Bionet BM3 Operation & User’s Manual

BM3 User’s Manual Patient Monitor Rev. 3.0 2019.11.22 Warning To ensure proper use of this medical equipment, you must read and comply with this user manual.

BM3 User Manual Softwareⓒ Bionet, Co., Ltd. 2016. All rights reserved. Reproduction in any manner, in whole or in part, except for brief excerpts in reviews and scientific papers, is prohibited without prior written permission of Bionet, Co., Ltd. Before using Bionet devices, read all the manual that are provided with your device carefully. Patient monitoring equipment, regardless of the complexity of the equipment, should never be used as a substitute for the patient care, attention, and critical judgment that only trained health care professionals can provide. CAPNOSTAT, LoFlo® is trademark of Respironics. All other brand or product names are the property of their respective owners.

Table of Contents Intended Use ....................................................................................................................................................... 9 General Description ......................................................................................................................................... 9 Patient Classification ................................................................................................................................... 10 Functional safety ............................................................................................................................................ 10 Warning, Caution, Note ............................................................................................................................. 11 Define groups .................................................................................................................................................. 12 General precaution on environment ................................................................................................... 13 Electromagnetic Compatibility ............................................................................................................... 14 1. Basic ................................................................................................................................................................ 15 Overview ........................................................................................................................................................ 15 Electric safety precautions ................................................................................................................... 15 Biocompatibility ......................................................................................................................................... 17 Product Configuration............................................................................................................................ 17 Option Product ........................................................................................................................................... 18 Basic Unit ....................................................................................................................................................... 19 Device Markings ........................................................................................................................................ 24 Power ............................................................................................................................................................... 25 How to replace the battery ................................................................................................................. 29 Getting Started ........................................................................................................................................... 31 2. SETUP .............................................................................................................................................................. 34 Overview ........................................................................................................................................................ 34

BM3 User’s Manual Monitor configuration ............................................................................................................................ 34 Main menu setup ...................................................................................................................................... 35 3. Network ......................................................................................................................................................... 41 Overview ........................................................................................................................................................ 41 Network connection ................................................................................................................................ 41 Remote View ............................................................................................................................................... 42 Display Mode .............................................................................................................................................. 44 4. Admission and Discharge .................................................................................................................... 46 Overview ........................................................................................................................................................ 46 Patient admission ..................................................................................................................................... 46 Patient discharge ...................................................................................................................................... 47 Registration of patient ID using barcode .................................................................................... 52 5. Alarm .............................................................................................................................................................. 53 Overview ........................................................................................................................................................ 53 Alarm priority .............................................................................................................................................. 53 Alarm management ................................................................................................................................. 55 Alarm settings ............................................................................................................................................. 56 Alarm event .................................................................................................................................................. 57 6. TREND ............................................................................................................................................................ 58 Overview ........................................................................................................................................................ 58 Trend setup .................................................................................................................................................. 58 Graphical trend........................................................................................................................................... 61 Tabular trend ............................................................................................................................................... 62 File export ..................................................................................................................................................... 63 Popup trend ................................................................................................................................................. 65

BM3 User’s Manual 7. ECG ................................................................................................................................................................... 67 Overview ........................................................................................................................................................ 67 ECG Precaution ........................................................................................................................................... 68 Patient preparation .................................................................................................................................. 71 ECG lead ......................................................................................................................................................... 72 ECG signal processing and display.................................................................................................. 73 ST signal processing and display ..................................................................................................... 74 Alarm and alarm status ......................................................................................................................... 74 Display............................................................................................................................................................. 75 ECG Settings ................................................................................................................................................ 75 Trouble shooting ....................................................................................................................................... 78 8. Arrhythmia Monitoring(*) ................................................................................................................... 80 Overview ........................................................................................................................................................ 80 Arrhythmia templette ............................................................................................................................. 80 Arrhythmia Settings................................................................................................................................. 81 9. SpO2 ................................................................................................................................................................ 83 Overview ........................................................................................................................................................ 83 Precaution ..................................................................................................................................................... 83 Patient preparation .................................................................................................................................. 84 Display............................................................................................................................................................. 85 Quality of SPO2 Waveform ................................................................................................................. 87 SPO2 Settings ............................................................................................................................................. 88 Status messages ........................................................................................................................................ 89 10. RESPIRATION ........................................................................................................................................... 90 Overview ........................................................................................................................................................ 90

BM3 User’s Manual RESP precaution......................................................................................................................................... 90 Patient Preparation .................................................................................................................................. 91 Display............................................................................................................................................................. 93 RESP Settings .............................................................................................................................................. 94 OxyCRG monitoring ................................................................................................................................. 94 11. NIBP .............................................................................................................................................................. 97 Overview ........................................................................................................................................................ 97 Display............................................................................................................................................................. 99 NIBP Settings ............................................................................................................................................ 100 Measurement Limitations ................................................................................................................... 103 Status Messages ...................................................................................................................................... 105 12. EtCO2(*) .................................................................................................................................................... 106 Overview ...................................................................................................................................................... 106 Precaution ................................................................................................................................................... 111 Sampling method ................................................................................................................................... 112 Display........................................................................................................................................................... 114 EtCO2 setup ............................................................................................................................................... 114 Status Message ........................................................................................................................................ 119 13. Temperature ........................................................................................................................................... 122 Overview ...................................................................................................................................................... 122 Display........................................................................................................................................................... 123 Temperature settings ............................................................................................................................ 124 14. Printer ........................................................................................................................................................ 125 Overview ...................................................................................................................................................... 125 Printer settings ......................................................................................................................................... 126

BM3 User’s Manual Thermal Paper Storage ........................................................................................................................ 128 Paper Change ............................................................................................................................................ 129 15. Maintenance and Troubleshooting ........................................................................................... 130 Inspection Equipment ........................................................................................................................... 130 Inspection Cables .................................................................................................................................... 130 Maintenance Task and Test Schedule ......................................................................................... 131 Noise in ECG .............................................................................................................................................. 133 SpO2 malfunction ................................................................................................................................... 134 Temperature malfunction ................................................................................................................... 134 NIBP malfunction .................................................................................................................................... 135 Abnormality in NIBP measurements ............................................................................................ 135 EtCO2 malfunction ................................................................................................................................. 136 Failure in battery recharge ................................................................................................................ 136 Power failure ............................................................................................................................................. 137 Data storage failure ............................................................................................................................... 137 Periodic noises.......................................................................................................................................... 138 Print failure................................................................................................................................................. 138 16. Clean and Care ...................................................................................................................................... 139 Overview ...................................................................................................................................................... 139 Monitor and Peripherals ..................................................................................................................... 139 17. Technical Specification ..................................................................................................................... 143 Overview ...................................................................................................................................................... 143 EMC Compatibility (EMC) ................................................................................................................... 143 Manufacturer’s declaration - electromagnetic emission................................................... 145 Manufacturer’s declaration - electromagnetic immunity ................................................. 146

BM3 User’s Manual Guidance and manufacturer’s declaration - electromagnetic immunity ................. 152 System Specification ............................................................................................................................. 154 Adult & Pediatric-ICU Mode ................................................................................................................... 160 Alarm level .................................................................................................................................................. 160 Neonate-ICU Mode ...................................................................................................................................... 161 Alarm level .................................................................................................................................................. 161 Parameter Limits .......................................................................................................................................... 162 Display ............................................................................................................................................................... 163 Abbreviations and Symbols ................................................................................................................... 164 PRODUCT WARRANTY ............................................................................................................................. 169 International Sales & Service Contact .............................................................................................. 170

BM3 User’s Manual Intended Use The BM3 monitor is for multi-parameter patient monitoring. The instrument generates visual and audible alarms when a variety of physiological parameters are monitored over a present limit and time, or where recording begins. This equipment is connected via BM central. Note All Bionet hardwares and screenshots in this user guide are for illustration purposes only. Actual products or screens may vary slightly. General Description The BM3 monitor can monitor the following:  Heart Rate  Respiration Rate  Non-Invasive blood pressure  Arrhythmia  Temperature  SpO2  Pulse Rate  Apnea  ST segment analysis  EtCO2(option)  FiO2(option) This equipment is designed to be used in an environment where a health care professional can determine when to use the equipment for its intended purpose, based on an expert assessment of the patient's medical condition, including physicians, nurses.

BM3 User’s Manual Patient Classification BM3 monitors are designed for use by adults, pediatrics and neonates. At this time, cardiac output, ST segment analysis and arrhythmia should be used for adults and pediatrics only. Functional safety The essential performance of the patient monitor is to provide the clinician with meaningful parameter values and to sound an alarm when the established parameter value is exceeded or the function that provides the value is not working properly. We assessed the risks associated with the use of these monitors in light of these essential performance features and mitigated the risk of lowering the residual risk to a level that could be used without compromise as long as the product maintained its regular lifecycle maintenance and service recommendations.

BM3 User’s Manual Warning, Caution, Note The following terms are defined in the User Guide to emphasize the agreement as follows: The user must follow all warnings and precautions. The specifications and functions shown in this manual are subject to change without prior notice. Warning “Warning” A warning contains important information regarding possible danger to you or the patient that is present during normal operation of the equipment Caution “Caution” A caution provides information or instructions that must be followed to ensure proper operation and performance of the equipment. Note “Note” A note presents information that helps you operate the equipment or connected devices.

BM3 User’s Manual Define groups The define groups for this product are users, service personnel, and experts. Define groups should read the user manual before using the product and be trained in the use, installation, reprocessing, maintenance and repair of the product. This product can only be used, installed, reprocessed, maintained and repaired by a defined group. User Users use the product for their intended use. Service personnel Service personnel are responsible for the maintenance of the product. They must be trained in the maintenance of the medical device, install, reprocess and maintain the product. Expert The specialist repairs the product or performs complex maintenance tasks. The expert Have the knowledge and experience to perform complex maintenance tasks on your product.

BM3 User’s Manual General precaution on environment - Do not keep or operate the equipment in the environment listed below. Avoid placing in an area exposed to moist. Do not touch the equipment with wet hand. Avoid exposure to direct sunlight Avoid placing in an area where there is a high variation of temperature. Avoid in the vicinity of Electric heater Avoid placing in an area where there is an excessive humidity rise or ventilation problem. Avoid placing in an area where there is an excessive shock or vibration. Avoid placing in an area where chemicals are stored or where there is danger of gas leakage. Avoid being inserted dust and especially metal material into the equipment Do not disjoint or disassemble the equipment. We take no responsibility for it. Power off when the equipment is not fully installed. Otherwise, equipment could be damaged.

