Beruflich Dokumente
Kultur Dokumente
Service Manual,
Version 2.1
COPYRIGHT INFORMATION This manual copyright 1992, 1997, 2003 by WR Medical Electronics Co. All rights reserved. No part of this manual may be reproduced in any form by any meansgraphic, electronic, or mechanical, including photocopying, recording, taping, or any information storage and retrieval systemwithout the written permission of WR Medical Electronics Co. All WR Medical Electronics Co. products (including Silverstein, Silverstein Adapter for Continuous Stimulation, SACS, Brackmann, Brackmann II, and Theratrode) are trademarks or registered trademarks of WR Medical Electronics Co.
Silverstein Facial Nerve Monitor/Stimulator, Model S8, Service Manual, version 2.1, item no. 3010), revised 05/13/03. P/N 920-W0-23016. WR Medical Electronics Co. 123 North Second Street Stillwater, MN 55082 USA 651-430-1200 FAX 651-439-9733 Toll-free 800-635-1312 Toll-free FAX 800-990-9733
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CONTENTS GENERAL
Electrocautery Warning .............................................................................................. 5 Other Warnings and Cautions .................................................................................... 5 Introduction ............................................................................................................... 7 Features of the Model S8 ............................................................................................ 7 Warranty, Service, and Loaner Program ...................................................................... 8 Sterilization Guidelines ............................................................................................... 8 Current Characteristics ............................................................................................... 8 Output Parameters ..................................................................................................... 9 Paralyzing Drugs ......................................................................................................... 9 Procedures for Use with Electrocautery Units ............................................................. 9 Sensitivity, the Sensitivity Switch, and Alarm Artifacts ............................................... 10 System Components ................................................................................................. 11 Testing for Stimulus Output: Stimulus Verification ..................................................... 11 Battery Condition Indicator and Battery Charging ..................................................... 12 Installing the Cheek Muscle Movement Sensor ......................................................... 12 Checking the Sensor Circuit...................................................................................... 13 Care of the Sensor .................................................................................................... 13 The Remote Probe ................................................................................................... 13 Aux Stimulator Jacks ................................................................................................. 13 Pad (Ground) Cable .................................................................................................. 13 Skin Preparation ....................................................................................................... 14 Pulse Light ................................................................................................................ 14 Horn/Light Switch .................................................................................................... 14 Use of the Remote Light ........................................................................................... 14 Tilt Stand .................................................................................................................. 15 General Theory of Nerve Stimulation ....................................................................... 15 General Procedure for Use of the Model S8 ............................................................. 16 Finding a Nerve Underlying Other Tissue ............................................................ 16 Indicating Proximity of a Nerve ........................................................................... 16 Nerve Identification ............................................................................................ 17 Nerve Evaluation ................................................................................................. 17
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APPENDICES ............................................................................................. 32
Board Layout and Schematic .................................................................................... 33 Parts List ................................................................................................................... 38 Suggested Reading ................................................................................................... 40
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READ ME FIRST
Memorize These Warnings Before Using This Instrument in the O.R.
ELECTROCAUTERY WARNING
To avoid patient burns and damage to the unit, observe the electrocautery precautions in the operators manual. Keep the ground electrode pads of the two units separated by at least 6 inches and keep the area between them free of electroconductive cream. Do not allow the cables of the electrocautery unit to be routed near the stimulator/monitor cables or sensor. Keep both sets of cables at least 6 inches apart. Never allow the electrocautery and stimulator probes to contact each other or simultaneously touch tissues or fluids in the surgical field.
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SERVICE & REPAIR: Because of the specialized circuitry of this instrument, the need for special test instruments, and our familiarity and experience with this instrument, we recommend that the instrument be returned to the factory for any necessary checking or servicing except routine battery replacement. See the Warranty, Service, and Loaner Program section of this manual for return instructions. This unit should be repaired only by qualified biomedical electronic technicians. GROUND ELECTRODE PLACEMENT: Do not place any stimulator ground electrodes on the chest or in close proximity to a pacemaker. Interference with the pacemaker could occur. If there is any uncertainty as to stimulator-pacemaker interference, do not use the stimulator on pacemaker patients.
