Technology Offering
Objective

The goal of our presentation is to equip your sales team
with the three most important concepts possible:

1.     Masimo’s new products are compelling and easy to introduce to
target customers.

2.    It will be easy to prove and demonstrate – to move the sales
process forward.

3.   The sales team can achieve their numbers by selling the new
Masimo offering.
Guidelines for anesthesia monitoring for Dogs and
                                 Cats
                                 from the American College of Veterinary
Oxygenation                      Anesthesiologists
•   Objective: to ensure adequate oxygenation of the patient’s arterial blood.
•   Methods:
•   (1) Pulse oximetry (non-invasive estimation of hemoglobin saturation)
•   (2) Arterial blood gas analysis for oxygen partial pressure (PaO2).

Recommendations: Assessment of oxygenation should be done whenever possible by pulse oximetry,
with blood gas analysis being employed when necessary for more critically ill patients.

Ventilation
Objective: to ensure that the patient’s ventilation is adequately maintained.
Methods: (1) Observation of thoracic wall movement or observation of breathing bag movement
when thoracic wall movement cannot be assessed.
(2) Auscultation of breath sounds with an external stethoscope, an esophageal
stethoscope, or an audible respiratory monitor. (Acoustic Respiration )
(3) Capnography (end-expired CO2 measurement)
(4) Arterial blood gas analysis for carbon dioxide partial pressure (PaCO2)
(5) Respirometry (tidal volume measurement)

Recommendations:
Qualitative assessment of ventilation is essential as outlined in either 1 or 2 above, and capnography
is recommended, with blood gas analysis as necessary
Masimo Mission:
               Improving Patient Outcomes and Reducing the Cost of Care . . .
         . . . by Taking Noninvasive Monitoring to New Sites and New Applications




AAHA Guidelines for anesthesia for dogs and cats includes Pulse Oximeter on
the list of monitoring tools that should be used when administering anesthesia.
Masimo SET
• Masimo’s breakthrough technology is capable of obtaining accurate and
  reliable oxygenation and heart rate in the presence of patient movement and
  low perfusion caused by drugs like Alpha 2 agonists.

•   140+ clinical publications over 15+ years have confirmed Masimo SET is the
    Gold Standard.

•   First to receive FDA clearance for accuracy during motion & low perfusion

•   Utilized in 20 out of the 28 accredited Veterinarian University Programs
More about SET
• In addition to motion, SET technology provides
  a 10 fold increase in reading low perfusion.

• Using Alph2’s (DexDormator, Xylazine etc) and
  Propoflo cause peripheral perfusion reduction.

• Use Masimo with all drugs, especially “alpha 2
  drugs” unsurpassed clinical superiority
Challenges with Non-Masimo SET®
        Pulse Oximetry Technologies
• In well-perfused patients who are not moving…
  – Most pulse oximeters work similarly
• But unreliable when needed most
  – Patient movement
  – Low perfusion (many critical care patients)
• Clinical impact
  – False alarms
  – Increased workload
  – Alarm fatigue
  – Delayed response may lead to compromised care and poor outcomes
  – Limited ability to provide accurate measurements to aid clinicians in diagnosis
    / prognosis
  – Patient disturbance
Masimo SET: the Proven Gold Standard in Pulse Oximetry

     Why is Masimo SET the best SpO2 technology
     delivering on the need for accurate monitoring
     during motion and low perfusion?
Sensitivity vs. Specificity

Sensitivity – The ability to detect true positives/alarms
Specificity – The ability to reject false positives/alarms


• Masimo has the highest sensitivity & specificity
• Other technologies have attempted to decrease false alarms at the
  expense of missing more true events
• Missed true events compromises patient safety
• Evaluations of performance must place much emphasis on sensitivity
  & specificity
Sensitivity & Specificity
          Masimo SET: Accurate Monitoring, Reduce False Alarms

   Independent study comparing Masimo SET vs
      Nellcor 600 and GE’s “TruSat” technology :                                                                                                  1




                                            Missed Event                   Sensitivity                 False Alarm                  Specificity
     Masimo SET     1/40                                          97.5%                               6/120                         95.0%
     Nellcor N600 17/40                                           57.5%                               34/120                        71.5%
     GE-D/O TruSat 33/40                                          17.5                                21/120                        82.5%
1 NitinShah, M.D., Laverne Estanol, M.S. Anesthesiology, 2006 Long Beach VA Medical Center, UC Irvine Medical Center, Long Beach,
California Comparison of Three New Generation Pulse Oximeters During Motion and Low Perfusion in Volunteers




