacts.
4. Now plug each of the wires of the defibrillator cable onto the connector of each Impulse 4000
electrode adapter. There should not be any exposed metal conductors in the connection from
the defibrillator to the Impulse 4000.
5. An altérnate method of connection is to place the defibrillator paddíes firmly on the

Impulse 4000 paddle contacts.
CAUTION: Never use electrode paste on the defibrillator paridles when testing with the
Impulse 4000 because it is not necessary and it wíll degrade the electrical connection.
Díscharging the Defibrillator

The Impulse 4000 has severa! functions that measure defibrillator parameters when the defibrillator
is discharged into its intemal test load. To perform any of these tests, first turn on the Impulse 4000
power switch, and then select the appropriate function using the menus and function keys.
Always follow the manufacturer’s instructions for the defibrillator that you are testing. Opérate the
defibrillator with the Impulse 4000 as follows:
WARNING! Defibrillators generate dangerous voltages between their paddles when

discharged. Be very careful never to touch either paddle when the energy is discharged. Most
defibrilíators have a safety interlock which requires buttons on both paddles to be pushed
simultaneously with sepárate hánds to discharge the energy. Never try to defeat this safety
interlock system.
CAUTION: Never use electrode paste on the defibrillator paddles or conductive disposable
electrodes when testing with the Impulse 4000 because it is not necessary and it will degrade the
electrical connectfort.
continued on the next page
1-2
Chapter 1 - General Information
SAFETY CONSIDERATIONS * continued
Discharging the Defibrillator - continued

NOTE: Cenain defibrillators have an altérnate connection path to the Impulse 4000 that requires the use of the
electrode adapters. If chis is the case, complete steps 1 through 4 in the preceding section, CONNECTING THE
DEFIBRILLATOR TO THE IMPULSE 4000.
1. Tum the power on to the defibrillator, then set the defibrillator to the desired energy leveL
If testing cardí o versión, tum on the synchronized mode of the defibrillator and connect the ECG
monitor leads of the defibrillator to the Impulse 4000 ECG posts. Tum on the ECG monitor of
the defibrillator and check that the ECG waveform is displayed and that the defibrillator is
recognizing the simulated heartbeat waveform and synchronizing on it. A marker or visual
indicator should be displayed on the defibrillator ECG monitor.
2. Charge the defibrillator to the preset energy level by pushing the charge button on the
defibrillator. The defibrillator will indícate when it is charged.
3. Place the defibrillator paddles firmly on the Impulse 4000 paddle contacts. The apex (+) paddle
should be on the right paddle contact and the stemum (-) paddle should be on the left*
Discharge the defibrillator by pushing both díscharge buttons on the paddle handles
simultaneously with sepárate hands.
•NOTE: On most defibrillators this ensures a positíve polarity of the signa! at the real-time scope
output. Reversing the paddles does not harm anything, even with grounded defibrillators, and still
gives a correct energy reading. Reversing the paddles does reverse the real-time scope output polarity.
4. After you have discharged the defibrillator, remove the paddles. The Impulse 4000 displays the results.
Discharging the Automatic Defibrillator

From the ECG signa!, the fuily automatic defibrillator can detect that defibrillation is needed; then
it will charge and discharge automatically. Automatic defibrillators do not use conventional apex
and stemum paddles. Instead, they have a cable that connects to adhesive defibrillation electrode
pads to facilítate safe and convenient use.
DNI Nevada has special electrode adapters available as optional accessories (see the Optional
Accessories section in Chapter 1). These electrode adapters connect to the defibrillator’s cable.
WARNING! Automatic defibrillators generate dangerous voltages at their outputs. Never

touch the defibrillator cable contacts, or the connected electrode adapter metal parís whenever
the defibrillator is turned on. Follow the defibrillator’s warnings to “stand back" when it discharges.
1. Complete steps 1 through 4 in the earlier section CONNECUNG THE DEFIBRILLATOR TO THE
IMPULSE 4000.
2. If the automatic defibrillator incorpórate^ an ECGmonitor with

’ECG ’jeáfls to ífie tfnpuíse 4866' "ÉCG posts’
continued on the nextpage
1-3
Chapter 1 - General Informaron
SAFETY CONSIDERATIONS - continued
Discharging the Automatic Defibrillator - continued

3. Select the appropriate function using the menus and function keys.
• Use the “VFIB” function (see Testing Sentí- and Fully Automatic Defibrillators in Chapter 3)
for manual tests.
• Use the “AUTO” function (see A UTOSEQUENCE TEST in Chapter 3) to automatically generate
simulated ventricular fibrillation waveforms during energy tests.
NOTE; Heed all defibrillator wamings, so that you are ready for che pending defibrillator discharge.
4. Tum on the automatic defibrillator. Follow the manufactureras instructions. The automatic
defibrillator detects the ventricular fibrillation waveform and determines that defibrillation is
necessary, then it charges to the preset energy level. The automatic defibrillator issues a waming
to stand back and then it discharges the energy.
5. The Impulse 4000 displays the test results.
6. Make sure to tum off the automatic defibrillator when you are done testing.
Internal Paddles
Some defibrillators have special defibrillation paddles for internal body use during open-heart
surgery. These paddles are small and are placed directiy on the heart. The Impulse 4000 has
adapters for these internal paddles that are suppiied as standard accessories. They are similar to the
automatic defibrillator adapters in that they plug into the center of each of the Impulse 4000 paddle
contacts and have plástic covers that go over the paddle contacts. They have a small curved contact
surface on top that mates with the internal paddles. To test defibrillators with internal paddles, plug
the two internal paddle adapters onto the Impulse 4000 paddle contacts, completely covering the
conductive paddle contacts. Then proceed, as described previously, to discharge the defibrillator
for an energy level measurement.
CAUTION: The internal defibrillation paddle adaptar set (DNI Parí # 5215-0198) is shipped
with the Impulse 4000 Analyzer as a standard accessory. This adapter set tests the unsterilízed
cardiac contact plates of íntemally discharged defibrillators that are typícally used during
open-heart surgery. The set ís shipped from the factory in an unsterilízed condition and should
not be used, as shipped, to test sterilízed contact plates during an open-heart procedure.
The infernal defibrillation paddle adapters can be gas sterilízed using Ethylene Oxíde (EtO)
protocol. Both the metal and plástic parts of these adapters can withstand repeated sterilízations,
but they should still be examined for damage such as cracking, discoloration, and warping both
prior to and immediately following EtO sterilization. No extended product liability or implied
warranty, beyond what is listed in the statement on the inside front cover of this manual, is
intended by the manufacturen
SAFETY INFORMATION
WAfíNlNG! Instructions for adjustments while

impüfcw 40ÜG áfé forliée by fráíned seh/íce personneí only. To avoíd dangerous electric shock,
do not perform such adjustments or servicing unless qualified to do so.
JNTRODUCTION AND FEATURES
Introduction
This manual is written for the biomedical equipment technícian or clínica! engineer responsable for
testing defibrillator and transcutaneous pacemaker equipment. It explains the intended operation and
service of the Impulse 4000 Defibrillator and Transcutaneous Pacemaker Analyzer.
The Impulse 4000 measures and reports specific defibrillator performance parameters and
transcutaneous pacemaker performance parameters.
Features
The following is a Iist of the Impulse 4000 features:
• Measures energy output of defibrillators.
• Measures cardioversion delay time of defibrillators in the synchronized mode.
• Measures output parameters of transcutaneous pacemakers.
• Simúlales the human body with an internal 50-0 resistance.
• Provides the specific resistance loads and measurement algorithms necessary to test
external transcutaneous pacemakers to manufacturer’s specífications.
NOTE: Requires the use of an adapter (pacemaker plug~in) module; this is an optional accessory.
• Automates testing by making 50 user-programmable autosequences available.

• Generales a wide variety of simulated ECG waveforms.
• Provides clínical training scenarios and interfaces to compatible training manikins
such as the Armstrong Medical Defib Chris Clean or the Laerdal Defib-Anne.
• Connects to DNI Nevada’s original medTester, medTester 5000, and medTester 5000B.
• Interfaces to a PC, terminal, or parallel primer.
Performs the following functions with defibrillators, transcutaneous pacemakers, and

12-Jead ECG devices:
• DEFIBRILLATOR MEASUREMENTS. Output energy, peak output voltage and
current, output pulse width, cardioversion delay time test, and charge time.
• TRANSCUTANEOUS PACEMAKER MEASUREMENTS. Peak current, pulse width,

pulse rate, pulsed-refractory period, and sensed-refractory period.
• AUTOMATED TESTING PROTOCOLS. Capacity for 50 unique test sequences that

inspect specific defibrillators and/or external transcutaneous pacemakers.
• ECG TEST/SIMULAT1ON. Performance waveforms, normal sinus rhythm waveforms,

arrhythmia simulations, and R-wave detector tests.
respond to defibrillator discharges and transcutaneous pacemaker ínputs. Excellent

for training medical personnel.
7-5
IMPULSE 4000 INSTRUMENT SPECIFICATIONS
Defibrillator Measurement
The Impulse 4000 Analyzer tesis the operation of defibrillators with output waveforms such as Lown,
Edmark, Truncated Exponential, or Trapezoidal. This instrument measures and digitally displays the
energy, peak voltage, peak current, pulse width, and charge time of the applied defibrillator output pulse.
The Impulse 4000 is designed to opérate up to the energy/voltage/current levels as specified below. The
actual accuracy of the Impulse 4000 has been verified and tested at 360 joules using an Edmark waveform
type defibrillator.
Modes of Operation: Manual, Factory Preprogrammed Autosequence, User-Programmable

Autosequence, and Remote Computer Control.
Internal Defibrillation Test Load: 50 Q, ±1%
Energy Measurement Ranges: HighRange

Energy: 360.0 J máximum at specified accuracies
NOTE: Readings are obtainable at energies up to
1000 J.
Resolution: 0.1 J
Accuracy: ±2% of reading for 100-360 J
±2 J for <100 J
Peak Voltage: 6000 V máximum
Resolution: 3V
Accuracy: ± (1% of reading + 10 V)
NOTE: Accuracy specified is for
energy levels <360 J.
Peak Current: 120 A máximum
Resolution: 0.1 A
Accuracy: +(1% of reading + 2 A)
NOTE: Accuracy specified is for
energy levels <360 J.
Trigger Leve!: 100 V
Test Pulse: 100 J ±5 J
Real-Time Output: 1V/1000 V
Accuracy: ±5% peak-to~peak
Playback: 1 mV/3000 V Lead II
(Time Expansión Factor « 200:1)
1-6
Low Ra.nge
Energy: 50.0 J máximum
Resoiution: 0.1 J
Accuracy: ±2% of reading for 20-50 J
±0.4 J for <20 J
Peak Voltage: 1200 V máximum
Resoiution: 1 V
Accuracy: ±(1% of reading + 2 V)
Peak Current: 24 A máximum
Resoiution. 0.1 A
Accuracy: ±(1% of reading + 0.1A)
Trigger Level: 20 V
Test Pulse: 4 J ±0.2 J
ReakTime Output: 1V/200 V
Accuracy: ±5% peak-to~peak
Playback: 1 mV/600 V Lead II
(Time Expansión Factor « 200:1)
Energy Measurement lime Window: 64 ms
Output Pulse Wídth Measurement. Measurement is 10% and 50% of the waveform peak; applies
to voltage or current.
Resoiution: 0.05 ms
Accuracy: ±0.2 ms
Automated Defibrillator Testíng: Seven ventricuiar arrhythmias can be output across the 5O-T2
test load to arm the automated defibrillator.
Selections: Ventricuiar Fibrillation 1 (coarse) and
Ventricuiar Fibrillation 2 (fine).
Ventricuiar Tachycardia at
130, 175, 180, 185, and 220 BPM.
Cardioversion Delay Time: Measured from the peak of the simulated ECG R wave to the
peak of the defibrillator output pulse.
Range: -120 to +380 ms from the R-wave peak.
Resoiution-. 1 ms
Accuracy: ±1 ms
ECG. Five selections—Normal SinusRhythm at
60, 80, and 120 BPM; Atrial Fibrillation 1
(coarse) and Atrial Fibrillation 2 (fine).
Charge Time: Measurement is initiated by pressing the function key

and simultaneously charging the defibrillator. Charge time is
displayed after the defibrillator output is applied across
«■< /-¿-i VÍV ivi’ivi »• ¡
Range: 1 to 99 s
Resoiution-, 1s
Accuracy: ±1 s
Cbapter 1 - General Jnformation
Transcutaneous Pacemaker Measurement

The Impulse 4000 Analyzer is specifically designed to test the basic operation of externa) transcutaneous
pacemakers.
NOTE 1: This particular type of pacemaker is used in both prehospital paramedic and hospital-based emergency cardiac
applicatíons to induce a producúve heart rhythm in a patient with either asystole (no cardiac activity) or bradycardia (very
low heart cate). The pacemaker pulse is typically delivered via a sel of disposable electrode pads that are dírectly attached
across the patient’s chest.
NOTE 2: The Impulse 4000 Analyzer is not intended for use wíth either externa! transvenous or internal implantable
pacemakers that use an indwelling invasive catheter to dírectly stimulate the heart. Refer to the specific device
manufacturar for the recommended testíng methods for these pacemakers.
The Impulse 4000 Analyzer measures monophasic external transcutaneous pacemaker pulse outputs
such as rectilinear, trapezoidal, and truncated waveform types. Thís analyzer displays rate, peak output
current, and pulse width of the applied pacemaker pulse. The Impulse 4000 Analyzer also has interactive
testíng capabilities for refractory period measurement and demand/asynchronous mode verification that
are conducted without the use of additional test equipment.
NOTE; The Impulse 4000 also tests transcutaneous pacemakers using optiona! adapter (pacemaker plug-in) modules.
These modules modify particular measurement techniques, add test load selections, and incorpórate the proper electrode
connectors to the standard Impulse 4000 as required by specific medical device manufacturers. Refer to Chapter 7 Modules
or the current DN1 Nevada price list for specific adapter (pacemaker plug-in) module avaílability.
Iniernal Pacemaker Test Load: 50 Q, ±1%
Current Amplitude Measurement: Range: 4 to 250 mA

Resolución: 0.2 mA
Accuracy: ±(1% of reading + 2 mA)
Trigger Level:
Test Pulse Amplitude: 100 mA, ±5 mA
Measurement Time Window: 100 ms (máximum)
Pulse Width Measurement: Pulse width is defined as the time between the initial upslope
and the final downslope of the applied monophasic pacemaker
pulse. This time is measured at 10% of the máximum
amplitude of the applied pacemaker pulse leading-edge slope.
Resolución: 0.1 ms
Accuracy: ±0.5 ms
Pulse Rate: Range: 30 to 200 PPM

Resolución: 1 PPM
Accuracy: ±1 PPM
Refractory Tests: These tests are performed in the pacemaker demand mode only.
Pulseó-Refractory Period (PRP)
This is the period of time that immediateiy follows the
pacemaker pulse during which time the pacemaker does not
sense cardiac activity.
Sensed-Refractory Period (SRP)
This is the period of time that immediateiy follows sensing of
cardiac activity during which time the pacemaker does not
sense further cardiac activity.
Measurement Range: 20 to 500 ms
Pacemaker Rate Range: 30 to 200 PPM
Measurement Points: PRP. Leading edge of the pacemaker
pulse to the peak of the first
ECG R-wave complex.
SRP: Berween the peaks of the first and
secónd ECG R-wave complex
following the pacemaker pulse.
ECG Waveform Stimulus: Havertriangle, 1 mV peak (Lead II),
and 40-ms width.
Measurement Resolution: 1 ms
Measurement Accuracy: ±2 ms
Demand Test: This is an interactive test that verifies the basic operation of the
pacemaker in the demand mode. The applied pacemaker pulse
rate is measured and two ECG heart rates are automatically
computed that either inhibir or enable the pacemaker output.
ECG Waveform Stimulus: Havertriangle,
1-mV peak (Lead II).
ECG Waveform Stimulus Rate Range: 1 to 250,
in 1-BPM steps.
1-9
This page intentionally blank.

Autosequence Test
The Impulse 4000 can store up to 50 autosequences with device-specific inspección protocols. These
autosequences can inelude a wide range of defibrillator, pacemaker, and ECG tests. The first 26
autosequences are factory-initialized for selected device manufacturers' models. The fírst 18 of these
seiectíons comprise defibrillator-only devices, the next 8 compuse combinación defibrillator/pacemaker
devices, and the remaining 24 are exclusively reserved for your own customized protocols. If desired,
you can program any of the 50 autosequences wíth your own customized protocols. However, the first
26 autosequences revert to factory valúes whenever the instrument is reinitialized and the rest of the
autosequences are erased.
Defibrillator Tests
Defibrillator Energy Levels. Up to 20 discrete energy levels with both ± test limits set in
% steps. For low-level energy settings, a mínimum test Ümit
of ±0.7 J is factory preprogrammed.
Máximum Energy: Records energy and charge time with ± test limits set in
1-J steps. A test can be repeated; only the results of the last
test are saved.
Cardioversion: Records up to three tests with both energy levels and delay
time measurements. Energy has both ± test limits set ¿n % steps.
ECG Performance Waveforms: Series of ECG waveforms sequenced to test the basic
operation of the ECG monitor and recorder functions.
(Refer to the next section, ECG Waveforms, for details.)
Pacemaker Tests
Pulse Mode: Up to 20 outputs with selectable amplitude and rate valúes. A
± test Ümit can be independently set for each of the parameters.
This test is intended primarily for the continuous (asynchronous)
mode of the transcutaneous pacemaker for basic amplitude and
rate accuracy testing. For low-level amplitude settings, a
mínimum test limit of ± 5 mA is factory preprogrammed.
Asynchronous Pacemaker Test; One discrete test for the continuous (asynchronous) pacemaker
to ensure that the desired continuous pacemaker output
selection is not disabled in the presence of a higher-rate ECG
signal. The overdrive ECG signal can be set by the operator to
a rate from 10% to 50% over the continuous pacemaker rate.
Demand Pacemaker Tests-. Five discrece rate tests. Interaction of the demand-mode
pacemaker pulse and a user-programmable ECG base rate can
be tested. Both the underdrive and the overdrive ECG races
can be set by the operator. Underdrive and overdrive rate
ranges are 10% to 50% of the selected ECG base rate.
Refractory Tests: Pulsed- and sensed-refractory tests are performed. A test can
be repeated; only the results of the last test are saved.
7-77
ECG Waveforms
The Impulse 4000 Anaíyzer generates a true 12-lead ECG simulation with independent outputs for each
signal lead.
Waveform Selections: Manuallv Selectable Performance Waveforms

• Zero Output
• Square Wave: 2 Hz
• Pulse: 4 s
• Sine Waves: 0.05, 0.5, 1, 10, 25, 30, 40, 50, 60, 100,
125, and 150 Hz.
• Square Wave: 1 kHz
• Triangle Wave: 2 Hz
NOTE: Referente lead signal ís 1-mV amplítude; selectable
between I and II.
Automated ECG Performance Waveform Sequence

A seríes of the above-Iisted performance waveforms is output
in the following sequence to facilítate the testing of
ECG monitoring and recording devices:
Zero Output; Square Wave; Pulse; Sine Waves 1, 10,
30, 40, 50, 60, and 100 Hz, and 1 kHz (Square Wave);
Triangle Wave; and Normal Sinus Rhythm rafes 60, 30,
60, 120, 240, and 60 BPM.
NOTE: Referente lead signal is 1-mV amplítude-, selectable
between I and II.
Manuallv Selectable Normal Sinus Rhvthms

30, 60, 80, 120, 160, 200, 240, and 300 BPM.
NOTE: Lead 11 signal is l~mV amplítude.
ECG R-Wave Threshold Detection Test

Determines the mínimum width and amplítude of the particular
R wave that is detectable, i.e., those R waves that reach threshold.
ECG R Waves
Width: 8, 12, 20, 40, 60, 80, 100, 120, 140,
l60, 180, and 200 ms.
Accuracy: ±1%
Amplitude: Lead II signal

0.05 to 0.50 mV in 0.05-mV steps.
0,50 to 5-50 mV in 0.25~mV steps.
Accuracy: ±5%
..Arrhythmia Selections- -• > -............ ......

