# Physics & Measurement

Peter C A Kam
Professor of Anaesthesia, UNSW St George Hospital

The Gas Laws 
    

Boyle¶s Law Charles¶ Law The Third Perfect Gas Law The Ideal Gas Equation Henry¶s Law Dalton¶s Law

Boyle¶s Law or First Gas Law 

Boyle's Law 

at a constant temperature, temperature, the volume of a given mass of gas varies inversely with its absolute pressure, or, 

PV = k1

Charles¶ Law or Second Gas Law 

Charles' Law 

at a constant pressure, pressure, the volume of a given mass of gas varies proportionately to its absolute temperature, or, 

V/T = k2

The Third Gas Law 

The Third Perfect Gas Law 

at a constant volume, volume, the absolute pressure of a given mass of gas varies proportionately to its absolute temperature, or, 

P/T = k3

Ideal Gas Equation 

for 1 mol of any perfect gas, the universal gas constant

R = PV/T 

or, where n = number of mol of gas,

PV = nRT

A Mole 

the quantity of any substance containing the same number of particles as there are atoms in 0.012 kg of 12Carbon 

1 mol ~ 6.0223 x 1023 Avogadro's number 

equal volumes of gases, at the same temperature and pressure contain equal numbers of molecules STP
T = 273.15 K (0°C) (0°  P = 101.325 kPa (760 mmHg)  for any gas at STP, 1 mol ~ 22.4 litre  

Henry¶s Laws 

Henry's Law 

at a constant temperature, the amount of a gas temperature, dissolved in a liquid is directly proportional to the partial pressure of that gas in equilibrium with that liquid

Dalton's Law of Partial Pressures 

Dalton's Law of Partial Pressures 

in a mixture of gases, the pressure exerted by each gas is equal to the pressure which would be exerted if that gas alone were present

Solubility 

Bunsen Solubility Coefficient 

the volume of gas, corrected to STP, which dissolves STP, in one unit volume of the liquid at the temperature concerned, where the partial pressure of the gas concerned is 1 atmosphere

Solubility 

Ostwald Solubility Coefficient
the volume of gas which dissolves in one unit volume of the liquid at the temperature concerned the temperature must be specified it is independent of pressure  as the pressure rises the number of molecules of gas in the liquid phase increases, however, when measured at the higher pressure the volume is the same 

Partition Coefficient 

Partition Coefficient 

the ratio of the amount of a substance present in one phase as compared with than in another the two phases being of equal volume the temperature must be specified, and the phases being in equilibrium 

eg. blood:gas and tissue:blood

Diffusion 

the spontaneous movement of molecules or other particles in solution, owing to their random thermal motion, to reach a uniform concentration throughout the solvent the constant random thermal motion of molecules, in gaseous or liquid phases, which leads to the net transfer molecules from a region of higher concentration to a region of lower concentration (thermodynamic activity) (thermodynamic activity) 

Fick¶s Law of Diffusion 

the rate of transfer of a gas through a sheet of tissue is,
proportional to the area available for transfer  proportional to the gas tension difference  inversely proportional to the tissue thickness 

V gas = k.A (P gas 1 - Pgas 2) T

Determinants of diffusion 

Characteristics of the Gas Pressure Gradient Membrane Characteristics  

Gas Characteristics 

Molecular Weight V w 1/MW 1/ Graham's Law: relative rate of diffusion is inversely Law: proportional to the square root of the gas molecular weight  thus, lighter gases diffuse faster in gaseous media than heavier gases  lighter molecules for given energy have faster velocities  therefore, O2 diffuses more rapidly than CO2 in the gas phase (1.17 : 1) 

Gas Characteristics: Solubility 

Henry's Law 

the amount of a gas which dissolves in unit volume of a liquid, at a given temperature, is directly proportional to the partial pressure of the gas in the equilibrium phase

Gas Characteristics: Solubility
relative solubilities of CO2 & O2 in water ~ 24:1  combining this with Graham's Law from above, the relative rates of diffusion 

from alveolus to rbc for CO2:O2 ~ 20.7 : 1 solubility determines the limitation to the rate of diffusion, gases being either

 diffusion limited, as for CO limited,  perfusion limited, as for N2O limited,

Diffusion, k 

further, the diffusion of gas across a membrane, or into or out of a liquid, is proportional to the gases solubility in the liquid  

CO2 being more soluble than O2 diffuses far more rapidly across the alveolar membrane and into the RBC N2O being far more soluble than N2 may diffuse into and expand closed cavities during induction of anaesthesia

Osmotic Pressure

Osmosis & pressure 

Osmosis : the movement of solvent across a semipermeable membrane, down a thermodynamic activity gradient for that solvent Osmotic Pressure : the pressure which would be required to prevent the movement of solvent across a semipermeable membrane, down a thermodynamic activity gradient for that solvent 

Osmolality 

the number of osmotically active particles (osmoles) per kilogram of solvent depression of freezing point of a solution is directly proportional to the osmolality  

1 mol of a solute added to 1 kg of water 1.86° depresses the freezing point by 1.86°C 

presence of increased amounts of solute also lowers the vapour pressure of the solvent, viz««.

Raoult¶s Law  

the depression or lowering of the vapour pressure of a solvent is proportional to the molar concentration of the solute as the presence of a solute decreases the vapour pressure, making the solvent less volatile, so the boiling point is raised

Raoult¶s Law
These phenomena,  depression of freezing point, depression of vapour pressure  and elevation of boiling point, being related to osmolarity  are termed colligative properties of a solution

Osmotic Pressure  

1 mol of any solute dissolved in 22.4 litres of solution at 0°C will generate an osmotic pressure of 1 atmosphere in mixed solutions the osmotic pressure is the sum of the individual molalities

Osmotic Pressure
> 99% of the plasma osmolality is due to electrolytes 

contribution of the plasma proteins: \$ 1 mosmol/l normal rbc's lyse at osmolalities ~ 200 mosmol/l as capillaries are relatively impermeable to protein, this generates an osmotic pressure difference between the plasma and the interstitial fluid, the plasma oncotic pressure ~ 26 mmHg  

COLLIGATIVE PROPERTIES OF A SOLVENT  Presence of solute stabilises solvent molecules  More stable solvent molecules cause (a) Increase in boiling point (b) Increase in osmotic pressure (c) Decrease in freezing point (d) Decrease in vapour pressure of solvent.

COLLIGATIVE PROPERTIES

1 Osmole of solute leads to ; a) Boiling point of water increase by 0.52oC b) Osmotic pressure increase by 2267kPa (17000) c) Freezing point 1.85oC depression d) Vapour pressure 0.04kPa (0.3 mmHg)

FREEZING POINT OSMOMETER

Thermometer

Stirring Wire

Sample

- 7OC
Ethylene Glycol

Thermocouple

MEASUREMENT OF OSMOLALITY

Temperature

True freezing point Supercooling

Time

GAS OR LIQUID FLOW

Hagen-Poiseuille
Q = Tr4HP 8Ll 

where flow is laminar, laminar, eta (h) = viscosity of the fluid in pascal seconds there are no eddies or turbulence flow  is greatest at the centre, being ~ twice the mean centre,  near the wall p 0  is directly proportional to the driving pressure

Laminar Flow 

but as R = dP/Q, so R = 8nl Tr4 

thus, resistance in inversely proportional to the (radius)4

Turbulent Flow 


the velocity profile across the lumen is lost flow becomes directly proportional to the square root of the driving pressure  

pressure flow is not linear and resistance is not constant flow at which R is measured must be specified 

other factors in turbulent flow follow,

Q = k r2 HP Vl
V (rho) = density of the fluid in kg.m-3

Turbulent Flow 


thus, radius has less effect, cf. laminar likelihood of the onset of turbulent flow is predicted by the Reynold's number

Re = Vvd L
d = the diameter of the tube v = the velocity of flow V = rho, the density of the fluid in kg.m-3 L = eta, the viscosity of the fluid in pascal seconds

Turbulent Flow   

empirical studies show that for cylindrical tubes, if Re > 2000 turbulent flow becomes more likely for a given set of conditions there is a critical velocity at which Re = 2000 the breakpoint for turbulent flow versus Re also varies with the nature of the fluid 

eg. for blood turbulent flow at Re > 1000

Viscosity   

for a given set of conditions, flow is inversely proportional to viscosity blood viscosity increases with, low temperatures increasing age cigarette smoking increasing haematocrit abnormal elevations of plasma proteins the viscosity of blood is anomalous due to the presence of cells  behavior is said to be non-newtonian non-

Tension 

Laplace's Law P = T.h.(1/r1 + 1/r2) 

T = the tangential force in N/m acting along a length of wall  h = the thickness of the wall (usually small) small)

Laplace¶s Law 

thus, for straight tubes, P = T.h./r 

and, for spheres, spheres, P = 2T.h/r

Laplace¶s Law   

thus, as vessel diameter becomes smaller, the collapsing force becomes greater this can lead to vessel closure at low pressures, the critical closing pressure seen in alveoli, leading to instability with small alveoli tending to fill larger ones 

major action of surfactant is to maintain alveolar stability

Measurement of Gas Volumes and Flows
Direct methods Indirect methods

WET SPIROMETER
Recorder

     

     

CO2 Absorber

Disadvantages 1. High inertia 2. Inaccurate at high respiratory rate or FVC

VITALOGRAPH
Recorder Bellows Patient

Disadvantage : Patient effort dependent Bellows collect expired gas. Only measures forced expiratory volumes and flows.

