Selling Stress 運(yùn)動(dòng)平板培訓(xùn)完整版

SellingStress

運(yùn)動(dòng)平板培訓(xùn)

運(yùn)動(dòng)心電圖的應(yīng)用范圍冠心病的輔助診斷多支血管病變的病人確定犯罪血管從冠心病人中選擇高危病人進(jìn)行PTCA和CABG心肌梗死病人有無存活心肌或缺血心肌心肌梗死病人出院前運(yùn)動(dòng)處方的制定冠心病人介入治療或CABG后再狹窄的判定評(píng)估冠心病病人預(yù)后心臟病內(nèi)外科治療療效評(píng)定評(píng)定心臟功能，安排病人活動(dòng)量體育療法運(yùn)動(dòng)處方的制定運(yùn)動(dòng)員體力狀態(tài)的鑒定飛行員體檢運(yùn)動(dòng)試驗(yàn)的原理運(yùn)動(dòng)測(cè)試心電圖用于冠心病診斷未能確認(rèn)確認(rèn)病人的身體狀況測(cè)驗(yàn)會(huì)記錄運(yùn)動(dòng)及藥物對(duì)心臟影響過程中的心電圖評(píng)估的指標(biāo)

傳統(tǒng)上采用ST段的壓低或抬高（預(yù)示心肌缺血）運(yùn)動(dòng)前的危險(xiǎn)因素和最大運(yùn)動(dòng)級(jí)量也是強(qiáng)有力的診斷依據(jù)運(yùn)動(dòng)級(jí)量由以下參數(shù)來體現(xiàn):最大運(yùn)動(dòng)時(shí)間，最大負(fù)荷，最大代謝當(dāng)量（MET）或最大心率及心率和血壓的乘積運(yùn)動(dòng)試驗(yàn)的類型標(biāo)準(zhǔn)運(yùn)動(dòng)試驗(yàn)-跑臺(tái)試驗(yàn)運(yùn)動(dòng)超聲心動(dòng)圖(StressEcho)用心臟超聲顯示心臟壁的運(yùn)動(dòng)核醫(yī)學(xué)運(yùn)動(dòng)測(cè)試（Nuclearstresstesting）核醫(yī)學(xué)影像掃描確認(rèn)血流的特點(diǎn)鉈,Cardiolite藥物學(xué)平板試驗(yàn)

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

報(bào)告格式

測(cè)量的準(zhǔn)確度臨床標(biāo)準(zhǔn)

心電信號(hào)描記質(zhì)量平板客戶關(guān)心的問題?技術(shù)員(平板技術(shù)員,

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

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

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