NOTE: Lead II signa! is 1-mV amplitude for all arrhythmia selections.
• Supraventricular: Atrial Fibrillation (1 & 2)
Atrial Flutter
Sinos Arrhythmia
1 ° AV block
2o AV block type I
2o AV block type II
3o AV block
• Ventricular: Premature Ventricular Contractions

(PVC 1 and PVC 2)
Multifocal PVCs
Couplet (pair of PVCs)
Bigeminy
Trigeminy
Ron of 5 PVCs
Run of 11 PVCs
Ventricular
Ventricular Tachycardia at 130, 175,
180, 185, and 220 BPM.
Ventricular Fibrillation (1 & 2)
Asystole (1 & 2)
• Transvenous Pacemaker:
Continuous
Demand (rype 1 & 2)
AV (Atrioventricular) Sequential
Noncapture
Nonfunctional
• Simulated Waveform Accuracy

Amplitude: ±5% (reference lead)
Rate: ±0.5%
Transvenous Pacernaker Spike Simuladon

Amplitudes: -700, -500, -200, -100, -50, -20, -18,
-16, -14, -12, -10, -8, -6, -4, -2, 0, 2,
4, 6, 8, 10, 12, 14, 16, 18, 20, 50,
100, 200, 500, and 700 mV.
Accuracy: +(10% of setting +0.2 mV)
Pulse Wídths: 0.1, 0.2, 0.5, 1.0, and 2.0 ms.
Accuracy: ±5%
AV í'i ’♦ VAV VVW«’ V * V
Chapter 1 ~ General Informaron
Low-Level ECG Posts

• Ten bínding posts that are compatible wíth disposable''' ’
snap electrodes, 3.2- and 4-mm pins, and loose wires.
* The binding posts are as foliows:

1. RL (right leg)
2. RA (right arm)
3. LA (left arm)
4. LL (left leg)
5. VI (chest)
6. V2 (chest)
7. V3 (chest)
8. V4 (chest)
9. V5 (chest)
10. V6 (chest)
• A true 12-lead simulation with independent signáis at

each lead (RA + LA + LL = 0).
• Amplitude sxving: ±2 mV máximum for each signal.
• Nominal levels for a Normal Sinus ECG R wave,

baseline to peak:
Lead I 0.7 mV
Lead II 1.0 mV
Lead III 0.3 mV
V Leads 1.0 mV
• Deflbrillator Paddle (50-0) Contacts are the same as

the low-level Lead II amplitude signal.
High-Level Output
• A high-level versión of the Lead II signal (LL-RA)
proportional to the low-level signal at 1 V/mV.
• U-inch phone jack connection.
1-14
Manikin Interface
Compatible wíth training manikins such as Armstrong Medical Defib Chris Clean and the Laerdal
Defib-Anne. Provides ECG signal and receives isolated defibriliator signal to sequence the ECG during
training scenarios.
ECG Signal Output: Low-ievel Lead II signal.
Training Scenarios
The Impulse 4000 has several training scenarios that are interactive wíth defibrillators, transcutaneous
pacemakers, and training manikins (listed in the preceding section). The Impulse 4000 outputs an ECG
waveform and then responds to the díscharge of a defibriliator or transcutaneous pacemaker thereby
providíng realistic training situadons for medical personnel. The student can be presented wíth a new
ECG selección, or defib/pacer conversión response by the instructor wíth the simple push of a button.
A printout of the student’s responses, elapsed time, ECG waveform series, and formatted evaluation
checkiist can be output at the end of each training scenario. (Refer to the sample printout in Using
Training Scenarios in Chapter 3 )
Defibriliator Training Scenarios: Emergency Ventricular Defibriliation (Sequence of waveforms that

simúlales a failing heart condítion and subsequent revival íf defibriliation
is successful; also VFIB1, VFIB2, VTACH, and NORM-NSR 80.)
Elective Cardioversion (AFIB1, AFIB2)
Transcutaneous Pacemaker Scenarios: Asystole

Bradycardía
Demand
Noncapture
Calendar/Clock
Both the date and time are maintained wíth internal battery backup. These selections can be viewed on
the display or printed on both the autosequence and training scenario test forms.
Data Interfaces
Printer Port: Parallel
Connector: IBM compatible DB25 female connector.
Serial Port: RS-232

Connector: IBM compatible DB25 male connector.
• Bi-directional port for controlling the instrument and
• CTS handshake for sending data.

• Baud rates are 300, 600, 1200, 2400, 4800, and 9600.
1-15
General Specifications for the Impulse 4000
PARAMETER SPECiFICATION
Power Requirements: Internal 12-V lead-acid battery provides a mínimum of

20 hours’ operation. Instrument will run from charger while
charging a fully depleted battery.
Battery is rechargeable from wall piug charger:

• Use North American 115-volt CSA-approved battery
charger with 115 VAC (±10%) @ 50-60 Hz.
• Use European 230-volt with IEC square—power input
jack battery charger with 230 VAC (±10%) @ 50-60 Hz.
Temperatura Range: Operating: 15° lo 35°C (59° to 95°F).

Storage: 0o to 50°C (32° to 122°F).
Relative Humidity: 95% máximum, noncondensing.
Display: 4-Iine x 40-character Supertwist Liquid Crystal Display.
Weíght: 3 86 kg (8.5 Ib),
Dimensions: 24.89 cm L x 26.92 cm W x 8.89 cm H

Standard Accessóries DNI Part #
Battery Charger
Domestic (115 VAC) or 1201-0088
European (230 VAC) 1201 -0089
Operating and Service Manual 9508-0242
Defibrillator Contact Píate

Intemal Paddle Adapter Set 5215-0198
Vinyl Carrying Case 9530-0050
Optional Accessories
Defibriliation-Only (50-Q) Electrode Adapters
Cardiotronics—Molded Wing Type Connector 3010-0448
Physio-Control LIFEPAK series (set of two) 5215-0256
SpaceLabs-First Medie 610;

Laerdai Heart Start 1000/2000/3000 (set of two) 5215-0278
External Transcutaneous Pacer-Only (50-íl) Electrode Adapters
Physio-Control LIFEPAK series (set of two) 5215-0322
Zoll Medical—NTP Electrode System Compatible 3010-0450
Combínation Defibrillator/External Transcutaneous Pacer (50-Q) Electrode Adapters
Cardiotronics—Latching Type Connector 3010-0449
Hewlett Packard—Round Connector 3010-0447
Marquette Medical (all models; set of two) 5215-0258
Zoll Medical PD2200

Multi-runcuon Electrode System 3010-0378
1-17
Adapter (Pacemaker Plug-ln) Modules DNI Parí #
TQA-2 Zoll Models PD1200 and PD1400;

PD2200 Electrode System.
(1000-Q Load) 9513-0180
TQA-3 Zoll Models NTP2000 and NTP2100.

(1000-n Load) 9513-0181
TQA-6 Medical Data Electronics (MDE) Model E300.

(600- and 1000-Q Loads, and Open Circuit) 9513-0179
TQA-7 Marquette Medical Model 1500.

(300-Q Load) 9513-0183
TQA-9 Physio-Control LIFEPAK series.

(100-, 700-, 1000-, and 1500-Q Loads) 9513-0178
TQA—11 Cardiotronics—Latching Type Connector.

(100-Q Load) 9513-0184
TQA-12 Hewiett Packard Code Master Series.

(50- and 400-0 Loads) 9513-0185
NOTE: Refer to the current DNI Nevada Pnce List for avaílability, part
number information, and price.
Other Optional Accessories
Hard-sided carrying case 9530-0048
Bi-directional Serial Communication Cable,

DB25 (female) to DB25 (female) connectors 3010-0250

Use this cable for a medTester

Adapter Module Output Cable,

2.5-mm phone plug to BNC 3010-0442
NOTE: Refer to the current DNI Nevada Price List for avaílability, part
number information, and price.
1-18
INSTRUMENT FAMIL1ARITY
Printer Port
® ESC. Escape Key
(£) RS-232 Serial Port

® F1-F5: Function keys execute the function displayed above the key.
Handle
® SELECT: Left and right arrow keys.
Manikin Port ® Power Switch
(j^) High-Level ECG Output

® Defibrillator Paddle Contacts: “Apex” (right), “Sternum” (left).
(J) Barrery Charger Input

® EPROM cover located on the underside of the instrument.
(/^) 10 ECG LeadkBinding Posts ® Adapter Module Receptade
' feaí-flme Óütput
1-19
Chapter 2
Installation
Chapter 2 - Installation
UNPACKING AND ¡NSPECTION
Follow standard receiving practices upon receipt of the instrument. Check the shipping cartón for
damage. If damage is found, stop unpacking the instrument. Notify the carrier and ask for an agent to
be present while the instrument is unpacked. There are no special unpacking instructions, but be careful
not to damage the instrument when unpacking it. Inspect the instrument for physical damage such as
bent or broken parts, dents, or scratches.
CLAIMS
Our routine method of shipment is via common carrier, FOB origin. Upon delivery, if physical damage
is found, retain all packing materials in their original conditíon and contact the carrier immediately to
file a claim.
If the instrument is delivered in good physical conditíon but does not opérate within specifications, or
if there are any other problems not caused by shipping damage, please contact DNI Nevada or your
local sales representative.
WARRANTY REPAIR
The warranty statement for this product is at the front of this manual.
When shipping an instrument to DNI Nevada for repair, complete the Service Retum Form and attach
to the instrument. Compieting this form will help to ensure timeiy repair of your instrument.
Use the original cartón and packaging material for shipment. If they are not available, we recommend
the following guide for repackaging:
a) Use a double-walled canon of sufficient strength for the weight being shipped.
b) Use heavy paper or cardboard to protect all instrument surfaces. Use a nonabrasive material
around all projecting parts.
c) Use at least four inches of tightly packed, industrial-approved shock-absorbent material around
the instrument.
CONNECTING THE PRINTER
You can connect any Centronics or IBM PC compatible parallel printer to the Impulse 4000. DNI Nevada
recommends that you use a standard IBM PC compatible parallel printer cable.
Connect this cable to the “PRINTER PÓRT”, a 25-pin (DB25) female connector, on the rear panel of the
Impulse 4000.
2-1
Cbapter 2 - Jnstallation
RS-232 SERIAL PORT SETUP
The Impulse 4000 can be connected to the medTester vía (he RS-232 serial port. Test results can be sent
to a computer using this port and it can also be used to control all test functions vía a personal computer
or compatible terminal device. DN1 Nevada recommends that you use the appropriate cable as can be
located in the Other Optional Accessoríes section in Chapter 1. The cable connects to the 25“pin (DB25)
male connector, labeled “SERIAL PORT”, on the rear panel of the Impulse 4000.
MANIKIN CONNECTION
The Impulse 4000 will output the selected ECG waveform to the defibrillator pick-up plates of either
the Armstrong Medical Defib Chris Clean traíning manikin or the Laerdal Defib-Anne training manikin.
Use the standard modular phone jack, labeled “MANIKIN”, on the rear panel of the Impulse 4000.
HIGH-LEVEL ECG OUTPUT PORT
Use this port—a M-inch diameter phone jack, labeled “ECG HI LEVEL OUTPUT”, on the rear panel of
the Impulse 4000—to connect to an oscilloscope for monitoring waveforms.
rVi
2-2
>
Chapter 3
íf.
Operating Instructions
3
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Chapter 3 - Operating Instructions
POWER~UP AND INITIALIZATION
The Impulse 4000 ís battery operated. The power on/off switch is located on the ríght side of the
Impulse 4000 case next to the ventilation slots. When you turn the instrument on, it displays the
fírmware versión foliowed by the MAIN MENU PAGE 1 as shown below:
7/21/94 IMPULSE 4000 15:06:20

MAIN MENU PAGE 1:
DEFIB PACER ECG PERF AUTO
<F1> <F2> <F3> <F4> <F5>
Press the “SELECT” right pointing arrow to view PAGE 2 of the MAIN MENU:
7/21/94 IMPULSE 4000 15:06:20

>/■
MAIN MENU PAGE 2:
<TRAIN CUSTOM MEDT UTIL

<F1> <F2> <F3> <F4> <F5>
>Y
>:•
'■/
MAIN MENU STRUCTURE
Below ís a brief outline of the Impulse 4000 main menú structure.
<F1> <F2> <F3> <F4>
3-1
TESTING A DEFIBRILLATOR
Defibrillator Testing Theory

Energy is defined as the integra! over time oí the instantaneous porver output of a defibrillator. Power
is equal to the voltage squared, then divided by the resistance.
E = J p dt = j V2/R dt = J V2 dt/R
The Impulse 4000 measures and stores the instantaneous voltage of the discharge pulse every
50 microseconds, 1280 times, for a total measurement time of 64 milliseconds. All of these instantaneous
voltages are squared, summed, multíplied by 50 microseconds, and finally divided by the 50~Q load
resistance to yíeld an energy measurement in joules (J), also referred to as watt-seconds.
E - C£ v^) • At/R « CE v^) • 50 ps/50 Q.
Available Energy Ranges

The Impulse 4000 provides a low- and a high-energy range for thorough testing of the defibrillator
output, as follows:
• Low energy « Less than or equal to 50 J.
• High energy « Up to 1000 J.
NOTE: Refer to the IMPULSE 4000 INSTRUMF.NT SPECIFICAT1ONS - Defibrillator Measurement section in Chapter 1
for more information.
Measuring Defibrillator Energy Output

WARN1NG! Cardiac defibrillators generate potentially dangerous voltages which can be lethal if
improperly handled by an untrained operator. Refer to the device manufacturéis
operator or service manual for the specific device-inspection requírements.
Additional safety informaron for testing cardiac defibrillators is included in the
SAFETY CONSIDEfíATIONS section at the beginning of Chapter 1.
To measure the defibrillator output energy:
1. If you are using electrode adapters, complete steps 1 through 4 in Chapter 1, SAFETY
CONSIDERATIONS - Connecting the Defibrillator to the Impulse 4000
2. Press <F1> “DEFIB” from the MAIN MENU PAGE 1.
3. If a printer is attached to the Impulse 4000, press <F5> to print a manual defibrillator test header.
Press <F4> to send the header to the serial port. If no header is desired, press <F1> to continué.
4. Press <F1> “ENERGY”.
5. Select eíther <F1> “LOW” for measurements up tp 50 J or

‘ * - ■ • ‘ ‘ • 50 J:k The ró^ “READ»Th¿ impulsé ÍÓÓÓ wilí accept a defibrillator
output pulse for energy measurement.
3~2
6; Place; ’ defibrillator- p&ddtes fhrtiy óh’ the Impulsé '40<W5 défífíftltótóf pactóle ¿oiitacts, and
charge the defibrillator to the desired energy level. Altemately, ensure that the electrode adapters
are connected properly as stated ín Chapter 1, SAFETY CONSIDERATIONS - Connecting the
Defibrillator to the Impulse 4000.
7. Discharge the defibrillator.
The Impulse 4000 displays the following measurement data.
DEFIB ENERGY: READY E= 98.1 J

Vpk = 2025 V Ipk = 40.5 A
t50 = 1.60 mS tío = 2.65 mS
VFIB VTACH PLYBCK SERIAL PRINT>
<F1> <F2> <F3> <F4> <F5>
where:
E - Energy in joules.
Vpk « Peak voltage.
Ipk - Peak current in amperes.
t50 = Pulse width at 50 percent of the waveform peak in milliseconds.
tlO » Pulse width at 10 percent of the waveform peak in milliseconds.
Seff-Test Feature
Press the “SELECT” right pointing arrow to view the next page of the display:
DEFIB ENERGY: READY E = 98.1 J

Vpk = 2025 V Ipk = 40.5 A
t50 = 1.60 mS tío = 2.65 mS
<TEST
<F1>
Use <F1> “TEST” to periodically test the Impulse 4000 operation. When you press <F1> "TEST”, the
Impulse 4000 supplies a simulated defibrillator pulse to test its circuitry. There is an actual pulse
generator circuit that feeds into the low-level measurement circuitry, after the high-voltage attenuator.
Therefore, the circuitry and the firmware are tested completely. This-isnot an absolute calibration pulse,
and in the “HIGH” range, the test pulse should measure 100 J ±5 J.
Printing Measurement Data

The displayed measurement data can be sent to an attached serial primer or parallel primer.
• To send to a serial primer, press <F4> “SERIAL”.
* To send to a parallel primer, press <F5> “PRINT”.
Below is an example of a printed report with a header:
IMPULSE 4000 DNI NEVADA

DATE: 08/21/94 TIME: 11:34:54
Optional Header
OP CODE: CN:
MANE: MODEL
SERIAL # ... _ LOC:
MANUAL DEFIB ENERGY TEST RANGE: HI

E * 105.0 J Ipk = 29.4 A
Vpk - 1472 V tío = 6.40 ms
15 0 = 3.10 tns
ECG OUTPUT: vfibl
Testing Semi- and Fully Automatic Defibríliators

Refer to the device manufactureras operator or service manual for specific device-inspection
requirements. The following ECG waveforms are available to actívate the automatic defibrillator:
• VFIB - VFIB1 (coarse) and VFIB2 (fine).
• VTACH Rate - vt130, vt175, vt18O, vt185, and vt220.
To test either semi- or fully automatic defibríliators:

1. Complete steps 1 through 3 in Chapter 1, SAFETY CONSIDERATIONS - Discharging tbe
Automatic Defibrillator.
2. Fress <F1> “DEFIB” from the MAIN MENU PAGE 1.
3 If a primer is attached to the Impulse 4000, press <F5> to prínt a manual defibrillator test header.
Press <F4> to send the header to the serial port. If no header is desired. press <F1> to continué.
4. Press <F1> “ENERGY”.
5. Select either <F1> “LOW” for measurements up to 50 J or <F2> “HIGH” for measurements over
50 J. The top line of the display flashes “READY”. The Impulse 4000 will accept a defibrillator
output pulse for energy measurement.
6. Press either <F1> “VFIB” (ventricuiar fibrillation) or <F2> “VTACH” (ventricular tachycardia) to
generate the required stimulus ECG waveform for the advisory shock feature of the device. Press
the key again to choose additional selections (coarse or fine VFIB or VTACH Rate). The display
shows your choice.
7. Discharge the defibrillator. The Impulse 4000 displays the measurement data.
DEFIB ENERGY: vt!85 READY E = 98.5 J