BM3 User’s Manual Electromagnetic Compatibility The monitor has been designed and tested for compliance with current regulatory standards as to its capacity to limit electromagnetic emissions(EMI), and also as to its ability to block the effects of EMI from external sources. The monitor complies with the following standards pertaining to EMI emissions and susceptibility: EN60601-1-2. To reduce possible problems caused by electromagnetic interference, we recommend the following:  Use only Bionet approved accessories.  Ensure that other products used in areas where patient monitoring and life support is used comply to accepted emissions standards (CISPR 11, Class A).  Try to maximize the distance between electro-medical devices. High-power equipment related to electrical simulators, electrosurgical instruments and radiators (X-ray machines) as well as evoked potential devices may cause monitor interference.  Strictly limit exposure and access to portable radio frequency sources (e.g. cellular phones and radio transmitters). Be aware that portable phones may periodically transmit even when in standby mode.  Maintain good cable management. Do not route cables over electrical equipment. Do not intertwine cables.  Ensure all electrical maintenance is performed by qualified personnel. Caution Infectious devices and parts must be sanitized and cleaned before disposal. 사용 안내서

BM3 User’s Manual 1. Basic Overview This patient monitor is for adult, pediatric, and neonatal monitoring. It can be used as an independent device or connected to the BM Central network. Use of the monitor is limited to one patient at a time. The following optional software features are available:  Arrhythmia analysis.  3-lead ST segment analysis.  It is common to connect B2B VIEWs, and the two connections are optional.  Wireless network connection Electric safety precautions Caution Please check the following before using the product. 1. Be sure that AC power supply line is appropriate to use. (AC100 - 240V) 2. Be sure that the power source is the one supplied from Bionet.(DC18V, 2.8A, BPM050 Made in BridgePower Co., Ltd.) 3. Be sure that the entire connection cable of the system is properly and firmly fixed. 4. Be sure that the equipment is completely grounded.(If not, there might be the problem occur in the product.) 5. The equipment should not be placed in the vicinity of electric generator, X-ray, broadcasting apparatus to eliminate the electric noise during operation. Otherwise, it may cause incorrect result.

BM3 User’s Manual Caution The Equipment should be placed far from generator, X-ray equipment, broadcasting equipment or transmitting wires, so as to prevent the electrical noises from being generated during the operation, When these devices are near the Equipment, it can produce inaccurate measurements. For BM3 both independent circuit and stable grounding are essentially required. In the event that the same power source is shared with other electronic equipment, it can also produce inaccurate output. Note BM3 is classified as follows: - BM3 classifies as Class II, BF & CF concerning electric shock. It is not proper to operate this Equipment around combustible anesthetic or dissolvent. - Noise level is A class regarding IEC/EN 60601-1 and the subject of Nose is A level concerning IEC/EN60601-1-2. Warning Do not touch the patient while using the defibrillator. The user may be at risk. When using the defibrillator, be careful about safety and use only the supplied cable. Warning In case the Equipment does not operate as usual or damaged, do not use on patient, and contact to the medical equipment technician of the hospital or the equipment supply division.

BM3 User’s Manual Equipment connection Caution Doctors and patients in hospitals are exposed to the risk of uncontrollable currents. This current is caused by a potential difference between the equipment and a conductive object that can be contacted. Use auxiliary equipment to meet this requirement in accordance with EN60601-1; 2011. Biocompatibility When used as intended, the parts of the product described in this operator manual, including accessories that come in contact with the patient during the intended use, fulfill the biocompatibility requirements of the applicable standards. If you have questions about this matter, please contact Bionet or its representatives. Product Configuration 1. Main body of BM3 Monitor 1 EA 2. 3-Lead Patient Cable with extension cable 1EA 3. Disposable electrodes 10 EA 4. NIBP extension horse 1EA 5. Reusable Adult NIBP Cuff 1EA 6. SpO2 extension cable 1EA 7. Reusable Adult SpO2 Probe 1 EA 8. DC Adaptor (BPM050S18F02 made in Bridgepower Co., Ltd.) 1 EA 9. Operator`s Manual 1 EA 10. Thermal roll Paper 2 ROLL

BM3 User’s Manual Option Product 1. Reusable Temperature Probe (Surface/Skin, TEMPSENS-430) 2. Sidestream EtCO2 Module (Respironics) 3. Mainstream EtCO2 Module (Respironics) 4. Sidestream EtCO2 airway adapter sampling kit 5. Mainstream EtCO2 airway adapter 6. 5-Lead Patient Cable with extension cable Warning In order to avoid electrical shock, do not open the cover. Disassembling of the equipment should be done only by the service personnel authorized by Bionet Warning Users must pay attention on connection any auxiliary device via LAN port or nurse calling. Always consider about summation of leakage current, please check if the auxiliary device is qualified by IEC 60601-1, or consult your hospital biomedical engineer.

BM3 User’s Manual Basic Unit Front view 1 Alarm lamp handle 5 Home key 2 Alarm control key 6 Rotary knob key 3 Printer key 7 Power ON/OFF Key 4 Blood-pressure measurement key 8 Battery status indicator 1 8 2 3 4 5 6 7

BM3 User’s Manual Right side view 1 ECG connector 2 Blood pressure Hose connector 3 SpO2 connector 4 Temperature connector 5 EtCO2 connector

BM3 User’s Manual Left side view 1 Printer 1

BM3 User’s Manual Back side view 1 Potential equivalent 2 NURSE CALL connector 3 USB connector (USB 2.0 5Vdc / Max. 500mA), 4 DC input 5 Service port connector 6 Network connector 7 HDMI output 7 6 5 4 3 2 1

BM3 User’s Manual Warning USB Compatible  The BM3 is compatible with external USB memory drives up to 64GB.  We recommend brands products listed in the manual (Sandisk, PNY, Transcend, Samsung).  When using a product with high power consumption, such as an external hard drive, be sure to use the provided adapter for suitable power supply.(Cannot be used alone as a power supply)  You should save the data of connected device before connecting the additional device.  It may not be supported some devices that required high power.

BM3 User’s Manual Device Markings Caution : Consult accompanying documents Ground terminal TYPE CF APPLIED PART TYPE BF APPLIED PART Printer Auxiliary Port LAN port HDMI HDMI external port DC Input Indicator USB port Battery Operation indicator DC input connector Temperature NIBP Power ON /OFF Function WEEE(Waste Electrical and Electronic Equipment) ECG European Medical Device Directive 93/42/EEC Date of manufacture Consult instructions for use. This symbol advises the reader to consult the operating instructions for information needed for the proper use of the device. Safety Sign : To signify that the instruction manual must be read. Reading the instruction manual before starting work or before operating equipment. Nurse call Change the Alarm Mode IP(Ingress Protection)

BM3 User’s Manual Power The BM3 monitor uses a DC adapter (100-240 VAC / 18VDC 2.8A). In the event of a power outage or cable shortage, the monitor automatically switches to battery power to continue patient monitoring without data loss. The built-in battery is intended for back- up use only during power-off. DC Product information Manufacture: BRIDGEPOWER CORP. Model name: BPM050S18F02 Input Power: 100~240V 1.2A Output Power: 18 V, 2.8 A DC Power LED is lighted on when the DC Power is plugged into the inlet at the back of the product. A press of power key makes the machine ready for use. Caution This equipment must be connected to a protective earth grounded power supply. Using non-standard products other than the adapters supplied by us may cause signal distortion or noise. Be sure to use a genuine adapter that is supplied by our company and is insulated. Battery power DC adapter, it uses battery power when power failure and portable use. The battery is attached to the bottom of the equipment and the additional extended battery is connected to the left side. Battery: 031PpTC(3ICR19/65) (10.8V - 2150mA, Li-ion) The Lithium-Ion battery is a rechargeable battery containing Lithium-Ion cells. Each battery contains an integrated electronic fuel gauge and a safety protection circuit.

BM3 User’s Manual Operation 1. Battery Power LED is lighted on when the machine is in use. 2. Battery is automatically charged when the machine is connected to DC Power Supply. The charging status is displayed at the top right of the screen 3. The charging status of the batteries is displayed with 5 green boxes, each indicating a different charging.( 5% -> 25% -> 50% -> 75% -> 100%) 4. When discharging, the battery image is displayed in Red. The monitor automatically turns off when the battery is depleted. The table below describes the function of the battery charging bar graph at the top of the screen. Battery charge/discharge display Display Charging remain time Description Your battery is fully charging Not applicable Your battery is fully charged Not applicable Your battery is 75% charged Not applicable Your battery is charged at 50% If possible, connect it to the AC adapter. Your battery is charged at 25% Immediately connect the monitor to the AC adapter. The internal battery is very low. (The power will turn off about 5min.) Immediately connect the monitor to the AC adapter. There is no built-in battery. Connect the battery.

BM3 User’s Manual Warning Older or defective batteries will have significantly reduced capacity or operating time. note  To maximize the charge for transport, keep the monitor connected until you are ready to transport the patient. Reconnect the monitor immediately after transport.  Bionet recommends replacing the lithium ion battery after 24 months of use.  Battery life depends on usage. If battery life continues, battery life will decrease and frequency of replacement will increase.  To prevent pre-discharge, recharge after the battery is discharged. Caution The battery charge display is accurate only when the battery is operating normally. - Battery Charging Time: more than 6 hours - Continuous Battery Usage Time: more than 3 hours for normal operation.(when fully charged) Caution The battery charge display is displayed correctly only when the battery is operating normally Note If no AC power is applied, the battery charge display will take up to 15 seconds to reflect the actual capacity of the internal battery.

BM3 User’s Manual Warning Be careful of the polarity when replacing the battery. We strongly recommend that you use the battery supplied by Bionet. Using unauthorized batteries may damage the equipment 5. Presence of battery: When the battery is disconnected from the equipment and it malfunctions, it shows 'X' as shown below. Note Charging is not possible at low power (below 16V). Cannot be used in vehicles with 24V power supply. When replacing the battery, be sure to remove the DC adapter and replace it.. Warning Older or defective batteries will have significantly reduced capacity or operating time.