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INTRODUCTION
The SILVERSTEIN FACIAL NERVE STIMULATOR/MONITOR, Model S8, is a greatly enhanced version of the JAKO FACIAL NERVE MONITOR which has been in use since 1974. The methods of stimulation and monitoring have remained unchanged from the JAKO, and the intended use remains the same, but the Model S8 is much more sensitive and has additional controls to make operation of the instrument easier. The Silverstein Facial Nerve Stimulator/Monitor, Model S8 uses adjustable, precisely controlled, low energy pulses to stimulate the facial nerve. A highly sensitive muscle movement sensor detects the resulting muscle movement in the cheek and generates an audible or visual signal. The muscle sensor is a clothespin shaped device which slides easily onto the patients cheek. This allows detection of super-fine cheek contractions (often finer than can be felt with the nurses hand) and allows drapes to remain over the face undisturbed. Pulses (current measured in amperes) are delivered to the tissues using a pencil shaped probe. The current intensity can be accurately adjusted by the surgeon using push buttons on the probe. At very low settings, the nerve will respond only when direct contact with the nerve is made. By probing the surgical site, and finding the lowest current which will elicit the least contraction, the surgeon can locate the Facial Nerve. The Model S8 utilizes two separate circuits: one for monitoring and one for stimulating. These circuits may be used concurrently or separately. The unit may be used as a stimulator only for plastic and reconstructive surgery, orthopedic surgery, or other procedures where visual or EMG confirmation of stimulus exists, or with the monitor for procedures involving the facial nerve.
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STERILIZATION GUIDELINES
Gas sterilize only: Muscle Sensor Remote Indicator Light Remote Probe Probe Tips Indifferent Electrode (pad) Cable
The Sensor, Probes, and Cables should not be immersed in liquids, but may be wiped with cleansing agents. The cables should be carefully coiled to prevent tangling and kinking.
CURRENT CHARACTERISTICS
The Model S8 is safer than most constant-voltage or non-pulsed-DC stimulators because it delivers pulsed, constant current stimulation. To illustrate, the amount of energy transmitted to the patient is proportional to the amplitude of current (in milliamperes) and the duration of the pulse. Constant-voltage units can deliver excessive current, because these units automatically deliver an unlimited amount of current (subject to circuitry limitations) to meet the voltage chosen by the operator. In some cases this can damage nerve tissue. Likewise, non-pulsed-DC-stimulation may damage nerve tissue because they allow non-pulsed current to be transmitted through the nerve as long as the probe tip touches the nerve. The Model S8 allows stimulation to be applied directly on nerve tissue without risk of over stimulaFigure 1 tion.
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OUTPUT PARAMETERS
The Model S8 provides a square wave pulse which is adjustable from .05 mA (residual current) to 10.0 mA (maximum current) by means of the remote probe or a switch on the front panel. Current intensity refers to the amplitude of the individual pulses, not to the average level of current. Between pulses there is no current. Nerve response to electrical stimulation is a function of current intensity through the nerve rather than of applied voltage. Consequently, precise control of current intensity is essential for quantitative evaluation of nerve response. In the Model S8, the voltage is automatically adjusted (utilizing a constant current output) to compensate for any differences or changes in the patient-stimulator circuit resistance so that the current is constant at any given setting of the current intensity display. The pulse width is .0002 sec., with an off time of .1998 sec, for a total period of .200 sec. (The corresponding frequency is 5 pulses per second. There is a residual current of .05 mA when the display is at 0.) The pulse width of .0002 seconds has been found to be optimal for subcutaneous (intraoperative) stimulation. For transcutaneous stimulation, a pulse width of .0006 seconds is required, due to the skin barrier. Stimulators with a .0006 second pulse width are available from WR Medical Electronics. Stimulators with a .0006 second pulse width may be used subcutaneously without ill effect but a .0002 second wave will not be effective transcutaneously.
