Philips CMS V24 V26 Service manual

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Philips CMS Patient Monitoring System

& V24 and V26 Patient Monitors

Concepts Guide

PHI

Part No. M1046-9421L

Printed March 2003

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Notice

Warranty

This document contains proprietary information which is protected by copyright. All Rights Reserved. Reproduction, adaptation, or translation withou t prio r written permission is prohibited, except as allowed under the copyright laws.

Philips Medical Systems Cardiac and Monitoring Systems 3000 Minuteman Road Andover, MA 01810 +1 (800) 934-7372

Publication number M1046-9421L Printed September 2002

The information contained in this document is subject to change without notice.

Philips Medical Systems makes no warranty of any kind with regard to this material, including, but not limited to, the implied warranties or merchantability and fitness for a particular purpose.

Philips Medical Systems shall not be liable for errors contained herein or for incidental or consequential damages in connection with the furnishing, performance, or use of this material.

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Printing History

New editions of this document will incorporate all material updated since the previous edition. Update packages may be issued between editions and contain replacement and additional pages to be merged by a revision date at the bottom of the page. Note that pages which are rearranged due to changes on a previous page are not considered revised.

The documentation printing date and part number indicate its current edition. The printing date and part number change when a new edition is printed. This guide combines the former CMS Patient Monitoring System Concepts Guide with the former Viridia 26/24 Series Concepts Training and Reference Guide to one manual; therefore, this guide is in its first edition. The printing histories of both Concepts Guides are listed below.

Printing histories of former Concepts Guide Versions

Edition CMS V24 and V26

First January 1996 November 1996

Second May 19 97 December 1996

Third January 1998 February 1998

Fourth --- April 1999

Patient Monitors

First Edition ............................... ...... .June 2000

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Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

The Purpose of This Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Who Should Use This Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

What The Book Contains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

Intro. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

How the Book is Structured. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

How the Content Is Organized. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

How to Use This Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Learning and Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Choose Your Approach. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Basic Plug-In Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

Electrocardiogram/Respirogram (ECG/RESP) Module Concepts . . . . . . . . . . . . . .3

ECG Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Measurement Principle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Measurement Acquisition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Criteria for Proper Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

Plug-In Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

ECG Measurements Exercises. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

ECG Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Theory of Operation (M1001A/M1002A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

ECG Module Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

ECG Module Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

RESP Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Contents-1

Page 6

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Measurement Principle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Measurement Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

Criteria for Proper Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

Plug-In Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

RESP Measurement Exercises. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

ECG/RESP Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24

Theory of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

ECG/RESP Module Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26

ECG/RESP Module Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28

Non-invasive Blood Pressure (NBP) Module Concepts . . . . . . . . . . . . . . . . . . . . 30

NBP Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

Measurement Principle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

Measurement Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

Criteria for Proper Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

Plug-In Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

NBP Measurements Exercises. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

NBP Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

Theory of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36

NBP Module Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36

NBP Module Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39

Cardiac Output (C.O.) Module Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

C.O. Measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40

Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40

Contents-2

Page 7

Measurement Principle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Measurement Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Criteria for Proper Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Plug-In Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

C.O. Measurement Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

C.O. Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Measurements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Theory of Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

C.O. Module Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

C.O. Module Exercises. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Cardiac Output #C10 (CCO) Module Concepts (CMS only) . . . . . . . . . . . . . . . . 49

C.O. #C10 (CCO) Measurement (CMS only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Measurement Principle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Measurement Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Injectate Temperature and Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

C.O. #C10 (CCO) Module (CMS only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Measurements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Theory of Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

C.O. #C10 (CCO) Module Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Arterial Oxygen Saturation/Plethysmography (SpO2/Pleth) Module Concepts . 56

SpO2 Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Measurement Principle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Measurement Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Criteria for Proper Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Plug-In Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

SpO2 Measurement Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Contents-3

Page 8

SpO2/PLETH Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60

Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60

Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60

Theory of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62

SpO2/PLETH Module Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63

SpO2/PLETH Module Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65

Temperature (TEMP) Module Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

TEMP Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66

Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66

Measurement Principle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66

Measurement Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66

Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66

Criteria for Proper Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66

Plug-In Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67

TEMP Measurement Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68

TEMP Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69

Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69

Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69

Theory of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71

TEMP Module Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71

TEMP Module Exercises. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72

Recorder Module Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Recorder Module (M1116A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73

Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73

Theory of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75

Recorder Module Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77

Recorder Module Exercises (M1116A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79

Recorder Module (M1116B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80

Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80

Theory of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .82

Recorder Module Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83

Contents-4

Page 9

Recorder Module Exercises (M1116B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

Data Transfer Module Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Data Transfer Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Theory of Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88

Data Transfer Module Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

Data Transfer Module Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

Advanced Plug-In Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Topics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Invasive Blood Pressure Module Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Invasive Blood Pressure Measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Measurement Principle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Measurement Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Measurement Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Criteria for Proper Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Plug-In Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Invasive Blood Pressure Measurement Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Invasive Blood Pressure Module (M1006A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Measurements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Theory of Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

PRESS M1006A Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

PRESS M1006A Module Exercises. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Invasive Blood Pressure Module (M1006A/Option #C01) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Measurements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Theory of Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Contents-5

Page 10

PRESS M1006A/Option #C01 Module Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

PRESS M1006A/Option #C01 Module Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

Invasive Blood Pressure Module (M1006B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Theory of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

PRESS M1006B Module Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

PRESS M1006B Module Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

CO2 Respiratory Gas Module Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

CO2 Respiratory Gas Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

Measurement Principle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

Measurement Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

Measurement Output. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

Criteria for Proper Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

Plug-In Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

CO2 Respiratory Gas Measurement Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

CO2 Respiratory Gas Module (M1016A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

Theory of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

CO2 M1016A Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

CO2 M1016A Module Exercises. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27

Sidestream CO2 Module (M1015A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28

Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28

Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28

Theory of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

M1015A Sidestream CO2 Module Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

M1015A Sidestream Module Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

FIO2 Module Concepts (CMS only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

FIO2 Respiratory Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33

Contents-6

Page 11

Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Measurement Principle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Measurement Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Measurement Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Criteria for Proper Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Plug-In Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

FIO2 Respiratory Measurement Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

FIO2 Module (M1017A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Measurements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Theory of Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

FIO2 M1017A Module Exercises. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Transcutaneous Gas (tcpO

/tcpCO2) Module Concepts . . . . . . . . . . . . . . . . . . . . 40

tcpO2/tcpCO2 Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Measurement Principle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Measurement Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Measurement Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Criteria for Proper Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Plug-In Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

tcpO2/tcpCO2 Measurement Exercises. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

tcpO2/tcpCO2 Module (M1018A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Measurements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Calibration Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Theory of Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

tcpO2/tcpCO2 M1018A Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

tcpO2/tcpCO2 M1018A Module Exercises. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

SvO2 Blood Gas Module Concepts (CMS only) . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

SvO2 Blood Gas Measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Measurement Principle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Measurement Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Contents-7

Page 12

Measurement Output. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50

Criteria for Proper Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50

Plug-In Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50

SvO2 Blood Gas Measurement Exercises. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51

SvO2 Module (M1021A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52

Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52

Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52

Theory of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54

SvO2 M1021A Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55

SvO2 M1021A Module Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57

Blood Analysis Module Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

Blood Analysis Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58

Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58

Measurement Principle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58

Measurement Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60

Measurement Output. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60

Negative Factors Affecting Proper Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61

Blood Analysis Module (M1022A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62

Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62

Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62

Theory of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64

Blood Analysis Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65

Blood Analysis Module - Software Update Requirements . . . . . . . . . . . . . . . . . . . . . . . .66

Blood Analysis Module Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67

VueLink Module Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68

VueLink Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68

Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69

Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69

Theory of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71

M1032A VueLink Module Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71

VueLink Module Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73

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Page 13

EEG Module Concepts (CMS only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

EEG Measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

EEG Channels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

EEG Signal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

Brain Waves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

Frequency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Amplitude . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

Symmetry. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

Patterns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

EEG Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Measurements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Theory of Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Electrode Application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

EEG Module Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

BIS Module Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

BIS

Measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Depth of Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

The Bispectral Index (BIS) and Depth of Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . 88

BIS Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Theory of Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

BIS Module Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

CMS Patient Monitoring System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Topics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

CMS Patient Monitoring System Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Contents-9

Page 14

Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

CMS Patient Monitoring System Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

CMS Functionality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

CMS Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

CMS Functions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

CMS Patient Monitoring System Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

CMS Patient Monitoring System Bus Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

Physical Backplane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

Message Passing Bus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

Local Bus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

Utility Bus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

Function Card Description Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Function Cards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Local Clusters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Card Placement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Minimum System Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

CMS Patient Monitoring System Power System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

Theory of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

CMS Patient Monitoring System Hardware Configurations . . . . . . . . . . . . . . . . . . . . . . . . . .19

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Application CPUs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Memory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Function Card Placement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

Plug-in Parameter Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

CMS Patient Monitoring System Software Configurations . . . . . . . . . . . . . . . . . . . . . . . . . . .31

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

Standard Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

Selection Window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

Task Window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

Screen Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

System Overview Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

CMS Patient Monitoring System Functional Modules . . . . . . . . . . . . . . . . . . . . . 34

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

Contents-10

Page 15

Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Topics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Computer Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Front of the Computer Module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Rear Connectors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Integral Power Supply - Computer Module (M1046B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Integral Power Supply - Connectors and Controls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Remote Power Supply (M1047A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Front Panel Controls - Remote Power Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Remote Power Supply - Rear Controls and Connectors . . . . . . . . . . . . . . . . . . . . . . . . . 42

Display Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Display Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Front of Main Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Front Panel Controls and Connectors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Rear of Main Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

External Alarm Device Connectors and Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

CRT Display Rear Panel Connectors and Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Switch-Mode Power Supply (SMPS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Remote Displays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Control Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Remote Keypad . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Data Entry Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Module Racks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Types of Racks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Integral Rack Connectors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Satellite Module Rack Connectors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Module Rack Theory of Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Module Rack Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Plug-in Parameter Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

Types of Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Installing a Parameter Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

“T” Parameter Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Connection to the Rack . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Connection to the Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Contents-11

Page 16

Precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59

CMS Patient Monitoring System Module Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60

CMS Master Function Cards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63

Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63

Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64

Master Card Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64

Master Card Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65

Communication with the MPB. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66

DC-to-DC Converter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67

Functional Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67

Theory of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68

Application CPU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69

Theory of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70

Functional Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71

LEDs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73

Summary of Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73

Configurable Processor Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74

Theory of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75

Functional Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76

Daughter Card Block Diagram. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76

CPC LEDs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77

Summary of CPC CPU Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77

Monochrome Display Controller . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78

Connection to Display Module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78

Theory of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79

Functional Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80

Summary of DSPC Card Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81

Color Display Controller Cards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81

Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81

Contents-12

Page 17

CDSPC_CTRL Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

Theory of Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

CDSPC_CTRL Functional Block Diagram. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

Summary of CDSPC Cards Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

Color Display Controller Card (New Version). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

CDSPC Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

Theory of Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

CDSPC Functional Block Diagram. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Summary of CDSPC Cards Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Flatscreen Display Controller Card. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

DSPC_FLAT Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

Theory of Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

DSPC_FLAT Functional Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88

Summary of DSPC_FLAT Card Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88

DSPC_FLAT_ASIA Flatscreen Controller Card. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

DSPC_FLAT_ASIA Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

Theory of Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

Summary of Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

DSPC_XGA Display Controller Card. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

DSPC_XGA Components. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

Theory of Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

DSPC_XGA Functional Block Diagram. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

Summary of DSPC_XGA Card Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

Utility CPU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

Connections or Interfaces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

Theory of Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Functional Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

Utility Card LEDs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Summary of Utility CPU Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

RS232/RS422 Dual Interface Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

Contents-13

Page 18

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98

Software Release Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98

Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99

Theory of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99

Functional Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101

Summary of RS232/RS422 Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102

HDLC Interface Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102

Theory of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102

Testing/Diagnostics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103

Functional Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104

Summary of HDLC Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104

Analog Interface Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105

Theory of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106

Functional Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108

Summary of Analog Card Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .109

CMS Local Function Cards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110

Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110

Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111

Local Card Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111

Local Card Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111

EPROM. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113

Theory of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114

Functional Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114

Summary of EPROM Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115

SRAM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115

Theory of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115

Functional Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117

Contents-14

Page 19

Summary of SRAM Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117

Color Display Video Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118

Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118

CDSPC_VIDEO Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118

Theory of Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

CDSPC_VIDEO Functional Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121

Summary of CDSPC Cards Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122

Serial Distribution Network Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122

Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123

Theory of Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123

Summary of SDN Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124

Functional Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125

Rack Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126

Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126

Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126

Theory of Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126

Summary of Rack Interface Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

Functional Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128

Aux Connector Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

Remote Switch Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

V24 and V26 Patient Monitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Topics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

V24 and V26 Patient Monitors Description and Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Clinical Uses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Product Releases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Contents-15

Page 20

V24 and V26 Patient Monitors Standard Package . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Mainframe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Rack Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Parameter Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Philips Patient Care System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Data Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Vital Signs Recording . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Split Screen Capability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Clinical Calculation Set. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Drug Calculator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Arrhythmia Detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

