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An Overview . . .
Measurement of blood pressure
Cardiac output
Cardiac rate
Heart sound
Respiratory rate
Gas volume
Flow rate of Co2, o2 in exhaust air
pH of blood,
ESR, GSR measurements
Plethysmography.
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Cardiac Output
It is the amount of blood delivered by the heart to the aorta per minute
For normal adults it is 4 -6 litres / minute
Any decrease may be due to
Low Blood Pressure
Reduced Tissue Oxygenation
Poor Renal Function
Shock
Acidosis
Methods of cardiac output measurements
Ficks Method
Indicator Dilution Method
Measurement of Cardiac Output by Impedance Change
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Ficks Method :
Based on analysis of gas - keeping of the organism
Cardiac output can be calculated by continuously
infusing oxygen into the blood or removing it from the
blood and measuring the amount of oxygen in the blood
before and after its passage
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Oxygen uptake
by Ventilation
Heart Catheter
Mixed Venous Blood Arterial Blood
Heart
and
Lungs
Q
Q
2
Aorta
Vena
Cava
Ficks Method for Cardiac Output Measurement
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Let I be the amount of infused or removed oxygen per unit time
It is equal to the difference between the amounts in the blood arriving at and
departing from the site of measurement
I = C
A
Q C
V
Q
Q = I
C
A
C
V
where
Q cardiac output in litres / minute
C
A
- Concentration of oxygen in the arterial blood in millilitres
of oxygen per litre of blood
C
V
- Concentration of oxygen in the mixed venous blood in
millilitres of oxygen per litre of blood
I - Volume of oxygen uptake by ventilation in millilitres of
blood
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Indicator Dilution Method
Principle
A known amount of dye or radioisotope is introduced as an indicator in the
blood circulation
The concentration of the indicator is measured with respect to time and the
volume of blood flow is estimated
Let M mg of an indicator be injected into a large vein or preferably into the
right heart itself
After passing through the right heart, lungs and the left heart, the indicator
appears in the arterial circulation
The presence of the indicator in the peripheral artery is detected by a
detector
The output of the detector is directly proportional to the concentration of
the indicator
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Let an increment volume dV pass through the sampling site in time dt
Let the mass of the indicator in dV = dM
Therefore the concentration of the indicator, c = dv
dt
dM
dt
dV
dt
c
=
Now
dV
dt
Q = But
Therefore dM = Q c dt
Integrating over the time of the experiment,
M = Q c dt
t
0
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Considering the flow as constant,
M = Q c dt
t
0
(or)
Q = M
c dt
t
0
Here concentration of the indicator c is a function of time
By drawing a curve between concentration and time, the area of the
curve gives directly the value of the denominator in the above equation
Q = M
Area of the curve
Thus
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. .
Thermistor for
Blood Temperature
Thermistor for
Thermoindicator
Temperature
Linearising
Amplifier
Linearity
Amplifier
Timer/Control
Integrator
Microcomputer
Preset Adjustment
Control
Cardiac
Output
Display
Block Diagram of the Thermo Dilution System
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A bolus of about 10 millilitres of 5% Dextrose in water at room
temperature is injected as a thermal indicator into the right atrium
After mixing it is detected in the pulmonary artery by means of a
thermistor mounted at the tip of a miniature catheter probe
The temperature difference between the injectate temperature and
the circulating temperature in the pulmonary artery is measured
The reduction in temperature is integrated with respect to time
After applying proper corrections, a meter reads the cardiac output
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S
A
1
A
2
Current
Electrodes
Potential Electrodes
Oscillator
f = 100kHz
Amplifier and
Demodulator
Differentiator
z
d
Cardiac Output Measurement by Impedance Method
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Electrodes 1 and 4 are used as current electrodes
Electrodes 2 and 3 are used to pick up the voltage across the thorax
If p - resistivity of the patients haematocrit
A - cross sectional area of the thorax
L - separation between the potential electrode 2 and 3
Then the resistance of the thorax is given by
R
pL
A
=
pL
2
AL
=
pL
2
V
=
V
pL
2
R
=
(or)
(V volume of the thorax)
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dV
- pL
2
R
2
=
During ejection of stroke volume, the change in volume is dV and
the corresponding decreasing in resistances is dR
Differentiating the above expression,
dR
Since a.c. excitation is used, R should be replaced by impedance Z
dV
- pL
2
Z
2
=
dZ Therefore
Taking
dZ = t
dZ
dt
max
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where,
dZ
dt
max
- corresponds to the peak negative value of
(dZ/dt) found during systole and
t - corresponds to the interval between (dZ/dt) = 0 and
the second heart sound
dV
- pL
2
Z
2
=
Thus
dZ
dt
max
t .