WRIGHT RESPIROMETER

1. Gas stream directed by tangential slits to vane 2. Gas flow drives spinning vane 3. Spinning vane activates gears to record flow 4. Over reads at peak flow Under reads at continuous flow

Vane

Channels

Gas Flow

DRAGER VOLUMETER

Gas flow

1. Consists of 2 interlocking dumb bell rotors 2. More accurate 3. Affected by water vapour

INDIRECT MEASUREMENT OF GAS VOLUMES
1. Magnetometers 2. Pneumographs 3. Capacitance spirometry 4. Respiratory inductance plethysmograph

MAGNETOMETERS

1. Electromagnets attached to chest wall and abdomen 2. Electromagnetic field generated . 3. Chest and abdominal diameter changes ± alter magnetic filed. 4. Disadvantage : Inaccurate ++

PNEUMOGRAPH

Chest wall

Pressure Transducer Pressure Transducer

CAPACITANCE SPIROMETRY

Top plate

C

Chest wall
Bottom plate

Used for apnoeic monitoring

INDUCTANCE SPIROMETRY

Chest wall

Oscillator

RECORDER

COMPUTER

GAS FLOW MEASUREMENT

1. Variable orifice (constant pressure drop) flowmeter eg. rotameter 2. Variable pressure ± fixed orifice flowmeter

ROTAMETER
1. Variable orifice flowmeter 2. Gas flow controlled by control value at bottom of rotameter 3. Vertical tube with tapering internal diameter - wider at the top - narrower at the bottom 4. Bobbin - acts as indicator of flow 5. Pressure drops across the annular space around bobbin opposes downward pressure produced by weight of bobbin.

ROTAMETER
Pressure drop [P1 ± P2] balances weight [W] of bobbin Bobbin Rotameter tube

P2

W

P1

Gas Flow

ROTAMETER

1. Non ± linear scale 2. At lower flow; - bobbin length > distance between bobbin and glass (d) - Laminar flow 3. At high flows; - bobbin length < d - turbulent flow 4. Accuracy + 2%

PNEUMOTACHOGRAPH
1. Measure gas flows. 2. Types (a) Fixed Resistance Gas flow across fixed resistance differential pressure signal & flow eg. screen and fleisch pneumotachograph. (b) Hot wire Signal produced by gas flow cooling a heated resistance wire. (c) Pitot tube

SCREEN PNEUMOTACHOGRAPH

Gas

Screen

P1

P2

Pressure difference E flow

FLEISCH PNEUMOTACHOGRAPH

Heating coil to prevent water condensation
HEATING COIL

GAS FLOW
HEATING COIL

Fine bore parallel tube Ensure laminar flow

P1

-

P2

PITOT TUBE PNEUMOTACHOGRAPH

GAS FLOW
Upstream P1 (total) Downstream P2 (static P)

P1 - P2 E velocity of gas

Heat & Temperature

Heat & Temperature 

Heat : a form of energy, being the state of thermal agitation of the molecules of a substance, which may be transferred by, 
 

conduction through a substance convection by a substance, and radiation as electromagnetic waves

Heat & Temperature 

Temperature : is the physical state of a substance which determines whether or not the substance is in thermal equilibrium with its surroundings, heat energy being transferred from a region of higher temperature to a region of lower temperature

Heat & Temperature 

Kelvin 


the SI unit of thermodynamic temperature equal to 1/273.16 of the absolute temperature of the triple point of water the temperature at which ice, water and water vapour are all in equilibrium 

Celsius scale 


Temperature (K) = Temperature (°C) + 273.15 (° @in Celsius the triple point of water is 0.01 °C

Critical Temperature 

the temperature above which a gas cannot be liquified by pressure alone 


N 2O O2

= 36.5 °C = -119 °C 

Gas: Gas: 

a substance in the gaseous phase above its critical T Vapour: Vapour: a substance in the gaseous phase below its critical T

Critical Pressure 

the pressure at which a gas liquifies at its critical T
N2O ~ 73 bar @ 36.5 °C N2O ~ 52 bar @ 20.0 °C 

PseudoPseudo-Critical Temperature 

for a mixture of gases at a specific pressure, the specific temperature at which the individual gases may separate from the gaseous phase N2O 50% / O2 50% = - 5.5 °C  for cylinders (most likely at 117 bar) N2O 50% / O2 50% = - 30 °C  for piped gas

the change of physical state of a gas, without the transfer of heat energy to or from the surrounding environment 

rapid expansion & energy required to overcome Van der Waal's forces of attraction, as this energy cannot be gained from the surroundings, it is taken from the kinetic energy of the molecules p basis of the cryoprobe rapid compression, the energy level between molecules compression, is reduced, as this energy cannot be dissipated to the surroundings, it is transferred to the kinetic energy of the molecules 

T Measurement: Non-electrical 

mercury thermometers 


Angulated constriction at base of stem prevents Hg column returning to bulb via surface tension forces 



requires 2-3 mins to reach thermal equilibrium 2unsuitable for insertion in certain orifices

T Measurement: Non-electrical 

alcohol thermometers 
  

cheaper than mercury useful for very low T, mercury p solid at -39°C 39° unsuitable for high T, alcohol boils at 78.5°C 78.5° expansion also tends to be less linear than mercury 



Bimetallic strips Bourdon gauge p pressure

T Measurement: Electrical 

resistance thermometer 


metals oR linearly with oT frequently use a platinum wire resistor, or similar 

accuracy improved with a Wheatstone bridge

Resistance Thermometer
Platinum Wire Disadv. R T R (linear)

Not sensitive

R

T

wire T

Battery

T Measurement: Electrical 

thermistor 

metal oxides qR exponentially with oT  made exceeding small  rapid thermal equilibration  narrow reference range  @ different thermistors for different scales  accuracy improved with a Wheatstone bridge  Accuracy reduced with exposure to severe T, eg. eg. sterilisation

Thermistor
Thermistor oxide of metal R exponentially with Temp. Adv : small - rapid change - accessible to remote location Disadv : Drift in calibration

R

T

o

T Measurement: Electrical 

thermocouple 


based on the Seebeck effect at the junction of two dissimilar metals a small voltage is produced, the magnitude of which is determined by the temperature metals such as copper and constantan (Cu+Ni alloy) requires a constant reference temperature at the second junction of the electrical circuit may be made exceeding small and introduced almost anywhere 

 

Thermocouple ± ³Seebeck effect´
Reference Junction

Copper

Constantan

Junction Potential mV Measuring junction Temp

Thermocouple
Junction of 2 different metals o P. Diff ( T ) Seebeck effect

Metal 1 eg Cu V Metal 2 eg. Constantin

Ref Temp (eg.Ice)

Measured Temp

Adv. Large linear range can be very small Disadv. Small output 40 v

Specific Heat Capacity 

heat required to raise the temperature of 1 kg of a substance by 1 K (J/kg/K) 


water SHC blood SHC

= 4.18 kJ/kg/K = 3.6 kJ/kg/K

or, 1 kcal/kg/K 

infusion of 2000 ml of blood at 5°C, requiring 5° warming to 35°C, @ require 35° 


2 kg x 3.6 kJ/kg/°C x (35-5)°C = 216 kJ kJ/kg/° (35-5)° would result in the person's temperature falling by ~ 1°C 1°

Specific Latent Heat 

the heat required to convert 1 kg of a substance from one phase to another at a given temperature 

latent heat of vaporisation (from liquid to vapour) at 100°C = 2.26 MJ/kg 100° at 37°C = 2.42 MJ/kg 37° @ the lower the T the greater the latent heat required 

LHV of water 
  

as T rises, the latent heat falls until ultimately it reaches zero at a point which corresponds with the critical temperature = 373°C 373°

Humidity

ABSOLUTE HUMIDITY
 Mass of water vapour (g) in a given

volume of air (m3) numerically = mg / 1L

 Fully saturated air @ 20oC contains 17mg/L water @ 37oC contains 44mg/L water

RELATIVE HUMIDITY  Defined as ratio of mass of water vapour in a given volume of air to the mass required to fully saturate that volume of air at a given temperature. (%).  By ideal gas equation, mass is proportional to number of moles present. Relative humidity = actual vapour pressure saturated vapour pressure

HAIR HYGROMETER

Principle : Hair lengthens as humidity increases Accuracy : - Low - Accurate between RH 15-85% - very simple & cheap
Hair RH L

WET AND DRY BULB HYGROMETER

T1

T2

Air
Wet Gauze

- -- - -- -- - - -

Water

WET AND DRY BULB HYGROMETER
T1 = temperature of wet bulb decreases because of evaporation in wet gauze. Lower humidity causes more evaporation and T1 decreases more. Humidity E T1 ± T2 - % humidity from tables

DEW POINT



Defined as temperature at which ambient air is fully saturated

 At this point condensation occurs

REGNAULT¶S HYGROMETER
Thermometer AIR Silver Tube

Ether Bubble Condensation at ³ dew point´

RH =

SVP at dew point SVP at ambient temperature

OR from tables

HUMIDITY TRANSDUCERS

 Principle : When a substance absorbs

water, its resistance or capacitance changes.  Substance is incorporated into electrical circuit as resistor or dielectric portion of a capacitor.