PARALYZING DRUGS
A fairly high concentration of Xylocaine injected in close proximity to the facial nerve can reduce its responsiveness to the stimulating current and/or paralyze the nerve so that the muscle does not respond to electrical stimulation. However, it has been found that solutions containing one per cent or less of Xylocaine injected in normal quantity and not unduly close to the nerve do not appear to affect the function of the Model S8. Succinylcholine can also cause muscle paralysis and prevent the facial muscles from contracting during stimulation.
designed to be quite sensitive in order to respond to very small muscle response. This sensitivity can cause artifacts that are not a result of nerve stimulation. Patient movement and accidental contact with cables can also cause a monitor response. Operation of electrosurgery/cautery equipment may also cause a false response, depending on the equipment, cable and electrode arrangement and other unknown factors.
Since the cheek can only contract as a result of nerve impulses, and since sensor only picks up contractions as a result of impulses (natural or artificial stimulation), most artifacts can be ignored with this exception: In some cases the exposed nerve will spontaneously fire impulses when it is directly manipulated with a surgical instrument, bumped with a tool, or irrigated with cold fluids. If the spontaneous impulses are large enough, they will cause a contraction large enough to be detected by the sensor. The sensitivity levels of each sensitivity-switch position (#1, 2, 3 and 4) can be checked and modified as outlined in the service manual. Settings should be set according to the latest standards issued by WR Medical Electronics.
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SYSTEM COMPONENTS
The Silverstein Facial Nerve Stimulator/Monitor Model S8 Components: Remote Control Probe Pad (ground) Cable Remote Indicator Light Cheek-muscle Movement Sensor Foot Switch Set of 3 Snaps 7 Probe Tips: Short Pointed Short Blunt Long Pointed Std Long Pointed Medium Long Pointed Fine Long Blunt Long Flush Tip Therasol Electrode Cream (4 oz. Bottle) Theratrode Disposable Electrode Pads (Pkg. of 10) Operators Manual Service Manual Reference Papers Video Tape Electrocautery Warning
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SKIN PREPARATION
An indifferent electrode pad, also called a ground pad, applied to the skin outside the sterile field completes the stimulator circuit through the patient. Use WR Medical THERATRODE or new selfadhesive THERATRODE II for best results. If using the THERATRODE pad, and to minimize the electrical resistance between the electrode and skin, the fabric layer of the pad must be thoroughly saturated with THERASOL electroconductive cream so that the cream reaches the underlying layer of foil. A small amount of the electrode cream should also be massaged into the skin to break down the natural skin oils and reduce the electrical resistance. THERASOL cream readily soaks through the fabric layer, but electroconductivity gels may not penetrate the fabric and will not assure good electrical contact. The purpose of the fabric layer is to retain the THERASOL electrode cream and maintain good conductivity during long surgical procedures. The THERATRODE pad is disposable and if it is reused, the solids from previous applications of THERASOL cream will retard penetration of the cream and cause excessive resistance. When the patient is being prepared for surgery, apply the THERATRODE electrode pad saturated with THERASOL cream in an appropriate area outside the sterile field underneath the drapes and secure it with adhesive tape. Attach one end of the Pad (ground) cable to the snap connector on the pad, allowing the other end to extend from beneath the drapes for later connection to the unit.
PULSE LIGHT
When instrument is on, the clear PULSE light flashes with each pulse of the stimulating current, indicating that the instrument is on and that the stimulator section is functioning. Between stimulating or monitoring activity, turn the instrument off to conserve battery power.
HORN/LIGHT SWITCH
The HORN/LIGHT switch is used to select aural or visual signal, at the option of the surgeon. In cases where other patient alarms have a similar aural signal, or where the operating environment may be too noisy to hear the audible tone, the visual signal may be selected. An extra loud audio signal has been provided for procedures where other surgical equipment may generate substantial sound levels. The sound level may be easily reduced to a comfortable level by adjusting the sound attenuator on the face of the horn.
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TILT STAND
The tilt stand can be rotated to the rear of the instrument to allow placement on a stack of monitoring equipment. To rotate, pull both stand hubs out simultaneously and rotate underneath the instrument.
