INDEX

∎ Introduction: ............................................................................................................ 3
1. Normal Oxygen Transport: .................................................................................... 4
1.2 VENTILATORY MECHANICS: ........................................................................ 5
1.2.1 Inspiration: ................................................................................................... 5
1.2.2 Expiration : .................................................................................................... 5
1.3 DIFFUSION TO BLOOD :.................................................................................. 6
1.3.1 The alveoli : .................................................................................................. 6
1.3.2 Gas exchange : ............................................................................................... 6
1.4 BIND TO HEMOGLOBIN : ................................................................................ 7
1.4.1 Characteristics of hemoglobin : ....................................................................... 7
1.5 DIFFUSION TO TISSUE : .................................................................................. 7
1.5.1 Difusion into interstitial fluid and cell : ............................................................ 7
1.5.2 Oxygen delivered : ........................................................................................... 8
2. Pulse Oximetry : .................................................................................................... 9
2.1 PULSE OXIMETER PRINCIPLES : ................................................................... 9
2.2 Pulse oximeter implementation : ......................................................................... 10
2.2.1 MED-SPO2 analog front end : ........................................................................ 11
2.2.2 Multiplexer circuit and LED driver circuit : ...................................................... 12
2.2.3 Current to voltage converter : ......................................................................... 13
2.2.4 Filtered and amplification : ......................................................................... 14
2.2.5 Vref generator : .......................................................................................... 15
2.3 Physiology and how the monitor works :............................................................... 16
2.4 Pulse oximeter problems : ............................................................................... 18
∎ Conclusion : ........................................................................................................... 20
∎ References : ........................................................................................................... 21
 INDEX For Figure

(Figure 1) . Blood Circulation diagram .............................................................8

(Figure 2). A pulse oximeter .............................................................................9
(Figure 3). MED-SPO2 Functional Block diagram ........................................... 11
(Figure 4). LED drive circuit ........................................................................... 12
(Figure 5) . Current to voltage converter ........................................................ 13
( Figure 6 ) . Filter circuit ................................................................................ 14
( Figure 7) . Notch filter ................................................................................... 14
(Figure 8) . Active low-pass filter .................................................................... 15
(Figure 9 ) . Vref generator circuit ................................................................... 16
(Figure 10 ) . Hemoglobin Light absorption graph ......................................... 17
(Figure 11) . Typical Pules oximetry signal ..................................................... 19
∎ Introduction:
Breathing is one of the vital processes that the human body needs to carry out
necessary activities. It works to bring in oxygen and take out carbon dioxide.[8 ]
It is worth knowing that oxygen is one of the important elements that the body
needs in order to maintain its health. Lack of oxygen in the blood is likely to cause
some damage, such as: headaches and shortness of breath, but in cases of severe
lack of oxygen, the individual may suffer from some problems in heart and brain
functions.[9]. Lack of oxygen in the blood poses a threat to human life if it is not
noticed in a timely manner.[01]
You can monitor the level of oxygen in the blood using a pulse oximeter. A pulse
oximeter, or Pulse Ox, is an electronic device that measures the oxygen saturation of
red blood cells. Pulse oximeters can be attached to your fingers, forehead, nose, feet,
ears, or toes The probe will be placed and within a few seconds, the oximeter will
provide a reading of your heart rate and oxygen saturation level. There are no
needles and no pain in taking pulse oximetry. A pulse oximeter uses a cold light
source that shines light through the fingertip, making the tip appear red. By
analyzing the light from the light source that passes through the finger, the device
can determine the percentage of oxygen in the red blood cell.[00]
Typical pulse oximeters monitor the SpO2 of a person's blood based on red light
(using wavelength 600-750 nm), infrared light (using wavelength 850-1000 nm) and
the absorption characteristics of HbO2 and Hb. This type of pulse oximeter flashes
red and infrared lights alternately across a part of the body, such as a finger, to a
photodiode sensor. A photodiode is typically used to receive the unabsorbed light
from each LED. This signal is then inverted using an inverting operational amplifier
or op amp. The resulting signal represents the light absorbed by the finger.[01]