 • All Pulse oximeters miss desaturations
 • All Pulse oximeters have False Alarms
 • Masimo with SET technology is more accurate with fewer false alarms.
Approaches to Reduce False Alarms with
 Conventional and “Next Generation” Pulse Oximetry

  • “Dynamic” / automatically increased averaging times*
     – Falsely low SpO2 values are mixed with normal SpO2 values
  • Value holding or freezing
     – Displaying numbers when the signal is corrupted by motion
  • Extended alarm delays
     – “Sat Seconds” can delay alarm notification by up to 100
       seconds*
  • Implications
     – False alarm and true alarm notifications can be delayed
     – If SpO2 or pulse rate are changing
         • Can result in missed patient events
* Nellcor N-600x operator’s manual
Masimo SET In the field
What are veterinarians saying about Masimo?




“Recent development of the Radical-7 pulse
oximeter (masimo.com) employs new algorithm
software that allows more reliable readings of SpO2
in case of motion, pigmentation, hypotensive, and
vasoconstrictive stage in animals.”

Jeff Ko , D.V.M., M.S.
Diplomate A.C.V.A.
Professor, Anesthesia

Department of Veterinary Clinical Sciences
Purdue University, School of Veterinary Medicine
What are veterinarians saying about Masimo?

“PVI tells you when you need fluid, it tells
whether your fluid administration is effective or
therapeutic and if it’s not, it actually is indirectly
indicating that you need to adjust anesthetic
protocol.

“The traditional methods for monitoring fluid
responsiveness during surgery are
inadequate. The PVI is a better method and
can be obtained from the Masimo pulse
oximeter. “

William W. Muir III DVM, MS, PhD,
DACVA, DACVECC
Selection that fits your needs
Unique Post-Op Oxygenation monitoring application
             using TFI on Ventral Tail




    “ Masimo’s equipment works consistently and gives the entire staff
    a lot more peace of mind with consistent, accurate readings and
    minimal drop-off alarms.”
     — Bob Klostermann, DVM
Perfusion Index (PI)
Perfusion Index, or PI-
is a relative assessment of the
pulse strength at the monitoring
site.

How to use PI?
Use PI during sensor
placement to evaluate the
quality of the application site.
A high PI reading means great
signal strength.
                                                    Perfusion Index= PI is a numerical value
                                                    that indicates the strength of the signal.
                                                    PI is a relative number which will vary
How does PI work?                                   by monitoring sites.
The ratio of the pulsatile vs.
non-pulsatile amounts of blood                      Low        = <0.5
at any particular site
corresponds to PI at that site.
                                                    Good = >0.5
 During sensor placement, how I can tell if the sensor site is a good one?.
 How do clinicians trouble shoot over the phone? They can now.
Signal IQ (SIQ): A visual indicator of
              Signal IQ                          the oximeters confidence level in the
                                                 displayed arterial oxygen saturation
                                                 and pulse rate measurements.

                                                 Why SIQ?
                                                 Masimo SET will continue to report
                                                 accurate oxygen saturation and pulse
                                                 rate during motion and low perfusion,
                                                 even when plethysmographic
                                                 waveform becomes corrupt and other
                                                 bedside oximeters read erroneously or
                                                 freeze.

                                                 How do I use Signal IQ?
                                                 •Use SIQ to be sure that valid O2
                                                 saturation and pulse rate readings are
  Signal IQ:                                     displayed during motion and low
                                                 perfusion.
                                                 •Use SIQ in the presence of
  Low                                            environmental interference like
                                                 sunlight, florescent lights or ceiling
  Good                                           fans.

How can we tell the oximeter picking up a good signal on this patient?
How do clinicians trouble shoot over the phone?
The Power of Masimo SET in the palm of your hand.




                    Features:
                    Lightweight, convenient handheld
                    Ideal for spot check monitoring or continuous monitoring
                    Audible and visual alarm for High/Low saturation, pulse rate, sensor-off and
                    low battery
                    Perfusion Index, FastSat, Signal IQ displays plus APOD
                    Up to 72 hours of trending memory
                    Long battery life: up to 48 hours on four AA batteries
                    Optional protective boot cover with built in tabletop stand

                                 Competitors
   Nellcor N-65VSAT                                         Nonin - 2500A Vet
Handheld Pulse Oximeter                                  Handheld Pulse Oximeter