BM3 User’s Manual How to replace the battery Please assemble and replace as shown below. The Impact of Lithium-Ion Battery Technology on the Battery The following are the key points you should know about Lithium-Ion battery technology: The battery will discharge on its own, even when it is not installed in a monitor. This discharge is the result of the Lithium-Ion cells and the bias current required for the integrated electronics. By the nature of Lithium-Ion cells, the battery will self-discharge. The self-discharge rate doubles for every 10°C (18°F) rise in temperature. The capacity loss of the battery degrades significantly at higher temperatures. As the battery ages, the full-charge capacity of the battery will degrade and be permanently lost. As a result, the amount of charge that is stored and available for use is reduced.

BM3 User’s Manual Warning When replace the battery, only use the battery provided by Bionet. Check the battery is properly secured to the bracket. Do not cause a serious impact on the battery. Ignoring the above warnings will cause battery explosion and serious damage to devices. Conditioning Guideline The battery in the monitor full charged and discharged every six months and condition it using the battery charger. Storage Guideline Store the battery outside of the monitor at a temperature between 20°C to 25°C (68°F to 77°F). When the battery is stored inside a monitor that is powered by an AC power source, the battery cell temperature increases by 15°C to 20°C (59°F to 68°F) above the room’s ambient temperature. This reduces the life of the battery. When the battery is stored inside a monitor that is continuously powered by an AC power source and is not powered by battery on a regular basis, the life of the battery may be less than 12 months. Bionet recommends that you remove the battery and store it near the monitor until it is needed for transport. How to Recycle the Battery When the battery no longer holds a charge, it should be replaced. The battery is recyclables. Remove the old battery from the monitor and follow your local recycling guidelines. Warning EXPLOSION HAZARD — DO NOT incinerate the battery or store at high temperatures. Serious injury or death could result.

BM3 User’s Manual Getting Started Starting the monitor: Press the power key (O) at the bottom right of the monitor front panel. The power light on the monitor lights up, the alarm bar lights up, the power is turned off, the screen lights up, the main screen is displayed after running the self-test. Stopping the monitor: Press and hold the power key (O) for 3 seconds. The screen goes off. Main screen setup After the monitor is turned on, the main screen is displayed. 1 Status Message 3 Numeric Window 2 Waveform Window 4 Menu Window 1 2 3 4

BM3 User’s Manual The parameter box displays values, alarm limits and icons for the selected parameter. You can set the parameters and their associated waveforms so that they are easy to distinguish. The message appears at the top of the screen. The patient name bed label is displayed in the upper left corner of the screen. The top right of the screen displays the time, network and device management status. Using Rotary knob switch The rotary knob switch allows the user to navigate menus, select settings, and perform menu functions. Rotate the rotary knob to move the menu item. To confirm the selection, press the rotary knob switch. Fixed key The fixed keys on the front panel of the monitor allow you to perform commonly performed functions. Fixed key Description Fixed key Description The alarm control key switches between Normal / Audio Paused and Alarm Paused mode. Press more than 3 seconds to switch to Audio Off or Alarm Off mode Start or end non-invasive blood pressure (NIBP) measurements. Start or stop recording on time. Return to the main screen or switch the extended parameter screen mode.

BM3 User’s Manual Function key On the right side of the monitor's front panel, the touch screen icon on the touch screen allows you to perform frequently-used functions. Fixed key Description Fixed key Description Opens a table where you can set the maximum and minimum alarm limits. This is an alarm mode key, so it enables to change Normal/ Audio Paused/ Alarm Paused mode. Access the Hospital / Emergency menu. Displays the setup menu. Enable waveform stop function. Displays the automatic blood pressure measurement interval setting menu. Displays the printer setup menu. Displays trend menu. Displays the mini Trend window. Set parameters in text screen.

BM3 User’s Manual 2. SETUP Overview This chapter describes how to configure your monitor and how to upgrade your software. Monitor configuration Setup Menu tree Parameter menu tree

BM3 User’s Manual Main menu setup The Setup menu allows the user to access submenus, display screens, and perform specific monitor setup functions. 1. To display the Settings menu, click the Settings icon to open the submenu. 2. Click the desired setting to access the submenu that performs the desired function or goes one step further down. 3. Click Close at the bottom of the submenu list to return to the previous menu or screen. Main menu Sub menu A. SETUP A-1. PARAMETER SETUP A-2. PARAMETER UNITS A-3. USER SERVICES A-4. SYSTEM INFORMATION A-5. NETWORK INFORMATION A-6. CENTRAL A-7. HL7 A-8. ALARM SETUP A-9. DISPLAY OPTION A-10. HOSPITAL INFORMATION B. BIOSIGNAL CALIBRATION B-1. ECG & RESP B-2. NIBP C. SCREEN CALIBRATION D. MAKER SERVICE D-1. MAC Address E. SW UPGRADE F. SW LICENSE

BM3 User’s Manual A. SETUP menu MENU Description Available settings A-1. PARAMETER SETUP measurement on the monitor Parameter selection and color setting menu:ECG,SPO2,RESP,NIBP,TEMP, ETCO2 PARAMETER enable ON/OFF PARAMETER COLOR setup A-2. PARAMETER UNITS Unit setting menu used for monitor measurement A-2-1. Weight UNIT Weight measurement unit Kg Lbs A-2-2. Height UNIT Height measurement unit Cm Inch A-2-3. BLOOD PRESSURE UNIT blood pressure measurement unit mmHg kPa A-2-4. ST UNIT ST measurement unit mm mV A-2-5. TEMPERATURE UNIT Temperature measurement unit °C °F A-2-6. GAS PRESSURE UNIT Gas measurement unit mmHg kPa vol% A-2-7. MULTI GAS PRESSURE UNITS Select whether to set the pressure unit for each gas type. When OFF, unit setting menu by gas type is displayed ON / OFF A-3. USER SERVICES User configuration menu A-3-1. HOSPITAL UNIT Set Monitor Environment Group GENERAL ICU NICU OR CCU USER DEFINE

BM3 User’s Manual A-3-2. BED # Set device number 1~300 A-3-3. KEY Sound Set Key activation ON / OFF A-3-4. KEY Volume Set Key sound OFF ~ 100% A-3-5. AC FILTER Power filter settings OFF, 50Hz, 60Hz A-3-6. SCREEN BRIGHTNESS Set screen brightness 10~100% A-3-7. DATE DISPLAY Set type of date display ON / OFF A-3-8. DEMO Set Demo ON / OFF A-4. SYSTEM INFORMATION A-4-1. MAIN VERSION Display main S/W version A-4-2.NIBP VERSION Display NIBP Module version A-4-3.LANGUAGE Set language English, Korean French, Bulgarian Polish, German Chinese, Portuguese Hungarian, Czech Romanian, Italian Turkish, Spanish Russian, Greek Japanese A-5.NETWORK INFORMATION Network information and setup A-5-1.WIRELESS Wireless setup ON/OFF A-5-2.DHCP Auto IP allocation setting menu ON/OFF A-5-3.DEVICE IP IP setting menu XXX.XXX.XXX.XXX A-5-4.SUBNET MASK SUBNET MASK setting menu XXX.XXX.XXX.XXX A-5-5.GATEWAY GATEWAY setting menu XXX.XXX.XXX.XXX A-6.CENTRAL CENTRAL NETWORK menu A-6-1. PROTOCOL Version Network protocol menu 1.30

BM3 User’s Manual A-6-2. CENTRAL Remote Communication menu ON/OFF A-6-3. Server IP Remote PC IP address setting XXX.XXX.XXX.XXX A-7. HL7 HL7 Network message settings A-7-1. COM Communication version A-7-2. Server IP Remote PC IP address setup XXX.XXX.XXX.XXX A-7-3. PORT Remote PC PORT address XXXX A-7-4. HL7 PERIOD Transmission cycle settings menu 10sec, 30sec, 1,3,5,10,15,30min, 1 hour, 6 hour A-7-5. HL7 NAK NAK Transmission menu setup ON/OFF A-7-6. EDIT HL7 LABEL Parameter label edit menu A-8. ALARM SETUP Alarm settings menu A-8-1. ALARM PASSWORD Alarm setup password activation menu ON/OFF A-8-2. SETUP PASSWORD Password setup menu A-8-3. ALARM SOUND Alarm sound type selection menu IEC60601 BIONET A-9. DISPLAY OPTION A-9-1. SWEEP SPEED (ECG/SPO2/RESP) 6.25 mm/sec, 12.5 mm/sec 25 mm/sec (basics),50 mm/sec A-9-2. SWEEP SPEED (RESP/ETCO2 ) 6.25 mm/sec, 12.5 mm/sec (basics), 25 mm/sec A-10. HOSPITAL Information Set Hospital information A-10-1. Name Hospital Name

BM3 User’s Manual A-10-2. Address 1 Address information 1 A-10-3. Address 2 Address information 2 A-10-4. Postal Code Set postal Code B. BIOSIGNAL CALIBRATION Set calibration menu B-1. ECG & RESP B-1-1. ECG Calibration ECG calibration menu 10mm/mV input calibration display B-1-2. RESP Calibration RESP calibration menu 1ohm 1cmm display B-2.NIBP B-2-1. ZERO Calibration NIBP Zero calibration menu Zero calibration menu at atmospheric pressure B-2-2. Gain Calibration NIBP Gain control menu Perform 250mmHg pressure calibration and select menu B-2-3. Pneumatic Pump NIBP Pump control menu ON/ OFF B-2-4. Pneumatic Valve NIBP valve control menu Close /Open C. SCREEN Calibration Perform touch screen calibration point input D. MAKER SERVICES D-1. MAC ADDRESS Editing Enter a unique address for the device D-2. SALSE COMPANY BIONET OEM E. SW Upgrade Software Upgrade menu F. SW LICENSE Software License menu

BM3 User’s Manual Parameter color Parameter Basic color Selectable colors Green, light blue, yellow, purple, blue, sky blue, orange, gray, light green, pink, white, red, light yellow ECG (ST) Green SpO2 Blue RESP Yellow NIBP Purple TEMP Green ETCO2 Yellow