Anesthetic Gas Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

ST Segment Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

oxyCRG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Neonatal Event Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Settings Transfer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

V24 and V26 Patient Monitors Features Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

V24 and V26 Patient Monitors Interfaces. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

V24 and V26 Patient Monitors Interfaces Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

V24 and V26 Patient Monitors User Controls and Connectors . . . . . . . . . . . . . . . . . . . . . . . .14

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

User Controls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Front Panel Controls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

The V24/V26 Front Panel Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

V24/V26 User Controls Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

Connectors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Eight-slot Rack. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Six-slot Rack. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Connectors Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Contents-16

Page 21

V24 and V26 Patient Monitors Software Configurations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Modules Partitioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Application CPU Architecture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Utility CPU Architecture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Front End Microcontroller Architecture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

V24/V26 Software Configurations Exercises. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

V24 and V26 Patient Monitors Theory of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

V24, V24C, V26C Power Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

V24CT/V26CT Power Supply. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

System Board . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Application Subsystem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Utility Subsystem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Front End Interface Subsystem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Common Subsystem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Front Panel Keyboard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Flat Panel Display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Display Adapter Board. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

3 Board Assembly. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Service Port Connectors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Six-slot Rack Eight-slot Rack . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

V24/V26 Theory of Operation Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Philips Monitoring Network (SDN) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Topics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Defining the Philips Monitoring Network (SDN) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Philips Monitoring Network (SDN) Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Philips Care Hub (SCC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Philips Monitoring Network (SDN) Interface Circuitry . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Wall Boxes and Face Plates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Branch Cables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Local Distribution Cables (LDC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

How the Philips Monitoring Network (SDN) Works. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Contents-17

Page 22

Defining the Inter-SDN Gateway. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

Defining the Inter-SDN Gateway Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

Contents-18

Page 23

Introduction

The Purpose of This Book

Philips Medical Systems’ CMS Patient Monitoring System & V24 and V26 Patient Monitors Concepts Guide is a companion volume to the Service Guides of both the

CMS and V24/V26 patient monitors. This volume contains conceptual information and technical details on both patient monitoring families.

The purpose of this book is to provide a conceptual foundation for the monitoring systems in order to support effective troubleshooting and repair. The book is not intended to be a comprehensive, in-depth explanation of the product architecture or technical implementation. Rather, it was developed to offer enough information on the functions and operations of the monitoring sy stems so that engineers who repair them will be able to better understand how they work.

The book provides a bird’s-eye-view of the product family in the context of the clinical settings and measurements for which they are used. It covers the physiological measurements that the products were des igned to provide, the modules that acquire those measurements, the three systems that use those modules, and the network that ties all of the pieces together into an integrated whole.

Who Should Use This Book

If you are a biomedical engineer or a technician responsible for troubleshooting, repairing, and maintaining Philips’ patient mon itoring systems, this book was designed for you. If you are new to Philips’ product line or monitoring systems, you may find it helpful as an orientation to the equipment. If you have been working on the systems for awhile and now want further details on how they work, you are lik e ly to find much of the information you need here. If you want to learn about patient measurements and the principles by which they are derived, this is a good place to start.

Introduct i on -1

Page 24

What The Book Contains

Intro The CMS & V24/V26 and their families of products are po werful, flexible patient

monitoring systems that provide a wide range of data acquisition and processing functions for all types of patients, in both critical care and routine care settings. Although these patient monitors are high ly r eliab le and easy to us e, its high degree of flexibility and functionality may seem daunting to users and technicians who do not work with it on a regular basis. The information in this book will, we hope, make the systems easier to understand.

How the Book is Structured

How the Content Is Organized

The book contains five chapters, each of which may be used independently of the others.

Chapters in This Book

Chapter Title Description

Basic Plug-In Modules The measurements taken by the basic set of plug-in

parameter modules used by Philips’ patient monitoring systems, and the functional descriptions of the modules themselves.

Advanced Plug-In Modules The measurements take n by the advanced set of

modules, along with the functio na l de scri pt ions of the modules.

CMS A functional description of the CMS, includi ng it s

components and operations.

V24 and V26 Patient Monitors A functional description of the V24/V26, including its

components and operations.

Philips Patient Network An overview of the Philips Patient Network (SDN),

including its major components, functions, and the services it provides.

The flow of information proceeds from the patient inward toward the system. The chapters begin with the measurements that are taken from patients and the plug-in modules that are designe d to acquire and process those data. The module information is organized based on the technical complexity of the device, not on the characteristics of the measurements. The first set of modules, from a technical perspective, are simpler in operation. The next set of modules performs more complex data processing operations.

Introduction -2

Following the plug-in modules are chapters that cover the monitoring systems with which the modules can be used. These are the CMS, Anesthesia CMS (ACMS) the Neonatal CMS (NCMS) and the V24/V26. The CMS is Philips’ premier modular monitoring system with full f u nctionality and the ability to use all of the modules. The V24 and V26 are designed to be used with patients who are being monitored in a Critical Care en vironment. The V24CT/V26C T can also be used during pati ent tra nsport b etween un its. It can use mos t, but not all, o f the plug-in modules of the Philips patient monito ri ng system.

Page 25

How to Use This Book

The final chapter covers the Philips monitoring network (SDN), also called Philips patient care system, which enables the monitoring sy stems to be connected to a central station. With Philips monitoring network (SDN), central monitoring stations can be connected to bedside monitors, external computers, and measurement instruments to provide clinical staff with the configuration that meets their needs.

Learning and Reference

Choose Your Approach

The book was designed as a combination self-paced training course and reference manual. While it does not cover every aspect of the monitoring systems in detail, it covers the functional descriptions that are provided in the Service Manuals for the individual systems. To help you plan and assess your learning, it provides:

• goals for each chapter

• learning objectives for each section within a chapter

• highlights of important concepts, as well as topic lists at the beginning of each section

• practice exercises within each chapter

• a final self-assessment test at the end of the book

Your approach to this book will likely depend on yo ur persona l prefer ence and job needs. You can use the book as a self-paced training course, a reference docu ment, o r both. Although the book has a logical information flow, the chapters are independent units that do not have to be read in any particular order. Here are some suggested approaches:

• If you are unfamiliar with the products and would like to use the book as a training document, start at the beginning and work your way through at your own pace, using the l earning aids provided.

• If you already have s om e knowledge of the systems and want to identify the areas in which you need to learn more, you may want to start by taking the test at the end of the book. The questions are grouped to co rrespond wit h specific sections of the book. By identifying the questions you were not able to answer correctly, you can focus your learning on only those areas. You’ll also have a better idea of how much you already know. Then, take the test again at the end to reinforce your knowledge.

• You may want to use the book as a reference as you study the troubleshooting guides for the systems, or as a pre-course to help prepare yourself for troubleshooting.

• If you already know a lot about the hardware and want to focus on the measurement principles exclusively, you may want to pull out those sections and put them together in whatever order would be useful to you.

Introduction -3

Page 26

How to Use This Book

Introduction -4

Page 27

Chapter 1 Basic Plug-In Modules

Introduction

This chapter covers the basic set of plug-in parameter modules used by the patient monitoring systems and the measurement principles on which they are based. The next chapter covers the more advanced modules and their meas urements.

The categorization of basic and advanced m odules is bas ed on the complexity of their data-processing functions, rather than on the ease or difficulty of taking the measurements. Engineers who maintain and repair the equipment may want to become familiar with the basic modules before moving on to the more complex ones.

Goals After successfully completing this chapter, you should be able to:

• Describe the physiologic measurements that can be acquired and processed by Philips’ basic plug-in parameter modules.

• Explain how Philips’ plug-in modules acquire and process physiologic measurements.

Objectives In order to meet the chapter’s goals, you should be able to:

• Define each of the physiologic measurements.

• State the principle by which each measurement is derived.

• Recognize the forms in which the data for each measurement are represented.

• Identify the criteria and influencing factors related to the proper acquisition of the measurement.

• Describe the method, components, and mechanisms by which the measurement’s electrical signals are processed by the corresponding plug-in module.

• Identify and describe the features of the module.

Basic Plug-In Modules 1-1

Page 28

Introduction

Topics This chapter contains the following topics:

Chapter Topics

Measurements and Modules Page

ECG Measureme n t 1-3

ECG Module 1-13

RESP Measurement 1-19

ECG/RESP Module 1-23

NBP Measurement 1-30

NBP Modules 1-34

C.O. Measurement 1-40

C.O. Module 1-44

C.O. #C10 (CCO) Measurement (CMS only) 1-49

C.O. #C10 (CCO) Module (CMS only) 1-52

SpO2 Measurement 1-56

SpO2/PLETH Module 1-60

TEMP Measurement 1-66

TEMP Module 1-69

Recorder Module (M1116A) 1-73

Recorder Module (M1116B) 1-80

Data Transfer Module 1-86

1-2 Basic P lu

-In Modules

Page 29

ECG Measurement

Electrocardiogram/Respirogram (ECG/RESP) Module Concepts

ECG Measurement

Description The skin surface electrocardiogram (ECG) measures the electrical activity of the

patient's heart, or myocardium. This information indicates the condition of the heart’s electrical conduction system.

ECG is also referred to as EKG, the abbreviation for the German spelling of the term.

Concepts ECG concepts important to electrocardiogram measurement are:

• Lead - A specific electrode or array of electrodes used to record changes in electrical potential created by activity of an organ, such as the heart.

• QRS complex - The portion of an ECG waveform that represents the depolarization of the cardiac ventricles.

• ST segment - The portion of an ECG waveform that represents the time period between the end of ventricular depolarization and the start of ventricular repolarization.

• Pace pulse - On an ECG waveform, the marks indicating the initiation of cardiac depolarization and contraction generated by an artificial pacemaker.

Measurement Principle

Measurement Acquisition

The electrical cells of the heart generate, conduct, and coordinate electrical impulses that cause the heart’s mechanical cells to contract. As these impulses move through the various parts of the heart’s conduction system, small electrical currents also move toward the body’s surface. An ECG measures the heart’s electrical activity as the heart contracts and relaxes by recording the electrical s ignals on the patient’s skin. The measurement represents the changing electrical potentials and their progression through the heart; the ECG records data on both the direction of electrical activity and its magnitude.

The electrical signals are detected by electrodes placed on various areas of the patient's trunk and limbs. The information carried by the signals varies according to where and how the electrodes are placed.

An ECG is recorded using lead cables connected to a monitoring device. ECG leads are single electrodes, or arrays of electrodes, placed at specific anatomical positions that detect the electrical voltage of a specific cardiac vector. Each lead monitors the heart’s electrical activity from a different perspective. Unipolar leads detect signals moving from the heart to the skin’s surface; bipolar leads detect the surface electrical activity moving from one electrode to anot her. The EASI 12-lead ECG uses a special lead positioning that detects electrical activity, which does not correspond directly to

Basic Plu

-In Modules 1-3

Page 30

ECG Measurement

Limb Leads Three bipolar limb leads are called leads I, II, and III. Electrodes are placed on the

the standard ECG vectors, but from which all 12 of the standard vectors can be derived.

Lead cable sets are available with various numbers of lead wires; common types are three, five, and twelve lead sets. The end of each wire is attached to an electrode and is color-coded to facilitate anatomical placement. Electrodes can be placed in many different arrangements, depending on factors such as clinical application, type of patient, and suspected diagnosis.

patient’s right arm, left arm, and left leg, forming a pattern known as Einthoven’s triangle. For convenience, the electrodes can also be placed on the patient’s trunk near the shoulders and hip.

The unipolar leads are called aVR, aVL , and aVF; they can be monitored by the same three electrodes. When selected on the monitor, these leads measure the current from the heart out to the specified limb.

Figure 1-1 shows the electrode placemen ts and direction of the signals for limb leads. (European colors in brackets)

1-4 Basic P lu

-In Modules

Page 31

ECG Measurement

WHITE

[RED]

aVL

aVF

III

aVR

80x80

BLACK

[YELLOW]

RED

[BLACK]

Figure 1-1 Electrode Placement for Limb Leads

Basic Plu

-In Modules 1-5

Page 32

ECG Measurement

Chest Leads Chest leads, also called precordial leads, are unipolar. Leads labelled V with a

number or letter designation can be placed around the entire circumference of the chest, as well as the back. The most common clinical objective in matching V leads is ischemia detection. Figure 1-2 shows an example of the placement of these leads.

V4R

V3R

80x80

Figure 1-2 Electrode Placement for Chest Leads

1-6 Basic P lu

-In Modules

Page 33

ECG Measurement

Modified Chest Lead

(MCL

is a bipolar chest lead in which two electrodes are placed over the chest as

MCL

shown in Figure 1-3. Other modified leads a re also commonly us ed. The positi on and

)

index of the chest electrode corresponds to the V-positions in Figure 1-2. (European colors in brackets).