Vpk = 2022 V Ipk = 40.4 A
t50 = 1.60 mS tío = 2.60 mS
VFIB VTACH . PLYBCK... SERIAL
<F1> <F2> <F3> <F4> <F5>
Cbapter 3 - Operating Instructions
Viéwíng Waveform Output
Real-Time Waveform Output

The attenuated defibriilator discharge pulse can be viewed on an oscilloscope using the Impulse 4000
real-time output. The ratios of displayed voltages to actual voltages are as follows:
Oscilloscope Defibriilator Voltage Defibriilator Voltage
(displayed) (actual)
High range 1V 1000 V
Low range 1V 200 V
To view waveform output in real time:

Connect a BNC cable from the real-time output on the ieft side of the Impulse 4000 to the
oscilloscope. A sample printout is shown below:
Time-Expanded Waveform Playback
The defibriilator discharge pulse can be viewed on a standard ECG monitor or recorder (e.g.> strip chart)
using time-expanded output, The expansión factor rescales at a ratio of 200:1. At typical 25 mm/s chart
speed, 5 mm = 1 ms.
NOTE: Typically monitors have frequency response characteristícs that can potentially distort the waveform.
Because the low-end frequency (-3-db) response for the chart recorder and monitor is approximately 0.5 Hz
or higher (in the monitoring quality mode), a certain amount of “droop” may be present in the playback
waveform. For the highest fidelity reproduction, use an oscilloscope and directly couple (DC) the input.
to waveform.
0.2 seconds wide in “HIGH” range or 0.1 seconds wide in “LOW” range. Then it plays back the
waveform. The complete playback takes 13 seconds since there is a 200:1 ratio on the 64-ms data
acquísition. Press <ESC> to termínate the playback if desired.
Chapter 3 - Opera ting Instructions
TESTING DEFIBRILLATOR CARDIOVERSION
Cardioversion Testing Theory, Measurement Technique and Parameters

The parpóse of the cardioversion test is to determine the ability of the defibrillator to synchronize ihe
discharge of íts output pulse with the selected Impulse 4000 simulated ECG waveform.
ldeally, the peak of the defibrillator output pulse should coincide or immediately follow the peak of the
ECG R wave within 30 milliseconds. Technica! Reference: ANS1/AAMI DF2-1989 (Cardiac Defíbrillators
Devíces Standard).
Cardioversion Delay Time

The Impulse 4000 can measure the cardioversion delay time of synchronized defibrillators. In this modes
the instrument outputs an ECG waveform (see the following section, Selecting the Stimulus Waveform)
while it waits for a concurren! defibrillator pulse. When the defibrillator pulse comes, the delay time is
computed from the R-wave peak of the last heartbeat to the onset of the defibrillator pulse. The ECG
waveform is 1 mV on Lead II.
The Impulse 4000 measures the delay time from the peak of the simulated ECG R wave to the peak of
the defibrillator output pulse. This measurement range is -120 to *380 ms. The valúes are negative if the
defibrillator discharges prior to the peak of the simulated R wave, such as on the QR up-slope. The
valúes are positive if the defibrillator discharges after the simulated R wave. If the delay time is outside
of these limits, “NO SYNC” is displayed.
Selecting the Stimulus Waveform

The following ECG waveforms are simulated by the Impulse 4000 for performing the cardioversion test.
Waveform Abbreviation
Normal Sinus @ 60 BPM NSR60
Normal Sinus @ 80 BPM NSR80
Normal Sinus @120 BPM NSR120
Atrial Fibrillation (COARSE) AFIB1
Atrial Fibrillation (FINE) AFIB2
To select the ECG stimulus waveform:

2. If a printer is attached to the Impulse 4000, press <F5> to print a manual defibrillator test header.
Press <F4> to send the header to the serial port. If no header is desired, press <F1> to continué.
3. Press <F2> “CARDIO”.
4. To select the range, press <F1> “LOW” for measurements up to 50 J or <F2> “HIGH” for
measurements over 50 J. The top line of the display flashes “READY”. The Impulse 4000 will
accept a defibrillator output pulse for cardioversion measurement.
WARNING! Follow all instructions in the next section, Conducting the Cardioversion Test.
before discharging the defibrillator.
5. Press <F1> “NSR* for a normal -sinus rhythm selección or press <F2> “AFIB” for an aerial
a. For NSR, press <F1> "NSR” until the desired heart rate is displayed.
b. For AFIB, press <F2> “AFIB” to select coarse or fine atrial fibrillation.
3-6
Conducting the Cardíoversiontést
WARNtNG! Cardiac defibrillators generate potentially dangerous voltages which can be lethal if
improperly handled by an untrained operator. Refer to the device manufacturéis
operator or service manual for the specific device-inspection requirements.
Additional safety information for testing cardiac defibrillators is included in the
SAFETY CONSIDERATIONS section at the beginning of Chapter 1.
CONSIDERATIONS - Connecting the Defibrillator to the Impulse 4000.
2. Complete step 1 ín Chapter 1, SAFETY CONSIDERATIONS - Discharging the Defibrillator.
3 Complete steps 1 through 5 in the preceding section, Selecting the Stimulus Waveform.
4. Select the “SYNCHRONIZED” mode of operation on the defibrillator.
5. Connect the ECG leads from the monitor/defibrillator to the Impulse 4000 binding posts.
6. Place the defibrillator paddles firmly on the Impulse 4000 defibrillator paddle contacts.
Alternately, ensure that the electrode adapters are connecced properly.
7. Charge the defibrillator to the desired energy level.
8. Press and hold the díscharge pushbuttons on the defibrillator paddles and wait for the
defibrillator to discharge.
After the defibrillator discharges, the Impulse 4000 displays the following measurement data:
DEFIB iCARDIO: nsr60 READY E = 145.6 J

Vpk = 2477 V Ipk - 49.5 A
Delay time = 88 mS
NSR AFIB PLYBCK SERIAL PRINT>
<F1> <F2> <F3> <F4> <F5>
where:
E = Energy in joules.
Vpk - Peak voltage.
Ipk « Peak current in amperes.
Delay time - Amount of time in ms; from -120 to +380.
NOTE: If the defibrillator discharges outside of the -120- to +38O-ms timing window, the prompt
“NO SYNC” displays. Verify that the “SYNCHRONIZED” mode of operation is selected on the
defibrillator.
Self-Test Feature. ....................................

Use <F1> “TEST”, on page 2 of the DEFIB CARDIO menú, to periodically test the Impulse 4000
operaüon. First, press the <right arrow> “SELECT" key to change the display to PAGE 2 of the MAIN
MENU. Then press <F1> “TEST”. When you press <F1> “TEST”, the Impulse 4000 supplies a simulated
defibrillator pulse to test its circuitry. There is a-n actual pulse generator circuit that feeds into the
low-level measurement circuitry, after the high-voltage attenuator. Therefore, the circuitry and the
firmware are tested completely. This is not an absolute calibration pulse, bul just a general purpose
seif-test. In the "LOW” range, the test pulse should measure 4 J ±0.2 J: and in the “HIGH” range, the
test pulse should measure 100 J ±5 J.
Printing Measurement Data

Because the ínformatíon is the same, refer to Printing Measurement Data in the previous section
TESTING A DEFIBRILLATOR.
Viewing Waveform Output

Because the information ís the same, refer to Viewing Waveform Output in the previous section
TESTING A DEFIBRILLA TOR.
TESTING DEFIBRILLATOR MAXIMUM ENERGY
Use the MAXE option to test the defibrillator’s máximum energy output for either the low or high range.
MAXE also measures the charging tíme of the defibrillator. The following ECG waveforms are avaílable
to actívate the serni- and fully automatic defibrillator:
• VFIB - VFIB1 (coarse) and VFIB2 (fine).
• VTACH Rafe - vt130, VI175, vt180, vt185t and vt22O.
Conducting the Máximum Energy Test

To run the máximum energy test;
1. Complete steps 1 through 3 in Chapter 1, SAFETY CONSIDERAT1ONS - Discharging the
Automatic Defibrillator.
3. If a printer is attached to the Impulse 4000, press <F5> to prínt a manual defibrillator test header.
Press <F4> to send the header to the serial pon. If no header is desired, press <F1> to continué.
4. Press <F3> “MAXE”.
5. To select the range, press <F1> “LOW” for measurements up to 50 J or <F2> “HIGH” for
measurements over 50 J.
6. For automatic defibrillators, press <F1> “VFIB” or <F2> “VTACH” repeatedly until the desired
waveform is displayed. For example, press <F1> twice to select VFIB2 (fine).
NOTE: The selected waveform doesn’t affect an energy test for a nonautomatic defibrihator.
7. Press <F3> “START” and begin charging the defibrillator.

The top line of the display flashes “READY”. The Impulse 4000 will accept a defibrillator output pulse.
Discharge the defibrillator. Test results display on the Impulse 4000 as shown in the sample below:
DEFIB MAXE vfib2 E = 97.5 J

Charge Time = 1 S
Push F3 and start charging defib
VFIB VTACH START SERIAL PRINT>
<F1> <F2> <F3> <F4> <F5>
Self-Test Feature
The test pulse becomes avaílable on <F5> afteryou press <F3> “START". When you press <F5> “TEST",
the Impulse 4000 supplies a simulated defibrillator pulse and displays the data as shown above.
Prínting Measurement Data

The displayed measurement data can be sent to an attached serial printer or parallei printer.
• To send to a serial printer, press <F4> “SERIAL”.
• To send to a parallei printer, press <F5> “PRINT”.
TESTING AN EXTERMAL TRANSCUTANEOUS PACEMAKER
The Impulse 4000 ís specifically designed to test the basic operation of external transcutaneous
pacemakers.
NOTE ]: This particular type of pacemaker is used in both prehospital paramedic and hospital-based emergency cardiac
applications to induce a productive heart rhythm ín a palie nt with either asystole (no cardiac activíty) or bradycardia (very
low heart rale). The pacemaker pulse is typically delivered via a set of disposable electrode pads that are directly aoached
across the patient's chest.
NOTE 2: The Impulse 4000 is not intended for use with either external transvenous or intemal implantable pacemakers
that use an indwellíng invasive cachete r to directly súmuiate the heart. Refer to the specific device manufacturen for the
recommended testing methods for these pacemakers.
The impulse 4000 measures monophasic external transcutaneous pacemaker pulse outputs such as
rectilinear, trapezoidal, and trunca ted waveform ty pes. This instrument displays rate, peak output
current, and pulse width of the applied pacemaker pulse. The Impulse 4000 also has interactive testing
capabilities for refractory period measurement and demand/asynchronous mode verification that are
conducted without the use of additional test equipment.
Test Load
The internal 50-íi noninductive resistance provides a standard test load for the pacemaker that simúlales
the thoracic impedance of the adult chest.
Pulse Current Amplitude Measurement

The híghest (or peak) current valué, in either polarity, of the pacemaker pulse is directly computed by
the Impulse 4000 and is displayed in miiliamperes (mA).
NOTE: Some pacemaker manufacturéis require different measurement techniques for their specific devices. Refer
to the sección Adaptar (Pacemaker Plug-ln) Modules for información or review the specific device specíficatíons
Usted in the manufacturéi s service manual.
Pulse Width Measurement

The width of the pacemaker pulse is measured at the 10°/&-point between the zero baseline and the
highest peak current valué. It is displayed in milliseconds (ms).
Pulse Rate Measurement

The rate is determined by measuring the elapsed time between the leading-edge points of consecurive
pacemaker pulse waveforms. This rate is directly displayed in pulses per minute (PPM).
3-10
Refractory Period Measürérñent

Refractory tests are to be performed in the pacemaker "DEMAND" mode only. These tests verify the
ability oí the pacemaker to interact with cardiac activity while the pacemaker is operating in the
“DEMAND” mode. The desired outcome of the “DEMAND” mode is to pace the heart during periods of
asystole or extreme bradycardia, and not to interfere with the heart when it beats at a normal rhythm
and rate.
While the pacemaker ¿s in the “DEMAND” mode of operación, it acts as a backup to the heart’s normal
rhythm. If chis normal rhythm rate falls below the seiected pacemaker rate, the pacemaker’s output is
enabled and the heart is artífícially paced. If the heart begins to beat at a normal rhythm and rate, the
pacemaker’s output becomes* inhibí red and discontinúes pacing.
The pacemaker is constantly monitoring the patient’s cardiac activity except during the intervals that the
pacemaker pulse is output and during the blanking period immediately following the pacemaker pulse.
The Pulsed-Refractory Period (PRP) is the period of time that immediately follows the pacemaker pulse
during which time the pacemaker does not sense cardiac activiry and its output is not inhibited. The
Impulse 4000 interactively outputs the ECG R-wave complex following the pacemaker pulse and makes
a seríes of adjustments to this coupling interval until the following pacemaker pulse is inhibited. The
Impulse 4000 measures the PRP from the leading edge of the pacemaker pulse to the peak of the first
ECG R-wave complex,
The Sensed-Refractory Period (SRP) is the period of time that immediately follows sensing of cardiac
activity during which time the pacemaker does not sense further cardiac activity. The Impulse 4000
measures the SRP from the peak of the first ECG R-wave complex to the next ECG R-wave complex
following the pacemaker pulse.
Demand Mode Interactive Testing

This is an interactive test that verifies the basic operation of the pacemaker in the “DEMAND” mode.
The applied pacemaker pulse rate is measured and two ECG R-wave drive rales are automatically
computed. The underdrive rate is 80 percent of the applied pacemaker pulse rate and the overdrive rate
is 120 percent of the applied pacemaker pulse rate. These rates either enable (underdrive) or inhibir
(overdrive) the pacemaker pulse rate when output by the Impulse 4000. If desired, you can adjust the
ECG R-wave complex rate from 1 to 250 BPM in one-beat-per-minute steps.
>>: •' ■ ■ • ■ ■ • ■ .....
3-11
Adapter (Pacemaker Plug-in) Modules«Optional

As an optional feature, DN1 Nevada offers a series of adapter (pacemaker plug-in) modules for the
Impulse 4000 designed to satisfy the testing requirements of specific manufacturera’ models. These
adapter (pacemaker plug-in) modules have the connector required to direcdy interface to the
pacemaker’s electrode cable, provide specified test loads, and also have an identification code that can
modify the impulse 4000 testing formats. While the standard pacemaker testing capabilities of this
instrument satisfy general testing needs, some device manufacturera require different measurement
techniques. The following manufacturera’ models are some of the examples:
Zoll Medical Models PD1200, PD1400, NTP2000, and NTP2100

DNI Nevada Adapter (Pacemaker Plug-in) Modules TQA-2 and TQA-3
Output Current: Displayed reading (in mA) is an averaged valué of samples taken every
50 microseconds across the entire rectilinear peak instead of a single máximum
peak current valué. Approximately 800 readings are averaged during this
40~millisecond time period.
Refractory Period: Pulsed-refractory period measurement is referenced from the trailing edge of the
pacemaker pulse instead of the inicial rising edge.
Medical Data Electrónica Model E300

DNI Nevada Adapter (Pacemaker Plug-in) Module TQA-6
Output Current: Displayed reading (in mA) is the peak amplitude measurement of the trailing
edge of the pacemaker pulse to the 2ero baseline instead of the máximum peak
current valué.
See the Adapter (Pacemaker Plug-In) Modules’ listing in Chapter 1, echona/y4ccessories section, for
specific información regarding the DNI Nevada Adapter Module model numbers and pare numbers for
each specific manufacturéis model.
NOTE: Refer to the current DNI Nevada Pnce List for the complete listing of available Adapter (Pacemaker Plug-in)
Modules.
Connecting the Pacemaker to the Impulse 4000
WAfíNING! Never touch the pacemaker connectíons when the pacemaker is tumed on. The
pacemaker must be turned off prior to changing any connectíons because the
pacemaker generales a potentially dangerous voltage that can be lethal if
improperiy handled.
Electrode adapters or an adapter (pacemaker plug-in) module (see above) can be used to connect the
pacemaker to the Impulse 4000. It is preferable to use an adapter module because it is compatible with
the pacemaker manufacturéis specifications.
CONSIDERAT1ONS - Connecting the Defibrillator to the Impulse 4000.
2. If you are using an adapter module, tum off the Impulse 4000 and plug the adapter module into
the “ADAPTER MODULE” receptacle on the left side of this instrument. Connect the adapter
•viví
NOTE: Readings will be idéntica 1 if the connectíons are accidently reversed. If you want to reverse the
polarity of the rea Mime output, reverse the connection.
Conducting the Manual Pacemaker Test
CAUTION: Do not discharge a defibrillator into the pacemaker adapter module ínputs! Thís may
result in damage to both the Impulse 4000 and the adapter module,
If this occurs, over-voltage protection circuitry in the Impulse 4000 displays an error
message, and the adapter module produces an audible “beep”. To reset the
Impulse 4000, turn it off, disconnect the defibrillator leads, and then turn ít on.
Measuring Pulse Parameters

1. Connect the pacemaker to the Impulse 4000 as explained in the preceding section.
2. Press <F2> “PACER” from the MAIN MENU PAGE 1.
3. If a primer is attached to the Impulse 4000, press <F5> to print a manual defibrillator test header.
Press <F4> to send the header to (he serial port. If no header is desired, press <F1> to continué.
4. Press <F1> "INT50 íl” to select the ínternal 50-0 resistance, or press <F2> “EXT” to select an
extemal adapter module.
5. When <F2> “EXT” is selected, the ñame of the connected module is displayed. For modules with
múltiple ioads, select the desired load.
6. Press <F1> “PULSE”. Turn on the pacemaker and set the desired pacing rate and amplitude. Start
sending pulses. The Impulse 4000 displays the following información:
PACER PULSE: Internal 50Q

Amp = 103.2 mA Pulse rate = 105 PPM
Pwd = 18.7 mS --- n---- n---- n_ --n----n-
HOLD TEST
<F1> <F2> <F3> <F4> <F5>
where:
Amp = Amplitude in milliamperes (mA).
Pwd ~ Pulse width in milliseconds (ms).
Pulse rate - Pulse rate in pulses per minute (PPM).
—n—n- - Visual representaron of the pulse rate (not calibrated), where ‘TT is the pulse.
7. Incoming pulses are measured, the data is updated, and then the parameters are displayed. To
print the test data or send it to the serial port, press <F1> “HOLD.” This freezes the test data.
Select <F4> “SERIAL” or <F5> “PRINT”.
8. To release the hold and continué measuring incoming pulses, press <F1> “REL” (release).
3-13
S
l
v) Cbapter 3 - Operating Instructions
í'
£
Self-Test Feature
Press <F5> “TEST” to input a test pulse at approximately 100 mA.
Viewing Real-Time Waveform Output

The pacemaker pulse waveforms can be viewed on an oscilloscope using this real-time output in a
manner similar to viewing the defibrillator discharge pulse. The ratio of displayed voltage to actual
pacemaker output current is as foilows:
Pacemaker Voltage Pacemaker Current
£
<• (displayed) (actual)
><’
1V 40 mA
To view waveform output in real time:

1. Connect a BNC cable from the real-time output on the left side of the Impulse 4000 to the
oscilloscope. A sample printout is shown below:
í?
Waéüring tte Fíétfácfóry Péríods ’' ’ - ' ’: ‘' ” ’' '' ’” '' '’'’"
Complete the following steps:
1. Connect the pacemaker output leads to the Impulse 4000 internal 50-41 input using the optional
electrode adapters or to the adapter (pacemaker plug-in) module if it is plugged into the left side
of the Impulse 4000.
NOTE 1: Refer to an eariier section in ibis chapter Connectíng the Pacemaker to the Impulse 4000 for more
información.
NOTE 2: To simplify the dírect connection of the pacemaker output ieads to the Impulse 4000, refer to the current
DNI Nevada Pnce List for availabilíty of optional electrode adapters and modules that are desígned for specific
manufacturéis’ models.
2. Connect the pacemaker’s ECG cable to the Impulse 4000 top panel color-coded ECG binding
posts.
3. On the pacemaker, select the pacemaker pulse rate and output level to be tested.
4. Press <F2> “PACER” from the MAIN MENU PAGE 1 on the Impulse 4000.
5. If a parallel printer is attached to the Impulse 4000, press <F5> to print a test form header. Press
<F4> to send the test form header to the serial port. If no test form header is desired, press <F1>
to continué.
6. Press <F1> TNT50 íl" to select the intemal 50-41 top panel test load, or press <F2> 'EXT’ to
select an adapter (pacemaker plug-in) module. If an adapter module is selected, it will be
identified on the top iine of the display. Some adapter modules have múltiple test loads; if this
is the case, select the desired valué,
7. Press <F2> “RFRCTRY” to show the ¿nitial refractory test display:
PACER REFRACTORY: Internal 50 Q

set pacer to demand mode,
30..200 PPM, push START when ready
START
<F1> <F2> <F3> <F4> <F5>
8. Place the pacemaker in the "DEMAND” mode of operation and actívate the output.
9- When ready, press the Impulse 4000’s <F1> “START” key.