Figure 4: General relationship between applied current and distance from nerve.
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NERVE IDENTIFICATION
In differentiating a nerve from fibrous tissue, the current intensity should be set at the minimum level which will evoke muscle contractions with the probe applied directly to the nerve. When the probe is applied to other tissues at this same setting, there should be no response. If the current is set too high, the nerve may be stimulated when the probe is applied to other tissues and the test will not differentiate the nerve. In differentiating two nerves or nerve branches in close proximity, the stimulating current is applied to each in turn and the differential muscle response is observed. It is essential that the current intensity be set low enough to stimulate only the nerve to which the probe is applied. Too high a current could stimulate both nerves simultaneously.
NERVE EVALUATION
When greater-than-threshold electrical stimulation is applied to an exposed nerve, the presence or absence of muscle contractions indicates the viability of the nerve. Stimulation of the exposed facial nerve with currents of .05 to .2 mA will indicate normal facial function postoperatively.
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1.0
MAINTENANCE INTRODUCTION
This section of the manual covers the Silverstein Facial Nerve Stimulator/Monitor model S8 periodic maintenance and checkout procedures. If you experience problems with your unit contact WR Medical Electronics Technical Service Hotline. Because of specialized circuitry only qualified biomedical personnel should attempt to repair the Silverstein Facial Nerve Stimulator/Monitor model S8.
MONITOR
The Silverstein Nerve Stimulator/Monitor model S8 is very sensitive. It utilizes a high gain differential amplifier in conjunction with a mechanical strain gage muscle movement sensor to detect contractions of the cheek muscle when the Facial nerve is stimulated. The signal is then processed and presented in the form of an audio alarm beep or the flash of an indicator light. The sensitivity of the monitor is controlled by the sensitivity switch on the front panel. Sensitivity position 1 is the most sensitive and position 4 is the least sensitive. The unit can be muted with the use of the foot switch.
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2.0
MAINTENANCE SCHEDULE
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3.0
MAINTENANCE PROCEDURES
Maintenance procedures in sections 3.2 through 3.6 must be done only when the instrument case is closed. If calibration procedures are going to be preformed, complete section 4 and then follow the maintenance procedures in section 3.2 through 3.6 for the final checkout.
Setup:
Procedure:
1. 2. The charge light should illuminate when the charger is plugged in and the unit is turned off. For full battery capacity, charge the unit for 36 hours, or leave the unit plugged in when not in use. When the unit is turned on, the green monitor Battery Good indicator should illuminate, this indicates adequate charge is present. Do not use instrument without the green Battery Good indicator illuminated. The yellow Battery Charge indicator illuminates when there is approximately 30 minutes of battery power remaining.
Check the charge circuit by turning the unit off and plugging the WR wall mount battery charger into the 115-volt wall outlet and the power plug into the rear of the unit. The red Battery Charge indicator should illuminate. Check the electrocautery mute foot switch for nicks and cuts in the cable or other obvious physical damage. Check the plug for proper fit into the foot switch jack on the instrument.
4.
3.5A
1. 2.
3.
4.
3.5B
1. 2. 3. 4.
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5. 6. 7. 8.
Tap on the top sensor blade lightly (the top blade has a thumb screw) the audio alarm should sound. Repeat steps 1-5 for sensitivity settings 2, 3, and 4. While taping on the sensor lightly to evoke the audio alarm step on the foot switch. No audible response should be evoked. If audible alarm does not cease when you step on the foot switch while taping on the sensor, check the foot switch with an ohm meter for continuity when the foot switch is at rest. Also check for infinite resistance when the switch is stepped on. If fault cannot be found, return complete unit to WR Medical Electronics for repair.
3.6A
This step checks the circuit board and wiring to be sure that excessive current is not being drawn from the stimulator AA battery pack.
Equipment Needed:
1. 2. 1. 2. 3. 4. 1. 2. Power supply VOM meter. Open the small gray door on the rear of the unit. Disconnect the AA battery pack. Set the power supply to zero (0) volts. Turn the power supply off. With the Silverstein S8 power switch in the off position, observe polarity and connect wires from the power supply to the stimulator battery connector with an in-line Ammeter. Turn the unit on and slowly bring the power supply voltage up to 4.75 volts. The current draw should equal approximately 20 mA at 4.75 volts.