WHITE

[RED]

RED

[GREEN]

BLACK

[YELLOW]

Figure 1-3 Modified Chest Lead (MCL1)

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-In Modules 1-7

Page 34

ECG Measurement

Five-Electrode

Placements

Electrodes for five-lead sets can be placed in various positions. One arrangement is shown in Figure 1-4. The right leg (RL) lead serves as a ground. (European colors in brackets).

Angle of

Lewis

BLACK

[YELLOW]

WHITE

[RED]

BROWN

[WHITE]

GREEN

[BLACK]

80x80

Figure 1-4 Five Electrode Placement

RED

[GREEN]

1-8 Basic P lu

-In Modules

Page 35

ECG Measurement

For EASI 12-lead ECG derivation, the leads should be placed as shown in Figure 1-5. (European colors in brackets).

Figure 1-5 EASI 12-lead Electrode Placement

Output ECG signals are depicted as continuous waveforms that show real-time changes in

lead voltages. The ECG shows the cycles of depolarization and repolarization of various parts of the heart, enabling practitioners to localize cardiac pathology. It interprets the electrical potentials as positive or negative, and plots them on a graph as upward and downward deflections from a baseline.

Basic Plu

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ECG Measurement

ECG Waveforms Many variations of the basic waveform are possible, depending on which leads are

being measured and the condition of the patient’s heart. Figure 1-6 shows the basic ECG wave.

Figure 1-6 Basic ECG Waveform

The parts of a wave are labeled, P, Q R S , and T, as shown in Figure 1-7. For patients with artificial pacemakers, small dashes called pace pulses appear at the beginning o f each wave. The QRS complex may actually be composed of only Q and R waves, only R and S waves, or only an R wave.

IDEAL

QRS

Normal QRS Complex

NO Q WAVE NO S WAVE

Figure 1-7 The QRS Complex

}

DIFFERENCE= ST VALUE

NO R WAVE

(Q& S COMBINE)

ONLY

R WAVE

ST Segment The ST segment is the part of the waveform between the S and T waves. This part of

1-10 Basic Plu

the waveform plays a critical role in diagnosing cardiac abnormalities. ST segment analysis is an important function in patient monitoring systems. An elevated or depressed ST segment can indicate a serious condition.

-In Modules

Page 37

ECG Measurement

Criteria for Proper

Factors affecting accurate measurement of ECG are:

Measurement

• Proper placement of electrodes. In order to record the strongest signals from the appropriate angles, electrodes must be placed precisely. Failure to do so may result in erroneous readings.

• Good skin contact. Because ECG signals are small, low voltages (millivolts), the electrodes must make good contact with the patient’s skin in order to get an accurate reading. Good contact requires proper skin preparation and periodic electrode replacement.

• Proper selection of leads. Leads must be selected with the correct cable sets to measure the appropriate electrical activity. Selecting the wrong leads could result in misdiagnosis of the heart’s condition.

• Elimination of external interference. A patient’s movements or bones can interfere with the signal, as can pacemaker activity and electrical interference from electrosurgical units (ESU). In the OR application, for example, electrodes should be placed equidistant from the surgical site to improve the ESU suppression. Other extraneous sources of electrical interference can be electrical appliances around the patient.

Plug-In Modules Two of Philips’ plug-in modules can measure ECG: the ECG Module (M1001A/B)

and the ECG/RESP Module (M1002A/B). Check the documentation for the system being used for determination of module usability.

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ECG Measurement

ECG Measurements Exercise s

1. An ECG measures both the magnitude and ________________ of the heart’s electrical signals.

2. Specific electrodes that measure specific cardiac vectors are called______________.

3. The right leg electrode serves as a ______________.

4. The part of the ECG waveform that plays a critical role in diagnosing serious heart conditions is the:

a. P wave b. QRS complex c. ST segment

1-12 Basic Plu

Answers

1. direction

2. leads

3. ground

4. c

-In Modules

Page 39

ECG Module

Description The M1001A/B ECG Module is a three-channel electrocardiogram measurement

parameter unit. It is designed to be used with adult, neonatal, or pediatric patients in Critical Care environments.

The M1002A/B ECG/RESP Module possesses the same ECG functionality as the ECG Module and adds respirograph functions as well.

Measurements The ECG produces up to 3 continuous real-time waveforms of the patient’s cardiac

electrical activity. It also generates numerics for the average heart rate (HR), derived from either the ECG or a remote arrhythmia computer.

Components The following components carr y ou t th e major s i gnal p roces si n g fu ncti ons wi thi n the

module.

Table 1-1 Major ECG Module Components

Component Function

Input Protection Network and ESU Filter

Lead Selection Switches Selects channels 1 and 2 for patient leads. (w ith EASI also

Right Leg Drive Minimizes interfer en ce fr om the 50/60Hz power line.

Highpass and Lowpass Filters Allow independent selection of diagnostic, monitoring, or

Test Signal Generates a calibration volta ge on each channel and tests the

Pace Pulse Detector Detects pace pul s es for channels 1and 2.

Protects the input amplifiers from defibrillation and high frequency interference sig nal s.

channel 3)

filter bandwidths for each cha nne l.

circuitry of the module.

Block Diagram Figure 1-8 shows the module’s logical structure.

Basic Plu

-In Modules 1-13

Page 40

ECG Module

AMPLIFIER

LOW

HIGH &

ENTIAL

DIFFER-

LEAD

SYSTEM

CONTROLLER

MUX

PASS

FILTERS

AMPS

SWITCHES

SELECTION

LEAD

DRIVE

PACE PULSE

TWO-CHANNEL

SIGNAL

SWITCH

DETECTOR

RACK

INTERFACE

VARIABLE

PATIENT

ISOLATION

LEADS OFF

ECG ASIC

1-14 Basic Plu

-In Modules

AMPS

INPUT

NETWORK

ESU-FILTER

PROTECTION

TEST

SIGNALS

INPUT CONN E CTOR

Figure 1-8 M1001A ECG Module Block Diagram

Page 41

ECG Module

Theory of Operation (M1001A/M1002A)

As ECG signals pass from the patient to the monitor, they progress through stages corresponding to the four logical sections of the module, as shown in the block diagram of Figure 1-8. Module-related faults can generally be isolated to one of the four stages.

1 Signals are received through patient electrodes and lead cables by the input

connector.

2 The input protection network and ESU Filter eliminate extraneous signals.

3 The signals are processed by two circuits: the ECG Application Specific

Integrated Circuit (ECG ASIC) and the Pace Pulse Detector (PPD ASIC). At this point, the analog signals from each lead are selected, amplified, filtered, and converted to digital form. During the process, the o utput of each inpu t amplifier is checked for a leads-off electrode condition, so that any detached electrode can be identified. The leads for channels 1 and 2 are selected using two identical lead selection circuits; channel 3 always carries the chest lead. The signals from the three channels are summed in the differential amplifiers.

To prevent interference from the 50/60Hz power line, the common mode signal derived from behind the lead selectors is used to drive the right leg drive amplifier. The output from the amplifier is then returned to the patient via the RL electrode. The PPD checks channels 1 and 2 to detect pulses from a pacemaker for display or cardiotach rejection. The high and low pass filters allow the independent selection of diagnostic, monitoring, or filter bandwidths for each channel.

For calibration purposes a 1mV calibration signal will be generated on each of the channels, in front of the filtering circuitry. The complete module can be tested (from in front of the first amplifier) on user request. That means switching the patients lead off, selecting lead V for all channels, and feeding in a test signal.

4 The microprocessor, which connects to the patient isolators and rack interface

through a front-end link, passes control signals for lead selection and pulse detection from the monitor to the module components through the control lines. It extracts the requested physiologic features from the cardiac signals and passes them on to the monitor. Meanwhile, all needed v oltage for the module’s operation is provided by the internal power supply, which receives 78 MHz and 60 V DC through the rack interface.

5 In the case of EASI 12-lead ECG, the signal is processed to derive any 3 of the

standard 12 vectors.

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ECG Module

ECG Module Features

Figure 1-9 shows the user controls and connector for the ECG Module. The parts are described following the figure.

M1001A

ECG

(2)

ECG

(1)

(3)

User Controls 1 Setup Key—A single-press key used to enter the ECG setup screen.

Connectors 3 The standard 12-pin connector will accept either a 3-lead or 5-lead ECG cable.

Waveforms The size of the waveforms can be adjusted automatically or manually.

1-16 Basic Plu

Figure 1-9 ECG Module Controls and Connectors

2 Setup Indicator—A green LED, lit when the ECG setup screen is activated.

For EASI a 5-lead cable is required.

Four configuration settings are possible to control the size and position of the waveform.

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Page 43

ECG Module

Table 1-2 Waveform Settings

Setting Description

Autoadjust The wave size is automatically adjusted to fit inside the channel. The

position of th e wave is optimized so that the middle o f the wave occupies the middle of the channel, unless ST moni to ring is switched on.

Autosize The wave size is automatically adjusted to fit in sid e th e channel. This

setting adjusts the amplitude of the wave but not its offset.

Gain x 1 The a mplitude of the wave is magnif ied by 1000.

Gain x 2 The a mplitude of the wave is magnif ied by 2000.

QRS Detection Because the QRS complex is the most prominent part of the ECG waveform, it is

used by clinicians to determine the strongest ECG signals.

QRS detection can occur in auto or manual mode. In auto mode, QRS complexes are detected automatically. In manual mode, the QRS detection level appears on the screen as a horizontal line across the ECG wave.

Paced vs. Non-Paced

Mode

In non-paced mode, no pace pulses are expected and no pace pulse rejection occurs. In paced mode, pace pulses are annotated with a small dash on the screen.

ST Segment Analysis ST segment analysis is an optional feature. ST segment measurements can be

recorded on up to three channels and three leads of a patient’s ECG. The measurements are shown as numerics on the standard display, graphically in the ST analysis task window, and as part of patient vital signs and trend graphs. They can be recorded with reference beats at the bedside, or without beats at a central monitor or recorder.

Up to 242 sets of real-time algorithm outputs can be graphed, stored, and recalled, each with up to three channels of data. All stored waves are cleared after a discharge procedure when the monitor is turned off for more than three hours, or when monitoring mode is reset.

Safety To ensure the safety of the patient, the patient-applied parts are isolated from ground

by optical isolators and a transformer. The module is also encapsulated in plastic.

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Page 44

ECG Module

ECG Module Exercise s

1. The ECG generates numerics for which physiologic measurement? a. pulse b. pace pulses c. heart rate

2. Which ECG Module component prevents interference from the 50/60 Hz power

line?

a. Input protection network b. Right leg drive c. Highpass and lowpass filters

3. Which channels does the PPD check for pace pulses?

a. Channels 1 and 2 b. Channels 2 and 3 c. Channels 1, 2, and 3

4. The number of ST segment measurements th at can be s t ored and retri eved i s____ _.

5. For EASI 12-Lead Monitoring you need a. a 3-lead or a 5-lead cable b. a 5-lead cable.

6. With a standard lead set and five-electrode cable set, the leads that can be

monitored are:

a. 3 limb or chest leads on Channels 1, 2, and 3 b. 3 limb or c hest leads on Channels 1 and 2, and 1 chest lead on Channel 3 c. 7 limb or chest leads on both Channel 1 and Channel 2, and 1 chest lead on

Channel 3

1-18 Basic Plu

7. With an EASI lead set, the leads that can be monitored are: a. 3 limb or chest leads on Channels 1, 2, and 3 b. any lead out of 12 for all 3 channels c. 7 limb or chest leads on both Channel 1 and Channel 2, and 1 chest lead on

Channel 3

Answers

1. c

2. b

3. a

4. 242

5. b

6. a

7. b

-In Modules

Page 45

RESP Measurement

Description A respirogram is a recording of respiratory activity that indicates the strength and

efficiency of a patient’s respiratory (pulmonary) muscles. The measurement can be accomplished using various techniques; the method employed by Philips’ patient monitoring devices is the impedance method.

Concepts Respiration is the metabolic pro cess by wh ich the bo dy obtains oxygen, expels carbon

dioxide, and regulates its acid-base (pH) balance.This process is carried out by a respiratory system composed of the lungs, the respiratory muscles (notably the diaphragm and intercostal muscles), and the organs that carry gas into and out of the lungs. Respiratory monitoring techniques measure either the nature of the gas exchange within the lungs, or the efficiency of the pulmonary muscles. A respirogram is concerned with the latter.

An important concept f or respirogram monitor ing is:

Measurement Principle

• Respiratory rate - The timing and rhythm of inspiration and exhalation.