The Impulse 4000 calcúlales the rate of the applied pacemaker pulse and then outputs the 1.0-mV
(Lead II) havertriangle waveform to conduct the PRP and the SRP measurements. If no pacemaker
pulses are sensed, the Impulse 4000 halts the test and then shows <F1> “START’ on the display. If
this occurs, check all connections and controls as listed above and press <F1> “START’ to restart
■the test.
3-75
When the measureipepts, ar.e comple te,, the Impulse 4000 displays the follmfcring informaron ■;
PACER REFRACTORY: Internal 50 Q

PRP = 297 mS
SRP = 282 mS
SERIAL PRINT
<F1> <F2> <F3> <F4> <F5>
The measurement can take up to 60 seconds to complete.
10. If a parallel printer is attached to the Impulse 4000, press <F5> to print a test form header. Press
<F4> to send the test form header to the serial port. Press <ESC> once to retum to “START".
3-16
Conducting a Demand Mode Test

Complete the following steps:
1. Connect the pacemaker output leads to the Impulse 4000 internal 50~Q input using the optional
electrode adapters or to the adapter module if it is plugged into the left side oí the Impulse 4000
NOTE li Refer to an earlíer sección in this chapter Connecting the Pacemaker to the Impulse 4000 for more
information.
NOTE 2-, To símplify the direci connectíon of the pacemaker output leads to the Impulse 4000, refer to the
curren! DNI Nevada Pnce List for availabilíty of optional electrode adapters and modules that are designed
for specific manufacturéis’ models.
2. Connect the pacemaker’s ECG cable to the Impulse 4000’s color-coded ECG binding posts
located on the top panel.
3. On the pacemaker, select the pacemaker pulse rate and output level to be tested.
4. Press <F2> “PACER” from the MAIN MENU PAGE 1 on the Impulse 4000.
5. If a parallel primer is attached to the Impulse 4000, press <F5> to print a test form header. Press
<F4> to send the test form header to the serial port. If no test form header is desired, press <F1>
to continué.
6. Press <F1> "INT50 íl” to select the internal 50-Q top panel test load, or press <F2> “EXT” to
select an adapter (pacemaker plug-in) module. If an adapter module is selected, it will be
identified on the top line of the display. Some adapter modules have múltiple test loads; if this
is the case, select the desired valué.
7. Press <F3> “DEMAND” to show the initial demand mode test display:
PACER DEMAND: Internal 50 Q

set pacer to demand mode,
30..200 PPM, push START when ready
START
<F1> <F2> <F3> <F4> <F5>
8. Place the pacemaker in the “DEMAND” mode of operation and actívate output.
9. ^ When .ready,, piess. the. Impulse .4000’$ <F1> - "START” tey: ” .. ....... ! '1 ’ ■
The Impulse 4000 calculates the rate of the applied pacemaker pulse and then computes an
underdrive ECG rate equal to 80 percent of the pacemaker rate. A 1.0-mV (Lead II) havertriangie
waveform is output at this underdrive rate. Observe the tracing on the ECG monitor. Ensure that
the havertriangie waveform is sensed by the pacemaker and that the selected pacemaker pulse
train is not interrupted by this lower underdrive ECG rate. The demand mode display now
shows-.
PACER DEMAND: Internal 50 Q

Under =60 BPM Testing for pulse...
Over = 90 BPM --- n----n---- n---- n---- n_
UNDER OVER UP DOWN HOLD
<F1> <F2> <F3> <F4> <F5>
NOTE: You may ha ve to adjust the amplitude and lead settings on the ECG monitor co be able to properly
view the signal.
If no pacemaker pulses are sensed, the Impulse 4000 halts the test and then shows <F1> “START”
on the display. If this occurs, check all connections and controls as listed above. Press
<F1> “START” to restan the test.
10. Press <F2> to output the overdrive ECG, which is equal to 120 percent of the applied pacemaker
pulse. The 1.0-mV (Lead II) havertriangie waveform is now output at this higher overdrive rate.
Observe the tracing on the ECG monitor and ensure that the havertriangie waveform is sensed
by the pacemaker. Also, verify that the selected pacemaker pulse is inhibited by this higher
overdrive ECG rate.
NOTE: Make sure that the pacemaker is in che “DEMAND" mode of operation.
11. Both the underdrive and overdrive ECG rates can be adjusted in 1-BPM steps using the
<F3> “UP” and the <F4> “DOWN" keys.
12. If you desire to print the measured pacemaker rate, the underdrive valué, and the overdrive
valué, press <F5> “HOLD”
13. Press <F5> to output valúes to the parallel printer. Press <F4> to send the valúes to the serial
port.
14. Press <F1> “REL” to release the held display, or press <ESC> once to return to “START’.
3-73
GENERATING ECG WAVEFORMS
The Impulse 4000 generales a wide range of ECG waveforms for testing che cardiac vigilance capabilities
of defibrillators and externa! transcutaneous pacemaker systems that incorpórate monitoríng, recording,
and diagnostic features.
The ECG waveform signa! is available on the
• ten ECG lead-binding posts (Impulse 4000 top panel),
• through-the-paddles pickup (Impulse 4000 top panel),
• high-level ECG output (Impulse 4000 rearpanel), and
• manikin connection (Impulse 4000 rear panel).
Selecting the ECG Waveform

To generate the ECG waveform:
1. Press <F3> “ECG” from the MAIN MENU PAGE 1.
2. Select the ECG wave group:
• <F1> “NORM” Normal Sinus Rhythm
• <F2> “SVARR” Supraventricular Arrhythmias
• <F3> “VENT1" Ventricular Arrhythmias - Series 1
• <F4> “VENT2" Ventrícuiar Arrhythmias - Series 2
• <F5> “PACED” Transvenous Paced Group
As an example, select the <F1> “NORM” ECG wave group, and the Impulse 4000 displays:
NORMAL SINUS GROUP:

select wave:
30 60 80 120 160>
<F1> <F2> <F3> <F4> <F5>
4. Press the “SELECT” right pointing arrow to view the next page of the display:
NORMAL SINUS GROUP:

select wave:
<200 240........ 300 ,;;; i Mí i ♦ *
<F1> <F2> <F3> <F4> <F5>
3-19
5,, , Use thje ECG. Wavefom Parameters Tablethat-foHow in this section to hetp yon seléct a wávéfórmí
6 For example, select 200 BPM and the following displays:
NORMAL SINUS GROUP:

select wave:
Normal Sinus beats at 200 BPM
<200 240 300
<F1> <F2> <F3>
Transvenous Paced Feature

The ECG wave group <F5> “PACED” Transvenous Paced Group provides waveforms that are seen on a
heart monitor when the patient has an impianted pacemaker.
1. To begin, press <F3> “ECG” from the MAIN MENU FAGE 1, then select <F5> “PACED”. Menú
selections of <F1> “WAVE”, <F2> “ATRIAL”. and <F3> “VENT are displayed.
2. Press <F1> “WAVE” to view the possible paced ECG waveforms. Refer to the ECG Waveform
Parameters Table that follows in this section for a description of the PACED wave group.
3. As an exampie, select <F2> “ASNC” (asynchronous pacemaker). Press <ESC> and the
TRANSVENOUS PACED menú returns with “ASNC” ready to have its pacemaker parameters set.
The pacemaker parameters default to 100-mV amplitude and 1.0-ms width when the ¿nstrument is tumed on.
You can change the parameters and they remain changed until the instrument is tumed off. All waveforms
use the ventricular pacemaker parameters, and the AVSQ (acrioventricular sequential) waveform also uses the
atrial pacemaker parameters. To set the pacemaker parameters, select <F2> “ATRIAL” or <F3> “VENT.
1. For example, complete steps 1 through 3 above, then select <F3> “VENT” to set up the
ventricular pacemaker parameters for “ASNC”. The following is displayed:
TRANSVENOUS PACED: ASNC Vent

amp = 100 mV width = 1.0 mS
AMP WIDTH DOWN UP AUTO
<F1> <F2> <F3> <F4> <F5>
where:
ASNC • The selected waveform (NSR 80 is the default).
amp « Amplitude in millivolts (100 mV is the default; see specifications for list of valúes),
width « Pulse width in milliseconds (1.0 ms is the default; see specifications for list of valúes).
2. Select <F1> “AMP" and adjust the amplitude using <F3> “DOWN” and <F4> "UP”.
3- Select <F2> “WIDTH” and adjust the pulse width using <F3> “DOWN” and <F4> “UP”.
4, Press <F5>. “AUTO” toiniúatgí# íhé ampfímde iot wí'dth* '
fieids. This function steadily changes the selected parameter every 5 seconds. It is possible to test
the monitor over a wide range of waveform amplitudes and widths using this function.
3-20
EüG Waveform Parameters Pable
Waveform Wave Group Description Rate

CKey)
Normal Sinus NORM Normal heart beats. 30 BPM
Rhythm (NSR) 60 BPM
80 BPM
120 BPM
160 BPM
200 BPM
240 BPM
300 BPM
Atrial SVARR Rapid, irregular atrial signal with no real P waves. N/A
Fibrillation (AFIB1) Irregular ventricular rate. Select COARSE (AFIBl)
(AFIB) (AFIB2) or FINE (AFIB2).
Atrial Flutter SVARR Large regular P waves. Ventricular response at Irregular

(AFLUT) 5:1 for 12 seconds, 13:1 for 6 seconds, 2:1 for
6 seconds, repeating.
Sinus SVARR Normal beats but triggered at irregular rate. From 60 to

Arrhythmia (SINAR) 100 BPM
1° AV Block SVARR First-degree atrioventricular block. Normal beats 80 BPM

(1AVB) except with long PR interval of 0.25 seconds.
2o AV Block SVARR Second-degree atrioventricular block, type I, 80 BPM

Type I (2AVBI) Wenckebach. Increasing FR interval from 0.22 to
0.47 seconds followed by a P wave only with no
QRS response, repeated. P waves at normal 80 BPM.
2o AV Block SVARR Second-degree atrioventricular block, type II. 80 BPM

Type II (2AVBII) Waveform similar to right bundle branch block
except PR interval is 0.25 seconds. Eighteen
beats followed by two missed beats, repeated.
3o AV Block SVARR Third-degree atrioventricular block. Normal 80 BPM

(3AVB) waveforms except with a P-wave rate of 80 BPM (P wave)
and a QRS rate of 30 BPM running
30 BPM
independently of each other.
(QRS rate)
Premature VENT1 Normal rhythm except every tenth beat is a PVC.

Ventricular (PVC1) Left focus with marked left axis deviation and
Contraction concordant positivity in the V leads.
(PVC) Type 1
NOTE; Normal heart rate amplitude = 1 mV
3-21
ECG Waveform Parameters TablePcpntin^d)......................
Waveform i W'ave Group Description Rate

(Key)
PVC Type 2 VENT1 Normal rhythm except every tenth beat is a PVC.
(PVC2) Right íocus with left axis deviation and
con corda nt negativity in the V leads.
Mulüfocal VENTl Normal rhythm except 2 of every 15 beats are

PVCs (MF) PVCs. PVC type alternates between type 1 and
type 2.
Couplet oí VENTl Two PVCs together in a series with 14 normal

PVCs (COUP) beats, repeated. Also called pair.
Bigeminy VENTl Normal beat followed by a PVC, repeated.

(BIGEM)
Trigeminy VENT1 Two normal beats followed by a PVC, repeated.

(TRIGEM)
Run of 5 VENTl Five ¡eft-focus PVCs together in a series with

PVCs (RUN5) eight normal beats, repeating continuously.
Run of 11 VENTl Ten left-focus PVCs followed by one right-focus

PVCs (RUN 11) PVC together in a series with eight normal beats,
repeating continuously.
Ventricular VENT2 Similar to left-focus PVCs at 120 BPM 120 BPM
Rhythm 120 (VENT)
Ventricular VENT2 Similar to left-focus PVCs at increased heart rates.

Tachycardia (VT130) 130 BPM
(VT175) 175 BPM
(VT180) 180 BPM
(VT185) 185 BPM
(VT220) 220 BPM
Ventricular VENT2 Irregular ventricular waveform.

Fibrillation (VFIB1) Coarse.
(VFIB2) Fine,
Asystole VENT2
(ASYS1) Irregular baseline.
(ASYS2) No beats (fíat line).

¿vivivi’í'i’iv i; i;
y,; ........ .................. ........... ............... [
NOTE: Normal heart rate amplitude = 1 mV
•?.
?•
?
ECG Waveform Parameters Table (continued)
£ Waveform Wave Group Description Rate

í (Key)
X Transvenous PACED Pacemaker waveforms. The AV sequential
Paced waveform uses both pacers. Al! others use the
X ventricular pacer which triggers a wide QRST
similar to LBBB since the ventricular pacer is in
1 the right ventricle. The pacemaker rate is 75 BPM.
'»■ (NSR) Normal Sinus Rhythm. 80 BPM

(ASNC) Asynchronous at 75 BPM continuousiy paced. 75 BPM
(DEM1) Series of 40 paced beats and 20 normal beats. Pacer
starts when normal beat is 20% late and stops when
normal beat synchronizes to 80 BPM.
£
(DEM2) Series of 20 paced beats and 40 normal beats. Pacer
starts when normal beat is 20% late and stops when
f. normal beat synchronizes to 80 BPM.
i (AVSQ) Atrioventricular sequential with dual pacer spikes.

í The first (atrial) spike triggers the P wave and the
f.
second (ventricular) spike triggers QRST; 0.15
seconds apart.
P:
£
(NONC) Asynchronous paced, except every tenth beat has
V no QRST response.
?•:
(NONF) Nonfunction. Pacer spikes only. No QRST
response.
í
1
X
$
• W» *"»■ »V>V vvv«
NOTE: Normal heart rale amplitude « 1 mV
3-23
GENERATING ECG PERFORMANCE WAVEFORMS
Use chis menú option to perform gain, damping, frequency response, and linearity tests on the ECG
sección of the defibrillator and external transcutaneous pacemaker. Use the manual mode to output a
single waveform, or use the automated mode to sequence a series of waveforms.
Manual Performance Mode

To output a single waveform:
1. Select <F4> “PERF” from the MAIN MENU PAGE 1.
2. Press <F1> “WAVES".
3. Press <F1> “MANUAL”.
NOTE: After you press <F1> “MANUAL”, the message “Zero output" displays. When you select a waveform
(as in the next step), its descripción displays.
4. Select the desired waveform:
• <F1> SQUARE
• <F2> PULSE
• <F3> SINE*
• <F4> TRIANGLE
• <F5> ECG*
NOTE 1. Refer to the ECG Performance Waveform Parameters Table that follows in this section for details
about the waveforms.
•NOTE 2. When you select <F3> “SINE" and <F5> “ECG”, function keyíí <F4> “DOWN" and <F5> “UP"
become available. Use these keys to manual!y step through the selections.
Automated Performance Sequence Mode

Use this option to output an automated series of ECG waveforms.
2. Press <F1> “WAVES”.
3- Select <F2> “AUTO”, then press <F5> “ADV” to begin.
NOTE: The Impulse 4000 outputs waveforms as listed in the ECG Performance Waveform Parameters Table
that follows in this section.
Reference Lead
Use this option to select the lead that is to be referenced at 1 mV. Your selección can be Lead I or Lead II
and it is stored permanently in EEPROM nonvolatile memory. This selección is only available for
ECG performance waveforms as descríbed in this section. The factory default selección is Lead II.
When Lead 1 is referenced at 1.0 mV, When Lead II is referenced at 1.0 mV,
Lead II ís 1.5 mV Lead 1 is 0.7 mV
Lead III is 0.5 mV Lead III is 0.3 mV
V leads are 1.0 mV V leads are 1.0 mV

2. Press <F1> “WAVES”.
4. Press <F5> “STORE”. Press <ESC> once to return to the “WAVES” menú and twice to return to
the “PERF” menú.
3-24
Chapter 3 - Operatíng Instructions
ECG Performance Waveform Parameters Table
Waveform Wave Group Manual Performance Mode Automated Performance

<Key> Amplitude refers to (he reference lead sígnal Sequence Mode
Square SQUARE 2 Hz, 1-mV amplitude. Outputs continuously; press
<F1> <F5> “ADV” to advance.
Pulse PULSE 4 s, 1-mV amplitude. Outputs once for 4 seconds and

<F2> then automatically advances.
Sine SINE The following are available, all at 1-mV Outputs the following sine
<F3> amplitude: 0.05, 0.5, 1, 10, 25, 30, 40, waves, all at 1-mV amplitude,
50, 60, 100, 125, and 150 Hz; and 1 kHz. for 2 seconds each: 1,10, 30,
(NOTE: 1 kHz ís a square wave.) 40, 50, 60, and 100 Hz; and
1 kHz; then automatically
advances.
Triangle TRIANGLE 2 Hz, 1-mV amplitude. Outputs continuously; press