BM3 User’s Manual 3. Network Overview When you connect the monitor to the network, you can access patient information from another monitor or central station connected to the network. These devices provide main screen information for remote viewing from each other. BM Central connects the monitors to the central station and each device to provide various monitoring functions. The User Monitor's B2B View (Bed to Bed View) feature allows the user to view other monitor screens connected to the network and to silence remote control and alarms[Audio Paused]. With the Remote Control feature in BM Central, you can perform the following tasks on a patient monitor that can be remotely controlled from a central station.  Start recording  Modify alarm limit  Alarm Mute  Print the current monitor screen to a network laser printer (Using the optional remote keypad)  Enter, edit and view patient data Network connection In a network, data can be exchanged over wired or wireless technology. All data interfaces (e.g. RS-232, LAN, USB interface) described in the standard and convention can be network. This device can exchange information with other devices through the network during operation and supports the following functions.  Display waveform and parameter data  Alarm signal  Remote control (e.g. alarm management)  Device setup and transmission of patient data Connecting this device to an integrated network with other devices, or subsequent changes to that network, can be a new risk to patients, users, and third parties. These risks must be identified,

BM3 User’s Manual analyzed and evaluated before the device is connected to the network or the network is changed, and appropriate action must be taken. Subsequent changes to the network example:  Network configuration change  Removing a device from the network  Adding new devices to the network  Upgrading or updating devices connected to the network Warning Recommendations for wireless connections  BM3 has a change in the number of equipment connections depending on wireless AP (Access Point) performance.  When using a general AP, it is recommended to connect 8 units to the same network.  Due to the nature of wireless, connectivity may not be good depending on the environment Remote View If the monitor is connected to a network, you can view other monitors connected to the network on your monitor and make the alarm silent. The procedure for displaying the remote view screen is as follows. To set the menu display time, refer to the setting page below. NOTE: The Print Screen Sticky key on the front panel of the monitor allows you to print the remote view screen as it appears on your local monitor. The menu below is a setup menu for retrieving data from other patient monitoring devices connected to the same network. To view the menu settings, touch the My BED number box in the top menu bar.

BM3 User’s Manual MENU Description Available Settings B2B VIEW MONITOR LIST sub menu REFRESH Menu to update monitor list connected to network UP Move to upper list DOWN Move to lower list MONITOR LIST List of monitor information connected to the network CONNECT Monitor connection menu for remote connection

BM3 User’s Manual Display Mode Wave and Numeric Mode Numeric Mode

BM3 User’s Manual MENU Description Available settings A-1 SELECT WAVE Waveform selection menu to view A-1-1. TRACE I The waveform selection menu for TRACE I in the B2B View window ECG, SPO2, RESP,ETCO2, A-1-2. TRACE II The waveform selection menu for TRACE II in the B2B View window ECG, SPO2, RESP,ETCO2 A-2 NEXT VITAL Additional parameter selection menu A-3 MORE VITALS WAVE screen and TEXT screen selection menu A-4 NEXT BED Connect to the following connected monitor devices A-5 SETUP ALARM Alarm setting menu of remotely connected monitor Normal Audio Paused Alarm Paused Audio Off Alarm Off A-6 NIBP START/STOP NIBP measurement start and stop menu START STOP A-7 CLOSE Remote viewer close menu

BM3 User’s Manual 4. Admission and Discharge Overview The Patient admit menu allows you to enter and edit a patient’s personal data (name, ID, Birthday, Height, Weight). If your monitor is operating in a network monitoring, you can also review or change the monitor’s care unit and bed label assignments. Patient data and trends can also be transferred to PC. The transfer procedure depends on whether the Inbound and Outbound monitors are connected to the Central network. Patient admission How to admit a patient: 1. Press the Patient icon button. 2. Click on Admit. 3. Click on Patient Information. 4. Please select a field. The data entry screen appears. 5. Click the letter of the word you want to input. If you made a mistake, click Backspace and try again. 6. Click Enter to confirm your entry. 7. Click on the next field and repeat steps5 and 6. Note:  To change a patient's classification (adult, pediatric or neonate), access the patient settings menu.  Additional settings (Gestational Age) are available for neonate mode.

BM3 User’s Manual Patient discharge The patient should be discharged before the other patient is admitted. Otherwise The monitor attaches the existing data to the patient in the back of the hospital. How to discharge a patient: 1. Press the Discharge. fixed key. 2. When you execute the discharging menu on the screen, you will be warned that all patient data will be deleted. 3. Press the Accept button. The discharge procedure is in progress. The monitor displays a Discharge message. When the patient is successfully discharged, a banner with the following message is displayed. PATIENT TYPE: When you set the animal type, type image is displayed on the upper left corner TYPE Male Admit Female Admit Discharge ADULT PEDIATRIC NEONATE

BM3 User’s Manual Main menu Sub menu A.Admit / Discharge B.Patient Information B-1. Patient Information C.Default Setting D.User Drug Change E.Drug Calculation E-1. Setting E-2. Titration Table MENU Description Available Settings A. Admit / Discharge Admission and discharge setting B. Patient Information B-1. Patient Information B-1-1. Patient Type Patient Type setting ADULT, PEDIATRIC, NEONATE B-1-2. ID Patient ID setting B-1-3. First Name First Name setting B-1-4. Last Name Last Name setting B-1-5. Gender Gender setup MALE , FEMALE B-1-6. Birthday Birthday setting menu YYYY/MM/DD B-1-7. Weight Age setting XXX.XX Kg B-1-8. Height Weight setting XXX.XX Cm B-1-9. Blood Type Default setting A Rh+/ Rh-/ -D-/ Rh Null B Rh+/ Rh-/ -D-/ Rh Null O Rh+/ Rh-/ -D-/ Rh Null AB Rh+/ Rh-/ -D-/ Rh Null Unknown C. Default Setting Set Patient Info to Default Value. D. User Drug Change D-1. DRUG TYPE Set Drug Type of Patient. DRUG-1~5 D-2. DRUG NAME Set Name of Drug D-3. DRUG UNIT Choose the Unit of Drug mg/hr, mg/min, mg/kg/hr mg/kg/min, mcg/hr, IU/hr, mcg/min, mcg/kg/hr, mcg/kg/min, units/hr E. Drug Calculation E-1. Setting

BM3 User’s Manual E-1-1. DRUG TYPE Choose Drug Type in the List(21) AMINOPHYLLINE TPA BRETYLIUM LIDOCAINE PROCAINAMIDE EPINEPHRINE LEVOPHED ISOPROTERENOL DOPAMINE DOBUTAMINE NITROGLYCERINE NITROPRUSSIDE INOCOR HEPARIN INSULIN STREPTOKINASE DRUG-1~5 E-1-2. Drug Quantity Set Drug Quantity E-1-3 Solution Volume E-1-4. Dose Quantity Set Dose Quantity E-1-5. Inflation Rate E-1-6. Weight Some drugs may not be supported E-1-7. Dose Step E-2. Titration Table E-2-1. DRUG NAME Set Drug Name E-2-2. DRUG QUANTITY Set Drug Name Refer to drug list bellow. E-2-3. SOLUTION VOLUMNE E-2-4. Dose Quantity Refer to drug list bellow.

BM3 User’s Manual E-2-5. Inflation Rate Refer to drug list bellow. E-2-6. WEIGHT Refer to drug list bellow. E-2-7. DOSE STEP Refer to drug list bellow. The table shows the formula for calculating the dosage of drugs below. Unit NameUnit Equation mg/hr AMINOPHYLLINE TPA Flow rate(ml/hr) = Dose(mg/hr) × SolutionVolume(ml) Drug QTY(mg) mg/min BRETYLIUM LIDOCAINE PROCAINAMIDE Flow rate(ml/hr) = Dose(mg/min) × SolutionVolume(ml) × 60 Drug QTY (mg) mcg/min EPINEPHRINE LEVOPHED ISOPROTERENOL Flow rate(ml/hr) = Dose(mcg/min) × SolutionVolume(ml) × 60 Drug QTY (mg) × 1000 Mcg/kg/min DOPAMINE DOBUTAMINE NITROGLYCERINE NITROPRUSSIDE INOCOR Flow rate(ml/hr) = Dose(mcg/kg/min) × Weight(kg) × SolutionVolume(ml) × 60 Drug QTY (mg) × 1000 units/hr HEPARIN INSULIN Flow rate(ml/hr) = Dose(units/hr) × SolutionVolume(ml) Drug QTY(units) IU/hr STREPTOKINASE Flow rate(ml/hr) = Dose(IU/hr) × SolutionVolume(ml) Drug QTY (IU)

BM3 User’s Manual Shows each unit setting range. Dose Drug QTY Unit Proper Range Unit Proper Range mg/hr 0.01 to 500 mg 0.01 to 2000 mg/min mg/kg/hr mg/kg/min mcg/hr mcg/min mcg/kg/hr mcg/kg/min units/hr 10 to 15000 Units 100 to 150000 IU/hr 1000 to 1500000 IU 1000 to 1500000 Items Unit Drug QTY unit Volume of Liguid mL 1 to 1000 WEIGHT Kg 0 to 300 Velocity of Flow ml/hr 0.1 to 600

BM3 User’s Manual Registration of patient ID using barcode This product can input the PATIENT ID in barcode format to the device using USB barcode scanner. First, connect the barcode scanner to the USB HOST connector on the left as shown in the figure below. After the BEEP sound is generated, the barcode icon ( ) appears at the bottom of the instrument screen. The barcode that you want to input is matched to the index LED generated by the scanner, and if you press the input button, the corresponding ID is read and sent to the equipment. The sender ID is displayed at the top center of the screen.

BM3 User’s Manual 5. Alarm Overview The monitor displays the alarm limit (parameter threshold) and can be configured by the user to raise an alarm if exceeded. Limits are displayed both in the alarm limits table and in the parameter box. If this limit is exceeded, a visual or audible alarm will occur. The bedside monitor is the primary alarm device, and there may be other secondary alarm devices depending on how you configured the device / network. Depending on the alarm condition, the monitor generates an alarm using one or more of the following devices:  Hearing sound reflecting alarm severity  Change the color in the parameter box of the alarm parameter  Alarm messages in the local message area  Alarm banner indicating alarm status  External alarm device such as nurse call system  Activate alarm recording The monitor generates an alarm when the parameter in the Alarm Limits table is ON. It is not a prerequisite that the parameter is displayed on the display or connected in the event of an alarm. Alarm priority The alarm type is divided into a patient status alarm and a product status alarm. The patient status alarm sounds when the diagnostic function (ECG 3 auto diagnosis) and alarm upper and lower limits are exceeded, and there are levels of HIGH, MEDIUM, LOW and MESSAGE, and there is a difference in the order and volume of the alarm. You can set the alarm level for each parameter and function. The patient status alarm provides the highest priority alarm. The features of each alarm are described as follows. The alarm priority is HIGH> MEDIUM> LOW> MESSAGE. For alarms over MEDIUM, the printer output is supported when ARMRM PRINT ON is set.