                         SurgiVet® V1030
                     Hand Held Pulse Oximeter
Features:
Masimo SET® pulse oximetry: proven accurate during motion and low perfusion in
Over 100 independent clinical studies.1,2
The accuracy of Masimo SET oximetry has been linked to improved care and reduced medical errors.3
Compact, lightweight design with extended battery life for transport applications.
Large LED color display is easy to read at a distance.
Up to 8 hours of continuous battery life (RECHARGABLE)


                                           Competitors
                                                            Smiths Medical SurgiVet
OxiMax™ N-560™ Pulse Oximeter
                                                         V3304 Tabletop Pulse Oximeter
The best patient safety choice today and tomorrow




 Features:
 Masimo SET is clinically proven to be the highest sensitivity and specificity pulse oximeter
 in the world
 Perfusion Index (PI) with trending capability indicates arterial pulse signal strength and
 may be used as a diagnostic tool during low perfusion
 Pleth Variability Index (PVI): captures vital thoracic pressure changes that may
 compromise normal cardiac function affecting systemic circulation
 Signal IQ® waveform for signal identification and quality indication during excessive
 motion and low signal to noise situations
 Detachable portable hand-held for patient transport
Select OEM Partners




Masimo is the leading Read-Through Motion and Low
 Perfusion pulse oximetry solution in physiological
                      monitors
Before We Move On….
Program my number in your phone : National Account Manager - Ian Quinn 949-689-
8082 and iquinn@masimo.com

Director Animal Health - Kevin Allen – 714-376-6805 and kallen@masimo.com

NEW CONTACT - Distribution Resource Manager – Jeff Goeggel - (949) 633-8014
JGoeggel@masimo.com

Before going into facility memorize 2 or 3 Masimo Bullet Points

Practice introduction question(s)

Progress with a smooth transition using sales tools and clinical supporting materials


A few points to remember before asking for the sale:

1. Masimo provides accurate technology when measuring pulse O2 with improved
   contact/lead points to avoid missed/frozen readings

2. Masimo provides a money back guarantee on their units
Marketing Materials
30 Second Elevator Speech
Target Accounts
Anyone using Alpha 2 agonist drugs like DexDormator, Xylazine and Propoflo as they cause
peripheral perfusion reduction. Masimo Pulse oximetry can read to 1/10th the perfusion
compared with conventional offering for unsurpassed clinical superiority

Anyone performing Dental Procedures!!! Every Masimo monitor comes with a new
transflectance sensor that works great under the base of the tail, allowing for more room in the
mouth when performing dental procedures.

Anyone performing Emergency and Critical Care Services!!! This is when motion and low
perfusion can cause conventional pulse to fail or read falsely low. Masimo’s measure through
motion and low perfusion is reliable when it matters most.


                                       Companion
                                        Animals




                              Equine                   Zoo
Masimo pulse ox training module 1 [compatibility mode]

Masimo pulse ox training module 1 [compatibility mode]