3
 1. Normal Oxygen Transport:

Oxygen is vital to the functioning of each cell in the human body. In the absence of
oxygen for a prolonged amount of time, cells will die. Thus, oxygen delivery to cells
is an important indicator of a patient's health.
Oxygen delivery to cells requires the use of the respiratory system as well as
the circulatory system. Ventilation is the initial step, moving air into and out of
the lungs. Within the lungs, gas exchange occurs. Oxygen is diffused into the
blood, while carbon dioxide, a byproduct of cellular respiration, diffuses into the
lungs. The oxygenated blood circulates around the body until it reaches oxygen
depleted areas, where oxygen is diffused to cells, and carbon dioxide is transferred
to the blood returning to the lungs. The ventilator process is controlled by neurons
in the brain stem. The circulatory system also can modulate cardiac output to effect
the oxygen delivery.[1]
1.1 VENTILATORY CONTROL :
Ventilation is the involuntary, rhythmic process of moving air in and out of the
lungs. This process is controlled by respiratory neurons in the brain stem. The
respiratory neurons excite motor neurons, which in turn cause the movement of
respiratory muscles. The output of the respiratory neurons is modulated by
chemoreceptors and mechanoreceptors .[1]
1.1.1 Neural control :
The respiratory neurons in the brain stem are responsible for the pattern
generation in normal breathing. The rate and depth of ventilation are modulated by
these neurons. The respiratory neurons excite motor neurons in the spinal cord. The
excitation of the motor neurons causes the contraction of the diaphragm, pectoral
muscles, and intercostal muscles. AIl of these muscles combine efforts pulling the
ribcage up and out, expanding the lungs, causing inspiration. The activity of
respiratory neurons is thought to occur spontaneously, with occasional inhibition
allowing the respiratory muscles to relax. This causes the rib cage to contract which
yields expiration.[1]

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1.2 VENTILATORY MECHANICS :
Ventilatory mechanics are based on the principle of air flow from areas of high
pressure to areas of lower pressure. The contraction of the intercostal muscles,
pectoral muscles, and the diaphragm causes the thoracic cavity to expand,
decreasing the pressure in the thoracic cavity. The atmospheric pressure is higher
than the pressure inside the lungs, causing air to flow into the lungs, which is
termed inspiration. The relaxation of the intercostal muscles and the điaphragm
causes the volume of the lungs to decrease, increasing the pressure in the thoracic
cavity. As the pressure in the lungs increases reaching levels above the atmospheric
pressure, air flows out of the lungs, which is referred to as expiration.[1]

1.2.1 Inspiration :
As discussed previously, the brain stem excites motor neurons in the spinal cord,
which, in turn, causes the contraction of the diaphragm, the pectoral muscles, and
intercostal muscles, located between the ribs. The contraction of the diaphragm
causes the flattening and lengthening of the thoracic cavity. The intercostal
muscles and pectoral muscles pull the ribcage up and out. Both of these sets of
muscles work to expand the lungs. This means that pressure will be reduced
within the lungs, since the air present will have a greater volume to expand in.
Thịs will create a pressure differential between the air outside the body and the
air inside the body. Thus, air flows into the body .[1]

1.2.2 Expiration :
Neurons in the brain stem cyclically inhibit the motor neurons in the spinal cord
that cause muscle contraction in the diaphragm, the pectoral muscles, and
intercostal muscles. The muscles then relax, causing the rib cage to contract,
decreasing the amount of air space. This causes air to flow out of the lungs when
the pressure inside the lungs is greater than the pressure outside the lungs

5
 Usually only 10% of the total lung volume is exchanged in normal breathing. With
deeper, more rapid breathing, the turbulence of the air flow increases, causing
greater resistance to airflow .[1]