If any of these measurements is above or below the normal range, other respiratory monitoring techniques may be needed to assess the patient’s overall respiratory condition.

Within the thorax (chest), the lungs are surrounded by a moist pleural membrane, which produces a lubricating fluid that enables the lungs to move easily during respiration. This fluid, along with the change in volume of air, allows the measurement of electrical impedance when the lungs expand and contract.

A respirogram measures the change in electrical impedance between two electrodes placed on the patient’s skin as the patient breathes in and out. By using a modulation technique for measuring the impedan ce, with a carrier freq uency that is far ou tside the ECG bandwidth, the same electrodes that are used for the ECG measurement can be used for respiration. Although the ECG and R ESP signals are obtained using the same electrode set, the measurement principles are fundamentally different.

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RESP Measurement

Measurement Acquisition

RESP is measured by placing two electrodes, right arm (RA) and l eft leg (LL), on the patient’s skin as shown in Figure 1-10. For EASI 12-Lead ECG the positions are different (see Figure 1-5).

Angle of

Lewis

BLACK

[YELLOW]

WHITE

[RED]

GREEN

[BLACK]

80x80

RED

[GREEN]

Figure 1-10 Electrode Placements for RESP

The impedance measurement contains several signals:

• The basic impedance of the thorax.

• The change in impedance caused by breathing.

• The change in impedance caused by cardiac activity.

The impedance change caused by breathing activity is extracted from the basic impedance and displayed as a resp iration wave. Impedance chang es caused by cardiac activity are discarded and are not included in the respiration rate.

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Page 47

RESP Measurement

Output RESP signals are depicted as continuous waveforms that show real-time changes in

impedance. Both the respiratory rate and heart rate are shown as numeric values.

Criteria for Proper

Factors affecting accurate measurement of RESP are:

Measurement

• Proper placement of electrodes, in order to optimize the measurement of impedance changes. Since ECG waveforms may require more precise placement, ECG waveform results may have to be considered when repositioning leads and electrodes to optimize respiratory wave size.

• Good skin contact, to maintain a good signal.

• Elimination of external interference. A patient’s movements, bones, or organs can interfere with the signal, as can pacemaker activity and electrical interference from electrosurgical units (ESU). Respirogram monitoring is not recommen ded for active patients because false alarms may occur. Normal cardiac activity is filtered out. However, artifacts from pulsating blood can interfere if the liver or cardiac ventricles are between the electrodes.

Plug-In Modules The ECG/RESP Module (M1002A/B) provides respirogram and electrocardiogram

functions. It can be used with most of the monitoring systems in the Philips patient monitoring family. Check the documentation for the system being used for determination of module usability.

References Ahrens, Tom. Respiratory Monitoring in Critical Care, in AACN Clinical Issues in

Critical Care Nursing. [For bibliography: Susan Osguthorpe, ed. Philadelphia, JB

Lippincott, 1993.]

Philips Part No. 78834-90090 “Neonatal Monitoring: The ABCs of ECG and R esp.”

Philips Part No. 5954-2304 Application Note

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RESP Measurement

RESP Measurement Exercise s

1. Respiratory monitoring gener ally measur es two types of pulmonary functioning: the effectiveness of _____________________ and efficiency of ______________.

2. RESP uses a ______________ ___ ___ _ t echn ique t hat al lows electrical imped a nce to be measured using ECG electrodes.

3. RESP uses ECG electrodes placed in which positions:

a. Left arm and right arm b. Left arm and right leg c. Right arm and left leg

4. The data displayed in a respiration wave are:

a. Impedance change from breathing activity b. Respiratory rate c. Heart rate, as a numeric d. all of the above

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Answers

1. Gas exchange, pulmonary muscles

2. Modulation

3. c

4. d

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ECG/RESP Module

Description The M1002A ECG/RESP Module is a three-channel electrocardiogram and

respiration measurement parameter unit. It is designed to be used with adult, neonatal, or pediatric patients in an ICU environment.

The module possesses the same ECG functionality as the M1001A and adds respirogram functions as well.

Measurements The ECG/RESP Module produces continuous real-time waveforms for both cardiac

and pulmonary electrical activity. It also generates numerics for the average heart rate (HR), derived from either the ECG or a remote arrhythmia computer, and for the respiration rate (RR).

Components The following components carr y ou t th e major s i gnal p roces si n g fu ncti ons wi thi n the

module.

Table 1-3 Major ECG Components of ECG/RESP Module

ECG Component Function

Input Protection Network and ESU filter

Lead Selection Switche s Selects ch annels 1 and 2 fo r patient leads .

Right Leg Drive Prevents interference fr om the 50/ 60Hz power line.

Highpass and Lowpass Filters Allow the independent selection of diag nost ic , monitoring,

Test Signal Generates a calib ration voltage on each channel and test s

Pace Pulse Detector Detects pace pulses for channels 1and 2.

Protects the input amplifiers from defibrillation and high frequency interference signals.

or filter bandwidths for each channel.

the circuitry for the module.

Table 1-4 Major RESP Components of ECG/RESP

RESP Component Function

Input Protection Network and ESU filter

Measurement Bridge Detects and modulates the RA and LL ECG signals with a

Protects the input amplifiers from defibrillation and high frequency interference signals.

39 kHz sine wave. Generates a calibration and test signal.

Synchronous Demodulat o r Demodulates the out put from the input amplifier.

Impedance Subtracter and Digital-to-Analog Converter

Subtracts the basic thoracic impedance from the signal and converts it to digital form.

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ECG/RESP Module

Block Diagram Figure 1-11 shows the ECG/RESP module’s logical structure.

PATIENT

RACK

INTERFACE

ISOLATION

SYSTEM

CONTROLLER

RESP

AMLIFIER

VARIABLE

LEADS OFF

MUX

LOW

PASS

HIGH &

FILTERS

DETECTOR

PACE PULSE

TWO-CHANNEL

AMPS

ENTIAL

DIFFER-

D / A -CONV

IMPEDANCE

SUBTRACTOR

AMPLIFIER

DIFFERENTIAL

FILTER

LOW PASS

SYNCH

RONOUS

DEMODULATOR

LEAD

SIGNAL

SWITCH

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LEAD

SELECTION

ECG ASIC

SWITCHES

DRIVE

39 kHz

INPUT

AMPS

INPUT

NETWORK

ESU-FILTER

PROTECTION

INPUT CONNECTION

TEST

SIGNAL

SINE SHAPER

Figure 1-11 M1002A/B ECG/RESP Module Block Diagram

INPUT

AMPLIFIER

BRIDGE

MEASUREMENT

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ECG/RESP Module

Theory of Operation As ECG and RESP signals pass from the patien t to the monit or , they pr ogress throu gh

stages corresponding to th e four logical sections of the module, as s ho wn in th e b l ock diagram. Module-related faults can generally be isolated to on e of the four stages.

1 Signals are received through patient electrodes and lead cables by the input

connector.

2 The input protection network and ESU filter eliminate extraneous signals.

3ECG: The signals are processed by two circuits: the ECG Application Specific

Integrated Circuit (ECG ASIC) and the Pace Pulse Detector (PPD ASIC). At this point, the analog signals from each lead are selected, amplified, filtered, and converted to digital form. During the process, the outp ut of each inp ut amplifier is checked for a leads-off electrode condition, so that any individual lead whose electrode has fallen off can be identified. The leads for channels 1 and 2 are selected using two identical lead selection circuits; channel 3 always carries the chest lead. The signals from the three channels are summed in the differential amplifiers.

To prevent interference from the 50/60Hz power l ine, the common mode signal derived from behind the lead selectors is us ed to drive the right leg driv e amplifier. The output from the amplifier is then returned to the patient via the RL electrode. The PPD checks for pace pulses on channels 1 and 2 for cardiotach rejection or marking of the display. The high and low pass filters allow the independent selection of diagnostic, monitoring, or filter bandwidths for each channel.

For calibration, a 1mV calibration signal is generated on each channel. This is done by a bandgap voltage reference from a precision voltage divider in front of the filtering circuitry. The complete module can be tested on user request.

RESP: The measurement bridge, driven by a 39kHz sine wave, detects and excites the ECG signals from the RA and LL lead paths behind the Input Protection Network. The modulated output is amplified by the differential input amplifier, demodulated by the synchronous demodulator, and input to a low-pass filter. The impedance subtracter subtracts the basic thoracic impedance to derive the respiration wave signal. The signal is then multiplexed with the ECG signals, amplified, and converted to digital for use by the microprocessor.

For calibration and testing purposes, a 1 ohm test signal is generated by the bridge circuitry.

4 The microprocessor, which connects to the patient isolators and rack interface

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ECG/RESP Module

ECG/RESP Module Features

Figure 1-12 shows the user controls and connector for the ECG/RESP Module. The parts are described following the figure.

(2)

(1)

(5)

ECG/RESP

M1002A

ECG

(4)

RESP

(3)

Figure 1-12 ECG/RESP Module Controls and Connectors

User Controls 1 ECG Setup Key—A single-press key used to enter the ECG setup screen.

2 ECG Setup Indicator—A green LED, lit when the ECG setup screen is

activated.

3 RESP Setup Key—A single-press key used to enter the Resp iration setup screen.

4 RESP Setup Indicator—A green LED, lit when the Respiration setup scr een is

activated.

Connectors 5 The standard 12-pin connector will accept either a 3-lead or 5-lead ECG cable.

ECG Modes In auto mode, the QRS complexes are detected automatically. In manual mode, the

QRS detection level appears on the screen as a horizontal line across the ECG wave. This enables the user to see exactly what is causing the heart rate counter to count.

In non-paced mode, no pace pulses are expected and no pace pulse rejection occurs. In paced mode, pace pulses are annotated with a small dash on the screen.

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ECG/RESP Module

ST Segment Analysis ST segment analysis is an optional feature. ST segment measurements can be

RESP Modes In auto mode, the mon itor measures respiration and adjusts the detection level

automatically, depending on waveform height, presence of cardiac artifact, and absence of valid breaths. In manual mode, the user sets the detection level for measuring respiration.

Safety To ensure the safety of the patient, the patient-applied parts are isolated from ground

by optical isolators and a transformer. The module is also encapsulated in plastic.

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ECG/RESP Module

ECG/RESP Module Exercise s

1. The ECG generates numerics for which physiologic measurement?

a. pulse b. pace pulses c. heart rate

2. Which module component prevents interference from the 50/60 Hz power line?

a. Input protection network b. Right leg drive c. Highpass and lowpass filters

3. Which channels does the PPD check for pace pulses?

a. Channels 1 and 2 b. Channels 2 and 3 c. Channels 1, 2, and 3

4. The RESP signal is detected by which component?

a. Differential amplifier b. Impedance subtracter c. Measurement bridge d. Synchronous demodulator

5. The impedance subtracter subtracts which part of the RESP signal?

a. heart rate b. respiratory rate c. cardiac impedance d. basic thoracic impedance

6. The number of ST segment measurements that can be stored and retrieved is ___.

7. Respiration is monitored from which two lead paths?

a. LA and RA b. LA and RL c. LL and LA d. LL and RA

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Answers

1. c

2. b

3. a

4. c

5. d

6. 242

7. d

ECG/RESP Module

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NBP Measurement

Non-invasive Blood Pressur e (NBP) Module Concepts

NBP Measurement

Description Blood pressure is the pressure exerted by the blood against the walls of the blood

vessels. Blood pressure measurement indicates the status of a patient’ s overall card iac condition. Most frequently, blood pressure is measured in the arteries, as they are the vessels that carry blood from the heart to the body’s major organs.

Non-invasive blood pressure measurements are taken by indirect methods of obtaining arterial blood pressure values, rather than by direct sampling of the blood stream. Various techniques can be used for measu ring bl ood pres s ure non-invasively; all are based on compressing the artery by means of an occludin g cuf f, and measurin g the effect of the compression on blood flow. The method used by Philips’ patient monitoring systems is the oscillometric method. That is, the monitor measures the oscillation or changes in the volume of the arteries accompanying the heart beat.

Concepts Blood pressure results from interactions between the heart’s pumping force, the

circulatory system’s blood volume, and the body’s vascular resistance to blood flow. Blood pressure measurements are related to cardiac output measurements in that both types are concerned with pumping force and vascular resistance. Cardiac output is a major determinent of blood pressure.

Concepts important to non-invasive blood pressure measurement are:

• Systolic pressure - The highest pressure of the blood against the arterial wall

following ventricular contraction. It is a measure of how hard the heart is working and how much oxygen it requires.