  • 1.
  • 2.
    Objective The goal ofour presentation is to equip your sales team with the three most important concepts possible: 1. Masimo’s new products are compelling and easy to introduce to target customers. 2. It will be easy to prove and demonstrate – to move the sales process forward. 3. The sales team can achieve their numbers by selling the new Masimo offering.
  • 3.
    Guidelines for anesthesiamonitoring for Dogs and Cats from the American College of Veterinary Oxygenation Anesthesiologists • Objective: to ensure adequate oxygenation of the patient’s arterial blood. • Methods: • (1) Pulse oximetry (non-invasive estimation of hemoglobin saturation) • (2) Arterial blood gas analysis for oxygen partial pressure (PaO2). Recommendations: Assessment of oxygenation should be done whenever possible by pulse oximetry, with blood gas analysis being employed when necessary for more critically ill patients. Ventilation Objective: to ensure that the patient’s ventilation is adequately maintained. Methods: (1) Observation of thoracic wall movement or observation of breathing bag movement when thoracic wall movement cannot be assessed. (2) Auscultation of breath sounds with an external stethoscope, an esophageal stethoscope, or an audible respiratory monitor. (Acoustic Respiration ) (3) Capnography (end-expired CO2 measurement) (4) Arterial blood gas analysis for carbon dioxide partial pressure (PaCO2) (5) Respirometry (tidal volume measurement) Recommendations: Qualitative assessment of ventilation is essential as outlined in either 1 or 2 above, and capnography is recommended, with blood gas analysis as necessary
  • 4.
    Masimo Mission: Improving Patient Outcomes and Reducing the Cost of Care . . . . . . by Taking Noninvasive Monitoring to New Sites and New Applications AAHA Guidelines for anesthesia for dogs and cats includes Pulse Oximeter on the list of monitoring tools that should be used when administering anesthesia.
  • 5.
    Masimo SET • Masimo’sbreakthrough technology is capable of obtaining accurate and reliable oxygenation and heart rate in the presence of patient movement and low perfusion caused by drugs like Alpha 2 agonists. • 140+ clinical publications over 15+ years have confirmed Masimo SET is the Gold Standard. • First to receive FDA clearance for accuracy during motion & low perfusion • Utilized in 20 out of the 28 accredited Veterinarian University Programs
  • 6.
    More about SET •In addition to motion, SET technology provides a 10 fold increase in reading low perfusion. • Using Alph2’s (DexDormator, Xylazine etc) and Propoflo cause peripheral perfusion reduction. • Use Masimo with all drugs, especially “alpha 2 drugs” unsurpassed clinical superiority
  • 7.
    Challenges with Non-MasimoSET® Pulse Oximetry Technologies • In well-perfused patients who are not moving… – Most pulse oximeters work similarly • But unreliable when needed most – Patient movement – Low perfusion (many critical care patients) • Clinical impact – False alarms – Increased workload – Alarm fatigue – Delayed response may lead to compromised care and poor outcomes – Limited ability to provide accurate measurements to aid clinicians in diagnosis / prognosis – Patient disturbance
  • 8.
    Masimo SET: theProven Gold Standard in Pulse Oximetry Why is Masimo SET the best SpO2 technology delivering on the need for accurate monitoring during motion and low perfusion?
  • 9.
    Sensitivity vs. Specificity Sensitivity– The ability to detect true positives/alarms Specificity – The ability to reject false positives/alarms • Masimo has the highest sensitivity & specificity • Other technologies have attempted to decrease false alarms at the expense of missing more true events • Missed true events compromises patient safety • Evaluations of performance must place much emphasis on sensitivity & specificity
  • 10.
    Sensitivity & Specificity Masimo SET: Accurate Monitoring, Reduce False Alarms Independent study comparing Masimo SET vs Nellcor 600 and GE’s “TruSat” technology : 1 Missed Event Sensitivity False Alarm Specificity Masimo SET 1/40 97.5% 6/120 95.0% Nellcor N600 17/40 57.5% 34/120 71.5% GE-D/O TruSat 33/40 17.5 21/120 82.5% 1 NitinShah, M.D., Laverne Estanol, M.S. Anesthesiology, 2006 Long Beach VA Medical Center, UC Irvine Medical Center, Long Beach, California Comparison of Three New Generation Pulse Oximeters During Motion and Low Perfusion in Volunteers • All Pulse oximeters miss desaturations • All Pulse oximeters have False Alarms • Masimo with SET technology is more accurate with fewer false alarms.
  • 11.
    Approaches to ReduceFalse Alarms with Conventional and “Next Generation” Pulse Oximetry • “Dynamic” / automatically increased averaging times* – Falsely low SpO2 values are mixed with normal SpO2 values • Value holding or freezing – Displaying numbers when the signal is corrupted by motion • Extended alarm delays – “Sat Seconds” can delay alarm notification by up to 100 seconds* • Implications – False alarm and true alarm notifications can be delayed – If SpO2 or pulse rate are changing • Can result in missed patient events * Nellcor N-600x operator’s manual
  • 13.
    Masimo SET Inthe field
  • 14.
    What are veterinarianssaying about Masimo? “Recent development of the Radical-7 pulse oximeter (masimo.com) employs new algorithm software that allows more reliable readings of SpO2 in case of motion, pigmentation, hypotensive, and vasoconstrictive stage in animals.” Jeff Ko , D.V.M., M.S. Diplomate A.C.V.A. Professor, Anesthesia Department of Veterinary Clinical Sciences Purdue University, School of Veterinary Medicine
  • 15.