BM3 User’s Manual Alarm priority Alarm sound Alarm Color Alarm printer Alarm lamp HIGH -5 2.0 Times/Sec Blinking MEDIUM -3 0.5 Times/Sec Blinking LOW -1 Non Blinking MESSAGE : Alarm sounds : Red Lamp is turned on. : Waves are printed out : Red color alarm indicator on the screen is blinked : Yellow color alarm indicator on the screen is blinked : Blue color alarm indicator on the screen is displayed Audible alarm Alarm priority BIONET IEC HIGH Two consecutive square beeps Beep 5 times Short stop time 5 beeps, 5 beeps MEDIUM Stop after two short beeps. 3 short beeps Short stop time, 15second pauses LOW Low sound 30 times per second Two beep for 30seconds

BM3 User’s Manual Alarm management You can use the lock key on the front of the monitor to hold the alarm. To change Alarm Mode: A short press of the alarm control key circulates through the Normal / Audio_Paused / Alarm_Paused alarm modes. Press and hold the key for more than 3 seconds to switch to Alarm_Off / Audio_Off mode using the mode selection dialog regardless of which alarm mode the monitor is currently in Audio_Paused: Stop the audible alarm for 1 minute but the visual alarm is activated still. Banner with the message Audio Paused and countdown timer are displayed on the screen. After the user switches to another alarm mode or after the timeout period has elapsed if the alarm occurs still, visual and audible alarms will be activated again Alarm_Paused: Stop visual and audible alarms during user defined time. Banner with the message Alarm Paused and countdown timer are displayed on the screen. After the user switches to another alarm mode or after the timeout period has elapsed if the alarm occurs still, visual and audible alarms will be activated again Alarm_Off: Stop visual and audible alarms. A banner with the message Alarm Off is displayed on the screen. The monitor maintains Alarm Off mode until user switch to another alarm mode. Audio_Off: Stop the audible alarm. A banner with the message Audio Off is displayed on the screen. The monitor maintains Audio Off mode until user switch to another alarm mode Alarm control: Various alarm functions, such as alarm hold, validity and alarm limit indicators, can only be configured in the alarm control menu, accessible only through the password protected unit manager menu. Nurse call: If the monitor is sounding an alarm, the nurse call system is signaling. When an audible alarm is silenced (Audio Paused or Audio Off) at the bedside unit, the nurse call system will not alarm. Your system administrator can change the alarm priority level for the nurse call signal. if the priority level is set to High , only high-priority alarms will sound on the nurse call system.

BM3 User’s Manual Note  Audio Paused and Audio Off modes only stop the audible alarm sound and touch or key sound is activated always.  To adjust the Touch or Key Sound, use the Key Sound menu in Setup. Alarm settings Main menu Sub menu A. Alarm Setup A-1. Parameter Alarm Limit A-2. Arrhythmia Alarm Condition A-3. System Alarm Condition A-4. Alarm Parameter A-5. Nurse Call B. Alarm Review MENU Description Available Settings A. Alarm Setup menu A-1. Parameter Alarm Limit All parameter alarm, level, activate Setup menu A-2. Arrhythmia Alarm Condition Arrhythmia alarm level setting menu ASYSTOL, VTAC, VTAC /VFIB, A-3. SYSTEM ALARM CONDITION System alarm level setting menu LOW BATTERY A-4. Alarm Parameter Alarm Settings menu A-4-1. Alarm Volume The volume can be changed from OFF 10~ 100%

BM3 User’s Manual to 10% to 100%. A-4-2. Alarm Pause Time No sound for 5minutes, Release on alarm again 1,2,3,5,10,15min A-5. Nurse call User Settings menu. A-5-1. Nurse call on Alarm NURSE CALL function ON / OFF; After setting ON, check if relay sound is heard in ALARM situation. ON/OFF A-5-2. Call Type NORMAL CLOSE / NORMAL OPEN; ACTIVE state change check Normal open Normal close A-5-3. Duration ONE TIME / CONTINUE / CYCLING One time Continue Cycling A-5-4. Level Message/ Low/ Medium/High Alarm event

BM3 User’s Manual 6. TREND Overview The monitor stores trend data for all connected signals. Users can request trend recording and can also print the screen of trends displayed. Triggered alarm events are displayed in red inverted triangles on the Event List and Timeline Trend setup Main menu Sub menu A. Trend Setup A-1. Popup Trend B. Graphic Trend B-1. Graphic Trend B-2. Tabular Trend C. Tabular Trend C-1. Graphic Trend C-2. Tabular Trend D. Trend Export E. OxyCRG Show/Hide

BM3 User’s Manual MENU Description Available settings A. Trend Setup menu A-1. Popup Trend A-1-1. Time Period Show time interval setting menu 30min, 60min, 90min, 3hour, 6hour A-1-2. Configure Parameters B. Graphic Trend menu B-1. Graphic Trend B-1-1. Event List B-1-2. Time Period Saved data can be viewed graphically in sections. 30min, 60min, 90min, 2hour, 3hour, 4hour, 6hour, 8hour, 12hour B-1-3. Display Group B-1-4. Print Set the time and see the stored values at each set time. B-2. Tabular Trend B-2-1. Event List B-2-2. Time Period Time period setting 1min, 5min, 10min, 15min, 30min, 1hour, 2hour B-2-3. Display Group B-2-4. Print Graphic trend print output C. Tabular Trend menu C-1. Tabular Trend

BM3 User’s Manual C-1-1. Event List C-1-2. Time Period Time period setting 1min, 5min, 10min, 15min, 30min, 1hour, 2hour C-1-3. Display Group C-1-4. Print Tabular trend print output C-2. Graphic Trend C-2-1. Event List C-2-2. Time Period Time period setting 30min, 60min, 90min, 2hour, 3hour, 4hour, 6hour, 8hour, 12hour C-2-3. Display Group C-2-4. Print Graphic trend print output D. Trend Export menu D-1. Start Time Parameter save start time setting menu hh:mm D-2. End Time Parameter Save Last Time Setting Menu hh:mm D-3. Export Time Period Time period setting 1min, 5min, 10min, 15min, 30min, 1hour D-4. Export Order Sequence of parameters Descending Ascending D-5. Export F. OxyCRG Show/Hide menu When selected, the screen shows heart rate, breathing, and oxygen saturation trends. It is not displayed in single parameter mode or 7ch ECG screen. SHOW HIDE

BM3 User’s Manual Graphical trend Trend graph shows saved trend data as individual graph type for each parameter. These graphs show that the displayed parameters are active over a significant period of time Shows five channels at a time. Confirmation color and scale Meter labels and numbers are displayed on the left side of the trend channel. Vertical lines in each graph. This displays the time distribution. Trends keeps the most up-to-date data. It is automatically updated on the right side of the graph. 1 2 3 4 5 6 7 8 9 10 11 ① Graphic trend select menu ② Tabular trend select menu ③ Event list menu ④ Event previous/next menu ⑤ Patient ID ⑥ Parameter numeric window ⑦ Interval search window ⑧ Trend interval setup menu

BM3 User’s Manual ⑨ Parameter selection menu to show ⑩ Printer menu ⑪ Parameter window selection menu Tabular trend The Trends table displays the trend data in an easy-to-read table format. Up to six are displayed, updated every minute. The time stamp above each column indicates the interval at which the data in that column was trended. The value displayed is the last one acquired during the interval, and the most recent data is displayed in the rightmost column. 1 2 3 4 5 6 7 8 9 10 11 ① Graphic trend select menu ② Tabular trend select menu ③ Event list menu ④ Event previous/next menu

BM3 User’s Manual ⑤ Patient ID ⑥ Numeric Parameter window ⑦ Selection Navigation window ⑧ Trend interval setting menu ⑨ Parameter selection menu ⑩ Printer menu ⑪ Parameter select window menu File export The file extract function can transfer trend to a file using USB memory. ① Confirm USB memory connection. ② Press TREND > Trend Export button. ③ Set a start time, end time, export time period, and export order. ④ Press Export button ⑤ The data is transferred to USB memory. A completion message is displayed when the transmission is completed.

BM3 User’s Manual Warning USB Compatible  The BM3 is compatible with external USB memory drives up to 64GB.  We recommend brands products listed in the manual (Sandisk, PNY, Transcend, Samsung).  When using a product with high power consumption, such as an external hard drive, be sure to use the provided adapter for suitable power supply.(Cannot be used alone as a power supply)  You should save the data of connected device before connecting the additional device.  It may not be supported some devices that required high power. Note Saving Patient Data to a USB  Exported patient data on a USB memory drive is not encrypted and therefore raises privacy concerns. So, only authorized personnel should be allowed to view, handle, store or transmit patient data.  The file format of the USB memory drive used for the BM7 patient monitoring device is FAT32.

BM3 User’s Manual Popup trend The user can continue to monitor the main screen waveform and parameter box while displaying trend data for up to 5 parameters for up to 6 hours. The pop-up trend graph follows the display order indicated by each parameter in the trend setup and is updated with new trend data every 60seconds. When selecting pop-up trend, you can switch to ST analysis window and double-zoom mode. If there is no parameter set in Trend setup> Configure parameters, only ST analysis window is displayed. To change the popup menu window, touch the top and bottom of the popup menu with the touch key, or select it with the rotary switch. Popup trend window

BM3 User’s Manual Popup ST window Popup enlarge trend window You can change the size of the popup menu by pressing and releasing the center of the popup menu for at least 1second.

BM3 User’s Manual 7. ECG Overview The monitor can calculate heart rate, detect arrhythmia (adult and pediatric patients), and display ECG data. The electrocardiogram screen provides 1 channel display. It calculates the heart rate by detecting the electrocardiogram signal of the patient and alarms according to the set upper and lower limit of alarm. ECG connector position and measurement cable SpO2 T CO2 ECG Connector Electrode placement 1. If you have a lot of hair, shave. With alcohol-soaked cotton, wipe the patient's skin to attach the electrode. Avoid wrinkled or uneven skin, and wipe off alcohol with a dry cotton towel. 2. Unpack the electrode package and remove the electrode 3. Remove the rear mounting surface of the electrode. Be careful not to touch the adhesive side. 4. Attach disposable electrodes to the previously sterilized skin.