Setup:
Procedure:
If the stimulator current draw exceeds 30 mA return unit to WR Medical Electronics for repair.
3.6B
1. 2. 3.
Procedure:
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Equipment:
1. 2. 3. 1. 2. 1. 2. 3. 4. Remote Probe Probe tip Jumper wire Insert a probe tip into the chuck on the remote probe Plug the remote probe into the probe jack. Turn the unit on. The pulse light and the Incomplete Stimulation Light should be flashing. Touch the end of the probe (with a tip inserted) to the PAD jack and then to the GND jack. The Incomplete Stimulation Light should go out, indicating a complete electrical path. Push the remote probe switch button nearest the probe tip. The current intensity should increase. When pushing the switch button on the cord end, the current intensity should decrease. Disconnect the probe from the unit. Attach a jumper wire between the active and GND jack; the incomplete stimulation should go out indicating a complete electrical path.
Setup:
Procedure:
Figure 5
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Equipment:
1. 2. 1. Oscilloscope IK 1/4 watt resistor Set the scope sweep to .1 milliseconds/division, sensitivity to 10.0 millivolts/division, DC coupled, slope to negative (-). Set the current intensity display on the Silverstein S8 to 0.00 mA. To Check the Stimulator Bias Current and Gain: Check the bias (current intensity display at 0.00) for 50 microamps or 50 millivolts displayed on the scope. Check the current gain by adjusting the scope to 2 volts/division and changing the units current intensity to 10 milliamps. By ohms law, 10 volts dropped across a 1K resistance equals 10 milliamps (E=I/R). Set the scope sensitivity at 2 volts/division, sweep at 20 milliseconds/div and align the triggered pulse precisely on the grid line on the far left side of the screen. Check the frequency for 200 milliseconds.
Setup:
2.
Procedure:
1.
2.
3.
To Check the Stimulator Pulse Width: Reset the sweep to 0.1 milliseconds/division and check for a pulse width of 0.2 milliseconds. If unit is out of calibration, return to WR Medical Electronics for calibration.
3.6E
Setup: 1. 2.
PART A Procedure:
1. 2. 3. Disconnect the stimulator output load (IK ohm). The excess resistance light should flash. Reattach the IK load. Adjust the current intensity display down from 10 milliamps progressively to settings of 6.0, 3.0, and 0.0 milliamps, checking the pulse amplitude on the scope against the current intensity display to verify linearity.
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4.
Test the excess resistance light operation at 6.0, 3.0, and 0.0 milliamps by disconnecting the IK resistor from the output. When the IK load is removed the Incomplete Stimulation light should flash.
PART B
Description: When the stimulator load resistance is too great to supply constant current, the Incomplete Stimulation light will flash.
Equipment:
1. 2. 3. 1. 2. 3. 4. 5. 1. Oscilloscope 1K 1/4W resistor 100K variable resistor Connect a 1K 1/4 W resistor and a 100K variable resistor in series across the stimulator output. Set the variable resistor at 0 ohms. Attach the scope output across the IK resistor. Set the scope sensitivity to 1 volt/division, sweep at 0.1 milliseconds/division, DC coupled, and the slope to negative (-). Adjust the current intensity to 5.50 milliamps. Adjust the 100K variable resistor upwards until it brings the pulse amplitude on the scope back down to 5 milliamps (5 volts displayed on the scope). Adjust the current intensity down below 5.0 milliamps, and then adjust it back to 5.0 and above. Up to a setting of 5.0 milliamps, the current intensity should increase. But above 5.0 milliamps the current should not increase. The incomplete stimulation light should come on between 4.5 and 5.2 milliamps.
Procedure:
2.
3.
If any problems are found in section 3, return complete unit to WR Medical Electronics for repair. If you are qualified and choose to perform Calibration procedures yourself, please follow section 4. If the unit is opened, section 3 must be repeated after the enclosure is closed. This helps assure safe and reliable operation.