• Diastolic pressure - The lowest pressure of the blood against the blood vessel

wall following closure of the aortic valve, just before ventricular contraction. It is one measure of how much oxygen the heart is getting from the pulmonary capillaries. I

• Pulse pressure - The difference between the systolic and diastolic readings. This

is the range of the pressure in the arteries.

• Mean arterial pressure - The average pressure used to push blood through the

circulatory system. This measurement is an important in dex of blood flow and gas exchange in the capillaries.

Measurement Principle

In the oscillometric method, blood pressure is measured as oscillations superimposed on cuff pressure. The cuff, inflated aro un d the patient’s limb, senses arterial pulses as oscillations whose amplitude changes as the cuff is deflated. The initial oscillations are roughly equivalent to systolic pressure; the larger oscillations represent mean pressure; and the diastolic pressure is then derived from the mean pressure.

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NBP Measurement

Measurement Acquisition

To take the measurement, the cuff is placed around the patient’s limb and inflated until the artery is occluded, at a point just above systolic pressure. Blood movement ceases when cuff pressure is greater than arterial pressure. As cuff deflation commences, blood begins to flow through the artery at the systolic pressure, and the resulting pulsations are detected as oscillations. The cuff continues to deflate, and the amplitude of arterial oscillations increases until it reaches a maximum value, which represents mean arterial pressure. As cuff deflation continues, arterial pressure drops due to decreased resistance from the cuff pressure. Diastolic pressure is measured when the oscillations begin diminishing rapidly.

Output Oscillometric blood pressure measurements are displayed as numerics.

Criteria for Proper

Factors affecting accurate measurement of non-invasive blood pressure are:

Measurement

• Cuff size. A cuff that is too narrow may produce false BP readings that are too high. Conversely, a cuff that is too wide may produce false low readings.

• Cuff placement. The cuff should be placed on the arm at the level o f the heart for a true zero reading. False high readings may be produced by cuffs that are applied too loosely.

• Artifacts, caused by shivering, bumping, or other rhythmic or external pressure.

Limitations The oscillometric measurement has limitations in certain clinical situations. When a

patient’s condition makes regular arterial pressure pulses difficult to detect, the measurement is unreliable and takes longer to derive. The following conditions can interfere with the measurement:

• Patient Movement: If the pat ient is moving, shivering, or having convulsions, reliab le me a s urement is difficult or impossible to ob tain.

• Cardiac Arrhythmias: Irregular heart beats during arrhythmias make measurements unreliable or impossible.

• Pressure Changes: If the patient’s blood pressure changes rapidly during the measurement period, measurements are unreliable.

• Severe Shock: Severe sh ock or hy pothermi a reduces bl ood flo w to the per ipher ies and thus reduces arterial pulses, making pressure measurement unreliable.

• Obese Patients: A thick layer of fat surrounding the limb can muffle arterial pulses and prevent them from reaching the cuff, thus reducing the measurement’s accuracy.

• Heart Rate Extremes: Measurements cannot be made if the heart rate is less than 15 bpm or greater than 300 bpm.

• Heart-lung Machine: Measurements are not possible if the patient is connected to a heart-lung machine.

• Movement of the tube

Plug-In Modules Philips’ M1008A and M1008B NBP Modules measure non-invasive blood pressu re.

The M1008B module replaced the M1008A.

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NBP Measurement

NBP Measurements Exercise s

1. The oscillometric method uses an occluding cuff to sense variations in which of the following:

a. Cardiac output b. Ventricular contraction c. Arterial blood flow d. Capillary blood supply

2. What is the highest pressure of blood against the arterial wall called?

a. Diastolic Pressure b. Systolic Pressure c. Mean Arterial Pressure d. Pulse Pressure

3. What is the lowest pressure of blood against the arterial wall called?

a. Diastolic Pressure b. Systolic Pressure c. Mean Arterial Pressure d. Pulse Pressure

4. What is the term for the difference between the highest and lowest blood pressure

measurement?

a. Diastolic Pressure b. Systolic Pressure c. Mean Arterial Pressure d. Pulse Pressure

5. What does the highest amplitude oscillation on a non-invasive blood pressure

waveform represent?

a. Diastolic Pressure b. Systolic Pressure c. Mean Arterial Pressure d. Pulse Pressure

6. False blood pressure readings that are too high can be produced by which of the following circumstances?

a. A cuff that is too narrow b. A cuff that is too wide c. A cuff applied too tightly

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Answers

1. c

2. b

3. a

4. d

5. c

6. a

NBP Measurement

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Page 60

NBP Modules

Description The M1008A and M1008B NBP Modules are non-invasive blood pressure

measurement parameter units for Philips’ patient monitoring devices. The M1008A Module is designed to be used with adult or pediatric patients, in both OR and ICU environments. The M1008B Module is designed to be used with adult, pediatric, or neonatal patients, in OR and IC U environ ments. The M10 08A and M1008 B Modul es cannot be used simultaneou sly in a patient monitor.

Measurements The modules produce numerics for the systolic, diastolic, and mean blood pressure

values. No waveform is associated with these modules.

Three different methods can be used to obtain the measurements:

• Manual: For each request, one measurement of systolic, diastolic, and mean

pressures is taken.

• Auto: Repeated measurements of the three values are taken at timed intervals

specified by the user.

• Stat: Measurements of the three values are taken immedi ately and repeatedly over

a period of five minutes. This method uses a faster measurement procedure but produces a less accurate reading.

Venous Puncture This is not a measurement mode, rather the cuff is inflated to and held at a preset

pressure to help you find a vein to puncture. The cuff deflates automatically after a fixed time, or you can deflate it manually.

Components The following components carry out the major signal processing functions within the

module.

Table 1-5 Major NBP Module Components

Component Function

Pressure Pump I n f lates the cuff to preset limits, once or repea tedly,

Pressure Sensor Measures cuff and arterial pressures using solid-state

Overpressure Safety System

Bandpass Filter Extracts arterial pressure oscillations from the cuff

Deflation System Automatically deflates the cuff at steps of a given

depending on the measurement method used.

technology.

Triggers alarms at given pressures and time limits, and deflates the cuff.

pressure.

magnitude.

Block Diagram Figure 1-13 shows the NBP module’s logical structure.

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Page 61

RACK

INTERFACE

SYSTEM

CONTROLLER

NBP Modules

(INTERFACE)

PUMP

PRESSURE

MUX

BANDPASS

PRE AMP

SENSOR

PRESSURE

CUFF

PRE AMP

SENSOR

PRESSURE

DEFLATION

SYSTEM

Figure 1-13 M1008A/B NBP Module Block Diagram

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NBP Modules

Theory of Operation As NBP signals pass from the patient to the monitor, they progress through stages

corresponding to logical sections of the module, as shown in the block diagram. Module-related faults can generally be isolated to one of the stages.

1 Signals from the patient are received by the pressure sensor through the cuff,

which is connected to the module by a single tube. The cuff is inflated, deflated, and monitored by a pump, deflation system, and safety system controlled by a microprocessor.

Cuff inflation: During the initial cuff inflation, the cuff is inflated by the pressure pump to a set pressure which is determined by the mode. Thereafter the cuff is inflated by the pressure pump to a cuff pressure above the patient’s systolic pressure. Depending on the measurement method used, inflation occurs once or repeatedly. When the cuff pressure is g reater than the systolic pressure, the artery is occluded; the pressure sensor then detects only the cuff pressure.

Cuff Deflation: Cuff pressure is automatically released by the deflation system in steps of approximately 8 mmHg until the artery is only partially occluded. At that point, measurement and processing of arterial pressure oscillations begin and continue as the cuff pressure is progressively released.

NBP Module Features

2 Detection: As arterial pressure oscillations are detected, they are superimposed on

the cuff pressure within the module’s circuitry. After being extracted by the bandpass filter, they are passed to the microcontroller and measured.

3Measurement: As the cuff is deflated, the magnitude of the oscillati ons as a

function of cuff pressure increases until the mean arterial pressure is reached. When cuff pressure falls below the mean arterial pressure, oscillation magnitude begins to decrease.

The systolic and dias tolic blood pressure val ues are deduced from the oscillometric signal by extrapolation, resulting in empirical values. Extrapolation uses the attenuation rate of the signal on both sides of the maximum readings. Invasive pressure measurement are also used as a reference to correlate non-invasive pressure.

Figure 1-14 shows the user controls and connector for the modules. The parts are described following the figure.

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Page 63

(7)

NBP Modules

(8)

(2)

(1)

(6)

Figure 1-14 NBP Module Controls and Connectors

User Controls 1 NBP Setup Key: A single-press key used to enter the NBP setup screen.

2 NBP Setup Indicator: A green LED, lit when the NBP setup screen is activated.

(9)

(

(4)

(5)

(3)

3Start Key: A single-press key, used to start the measurement cycle.

4 Start Indicator: a green LED, lit when the measurement cycle is entered.

5Stop Key: a single-press key, used to stop the measurement cycle.

6Stat Key: A single-press key, used to start a static measurement cycle.

7 Stat Indicator: A green LED, lit when the static measurement cycle is entered.

8 Venou s Puncture Symbol: indicates that the module supports the Venous

Puncture function.

Connectors 9 A standard NBP connector connects to the cuff.

NPB Modes The M1008A Module offers adult and pediatric modes. The M1008B Module offers

adult, pediatric, and neonatal modes.

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NBP Modules

T ab le 1-6 shows the cuff inflation limits for each mode.

Ta b le 1-6 Cuff In fl ation Limits, in mmHg

Mode First Inflation

Adult 165 25

Pediatric 125 20

Neonatal 100 15

Subsequent Inflations, Above Systolic Pressure

Table 1-7 shows the measurement ranges for each mode.

Table 1-7 Measurement Ranges, in mmHg

Mode Systolic Diastolic Mean

Adult 30 - 270 10 - 245 20 - 255

Pediatric 30 - 180 10 - 150 20 - 160

Neonatal 30 - 130 10 - 150 20 - 160

Safety Table 1-8 gives the maximum limits that ensure patient safety.

Table 1-8 Maximum Safety Lim i ts

Mode

Maximum Measurement Time

Maximum Time/Pressure

Over-pressure Maximum

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Adult 100 seconds 120 seconds for

pressure > 10 mmHg

Pediatric 100 seconds 120 seconds for

pressure > 10 mmHg

Neonatal 60 seconds 60 seconds for

pressure > 5 mmHg

330 mmHg for > 2 seconds

220 mmHg for > 2 seconds

165 mmHg for > 2 seconds

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NBP Modules

NBP Module Exercise s

1. The NBP Modules provide numerics for which measurements:

a. systolic, diastolic, and mean arterial pressures b. pulse rate c. heart and respiration rates d. a and b e. a, b, and c

2. The M1008B Module provides the same functions as the M1008A Module, with the addition of a mode for:

a. Adults b. Pediatrics c. Neonates d. Pediatrics and Neonates

3. In which mode are measurements taken repeatedly over a period of five minutes?

a. Manual mode b. Auto mode c. Stat mode

4. What is the function of the bandpass filter?

a. It filters artifact from the mean arterial pressure. b. It extracts the arterial pressure oscillations from the cuff pressure. c. It protects the circuitry from high-frequency interference.

5. The systolic and diastolic blood p ressure values are ded uced fro m the oscillometric

signal by ____________________,resulting in empirical values.

Answers

1. a

2. c

3. c

4. b

5. extrapolation

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C.O. Measurement

Cardiac Output (C.O.) Module Concepts

C.O. Measurement

Description Cardiac output is an important measure of cardiac performance. It measures the

volume of blood pumped into the circulatory system by the heart over a specified period of time. Cardiac output is closely related to blood pressure.

Several methods can be used for determining cardiac output. The method used by Philips’ patient monitoring systems is the thermodilution method. With thermodilution, cardiac output is measured as the liters of blood pumped per minute into the pulmonary artery by the right ventricle of the heart.

Concepts Cardiac output is determined by heart rate and stroke volume, as defined below.

Measurement Principle

Measurement Acquisition

• Heart rate - The number of times the heart beats in one minute.

• Stroke volume - The amount of blood pumped per beat.

• Cardiac index - A measure of an individual’s cardiac output adequacy, calculated

by dividing the cardiac output by the body surface area.

The thermodilution method is based on th e principl e that the f low rate of an u nknow n quantity of liquid can be determined by adding a known quantity of indicator and measuring its concentration downstream. Thermodilution involves injecting a cooled solution at a known temperature into the heart. The injectate solution mixes with and cools the warmer surroundin g blood. When the blood leaves the heart, its temperature as a function of time indicates the rate of blood flow.

The measurement is taken with a pulmonary artery (PA) Swan Ganz catheter.