BM3 User’s Manual 5. Connect the lead of the electrode and the wire of the monitor 6. Fix the electrode to the skin, and secure the cable with the remaining length between the instrument and the electrode with surgical tape. This fixation prevents the electrode from moving. Note  Make sure that the contact area of the disposable electrode is not dry to maintain a good connection between the electrode and the skin.  If you suspect that the disposable electrode is in poor contact, replace it immediately with a new electrode. Otherwise, the contact impedance of the skin and electrode will increase, and the correct ECG signal will not be obtained.  If the contact condition gets worse before expiration date on the packaging, replace with a new one.  To get a stable ECG waveform, rub the skin with gel or benzoin tincture. ECG Precaution Caution  Use caution when using evoked potential equipment as it may interfere with ECG monitoring.  Do not rely solely on ECG for patients with epileptic tendencies. Electrical disturbances of non-cardiac circles such as seizures may interfere with the detection of specific arrhythmias. Warning CABLES — Route all cables away from patient's throat to avoid possible strangulation. CONDUCTIVE CONNECTIONS — Extreme care must be exercised when applying medical electrical equipment. Many parts of the human/machine circuit are conductive, such as the patient, connectors, electrodes, transducers. It is very important that these conductive parts

BM3 User’s Manual do not come into contact with other grounded, conductive parts when connected to the isolated patient input of the device. Such contact would bridge the patient's isolation and cancel the protection provided by the isolated input. In particular, there must be no contact of the neutral electrode and ground. DEFIBRILLATION — Do not come into contact with patients during defibrillation. Otherwise serious injury or death could result. To avoid the risk of serious electrical burn, shock, or other injury during defibrillation, all persons must keep clear of the bed and must not touch the patient or any equipment connected to the patient. After defibrillation, the screen display recovers within 10seconds if the correct electrodes are used and applied in accordance with the manufacturer’s instructions. Patient cables can be damaged when connected to a patient during defibrillation. Check cables for functionality before using them again. The peak of the synchronized defibrillator discharge should be delivered within 60ms of the peak of the R wave. The signal at the ECG output on the patient monitors is delayed by a maximum of 30ms. If the ECG waveform on the screen is too unstable to synchronize with the patient’s heart beat because of the following reason, remove the cause of an alarm, message, or unstable ECG, and then use a stable ECG lead for synchronization.  ECG electrode is detached or broken. Lead wire is detached or broken.  Lead wire moves. AC interference, EMG noise or noise from ESU is superimposed.  Connection cable is broken or has a short circuit. Connector has poor contact. INTERFACING OTHER EQUIPMENT — Devices may only be interconnected with each other or to parts of the system when it has been determined by qualified biomedical engineering personnel that there is no danger to the patient, the operator, or the environment as a result. In those instances where there is any element of doubt concerning the safety of connected devices, the user must contact the manufacturers concerned (or other informed experts) for proper use. In all cases, safe and proper operation should be verified with the applicable Manufacturer’s instructions for use and system standards IEC 60601-1-1/EN 60601-1-1 must

BM3 User’s Manual be complied with. Electro surgery Unit  Electrosurgical unit (ESU) emits a lot of RF interference. If the monitor is used with an ESU, RF interference may affect the monitor operation.  Locate the monitor as far as possible from the ESU. Locate them on opposite sides of the operating table, if possible.  Connect the monitor and ESU to different AC outlets located as far as possible from each other.  When using this monitor with an electrosurgical unit, its return plate and the electrodes for monitoring must be firmly attached to the patient. If the return plate is not attached correctly, it may burn the patient’s skin where the electrodes are attached. During surgery: Use the appropriate orange electrode ECG safety cable, or lead cable with an red connector, for measuring ECG in the operating room. These cables have extra circuitry to protect the patient from burns during cautery, and they decrease electrical interference. This also reduces the hazard of burns in case of a defective neutral electrode at the HF device. These cables cannot be used for measuring respiration.

BM3 User’s Manual Patient preparation Careful skin preparation and proper electrode placement allow you to receive a strong signal that minimizes handwriting. If a technical alarm (e.g. lead disconnect) has occurred, prepare the patient again according to the following recommendations. Follow hospital approved clinical procedures to prepare the patient's skin. Change the electrode every 24 to 48 hours to improve signal quality. You may need to replace the electrode more often in the following situations:  ECG signal degradation  Excessive sweating of the patient  Patient's skin irritation There are a variety of reusable and disposable electrodes available. Choose the electrode that best fits your monitoring situation. Bionet recommends Ag / AgCl disposable electrodes. If you are using an electrode with a gel beforehand, make sure that the electrode is sufficiently gelled. Never use this product if the disposable electrode has expired or the gel is dry. Determine the electrode location that will provide the best ECG in the configuration (P-wave and T-wave amplitudes should not exceed 1/3 of the QRS amplitude). Choose a flat, muscular location to maximize contact with the electrodes and minimize muscle fatigue. Avoid joints or bony protrusions. When choosing a location for electrode placement, consider the following special conditions: Surgery - Place electrodes as far away from the surgical site as possible. Burn patient - use sterile electrodes. Thoroughly clean the equipment. Follow hospital infection control procedures. Use a waterproof tape (about 2 inches wide) or Steri-Drape to secure the electrode Protect from liquids. Make a small loop from the lead wire just below the connection and secure with tape.

BM3 User’s Manual ECG lead 5 LEAD electrode placement 3 LEAD electrode placement How to attach neonate electrodes

BM3 User’s Manual Cable color and size AHA：American Heart Association (U.S.A. standard) IEC：International Electro technical Commission (Europe standard) 3LEAD / 5LEAD Lead wire AHA Color code AHA Label IEC Color code IEC Label Right arm White RA Red R Left arm Black LA Yellow L Right leg Green RL Black N Left leg Red LL Green F V1(precordial) Brown V1 White C1 ECG signal processing and display The monitor is a QRS Complex with a QRS complex amplitude of 0.4 to 5.0 mV (0.2-5.0 mV with a scale setting of 0.5 mV / cm or less) and an adult with a QRS width of 70-120 ms (or a newborn with a QRS / ARR Select chapter). The heart rate is calculated from 15 to 300 times per minute using the last 10seconds of the R-R interval and the two longest intervals and the two shortest intervals at the R-R interval. The remaining interval is averaged, and the current heart rate is displayed in the HR parameter box of the main screen as a result. . If arrhythmia monitoring is possible (except for neonatal patients), the HR parameter box will

BM3 User’s Manual change accordingly. If you select Basic, you can display three basic arrhythmias called ASYS, VFIB, and VTAC. If Full is selected, a separate ARR parameter box will be displayed next to the HR parameter box (for details on selecting the arrhythmia mode, refer to the Arrhythmia setting chapter). When the ECG signal is 80 BPM, the interval of the T wave is 180 ms, and the QT period is 350 ms. ST signal processing and display ST segment deviation is defined as the movement above or below the equipotential level (mm). The difference measurement compares the isoelectric point with the ST measurement point. The isoelectric point defines a zero volt point (no electrical activity, 0 mm) with a base position on the horizontal axis (in hours) of 28 ms before QRS complex generation. In the ST segment, the ST point occurs between the QRS offset (J point) and the T-wave. The default position is 80ms after the QRS offset. The following figure shows a typical QRS complex. The ST analysis features are classified as "normal" beats in up to 12 selected ECG leads QRS Complex. Alarm and alarm status High P-wave and T-wave - Long P-wave or T-wave with high amplitude duration can be detected by QRS Complex. Place the leads on the ECG1 channel with the highest R-wave (compare to T- wave and / or P-wave) to allow the monitor to properly detect low heart rate conditions in this situation. If the monitor continues to misinterpret the P-wave or T-wave, use a pulse oximeter to reposition the electrodes or monitor the patient's pulse rate.

BM3 User’s Manual Display ① ② ③ ④ ⑤ ① Heart rate detector: It detects heart rate and flickers simultaneously. ② Pace maker: Pace maker signal is detected and flashes simultaneously. ③ HR Alarm limits: Heart rate threshold is display. ④ Heart rate: Displays the heart rate per minute. ⑤ PVC count number per 1 minute is display. ECG Settings Main menu Sub menu ECG A. ECG Parameters A-1. Alarm A-2. QRS Volume A-3. Display Option A-4. Arrhythmia A-5. ST/PVC A-6. Pace Maker

BM3 User’s Manual A. ECG menu MENU Description Available settings A-1. Alarm ECG alarm setting menu A-1-1. PARAMETER ALARM LIMIT HR, ST, PVC parameter alarm limits, level, activation setup menu. A-1-2. TECHNICAL ALARM CONDITION ECG-LEADFAULT ECG-CHECKELECTRODE ECG-HR-SEARCH A-2. QRS VOLUME QRS detection volume setting menu. When you set the SpO2 volume, it is automatically set to OFF. OFF, 0%~100% A-3. DISPLAY OPTION A-3-1. SWEEP SPEED The speed of the ECG displayed on the screen can be set. Default setting: 25mm/s 6.25mm/s, 12.5mm/s, 25mm/s, 50mm/s A-3-2. FILTER The filter setting is MONITOR by default. ECG FILTER： Selects among four frequency bands to filter the signal. MONITOR 0.5Hz ~ 40Hz MODERATE 0.5Hz ~25Hz MAXIMUM 5Hz ~ 25Hz DIAGONOSIS 0.05Hz ~150Hz MONITOR MODERATE MAXIMUM DIAGONOSIS A-3-3. SIZE (SENSITIVITY) Changes the display amplitude of the ECG waveform. 0.25 , 0.5, 1, 2, 4mm/mV A-3-4. HR SOURCE The cardiac source can be selected as ECG or SpO2, AUTO. ECG, SpO2, AUTO A-3-5. VIEW CHANNEL Number of channels in the ECG waveform to be shown on the screen. Display two lines of 1CH ECG 1CH,

BM3 User’s Manual waveform. A-3-6. TRACE 1 The ECG channel is selectable from I to V6. 3 When using the lead cable selection, only TRACE I can select I, II, III. 5 lead cable selection I, II, III, aVR, aVL, aVF, V can be selected. I, II, III, aVR, aVL, aVF, V1,V2,V3,V4,V5,V6 A-4. Arrhythmia Arrhythmia alarm setting menu A-5.ST/PVC PVC Diagnostic setting, ST template channel selection, ST analysis and ISO (R-) / ST (R +) value setting A-5-1. PVC Analysis PVC Diagnostic Results Display Setup Menu ON/OFF A-5-2. ST Template Ch ST Diagnostic ECG Channel Setup Menu(Menu display according to the currently connected cable) Lead I, II, III, aVR, aVL, aVF, V A-5-3. ST Analysis ST Diagnostic ECG Channel Setup Menu A-5-4. ISO(R-) ISO Point Position Setting Menu 120 ~ 4ms A-5-5. ST(R+) ST point position setting Menu 4~160 ms A-5-6. Initial Setup ISO, ST point position initial value setting Menu ISO : 80 ST : 108 A-6. Pace Maker Pace Maker detection display setting ON/OFF

BM3 User’s Manual Trouble shooting Problem: Inaccurate heart rate and/or false asystole. Solution: Check ECG signal from patient: 1. Check/adjust lead placement. 2. Check/perform skin preparation. 3. Check/replace electrodes. Check amplitude of ECG waveform: 1. Select ECG parameter label. 2. Select DISPLAY LEAD, 3. Scroll through all ECG leads and check for 0.5mV amplitude at normal (1X) size. (at least 0.5mV amplitude is required for QRS detection.) for borderline signals, validate on a graph. 4. If amplitudes are low, electrodes may need to be repositioned or replaced. Problem: False ventricular calls. Solution: Check ECG signal from patient: (the chest lead may exhibit polarity changes which may occasionally cause an inaccurate call.) 1. Check/adjust lead placement. 2. Check/perform skin preparation. 3. Check/replace electrodes. (if chest lead is a problem, move the chest lead to another chest position or leg position.)