Figure 8
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Equipment:
1. 1. 2. 3. 1. 2. Two Digital VOMs (fused) Separate the nickel cadmium battery connectors and put an ammeter in series with the positive red battery leads. Put an ammeter in series with the negative black battery leads. Attach the remaining two battery connections to there matched connections with two jumpers. Turn the ammeters on. Turn unit on momentarily. The positive side of the battery supply should draw approximately 50 milliamps and the negative side of the battery supply should draw approximately 100 milliamps.
Setup:
Procedure:
4.1A
1. 2. 1. 2. 3. 4. 5. 6.
Equipment:
Setup:
Procedure:
1.
2.
Turn the supply down to 16.2 volts. The red battery fail indicator should come on at this point. If the fail indicator does not illuminate, adjust component R70 until it just comes on at 16.2 volts.
4.2 STIMULATOR INITIAL POWER UP, STIMULATOR BATTERY METER SET, AND STIMULATOR VOLTAGE REGULATOR CALIBRATION:
Equipment:
1. 2. 1. 2. 3. 4. 5. 6. 7. Digital VOM Power supply Set the power supply to 0 volts and turn supply off. Unplug the AA battery pack. Connect power supply to the AA battery pack connector observing polarity. Turn the power supply on. Slowly raise the power supply voltage to 4.75 volts while observing the current draw. The current draw should be approximately 20 milliamps. If the unit is drawing proper current, check the red battery fail indicator. The indicator should just be coming on at 4.75 volts. Adjust component R72 for battery fail at 4.75 volts if necessary. With the power supply at 4.75 volts adjust the stimulator voltage regulator to 3.8 volts. Move the positive volt meter leads to the positive pole of capacitor C16. Move the negative leads to TP7. Adjust R45 until 3.8 volts is displayed on the volt meter.
Setup:
4.3 STIMULATOR PULSE WIDTH, FREQUENCY, AMPLITUDE AND MOTOR POT OPERATION:
Current intensity refers to the stimulator pulse amplitude in milliamperes. Stimulator pulse amplitude is measured with a 1K resistor across the output of the instrument. The voltage drop across the IK is displayed on the scope. In accordance with Ohms law, the scope therefore measures pulse amplitude directly in milliamps (1 volt on scope = 1 milliamp). The GND jack corresponds to the PAD jack and the ACTIVE jack corresponds to the probe tip or active electrode. The output pulses are negative-going on the scope. See Figure 1 for complete description of stimulator waveform.
Equipment:
1. 2. 1. 2. 3. Oscilloscope IK 1% 1/4W resistor Attach a 1K resistor across the output of the stimulator see figure 5 (between ACTIVE and GND). Attach the scope input across the stimulator output see figure 5 (ACTIVE to pos(+), GND to neg (-)). Scope: sweep = .1 milliseconds, sensitivity = 10 millivolts/division, DC coupled, slope at negative (-).
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Setup:
4. 1.
Set the Silverstein S8 current intensity display to 0.00 mA. Turn unit on and set the stimulator bias with R62 to 50 microamps (50 millivolt on scope). Change scope sensitivity to 2 volts/division, set the current intensity display to 10 mA and adjust the gain trimpot R59 to 10 milliamps amplitude (10 volts on scope). The bias and gain trimpots are interactive. Repeat step 1 above until both the bias (50 microamps) and the gain (10 milliamps) are correct. Set scope sensitivity to 2 volts/division, sweep to 20 milliseconds/division and align the triggered pulse precisely on the far left grid division marker. Adjust the pulse frequency trimpot R60 to 200 milliseconds (5 pulses/second). Reset the sweep to 0.1 millisecond division and Adjust R46 for a pulse width of 0.2 milliseconds. The motorpot should run smoothly from 0 milliamps to 10 milliamps. If operating improperly check for proper alignment between the motor and the 10 turn potentiometer.
Procedure:
2. 3. 4. 5. 6.