HUMIDITY TRANSDUCERS

Advantages : 1. Extremely sensitive 2. Rapid response - can be used as servo-systems. Disadvantages : 1. Display hysteresis ± unsuitable for critical applications where high degrees of accuracy required.

MASS SPECTROMETER for measuring humidity

-

Used to measure water vapour pressure

- Rapid response - can be used to measure breath ±by- breath changes. - Disadvantage - very expensive

WEIGHING TECHNIQUES
a) Weighing quantity of water vapour that has condensed in a known volume of air or b) Warming air so that all water droplets are evaporated & then weighing volume of air. c) Absorption techniques Absorption of water vapour in either concentrated sulphuric acid, silica gel or anhydrous CaCl2

PRESSURE ± Physics and Measurement

PRESSURE

 Defined as Force per unit area

 Units : Pascal (Pa) or Newton per square meter ( N.m-2). Newton = Force that will accelerate 1 kg (N) mass at 1ms-2. 1 Pascal = 1 N acting on area of 1m2  Gravity = 9.81m.s-2

PRESSURE UNITS

1 kPa = 10.2 cm H2O = mm Hg [mercury = 13.6 times as dense as water] 


1 bar = 100 kPa = mm Hg

GAUGE PRESSURE



Pressure relative to atmospheric pressure. i.e. zero at atmospheric pressure Gauge Pressure may be determined by how much pressure is above or below atmospheric pressure.



ABSOLUTE PRESSURE Pressure relative to a true zero pressure(i.e.vacuum) Therefore, Zero gauge pressure = 1 atmosphere absolute  Gauge pressure 1 atmosphere = 760 mmHg = 101.325 kPa = 2 atmosphere absolute

MEASUREMENT OF BLOOD PRESSURE
UNITS OF PRESSURE Unit Pascal ( Pa) mmHg bar Torr cmH2O Value N/m2 133.3Pa 105Pa almost = 1 mmHg ~ 1-Pa SI Unit 1 mmHg = 7.5kP

PRESSURE

P = p x g x h p = density of fluid g = acceleration due to gravity H = Height of column Conversions 10cmH2O = 7.4 mmHg 10mmHg = 13.6 cmH2O Mercury 13.6 x water density

INDIRECT BLOOD PRESSURE MEASUREMENT
Principle a) Utilise cuff - occlude pulse a) Detection of return of pulse or blood flow distal to cuff.

OCCLUDING CUFF

 Cuff pressure transmitted to tissues surrounding

artery.  Cuff width = 40% limb circumference  Bladder - at least half circumference - Centred over artery

 Cuff level with heart

ERRORS WITH CUFF

a) Too narrow or to loose cuff overestimate SP and DP. b) Too wide underestimate SP and DP (Pressure = F/A)

CUFF ± AHA STANDARDS

Arm Circumference 22 ± 26 cm 27 ± 34 cm 35 x 44 cm 45 ± 52 cm

DEVICES MEASURING CUFF PRESSURE
Mercury manometers - Used to be standard - Now phased out - Column must be vertical - Air vent on top of column Aneroid gauges - Convenient - Commonly under-read BP - Calibrated 6 monthly

FLOW DETECTION DISTAL TO CUFF
Palpation Finger palpation Finger Photoplethysmograph Auscultation Audible range ± Korotkov sound Ultrasound (5MH2) range ± Arteriosounde Subaudible (10-40mH2) range ± Infrasound Oscillometry Defection of oscillations von Recklinghausen¶s oscillations NO2 invasive BP

KOROTKOV SOUNDS
Phase I: First appearance of tapping sounds Phase II: Brief softening of sounds Auscultation gap : disappearance of sounds Phase III: Return of sounds Phase IV: Muffing of sounds Phase V: Disappearance of all sounds

KOROTKOV SOUNDS

Cuff deflation rate = 2-3 mm Hg per sec. Rapid deflation = underestimate BP

Note auscultatory gap may be present DBP = point of disappearance of sound Difference between phase IV & V ~ 5 mmHg

OSCILLOMETRY



Basis of NIBP Only one cuff acts as (i) occluding cuff (ii) Sensor using microprocessor Cuff both actuator & transducer





OSCILLOMETRY

Oscillations begins at SBP Maximal at MAP Abruptly diminishes at DBP

OSCILLOMETRY - NATURE OF OSCILLATIONS

 Diamond shaped pattern

 Pressures at oscillation between 2 heart beats compared.  Average is recorded  MAP most accurate

OSCILLOMETRY

Advantage : 1. Not operator dependent 2. ³hands free´ 3. Automated Disadvantage : 1. Inaccurate in shock or arrhythmia. 2. Cuff placement important 3. Bruising + skin damage 4. Venous congestion 5. Nerve compression

FINAPRES

 Cuff placed around finger

 Changes in volume of arterial blood in finger detected by plethysmography  MAP - cuff inflated to maximal - cuff pressure approximates arterial pressure waveform

ARTERIAL TONOMETER

 Force transducer placed over artery with under

lying bone.  Electrical signal - reproduces arterial waveform  Needs to be calibrated 5 ± 10 min against oscillometric measurements

INVASIVE (DIRECT) BP MEASUREMENT

Advantages 1. Continuous monitoring 2. Trends observed 3. Accuracy over wide range 4. Enables visual analysis of pulse pressure

VISUAL ANALYSIS OF WAVEFORM

Myocardial Contractility Upstroke of pulse pressure ~ LV dp/dt Steep upstroke = strong LV contraction Stroke Volume Area under systolic ejection ~ LV stroke volume Systemic Vascular Resistance Low diastolic notch = Rapid run off & Steep down stroke low SVR CIRCULATING BLOOD VOLUME Exaggerated beat to beat variation with ventilation = hypovolaemia

INDICATIONS FOR INVASIVE BP
1. Rapid changes in BP 2. Monitor effects of potent hypotensive or vasopressor agents 3. During CP bypass 4. Operation with volume shifts eg. AAA or phaeochromocytoma. 5. Shock 6. Difficult access eg. Morbid obesity

VARIATION OF BP
 Waveform distorted the further away from the heart.

 High frequency components eg. incisura damped out / disappear.  Systolic BP increases distally.  Hump becomes more prominent in diastolic part of waveform

VARIATION OF BP
 SBP increases towards periphery  DBP decreases towards periphery  MAP - only slight drop eg. MAP radial 5% < MAP aorta  Pulse Pressure increases towards periphery Causes : a) Reflection of pressure wave from peripheral arterioles b) Resonance

BP AND POSTURE

- 42 mmHg

0

+80 mmHg

COMPONENTS OF INVASIVE BP

 Mechanical coupling of blood to transducer

intravascular catheter connecting tubing stop lock  Transducer Converts pressure changes to voltage changes  Electronic processing  Display + recorder

REQUIREMENTS FOR ACCURACY INVASIVE BP
1. STATIC Accuracy - Ability to measure stationary events - No baseline/sensitivity drifts - Input & output linearity - No hysteresis 2. DYNAMIC Accuracy - Ability to accurately record over rapid changes. 3. PHYSIOLOGICAL Reactance - measuring system must have effect on event recorded / measured.

TRANSDUCER

 Coverts pressure energy

movement electrical signal resistance change resistance

 Commonly diaphragm movement Wire stretch

 Wheatstone bridge used to convert resistance change to voltage signal

STATIC CALIBRATION


Linear response (straight line) between pressure and output voltage.
Output
Gain = slope of line offset

Pressure

Offset - Transducer output at zero pressure  Gain - Change in output for given change in pressure must be constant.  Sensitivity (factory set) at 5QV/V/mmHg


MEAN BLOOD PRESSURE

a MAP b

Average Pressure  Equal to pressure when a = b  Electronically averaged instantaneous measurements  Highly damped system eg. aneroid gauge gives MAP  MAP = diastolic pressure + 1/3 pulse pressure = SBP + 2DBP 3


DYNAMIC RESPONSE


Basic or Fundamental Harmonic (1st) Heart Rate 60 beats/min = 1 Hz Heart Rate 120 beats/min = 2 Hz

 By Fourier Analysis Fundamental = f = 2Hz (HR 120) 2nd Harmonic = 2 x f = 4Hz 3rd Harmonic = 3 x f = 6Hz 10th Harmonic = 10 x f = 20Hz  Accurate waveform without amplitude distortion achieved with 10th harmonic ~ 20Hz

PRACTICAL ASPECTS OF DYNAMIC RESPONSE

 Natural frequencies of clinical systems approx, 30Hz

 Acceptable if damping ratio is optimal  To achieve dynamic accuracy - fundamental frequency (fo) must be maximised.