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The voltage signal due to changes in impedance is amplified and
demodulated to obtain impedance Z of the thorax
The value of (dZ/dt) is calculated using a differentiator and its
output is recorded on a recorder
From that (dZ/dt)
max
can be noted
By determining dV, the cardiac output can be measured by
multiplying dV with heart rate per minute
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o
V
OUT
+
-
VOL
L
h
r
Patient
air into
Bellows
Linkage
kR
R
.
V
BB
Spirometer
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Spirometer
Used for respiratory volume measurements
All lung volumes and capacities can be measured
Consists of light weight bellows
These bellows are mechanically articulated to a biased potentiometer such that the wiper voltage is proportional
to volume of the bellows
The maximum volume of the bellows is given by
VOL
max
= L(Pi)r
2
If k is the proportionality constant giving the fractional position of the wiper arm on the potentiometer R such
that
k = V
out
= VOL
V
BB
VOL
max
Therefore VOL = V
out
(VOL
max
)
V
BB
Better Linearity can be obtained in measuring respiratory volumes
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Gas Analysers
Used to
Determine the quantitative composition of inspired and expired gas
Assess the lung function
Types
Infrared Gas Analyser based on infrared absorption of carbon dioxide
Paramagnetic Oxygen Analyser - based on paramagnetic behaviour of
oxygen
Thermal Conductivity Gas Analyser based on thermal conductivity of
carbon dioxide
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o
Diaphragm
Panel Meter Recorder
Sample
Cell
Sample Tube
Motor
Amplifier
Detector Unit
Reference Tube
Infra red
Source
Mirror Mirror
Block Diagram of Infrared CO
2
Analyzer
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By means of mirror assembly two infrared beams with same intensity are produced
A high speed rotating chopping disc is present which occludes each beam twice per motion
The chopped lights pass through the reference and sample tubes
When the opaque portions of the choppers are not in the way, the beam falls on the balanced
condenser microphone detector after passing the gas
The sample beam falling on the detector will be weaker than the reference beam since there is
absorption in the sample cell by the component of interest
The heating of the gas in the detector situated in the reference beam side will cause rise in
pressure
The diaphragm vibrates at the chopping frequency
The diaphragm forms one half of the capacitor
Thus, the change in position of the diaphragm produces a periodic change in the capacity of the
capacitor
This change is amplified and demodulated and the output is displayed on a meter or a recorder
in terms of concentration of the wanted component
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DUMB CELL
o
O
2
N
S
MIRROR
SCALE
Simplified Block Diagram of Oxygen Analyzer
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There is a small glass dumb cell shaped assembly containing a
weakly diamagnetic gas such as nitrogen
It is suspended from a platinum iridium thread between the poles
of a powerful permanent magnet
The pole pieces are wedge shaped in order to produce a non linear
field
If the gas surrounding the dumb shell is also nitrogen there will be
no force acting on the dumb shell
If oxygen is added to the gas, the oxygen molecules experience a
force, displacing the diamagnetic dumb shell
The resulting rotation of the suspension turns a small mirror and
deflects a small beam of light over a scale calibrated in percentages
by volume of oxygen or partial pressure of oxygen
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uA
A
R
1
R
2
S
1
S
2
Reference Gas
Flow
Sample Gas
Flow
Hot Wire Cell Thermal Conductivity Analyzer
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There are four platinum filaments as heat sensing elements
Each of these is placed in a brass black
These are maintained at constant temperature and form the four arms of a bridge
Two filaments R
1
and R
2
act as reference gas arms
S
1
and S
2
act as sample gas arms
Initially reference gas is made to flow through all the filament cells and the
bridge is balanced
When the sample gas flows through the sample gas filament cells, the
temperature of the filaments in those cells are changed
If the thermal conductivity of the sample gas is more, then cooling of the
filaments takes place
This changes the resistances of the filaments
The bridge becomes unbalanced and a current flows through the meter which is
calibrated in terms of concentration of CO
2
gas
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V
OUT
= E
r
E
IN
- Y
T
Y
T
o
-10 mV /
o
C
From
Temperature
Sensor
E
IN
( From Solution )
-E
r
( From Reference )
V
OUT
.