    What are veterinarianssaying about Masimo? “PVI tells you when you need fluid, it tells whether your fluid administration is effective or therapeutic and if it’s not, it actually is indirectly indicating that you need to adjust anesthetic protocol. “The traditional methods for monitoring fluid responsiveness during surgery are inadequate. The PVI is a better method and can be obtained from the Masimo pulse oximeter. “ William W. Muir III DVM, MS, PhD, DACVA, DACVECC
  • 16.
  • 17.
    Unique Post-Op Oxygenationmonitoring application using TFI on Ventral Tail “ Masimo’s equipment works consistently and gives the entire staff a lot more peace of mind with consistent, accurate readings and minimal drop-off alarms.” — Bob Klostermann, DVM
  • 18.
    Perfusion Index (PI) PerfusionIndex, or PI- is a relative assessment of the pulse strength at the monitoring site. How to use PI? Use PI during sensor placement to evaluate the quality of the application site. A high PI reading means great signal strength. Perfusion Index= PI is a numerical value that indicates the strength of the signal. PI is a relative number which will vary How does PI work? by monitoring sites. The ratio of the pulsatile vs. non-pulsatile amounts of blood Low = <0.5 at any particular site corresponds to PI at that site. Good = >0.5 During sensor placement, how I can tell if the sensor site is a good one?. How do clinicians trouble shoot over the phone? They can now.
  • 19.
    Signal IQ (SIQ):A visual indicator of Signal IQ the oximeters confidence level in the displayed arterial oxygen saturation and pulse rate measurements. Why SIQ? Masimo SET will continue to report accurate oxygen saturation and pulse rate during motion and low perfusion, even when plethysmographic waveform becomes corrupt and other bedside oximeters read erroneously or freeze. How do I use Signal IQ? •Use SIQ to be sure that valid O2 saturation and pulse rate readings are Signal IQ: displayed during motion and low perfusion. •Use SIQ in the presence of Low environmental interference like sunlight, florescent lights or ceiling Good fans. How can we tell the oximeter picking up a good signal on this patient? How do clinicians trouble shoot over the phone?
  • 20.
    The Power ofMasimo SET in the palm of your hand. Features: Lightweight, convenient handheld Ideal for spot check monitoring or continuous monitoring Audible and visual alarm for High/Low saturation, pulse rate, sensor-off and low battery Perfusion Index, FastSat, Signal IQ displays plus APOD Up to 72 hours of trending memory Long battery life: up to 48 hours on four AA batteries Optional protective boot cover with built in tabletop stand Competitors Nellcor N-65VSAT Nonin - 2500A Vet Handheld Pulse Oximeter Handheld Pulse Oximeter SurgiVet® V1030 Hand Held Pulse Oximeter
  • 21.
    Features: Masimo SET® pulseoximetry: proven accurate during motion and low perfusion in Over 100 independent clinical studies.1,2 The accuracy of Masimo SET oximetry has been linked to improved care and reduced medical errors.3 Compact, lightweight design with extended battery life for transport applications. Large LED color display is easy to read at a distance. Up to 8 hours of continuous battery life (RECHARGABLE) Competitors Smiths Medical SurgiVet OxiMax™ N-560™ Pulse Oximeter V3304 Tabletop Pulse Oximeter
  • 22.
    The best patientsafety choice today and tomorrow Features: Masimo SET is clinically proven to be the highest sensitivity and specificity pulse oximeter in the world Perfusion Index (PI) with trending capability indicates arterial pulse signal strength and may be used as a diagnostic tool during low perfusion Pleth Variability Index (PVI): captures vital thoracic pressure changes that may compromise normal cardiac function affecting systemic circulation Signal IQ® waveform for signal identification and quality indication during excessive motion and low signal to noise situations Detachable portable hand-held for patient transport
  • 23.
    Select OEM Partners Masimois the leading Read-Through Motion and Low Perfusion pulse oximetry solution in physiological monitors
  • 24.
    Before We MoveOn…. Program my number in your phone : National Account Manager - Ian Quinn 949-689- 8082 and iquinn@masimo.com Director Animal Health - Kevin Allen – 714-376-6805 and kallen@masimo.com NEW CONTACT - Distribution Resource Manager – Jeff Goeggel - (949) 633-8014 JGoeggel@masimo.com Before going into facility memorize 2 or 3 Masimo Bullet Points Practice introduction question(s) Progress with a smooth transition using sales tools and clinical supporting materials A few points to remember before asking for the sale: 1. Masimo provides accurate technology when measuring pulse O2 with improved contact/lead points to avoid missed/frozen readings 2. Masimo provides a money back guarantee on their units
  • 25.
  • 26.
  • 27.
    Target Accounts Anyone usingAlpha 2 agonist drugs like DexDormator, Xylazine and Propoflo as they cause peripheral perfusion reduction. Masimo Pulse oximetry can read to 1/10th the perfusion compared with conventional offering for unsurpassed clinical superiority Anyone performing Dental Procedures!!! Every Masimo monitor comes with a new transflectance sensor that works great under the base of the tail, allowing for more room in the mouth when performing dental procedures. Anyone performing Emergency and Critical Care Services!!! This is when motion and low perfusion can cause conventional pulse to fail or read falsely low. Masimo’s measure through motion and low perfusion is reliable when it matters most. Companion Animals Equine Zoo