MAXIMISING Fo
Note : fo = 1 2T E M

To minimize fo Minimize M (mass) - Minimal volume of fluid in transducer - Short tubing Maximise E, modulus of elasticity - Stiff tubing - Stiff diaphragm - Eliminate air bubbles

FACTORS THAT INCREASE DAMPING

 Increase fluid viscosity eg. blood clots

 Narrow tubing eg. kinked catheter  Increased tubing length  Decreased stiffness of tubing

LIQUID MANOMETERS (Absolute Pressure)
Mercury Barometer
Torricellian Vaccum
   P                        

h

Mercury

Measures Absolute Pressure

LIQUID MANOMETERS (Gauge Pressure)

P h - Amount by which pressure exceeds atmospheric

Note tube open at both ends

LIQUID MANOMETERS Methods to increase sensitivity

 Use low density liquid  Amplify vertical movement of meniscus. a) inclined plane manometer b) differential liquid manometer

MECHANICAL PRESSURE GAUGE
Bourdon Gauge
Wheel Pointer Cross Section Coiled tube unwinds at high pressure Fixed Point Pressure

High Pressure Low Pressure

Usually for measuring high pressure  Can be adapted for temperature or flow measurement


MECHANICAL PRESSURE GAUGE
Aneroid Gauge
Lever System - amplifies change
Pointer Bellows Expands with

pressure

P

Uses : BP, Airway Pressures on IPPV

DIAPHRAGM GAUGE

 Pressure measurement made by sensing movement of flexible diaphragm.  Diaphragm movement sensed by a) Direct movement of levers etc. (not sensitive) b) Optical method pressure Diaphragm Mirror stretched more rotated & curved c) Electromechanical transducers

OPTICAL ELECTROMECHANICAL TRANSDUCERS
Principles : 1. Increased pressure Diaphragm more convex

2. Light beam reflected off silvered surface of diaphragm on to photoelectric cell. 3. Reflected light beam more divergent. 4. Light intensity sensed by photo-electric cell decreases and electrical output falls

OPTICAL ELECTROMECHANICAL TRANSDUCERS
P1
Photoelectric Convergent Cell Reflected light Slivered surface

P
2

Photoelectric Cell Divergent reflected light

Mirror

Slivered surface

Mirror

Light Source

STRAIN GAUGE ELECTROMECHANICAL TRANSDUCERS

Principles : Wire stretched or compressed
Change in length and diameter atomic stricture change

Resistance change

STRAIN GAUGE TRANSDUCER

Diaphragm

Fixed point

Movable block

P
Wired compressed

Resistance wire stretch

1. 2. 3.

Resistance wires arranged in 2 sets When pressure increases, one set stretches & other set compresses Difference in resistance is measured by wheatstone bridge system.

BONDED STAIN GAUGE

P

Strain gauge Bonded to diaphragm Double Bond

Single Bond

1. 2. 3. 4.

Resistance wires in zig-zag patter cemented to diaphragm surfaces. Robust but subject to hysteresis. Resistance wire ± low temperature coefficient. Double bonded strain gauge one stretched & other compressed.

WHEATSTONE BRIDGE ARRANGEMENT OF RESISTANCE WIRES

OUTPUT

OUTPUT

Strain Gauge element Half bridge circuit

Strain Gauge element Full bridge circuit

CAPACITANCE TRANSDUCER

Diaphragm as one plate

2ND plate

Charge

Characteristics : 1. Very sensitive 2. High natural frequency 3. Temperature drift 4. Unstable

VARIANCE INDUCTANCE TRANSDUCER

Diaphragm

P

Iron Core

Coil

magnetic field

WHEATSTONE BRIDGE
Wheatstone bridge is a special arrangement of resistors designed to amplify change in resistance.

R1

R2

R2 R1

Balanced Wheatstone bridge

FREQUENCY RESPONSE
1. Measurement systems respond to restricted range of frequencies. 2. Input signals of same amplitude at different frequencies will produce output over a limited range of frequencies. 3. Within this frequency range, response may be more sensitive to some frequencies than others. 4. Response of system (system gain) plotted against signal frequency is called ³ Frequency Response of System´.

FREQUENCY RESPONSE OF A SYSTEM
System gain

Bandwidth Frequency Lower cut off Upper cut off

DETERMINANTS OF FREQUENCY RESPONSE

MECHANICAL SYSTEM Inertial elements (eg. mass) Compliance elements (eg. spring) ELECTRICAL CIRCUIT Inductance Capacitance

NATURAL OR RESONANT FREQUENCY
1. When a constant amplitude waveform is applied at increasing amplitude occurs at resonant or natural frequency (fo) of the system. 2. Beyond fo (higher frequencies), amplitude of oscillations increase and then fall to zero. 3. Fo depends on inertial and compliance etc.

AMPLITUDE AS FREQUENCY INCREASES
Amplitude of oscillation

Natural or resonant Frequency (fo) (maximal oscillation)

Increasing frequency

Amplitude decreased Beyond fo

ENERGY INTERCHANGE IN OSCILLATING SYSTEM
1. Continental interchange between kinetic energy of mass in motion and potential energy. 2. Kinetic energy = ½ mv2. 3. Narrow Tube (a) More energy required to make given mass of fluid to oscillate because it has to reach higher velocity. (b) Catheter fluid velocity > fluid velocity at diaphragm. (c) E, Effective mass catheter > E, diaphragm. (d) Larger effective mass lower fo.

RESONANT FREQUENCY

OUTPUT

FREQUENCY

FO

Resonant frequency

UNDAMPED NATURAL FREQUENCY

Fo = 1 2T

S M

Fo = undamped natural frequency S M = stiffness of transducer diaphragm = Effective mass

HIGH UNDAMPED NATURAL FREQUENCY

Catheter - Transducer System Needs high fo Occurs when fluid velocity is minimized Achieved by; (a) (b) Stiff diaphragm Short and wide catheter.

DAMPING


Defined as tendency of a system to resist oscillations caused by a sudden change.  In mechanical devices, damping arises from frictional effects on mechanical moving parts.  In fluid operated devices, damping is caused by vicious forces that oppose fluid movement. In electrical devices, electrical resistance oppose passage of electrical currents.



EXTENT OF DAMPING

Underdamping - Results in oscillation and overestimation of measurement (overshoot of output) . Overdamping - Results in slow response and underestimation of measurement. Critical damping - No overshoot of output signal but speed of response is too slow.

SIGNAL AMPLITUDE & DAMPING

2 Relative Amplitude 0.2

0.5 1 D=1.0 0.64

0.5 0.1 0.5 1.0 1.5

OPTIMAL DAMPING

1. State of damping in which (a)Minimal overshoot (b)Response speed only slightly reduced 2. D = 0.64 (i.e. 64% critical damping) (a)7% overshoot (b)Response speed only minimally reduced

PHASE SHIFT RESPONSE
1. Waveform or signal composed of series of component frequencies. 2. Each component waveform undergoes different time delay or phase shift. 3. Phase shift is time delay expressed as an angle (radians). 4. At fo, waveform delayed by 90% 5. Other frequencies, phase lag is linearly related at D = 0.64 I.e. phase distortion minimal at D = 0.6.

SPECIFICATIONS OF TRANSDUCERS

1. To avoid waveform, amplitude and phase distortion, catheter-transducer system should have undamped natural frequency 25-40Hz . 2. Standard transducer ± undamped natural frequency of 100 Hz or more. 3. Catheter - tap - cannula arrangement reduces natural frequency of the system.

DIRECT BP MEASUREMENT SPECIFICATIONS
1. Transducer : - Frequency response > 100 Hz i,.e. resonant frequency > 100Hz. 2. Tubing & cannula : - Lowers fo and adds damping. Length increase - lower fo, more damping Compliant tube - lower fo, more damping Small bore tube - lower fo, more damping air/clot in tube - lower fo, more damping

Factors that increases fo tend to lower damping.

CARDIAC OUTPUT MEASUREMENT

USES OF CARDIAC OUTPUT MEASUREMENT 1. GENERAL ICU - Cardiac performance assessment in shocked patients. - Management of inotropes and vasoconstrictors - Optimisation of PEEP Therapy.

2. OPERATING THEATRES - Major Anaesthetic eg. AAA, Liver transplant - Anaesthesia in severe cardiac disease (eg. L V failure, Recent MI)

CARDIAC OUT MEASUREMENT USES

3. Post-cardiac Surgery Intensive Care Units 4. Coronary Care Units / Laboratories - Assessment of severity of ischaemic & valvular disease - Management of inotropes vasoconstrictors and vasodilators.