+
+
+
-
-
-
Digital
Voltmeter
Analyzed
Solution
Glass Membrane
Buffer Solution
Electrical
Conductor
Reference
Electrode
Digital pH Meter
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Used to measure pH at a given temperature and also at different
temperature
Consists of a glass electrode terminal and reference terminal
The calomel or silver silver chloride in potassium chloride electrolyte acts
as the reference terminal
A salt bridge consisting of a fiber wick saturated with KCl is at the tip of the
reference electrode
This keeps the reference terminal potential the same regardless of the
solution under test
The active terminal is sealed with common glass except for the tip
The tip is made of sensitive glass consisting of hydrated gelatinous glass
layer
Its membrane potential is proportional to the pH of the solution under test
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The electronic circuitry is adopted to increase the sensitivity and
accuracy
It consists of an external reference voltage to compensate the various
errors
To determine the pH at different temperatures , a voltage from the
temperature regulator circuit corresponding to a given temperature
is also added with the output from pH electrode
The operational amplifiers amplify these voltages in the required
manner
The final output is given to a digital voltmeter
In the digital voltmeter the display is obtained in terms of pH as
discrete numerals
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Plethysmography
Used to measure the volume changes in any part of the body that result from the
pulsations of blood occurring with each heart beat
Used to measure Total Lung Capacity (TLC)
Consists of a rigid cup or chamber placed over any part of the body in which the
volume changes are to be measured
The cup is tightly sealed
The changes in the volume reflect the pressure changes of air inside the chamber
The pressure change is measured at constant volume or vice versa
Types based on nature of sensor
Capacitance Plethysmograph
Impedance Plethysmograph
Photoelectric Pltehysmograph
Mercury Strain Gauge Plethysmograph
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Measurement of Total Lung Capacity
The principle operation is the Boyles Law which states that at a
Kelvin Temperature, the pressure of a given mass of gas is inversely
proportional to its volume
i.e. P * (VOL) = k
1
T
where k1 is a constant
Since the patient is made to sit inside an air tight chamber whose
temperature is constant,
P * (VOL) = constant
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Partially Differentiating the above equation
d (P VOL) =
(PVOL)
P
dP +
(PVOL)
VOL
dVOL
(or)
VOL dP + P dVOL = 0
dP
dVOL
P
VOL
=
-
Now the door of the air tight chamber is sealed with the patient
inside and the valve on the mouthpiece is closed
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The patient cannot breathe with the valve closed, so the air
pressure in the mouthpiece is equal to the lung pressure P
T
In the body,
d TLC
d P
T
TLC
P
T
=
-
where TLC = Thorax Volume
P
T
= Thorax Pressure
In the chamber,
d (VOL
C
)
d P
C
VOL
C
P
C
=
-
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where VOL
C
= Chamber Volume
P
C
= Chamber Pressure
Since the chamber is closed, any increase in the thoracic volume
causes a decrease in the chamber volume of air
,
i.e. d (VOL
C
) = - d (TLC)
TLC
P
T
VOL
C
P
C
=
-
d P
T
d P
C
Since the changes in pressure induced by breathing motions are
small when the patient is sitting normally
,
P
C
= P
T
TLC
d P
T
=
-
d P
C
VOL
C
Therefore
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Procedure
First mouthpiece valve is closed when the patient is sitting inside
the sealed chamber
Now the patient is asked to make breathing motions
The change in pressure reading in the pressure gauge 1 is noted
down, this gives dP
T
The change in pressure reading in the pressure gauge 1 is noted
down, this gives dP
C
Thus knowing the value of VOLC, the TLC can be calculated using
the formula,
TLC
d P
T
=
d P
C
VOL
C
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Blood Pressure
Blood pressure (BP) is a force exerted by circulating blood on the walls
of blood vessels
The termblood pressure usually refers to the pressure measured at a
person's upper arm.