1.3 DIFFUSION TO BLOOD :

The process of ventilation provides a continuous supply of fresh air in the lungs.
After oxygenatcd blood has been circulated through the body, it is brought back
to the lungs through arterial capillaries to exchange gases, receiving oxygen and
ridding itself of carbon dioxide. Blood is reoxygenated and is then recirculated
through the body. Gas exchange occurs through the process of diffusion. Difusion is
the net movement of particles from an area of higher partial pressure to a region of
lower partial pressure through a process of random motion. The actual gas
exchange to the blood takes place through the process of diffusion in the alveoli .[1]

1.3.1 The alveoli :

The alveoli are surrounded by large pulmonary capillary beds. Since diffusion
can only occur overa distance of 1 mm, the gas exchange takes between the two
cells between the capillary and the alveolus, a distance of only 0.5 um. The 600
million alveoli each adult has provide 70 m² of surface area for gas exchange .[1]

1.3.2 Gas exchange :

Air in the alveoli has a higher partial pressure of oxygen and a lower partial
pressure of carbon dioxide than the aortic blood. The pressure gradient causes
diffusion to occur. The net movement of carbon dioxide will be towards the
alveoli and the net movement of oxygen towards the blood . The blood then returns
to the heart via a pulmonary venule to be pumped out to the rest of the body. Other
gases may diffuse as a result of the partial pressure gradient between the air in the
alveoli and the pulmonary arterial blood .[1]

6
1.4 BIND TO HEMOGLOBIN :
Gases are not particularly soluble in blood, which is composed mostly of water.
Thus, for effective oxygen transport, a secondary method of transport is required.
The compound hemoglobin provides a binding mechanism that allows oxygen to be
transported through the bood. Hemoglobin plays an essential role in transporting
the necessary amount of oxygen to the body. For the same amount of plasma, 65
times more oxygen can be transported with hemoglobin than would be possible
without hemoglobin .[1]

1.4.1 Characteristics of hemoglobin :

Hemoglobin is a respiratory pigment contained within red blood cells. One red
blood cell contains approximately 265 million molecules of hemoglobin Hemoglobin
is composed of heme units, which are molecules containing iron, and globin units,
polypeptide chains. One hemoglobin molecule contains four heme and four globin
units. Each hemo and globin unit can carry one molecule of oxygen. Thus, one
hemoglobin molecule can carry four molecules of oxygen As respiratory pigment,
hemoglobin changes color when oxygenated. An oxygenated hemoglobin molecule is
bright red, while a deoxygenated hemoglobin molecule, a hemoglobin molecule
without oxygen, is dark red. This color change is used in the application of pulse
oximetry to measure hemoglobin oxygen saturation .[1]

1.5 DIFFUSION TO TISSUE :

Diffusion occurs over a distance of aboutl mm. Thus, once blood is oxygenated,
although it may pass through oxygen depleted tissue, oxygen does not diffuse
until it reaches the capillaries with one cell thickness in the wall. Oxygen diffuses
into the interstitial fluid and into the cells. .[1]

1.5.1 Difusion into interstitial fluid and cell :

Once blood reaches the systemic capillaries, the surrounding tissue usually has a
lower partial pressure of oxygen than that of he blood. Oxygen diffuses into the
surrounding tissue. When the tissue has a higher metabolic rate, the difference in
partial pressure is greater, and more oxygen is released using the steep part of the

7
Oxyhemoglobin dissociation curve. While Oxygen diffuses into the interstitial
fluid, carbon dioxide difuses into the blood. Once the oxygen is near the cell, it
diffuses through the cell membrane. [1]

1.5.2 Oxygen delivered :

The oxygen delivery index (DO) is defined as DO2 = CaOz x Cl x 10
which is typically 550 to 650 mJ(min m2). This is a measure of the amount of
oxygen available to tissue. The oxygen consumption is a measure of the oxygen
diffused into the tissue. It is defined as CIx (C,02 -C,02) where C,O, is the oxygen
content of the venous blood. A normal value for Oxygen delivery is 115 to 165
mLJ(min m²). This means that not all of theavailable oxygen diffuses into the tissue
.(see Figure 1) .[1]