INFORMATION FROM C.O. MEASUREMENT

Cardiac output Cardiac Index = CO Surface area Systemic vascular resistance = MAP-RAP CO

L/min

L/min/m2 mmHg/L/min or PRU dyne.sec.cm-5

Pulmonary Vascular Resistance = MPAP-LAP CO

mmHg/L/min or PRU dyne.sec.cm-5

INFORMATION FROM C.O. MEASUREMENT

LV stroke work = MAP x SV RV stroke work = MPAP x SV Oxygen Consumption = CO x (CaO2-Cv-O2) Oxygen Delivery = CO x CaO2 (D O2)

gm.m gm.m ml/min ml/min

DIRECT CO MEASUREMENT

1. ELECTROMAGNETIC FLOWMETER PROBE a) Periaortic b) Intraaortic 2. Ultrasonic Flow Probe 3. Intravascular thermal velocity transducer

INDIRECT CO MEASUREMENT
A. INVASIVE METHODS 1. Fick method (1970) i) Direct (O2 Consumption) ii) Indirect (CO2 production) 2. Dye dilution (Stewart, 1894, Hamilton, 1979) 3. Thermodilution (Fegler, 1954) NON-INVASIVE METHODS 1. Radioactive tracer dilution (radiocardiography) 2. Bollisto cardiography 3. Pneumocardiography 4. Impedance Plethysmography

ELECTROMAGNETIC FLOW PROBE

Faraday¶s Law states that :³When a conductor moves with a given velocity across the Lines of force of a uniform magnetic field, an electromotive Force will be induced at right angles to the flow, and will be Proportional to the velocity of the conductor´

MAGNETIC FIELD
E
Blood flow

a V

Magnetic

H

Magnetic field is held at right angles to blood flow Electromotive force induced at right angles to moving conductor, the blood flow. NOTE : EMF technique measures blood velocity

ELECTROMOTIVE FORCE, E

+a E = -a

v. H 2a 10 -8

V = Velocity of blood H = strength of magnetic field (gauss) 2a = length of conductor or diameter of blood vessel.

BLOOD VELOCITY

Blood velocity =

Flow rate (cm3 / sec) Cross section area of vessel (cm2)

Flow rate

= Blood velocity x cross section area

TYPES OF EMF FLOW PROBES

NOTE : Peri or intra-aortic flow probes measure CO (less coronary blood flow) (a) Periaortic Flow Probe  used in open heart surgery  rarely used clinically (b) Intravascular Flow Probe  introduced via peripheral artery  invasive  velocity depends on exact site (maximal in centre of blood vessel)

ULTRASONIC FLOW PROBE

Measures velocity of flowing fluid (a) Pulsed Ultrasound - Cuff transducer around artery - Pulse of 5 MHz from piece-electric crystal in cuff. - receiver crystal downstream - Transit time between

ULTRASONIC FLOW PROBE

(B) Doppler Effect Principle : frequency shift of emitted wave from barium titanate crystal when it is reflected from moving fluid column Disadvantage : Cannot detect difference between forward and backward flow. eg. aortic blood flow : mean velocity = 40 cm/sec systolic velocity = 120 cm/sec

ULTRASONIC FLOW PROBE

1. Probe placed at suprasternal notch with beam directed to aortic arch or 2. Transoesophageal probe with beam directed at descending aorta 3. Velocity of blood flow and cross ± sectional area of aorta determined.

ACCUCOM C.O. MONITOR

1. Continuous C.O reading 2. Oesophageal probe containing dual crystal Doppler probe transducer to measure velocity in descending aorta. 3. Second Doppler probe placed at suprasternal notch used to calibrate instrument 4. Aortic diameter determined by echocardiogram or monogram

2 D COLOUR FLOW ± ECHO-DOPPLER

1. Pulse ultrasound for imaging of cardiac flow 2. L V outflow tract imaged and cross sectional area determined. 3. Velocity of blood flow in LV ± outflow tract measured. 4. CO = Cross Section Area x Velocity. 5. Colour Doppler to demonstrate direction of flow

INTRAVASCULAR THERMAL VELOCITY TRANSDUCER

1. Heated thermistor placed in moving liquid stream dissipates heat as a function of flow velocity. 2. Probe maintained at fixed position in blood stream within vessel of fixed diameter. 3. Velocity signal translated into flow.

INDIRECT METHODS OF C.O. MEASUREMENT
I INVASIVE METHODS

Direct Fick Method Indirect Fick Method Dye dilution Method Thermodilution technique
II

NON INVASIVE METHODS Radioactive tracer dilution Ballisto cardiography Thoracic impedance plethysmography

FICK PRINCIPLE (Adolph Fick ± 1870)

States that : ³ the flow of a liquid in a given period of Time is equal to the amount of substance entering or Leaving the stream / or organ) in the same period of Time, divided by the difference between the concentration of the substance before and after the Point of entry or exit ³

DERIVATION OF FICK PRINCIPLE

-

o

Amount of Indicator At entry (-)

+

=

Amount of Indicator at Exit ( o )

Concentration = Amount Volume Amount = Volume x concentration

DERIVATION OF FICK PRINCIPLE

Concentration At entry ( - )

x

Volume at (-)

+

= CE VE

Dividing at entry = Vol at exit Conc. At entry x flow rate + M (amount added/min) Therefore Flow Rate = = Conc x At Exit Flow rate

Amount indicator added per min Exit conc. ± entry conc.

HYDRAULIC ANALOGUE MODEL

M mgs-1

V ml

Q ml sec ±1

C mg / m

INDICATOR CONCENTRATION CHANGE AT CONSTANT INFUSION WITH NO INDICATOR INPUT

Conc. (mg ml-1)

C max

C1
Time

INDICATOR CONCENTRATION
(known concentration Co at input with constant infusion)

C max Conc

Co Time

INDICATOR CONCENTRATION vs TIME (Bolus Injection)

yo Conc y1 = yoe-ke

y1 Time

FICK METHOD
Used in 3 ways 1. Direct Fick - uses oxygen uptake as indicator Co = ___Vo2____ CaO2 - CVO2 2. Indirect Fick ± uses CO2 production as indicator Co = VCO2 CVCO2 ± CaCO2 3. INERT GAS METHOD eg. N2O xe137, K85, KK7a - Used for specific organ blood flow measurement - basis of Kety ± Schmidt Method

DIRECT FICK METHOD

Assumptions ; 1. Steady State of both flow (Q) and oxygen consumption. 2. CaO2 and CVO2 constant. 3. Closed system I.e. blood is only source of substance taken up.

DIRECT FICK METHOD

Measurement of O2 consumption 1. Breathe O2 (FIO2) via one-way valve 2. Expires into Douglas bag or Tissot Spirometer V E = Volume measured Time
.

DIRECT FICK METHOD

Calculation of Oxygen consumption VO2 = Inspired Gas Vol
x

FiO2 - Expired x FEO2 Gas Vol

DIRECT FICK METHOD
Oxygen consumption calculations Nitrogen is in steady state V inspired N2 = V expired N2 VI x FIN2 = VE x FEN2 VI = VE x FEN2 FIN2 FIN2 = I - FIO2 FEN2 = 1 ± FEO2 ± FECO2 VI = VE x 1 ± FEO2 ± FECO2 1 ± FIN2 VO2 = (VI x FIO2) ± VE x FEO2

DIRECT FICK METHOD

CaO2 = Hb (g/L) x SaO2 x 1.34 ( mIO2) + 0.003 x PaO2 SaO2 measured using arterial blood and calibrated oximeter

DIRECT FICK METHOD

( Mixed Venous Oxygen Content)

Need pulmonary artery blood for mixed venous Sample. CVO2 = Hb x SVO2 x 1.34 dissolved component usually ignored

DIRECT FICK METHOD
CO = 250 ml / min_____ 200ml/L - 150 ml/L

= 5 L / Min Features : 1. Steady state of CO, VO2, CO2 production N2 balance arterial; and venous O2 concentration. 2. Accuracy + 10% used as reference. 3. Slow, cumbersome, unsuitable for rapid measurements. 4. Unsuitable during GA - Not a steady state - Uptake of volatile agents and N2 washout.

INDIRECT FICK METHOD

1. CO2 used as indicator 2. Theoretical advantage : Mixed venous CO2 estimated by rebreathing technique - No need for CVP. 3. Problem : Large CO2 stores - steady state not easily achieved.

DYE DILUTION METHOD

1. Applies to bolus of indicator 2. Also known as Stewart ± Hamilton principle. 3. Basis of dye dilution and thermodilution techniques.

DYE DILUTION METHOD
Exit Conc.

Cmax

Ct

C (t)

0

time

T 00

Ct = C maxe-kt Where e = 2.718 K = decay constant of exponential

DYE DILUTION METHOD: CALCULATIONS
At any moment c = M V M =CxV Integrating :

g
o Vdt Where Mdt = o

g

g
Cdt x o

g

Mdt = Original o g = total volume flow o

injected

STEWART ± HAMILTON FORMULA

g
M = o Q = ___M___ cdt x Q

g

cdt o

DYE ± DILUTION INFUSION TECHNIQUE
C exit

C entry Q = __M__
t=1

t

o

t

1

Cdt
t-0

= __M__ Ct1 - Ct0 = _______M________ C exit - C entry

DYE ± DILUTION METHOD

Dye - Indocyanine green (ICG) - peak absorption = 805 nm (isobestic point of HbO2) - non toxic - rapid removal 18-24% per min - 2.5-5mg injected into right atrium

DYE DILUTION ± GRAPH ANALYSIS

recirculation
C

g
o

t

Cdt = area under curve Methods used (a) Trapezoid Method (b) Forward method Triangle area - Peak Height x width at halve peak height (c) Computer integrator

DYE DILUTION METHOD

EQUIPMENT 1. Withdrawal Pump/syringe ~ 20ml/min 2. Optical densitometer ~ 805 nm 3. Chart Recorder

THERMODILUTION TECHNIQUE
Bolus of ³Negative Heat´ Sensor = Thermistor in pulmonary artery

Cardiac Output = ___Amount of ±ve Heat (M)__ g Tdt
o

THERMODILUTION METHOD

Negative Heat M = V1 x (TB ± T1) D- SDBSB
Where M VI TB TI DI DB SI SB = = = = = = = = Amount of negative heat Volume injectable ( 10ml 5% D) Patient¶s blood temperature Injectable temperature Injectable density Blood density Specific heat of injectate Specific heat of blood = __DS SI__ = 1.08 DB - SB

For 5% Dextrose

(a) Correction factor (b) AVC = Calculated to
t

1.22
0

Tdt

t where C = _30 Cmax 100 (c) Final Formula CO = VI x (TB ± TI) x 1.08 x CT x 60
-

1.22
o

Tdt

THERMODILUTION

1. Room temperature D 5% used 2. Inject within 1.5 sec. 3. Inject at end-expiration

ICED vs ROOM TEMPERATURE INJECTATE

1. Random error greater with injectate at room temperature 2. Iced Injectate slightly overestimates at low cardiac output. 3. Room temperature significantly overestimates at CO < 2-3L/min by 20-50%.

