[Music] hello i'm lisa nepper director of sales support at mgc diagnostics this presentation will walk you through an entire pulmonary function test utilizing mgc diagnostics new ascent software this is the ascent home screen the device status green disk at the bottom right of the screen says ready when the system is warmed up and ready to use calibration status will tell you if a calibration is required select required to begin the calibration process the general calibration tab allows the user to check and enter the ambient conditions calibration status will inform the user of which checks calibrations are required such as ambience flow dlc pleth o2 and co2 complete system information is displayed such as software version by selecting system information service log allows entry of time stamp service logs or to reset qc trend graph data to today's date selecting the flow tab will allow the flow calibration of the prevent connect a three liter syringe with the plunger all the way in select start and perform three strokes keeping the flows at the recommended levels calibration successful will confirm a good calibration the bar graphs to the right will give the range of acceptability for mean error range and gain settings top screen right will allow the adjustment of the syringe volume selecting the dlc tab will allow the dlc analyzer to be calibrated place the umbilical into the calibration port select start the calibration successful notification will appear at the top of the screen and the acceptable limits for each of the gases co ch4 and co2 will be seen settings top right of screen will allow the adjustment of gas concentrations selecting the o2 co2 tab will allow the oxygen and co2 analyzer to be calibrated be sure the umbilical is placed into the calibration port and the gas is turned on select start the calibration is successful will appear at the top of the screen if the calibration is successful the acceptable limits will be shown in the o2 and co2 bar graphs be sure the gas is turned on and the box door is closed and sealed select the pleth tab and then start during calibration the box pressure mouth pressure and maximal inspiratory in excretory mip and map will be calibrated calibration successful will be seen at the top of the screen when the calibration is successful selecting the reports tab will allow pdf or printed copy of a complete calibration report for any day selected selecting the trends tab will allow the trending of all calibration parameters selecting the calibration type will allow viewing of any calibration variable alternating the limits standard deviation tab will alternate between the standard deviation of different flow calibrations which must be within two standard deviations select exit calibration to save and exit the calibration screen performing patient tests a patient can be entered into quick search if they have already had a test done you would find the patient highlight the patient and select add a visit by selecting the blue plus sign to the right of the patient's name enter the patient's height and weight and race enter the occupational information such as painter check currently for tobacco use and select cigarettes three years smoked and one pack per day pack years will be calculated for shortness of breath from the drop down box select on hills and stairs select none for cough select rare for wiis for medications select the blue plus sign and from the drop down box select albuterol type in asthma in the diagnosis field and select mild persistent asthma uncomplicated for test details select the appropriate physician check the tests that were ordered fec svc mvv dlco rtd frc plath mip and map any comments can be written into the test comment section select begin testing the first test starts with a flow volume loop note that the flow volume loop icon has a green highlight around it the order of tests performed can be changed by selecting a different test icon to perform a test i'm going to have you put this flow sensor in your mouth with your lips tight around it so there are no leaks then i'm going to have you breathe normally take the deepest breath possible in then blow out as fast and as hard and as long as you can then i'm going to ask you to take it in as quickly as possible another deep breath the graph shows in real time back extrapolated volume less than five percent expiratory time and plateau criteria as each of these requirements are met the area for that section will turn green when all areas of the qc graph are green the user can select stop and the effort will have met all ats criteria there is less need to look at the actual patient tracings as all ats ers criteria for that particular effort can be seen by looking at the qc graph we are going to do two more efforts and a big breath in and blast it out go go go go go go go go go go go go go go go go go go go go go go go go go go you're doing great you're doing great and a big breath in nice after the repeatability criteria is met then the repeatability dialog box will be shown on the screen the scorecard can be used to quickly see which individual efforts met which ats criteria with regard to back extrapolated volume in a test criteria exhalation time cough within the first second a green dot passes and a red dot fails for repeatability the two largest fvc and fev1 within 150 mils also the mill difference from the largest is shown this will tell the operator how close to the standard two efforts were svc select the svc icon select start and perform a slow vital capacity to perform the test tell the patient that will put the flow sensor into their mouth and breathe normally for four breaths then at the top of a breath they will exhale completely and when they are totally empty they will inhale as deep as they can when they have four stable title breaths a line will appear then have the patient exhale until they meet a flow of less than 25 mils per second when they've done this they will have the patient inhale maximally then you're going to repeat the effort one more time placing the pointer on the dashed line such as the end resting level line press the left pointer button and move the line up or down to select a different exhale title volume then select save changes select reset to return to the original settings select the scorecard top right icon to see the two svc values are within 150 mils in this case they were within six performing an mvv select the mvv icon and perform the mvv test have the patient