(Figure 1) . Blood Circulation diagram [14]

8
 2. Pulse Oximetry :

(Figure 2). A pulse oximeter [13]

2.1 PULSE OXIMETER PRINCIPLES :

A pulse oximeter shines light of two wavelengths through a tissue bed such as the
finger or earlobe and measures the transmitted light signal. The device operates
on the following principles:
1. The light absorbance of oxygenated hemoglobin and deoxygenated
hemoglobin at the two wavelengths is different. To be more precise, the set
of associated extinction coefficients for the absorption of light for these
wavelengths is linearly independent with great enough variation for adequate

9
sensitivity but not so large that the blood appears opaque to either of the light
sources. This model assumes that only oxygenated and deoxygenated
hemoglobin are present in the blood.
2. The pulsatile nature of arterial blood results in a waveform in the
transmitted signal that allows the absorbance effects of arterial blood to be
identified from those of nonpulsatile venous blood and other body tissue. By
using a quotient of the two effects at different wavelengths it is possible to
obtain a measure requiring no absolute calibration with respect to overall
tissue absorbance. This is a clear advantage of pulse oximeters over previous
types of oximeters.
3. With adequate light, scattering in blood and tissue will illuminate sufficient
arterial blood, allowing reliable detection of the pulsatile signal. The
scattering effect necessitates empirical calibration of the pulse oximeter. On
the other hand, this effect allows a transmittance path around bone in the
finger. The principles above, associated issues and design and application of pulse
oximeters comprise the better part of this text. The remainder of this chapter
concentrates on the role and importance of pulse oximetry and limitations of
thedevice. (See the Figure 2 ).[1]

2.2 Pulse oximeter implementation :

The pulse oximeter is implemented using the Freescale MCU Kinetis K53 which
embeds the following key features for the
pulse oximetry signal treatment, among other medical oriented applications:
• 32-bit ARM® Cortex™-M4 core up to 100 MHz, bus speed up to 50 MHz
• DSP instructions for signal filtering
• Two Operational Amplifiers (OpAmp)
• Two Transimpedance Amplifiers (TRIAMP)
• USB connectivity as host, device or On-The-Go (OTG)
• Up to four pairs of differential and 24 single-ended 16-bit ADC channels

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• 3 x 16-bit Flex Timer Modules (FTM) with PWM capability
The Kinetis K53 integrates most of the peripherals needed for pulse oximeter
implementation, although some external components are required. These
components are integrated in an external Analog Front End, described below .[4]

2.2.1 MED-SPO2 analog front end :

MED-SPO2 AFE includes all the necessary external components (except sensor) to
implement a pulse oximeter together with the Kinetis K53 MCU. The AFE
functional block diagram is shown and described below (See the Figure 3 ) .[4]

(Figure 3). MED-SPO2 Functional Block diagram [4]

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2.2.2 Multiplexer circuit and LED driver circuit :
The pulse oximeter needs two different wavelengths to perform measurements.
These wavelengths are generated using two
Light Emitter Diodes (LEDs), a Red LED (660 nm,) and an Infra Red LED (940
nm). Samples cannot be taken at the same
time because there is only one photodetector for two signals, therefore signals must
be multiplexed. MED-SPO2 includes a GPIO-controlled analog multiplexer that
allows selecting the wavelength to be sampled. LED intensity is controlled using a
PWM signal. However, MCU PWM pins do not provide enough strength to drive
LEDs in a proper manner. A LED driver circuit provides the LED with sufficient
energy to work. (Figure 4) shows a basic LED driving circuit. [4]

(Figure 4). LED drive circuit [4]

12
2.2.3 Current to voltage converter :
The output generated by the photodetector is a current that represents the light
absorption. This current needs to be converted into a voltage in order to be properly
filtered and treated. Conversion is performed using a current to voltage converter
which consists in a single supply, low input offset voltage, low input offset and bias
current TRIAMP embedded on K53 together with a feedback resistance and a
capacitor for filtering purposes. (Figure 5) shows the implemented circuit. .[4]

(Figure 5) . Current to voltage converter [4]

This circuit combines a current to voltage converter and a low-pass filter to improve
the signal treatment. The output voltage and cut frequency. A 125 Hz low-pass filter
is to remove high frequency noise from the received signal.