<F4> <F5> “ADV” to advance.
ECG ECG The following are available, all at 1-mV First, a 60-BPM waveform is
(normal <F5> amplitude: 30, 60, 120, and 240 BPM. output at 1-mV amplitude.
sinus This is output continuously
rhythms) to allow the monitor to settle
down.
To continué, press <F5>
“ADV”.
Next, the following waveforms
are output for 20 seconds
each in the sequence
shown: 30, 60, 120, 240, and
60 BPM.
End of the automated

performance sequence;
returns to PERFORMANCE
WAVE menú. Press <F2>
“AUTO” to begin this
sequence again.
NOTE: Press <F5> “(ADV)” to

skip segments of this sequence
if necessary.
R-Wave Detector Testing

The Impulsé 4ÓÓO generales án R wave that is used to determine the threshold of the ECG device. The
R-wave waveform can be precisely adjusted in both amplitude and width to simúlate the range of the
normal sinus rhythm R-wave complex. R-wave amplitude refers to the Lead H signal.
Complete the followíng steps to generare an R wave:
1. Connect the ECG leads to the Impulse 4000.
2. Select <F4> “PERF" from the MAIN MENU PAGE 1.
3. Press <F2> “RDETECT”.
4. Press <F1> “AMP” or <F2> “WIDTH”. For settings, refer to the table below. Press <ESC> to
change between the amplitude and width parameter settings.
5. Press <F3> “AUTO” and the Impulse 4000 will automatically change the valúes of the amplitude
or width at 6-second intervals.
R~ Wave Detector Tests

R-Wave Amplitude 0.05 to 0 50 mV in 0.05-mV steps
0.50 to 5.50 mV in 0.25-mV steps
Menú Entry Default: +2.0 mV
R—Wave Width 8 and 12 ms

20 to 200 ms in 20-ms steps
Menú Entry Default: 40 ms
Auto-Step Time Interval 6 s
3-26
AUTOSEQUENCE TEST
The Impulse 4000 can store up to 50 autosequences with device-specific inspection protocols. These
autosequences can indude a wide range of defibrillator, pacemaker, and ECG tests. The first 26
autosequences are factory-initialized for selected devíce manufacturéis’ models. The first 18 of these
selections compuse defíbrillator-only devíces, the next 8 compase combination defibrillator/pacemaker
devices, and the remaining 24 are exclusive ly reserved for your own customized protocols. If desired,
you can program any of the 50 autosequences with your own customized protocols. However, the first
26 autosequences reven to the factory default valúes whenever the instrument is reinilialized and the
rest of the autosequences are erased.
Each autosequence is identified by an alphanumeric entry (máximum of six digits). In many cases, a
similar designation is used for several autosequences. To help you identify the correct autosequence for
the equipment under test, all the factory-initiaBzed autosequences with pacemaker tests contaín the
suffix *'P” or MPM". The “P” suffix ís reserved for pacemaker tests using the intemal 5O-Í2 test load. The
“PM” suffix is reserved for pacemaker tests using a specific adaptar (pacemaker plug-in) module.
For example,
• “LP10” is for the Physio-Control Model LIFEPAK 10© defibrillator tests only.
• “LP10P” adds a series of pacemaker tests using the intemal 50-0 test load.
• “LP10PM” upgrades the pacemaker tests with the factory-specified 700-0 test load provided
by the DNI Nevada Adapter Module TQA-9.
Running Autosequences
To run an autosequence:
1. Refer to the Factory-Initialized Autosequence Tables that follow in this section to determine the
correct autosequence to run for the equipment under test. Use the defibrillator paddle contacts,
disposable defibrillator/pacemaker electrode adapters, and/or the listed adapter module to
conduct these tests. If desired, connect a printer/seriai device to the Impulse 4000 for a hard copy
record of the autosequence.
2. Select <F5> “AUTO” from the Impulse 4000’s MAIN MENU PAGE 1.
3- Use the <right arrow> and <left arrow> “SELECT” keys to scroll through and lócate the
autosequence.
4. To begin, press the function key (<F1> through <F5>) beneath the desired autosequence.
5. Follow the displayed operating instructions to conduct the various test steps.
NOTE 1: If any of the preprogrammed test limits are exceeded, you are prompted to either rerun that
particular test step or continué with the autosequence. If you rerun the test and the test result is with i n
limits, the Impulse 4000 stores the new test result. When you view or output the autosequence test record,
a pound sign (#) marks the failed test steps.
NOTE 2: The Impulse 4000 does not retain the autosequence test record if you either press the <ESC> key
or turn-ít cff. ■ ■ .......................................................................................................................................................................
................ ......................... “ ♦ ♦ ♦........
»»-*♦K
3-27
To run an autosequence {continuad)-.
6. After you’ve conducted all (he test steps, you can access the test record as follows:
a. View the autosequence test record. Press <F1> “VIEW” to view the result of each test step.
Press <F5> “ADV" to advance through the steps.
b. Print the autosequence test record. Press <F5> “PRINT" to send the autosequence test
record to a parallel primer.
c. Send the autosequence test record to a serial device. Press <F4> “SERIAL” to send the
autosequence test record to a serial device.
NOTE : When you view or output the autosequence test record, a pound sign (#) marks the failed test steps.
7. Refer to the sample printouts that follow for information about the autosequence "HPXLPM”.
These printouts were generated by inspecting the Hewlett Packard Codemaster XL+
defibrillator/pacemaker wíth the Impulse 4000 using DN1 Nevada Adapter Module TQA-12.
3-28
Sample Printouts for the Hewlett Packard Model Codemaster XL+ Defibrillator
Autosequence: "HPXLPM” Defibrillator/Pacemaker
Adapter Module: Model TQA-12
Program Sequence Printout

DATE; 03/13/' 95 TIME: 02:24:43
SEQUENCE: HPXLPM TYPE: DEFIB/PACER
ENERGY LEVEL TESTS
1. 2J
2. 3J
3. 5J
4. 7J
5. 10 J Test. lesults Printout
6. 20 J IMPULSE 4000 DNI NEVADA
7. 30 J DATE: 03/13/95 TIME: 02:23:57
8. 50 J
9. 70 J SEQUENCE: HPXLPM TYPE DEFIB/PACER
10. 100 J OP CODE: MCB CN:CN00D5
11. 150 J
MANFzHP MODEL: Codemaster XL+
12 . 200 ¿T
13 . 300 J SERIAL #A123456 LOC:CCU
14. 360 J ENERGY LEVEL TESTS (+15/-15* or ±O.7J)
+LIMIT (%) 15
SET LEVEL ENERGY
-LIMIT (%) 15
(J) (J)
VE IB? NO 2 2.1
3.1
MAX ENERGY? YES 5 5.3
MAX LEVEL 7 7.1
360 J
MAX +LIMIT 385 J 10 10.3
MAX -LIMIT 335 J 20 20.8
30 30.8
CARDIO? YES 50 51.1
ENERGY LEVEL TESTS 70 70.1
100 J 100 100.0
1.
2. 100 J 150 150.7
3. 100 J 200 201.8
+LIMIT (%) 15 300 302.0
-LIMIT (%) 15 360 362.6
MAX ENERGY 359.2 J (385/335)
PERF WAVES? YES TIME TO CHARGE: 3 Seconds
CARDIOVERSION TESTS (+15/-15% or +0.7J)
SET LEVEL ENERGY DELAY
(J) (J) (mS)
100 103.9 23
100 104.8 23
100 105.0 22
COMMENTS:
NEXT TEST DUE DATE:
3-29
.......................... ... ..................................... ............•. 7 i-
Sample Printouts for the Hewlett Packard Modet Codemaster XL+ Pacemaker
Autosequence: "HPXLPM” Defíbríllator/Pacemaker
Adapter Module; Model TQA-12
Program Sequence Priniout

DATE: 03/13/95 TIME: 02:24:44
SEQUENCE: HPXLPM TYPE: DEFIB/PACER
PACER MODULE: TQA-12 HP
PULSE MODE TESTS
1. 400OHMS 40 PPM 30mA
2. 400OHMS 50PPM 30mA Test. tesults Priniout
3. 400OHMS 60PPM 30mA IMPULSE 4000 DNI NEVADA
4. 400OHMS 70 PPM 30mA DATE: 03/13/95 TIME: 02 :23:59
5. 400OHMS 80PPM 30mA
6. 90PPM 30mA SEQUENCE: HPXLPM TYPE. DEFIB/PACER
400OHMS
7. 400OHMS 100PPM 30mA OP CODEiMCB CK:CNO0O5
MANF :HP MODEL: Codemaster XL+
10. 400OHMS 130PPM 30mA SERIAL #A123456 LOC: CCU
11. 400OHMS 140PPM 30mA PACER MODULE: TQA-12 HP
12 . 400OHMS 150PPM 30mA PULSE MODE TESTS (RATE ±5%)
13 . 400OHMS 160PPM 30mA (AMPLITUDE ±10% OR ±5mA)
14 . 400OHMS 170PPM 30mA
30rnA LOAD SET LEVEL RATE SET LEVEL AMP
15. 4QOOHMS 180PPM
(OHMS) (PPM) (PPM) (mA) (xrA)
16. 4000HMS 80PPM 60mA
17 . 400 40 40 30 29.6
4000HMS 80PPM lOOmA
400 50 50 30 29.6
18. 4000HMS 80PPM 140mA
180mA 400 60 60 30 29.6
19. 400OHMS 80 PPM
400 70 70 30 29.6
20. 400OHMS 80 PPM 200mA
400 80 80 30 29.6
+-LIMITS (%) 5 10
400 90 91 30 29.6
400 100 100 30 29.6
ASNC MODE? YES
400 110 111 30 29.6
ASNC MODE TEST
20% 400 120 121 30 29.6
1. 400OHMS 80 PPM
DEMAND MODE? YES 400 130 132 30 29.6
DEMAND MODE TESTS 400 140 141 30 29.6
400 150 152 30 29.6
1. 400OHMS 80PPM
400 160 162 30 29.6
OVERDRIVE (%) 20
400 170 170 30 29.6
UNDERDRIVE {%) 20
400 180 181 30 29.6
400 80 80 60 59.5
REFRACTORY? NO
400 80 80 100 99.8
400 80 80 140 140.1
400 80 80 180 181.0
400 80 80 200 202.1
ASNC TESTPASSED (80PPM/96PPM)
DEMAND MODE TESTS (20/20%)
LOAD SET LEVEL RESULT
{OHMS) (PPM)
400 80 PASSED
CCMMENTS:
NEXT TEST DUE DATE:
3-30
i-i';”'
Tbis page intentionally blank.

Factory-Initialized Autosequence Table - Defibrillator
LF4 Physio-Control 10, 25, 50, 100, 200, 15 15 N 450 480 418 100, 100, 100 10 10 Y
LIFEPAK 4 300, 400, 450
LP5 Physio-Control 20, 50, 100, 200. 300, 15 15 N 360 396 324 100, 100, 100 10 10 Y
LIFEPAK 5 360
LPó Physio-Control 5, 10, 20, 30, 50, 100, 15 15 N 400 428 372 100, 100, 100 10 10 Y
LIFEPAK 6 200, 300, 400
LP6S Physio-Control 5, 10, 20, 30, 50, 100, 15 15 N 360 385 335 100, 100, 100 10 10 Y
LIFEPAK 6S 150, 200, 300, 360
LP7 Physio-Control 5, 10, 20, 30, 50, 100, 15 15 N 360 385 335 100, 100, 100 10 10 Y
LIFEPAK 7 200, 300, 360
LP8 Physio-Control 2, 5, 9. 10, 20, 30, 50, 15 15 N 360 385 335 100, 100, 100 10 10 Y
LIFEPAK 8 100, 150, 200, 300, 360
M/D3 Datascope M/D3 5, 10, 20, 35, 50, 75, 15 15 N 400 440 360 100, 100, 100 10 10 Y
100, 150, 200, 300, 400
HP660 Hewiett Packard 5, 10, 20, 40, 60, 100, 15 15 N 360 400 330 100, 100, 100 10 10 Y
78660A 150, 200, 250, 300, 360
NK7K Nihon Kohden 3, 5, 10, 20, 30, 50, 70, 15 15 N 360 396 324 100, 100, 100 10 10 Y
7000 100, 150, 200, 300, 360
HS2K Laerdal 200, 200, 360, 200, 200, 15 15 Y 0 0 0 0, 0, 0 10 10 N

Heart Start 2000 360
AOIOXVN American Optica! 5, 10, 20, 30, 40, 50, 15 15 N 360 414 306 100, 100, 100 10 10 Y
100, 150, 200, 300, 360
M/D4 Datascope M/D4 1, 8, 40, 80, 160, 240, 320 15 15 N 320 384 256 100, 100, 100 10 10 Y
M/D2 Datascope M/D2 8, 20, 30, 40, 50, 100, 15 15 N 400 480 320 100, 100, 100 10 10 Y
200, 300, 400
M/D2J Datascope M/D2J 5, 10; 20, 40, 75, 100, 15 15 N 460 506 404 100, 100, 100 10 10 Y
200, 300, 400, 460
HP670 Hewiett Packard 5, 10, 20, 30, 50, 70, 15 15 N 360 414 306 100, 100, 100 10 10 Y
78Ó70A 100, 150, 200, 300, 360
HP431 Hewiett Packard 2, 3, 5, 7, 10, 20, 30, 50, 15 15 N 360 414 306 100, 100, 100 10 10 Y
43100 70, 100, 150, 200, 300,
360
>i"¿ VÍV »"i vivv »"iv »"iv iviv » V» »■»■ V» •» v» ■ »'»"*■ viví ivivvi' i i ík i ».
—
3-32
Factory-lnitialized Autosequence Table - Defibrillator Data for Defibrillator/Pacer
3-34
PaptQryrJnitial^^..ApiQspquence-.- Tapie - PaceKDataÍQr Defibrillator/Pacer ■
LP8P Physío-Control Int 50Q 50Q, 40 PPM,200mA 10 10 5041, 70 PPM 20 50fif 50 PPM 20 20 N
LIFEPAK 8P 50Q, 50 PPM,200mA
50fí, 60 PPM,200mA
500, 70 PPM,200mA
500, 80 PPM,200mA
500, 90 PPM,200mA
LP?P Physío-Control Int 500 500, 60 PPM, 55mA 10 10 5042, 60 PPM 20 50H, 50 PPM 20 20 N
LIFEPAK 9P 500,150 PPM, 55mA
500,170 PPM. 55mA
500,160 PPM, 55mA
500,140 PPM, 55mA
500,130 PPM, 55mA
500,120 PPM, 55mA
500,110 PPM, 55mA
500,100 PPM, 55mA
500, 90 PPM, 55mA
500, 80 PPM, 55mA
500, 70 PPM, 55mA
500, 60 PPM, 55mA
500, 50 PPM, 55mA
500, 40 PPM, 55mA
500, 60 PPM,200mA
500, 60 PPM,150mA
500, 60 PPM,100mA
500, 60 PPM,130mA
LP9PM PhysioControl TQA-9 70041, 60 PPM, 55mA 10 10 10042, 60 PPM 20 700Q, 50 PPM 20 20 N
LIFEPAK 9P 70041,150 PPM, 55mA
Module 70041,170 PPM, 55mA
70041,160 PPM. 55mA
70041,140 PPM, 55mA
70041,130 PPM, 55mA
70041,120 PPM, 55mA
70041,110 PPM, 55mA
70041,100 PPM, 55mA
70041, 90 PPM, 55mA
70041, 80 PPM, 55mA
70041, 70 PPM, 55mA
70041, 60 PPM, 55mA
70041, 50 PPM, 55mA
70041, 40 PPM, 55mA
70041, 60 PPM,200mA
70041, 60 PPM,150mA
70041, 60 PPM.lOOmA
70041, 60 PPM,130mA
.'iví/i' VÍVÍwÍ '»"»V >• * wív
3-35
Factory-Initialized Autosequence Table - Defibrillator Data for Defibrillator/Pacer contínued
Factory-Initialized Autosequence Table - Pacer Data for De fibrillator/Pacer continuad
LPIOP Physio-Control 500, 40 PPM, 40mA

LIFEPAK 10P 500, 50 PPM, 40mA
500, 60 PPM, 40mA
500, 70 PPM, 40mA
500, 80 PPM, 40mA
500, 90 PPM, 40mA
500,100 PPM, 40mA
500,110 ppm, 40mA
500,120 PPM, 40mA
500,130 PPM, 40mA
500,140 PPM, 40mA
500,150 PPM, 40mA
500,160 PPM, 40mA
500,170 PPM, 40mA
500, 80 PPM, 60mA
500, 80 PPM, 80mA
500, 80 PPM, lOOmA
500, 80 PPM,140mA
500, 80 PPM,180mA
500, 80 PPM,200mA
LP10PM Physio-Control 7000, 40 PPM, 4ümA 100Q, 80 PPM 7000, 80 PPM

LIFEPAK 10P 7000, 50 PPM, 40mA
Module 700Q, 60 PPM, 4ümA
700O, 70 PPM, 40mA
700Q, 80 PPM, 40mA
7000, 90 PPM, 40mA
7000,100 PPM, 40mA
7000,110 PPM, 40mA
7000,120 PPM, 40mA
7000,130 PPM, 40mA
7000,140 PPM, 40mA
7000,150 PPM, 40mA
7000,160 PPM, 40mA
7000,170 PPM, 40mA
7000, 80 PPM, 60mA
700Q, 80 PPM, 80mA
700O, 80 PPM,100mA
700Q, 80 PPM,l40mA
700O, 80 PPM,180mA
7000, 80 PPM,200mA
3-37
Chapter 3 ~ Operating Instructions
3-38
^áctory-Initialized Autosequence Tabíe - Pacer Data for Defibrillator/Pacer conttnued
1500PM Marquette TQA-7 3000,40 PPM, 30mA 10 10 3000, 80 PPM 20 3000, 80 PPM 20 20 N
Model 1500 3000,50 PPM, 30mA
Module 3000,60 PPM, 30mA
3000,65 PPM, 30mA
3000,70 PPM, 30mA
3000,75 PPM, 30mA
3000,80 PPM, 30mA
3000,90 PPM, 30mA
3000,100 PPM,30mA
3000,110 PPM,30mA
3000,120 PPM,30tnA
3000,130 PPM,30mA
3000,140 PPM,30mA
3000,150 PPM,30mA
3000,160 PPM,30mA
3000,180 PPM,30mA
3000,80 PPM, 50mA
3000,80 PPM,100mA
3000,80 PPM,l50mA
3000,80 PPM,200mA
HPXLPM Hewlett Packard TQA-12 4000, 40 PPM, 30mA 10 10 400Í1, 80 PPM 20 4000. 80 PPM 20 20 N
Code Master 4000, 50 PPM, 30mA
Series 4000, 60 PPM, 30mA
4000, 70 PPM, 30mA
4000, 80 PPM, 30mA
4000, 90 PPM, 30mA
4000,100 PPM, 30mA
4000,110 PPM, 30mA
4000,120 PPM, 30mA
4000,130 PPM, 30mA
4000,140 PPM, 30mA
4000,150 PPM, 30mA
4000,160 PPM, 30mA
4000,170 PPM, 30mA
4000,180 PPM, 30mA
4000, 80 PPM, 60mA
4000, 80 PPM,100mA
4000, 80 PPM,140mA
4000, 80 PPM,180mA
4000, 80 PPM,200mA
ÍWrtV¡V»W» * » » ’íw» **-'

3-40
EactQr\Îmtialized Aiitoseqiience Table - Pacer Gata for Defibj-ilUitor/P-acer contitnted
MD300M Medica] Data 6000,40 PPM, 60mA

Electronics (MDE) 6000.60 PPM, 60mA
Series 300 Module 6000,70 PPM, óOtnA
6000,75 PPM, 60mA
6000,80 PPM, 60mA
6000,90 PPM, 60mA
6000,100 PPM,60mA
6000,120 PPM,60mA
6000,140 PPM,60mA
6000,160 PPM,60mA
6000,100 PPM,60mA
6000,100 PPM,90mA
6000,100 PPM,120mA
10000.60 PPM,120mA
Programming Custom Autosequences

The CUSTOM option from the MAIN MENU PACE 2 makes it easy to program your own autosequences.
You can change a factory-initialízed autosequence or create a new autosequence for a defibrillator-only,
defibrillator/pacemaker combination, or pacemaker-only model.
Reset changed autosequences to factory default settings using <F3> TNIT”.