The catheter is inserted into the heart, with the proximal lumen opening positioned in the right atrium for introducing the injectate, and the thermistor, used for monitoring temperature, positioned in t h e pu lmonary artery. Positioning of the catheter is gauged by using pressure measurements and X-rays of the catheter location. A small amount of thermal indicator is introduced into the right atrium. The indicator mixes with the blood in the right ventricle and approaches a temperature equilibrium. When the diluted blood reaches the pulmonary artery, the thermistor measures the decrease in blood temperature over time.

1-40 Basic Plu

The temperature of the injectate solution can be m easured either indirectly o r directly. Indirectly, the temperature of the cooling bath is measured. Direct measurement uses a flow-through temperature probe to measure the injectate temperature as it is being

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C.O. Measurement

introduced into the catheter. The probe is positioned where the syringe injects the indicator into the proximal lumen port.

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C.O. Measurement

Output The time/temperature curve resulting from the measurement resembles a bell-shaped

curve, except that it has an exponential decay. The data are integrated to calculate the area beneath the curve. By convention, the y-axis of the graph shows decreasing temperature.

THERMODILUTION

CURVE

Criteria for Proper Measurement

P.A.

BLOOD

TEMP

36.0 C

36.5 C

37.0 C

INJECTION

TIME

EXPONENTIAL

DECAY

Factors affecting accurate measurement of cardiac output include:

• Physiological conditions. Variations in cardiac rate and rhythm, cardiac abnormalities, or patient anxiety or movement can cause errors in measurement.

• Catheter conditions. A damaged or incorrectly positioned catheter, or a prematurely inflated balloon will cause measurement errors.

• Injectate factors. Inaccurate timing, volume, or temperature of injectate, as well as use of the wrong catheter port will result in errors.

Plug-In Modules The M1012A C.O. Module provides the t her modil uti o n cardi ac o utput meas ur ement .

References

Woods, Susan and Susan Osguthorpe. Cardiac Output Determination, in AACN Clinical Issues in Critical Care Nursing. [For bibliography: Susan Osguthorpe , ed. Philadelphia, JB Lippincott, 1993.]

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C.O. Measurement

C.O. Measurement Exercise s

1. The time it takes for cooled blood to change temperature in the thermodilution method is used to derive which of the following measurements?

a. Mean arterial blood pressure b. Core body temperature c. Rate of blood flow d. Blood gas exchange

2. Which term refers to the amount of blood pumped per heartbeat?

a. Cardiac index b. Cardiac output c. Heart rate d. Stroke volume

3. Using thermodilution, at what location does the cold injectate solution leave the catheter and enter the heart?

a. Right atrium b. Right ventricle c. Pulmonary artery d. Left atrium

4. The graph of the cardiac output meas urement resembles:

a. A RESP waveform b. A bell-shaped curve c. Blood pressure oscillations d. An inverted QRS wave

Answers

1. c

2. d

3. a

4. b

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C.O. Module

Description The M1012 C.O. Module is a cardiac output measurement parameter unit. It is

designed to be used with adult patients in an ICU or OR environment. It uses the thermodilution method to generate the measurement.

Measurements The C.O. Module produces a thermodilution curve, together with numerics for the

cardiac output, cardiac index, blood temperat ure, and injectate temperature values.

Components The following components carry out the major signal processing functions within the

module.

Table 1-9 Major C.O. Module Components

Component Function

Reference Sw itching Matrix Calibra tes the measur ement using reference resis t o r s .

Differential A mplifier Amplifies the signa ls from the reference swit ching matrix.

Dual-Slope, Analog-to-Digital Converter

Digitizes the analog signals from both the blood and injectate channels.

Block Diagram Figure 1-15 shows the block diagram of the C.O. Module M1012A.

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C.O. Module

RACK

INTERFACE

PATIENT

ISOLATION

SYSTEM

CONTROLLER

CON-

D / A

VERTER

SOURCE

CURRENT

A / D

VARIABLE

LOW

DIFFERENTIAL

REFERENCE

CON-

VERTER

MUX

GAIN

AMPLIFIER

PASS

FILTER

AMPLIFIER

MATRIX

SWITCHING

GAIN CONTROL

REFERENCE CONTROL

LOW

REFERENCE

PASS

AMPLIFIER

DIFFERENTIAL

SWITCHING

MATRIX

FILTER

SOURCE

CURRENT

BLOOD

INJECT

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C.O. Module

Figure 1-15 M1012A C.O. Module Block Diagram

Theory of Operation The module has two separate circui ts for meas uring bloo d and in jectate temperat ures.

The signals progress through the module as follows:

1 Blood Channel: The temperature sensor distal, T

, in the catheter is

blood

connected to a reference switching matrix that continuous ly compares the input to reference resistors for continuous calibration of the measurement. The sequentially produced voltages across the reference and sensor resistors are amplified before being input to a low-pass filter. The filtered signals are then passed through the multiplexer to the analog-to-digital converter.

2 Injectate Channel: The temperature sensor, T

, which is either a flow-

injectate

through or bath probe, is connected to a separate reference-switching matrix on its own circuit. The matrix compares the signals to the same reference resistors used for the blood circuit. The output is amplified, filtered, and then multiplexed with the blood temperature signal before the signals are digitized for the microcontroller.

3 The cardiac output measurement is obtained by first compensating for the blood

temperature by the digital-to-analog converter. The difference signal is then amplified by a variable amplifier with a high gain, which increases the sensitivity for measuring the thermodilution curve.

The continuous calibration, linearization, control, and conversion to degrees C is performed by the software.

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C.O. Module

C.O. Module Features

Figure 1-16 shows the user co ntrols and connector f or the C.O. Module. Th e parts are described following the figure.

M1012A

C.O.

(2)

C.O.

(1)

START

(3)

(4)

Figure 1-16 Cardiac Output Module Controls and Connectors

User Controls 1 C.O. Setup Key -- A single-press key used to enter the cardiac output setup

screen.

2 C.O. Setup Indicato r -- A green L ED, lit when the cardiac output setup screen is

activated.

3Start Key -- A single-press key, used to enter the measurement cycle.

Connectors 4 This is a standard 12-pin connector for use with a catheter, thermistor, and start/

stop switch.

Safety To ensure the safety of the patient, the patient-applied part is isolated from ground by

opto-couplers and a transformer. The module is also encapsulated in plastic.

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C.O. Module

C.O. Module Exercise s

1. The M1012A C.O. Module can be used with which patients?

a. adults b. adults and pediatrics c. adults, pediatrics, and neonates

2. Which component of the C.O. Module calibra tes the measurement using referen ce

resistors?

a. Differential amplifier b. Reference switching matrix c. Dual-slope analog-to-digital converter d. Digital-to-analog converter

3. Which component converts the measurement to degrees C?

a. Reference Switching Matrix b. Dual-Slope Analog-to-Digital Converte r c. Digital-to-analog converter d. Application software

1-48 Basic Plu

Answers

1. a

2. b

3. d

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C.O. #C10 (CCO) Measurement (CMS only)

Cardiac Output #C10 (CCO) Module Concepts (CMS only)

This chapter describes the Transpulmonary Thermodilution method of measuring the Cardiac Output. For information regarding the Right Heart method, pleas e refer to chapter “Cardiac Output (C.O.) Modu le Concepts” on page 1-40.

C.O. #C10 (CCO) Measurement (CMS only)

Description The transpulmonary thermodilution method requires the M1012A #C10 Cardiac

Output Module. Option C10 is Philips’ implementation of Pulsion Medical Sys tem s

PiCCO

method, which offers the following features:

• Measurement of Cardiac Output (C.O.), Intrathoracic Blood Volume (ITBV) and Extravascular Lung Water (EVLW)

• Measurement of Continuous Cardiac Output (CCO), Stroke Volume (SV), Systemic Vascular Resistance (SVR) and Stroke Volume Variation (SVV) by means of Pulse Contour analysis of the arterial blood pressure waveform.

Concepts The PiCCO

technique and blood pressure waveform analysis to measure Card iac Output (C.O.), Intrathoracic Blood Volume (ITBV) and Extravascular Lung Water (EVLW)

Measurement Principle

Measurement Acquisition

The measurement of transpulmonary thermodilution cardiac output and blood pressure requires a central venous line and an arterial thermal dilution catheter placed downstream from the heart, in or near the aorta, e.g. the femoral or the axillary artery. The injectate is injected through the central venous line. The temperature of the injectate solution is measured by a flow-through temperature probe as it is being introduced into the central venous line. The injectate mixes with the blood in the right ventricle and approaches a temperature equilibrium. W h en the diluted blood reaches

using transpulmonary thermodilution.

method is a combination of the transpulmonary thermodilution

1. EVLW is not av ailab le in U.S.A.

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C.O. #C10 (CCO) Measurement (CMS only)

the artery with the arterial catheter, the thermistor measures the decrease in blood temperature over time. The blood pressure wave acquisition is achieved with the M1006A/B Invasive Pressure module. For det ails regarding this module please refer to “Invasive Blood Pressure Module Concepts” on page 2-3.

Sterile Injectate Solution

Injectate Syringe

C.O. Module

M1012A #C10

C.O. Interface

Cable

M1643A

Temperature Probe

3-Way

Stopcock

Central Venous Line

Pressure Module M1006B

Pulsion Pressure

Transducer

1-50 Basic Plu

Cooling Container

Pulsion

Arterial Catheter

Figure 1-17 Setup for Transpulmonary Thermodilution and Continuous Cardiac

Output

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C.O. #C10 (CCO) Measurement (CMS only)

Injectate Temperature and Volume

C.O. [l/min]

Based on the injectate temperature and the patient’s cardiac output the necessary injectate volume differs.The following graphic is a guideline on which injectate volume shou ld be used.

= 37oC

blood

25.0

15.0

< 7oC

inj

< 25oC

inj

12.5

7.50

2.50

1.50

1.25

0.75

0.25

210 20

Injectate Volume [ml]

The dilution of injectate is also influenced by the extravascular tissue. The Extravascular Thermovolume Index (ETVI) is a quality indicator which quantifies this influence. ETVI is cal culated base d on th e patient’s body weight and only applies to the current single transpulmonary thermodilution measur em ent. Fo r patien ts with high ETVI values, the accuracy of the transpulmonary th ermo dilution measuremen t may be reduced. It is recommended to use a higher injectate volume and/or colder injectate in these patients based on the following table.

Cold Injectate Room Temp. Injectate

Patient W eight

ETVI < 10 ETVI ≥ 10 ETVI < 10 ETVI ≥ 10

< 3 kg 2 ml 2 ml 3 ml Use cold injectate

< 10 kg 2 ml 3 ml 3 ml

< 25 kg 3 ml 5 ml 5 ml

< 50 kg 5 ml 10 ml 10 ml

< 100 kg 10 ml 15 ml 1 5 ml

≥ 100 kg 15 ml 20 ml 20 ml

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C.O. #C10 (CCO) Module (CMS only)

This section describes the Transpulmonary Thermodilution method of measuring the Cardiac Output. For information regarding the Right H eart method, pl ease refer to chapter “Cardiac Output (C.O. ) Module Concepts” on page 1-40.

Description The M1012 #C10 C.O. Module is a cardiac output measurement parameter unit. It is

designed to be used wi th adult, ped iatric or n eonatal pat ients down to 2kg of we ight in the range of hospital environments. It uses the transpulmonary thermodilution method and the pulse contour analysis to generate the measurement.

Measurements The C.O. #C10 Module produces a thermodilution curve, together with numerical

values for the transpulmonary thermodilution Cardiac Output (C.O.), IntraThoracic Blood V olume (ITBV) and ExtraVascular Lung Water (EVLW) measurement is also used for the calibration of the Continuous Cardiac Output

(CCO), derived by pulse contour analysis from the arterial blood pressure wave.

Components The following components carry out the major signal processing functions within the

module.

. The thermodilution

Table 1-10 Major C.O. #C10 Module Components

Component Function

Reference Sw itching Matrix Calibra tes the measur ement using reference resis t o r s .

Differential A mplifier Amplifies the signa ls from the reference swit ching matrix.

Dual-Slope, Analog-to-Digital Converter

Digitizes the analog signals from both the blood and injectate channels.

Block Diagram Figure 1-18 shows the block diagram of the C.O. Module M1012A #C10.

1-52 Basic Plu

1. EVLW is not av ailab le in U.S.A.

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C.O. #C10 (CCO) Module (CMS only)

RACK

INTERFACE

PATIENT

ISOLATION

SYSTEM

CONTROLLER

CON-

D / A

VERTER

SOURCE

CURRENT

A / D

VARIABLE

LOW

DIFFERENTIAL

REFERENCE

CON-

VERTER

MUX

GAIN

AMPLIFIER

PASS

FILTER

AMPLIFIER

MATRIX

SWITCHING

GAIN CONTROL

REFERENCE CONTROL

LOW

REFERENCE

PASS

AMPLIFIER

DIFFERENTIAL

SWITCHING

MATRIX

FILTER

SOURCE

CURRENT

BLOOD

INJECT

Figure 1-18 M1012A C.O. #C10 Module Block Diagram

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C.O. #C10 (CCO) Module (CMS only)

Theory of Operation The module has two separate circui ts for meas uring bloo d and in jectate temperat ures.