13
2.2.4 Filtered and amplification :
This block is divided in five filters, four of them are passive filters and one of them is
an active filter. Both 660 nm and 940 nm signals are processed using these filters for
noise elimination and amplification. (Figure 6) shows the filter circuit.

( Figure 6 ) . Filter circuit [4]

 The first filter is a low-pass filter with a cutoff frequency of 6 Hz designed to

eliminate high frequency noise.
 The second filter is a 60 Hz notch filter. The purpose of this filter is to
eliminate the 60 Hz line interference. (Figure 7) represents the connections
for a notch filter.

( Figure 7) .14
Notch filter [4]
The notch filter is referenced to VCC/2 to add an offset voltage.

 The third filter is a 0.8 Hz high pass filter. The cutoff frequency of this filter
is calculated using Equation 5. This filter removes the DC component of the
signal.
 The fourth filter is a first order active 6 Hz low-pass filter that also provides a
gain of 31. ( Figure 8) shows an active low pass filter.

(Figure 8) . Active low-pass filter [4]

This filter uses a K53 internal OpAmp to be developed. Vref on positive input
allows using an inverter amplifier.
 The last one is a 4.8 Hz low pass filter similar to the first one and the
equation that represents this filter is the same that represents the first one.

2.2.5 Vref generator :

Because a negative voltage source implies extra costs and components, analog
signals are handled in a positive voltage range.
Nevertheless some analog signals like some biopotentials have negative voltages that
need to be considered. This is solved mounting the AC signal on a positive DC level,
typically VCC/ 2. Vref generator produces this signal using a simple voltage
divisor and a K53 embedded OpAmp. (Figure 8) shows a Vref generator circuit .[4]

15
 (Figure 9 ) . Vref generator circuit [4]

2.3 Physiology and how the monitor works :

Pulse oximetry is based on the fact that oxyhemoglobin (hemoglobin bound to
oxygen) and deoxyhemoglobin (hemoglobin not attached to oxygen) absorb infrared
and red light at different wavelengths. The probe of the oximeter emits infrared
light (920-940 nm) and red light (660 nm) several hundred times per second by two
light-emitting diodes (LEDs). Sensitive photodetectors placed across an arterial bed
measure the amount of light absorbed at each wavelength. The data is calculated
and is expressed as a percentage of oxygenated hemoglobin to total hemoglobin
(SpO). Arterial blood is pulsatile (venous blood and tissue beds are not) and
oximeters are designed to restrict readings to areas that pulsate due to arterial blood
flow, hence the name pulse oximetry. Although the pulse oximeter appears to be
directly measuring arterial hemoglobin saturation, it is measuring light absorption in
tissues with pulsatile flow during systole and subtracting that measured during

16
diastole . Therefore, in a still patient, because arteries are pulsating, arterial
saturation only is calculated .(See Figure 10).
Each manufacturer uses its own unique calibration method, and as a result, different
- probe over the patient's finger so that light beams and sensors oppose each
other. If the patient has long fingernails, position the probe perpendicular to
the finger, if possible, or clip the fingernail. Always position the patient's
hand at heart level to eliminate venous pulsations and to promote accurate
readings.
- Turn on the power switch. If the device is working properly, a beep will
sound, a display will light momentarily, and the pulse searchlight will Aash.
The Spo, and pulse rate displays will show stationary zeros. After four to six
heartbeats, the Spo, and pulse rate displays will supply information with each
beat, and the pulse amplitude indicator will begin tracking the pulse.
(See Figure 10) .[2]

(Figure 10 ) . Hemoglobin Light absorption graph [4]