Setup:
1. Attach the negative lead on the volt meter to monitor Ground TP6, and the positive lead to TP5.
Procedure:
1. 2. Turn the sensitivity Knob to position #1. TP5 should read as follows: Position 1 = 35 mv, R27. Position 2 = 50 mv, R28. Position 3 = 65 mv, R29. Position 4 = 100 mv, R30.
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3.
Figure 9
4.
WR Medical Electronics suggests sending the complete unit to them if calibration is necessary. If you attempt to adjust the input, use two 350 ohm resistors connected in series that are within 2% of each other, in place of the sensors strain gages (refer to Figure 8). The common point is where the two resistors connect together. This point represents the center connection on the sensor plug where the strain gages meet. Attach the remaining end of each resistor to there respective location. See the schematic for details before attempting this procedure. Adjust R2 until -2 volts is obtained. After calibration repeat step 1, 2, and 3 of section 4.5, part 2. If the offset is still not within specifications, the sensor is defective and must be repaired or replaced. After completing part 2, tap lightly on the sensor to test for alarm output with the sensitivity set at positions 1, 2, 3, and 4. Test the sensor for shorts and open circuits when flexed. The monitor bias with the sensor installed should be checked before testing for sensor shorts and open circuits. This is because the resistance of the strain gages are altered when the blades are flexed a small amount. It takes a short time for the strain gage resistance to stabilize after being flexed. See section 3.5 (part a) for procedure.
5. 6.
After the unit calibration is complete, and the case is closed, it must then go through complete final checkout procedures, see section 3.
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APPENDICES
Board Layout and Schematic Parts List Suggested Reading
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#
4 2 1 1 1 1 1 1 1 9 3 1 1 1 1 2 2 1 1 1 1 1 1 1 1 1 1 1 4 1 1 1 1 1 9 6 2 4 3 3
Part # Component
14146 15002 15006 15010 15014 15042 15048 15049 15079 15091 15095 15098 15103 15121 15146 15149 15163 16000 16005 16007 16009 16011 16013 16014 17026 17034 17038 17039 17040 17042 17043 17046 17048 17049 17050 17051 17052 17053 17054 17057 Conn,Crimp,.10,6 cond,mol Decal, Wall Mt Chgr S8/Br Decal,(Bright Orange) Decal,(Ser No.) Decal,Batt Repl,S8 Hdwr,Bracket motorpot Hdwr,Cardboard,rect Hdwr,Cardboard,sq Hdwr,Elec,Test Point Hdwr,Knob,chrome faced Hdwr,Lock washer,int,#4 Hdwr,Nut 4-40 Hex-Keps Hdwr,Nut 8-32 Hex-Keps Hdwr,Screw,Phil pan hd,#4x1/4 Hdwr,Screw,pan hd,4-40x1/2 Hdwr,Screw,pan hd,8-32x1/2 Hdwr,Stand-off,PSA, 1/4" Audio,alarm Display,LCD,Backlit Lamp,LED,green Lamp,LED,red Lamp,LED,yellow Lamp,neon,amber Lamp,neon,clear Res,1/4w,270 ohm Res,1/4w,O ohm,(jumper) Res,1/4w,100 ohm,CF Res,1/4w,100K ohm,CF Res,1/4w,10K ohm,CF Res,1/4w,150K ohm,CF Res,1/4w,15K ohm,CF Res,1/4w,1K ohm,CF Res,1/4w,2.2K ohm,CF Res,1/4w,2.2M ohm,CF Res,1/4w,2.7K ohm,CF Res,1/4w,220 ohm,CF Res,1/4w,220K ohm,CF Res,1/4w,221 ohm,1% Res,1/4w,22K ohm,CF Res,1/4w,270K ohm,CF
#
2 1 1 1 1 1 5 1 8 1 4 2 2 16 2 2 4 1 1 2 4 1 1 1 4 13 1 1 25 1 1 6 1 1 3 2 1 2 3 1