NOTE 1: Factory default defibrillator energy limitó changed from 10% to 15% with firmware versión 1.01. If the limitó
on your Impulse 4000 are not 15% and you want them to be 15%, reinitialíze your instrument to factory default
valúes as explained beíow.
1. Select <F2> “CUSTOM” from the MAIN MENU PAGE 2.
2. Press <F3> “INIT”,
3. Press <F1> “YES”.
NOTE 2: Reinitialization affects all 50 autosequences; the first 26 revert to the factory default valúes and the rest
are erased.
View autosequence steps using <F2> “VIEW” and print autosequence steps using <F5> “PRINT”.
You will be prompted for different information depending on whether you are making a defibrillator or
pacemaker autosequence. For combination defibrillator/pacemaker models, the Impulse 4000 prompts
first for defibrillator information, then pacemaker information. Before making an autosequence, it is
suggested that the parameter entries be planned using the Autosequence Test Options Tatole that follows
in this chapter.
To make a custom autosequence:
1. Select <F2> "CUSTOM” from the MAIN MENU PAGE 2.
2. Press <F1> “MAKE” to begin making the autosequence.
3 Select the autosequence to make using the <left arrow> and <right arrow> "SELECT” keys.
NOTE: Blank autosequences begin at AS#27.
4. The Impulse 4000 prompts for the autosequence ñame. Assign the autosequence a ñame up to
six characters.
a. Use the <F3> “DOWN” and <F4> “UP” keys to change the character displayed. Letters are
followed by symbols, then numeráis.
b. Use the <left arrow> and <right arrow> “SELECT” keys to move left and right in the ñame.
c. When fínished, press <F5> “ENTER”.
5. Select the type of instrument this autosequence is for
Defibrillator-Only<F1> “DEFIB"
Defibrillator/Pacemaker Combination<F2> “DFB/PCR”
Pacemaker<F3> “PACER”
Making Defibrillator Autosequences

1. Complete steps 1 through 4 in the previous section Programming Custom Autosequences, and
select <F1> “DEFIB”.
2. Energy Level Tests. Select up to 20 sepárate energy levels to test in sequence: “Step 1”, “Step T,
“Step 3”, and so on.
a. For each step, set the energy level from 1 to 500 J. Use the <F4> "UP” and <F3> “DOWN*
keys to increase and decrease the energy level (press continuously to advance rapidly).
b. To move to the next step, press <F2> “NEXT", or press <F1> “PREV” to retum to a previous step.
c. When you have programmed all energy levels to test, press <F5> “END”.
d. Next, select the upper (+) and lower (-) level limits as a percentage- for example, +10%,
-10%. This programs the Impulse 4000 to flag any output that is outside these limits.
e. Use <F2> “-LIM” to select a lower limit and <F1> “+LIM” to select an upper limit. Both limit
ranges are 0% to 99%.
f. Use the <F4> “UP” and <F3> “DOWN” keys to increase and decrease the energy level limits.
g. When you are done setting both upper and lower limits, press <F5> “ENTER”.
3. V-FIB for Energy Tests. Press <F1> “YES” to have a ventricular fibrillation ECG waveform output
for energy level tests and máximum energy tests. Or press <F2> “NO” to output the previous
pulse playback waveform.
4. Max Energy Test. Press <F1> “YES” to perform a máximum energy test or <F2> “NO” to bypass
the máximum energy test. If you answer “YES,” you can enter máximum energy high and low
test limits from 1 to 999 J.
5. Cardio Energy Level Tests. Press <F1> “YES” to perform cardioversion tests or <F2> “NO” to
bypass the cardioversion test. If you are performing cardioversion tests, you will be prompted
for the information in (a) and (b) below:
a. Enter up to three cardioversion energy levels to test; from 1 to 500J. Press <F5> “END” when done.
b. Select the cardioversion energy level limits. Use <F2> “-LIM” to select a lower limit and <F1>
“+LIM” to select an upper limit. Use the <F4> “UP” and <F3> “DOWN” keys to increase and
decrease the energy level limits. Press <F5> “ENTER” when done. Both limit ranges are 0% to 99%.
7. Performance Waveforms. Press <F1> “YES” to run performance waveforms or <F2> “NO” to
bypass them.
8. Saving the Custom Autosequence. Press <F1> “YES” to save your custom autosequence, or
<F2> “NO” to exit without saving.
9. The impulse 4000 displays “END MAKE” and retums to the custom autosequence menú.
Making Defibrillator/Pacer Autosequences

1. Complete steps 1 through 4 in the section Programming Custom Autosequences, and select
<F2> “DFB/PCR”.
3- Use the instructions that follow next, Making Pacer Autosequences,

NOTE: The Defibrillatoi/Pacer autosequence ineludes fírst, al) steps from the Defibrillator Autosequence series
and then, second, all steps from the Pacer Autosequence series.
Maklng Pacer Autosequences

1. Complete steps 1 through 4 in the section Programming Custom Autosequences, and select <F3> “PACER”.
2. Pacer Test (Input) Load. Select the external adapter (pacemaker plug-in) module you are using.
Select “INTERNAL” if you are not using a module.
3 Pulse Mode Tests. Select up to 20 pulse-mode pacemaker rates lo test in sequence: “Step 1”»
“Step 2”, “Step 3”, and so on.
a. For each step, set the rale from 30 to 200 PPM (in I-PPM increments). Use the <F4> “UP” and
<F3> “DOWN” keys to increase and decrease the rate (press continuously to advance rapidly).
b. Press <F2> “NEXT” (moves the cursor). Set the amplitude from 10 to 250 mA (in I-mA
increments). Press <F2> “NEXT” (begins next step). Press <F1> “PREV” to retum to a previous
step and/or parameter.
NOTE: If you are using a module that has more than one load, use the “UP" and “DOWN" keys to
select the required load for the test. Use the “NEXT” key to move the cursor to the rate parameter.
c. When you ha ve programmed all rates and amplitudes, press <F5> “END”.
d. Select the rate and amplitude limits as percentages: for example, Rate Limit (%) • 5 (press
<F1> “RATE”)*, Amp Limit (%) « 5 (press <F2> “AMP”)*. This programs the Impulse 4000 to flag
any output that is outside these limits. The limit range is 0% to 99% (in 1% increments) and
applies to all steps in this mode. When both limits are set, press <F5> “ENTER”.
•NOTE: Use the <F4> "UP” and <F3> “DOWN” keys to increase and decrease the limits.
4. Async Mode Test. Press <F1> “YES” to enter the asynchronous mode test parameters for the
pacemaker or <F2> “NO” to bypass them.
a. Use <F1> “RATE” to select rate limits from 30 to 200 PPM (in 1-PPM increments). Use the
<F4> “UP” and <F3> “DOWN” keys to increase and decrease the rate.
b. Use” <F2> “OVER to select the overdríve limits from 10% to 50% (in 1% increments). Use the
<F4> “UP” and <F3> “DOWN” keys to increase and decrease the overdríve limits.
c. When both parameters are set, press <F5> “ENTER”.
5. Demand Mode Test. Press <F1> “YES” to perform demand mode pacemaker tests or <F2> “NO” to
bypass them. If you answer “YES,” you can enter demand mode pacemaker rates for up to 20 steps.
a. For each step, set the rate from 30 to 200 PPM (in 1-PPM increments). Use the <F4> “UP”
and <F3> “DOWN” keys to increase and decrease the rate.
b. To begin the next step, press <F2> “NEXT”, or press <F1> “PREV” to retum to a previous step.
NOTE: If you are using a module that has more than one load, use the “UP" and “DOWN” keys to select
the required load for the test. Use the “NEXT’ key to move the cursor to the rate parameter.
c. When you have programmed all rates necessary for your test, press <F5> “END”.
d. Select the demand mode pacer drive limits as percentages: for example, Overdrive (%) «10
(press <F1> “OVER”)*, Underdrive (%) « 10 (press <F2> “UNDER")*. This programs the Impulse
4000 to flag any output that is outside these limits. The limit range is 10% to 50% and applies
to all steps in this mode. When done with both limits, press <F5> “ENTER”.
•NOTE: Use the <F4> “UP” and <F3> “DOWN" keys to increase and decrease the limits.
6. Refractory Tests. Press <F1> “YES” to perform the refractory mode pacemaker tests:
pulsed-refractory period and sensed-refractory period (compatible with pacemaker rate ranges oí 30
to 100 PPM), or <F2> “NO” lo bypass them.
<F2> “NO” to exit without saving.
8. The Impulse 4000 displays “END MAKE” and returns to the custom autosequence menú.
..................................................................................................... —......... ............................. .......... í /; ;;;V<i‘i ;7í i'í'i,:íiiy,
VíewingAutosequences
View steps in any existing autosequence.
2. Press <F2> “VIEW”.
3 Select the autosequence you wish to view by pressing the corresponding function key. Use the
<left arrow> and <right arrow> “SELECT” keys to see all autosequence selections. The
Impulse 4000 displays the autosequence ñame and type.
4. Press <F5> “ADV” to advance to the next step in the autosequence.
Printing Autosequences
Print the steps in any existing autosequence using a parallel printer.
1. Select <F2> "CUSTOM” from the MAIN MENU PAGE 2.
2. Press <F5> “PRINT”.
3. Select the autosequence you wish to print by pressing the corresponding function key. Use the
Impulse 4000 displays the autosequence ñame and prints the selected autosequence.
Print the steps in any existing autosequence using a serial printer.
2. Press <F4> “SERIAL”.
3. Select the autosequence you wish to print by pressing the corresponding function key. Use the
Impulse 4000 displays the autosequence ñame and prints the selected autosequence.
Initializing Autosequences
Initialize all existing autosequences to factory default valúes.
NOTE 1: Initialization affects all 50 autosequences; the first 26 revert to factory default valúes and the rest are erased.
NOTE 2: All user-programmed autosequences are erased.
To initialize autosequences:
2. Press <F3> “INIT”.
3. Press <F1> “YES” to overwrite current autosequence definitions with factory default valúes.
4. Press <F2> “NO” to bypass initialization.
3-45
Chapter 3 ~ Operating Instructions
Autosequence, Test, Options. Tqble
DEFIBRILLATOR PACER
Energy 1 to 20 steps. Pacer Internal 50 or

Levels 0 to 500 J. Test Load Externa! Pacer Module (TQA-*#).
Musí enter a valué other than zero Pulse 1 to 20 steps.

to move to next step. Mode Load: Module dependen!.
Rate & Race: 30 to 200 PPM.
Energy + Limit: 0% to 99%. Ampiitude Ampiitude: MIN - 10 mA,
Level MAX - 250 mA.
- Limit: 0% to 99%.
Limits
Rate & Rate Limit: 0% to 99%.
Ampiitude
V-FIB YES. Outputs ventricular Ampiitude Limit: 0% to 99%.
Limits
for fibrillation ECG waveform
Energy for energy level tests and
Perform YES: Performs asynchronous
Tests? máximum energy test.
Async mode pacer tests; prompts
NO: No ECG waveform. Mode for rates shown below.
Tests? NO: Bypasses async mode pacer
tests.
Perform YES: Performs máximum energy
Max test. Asno One step.
Energy NO: Bypasses máximum energy Mode Rate: 30 to 200 PPM.
Test? test. Rate &
Overdrive: 10% to 50%.
Overdrive
Max Sets high and low limits.
Energy
Oto 999 J. Perform
Test YES: Performs demand mode
Limits Demand pacer tests; prompts for
Mode rates shown below.
Perform YES: Performs cardioversion test. Pacer NO: Bypasses demand mode
Cardio Tests? pacer tests.
NO: Bypasses cardioversion test.
version
Test?
Demand
1 to 5 steps.
Cardio Mode
1 to 3 steps.
Pacer Rate: 30 to 200 PPM.
Energy
0 to 500 J. Rates
Levels
Must enter a valué other than zero
to move to next step. Demand
Mode Overdrive: 10% to 50%.
Cardio + Limit: 0% to 99%. Drive Underdrive: 10% to 50%.
Energy Limits
- Limit: 0% to 99%.
Level
Limits
Refrac- YES: Performs refractor}’ mode tests:
tory Pulsed-Refractory Period and
Run YES: Outputs ECG sequence.
Performance Mode Sensed-Refractory Period.
NO: Bypasses ECG sequence. Tests?
Waveforms? NO: Bypasses refractor}’ mode tests.
YES; Save.s. autosequence..................... ¿pKtpr YES: Saves autosequence............................

OKto .^’fe-fe’fe’fe'fe-fe'feV-fe-k'fe'tVfeVfe-fe-feVfeVfe-feVt-feV.'fe’fefe'fe’fe’fe’feVfeVfe’fe’fe-íVfe'feVfe-fefek.-fe-fe-fe-;
Save? NO: Discards autosequence. Save?
NO: Discards autosequence.
5-46
f... ............ - TRAIMIhie .................................................. -...................... ..........................■........-.......
The Impulse 4000 has several training scenarios that are interactive with the defibrillator, transcutaneous
f pacemaker, and manikins su ch as the Armstrong Medical Defib Chris Clean™ and the Laerdal
$>.• Defib-Anne™.
í This instrument outputs ECG waveforms that simúlate real-lífe situations.

I
g Three types of interactive—real-lífe—training scenarios are available:
• Emergency Ventricular Defibrillation
g. • Elective Cardioversion
g • Transcutaneous Pacemaker
x-
y
g The Impulse 4000 outputs a simulated ECG waveform that, in tum, responds to
% • a defibrillator discharge at the Impulse 4000 defibrillator paddle contacts.
• a defibrillator discharge at the defibrillator pick-up plates of the connected manikin.
jg • an input of a transcutaneous pacemaker pulse vía the electrode adapters at the
Impulse 4000 defibrillator paddle contacts or the connected adapter (pacemaker
plug-in) module; refer to the Optional Accessories section in Chapter 1.
Using Training Scenarios

The training scenarios may require use of Impulse 4000 accessories such as the defibrillator electrode
adapters, pacemaker adapters, and adapter (pacemaker plug-in) modules.
For more information, refer to (hese sectíons ín this manual: Connecting the Defibrillator lo the Impulse 4000
in Chapter 1 (SAFETY CONS1DERATIONS section); Connecting the Pacemaker to the Impulse 4000 and Adapter
(Pacemaker Plug-In) Modules in Chapter 3 (TESTING AN EXTERNA! TRANSCUTANEOUS PACEMAKER section);
or the current DN1 Nevada Pnce List.
Common features are programmed in the training scenarios. These features appear on the Impulse 4000
display as follows: "NEXT”, "INHIBIT”, “CONVERT”, "END”, and "ESCAPE”.
Explanations of common training scenario features follow:
• <F1> "NEXT” - Returns to the waveform selection menú within the training scenario.
• <F2> “INHIBIT” - Allows the instructor to introduce randomness, or a real-life

nonconversión simulation into a training scenario. When the inhibit feature is used,
the Impulse 4000 senses the defibrillator pulse or pacemaker pulse and does not
respond to it.
For example: The instructor can press the inhibit button in several successive
defibrillator training scenarios, each time requesting the student to increase the energy
level. At the instructor’s discretion, the <F2> “INHIBIT’ key can be pressed again to
f turn the inhibit feature off. When the inhibit feature is turned off, the Impulse 4000
£ responds to the defibrillator input (conversión is not inhibited).
Aiso, if the instructor notices that the student is máking an error, he or she can stop the
contínued on the next page
3-47
Explanations of common training scenario features follow (continuedy.
• <F3> “CONVERT - Provides a simulated defibrillator pulse. If a defibriilator is not

available, use chis feature to show students ECG waveforms and the effect that an
applied "energy pulse” has on a waveform.
NOTE: A properly timed “energy pulse” for recovery (conversión) is oupui in the eledive
cardioversion scenario.
® <F5> “END” - Ends a particular training sessíon. At this time, press <F4> “SERIAL” to
transmit the training session data via the serial port or <F5> “PRINT” to print the results
of the training sessíon.
NOTE: An improper defibrilladon automatícally ends a training session.
Below is a sample printout:

IMPULSE 4 Ó 00 DNl” NEVADA
DATE: 03/16/94 TIME: 13:08:45
DEFIB SKILLS EMERGENCY
STUDENT:
INSTRUCTOR:
DEVICE MAN: MODEL:
SERIAL #:
TIME ACTIVITY
00:00 NSR 80 BPM
00:00 Failure Sequence Initiated
00:13 VFIB1
01:43 Defib Pulse - E = 109.6 J
01:43 Converted
02:00 NSR 80 BPM
EVALUATION: PASS FAIL

Verbal Skilis
Equipment Skilis
Safety Procederes ____ _________

Protocol/Format
Overall Assessment ____ _________
CPR/Ventilations
CPR/Compressions
DEFIB Student:___________________________
Re-Certification Date:
COMMENTS:________________________________
<ESC> “ESCAPE” - Returns to training scenario selection. Repeatedly pressing <ESC>

retaros to previous menus.
Interactíve Defíbríllator Training

The Impulse 4000 is well-suited for use as a defibrillator training tool. Both types of interactive
defibrillator training scenarios, Emergency Ventricular Defibriliation and Elective Cardíoversion, are
covered in this section. Ensure that the proper connections have been made; refer to Connecting tbe
Defibrillator to tbe Impulse 4000 in Chapter 1 (SAFETY CONS1DERAT1ONS section).
Emergency Ventricular Defibriliation