BM3 User’s Manual Problem: Inaccurate pacemaker detection Solution: Use pacemaker processing: 1. Select ECG parameter label. 2. Display the lead of ECG with the greatest amplitude in the top waveform position. 3. Select Pace Maker. 4. SELECT PACE MAKER ON.

BM3 User’s Manual 8. Arrhythmia Monitoring(*) Overview On supported models only(*), Arrhythmia monitoring is available for adult and pediatric patients. The selected mode (Lethal or OFF) determines which events are processed. Arrhythmia monitoring is not available for newborns. Arrhythmia monitoring is available for adult and pediatric patients only. The monitor compares the received beats to the reference beats that have been recorded and stored in the reference template. Through this process, the monitor can identify the occurrence of an arrhythmia event, classify it, and then draw clinically useful conclusions based on the frequency and type of the signal. The monitor will observe all beats in question if the baseline moves beyond a defined limit. The monitor uses QRS processing results for arrhythmia analysis. During multiple lead arrhythmia treatment, measure the QRS Complex of each lead and compare it to the main learned beats. The monitor classifies the beats based on information obtained from all available leads. Arrhythmia templette ASYSTOLE Ventricular asystole occurs whenever the displayed heart rate drops to zero. VFIB/VTAC Ventricular fibrillation occurs when the ECG waveform indicates a chaotic ventricular arrhythmia.

BM3 User’s Manual Arrhythmia Settings A. ECG menu MENU Description Available Settings A-1. Arrhythmia ARRHYTHMIA parameter alarm, level, Activation setup menu. A-1-1. Arrhythmia Type Sets up ON/OFF to indicate detection of diagnosis (Asys, VTAC/VFIB and VTAC). OFF: Do not perform arrhythmia diagnosis. LETHAL: Performs the detection of Asys, VTAC/VFIB, and VTAC at the selected lead OFF, LETHAL A-1-2. Arrhythmia Alarm Condition Alarm setting menu by arrhythmia type Warning Display Heart Beat Equipment Signal Hart Beat equipment signal displays when the PACE mode is. the signal appears series form. The signal size or form are meaningless clinically Number Of Heart Beat Attention to the patient with heart beat equipment. The heart beat equipment can show heart beat even during arrhythmia continuously. Therefore, do not depend on heart beat alarm excessively.

BM3 User’s Manual Warning VENTRICULAR ARRHYTHMISAS The arrhythmia analysis program is intended to detect ventricular arrhythmia. This program is not designed to detect trial or supra ventricular arrhythmias. In some cases, it may not be possible to distinguish the presence or absence of arrhythmias. Therefore, doctors should analyze the arrhythmia information like other medical information. SUSPENDED ANALYSIS Certain conditions can delay the arrhythmia analysis. Detection and alarms associated with arrhythmias do not occur when arrhythmia conditions are delayed. This message is generated when the arrhythmia analysis is delayed: LEADS FAULT, ALARM PAUSE, ALL ALARMS OFF, DISCHARGED.

BM3 User’s Manual 9. SpO2 Overview SpO2 monitoring is a non-invasive technique that measures the total amount of oxygen in hemoglobin. The pulse rate is measured by measuring the absorption of the wavelength of the selected light. The light emitted by the sensor in the probe passes through the tissue and is converted into an electrical signal by the light-detecting sensor in the probe. The monitor processes the electrical signal and displays the waveform, %SpO2, and pulse rate on the screen as quantified values. Red and infrared rays are passed through the capillaries of the fingertip to detect the pulsating component, calculate HR and oxygen saturation, and alarm according to the set alarm value. Precaution SpO2 measurements are particularly sensitive to arterial and arteriolar pulse rates. Patients experiencing shock, hypothermia, anemia, or patients taking medications that reduce arterial blood flow may have incorrect measurements. Warning:  The pulse oximeter cannot be used as an apnea monitor.  High oxygen levels can make premature babies vulnerable to retrolental fibroplasia. When this is the case, do not set the maximum alarm limit to 100%, such as the effect of turning off the alarm. Percutaneous pO2 monitoring is recommended for premature infants receiving supplemental oxygen.  Inspect the applied area every 2-3 hours to check the skin condition and check if it is attached to the naked eye. If skin conditions change, move the sensor to another location. Change the application site every 4 hours at least.  Use only Bionet-designated sensors. Other sensors may not provide adequate protection against defibrillation or may put the patient at risk.  Disposable accessories (disposable electrodes, transducers, etc.) should be used only once. Do not reuse disposable accessories.

BM3 User’s Manual Patient preparation The accuracy of SpO2 monitoring is largely dependent on the strength and quality of the SpO2 signal. If you use your fingers as a monitoring site, remove the nail polish. Cut the patient's fingernail if needed to improve placement of the sensor. Only use sensors provided by Bionet and apply them according to manufacturer's recommendations on a per-sensor basis. If the sensor is not attached correctly, the ambient light may interfere with the pulse oximetry, making the measurement irregular or causing the value to disappear. If you suspect interference from ambient light, make sure that the sensor is properly positioned and that the sensor cover with the opaque body is covered. 1. Select the sensor type and size that best suits your patient. 2. If the sensor can be reused, please wash it before use for each patient. 3. Position the sensor correctly and attach it to the patient. 4. Connect the sensor to the patient cable. 5. Check the application area of the sensor from time to time. If the sensor is too tight, it may delay blood flow or overheat the skin and damage the tissue. Do not use a damaged sensor. Note: Read the documentation that came with your sensor for the best application technology and safety information. Never use a damaged sensor. Note: If the sensor does not turn on after connecting the sensor, observe that a message appears on the monitor. If the sensor-LED does not turn on, replace the sensor. SpO2 connector

BM3 User’s Manual Note The signal input is a high-insulation port and it is defibrillator proof ( ) The insulated input ensures patient safety and protects the device during defibrillation and electro surgery. Display ① ② ③ ④ ① SpO2 pulse rate display ② SpO2 PI (Perfusion Index) measurement display SpO2 measurement Cable %S pO2 100 / 90 99 80 PR

BM3 User’s Manual ③ SpO2 Alarm limits display ④ SpO2 strength indicator ⑤ %SpO2 Value display The current SPO2 value and the derived pulse rate (RATE) are displayed. The block sets indicate the strength of the signal (twenty block bars indicate the strongest signal). The SPO2 measurements are averaged over a 6-second period of time. The monitor display is updated every second. The SPO2 monitoring features are found in the SPO2 menu. These features include alarm limit adjustment, display of RATE, and RATE volume. Note SpO2 WAVE SIZE is changed automatically. Signal and Data Validity It is extremely important to determine that the probe is attached to the patient correctly and the data is verifiable. To make this determination, three indications from the monitor are of assistance—signal strength bar, quality of the SPO2 waveform, and the stability of the SPO2 values. It is critical to observe all three indications simultaneously when ascertaining signal and data validity. Signal Strength Bar The signal strength bar is displayed within the SPO2 values window. This bar consists of 10 blocks set depending on the strength of the signal. Proper environmental conditions and probe attachment will help to ensure a strong signal.

BM3 User’s Manual Quality of SPO2 Waveform Under normal conditions, the SPO2 waveform corresponds to (but is not proportional to) the arterial pressure waveform. The typical SPO2 waveform indicates not only a good waveform, but helps the user find a probe placement with the least noise spikes present. The figure below represents an SPO2 waveform of good quality. Good Quality SPO2 Waveform If noise (artifact) is seen on the waveform because of poor probe placement, the photo detector may not be flush with the tissue. Check that the probe is secured and the tissue sample is not too thick. Pulse rate is determined from the SPO2 waveform which can be disrupted by a cough or other hemodynamic pressure disturbances. Motion at the probe site is indicated by noise spikes in the normal waveform. (See the figure below.) It has been noted that letting the patient view the SPO2 waveform enables them to assist in reducing motion artifact. SPO2 Waveform with Artifact Stability of SPO2 Values The stability of the displayed SPO2 values can also be used as an indication of signal validity. Although stability is a relative term, with a small amount of practice one can get a good feeling for changes that are artifactual or physiological and the speed of each. Messages are provided in the SPO2 values window to aid you in successful SPO2 monitoring.