The signals progress through the module as follows:

1 Blood Channel: The temperature sensor distal, T

, in the catheter is

blood

2 Injectate Channel: The temperature sensor, T

, which is a flow-through

injectate

probe, is connected to a separate reference-switching matrix on its own circuit. The matrix compares the signals to the same reference resis tors used f or the bloo d circuit. The output is amplified, filtered, and then multiplexed with the blood temperature signal before the signals ar e digitized for the microcontroller.

3 The cardiac output measurement is obtained by first compensating for the blood

The continuous calibration, linearization, control, and conversion to degrees C is performed by the software.

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Page 81

C.O. #C10 (CCO) Module (CMS only)

C.O. #C10 (CCO) Module Features

Figure 1-19 shows the user controls and connector for the C.O. #C10 Module. The parts are described following the figure.

M1012A

C.O.

#C10

(2)

C.O.

(1)

START

(3)

80x40

(4)

Figure 1-19 C.O. #C10 Module Controls and Connectors

User Controls 1 C.O. Setup Key -- A single-press key used to enter the cardiac output setup

screen.

2 C.O. Setup Indicato r -- A green L ED, lit when the cardiac output setup screen is

activated.

3Start Key -- A single-press key, used to enter the measurement cycle.

Connectors 4 This is a standard 12-pin connector for use with a catheter, thermistor, and start/

stop switch.

Safety To ensure the safety of the patient, the patient-applied part is isolated from ground by

opto-couplers and a transformer. The module is also encapsulated in plastic.

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SpO2 Measurement

Arterial Oxygen Saturation/Plethysmography (SpO2/Pleth) Module

Concepts

SpO2 Measurement

Description SpO

is a measure of arterial oxygen saturation obtained using the pulse oximetry

method. Pulse oximetry is a continuous, non-invasive method of measuring the oxygen content of the arterial hemoglobin. It measures the amount of light transmitted from a light source through a patient’s tissue to the receiving sensor.

Concepts The following concepts are important to the measurement of arterial oxygen

saturation:

SaO

- Arterial oxygen saturation, or the percentage of oxygen carried by the red

blood cells within the arteries. Approximately 97 per cent of the oxygen is normally carried on the red blood cells; the rest is dissolved in the plasma. A decrease in hemoglobin will decrease the amount of oxygen available to the tissues.

SpO

- The arterial oxygen saturation measurement obtained from pulsations in the

arterioles using pulse oximetry.

Hemoglobin - The protein in red blood cells that transports oxygen (O dioxide (CO (Hb) attaches to oxygen molecules in the pulmonary alveoli and releases them to other systemic tissue cells. When carrying oxygen, it forms oxyhemoglobin (HbO Oxygen saturation can be measured by calculating the percentage of HbO

V entilation - The volume of air that reaches the pulmonary alveo li through breathing. Ventilation refers to the process in which air enters the alveoli, enabling the capillaries to receive oxygen and release carbon dioxide.

) molecules to and from the body’s tissues. A hemoglobin molecule

) and carbon

to Hb.

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Perfusion - Passage of blood through a vascular bed. Perfusion facilitates gas

exchange in the capillary beds of the lung and the tissue. In well perfused organs, blood flows evenly through the capillaries, ensuring a steady supply of available oxygen. Perfusion also enables the body to release carbon dioxide.

Photo plethysmography - A method of measuring oxygen saturation in relation to blood volume using the principle of light absorption. Also called absorption plethysmography.

Pulse oximetry - A method of measuring arterial oxygen saturation using two wavelengths of light and the pulsatile activity of the blood.

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SpO2 Measurement

Measurement Principle

Measurement Acquisition

Pulse oximetry is base d on the principle that red blood cell s a bso rb d i f f e rent amo un ts of light depending on the amount of oxygen they contain. When light is transmitted through body tissue such as a finger, it is absorbed differently by skin pigments, tissue, cartilage, bone, arterial blood, and venous blood. Most of these substances absorb light at a constant rate. The blood in the arteries and arterioles, however, is pulsatile. As the blood vessels expand and contract, the length of the light path is altered, affecting its absorption. Because the only significant variable is due to pulsing blood, the ratio of HbO signal to reveal the oxygen saturation of the arterial flow. The measurement is derived using two wavelengths of light -- one in the red region and one in the infrared -- t o measure maximum and minimum absorption differences between the two molecules.

The SpO2 measurement is taken by means of an optical cuff that is placed on the patient’s fingertip. From the transmitting side of the transducer, red and infrared light is scattered through the capillary bed and detected by a photo-diode on the receiving side. The measurement is independent of skin permantation, tissue absorbtion, and other constants.

to Hb can be measured in the pulsatile part of the

Output The resulting measurement is plotted as a plethysmogram. The waveform is

proportional to the blood volume changes, the pulse rate, and the relative perfusion of the skin and transducer.

Criteria for Proper Measurement

A number of factors can affect the accuracy of the measurement or the ability to obtain it.

• Incorrect positioning may cause incorrect measurement. The light emitter and the photodetector are directly opposite each other and all the light from the emitter passes through the patient’s tissues when it is positioned correctly. Pushing the transducer on too far or not far enough, may result in inaccurately low or high SpO

readings, respectively.

• The measurement requires pulsatile activity. When pulses drop below a certain threshold, no measurement can be taken. This situat i on might arise from conditions such as shock, hypothermia, vasoactive drugs, inflated blood pressure cuffs, or any condition in which tissue perfusion is impaired.

Conversely, situations may exist in which venous blood is pulsatile, such as from venous obstructions or certain cardiac conditions. In such cases, the measurement will be erroneously low due to the inclusion of the venous blood in the pulsatile signal.

• Optical interference can cause inaccurate measurements. Pulse oximetry assumes that only two light absorbers will be measured: HbO elements may be present in the blood with similar absorption properties, thus causing falsely low readings. Examp l es of these are carboxyhemoglobin (HbCO), methemoglobin (MetHb), and several dyes used in clinical tests.

Interference from ambient lights can be prevented by cover ing the finger cuff w ith an opaque material.

• Any factor that affects the transmission of light through the tissue, such as nail polish, can affect the measurement.

and Hb. However, other

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SpO2 Measurement

• Motion artifact may interfere with the accuracy of the measurement, as it has the same frequency range as pulse activity.

Plug-In Modules The M1020A SpO

measurement. References

Ahrens, Tom. Respiratory Monitoring in Critical Care, in AACN Clinical Issues in Critical Care Nursing. [For bibliography: Susan Osguthorpe, ed. Philadelphia, JB Lippincott, 1993.]

/PLETH Module provides the arterial oxygen saturation

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SpO2 Measurement

SpO2 Measurement Exercise s

1. Which measurement method is based on prin ciples of l ight-ab sorbin g propert ies of blood?

a. Plethysmography b. Pulse Oximetry c. Thermodilution

2. What factor determines the difference in definition between SaO

and SpO2?

a. The site where the measurement is taken. b. The method used to take the measurement. c. The clinical application for which the measurement is needed.

3. The molecule in the blood that transports oxygen to the cells of the body is:

a. Hb b. HbCO c. HbO

d. MetHb

4. Which term refers to the process of gas exchange in the cells by means of capillary

blood flow?

a. Perfusion b. Transmutation c. Ventilation

5. Which condition does pulse oximetry require in order to measure SpO

a. Adequate ambient light b. The absence of CO

in the blood

c. Pulsatile blood activity d. An unconscious patient

Answers

1. b

2. b

3. c

4. a

5. c

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SpO2/PLETH Module

Description The M1020A SpO

/PLETH Module is a pulse, arterial oxygen saturation, and

plethysmogram measurement parameter unit.

Measurements The module produces numerics for the arterial oxygen saturation value and the pulse

rate, along with a real-time waveform for the plethysmogram. The module also provides a perfusion indicator value for the pulsatile arterial blood flow.

Components The following components carry out the major signal processing functions within the

module.

Table 1-11 Major SpO

Component Function

Input Protection Network Protects the module agains t de f ib r illator spikes.

Current-to-Voltage Converter Converts the current from the photodiode, and removes ESU

interference.

Ambient Light Reje ction Circuitry

Over-range Detector Detect s ove rload voltages caused by strong ambient light and

Subtracts ambient ligh t f ro m the signal

high LED currents.

/PLETH Module Components

Dark Light Subtracter Subtracts the dark vol ta ge from the red and infrared voltage.

Analog-to-Digital Convert er Converts the signa l fo r proc essi ng;

Block Diagram Figure 1-20 shows the block diagram of th e SpO

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/PLETH Module M1020A.

Page 87

LOW

GAIN

SpO2/PLETH Module

PASS

FILTER

AMP

SHIFT

DISPLAY

SYSTEM

PROCESSOR

CONTROL

OVER

RANGE

CIRCUIT

DETECTOR

DARK

PASS

LOW

GAIN

VARIABLE

LIGHT

AMBIENT

PATIENT

ISOLATION

LIGHT

SUBTRACT.

CIRCUIT

CONTROL

A / D

FILTER

AMP

REJECTION

CON-

VERTER

MUX

GAIN

D / A

CON-

VERTER

SENSOR DETECTION

VOLTAGE

CURRENT

CONVERTER

TEST SIGNAL

NETWORK

PROTECTION

CURRENT

CHOPPED

INPUT CONNECTOR

SOURCE

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SpO2/PLETH Module

Figure 1-20 M1020A Sp

/PLETH Module Block Diagram

Theory of Operation The signals progress through the module as follows:

Light Transmission: Two LEDs in the trans ducer gener ate red and infrar ed light t hat

is transmitted through a well-perfused capillary bed in the patient’s finger or toe.

The LEDs are controlled by the software and are supplied with a chopped current of 375 Hz. Sensor-detection circuitry detects both the presence and type of transducer connected. To optimize the amplitude in the pulse sequence, the chopped current source is independently controlled by the digital-to-analog converter. A test signal can be generated in the input stage by switching the sensor signals off.

A photodiode directly opposite the LEDs detects the amount of light passing through the tissue, and generates a current that r epresents the intensity of the light detected for each wavelength. The current consists of a DC part, representing ambient light, modulated with a small AC signal from the pulsatile blood flow. The current passes through the input protection network and is converted to voltage.

Over-range Detection: The over-range detector checks the input voltage for overload due to an excessively high current from ambient light. It also checks the pulsatile signal for overload from the transducer light source.

Ambient Light Rejection: The ambient light is then subtracted by the high pass filter. The signal amplitude is optimized in the variable amplifier and passed to a low pass filter, where the dark signal, representing the ambient light current, is subtracted from the red signal. The high pass and low pass filters act as a demodulator. The pulse sequence representing red, infrared, and plethysmogram voltages is then amplified, multiplexed, and digitized.

1-62 Basic Plu

Signal Processing: From the digitized signal, the microprocessor derives the oxygen

saturation value and the plethysmogram waveform for display. It can also derive a pulse value from the PLETH signal, if configured to do so.

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SpO2/PLETH Module

SpO2/PLETH Module Features

Figure 1-21 shows the user controls and connector for the module. The parts are described following the figure.

(2)

(1)

(5)

SpO / PLETH

M1020A

SpO

(4)

PLETH

(3)

Figure 1-21 SpO

User Controls 1 SpO

2 SpO

3 PLETH Setup Key -- A single-press key used to enter the PLETH setup screen.

4 PLETH Setup Indicator -- A green LED, lit when the PLETH setup screen is

Connectors This is a standard 12-pin connector for use with an SpO

Safety To ensure the safety of the patient, the patient-applied part is isolated from ground by

opto-couplers and a transformer. The module is also encapsulated in plastic.

Setup Key -- A single-press key used to enter the SpO2 setup screen.

Setup Indicator -- A green LED, lit when the SpO2 setup screen is

activated.

/PLETH Module Controls and Connectors

/PLETH transducer.

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SpO2/PLETH Module

PLETH Waveform The waveform can be configured for either of two settings: Perfusion or SpO

These settings control the way the PLETH wave is adjusted for display on the screen.

The Perfusion Indicator, if co nfigured, functions independentl y from the selected wave presentation and gives additional information about arterial blood perfusion. It is a scaled ratio between two different light-absorbing volumes: one that varies with time and one that is constant. The perfusion indicator is directly related to the amount of blood perfusion at the transducer site.