To enter this mode:
• Select <F1> “TRAIN” from the MAIN MENU PAGE 2.
• Press <F1> "DEFIB”, then press <F1> “EMRG".
Use emergency ventricular defibriliation when the patient's heart is in a failing condition. Press
<F1> "FAIL”, then <F1> “START” and the Impulse 4000 outputs a sequence of ECG waveforms that
simulares a failing heart condition and subsequent revival if defibriliation succeeds. The failure sequence
is NSR80, PVC1, NSR80, PVC1, VFIB1. Defibriliation musí occur during the VFIBl period (two minutes)
for it to succeed.
Student Training Aid. The remaining function keys on the “DEFIB EMRG” menú offer these
simulations: “VFIB1”, "VFIB2”, “VTACH", and “NORM” (NSR 80).
• When you press <F2> “VFIB1”, <F3> “VF1B2", or *<F4> "VTACH” and then press
<F1> "START”, the selected ECG waveform runs for two minutes and then changes
to an asystole waveform. If the student does not defibriiiate correctly during the
two-minute period, the message “IMPROPER DEFIBRILIATION” displays and the
training session terminates.
•NOTE: After you press <F4> “VTACH”, the simulations “VT130", “VT175”, “VT180’’, “VT185”,
and “VT220,‘ are offered.
• When you press <F5> “NORM" and then press <F1> “START”, a normal sinus rhythm
of 80 BPM outputs continuously. Defibriliation at this time gives the message
“IMPROPER DEFIBRILLAT1ON” and the training session terminates.
Elective Cardíoversion
To enter this mode:
• Select <F1> “TRAIN” from the MAIN MENU FAGE 2.
• Press <F1> “DEFIB”, then press <F2> “C ARDIO".
Use elective cardíoversion when a synchronized defibriliation is required to change or conven a

patient’s irregular heartbeat to a regular heartbeat. Select <F1> “AFIB1” (coarse) or <F2> “AFIB2” (fine).
The common training scenario features opérate as explained previously in Using Training Scenarios.
The features explained below are specific to the elective cardíoversion mode:
• <F3> "CONVERT” - Outputs a properly timed “energy pulse”, within the delay time
range, for recovery (conversión).
• <F4> “NO-SYNC” - Outputs a poorly timed “energy pulse”, outside the delay time
The cardíoversion delay time range is -120 to +120 ms from the R-wave peak. Outside of this range,
synchronization does not occur and a ventricular fibrillation (VF1B) outputs.
3^49
Interactive Transcutaneous Pacemaker Training

The Impulse 4000 is an effective traíning too! for instructing clinical staff in the basic use and operation
of the transcutaneous pacemaker.
Four different transcutaneous pacemaker traíning scenarios output. These scenarios simúlate typical
patient ECGs that require intervention by a transcutaneous pacemaker. Run these scenarios with or
without a transcutaneous pacemaker connected to the Impulse 4000. Connect a transcutaneous
pacemaker to the Impulse 4000, and you can interact with the operation of the pacemaker.
NOTE: During the pacemaker scenaríos, the ECG signal is available on the chest electrode piales of the attached
traíning manikin for monitoring purposes only. If you connect the pacemaker to the manikin chest electrode plates,
the Impulse 4000 and the pacemaker can’t interact.
For best monitoring results, connect the pacemaker electrodes to either the 50-íl internal test load or to the adapter
(pacemaker plug-in) module, and then monitor the ECG signal using the pacemaker’s 3- or 5-Iead patient cable
connected to the Impulse 4000’s top panel ECG lead binding posts.
The Impulse 4000 connections explained above and a manikin attached to the Impulse 4000 interact in the
defibrillation scenarios only.
1. Connecting the transcutaneous pacemaker to the Impulse 4000.
Follow the instructions in the Connecting the Pacemaker to the Impulse 4000 section, which is
located earlier in this chapter.
NOTE: You can attach a printer or serial device to the Impulse 4000 to document the traíning scenario.
2. Beginning the pacemaker training scenario.
• Press the <right arrow> "SELECT” key from the MAIN *MENU PAGE L
• Press <F1> “TRAIN” from the MAIN MENU PAGE 2.
• Press <F2> “PACER"
3. Preparing to run pacemaker training scenarios with or without a pacemaker.
a. Prepare to run the scenario interactively with a pacemaker.
• Press <F1> “ACTUAL”.
• Press either <F1> “INT50” for the internal 50-Q test load or <F2> “EXT” for the first
(lowest resistance) test load selection of the adapter module.
• Connect the pacemaker electrodes and the ECG patient cable to the Impulse 4000.
b. Press <F2> “SIMULATE” to prepare to run the scenario without a pacemaker.

NOTE: If a transcutaneous pacemaker is not available and you choose <F2> “SIMULATE”, you need a
basic cardiac monitor (or equívalent device) to view the ECG waveform generated by the Impulse 4000.
4. Interacting with the pacemaker operation.
• In the “ACTUAL" mode, press <F2> ‘TNHIBTT to cancel (inhibir) (he effect pf the
• In the “SIMULATE” mode, press <F3> “CAPTURE” to mimic a paced beat.
3-50
'w,5.’ ’ ’Rühhing scehános?
a. Press a below-listed function key and then press <F1>”START"
<F1> “ASYS” ASYSTOLE—Fíat líne ECG waveform.
<F2> “BRADY” BRADYCARDIA—Normal sinus rhythm ECG @ 30 BPM.
<F3> “DEMAND” Normal sinus rhythm ECG @ 80 BPM that degrades to asystole on
the 20th beat and then restarts to a normal sinus rhythm
after 40 seconds. Set up the pacemaker in the "DEMAND” mode
at a rate less than 80 PPM.
NOTE: Whenever the Impulse 4000 senses a pacemaker pulse while it is
outputting a normal sinus rhythm ECG waveform, the message
“PACER/PATIENT CONFLICT” flashes on its display.
This flashing message makes you aware that the pacemaker is ímproperly
set for the simulated patient condítion.
The Impulse 4000 outputs an 80-BPM normal sinus rhythm ECG waveform
that degrades to an asystole waveform after 19 beats and then restarts after
40 seconds. The pacemaker must be sel in the “DEMAND” mode at a
pacemaker rate less than 80 PPM to properiy conven the asystole
waveform and sense the restan of the 80-BPM normal sinus rhythm ECG
waveform
<F4> “NONC” NONCAPTURE—Asystole. Upon capture, everv lOth ventricular

paced beat is dropped.
b. During the scenario, you can use the function keys as explained below:
1) Change scenarios. Press <F1> "NEXT” and then select another scenario.
2) Stop a scenario- Press <F5> “END” to stop a scenario.
3) Print the scenario data. Press <F5> “END” and then press <F5> “PRINT". Ensure that
a parallel printer is attached to the Impulse 4000. The Impulse 4000 outputs the elapsed
time indicated in its upper right display.
4) Send the scenario data to the serial data port Press <F5> “END” and then press
<F4> “SERIAL”. The Impulse 4000 outputs the elapsed time indicated in its upper right
display.
5) Retum to the earlier “ACTUAL SIMULATE” display Press <ESC> “ESCAPE” once.
NOTE: An automatic time-out terminales a scenario if you do not initiate intervention during any elapsed
W-mínute íntérval. Adáilionálly, if the máximum riumber of 20Ó events or a total scenario-elapsed time of
The prompt “Máximum training time exceeded" displays and you have the option to either immediately
abort the selection or output the scenario log/data to an attached printer or serial device.
3-57
MEDTESTER INTERFACE
The Impulse 4000 is designed to interface with the original medTester (one that can run an
autosequence) or the medTester 5000B. When the medTester runs a defibrillator autosequence, it uses
the Impulse 4000. Both the Impulse 4000 and the medTester are switched to a 2400-baud rate by this
feature. When this feature is exíted, the previous baud rates resume.
Using the Impulse 4000 with the medTester

This feature enables the sending of data obtained from an Impulse 4000 after a defibrillator discharge
to the medTester.
Connect an RS—232 interface cable (DNI Part * 3010-0250) from the Impulse 4000 to the medTestefs
COM2. Turn both instruments on.
From the medTester “DEFIB” menú, select “CASO**, “LOAD”, then “IMPULSE”. The medTester baud rate
is automatically set to 2400 upon entering this mode. Escape to any medTester defibrillator
autosequence. Opérate the autosequence until the medTester display indicates “ready” and the
medTester is waiting to accept defibrillator energy information.
Select <F3> “MEDT” from the MAIN MENU PAGE 2 of the Impulse 4000 and “MEDTESTER INTERFACE:
READY” displays. Also, “TEST” appears above the <F5> key. At this point, there is an ECG NSR 60
waveform presen! at the ECG jacks of the Impulse 4000 (a mode similar to CARDIOVERSION). The
Impulse 4000 baud rate is automatically set to 2400 upon entering this mode.
Use <F3> and <F4> to change the waveform from NSR 60 to VFIB or from VFIB to NSR 60. Use <F1>
and <F2> to select the range. The autosequence starts out in the low range then a prompt occurs to
switch to the high range.
• NSR 60 - For a nonautomatic defibrillator; a delay time reading.
• VFIB - For an automatic defibrillator; no delay time reading In VFIB “YYY” is

transmitted for the delay time.
Press <F5> for a test pulse.
Discharge the defibrillator into the Impulse 4000 when both the Impulse 4000 and the medTester
displays indícate “ready”. The Impulse 4000 then sends data to the medTester containing the defibrillator
energy and cardio delay time. The Impulse 4000 displays the delay time in milliseconds (mS) and the
energy (E^) in joules (J).
Press <ESC> to return to MAIN MENU PAGE 2; reverts the baud rate to its previous setting.
ütilities...■.......... -...... -......... ■-....... ■....... ■ ............ ..........

Opüons in this section affect operating the Impulse 4000 but not taking measurements. Press
<F4> “UTIL” from the MAIN MENU PACE 2 to access the UTILITIES menú.
Availabie optíons:
• <F1> VIEW
• <F2> CLOCK
• <F3> BATT
• <F4> BAUD
• <F5> CAL
• <F1> DIAG (UTILITIES MENU PACE 2)
View Angle
Changes the viewing angle (contrast) of the Impulse 4000’s display. The Impulse 4000 is shipped from
DNI Nevada with the display viewing angle set at five. The adjustmeni range vanes from zero (dimmest)
to seven (brightest).
Set the view angle as foilows:
1. Select <F4> •'UTIL" from the MAIN MENU PAGE 2.
2. Press <F1> “VIEW”.
3. Use the <F3> “DOWN” and <F4> “UP” keys to adjust the angle between zero and seven.
4. Press <F5> “STORE” to save the setting ín non voladle memory (EEPROM).
5. Press <ESC> to exit this option.

NOTE: If you exit this option without storing your setting, the view angle remains at the prevíous seuing.
Clock
Sets the day and time of the real-time clock.
NOTE: The dock runs on 24-hour time, i.e., military time.
Set the clock as foilows:
1. Select <F4> “UTIL” from the MAIN MENU PAGE 2.
2. Press <F2> “CLOCK”.
3- Use the <F1> “left arrow" and the <F2> “right arrow” to select the digit you want to change. The
asterisk moves to the digit you select.
4. Use the <F3> “DOWN” and <F4> “UP” keys to increase or decrease the valué of the digit. The
clock stops counting while you change the digit.
5. Press <F5> ^START^ and the dock resumes counting.
6. Press <ESC> to exit this option.

NOTE: If you exit without pressing <F5> “START” (step 5). the time reverts to the previously set time.
3-53
Battery
Displays the battery status.
View the battery status as follows:
1 Select <F4> “UTIL” from the MAIN MENU PAGE 2.
2. Press <F3> “BATT”. The table below describes the various displayed messages.
Status Table
Impulse 4000 Wall Plug Charger Message
Battery 115-volt or 230-volt displayed on the Impulse 4000
Fully charged Not plugged in Battery voltage: 12.4 v to

13.7 V ±0.15 V
Not charging
Not fully charged Plugged in Battery voltage: ##.# V

Charging at: ## mA
Lowly charged Not plugged in Battery voltage: 10.5 V

NOTE: At battery voltages below Not charging
10.5 V, the Impulse 4000 doesn’t
opérate as specified.
Almost depleted Not plugged in BATTERY DEAD

of charge CHARGE BEFORE USING
Depleted of charge Not plugged in No message displayed
Turneó off Plugged in No message displayed

(Impulse 4000 ísn’t powered up) (Impulse 4000 battery is charging)
The internal 12-V lead-acid battery provides a mínimum of 20 hours of operation. The instrument will
run from the charger while it is charging a fully depleted battery.
The battery charger limits the charging voltage to 13-7 V ±0.15 V. As the battery charges, the charging
current decreases. The battery is fully charged when the charging current decreases to 50 mA or less.
The amount of time required to fully charge the battery varíes. Generally, 12 hours is adequate to
recharge a depleted battery.
To optimize battery lite

1. Opérate the Impulse 4000 without the charger for a máximum of 10 hours, which is 50 percent
of capacity.
2. Plug in the charger and fully recharge the Impulse 4000.
3. Again, operare the Impulse 4000 without the charger for a máximum of 10 hours.
4. Plug in che charger and fully recharge the Impulse 4000. Repeat this cyde of use.
‘ tjpéyáttóg’W tfie Instruníént.* ~ ~ v ”fc ™~‘’
3-54
Matches the Impulse 4000’s baud rate to a serial communication device. Refer to che Serial Port
Operation section later in chis chapter.
Set the baud rate as follows:
2. Press <F4> “BAUD”.
3. Use the <F3> “DOW” and <F4> “UP” keys to adjust the valué.
4. Press <F5> “OK” to save the baud rate for the current instrument usage. The baud rate is always
reset at power-up to 2400.
NOTE: There is a remóte command—"BAUD"—for changing the baud rate vía the serial port. See the SERIAL PORT
OPERATION section láter in this chapeen
Calibration
Refer to Chapter 4 - Test and Calibration for more information on this option.
Start calibration as follows:
2. Press <F5> “CAL”.
Diagnostica
Checks the Impulse 4000’s interna! functions.
Begin the diagnostic option as follows:
2. Press <F1> “DIAG”. UTILITIES PAGE 2.
3. A brief summary of the Impulse 4000’s diagnostic capabilities follows:
• <F1> “MEM” Checks the ROM (press <F1>) using a checksum method.
Tests the RAM (press <F2>) and the EEPROM (press <F3>) by
writing and then reading back from every byte in (hese
memories. Ensures the RAM and the EEPROM are working.
• <F2> “MODTST” Tests the adapter module (when it’s plugged in the Impulse 4000)
by switching the loads in the module.
To check that the load is switched correctly, attach an ohmmeter to
the inpu-ts and measure the resistance .
• <F3> "VWCAL” View of calibration constants.
• •<p4>'apiONTER,? Iniciares printout.
• <F5> “PACEIN” For DNI Nevada’s use oniy.
3-55
SERIAL PORT OPERATION
The Impulse 4000 serial port ís compatible with the RS-232 Standard: El A RS-232-C, and the 1BM PC
connector configuraron. It uses a 25-pin (DB25) male D-sub connector. The port is wired as Data
Terminal Equipment (DTE). The connector signáis are as follows:
• Pin 1 - Chassis ground connection (sometimes used for shielding)
• Pin 2 - Transmit data connection (from the Impulse 4000)
• Pin 3 - Receive data connection (to the Impulse 4000)
• Pin 5 - Clear to send connection (CTS)
• Pin 7 - Signa! ground connection
Test results can be downloaded to a computer or other serial device using the Impulse 4000 serial port.
The use of this port provides a way to remoteiy control the instrument and obtain test data.
A standard null-modem cable with female connectors is required to connect the Impulse 4000 to a
personal computer (wired as DTE with a male connector). The appropríate cable is available from
DNI Nevada and its parí number can be found in the Other Optional Accessories section in Chapter 1.
This cable connects the Impulse 4000 to the medTester. When using the cable, notice that píns 1, 2, 3»
and 7 are connected but not pin 5.
The clear-to-send (CTS) line is not usually used when the Impulse 4000 is connected to a personal
computer or a serial terminal; therefore, it ís best to lea ve this line disconnected.
There are instances when a serial printer or other device needs to interrupt the flow of data it is
receiving. This occurs to prevent a loss of data during operations such as a carriage return [CR] or a line
feed [LF]. When the interruptions are necessary, connect the CTS line to the Data Terminal Ready (DTR)
line of the attached device. Then assert the CTS line high using the attached device’s DTR line;
otherwise, the Impulse 4000 will not send data.
The CTS line ís a hardware function of the Impulse 4000 and ís not programmable. When it is left
disconnected, the line is pulled high by a resistor. If connected, the line must be asserted high by the
attached device to allow the Impulse 4000 to send data. If a user mistakenly connects the CTS line and
does not assert it high, the Impulse 4000 will not respond to any inputs.
Baud Rate
The Impulse 4000 can be queried as to what baud rates it accepts using
• QBAUD
The Impulse 4000 responds with

• 300,600,1200,2400,4800,9600
To set the baud rate, send
• BAUD~baudrate
Where “baudrate” is one of the baud rates listed in the above response, the Impulse 4000 responds with
• OK
The baud rate of the Impulse 4000 is now changed. The controller should wait approximately 0.5
seconds before attempting communication at the new baud rate. Communication should be started with
[CRKLF] tp clear the buffets. At powerûp, the Impulse 4000 opérales at 2400 baud.
PAGE 2, press <F4> “UTIL”, then <F4> “BAUD”. Choose the baud rate using the <F3> TOWN” and <F4> “UP”
keys. Then press <F5> uOKn to set the baud rate. Escape to previous menus using the <ESC> “ESCAPE” key.
3-56
XON/xOFF
The Impulse 4000 supports XON/XOFF handshaking for both transmitting and receiving data. Initially,
the Impulse 4000 transmits characters to a connected device. If a connected device sends the XOFF
character (13 hexadecimal) to the Impulse 4000, it stops sendíng data. When the connected device sends
an XON character (11 hexadecimal), the Impulse 4000 resumes sendíng data. In this way the connected
device controls the incoming stream of data.
When receiving data, the Impulse 4000 monitors the receive buffer. When this buffer is almost filled,
the impulse 4000 sends an XOFF character to the connected device teiling it to stop sendíng data. When
the Impulse 4000 has processed the buffer data, it sends an XON character to the connected device
indicating that it can resume sendíng data.
Serial Printing of Test Data