FICK METHOD

ADVANTAGES Correlates with direct measurements reference Method. DISADVANTAGES Slow and cumbersome Not suitable for rapid repeated measurements.

DYE DILUTION

ADVANTAGES 1. Correlates well with direct and Fick method DISADVANTAGES 1. Arterial cannulation needed 2. Limited to 3 measurements 3. Recirculation ³Noise´ 4. Unsuitable for rapid, repeated measurements

THERMODILUTION METHODS

ADVANTAGES 1. Simple and convenient 2. No blood withdrawal 3. Limited recirculation 4. Unlimited number of measurements 5. Rapid repeated measurements possible

Risa washout over heart Scintillation Counter Difficult to calibrate Radiation hazard.

BALLISTOCARDIOGRAPHY
Patient coupled to light bed Ultralow frequency recording Body acceleration (recoil) measures aortic Acceleration ( dQ/dt) and stroke volume
H F L

G I t I and J waves = dQ/dt

Lo

IMPEDANCE PLETHYSMOGRAPHY
1 2

-100Yz sinusoidal current 4 mA through chest -Wheatstone bridge to measure resistance
3 4

-Voltage change with constant current I -R = Voltage change I -Resistance change reflect pulmonary blood flow

LITHIUM DILUTION CARDIAC OUTPUT

-

Indicator = Lithium chloride (150 mM) Dose ~ 0.3 mmol via any venous line Artyerial litium plasma concentration measured by lithium sensitive electrode aspirated at 4 ml/min. Co = LiCl dose x 6- Area (1 ± haemocrit)

-

-

PULSE PRESSURE ANALYSIS

-

Arterial pulse pressure waveform analysed

- Cardiac output ~ Area under systolic portion of arterial waveform from diastole to end-systole - Calibrated initial using lithium dilution technique.

Measurement of pH

Measurement of pH 
 

pH = - log10 of the hydrogen ion activity (~ []'n) at 37°C, normal blood pH = 7.4 0.04 37° circuit consists of,
capillary tube of pH sensitive glass ® dV  reference buffer solution the other side of the glass + a silver/silver chloride electrode  an electrolyte solution (KCl) in contact with blood + a silver/silver chloride electrode  surrounding water jacket at 37°C 37°  voltmeter 

Measurement of pH

MEASUREMENT OF pH pH electrode

-

Depends on ion selective electrode pH sensitive Glass Electrode Utilises glass membrane which is selectively permeable to hydrogen ions. Glass electrode - placed in series with 2 half cells which generate a constant potential gradient

pH ELECTRODE SYSTEMS



Electrode consists of: metal ± conducts - electrons electrolyte ± conducts ions. Ag:AgCl + Hydrochloric Acid Hg:Hg2Cl2 + saturated KCl Solution EMF generated at interface of 2 electrodes.





SCHEMATIC ARRANGEMENT OF pH ELECTRODE

V

Voltmeter pH sensitive glass Ag/AgCl Reference Electrode

Porous Plug Hg / Hg2Cl2 Calomel Reference Electrode KCl Salt bridge

SAMPLE

HCl

Potential

Constant

Constant

Variable Constant

pH ELECTRODE

Saturated KCl  Provides salt bridge  Completes circuit between blood sample and calomel electrode.  Porous plug prevents diffusion of KCl into blood sample.

pH ELECTRODE

 Measures activity of H+; not concentration  Calibrated against 2 standard buffers; (a) pH 6.841 = Zero (b) pH 7.383

pH ELECTRODE

SENDING CIRCUIT AND DISPLAY

Ag : AgCl electrode

Platinum Wire

HCl

Mercurous chloride Mercury Saturated KCl SAMPLE CUVETTE pH sensitive glass Porous Plug

Measurement of Gases

GAS ANALYSIS CHEMICAL METHODS Absorption in chemicals using Haldane apparatus CO2 : 10 ± 20% KOH or NaOH O2 : Alkaline pyrogallol or sodium anthraquinone PHYSICAL METHODS :  Mass spectrometers  Infra-red absorption  Polarography  Galvanic fuel cell  Ultra violet absorption  Paramagnetism  Thermal conductivity

Spectrophotometry 

first used to determine the [Hb] the 1930's, by application of the Lambert-Beer Law Lambert-

ITrans = ISource x
Ii It D C w = = = = =

- DCE e

the incident light the transmitted light the distance through the medium the concentration of the solute the extinction coefficient of the solute

Spectrophotometry   

the extinction coefficient is specific for a given solute at a given wavelength of light therefore, for each wavelength of light used an independent Lambert-Beer Lambertequation can be written if the number of equations = the number of solutes, then the concentration for each one can be solved

Spectrophotometry  

by convention oxyhaemoglobin concentration, HbO2 is the fractional concentration as measured by cooximetry a 4 wavelength device, and includes COHb and MetHb in the denominator
%HbO2 = 100 [ HbO2 ] Hb + HbO2 + COHb + Met Hb

ULTRA-VIOLET ABSORPTION



Halogenated vapours absorb uv light

 used for measuring halothane  Disadvantage : Slow response time produce toxic product

THERMAL CONDUCTIVITY (KATHAROMETERS)
1. High thermal conductivity gas - more rapid heat conduction eg. Helium 600% CO2 35% compared with air 2. Gas passed over heated wire which cools. 3. Decreased wire temperature ± depends on flow rate and thermal conductivity of gas. 4. Temperature leads to wire resistance

5. Advantages : Simple and inexpensive 6. Disadvantage : Slow response time ( ~ 5s)

Measurement: Methods 

Mass spectrometry Raman spectrography PhotoPhoto-acoustic spectrography InfraInfra-red spectrography   

RAMAN LIGHT SCATTERING

1. Photon of light passes thro¶ gas 2. Photon energy partly given to gas molecule 3. Light is re-emitted at longer wavelength characteristic to gas.

Measurement: Raman Spectrography 

Raman scattering occurs with illumination with high intensity argon laser light absorbed light energy produces unstable energy states (rotational & vibration) emitted low energy light, Raman light   

measured at 90° to the laser path 90° 

can be used to identify all types of molecules in the gas sample, and has been incorporated into new monitors (RASCAL) which instantaneously identify & quantify CO2 and inhalational agents

Measurement: Photo-acoustic spect. 

relies on the absorbance of IR light by CO2 

p gas expansion  

IR light is pulsed at acoustic frequencies and the energy absorbed is detected by a microphone amount of light absorbed is measured directly
without the need for a reference chamber  pno zero point drift pno other claimed advantages over IR spectrometry,  higher accuracy  increased reliability  reduced maintenance & reduced need for calibration  

MASS SPECTROMETER
PRINCIPLE : 1. Gas passed into ionizing chamber 2. Electron beam ionizes gas 3. Ions diffuse thro¶ slit in chambers 4. Negatively charge plate accelerate ions 5. Different particles streams separate according to mass & charge. 6. Detector plate

MASS SPECTROMETER

Detector Magnetic field Low charge / mass ratio Deflection Angle

GAS

High charge / mass ratio Accelerator Potential On screen electrode

MASS SPECTROMETER

ADVANTAGES 1. Rapid response time ( < 0.1s) 2. Can measure variety of gases (May be affected by water vapour) DISADVANTAGES 1. Complex 2. Expensive

Capnometry 

capnometry is the measurement and display of CO2 concentrations on a digital or analogue display capnography is the graphic recording of instantaneous respired CO2 concentrations during the respiratory cycle 

Capnometry    

first IR CO2 measuring and recording apparatus was introduced by Luft in 1943 expensive, bulky and principally only used for research widespread use within the last 10-15 years with 10cost and size reduction ASA closed claims p 93% of anaesthetic mishaps preventable by ETCO2 / SpO2

INFRA-RED ABSORPTION
PRINCIPLE : 1. Molecule composed of 2 or more dissimilar atoms absorb infra red light. 2. Absorption of 2.5 - 25 Qm cause covalent bonds to bend and vibrate; increasing rotational speed. 3. Different gas molecules absorb specific light. of infra red

4. Detecting increased absorption allows their concentrations to be determined

Measurement: IR Spectroscopy 
 

LambertLambert-Beer law applies, (cf. Hb) more compact and less expensive assymetric, polyatomic gases of two or more molecules, absorb IR radiation (> 1.0 µm) 

pH pH2O, N2O, CO2 CO2 ~ 4.28 µm 

absorbance peak is characteristic for a gas 

Measurement: IR Spectroscopy
 

chamber windows must be made of a crystal sodium chloride or sodium bromide 

calibration may be achieved by filling the chamber with a CO2 free gas, or by splitting the incident beam and passing this through a reference chamber

Measurement: IR Spectroscopy 

the use of a reference beam also allows for compensation for variations in the output of the IR source the sample chamber is made small, so that continuous analysis is possible the response time ~ 100 ms   

enabling end-tidal CO2 estimations and real-time endrealgraphical analysis

INFRA-RED GAS ANALYSER (SPECTROPHOTOMETER)

1. LED split infra-red into different

.