For each heartbeat, BP varies between systolic and diastolic pressures.
Systolic pressure is peak pressure in the arteries, which occurs near the end
of the cardiac cycle when the ventricles are contracting.
Diastolic pressure is minimum pressure in the arteries, which occurs near
the beginning of the cardiac cycle when the ventricles are filled with blood.
A person's BP is usually expressed in terms of the systolic pressure and
diastolic pressure, for example 120/80 millimetres of mercury (mmHG)
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Measurement
Noninvasive measurement
Palpation method
Auscultatory method
Oscillometric method
White-coat hypertension
Home monitoring
Invasive measurement
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Auscultatory method
Uses a stethoscope and a sphygmomanometer
Comprises an inflatable (Riva-Rocci) cuff placed around the upper armat roughly the
same vertical height as the heart, attached to a mercury or aneroid manometer
The mercury manometer measures the height of a column of mercury giving an
absolute result
A cuff of appropriate size is fitted smoothly and snugly, then inflated manually by
repeatedly squeezing a rubber bulb until the artery is completely occluded.
Listening with the stethoscope to the brachial artery at the elbow, the examiner
slowly releases the pressure in the cuff
When blood just starts to flow in the artery, the turbulent flow creates a "whooshing"
or pounding (first Korotkoff sound).
The pressure at which this sound is first heard is the systolic BP.
The cuff pressure is further released until no sound can be heard (fifth Korotkoff
sound), at the diastolic arterial pressure.
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Auscultatory method aneroid sphygmomanometer with stethoscope
Mercury manometer
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Invasive measurement
Arterial blood pressure (BP) is most accurately measured invasively
through an arterial line.
Involves direct measurement of arterial pressure by placing a cannula
needle in an artery (usually radial, femoral,dorsalis pedis or brachial)
The cannula must be connected to a sterile, fluid-filled system, which is
connected to an electronic pressure transducer
The advantage of this system is that pressure is constantly monitored beat-
by-beat, and a waveform (a graph of pressure against time) can be
displayed
Regularly employed in human and veterinary intensive care
medicine, anesthesiology, and for research purposes
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Classification of blood pressure for adults
Category systolic, mmHg diastolic, mmHg
Hypotension < 90 < 60
Normal 90 120 and 60 80
Prehypertension 121 139 or 81 89
Stage 1 Hypertension 140 159 or 90 99
Stage 2 Hypertension 160 or 100
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Heart sounds
The heart sounds are the noises (sound) generated by the beatingheart and the
resultant flow of blood through it.
In healthy adults, there are two normal heart sounds often described as a lub and
a dub (or dup), that occur in sequence with each heart beat. These are produced by
the closing of the AV valves and semilunar valves respectively
In addition to these normal sounds, a variety of other sounds may be present
including heart murmurs,adventitious sounds, and gallop rhythms
Heart murmurs are generated by turbulent flow of blood, which may occur inside or
outside the heart.
Abnormal murmurs can be caused by stenosis restricting the opening of a heart
valve, resulting in turbulence as blood flows through it.
Abnormal murmurs may also occur with valvular insufficiency which allows
backflow of blood when the incompetent valve closes with only partial effectiveness
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