SpO

SQI Mode is the factory default. It automatically and continuously adjusts the size of

the wave, which represents the quality of the SpO

measurement signals. Manual wave

adjustments in this mode are not possible. If the signal quality becomes weak, the waveform becomes progressively smaller, and the perfusion indicator reading typically falls below 1. If the signal degrades below an acceptable level, the wave becomes flat and an INOP alarm results. A poor signal may be caused by poor perfusion at the transducer site, or by the transducer; it is not related to low oxygen saturation.

Figure 1-22 contains an example of a typical waveform in SpO

SQI Mode.

Figure 1-22 Waveform in Sp

SQI Mode

Perfusion Mode automatically adjusts the waveform but also allows manual adjustment by the user. In this mode, the size of t he waveform is not related to the quality of the SpO

signal.

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SpO2/PLETH Module

SpO2/PLETH Module Exercises

1. Which component controls the current to the chopped current source?

a. Current-to-voltage converter b. Digital-to-analog converter c. Input protection network d. Over-range detector

2. Which component removes ESU interference?

a. Current-to-voltage converter b. Digital-to-analog converter c. Input protection network d. Low-pass filter

3. Which setting produces a waveform that indicates the quality of the SpO

signal?

a. Perfusion mode b. Pulse mode c. SpO

SQI mode

measurement

Answers

1. b

2. a

3. c

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TEMP Measurement

Temperature (TEMP) Module Concepts

TEMP Measurement

Description T emperature is the measurement of the amoun t of heat present in a region of the body.

Various regions and tissues within the body have widely divergent temperatures, and many factors can influence temperature change. Body temperature can indicate conditions such as infection, inflammation, and antigenic responses, as well as effectiveness of treatment. Careful monitoring of body temperature is vital for critically ill patients.

Concepts Thermometry can include a broad range of temperature-sensing devices, such as

mercury thermometers, thermistors, thermocouples, and units that reflect infrared light. Because heat increases the movement of molecules, thermometry uses scales based on the thermodyn amic properties of given substances.

Measurement Principle

Measurement Acquisition

The temperature measurement used by Philips’ patient monitoring systems is based on a thermistor whose resistance is inversely proportional to its temperature. By measuring the thermistor’s resis tance, its temperature can be calculated. The resistance of the thermistor is measured by passing a current through it and meas uring the voltage developed across it.

The delta temperature measurement reflects two different temperature probe values and calculates the difference in temperature between the two measurements. A temperature delta from different sites can be diagnostic of an altered physiologic state.

Temperature can be measured by a variety of temperature probes designed for use with different anatomic sites. The choice of site is determined by the type of information needed by the clinician.

Output Temperature measurements can be graphed over time or represented as numerics,

depending on the application.

Criteria for Proper Measurement

A thermometer should provide a quick, accurate, and reliable measurement of temperature. Factors affecting accurate measurement of temperature include:

• Frequency and accuracy of calibration.

• Appropriateness of the reference standard against which the thermomete r is calibrated.

• Choice of anatomic site for taking the measurement.

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TEMP Measurement

• Environmental conditions.

• Activity and movement of the patient.

Plug-In Modules The M1029A TEMP Module provides the temperature measurement. I

References Holtzclaw, Barbara, Monitoring Body Temperature, in AACN Clinical Issues in

Critical Care Nursing. [For bibliography: Susan Osguthorpe, ed. Philadelphia, JB Lippincott, 1993.]

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TEMP Measurement

TEMP Measurement Exercise s

1. Thermistors, thermocouplers, and infrared reflectors are an integral part of which

measurement technique?

a. Thermodilution b. Thermometry c. Pulse Oximetry

2. The resistance of the temperature thermistor is _______________ proportional to

its temperature.

3. How many temperature measurements are taken to calculate an individu al’s

temperature difference?

a. one b. two c. three

4. Factors affecting accurate measurement of temperature include

______________________________ and ________________________________.

Answers

1. b

2. inversely

3. b

4. Any of the following:

Calibration Reference standard Anatomic site Environmental conditions. Patient’s Activity

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TEMP Module

Description The M1029A TEMP Module is a temperature measurement parameter unit. It is

designed to be used with adult, pediatric, or neonatal patients in an ICU or OR environment.

Measurements The TEMP Module produces numerics in degrees Celsius for the temperature.

Different labels can be selected for temperature readings fro m different measurement sites.

Components The following components carr y ou t th e major s i gnal p roces si n g fu ncti ons wi thi n the

module.

Table 1-12 Major TEMP Module Components

Component Function

Reference Switching Mat ri x Calibrates the measurement using reference resistors.

Differential A mplifier Amplifies the signa ls from the reference swit ching matrix.

Dual-Slope, Analog-to-Digital Converter

Digitizes the analog signals from the temperature and thermistor calibration.

Block Diagram Figure 1-23 shows the block diagram of the TEMP Module M1029A.

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Page 96

TEMP Module

PATIENT

RACK

INTERFACE

ISOLATION

SYSTEM

CONTROLLER

SOURCE

CURRENT

A / D

CONVERTER

FILTER

LOW PASS

AMPLIFIER

DIFFERENTIAL

AMPLIFIER

SWITCHING

REFERENCE

REFERENCE CONTROL

INPUT CONNECTOR

1-70 Basic Plu

Figure 1-23 TEMP Module Block Diagram

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Page 97

Theory of Operation The signals progress through the module as follows:

The thermistor in the temperature probe is conn ected to a reference switching matrix that continuously compares the input to reference resistors for continuous calibration of the measurement. The sequentially produced voltages across the reference and probe resistors are amplified, filtered, and digitized. The continuous calibration, linearization, control, and conversion to degrees C is performed by the software.

TEMP Module

TEMP Module Features

Figure 1-24 shows the user controls and connector for the TEMP Module. The parts are described following the figure.

M1029A

TEMP

(2)

TEMP

(1)

(3)

Figure 1-24 TEMP Module Controls and Connectors

User Controls 1 TEMP Setup Key -- A single-press key used to enter the temperature output

setup screen.

2 TEMP Setup Indicator -- A green LED, lit when the temperatu re se tup screen is

activated.

Connectors 3 This is a 2-pin connector for use with standard 217xx series temperature probes

(yellow spring series 400 characteristics) and 218xx series disposable temperature probes (the 218xx series probes are not sold in Germany.)

Safety To ensure the safety of the patient, the patient-applied part is isolated from ground by

opto-couplers and a transformer. The module is also encapsulated in plastic.

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TEMP Module

TEMP Module Exercise s

1. The M1029 TEMP Module can be us ed with which patients?

a. adults b. adults and pediatrics c. adults, pediatrics, and neonates

2. To which component is the temperature probe connected?

a. Current source b. Reference switching matrix

3. The module can be used with YSI Series _____ temperature probes.

a. 100 b. 200 c. 400

4. What isolates the patient from the module’s current?

a. Opto-couplers b. Input Connector c. Input Protection Network

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Answers

1. c

2. b

3. c

4. a

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Recorder Module (M1116A)

Recorder Module Concepts

Recorder Module (M1116A)

Description The M1116 A Reco rder Modu le provides th er m a l array recording capability f or the

Philips patient monitoring family, including the V24/V26. Like the M1 1 16B Recorder Module, it can write up to three overlapped waveforms and three lines of annotation. The M1116A offers eight recording speeds; the M1116B offers ten speeds.

The following components carry out the major functions within the M1116A Recorder Module.

Table 1-13 Major Recorder Module (M1116A) Components

Component Function

DC-to-DC Converter Generates power for the digit al ci rcuitry and printing

mechanisms.

Motor Control Circuits Control the operatio n of the paper drive motor.

I/O Microcontroller Manages the I/O operations for the mod ul e.

Print Microcontroller Regulates print speed and c ont ra st.

Random Access Memory Provides storage for data accessed by the microcontrollers.

Paper Drive Motor Feeds the paper through the printer.

Thermal Printhead Provides the printing mechanisms for the reco rder.

Block Diagram Figure 1-25 shows the block diagram of the Recorder Module M1116A.

Basic Plu

-In Modules 1-73

Page 100

Recorder Module (M1116A)

RECORDER

MECHANISM

THERMAL

PRINTHEAD

MOTOR

PAPER DRIVE

+10 VDC

+16 VDC

MICRO-

AND

MOTOR

FORMAT

FRONT PANEL

CONTROLS & LAMPS

I/O

MICROCONTROLLER

CONTROLLER

SHARED

(RAM)

DATA

MEMORY

DIGITAL BOARD

+5 VDC

DATA

SIGNALS

OPTO ISOLATORS

FE LINK

PROTOCOL

RACK

MOTOR

CONTROL

CIRCUITS

DC TO DC

60 VDC

+16

+10

CONVERTER

POWER SUPPLY BOARD

1-74 Basic Plu

-In Modules

Philips CMS V24 V26 Service manual

Specifications and Main Features

Frequently Asked Questions

User Manual

Introduction

The Purpose of This Book

Who Should Use This Book

What The Book Contains

Intro The CMS & V24/V26 and their families of products are po werful, flexible patient

How the Book is Structured

How the Content Is Organized

How to Use This Book

Learning and Reference

Choose Your Approach

Chapter 1 Basic Plug-In Modules

Introduction

Goals After successfully completing this chapter, you should be able to:

Objectives In order to meet the chapter’s goals, you should be able to:

Topics This chapter contains the following topics:

ECG Measurement

Electrocardiogram/Respirogram (ECG/RESP) Module Concepts

Description The skin surface electrocardiogram (ECG) measures the electrical activity of the

Concepts ECG concepts important to electrocardiogram measurement are:

Measurement Principle

Measurement Acquisition

Output ECG signals are depicted as continuous waveforms that show real-time changes in

Plug-In Modules Two of Philips’ plug-in modules can measure ECG: the ECG Module (M1001A/B)

ECG Measurements Exercise s

ECG Module

Description The M1001A/B ECG Module is a three-channel electrocardiogram measurement

Measurements The ECG produces up to 3 continuous real-time waveforms of the patient’s cardiac

Components The following components carr y ou t th e major s i gnal p roces si n g fu ncti ons wi thi n the

Block Diagram Figure 1-8 shows the module’s logical structure.

Theory of Operation (M1001A/M1002A)

ECG Module Features

ECG Module Exercise s

RESP Measurement

Description A respirogram is a recording of respiratory activity that indicates the strength and

Concepts Respiration is the metabolic pro cess by wh ich the bo dy obtains oxygen, expels carbon

Measurement Principle

Measurement Acquisition

Output RESP signals are depicted as continuous waveforms that show real-time changes in

Plug-In Modules The ECG/RESP Module (M1002A/B) provides respirogram and electrocardiogram

References Ahrens, Tom. Respiratory Monitoring in Critical Care, in AACN Clinical Issues in

RESP Measurement Exercise s

ECG/RESP Module

Description The M1002A ECG/RESP Module is a three-channel electrocardiogram and

Measurements The ECG/RESP Module produces continuous real-time waveforms for both cardiac

Components The following components carr y ou t th e major s i gnal p roces si n g fu ncti ons wi thi n the

Block Diagram Figure 1-11 shows the ECG/RESP module’s logical structure.

Theory of Operation As ECG and RESP signals pass from the patien t to the monit or , they pr ogress throu gh

ECG/RESP Module Features

ECG/RESP Module Exercise s

NBP Measurement

Non-invasive Blood Pressur e (NBP) Module Concepts

Description Blood pressure is the pressure exerted by the blood against the walls of the blood

Concepts Blood pressure results from interactions between the heart’s pumping force, the

Measurement Principle

Measurement Acquisition

Output Oscillometric blood pressure measurements are displayed as numerics.

Plug-In Modules Philips’ M1008A and M1008B NBP Modules measure non-invasive blood pressu re.

NBP Measurements Exercise s

NBP Modules

Description The M1008A and M1008B NBP Modules are non-invasive blood pressure

Measurements The modules produce numerics for the systolic, diastolic, and mean blood pressure

Components The following components carry out the major signal processing functions within the

Block Diagram Figure 1-13 shows the NBP module’s logical structure.

Theory of Operation As NBP signals pass from the patient to the monitor, they progress through stages

NBP Module Features

NBP Module Exercise s

C.O. Measurement

Cardiac Output (C.O.) Module Concepts

Description Cardiac output is an important measure of cardiac performance. It measures the

Concepts Cardiac output is determined by heart rate and stroke volume, as defined below.

Measurement Principle

Measurement Acquisition

Output The time/temperature curve resulting from the measurement resembles a bell-shaped

Criteria for Proper Measurement

Plug-In Modules The M1012A C.O. Module provides the t her modil uti o n cardi ac o utput meas ur ement .

C.O. Measurement Exercise s