2. Sample chamber is transilluminated and IR absorption measured. 3. Reference chamber transilluminated & absorption allows calibration. 4. IR absorption in sample chamber compared with reference chamber.

INFRA-RED SPECTROPHOTOMETER
Chopper Light splitter REFERENCE Known CO2 Detector

SAMPLE CELL

ADVANTAGES : Fast response for CO2 N2O and volatile anaesthetic agent DISADVANTAGES : Rapid respiratory rates decrease accuracy

ETCO2 : Classification 1 

sideside-stream
sensor is located within the main unit and gas is aspirated from the circuit  sampling flow rate may be high > 400 ml/min, or low < 400 ml/min  optimal gas flow is considered to be 50-200 ml/min, 50ensuring reliability with both adults and children  exhaust gases contain anaesthetic agents & should be routed to the scavenging unit 

ETCO2 : Classification 2 

mainstream 

sensor is located at the patient, with a curvette placed within the circuit these are heated to > 39° to prevent occlusion by water 39° vapour no mixing of gases occurs during sampling and the response time is more rapid curvettes tend to be bulky, add dead space, are heated, and are expensive if dropped & broken   

ETCO2 : Sources of Error 
  

Atmospheric pressure differences N2O H2O Others
O2  alinearity  volatile agents 

ETCO2 : PAtm 

direct effects 

o gas density
for a given chamber thickness, no. of molecules increases eliminated by calibration against a known PCO2 (% x Atm.) units calibrated against CCO2 require correction (1%:1%) 

o IR absorbance
o intermolecular forces ® - IR absorbance for a given [CO2] o PAtm ~ 1% po absorbance ~ 0.5-0.8% 0.5-

ETCO2 : PAtm 

direct effects (continued) 

o sampling flow rate may reduce sample chamber pressure
units should be calibrated for a given sample rate 

PEEP may o PCO2 reading (some unit compensate automatically)
PEEP ~ 20 cmH2O p o PCO2 ~ 1.5 mmHg

ETCO2 : PAtm 

indirect effect : volume percent, percent, where PCO2 = FCO2 x Atm. 

where PAtm at calibration is different to the time of measurement

ETCO2 : N2O 

absorbs IR at 4.5 µm 

(cf. CO2 ~ 4.28 µm)

@ N2O pfalsely elevated CO2 readings pfalsely  effect minimised by a narrow bandwidth filter 

however, presence of N2O molecules results in collision broadening of the absorbance peak of CO2 

resulting in apparently elevated CO2 readings

ETCO2 : N2O 

simplest correction is to calibrate the monitor with the same background gas as is to be used during anaesthesia alternatively correction factors may be applied,
50% N2O  70% N2O  

p p

P'CO2 ~ PCO2 x 0.9 P'CO2 ~ PCO2 x 0.94

ETCO2 : H2O 

condensed water 

result in falsely high readings prevented in mainstream units by heating the sensor sideside-stream units use water traps some units use semipermeable Nafion® tubing   

ETCO2 : H2O 

water vapour 


mainstream analysers measure breathing circuit gas generally saturated at body T. but may be affected by the use of humidifiers, FGF's, and the ambient T. 

sideside-stream units, cooling of the gases results in
q water vapour pressure, and apparent increase in PCO2 ~ 1.5-2% 1.5-

ETCO2 

transit time 
  

creating a phase shift, but no distortion shift, gas is subject to mixing with overdamping of a square waveform results in underestimation of ETCO2, especially in children this error increases both with, increased width and length of the sample tubing reduced sample flow rates < 50 ml/min higher frequency breathing patterns

ETCO2 

rise time T10-90 timeT10

time to change from 10% to 90% of the final value depends on size of the sample chamber and flow rate capnographs used clinically ~ 50-600 msec 50prolongation may decrease the slope of phase II, and underestimation of anatomical dead space    

ETCO2 in adults at < 30 bpm with ± 5% accuracy faster units are required in children, T70 < 80 msec 

ETCO2 

rise time 

T10-90 (continued) 10-

response times have been markedly reduced by, more powerful signal amplifiers minimising the volume of the sample chamber use of relatively high sample flow rates > 150 ml/min

ETCO2 : Other Factors 

oxygen 


O2 does not directly absorb IR light may affect reading by collision broadening results in falsely low PCO2 readings not as great as with N2O (some units incorporate correction)

ETCO2 : Other Factors 

halogenated agents 


absorb IR light at ~ 3.3 µm interference is not clinically significant 

alinearity of CO2 analysis 

the concentration of the calibration gas should be as close as possible to the measured gas sample

Severinghaus CO2 Electrode 

Severinghaus developed the CO2 electrode in 1958 

modern arterial blood gas analysis was born 



Essentially a modified pH electrode provides a direct measure of PCO2 from the change in pH

Severinghaus CO2 Electrode 

circuit consists of, 
  

a closed cylinder of pH sensitive glass in the centre 2 electrodes, 1 inside, the other outside the cylinder a surrounding solution of sodium bicarbonate a thin film of bicarbonate impregnated nylon mesh covering the end of the cylinder a thin, CO2 permeable membrane covering the end of the electrode 

Severinghaus CO2 Electrode

Severinghaus CO2 Electrode 

CO2 diffuses from the blood sample through the membrane into the nylon mesh and by the formation of carbonic acid lowers the pH of the bicarbonate solution the change in pH alters the dV across the glass, such that, HpH ~ Hlog10
CO2 

CO2 Electrode 
  

output of voltmeter calibrated in terms of PCO2 electrode accuracy ~ 1 mmHg response time ~ 2-3 mins 2as for the pH electrode, the CO2 electrode kept at 37°C and regularly calibrated with known 37° concentrations of CO2

Measurement of OXYGEN

OXYGEN MEASUREMENT ELECTROCHEMICAL METHODS
 Based on electrochemical reaction in buffer solution occurring between 2 electrodes, involving gas molecules.

 2 Devices (a) Polarographic electrode (b) Fuel cell.

Measurement of Oxygen 

Leyland Clarke developed the polarographic oxygen electrode in 1956 

prior to this the PO2 had not been measured

Other Methods 

PO2 may also be measured by,
Volumetric - van Slyke/Neill  Clarke electrode  Fuel cell  Paramagnetic  Hummel Cell - paramagnetic  Optode - photoluminescence quenching  Raman scattering  Mass spectrometer 

PARAMAGNETISM

 Paramagnetic : attracted toward magnetic field eg. oxygen  Diamagnetic : repelled by magnetic field eg. nitrogen

 Paramagnetic molecules = 2 unpaired electrons in outer electron shell spinning in the same direction.

PAULING TYPE OF PARAMAGNETIC OXYGEN ANALYSER
MAGNET POLE

MAGNET POLE
Gas O2 Nitrogen In Glass Dumb-Bell

MAGNET POLE
Light beam Slow response ( 5 ± 20 s) Detector

RAPID PARAMAGNETIC O2 ANALYSERS
Sample Differential Pressure transducer Reference Gas

Made more compact Rapid response time Gas Mixture out

Magnetic field

POLAROGRAPHIC ELECTRODE

PRINCIPLE  1 pair of electrodes in electrolyte solution  Electrodes maintained at potential difference  Current through electrolyte solution dependent on gas concentration in solution  Reaction driven by voltage applied to electrodes

CLARKE OXYGEN ELECTRODE
 Cathode

- Platinum covered by permeable membrane - Silver/Silver chloride covered by membrane

 Anode

 Electrolyte Solution - KCl  Electrodes connected to DC voltage 0.6V  Electrons produced by Ag / AgCl anode migrate to cathode to reduce O2 molecules.