put the flow sensor in his mouth with lips tightly sealed have the patient begin to pant as fast and deep as possible the ideal tidal breath during the test is from one third to one half of a patient's vital capacity and the respiratory rate should ideally be from 80 to 100 breasts per minute the quality graph will help you get the perfect combination of respiratory rate and tidal volume in the example above the patient averaged 96 breaths per minute and was breathing at 36 percent of the vital capacity therefore the quality disc was all green dlco select the dlco icon and perform the dlco test enter the patient's hemoglobin and or carboxy hemoglobin by selecting manual entry and then blood insert the umbilical into the calibration port select gas calibration at the top left of the screen when the calibration is complete attach the umbilical clip to the flow sensor attach the flow sensor to the patient circuit select start have the patient put the mouthpiece in his mouth with lips tight and breathe normally for four breaths at the end of the fourth breath have the patient inhale slightly then have the patient exhale totally and completely to residual volume have the patient inhale smoothly and quickly not forcibly to the very top of their lungs have the patient hold their breath for 10 seconds at the end of 10 seconds have the patient exhale completely the top of the gauge will turn green when the patient inhales 90 of their vital capacity the bottom of the gauge will be green when the patient is inhaling within the appropriate flow range not too fast the center of the gauge will show you the patient's mouth pressure and if the pressure is between the user adjustable upper and lower limits the quality graph displays the percent of vital capacity breath hold time and inspiratory expiratory time to repeat the test insert the umbilical into the calibration port and select gas calibration place the umbilical into the prevent and repeat the test sets at the end of the second test if repeatability criteria has been met you will see the repeatability dialog box the scorecard will easily show you which ats and ers standards were met nitrogen washout connect the umbilical to the gas calibration port and select gas calibration gas calibration successful message will appear at the bottom of the screen when the calibration is complete connect the umbilical to the pre-even flow sensor have the patient put his lips tightly around the mouthpiece and put the nose clip on the patient select start and have the patient breathe normally there will be four countdown breaths in the quality control gauge then perform four title breaths the breasts will be seen on the screen have the patient exhale fully at the bottom of the fifth title breath and then inhale maximally have the patient return to normal breathing and select the space bar at the end of the title breath the shutter will switch the patient to 100 oxygen during the test the quality control gauge will show the respiratory rate the accumulated frc the percent of nitrogen and the switching air keep in mind that the switch in should be between plus or minus 250 mils the test will stop automatically when the final n2 percent is at or below 1.5 percent this will also be shown on the qc gauge the scorecard shows which ats criteria were met plecosmography have the patient sit in the box attach the nose clip and put hands on cheeks close the door and have the patient breathe normally close the box vent open and close the box vent the top left of the screen to equilibrate the pressure in the box if the patient is breathing in the green area of the stability area the quality control gauge select tgv collect at least four stable title breaths at the end of a breath press the space bar to collect closed shutter pants the panting rate is guided by the metrodome on the side of the quality graph have the patient inhale maximally and exhale maximally blow it all out keep blowing keep blowing keep blowing keep blowing select the space bar to end the test at the end of the test the quality graph shows the closed panting rate it will be green if it's in the set number of minimum and maximum range the switch and error will be displayed in the center in the event your patient cannot do plathismography nitrogen washout is a great alternative plethosmography airways resistance and thoracic gas volume have the patient sit in the box attach nose clip and put hands on cheeks close the door and have the patient breathe normally close the box vent open and close the box vent the top left of the screen to equilibrate the pressure in the box if the patient is breathing in the green area of the stability area the quality control gauge select raw collect at least four stable title breaths at the end of the breath press the space bar and collect open shutter pants the painting rate is guided by the metronome on the side of the quality graph after the open shutter pants are collected press the space bar and collect four closed shutter pants the painting rate again is guided by the metronome on the side of the quality graph select spacebar to end test note when performing airways resistance and thoracic gas volume together it is often difficult to get an acceptable switch in this is why it is recommended to perform tgv separately adjustment of the tgv tracing double left click on the tgv raw graph select the graph type close for tgv and open for raw adjust the position of the angle of the graph select show guides will place parallel lines on the graph select open to show open shutter pans show four breaths superimposed or four separate breaths select the mip and map icon connect patient to the head assembly select start have patient perform four title breaths and breathe in and out just normal you're doing great to perform a mip have the patient exhale fully press the space bar to close the shutter at full exhalation have the patient inhale maximally against the close shutter the shutter will automatically open after three seconds to perform a map have the patient breathe tidally have the patient inhale fully press spacebar to close the shutter at full inhalation with hands on their cheeks exhale as hard as possible against the closed shutter the shutter will automatically open after three seconds notice there are no ats ers standards for this test therefore a scorecard will not be shown i hope you enjoyed this presentation it will give you a great start in getting to know mgc diagnostics new ascent software