BM3 User’s Manual WARNING In the monitoring of patients the coincidence of adverse conditions may lead to a disturbed signal going unnoticed. In this situation artifacts are capable of simulating a plausible parameter reading, so that the monitor fails to sound an alarm. In order to ensure reliable patient monitoring, the proper application of the probe and the signal quality must be checked at regular intervals. SPO2 Settings A. SPO2 menu MENU Description Available Settings A-1. Alarm SPO2 Alarm setup menu A-1-1. PARAMETER ALARM LIMIT PERCENT, PR parameter alarm , level , activate setup menu A-1-2. TECHNICAL ALARM CONDITION SPO2-PROBEOFF SPO2-CHECKPROBE SPO2-POORSIGNAL SPO2-LOSTPULSE SPO2-ARTIFACT SPO2-PULSE SEARCH A-2. RATE VOLUME Menu in which RATE VOLUME is set up When the ECG volume is set, it is automatically set to OFF. OFF, 0%~100% A-3. DISPLAY OPTION SPO2 waveform display setting A-3-1. SWEEP SPEED It can set the speed of SPO2 displayed on the screen. Default: 25 mm/s. 6.25mm/s, 12.5mm/s, 25mm/s, 50mm/s

BM3 User’s Manual Status messages Below is a list of system status alarm messages which may be displayed in the SPO2 parameter window during monitoring. CHECK PROBE Reusable finger probe is off the patient. Check the probe. The factory default for this alarm is MESSAGE ALARM. PULSE SEARCH Detection by the monitor of a repeatable pulse has ceased. Check the patient and the probe site. POOR SIGNAL The SPO2 signal is too low. No SPO2 data is displayed. This can be due to a low patient pulse, patient motion, or some other interference. Check the patient and the probe. LOST SIGNAL SPO2 data continues to be displayed, but the quality of the signal is questionable. Check the patient and the probe. ARTIFACT It indicates that something happened to the pulses; determine if the artifact to be abnormal and irregular Cleaning  Do not autoclave, pressure sterilizes, or gas sterilizes this oximeter.  Do not soak or immerse the monitor in any liquid.  Use the cleaning solution sparingly. Excessive solution can flow into the monitor and cause damage to internal components.  Do not touch, press, or rub the display panels with abrasive cleaning compounds, instruments, brushes, rough surface materials, or bring them into contact with anything that could scratch the panel.  Do not use petroleum-based or acetone solutions, or other harsh solvents, to clean the oximeter. These substances attack the device’s materials and device failure can result.

BM3 User’s Manual 10. RESPIRATION Overview Respiration via ECG Lead I or Lead II electrode makes the skin area of the chest enlarged, causing changes in the resistance of skin. Through this it calculates respiration value per minutes and performs the alarm function according to limit value. The monitor can use ECG leads I or II for breath detection, regardless of the leads selected for QRS processing. The measurement range for impedance breath monitoring is 0 to 155 breaths per minute. The alarm setting range is 5 ~ 150 breaths per minute. In neonatal and pediatric mode, the monitor can detect central apnea. You can monitor the heart rate, SpO2 using the appropriate accessories, and display the relevant values in the Oxycardiorespirogram. RESP precaution Safety and efficacy of respiration measurement methods for apnea detection, especially apnea of premature babies and apnea of infants, have not yet been established.  This device does not monitor obstructive apnea. Patients in a breathing crisis should be closely monitored.  Impedance breath monitoring should not be considered the only way to detect breathing stops. Bionet recommends monitoring of additional parameters, such as EtCO2 and SpO2, that indicate the patient's oxygen supply status.  • If you use an ESU block or cable, the impedance breath monitor may not work and the pacemaker detection performance may be degraded. If pacemaker detection is enabled, ESU interference may be detected as a pacemaker.  • Large amplitude pacemaker pulses ( > 100mV) may interfere with the monitor's breath measurement or detection function.

BM3 User’s Manual Patient Preparation Skin preparation and electrode placement must be properly and carefully monitored in impedance breath monitoring. You can produce reliable results. Follow the same recommendations as ECG monitoring Please. In general, the electrodes should be placed as clean as possible with the 60Hz noise minimized Make it possible to generate a signal. The best results can be obtained when the electrode is firmly bonded and the electrode area is wide. To improve the RESP signal, use a 5- lead cable set (RL as a neutral electrode). It is recommended that the electrode be placed in the maximum expansion and contraction range of the lung, especially if deep breathing is involved. For newborns, place the RA and LA electrodes on the mid-armpit line with the nipple. Place the LL electrodes under the diaphragm and navel. Avoid the liver and the ventricles of the heart to prevent 60Hz noise from pulsatile blood circulation. The following figure shows where we recommend placing ECG leads for impedance breathing in adults and neonates Lead II Respiration position Lead I Respiration position

BM3 User’s Manual Respiration connector and measurement cable Respiration connector SpO2 T CO2 ECG Connector Note Respiration Rate measures the cable and connector will be used as the ECG and common. Respiration cable

BM3 User’s Manual Display ① Breathe indicator: indicates the detected breath ② Breathing number : displays the number of respiration per minute ③ Respiration alarm limit: indicates respiration limits ④ Apnea limit Setting: Apnea limit sign

BM3 User’s Manual RESP Settings A. RESP menu Menu Description Available Settings A-1. Alarm RESP Alarm setting menu A-1-1. PARAMETER ALARM LIMIT RR, APNEA Parameter alarm , level ,Activation setup menu A-1-2. TECHNICAL ALARM CONDITION RESP-CABLE OFF RESP-LEAD FAULT RESP-CHECK ELETRODE A-2. DISPLAY OPTION This is for changing the reference LEAD for respiration A-2-1. SWEEP SPEED A menu to setup Wave Display of speed 6.25mm/s, 12.5mm/s, 25mm/s, A-2-2. SIZE A menu to setup Wave Display 2, 4, 6, 8, 10 A-2-3. LEAD SELECT This is for changing the reference LEAD for respiration LEAD I LEAD II A-3. APNEA DETECT A menu to setup APNEA alarm display OFF/ ON OxyCRG monitoring The monitor can display Oxycardiorespirogram (OxyCRG or OCRG) in neonatal mode. OCRG displays updated HR trend, SpO2 or trend, respiratory / etCO2 waveforms, as well as apnea events in 3 or 6 consecutive minutes. The monitor will continue to update the main screen parameters, alarm announcement, and alarm recording start. OxyCRG display method:

BM3 User’s Manual 1. Set patient type to Neonatal 2. Connect SpO2 sensor, HR lead and breath or etCO2 lead. 3. Set the apnea time in the RESP menu. 4. Press the TREND icon key. 5. Click OxyCRG to display the OxyCRG screen. Scale To change the HR scale: 1. Select the parameter window using the rotary knob and click. 2. Turn the dial to the desired scale setting and click. The values are shown in the following table (you can only modify HR scales). Cursor When you select the cursor box, a vertical bar is displayed in the trend area of the screen. The number on the left of the screen no longer indicates the scale value, but the parameter value of the time marked with the cursor is displayed. The monitor continuously displays the current value (real time) on the right side of the screen. When the cursor is moved to the right or left with the rotary knob, it is corrected and displayed accordingly. Parameter definition The highest (maximum) and lowest (lowest) HR values over the last 6 minutes SpO2 50 -100% The lowest saturation value over the last 6 minutes Respiration waveform

BM3 User’s Manual OxyCRG Setup menu MENU Description Available Settings ECG AUTO SCALE ECG RANGE AUTO SCALE setup ON/OFF ECG MANUAL SCALE ECG RANGE MANUAL SCALE setup PARAMETER TYPE RESP, ETCO2 parameter setup menu RESP ETCO2

BM3 User’s Manual 11. NIBP Overview The monitor can acquire and process non-invasive blood pressure (NIBP) signals and display the output. Blood pressure measurements are determined by the oscillometric method and are equivalent to those obtained by intra-arterial methods, within the limits prescribed by the Association for Advancement of Medical Instrumentation, Electronic Automated Sphygmomanometers (AAMI/ANSI SP-10). If the pulse signal is poor due to patient movements, improper cuff placement or noise in the signal, the cuff deflates and the monitor attempts a second measurement. For causes and possible remedies for a poor pulse signal see the alarm message tables. The hose connects the cuff to the monitor to determine the contraction, expansion and mean blood pressure of an adult, pediatric or neonatal patient. The monitor can start the blood pressure measurement alone with set intervals, or persistence lasting more than 5minutes. NIBP Connector

BM3 User’s Manual Adult Cuff Optional accessory list Thigh Adult Big Adult NIBP Cuff Cuff Size : 458 * 143 Arm circumference : 45 to 56.5Cm Option Big Adult Big Adult NIBP Cuff Cuff Size : 458 * 143 Arm circumference : 35.5 to 46 Cm Option Child Child NIBP Cuff Cuff Size : 430 * 108 Arm circumference : 20.5 to 28.5 Cm Option Pediatric Pediatric NIBP Cuff Cuff Size : 313 * 88 Arm circumference : 13.8 to 21.5 Cm Option Infant Infant NIBP Cuff Cuff Size : 210 * 60 Arm circumference 9 to 14.8 Cm Option Neonate NIBP Disposable Cuff Neonate 1 (3.3~5.6cm) Option

BM3 User’s Manual NIBP Disposable Cuff Neonate 2 (4.2~7.1cm) Option NIBP Disposable Cuff Neonate 3 (5.0~10.5cm) Option NIBP Disposable Cuff Neonate 4 (6.9~11.7cm) Option Note The NIBP should be set in the menu because the measured value differs depending on the patient's age and gender. Display ① Measurement Cuff type. ② Pulse rates: Indicates pulse rate. ③ Measurement time: Indicates the completion time of measuring. ④ Measure time: Indicates the schedule counter time of measuring. ⑤ Indicates recent measurement data.

⑥ Systolic Alarm limit: Indicates alarm limit of blood pressure. ⑦ Interval Time: indicates interval time when measures the blood pressure periodically. ⑧ Systolic blood pressure: Indicates the maximum limit of blood pressure. ⑨ Diastolic blood pressure: Indicates the maximum limit of blood pressure. ⑩ Mean blood pressure: Indicates the maximum limit of blood pressure. NIBP Settings A. NIBP menu Menu Description Available Settings A-1. Alarm NIBP Alarm setup menu A-1-1. PARAMETER ALARM LIMIT SYS, MEAN, DIA Parameter alarm limit, level , activation setup A-1-2. TECHNICAL ALARM CONDITION NIBP-OVER PRESSURE NIBP-OVERTIME PRESSURE NIBP-INFLATION FAILURE NIBP-DEFLATION FAILUER NIBP-MEASUREMENT ERROR NIBP-PULSE TOO WEAK NIBP-AIR LEAK NIBP-EXCESSIVE MOTION NIBP-SYSTEM FAULT A-2. CUFF SIZE A menu to select cuff size ADULT PEDIATRIC NEONATE A-3. INFLATION It is a function to set the range that is usually used by setting pressure at the beginning because it can give pain to the patient when the equipment is ADT : 120 – 250 mmHg PED :