After the Impulse 4000 performs measurements, the results (test record) can be sent out the serial port
to a serial printer. Simply select the “SERIAL*’ function key to send the test data. This menú selection is
located within the Defibrillator Manual Tests (DEFIB) menus, the Pacemaker Manual Tests (PACER)
menus, and at the end of an autosequence—after you’ve conducted all test steps. To send the existing
steps ín an autosequence to a serial printer, select the "SERIAL” function key in the
CUSTOM AUTOSEQUENCES menú.
Remote Commands
Introduction
Use the remote commands to control the Impulse 4000 from a personal computer or other serial device,
to make measurements, and to obtain test results.
Primary commands are valid when the instrument is in the MAIN MENU or in the REMOTE MAIN
MODE. When a valid command is received from the MAIN MENU, the instrument enters the REMOTE
MAIN MODE. In this mode, and in any remoce submodes, the remote commands are displayed and the
keys on the top panel are deactivated.
The "LOC” command is a special command that leaves whichever remote mode the instrument is in and
retums to local control at the MAIN MENU.
The “EXIT” command is a special command that is valid in any of the remote submodes and which exits
that submode and returns to the REMOTE MAIN MODE,
Commands that are listed more than once are defined only at the first occurrence.
Ai power-up, the global variables are set to the default. When entering a mode, the variables for that
mode are set to the default. The default setting is the one listed first unless otherwise stated. The global
variable setup commands are valid in the MAIN MENU and also ¿n the modes where they are listed.
Other measurement commands are only valid in the specific mode they are listed in.
3-57
Qprnrnand, ......,_......... .,„, wz,.:. ....,. ,., ______________________
Commands can be sent in upper or lower case. All command strings must be terminated with a carriage
retum [CR] and/or a line feed !LF), i.e., [commandllCRJlLFJ. Spaces are ignorad.
Commands shown with are setup commands that require at least one parameter to be included with
che command. Múltiple parameters, if required, ara separated by commas. All possible parameter
choices are shown. Uniess otherwíse stated, the default parameters are listed first.
Responses to Commands
The instrument responds to all commands. Commands that do not retum any other message or data
return “OK”.
After receiving a command, the instrument ignores all other incoming characters until it has responded
to the one at hand. Some commands take a while to complete. These are noted.
The nuil command, which has no characters and consists only of terminating characters, retums
All responses are in upper case and are followed by a [CR] and [LFL Where a command retums more
than one item, they are separated by commas. The items are retumed in the order listed.
Commands can return character strings, integers, or floating point numbers.
Measurement readings are retumed as floating point numbers. The readings are in scientific notation
and inelude a unit of measurement.
Readings ara in the following format:
[+/-][readíng][E][+/'’][exponent][unit]
The leading + sign is not transmitted.
The reading is up to four digits with or without a decimal point.
The E indica tes that an exponent follows.
The exponent has either a plus or minus sign and is 0, 3, 6, or 9.
The units of measurement ha ve the following abbreviations?
« volt
~ ampere
= second
~ joule
PM ~ per minute
If an error is detected, an error response is returned in the following formati

• ERR=XX, description
The possible error responses are as follows:

• ERR«00,NO COMMANDS ALLOWED NOW
The instrument is in a mode in which commands are not allowed.
• ERR«01,UNKNOWN COMMAND
The received command was not recognized.
• ERR=02,ILLEGAL COMMAND
The command was understood, but it is not allowed at this time.
• ERRO3.1LLEGAL PARAMETER
A parameter sent wíth a command was not the right type, was out of range, was not
understood, or the right number of parameters were not sent.
• ERR=20,OVERLOAD
The adapter module has been overloaded because a defibriilator has been
discharged into it. This is a terminal condition that causes the instrument to go into
a dead-end state. This message is unique in that it is not a response to a command,
but is sent immediately when an overload is detected. The Impulse 4000 displays
“II! MODULE OVERLOAD !!!” and the adapter module produces an audible “beep”.
To reset the Impulse 4000, tum the instrument off, disconnect the defibriilator leads,
wait 5 seconds, and then tum the instrument back on.
Special Commands
• LOC
Lea ves any remote mode and returns to local key control at the MAIN MENU.
Returns “OK”.
• EXIT
Exits any of the remóte submodes and returns to the REMOTE MAIN MODE.
Returns "OK”.
Instrument Identif¡catión Commands

• IDENT
Asks for the instrument identificación, then returns a string which contains the
instrument ñame, firmware versión leve!, and any installed options. The IDENT
string is in the following formar [model],[versión],[options].
Where model is “1MPULSE4000”, versión is a character string (for example,
“VER 1.02”), and options is a character string listing the options.
Asks for the adapter modulé láteñtíficátion, ffien

that identifies the installed adapter module. This number correspondí to the TQA
number on the adapter module.
Chapter 3 - Operating Jnstructions
./f
• DEFRANGE-range
S Sets the defibrillator measurement range. Use “H1GH” for high range or “LOW” for
low range. Returns “OK”.
• PACELOADdoad
Sets the pacemaker load using one of the following commands:
INT Internal 50 £1
ADAPO Adapter, open circuit.
ADAP1 Adapter, load 1.
AOAP2 Adapter, load 2.
ADAP3 Adapter, load 3-
ADAP4 Adapter, load 4.
g Returns “OK”.
$ NOTE: If running a transcutaneous interactive waveform, the waveform must be resurted

with a new ECG wave command when the pacemaker load is changed wíth this command.
£
i’-
»’?
■<
1 • PACEIN-enable
Enables or disables the incoming pacemaker pulse from affecting the ECG
waveform when running one of the transcutaneous interactive waves (TQXXX).
£ ON Pulse affects the waveform.

g OFF Pulse doesn't affect the waveform.
§ Returns “OK”.
£ For the next two commands the width and amplitude parameters are as follows:
£ Width: A number that represents the width ¡n milliseconds. It must be from the
following list, exactly as shown: 0.1, 0.2, 0.5, 1.0, 2.0. The default valué is 1.0.
| Amplitude' A number that represents the amplitude in millivoks. It must be from the
following list, exactly as shown: -700, -500, -200, -100, -50, -20, -18, -16, -14, -12, -10,
| -8, -6, -4, -2, 0, 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 50, 100, 200, 500, 700. The default
valué is 100.
• ATRPACE^width,amplitude
£ Sets the width and amplitude of the atrial pacemaker spíke in transvenous paced
? ECG waveforms. Returns “OK”.
g ♦ VENTPACE^ width, amplitude

S....................... . ............ ........... .............. Sets. xhe width- amplitude. of, the, ventricuUr pacemaker spíke. in, transvenous
% paced ECG waveforms. Returns “OK”.
■y;
3-60
General Purpose Command

The following command is valid during measurement modes to query the status of measurement data
in that mode:
QDATA
Asks if the measurement data is available. Valid during all measurement modes,
Returns one of the following:
NODATA No data is available.
NEWDATA Data is available. Reading the data with the “XXXDATA” command,
for that mode, resets the status to "OLDDATA”.
OLDDATA Data has been read by the “XXXDATA” command. It can be read
again if desired.
Defibrillator Measurement Commands

• ENERGYMODE is a command that enters the energy mode and enables measuring a defibrillator pulse
when ready. The following commands are enabled and then “OK” is returned.
• DEFRANGE (See definitíon in a previous section Global Variable Setup Commands.)
• DEFTBWAVE-ECG waveform
Sets the ECG waveform for a defibrillator test as follows:
NONE No waveform.
VFB1 Ventricular fibrillation 1, coarse.
VFB2 Ventricular fibrillation 2, fine.
VTC130 Ventricular tachycardia 130 BPM.
Returns “OK”
• QDATA (See definitíon in (he preceding section General Purpose Command.)
• ENERGYDATA
Asks for the energy mode defibrillator pulse data. Returns all the following if the
data is available:
Defibrillator energy J
Peak voltage V
Peak current A
50% pulse width S
10% pulse width S
If no data is available, "NODATA" is returned.
• CHKENERGY (medTester checklist command)

Returns the defibrillator energy reading: “DEFIB ENERGY^ddd.d J”
NOTE: Does not change NEWDATA to OLDDATA.
• PLAYBACK
Returns “OK” when complete.
• EXIT (See definición in a previous section Special Commands.)
3-61
.• maxg,. mode.,andenaWg^ , d?fibrifetor

máximum energy and charge time. The following commands are enabled and then “ÓK” is returned.
• DEFRANGE
• DEFIBWAVE
• QDATA
• MAXESTART
Starts the charge time test. Shouid be sent at the same time that the defibrillator is
set to start charging. Returns “OK”.
• MAXEDATA
Asks for the maxe mode defibrillator pulse data. Returns all the following if good
data is available:
Defibrillator energy’ J
Peak voltage V
Peak current A
Charge time S
If no data is available, “NODATA” is retumed. If a defibrillator pulse arrives and the
MAXESTART command has not started the test yet, “NOSTART” is retumed. If the
charge time was greater than the máximum of 99 seconds, “CT>99S” is returned.
• PLAYBACK
• EXIT
• CARDIOMODE is a command that enters the cardio mode and enables measuring defibrillator
cardioversion delay time. The following commands are enabled and then “OK” is retumed.
• DEFRANGE
• CARDIOWAVE-ECG waveform
Sets the ECG waveform for a defibrillator cardioversion test as follows:
NSB60 Normal sinus rhythm 60 BPM.
AF1 Atrial fibrillation 1, coarse.
AF2 Atrial fibrillation 2, fine.
Returns “OK”.
♦ QDATA
• CARDIODATA
Asks for the cardio mode defibrillator pulse data. Returns all of the following if the
data is available:
Defibrillator energy' J
Peak voltage V
Peak current A
Cardio delay time S
If the cardio delay time is outside the measurement range or -120 to -380 ms.
“ NODATA” is returned ’
3-62
• CARD1OMODE continued
* CHKCARDIO (medTester checklist command)

Returns ihe cardioversíon delay tíme: “DEFIB CARDIOddd mS".
• PLAYBACK
* EXIT
Pacemaker Measurement Commands

• PACEPMODE is a command that enters the pacep mode and enables measuring pacemaker pulse parameters.
NOTE: Complete data is not available until al least two pulses have been received. Two pulses are required to
estabhsh the pacing rate. The following commands are enabled and then “OK* is retumed.
• QADAPTER
• PACELOAD
• HOLD=hold
Sets or releases a hold on the current data during which the instrument will not look
at additionai incoming pulses. The hold parameter can be
RESUME Resume measuring pulses.
HOLD Hold current data.
Returns “OKn.
• QDATA
• PACEPDATA
Asks for the pacep mode pacemaker pulse data. Returns all the following if data is
available:
Peak current A
Pulse width S
Pulse rate PM
If no data is available, "NODATA” is returned.
• CHKPACEP (medTester checklist command)

Returns the pacemaker pulse amplitude and pacing rate:
"PACER PULSE-ddd.d mA? ddd PPM”.
• EXIT
• PACEREFRACT is a command that measures the pacemaker pulsed- and sensed-refractory periods,
and the pacing rate.
• If no pacemaker pulse is detected within 10 seconds, “NO PACER” is returned.
• If the pacing rate is less than the mínimum, “PACERATE TOO LOW" is returned.
• If the pacing rate is greater than the máximum, “PACERATE TOO HIGH” is returned.
• If the pacing rate is within the range (30 to 100 PPM) and the refractory periods are
able to be measured, all of the fpllowing are returned:
Pulsed-refractory period S
Sensed-refractory period S
NOTE: The entire measurement can take up to 60 seconds to complete.
.W^yefpra.Gpn^Si^................................................................................................. ........ ........... ................................................ .

« PERFLEAD-lead
Sets the performance waveform reference lead to I or II.
Returns "OK”.
NOTE: When you run waveforms from the serial commands, performance waveforms (as Usted
befow) are affected by the reference lead selection; ECO waveforms (as Usted below) aren’t
affected by the reference lead selection.
The following waveform commands simply turn on the specified waveform. They do not enter a special
mode. AH of (hese commands re turn “OK”.
NOTE: The "WO**” commands are al lerna ti ves (secondáry commands) to the commands they follow, and are
compatible with the medTester.
Performance Waveforms
• ZERO Zero output.
• SQU or W001 2-Hz square wave.
• PUL or W002 4-second pulse.
• S1N0.05 0.05~Hz sine wave.
• SINO. 5 or W014 0.5-Hz sine wave.
• SIN1 1-Hz sine wave.
• S1N10 or W003 10-Hz sine wave.
■ SIN40 or W004 40-Hz sine wave.
• SIN50 SO-Hz sine wave.
* SINÓO or W005 60-Hz sine wave.
• SIN100 or W006 100-Hz sine wave.
SIN125 125-Hz sine wave.

• SQ1K W007 1-kHz square wave.
• TRI W008 2™Hz triangle wave.
ECG Waveforms
• NSB30 W010 Normal sinus rhythm at 30 BPM.
• NSB80 Normal sinus rhythm at 80 BPM.
e NSB200 Normal sinus rhythm at 200 BPM.
'WsEMíJ'”' woly ■ ■ •WtBWWyffim af2W3PM.'‘

3-64
ECÍj Waveforms coniinúed

AF1 W015 Atrial fibrillation 1, coarse.
AF2 A tria 1 fibrillation 2, fine.
AFL Atrial flutter.
SINA Sinus arrhythmia.
1DB Ist degree AV block.
2DB1 W016 2nd degree AV block, type 1, Wenckebach.
2DB2 W017 2nd degree AV block, type 2.
3DB 3rd degree AV block.
PVC1 W020 PVC type 1.
PVC2 W021 PVC type 2.
MF WO22 Mukifocal PVCs.
PAIR W024 A pair or couplet of PVCs.
BIG Bigeminy.
TRG Trigeminy.
RUN5 WO25 Run of 5 PVCs.
RUN11 W026 Run of 11 PVCs.
VNT Ventricular rhythm 120 BPM.
VTC180 WO28 Ventricular tachycardia 180 BPM.
VFB1 WO29 Ventricular fibrillation 1, coarse.
VFB2 Ventricular fibrillation 2, fine.
ASY1 Asystole 1, some movement.
ASY2 WO3O Asystole 2, fíat.
ASN Asynchronous, continuous, transvenous paced.
DM1 Demand 1, mostly paced, transvenous paced.
DM2 Demand 2, mostly norma!, transvenous paced.
AVS Atrioventricular sequential, transvenous paced.
NCA Noncapture, transvenous paced.
NFU Nonfunctional, transvenous paced.
TQASYS Asystole, transcutaneous paced.
TQERAD , Brady&Midfe p^c^d. ..
TQDEM Demand, transcutaneous paced.
TQNC Noncapture, transcutaneous paced.
3-65
, • ________________________________________________________________________..........Wl
Turns on the R-wave threshoíd detección wâveform with the specified width and
amplitude parameters as indicated below:
Width-. A number that is the width in milliseconds. It must be from the following
list, exactly as shown: 8, 12, 20, 40, 60, 80, 100, 120, 140, 160. 180, 200.
Amplitude\ Referenced to Lead II. A number that represents the amplitude in

millivolts. It must be from the following iist, exactly as shown: 0.05, 0.10, 0.15, 0.20,
0.25, 0.30, 0.35, 0.40, 0.45, 0.50, 0.75, 1.00, 1.25, 1 50, 1.75, 2.00, 2.25, 2.50, 2,75,
3.00, 3.25, 3-50, 375, 4.00, 4.25, 4.50, 4.75, 5.00, 5.25, 5.50.
Returns “OK\
Utilities and Diagnostics

• QBAUD
Asks for all possible baud rates that the ¿nstrument can opérate in. Returns all the
possible baud rates separated by commas, exactly as foliows:
300,600,1200,2400,4800,9600
• BAUD^baudrate
Sets the baud rate that is a number from the following list exactly as shown:
300, 600, 1200, 2400, 4800, 9600.
Returns UOK'’.
• SETCLOCK^month,day,year, hour,minute,second
Sets the real-time ciock. Note that time is always in a 24-hour formal.
month An integer 1 through 12.

day An integer 1 through 31.
year An integer 0 through 99.
hour An integer 0 through 23.
minute An integer 0 through 59.
second An integer 0 through 59.
Returns 4iOKM
• QCLOCK
Asks for the date and time from the real-time dock. Returns the following as
integers: month, day. year, hour, minute, and second.
’XwX V, viwX'X-ívX-i'iv-í-
« ROMCHECK
Calculares the ROM checksum and checks to see if ít is equal to the stored
checksum. All checksums are four-digit hexadecimal numbers. Rerurns one of the
following:
GOOD The checksum does match the stored checksum.
BAD The checksum doesn’t match the stored checksum.
• RAMTEST
Performs a RAM test. Returns one of the following:
GOOD The RAM tests good.
BAD The RAM tests bad.
• EEPROMTEST
Performs an EEPROM test. Note that chis test can take up to 60 seconds. Returns one
of the following:
GOOD The EEPROM tests good.
BAD The EEPROM tests bad.
3-67

Dninevada - : Operating and Service Manual

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DNiNEVADA___________

Operating and Service Manual

To order this manual, use Parí Number 9508-0242.

hrmware Versión LOO

Standard Terms and Conditions

General.... ............................................................................................. . 1-1

Battery Charger...... ................................................................................ 1-1

Defibrillators.................................... ................................ ..................... . 1-1

Automatic Defibrillators................. ............................. . 1-1

Connecting the Defibrillator to the Impulse 4000............................. ........... 1-2

Discharging the Defibrillator.

Discharging the Automatic Defibrillator............................................ . 1-3

Intemal Paddles .............................................................................................. 1-4

Safety Information ................................................................................................ 1-4

Introduction and Features...................................................................................... 1-5

Impulse 4000 Instrument Specifications...................................................... . 1-6

Defibrillator Measurement......... .............................................................. 1-6

Transcutaneous Pacemaker Measurement.................................................. 1-8

Autosequence Test....... ............................................................................... 1-11

Defibrillator Tests........... ................. .......................... ............... . 1-11

Pacemaker Tests................................................................................ 1-11

¿f ECG Waveforms.....____________ ________ -—.—...................................... 1-12

Training Scenaños ......................... . 1-15

Calendar/Clock ........................................................................... 1-15

Data Interfaces............................. ...................................................... 1-15

General Specifications for the Impulse 4000..................................... 1-16

£ Optional Accessories................................................................. 1-17

Defibrillation-Only (50-Q) Electrode Adapters................... 1-17

Combinatíon Defibrillator/Extemal Transcutaneous Pacer

Adapter (Pacemaker Plug-ln) Modules.................. . 1-18

Instrument Familiarity 1-19

Claims........... ................ .. ............................. ....................... ..................................2-1

Warranty Repair.............. ........................... ............................... ............... ..............2-1

Connecting the Printer .......................................................................................... 2-1

RS-232 Serial Port Setup................................. ............................... ........................2-2

Maníkín Connection.................................... ................................ ........................... 2-2

High-Level ECG Output Port.............. .................................................................... 2-2

Main Menú Structure ...... .......... ....................... .............................. 3-1

Testíng a Defibrillator................... ..........................-............................ . 3-2

Defibrillator Testíng Theory............................ ..................... .........................3-2

Available Energy Rangos....... .............. ................................................ 3-2

Measuring Defibrillator Energy Output.........................................................3-2

Self-Test Feature.............................................................. ............................... 3-3

Printing Mea su reme nt Data ............. 3-4

Testíng Semi- and Fully Automatic Defibrillators ...................... 3-4

Viewing Waveform Output........ ....................................................... . 3-5

Real-Time Waveform Output.............. . 3-5

Time-Expanded Waveform Playback................................................ 3-5

Testíng Defibrillator Cardioversion ............................................................... . 3-6

Cardioversion Testíng Theory, Measurement Techo ¡que

Cardioversion Delay Time....... .................... .................. 3-6

Selecting the Stimulus Waveform............................................... 3-6

Conducting the Cardioversion Test............................................. 3-7

Self-Test Feature ................................ . 3-8

Printing Measurement Data........ ......... ........................................................ . 3-8

Viewing Waveform Output 3-8

Testíng Defibrillator Máximum Energy .............................................. 3-9

Conducting the Máximum Energy Test.............................................. .......... 3-9

..v Seif-Tesí. Feature3*9

¿f ECG Waveforms.....____ -—.—...................................... 1-12