17
2.4 Pulse oximeter problems :
To maintain a continuous display of oxygen saturation levels, you'll need to keep the
monitoring site clean and dry. Make sure the skin doesn't become irritated from
adhesives used to keep disposable probes in place. You may need to change the site
if this happens. Disposable probes that irritate the skin can also be replaced by
nondisposable models. Another common problem with pulse oximeters is the failure
of the devices to obtain a signal. If this happens, your first reaction should be to
check the patient's vital signs.
If they're sufficient to produce a signal, check for the following problems. Venous
pulsations Erroneous readings may be obtained if the pulse oximeter detects venous
pulsations. This may occur in patients with tricuspid regurgitation or pulmonary
hypertension or if a finger probe is taped too tightly to the finger.
Poor connection Check that the sensors are properly aligned. Make sure that wires
are intact and securely fastened and that the pulse oximeter is plugged into a power
source. Inadequate or intermittent blood flow to site Check the patient's pulse rate
and capillary refill time, and take corrective action if blood flow to the site is
decreased. This may mean loosening restraints, removing tight-fitting clothes, taking
off a blood pressure cuff, or checking arterial and 1.V. lines. If none of these
interventions works, you may need to,find an alternate site. Finding a site with
proper circulation may also prove challenging when a patient is receiving
vasoconstrictive drugs. Equipment malfunctions Remove the pulse oximeter from
the patient, set the alarm limits according to your facility's policies, and try the
instrument on yourself or another healthy person. This will tell you if the equipment
is working correctly.[3]

18
(Figure 11) . Typical Pules oximetry signal [4]

19
∎ Conclusion :
Pulse oximetry has become an important diagnostic tool and safety indicator. It
brings particularly vital information to the operating room, intensive care unit,
neonatal care, and in general, it is used as a safety indicator for many inpatients. It is
important that pulse oximetry be available in treatment facilities and at home.[6].
It is a home medical device that measures oxygen saturation in the blood and heart
rate It serves as an early warning system for people who are at increased risk of
death as a result of silent pneumonia. Doctors have indicated that more than a
million people suffer from chronic obstructive pulmonary disease (COPD), a lung
condition linked to smoking, and another 250,000 people who suffer from severe
asthma are at great risk. Special for lack of oxygen These devices are mounted on a
finger and send a beam of light through the finger to a sensor on the other side of
the unit. Fingertip oximeter is an economical and accurate way to detect pulse rate
and blood oxygen saturation with fingertip. Measures your health at any time.
The pulse oximeter can accurately determine SpO2 (blood oxygen saturation) and
PR (pulse rate), rapid SpO2 readings and pulse oximetry. Monitor the health of
family members at any time.
According to the volume pulse scanning and recording technology, photoelectric
oxygen saturation detection technology is adopted. The pulse oximeter can measure
pulse oxygen saturation and pulse rate through the fingers. Just place your finger on
the device, press the power button and wait. After a few seconds, you will know your
SpO2 level and pulse rate accurately. The operation is simple and one button start.
Eliminate tedious process steps. Small portable pulse oximeter, widely used in home
health care, offices, community centers, high mountain areas, sports health care and
other places.[7].

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∎ References :
1- DESIGN OF PULSE OXIMETERS ,Edited By J G WEBSTER ,1997 .
2- Anesthesia for Veterinary Technicians , Susan Bryant ,1963 .
3- Lippincott s Nursing Procedures , Judith A. Schilling 2009 .
4- Pulse Oximeter Fundamentals and Design , By Santiago Lopez , 2012 .
5- Pulse Oximeter , By Amal Jubran , 1999 .
6- https://www.meditech.com.cn/Education/pulse-oximetry-mechanism-
Oximeter-history-
7- https://souqalurdon.com/adsmanager-details
8- https://didaquest.org/wiki
9- https://www.webteb.com/articles
10- https://www.masrawy.com
11- https://www.lung.org
12- https://embeddedcomputing.com
13- https://www.nytimes.com
14- https://ar.m.wikipedia.org

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