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#
1 1 1 1 2 5 1 2 4 2 1 4 2 1 1 7 3 2 1 4 2 1 1 1 2 1 1 1 5 5 2 1 1 2 1 2 2 1 2 2
Part # Component
20054 20056 20065 20068 20069 20070 20074 20092 21010 21011 21014 21015 21016 22004 23014 23015 23016 23017 23018 23019 23020 IC, Socket,18 pin IC, Socket,8 pin Transis, 2N3638 Transis, NTE-194 Transis, 2N6027 Transis, 2N697 Transis, GE-53/Phil ECG158 Diode,1N4005 SW,relay,2 Form C SW,rotary,3P4T SW,toggle,3PDT SW,toggle,SPDT SW,toggle,SPDT,(on)/off/(on) Wire Set, S8 Manual pgs, SS opr (3009) Manual pgs, SS serv (3010) Manual pgs, H3 opr (3025) Manual pgs, H3 serv (3024) Manual pgs, SACS kit opr (3029) Manual pgs, Br Il serv (3170) Manual pgs, Br II scientific (3169)
#
1 13 2 4 1 4 1 2 2 1 1 1 1 1 1 1 1 1 1 1 1
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SUGGESTED READING
The following references will provide excellent reading. Pay particular attention to the articles written by Herbert Silverstein, MD, and view the video provided with the instrument. Campbell, E.D.R. A Simple Prognostic Test in Facial Palsy. J. of Laryngology 77:462466, June, 1963. Campbell, E.D.R.; Hickey, R.P.; Nixon, K.H.; and Richardson, A.T. Value of Nerve Excitability Measurements in Prognosis of Facial Palsy. Brit. Med. J.2:710, July 7,1962. Chase, S. G.; Hughes ,G.B.; and Dudley, A.W. Neuropathic Changes Following Direct-Current Stimulation of the Rat Sciatic Nerve. Otolaryng. Head Neck Surg.92:615617, Dec., 1984. Gray, Jack A. Nerve Stimulators and Burns. Anesthesiology 42/2:231232, Feb., 1975. Hilger, Jerome A. Facial Nerve Stimulator, trans. Amer. Acad. Opthal. & Otolaryng.64:7476, Jan.Feb., 1964. Hughes, G.B.; Bottomy, M.B.; Dickens, J.R.E.; Jackson, C. G.; Sismantis, A.; and Glasscock III, M.E. A Comparative Study of Neuropathologic Changes Following Pulsed and Direct Current Stimulation of the Mouse Sciatic Nerve. Amer. J. Oto. l/5:378384, Nov., 1980. Lippmann, Maurice; Fields, William A. Burns of the Skin Caused by a Pheral-Nerve Stimulator. Anesthesiology 40/1:8284, Jan., 1974. Love, Jr, J.T.; and Marchbanks, J.R. Injury to the Facial Nerve Associated with the Use of a Disposable Nerve Stimulator. ORL 86:6164, Jan.-Feb., 1978. Prass, R.L.; Kinney S.E.; Hardy, Jr., R.W.; Hahn, J.F.; and Luders, H. Acoustic (Loudspeaker) Facial EMG Monitoring, II: Use of Evoked EMG Activity During Acoustic Neroma Resection. Otolaryngol. Head Neck Surg. 97/6:541551, Dec., 1987. Silverstein, H. Microsurgical Instruments and Nerve Stimulator Monitor for Retrolabyrinthine Vestibular Neurectomy. Otalaryngol. Head Neck Surg. 94/3:409411, 1986. Silverstein, H.; Smouha E.; Jones R.O. Routine Intraoperative Facial Nerve Monitoring During Otologic Surgery. Amer. J. Otol. 9/4:269275, July, 1988. Silverstein, H.; Smouha, E.; and Jones, R.O. Routine Identification of the Facial Nerve Using Electrical Stimulation During Otological and Neurotological Surgery. Laryngoscope 98:14, July, 1988. Silverstein, Herbert. Surgery of the Facial Nerve. J. of Otolaryngol. 10/6:449458, 1981. Zini, Carlo; Gandolfi, Angelo. Facial-Nerve and Vocal-Cord Monitoring During Otoneurosurgical Operations. Otolaryngol. Head Neck Surg. 113:12911293, Dec., 1987.
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