Clarke Electrode 

the circuit consists of, 
    

DC voltage source (0.6 V) ammeter platinum cathode silver/silver chloride anode electrolyte solution (KCl), and O2-permeable membrane

Clarke Electrode

Clarke Electrode  

Ohm¶s Law: for any resistive I w V circuit: for the Clarke electrode there is a plateau voltage range 
 

I does not change with o V however: oI w oPO2 this occurs as the cathode reaction requires both O2 and free electrons

Clarke Oxygen Electrodes (Cont¶d)
 Platinum Cathode (reduction) 

- O2 + 4e 2 O + 2 H 2O

2O 4 OH

reaction at the platinum cathode, O2 + 2H2O + 4ep

4OH-

At Ag / AgCl Anode (oxidation) : 4 Ag 4 Ag+ + 4e-

Current flow between both electrodes measured

Clarke Electrode  

current flow being in direct proportion to the consumption of oxygen the platinum electrode cannot be inserted directly into the blood stream as protein deposits form an affect its accuracy

CLARKE ELECTRODES

: Robust Portable

Disadvantages : Limited life span Silver anode eventually used up by current

FUEL CELL
Cathode Silver - reduces O2 molecules in solution. Anode : Lead : 2Pb + 40H 2Pbo +2H2O + 4eElectrolyte : potassium bicarbonate
No polarising current required Lead Anode M Potassium Bicarbonate Solution Silver Cathode O2 + 4e + 2H2O 4OHSAMPLE

:

FUEL CELL

Advantages : Compact No power supply required Unaffected by N2O Disadvantage : Slow response time life-span 6-12 months

OPTODES - PRINCIPLE
1. Oxygen has the property of ³quenching´ fluorescence of certain dyes. 2. Dyes exposed to light ± electrons excited and release photons when they return to their original state (fluorescence). 3. Oxygen absorbs energy from excited electrons electrons return to original state without releasing photon 4. Absorption of light and reduction in light emitted is proportional to PO2

OPTODE - MECHANISM

 Optical fibre with dye coated tip  O2 permeable membrane cover  Sequential illumination of fibre causes dye to fluorescence  Intensity of fluorescence depends on oxygen concentration at tip  Fluorescence measured by photo multiplication.

OPTODE : Uses
 Intravascular PO2 monitoring

 Advantages : Independent of blood flow Stable Rapid response times  Disadvantage : expensive Dye deteriorate with time Fibrin deposition

Oximetry   

Kramer optically measured the O2 in animals in the early 1930's Karl Matthes in 1936 was the first to measure O2 from bluetransmission of red and blue-green light through the human ear the term oximeter was coined by Millikan et al. in the 1940's al.  they developed a lightweight oximeter, a smaller version of Matthes' design, which measured SaO2 by transillumination of the earlobe using red & green filters covering Kramer's barrier layer photocells

Oximetry 

the signal detected from the photocell under the green filter later proved to be in the IR range there were two technical problems with this approach,  

there are many non-Hb light absorbers in tissue nonthe tissues contain capillary & venous blood in addition to arterial blood 

TRANSMISSION OXIMETRY

Based on absorbance laws Blood consists of a mixture of Oxyhaemoglobin and Deoxyhaemoglobin

ABSORBANCE CURVES FOR HbO2 AND Hb

RED

INFRARED

ISOBESTIC WAVELENGTH

Absorbance

OXY Hb

DEOXY Hb

660

805

940

wavelength

ABSORBANCE CURVES Secondary Peaks of Absorbance 660 nm - Deoxyhaemoglobin 940 nm - Oxyhaemoglobin 805 nm - Isobestic point defined as point at which absorbances of HbO2 and Hb are equal. Depends on haemoglobin concentration

CO - OXIMETER     Measures Oxygen saturation Based on absorbance curves Requires haemolysis of blood sample before ³sats´ measurement 2 types Reflectance Transmission

Measure at 4 wavelength to enable measurement of metHb and HbCO

CO-OXIMETER

ADVANTAGES : Light absorbance measured at several wavelength enables fraction estimation. DISADVANTAGES : Cannot provide continuous monitoring Expensive cost and maintenance

PULSE OXIMETRY

Pulse Oximetry 

early 1970's, Japanese engineer Takuo Aoyagi working on a dye dilution method for CO, using an earpiece densitometer noted that the pulsatile components of the red & IR absorbances were related to SaO2 prototype, built by Nihon Khoden, was tested clinically in 1973 and the first commercial prototype available in 1974 further refinements were required and widespread use did not eventuate until the early 1980's   

Pulse Oximetry  

the signal detected from the photocell under the green filter later proved to be in the IR range there were two technical problems with this approach,
there are many non-Hb light absorbers in tissue non the tissues contain capillary & venous blood in addition to arterial blood 

Pulse Oximetry   

these were overcome by first measuring the absorbance of the ear while it was compressed to remove all blood after this bloodless "baseline" measurement the ear was heated to "arterialise" the blood this device was shown to accurately predict intraoperative desaturations, however, due to the technical difficulties was never adopted on mass

Nomenclature 

SaO2 = 100.(O2 content)/(O2 capacity) 
 

arterial blood saturation measured in vitro O2 capacity the amount of O2 which can combine with reduced Hb, without removing COHb or MetHb thus, at high PaO2 the SaO2 = 100% irrespective of the [COHb + MetHb] multiwavelength spectrometers measure all species SaO2 computed from PO2 and pH approximates SaO2, not HbO2 

HbO2= oxyhaemoglobin concentration 
 

SpO2 = pulse oximeter saturation

Methodology 

2 wavelengths of light,
red = 660 nm IR = 910-940 nm 910- 

the signal is divided into two components,
ac = pulsatile arterial blood dc = non-pulsatile arterial blood non+ tissue + capillary blood + venous blood 

NB: all pulse oximeters assume that only the pulsatile absorbance is arterial blood

AC AND DC SIGNALS RECEIVED BY PULSE OXIMETER

AC

Variable absorption due to pulsatile arterial blood

Absorption due to arterial blood

VENOUS BLOOD
DC

Absorption due to venous blood

TISSUE

Tissue absorption

Methodology 

for each wavelength, the oximeter determines the ac/dc fraction 

independent of the incident light intensity = pulse added absorbance R = (ac absorbance/dc absorbance)Red (ac absorbance/dc absorbance)IR = A660nm / A940nm 

the ratio (R) of these is calculated, 

R and SpO2 

this value varies from, 

SaO2 = 100% SaO2 = 85% SaO2 = 0%

R = 0.4 R = 1.0 R = 3.4

(0.3)  

R and SpO2

Methodology  

the photo-detector diodes of the sensor will also photoregister ambient light interference is reduced by cycling the light
red only p infrared only p both off  repeated at 480-1000 Hz in an attempt to subtract the 480ambient light signal, even when this is oscillating   

this allows accurate estimation of SpO2 at arterial pulse frequencies ~ 0.5-4 Hz (30-240 bpm) 0.5(30data is averaged over several cycles

Uses: Oxygenation
anaesthesia & recovery  intensive care  emergency care & transport  labour  premature & newborn infants  home & hospital monitoring for SIDS  patients in remote locations eg XRay, MRI  "office" procedures eg. dentistry, endoscopy 

Uses: Circulation
systolic BP & pleth waveform appearance inflation better than deflation  sympathetic blockade with central neuraxis anaesthesia  autonomic dysfunction with valsalva manoeuvre  anecdotally reported uses patency of the ductus arteriosus level of ischaemia in PVD patency of arterial grafts circulation in reimplanted digits or grafts 

Uses: Therapy 
  

optimise FIO2 in ventilated patients optimise CPAP or PEEP extubation of ventilated patients adjust O2 therapy in preterm infants 

no consensus on optimal levels 

optimisation of home O2 therapy

Signal:Noise 

Freund et al. 1.12% failure 

cumulative > 30 mins in 11,046 anaesthetics 2 x 15 mins in 1,403 anaesthetics 

Gilles et al. found a 1.1% incidence  

automatic gain controls
amplification of low signal strengths p low signal to noise ratio  most new meters give "low signal strength" warnings once the ac component falls below an arbitrary fraction of the total transmitted light (0.2% for the Biox-Ohmeda) Biox

Low S:N Causes 
       

low perfusion pressure motion artefact ambient light skin pigments & dyes probe position p the "penumbra effect"

Ventilation - a large paradox may lead to searching venous pressure waves - TI, reflectance operation electrocautery - most unit are now immune

MRI interference - rare, usually lead distorts MRI image

Ultrasound and anaesthesia

ULTRASOUND

 Sound = disturbance propagating in material (Air, water, tissue or solid)  Characterized by frequency and intensity.  Frequency measured in hertz  ULTRASOUND = sounds waves > 20 KHz Cannot be perceived by human ear.

WAVELENGTH OF SOUND

 Sound Wavelength = Velocity frequency  Shorter wavelength higher resolution less penetration

 Compromise between penetration and resolution required.

SOUND PRODUCTION



Ultra-sound probe = Transducer containing an array of piezo-electric crystals. Electrical voltage applied to crystals causes piezoelectric crystals to oscillate at resonant frequency. Electrical energy - converted to sound energy.





ELECTRICAL ENERGY

Electrical Energy

Piezo ± electric crystals oscillate Electrical energy

Sound

ULTRASOUND PROPAGATION
In homogenous tissues : ultrasound is absorbed Absorption ± least in fluids greatest in solid tissues Absorbed energy converted to heat (small) Amount of heat dissipated hence useless

ULTRASOUND PROPAGATION

In heterogenous tissues :  Ultrasound strikes interfaces  Wave is either a) refracted - transmitted ± thro¶ interface b) reflected - depends on smooth (specular) or non-smooth surfaces.  Bone and calcium more reflective

PULSED SOUND WAVES

 Used to prevent transmitted and reflected sound waves.  Pulse repetition frequency = 10 ± 20 Hz  Longer path sound wave travels - lower is PRF

PULSES OF ULTRASOUND

Usually 2.5 to 7.5 MHz Frequency resolution penetration

ULTRASOUND REFLECTION

Incident

Reflected Wave

Incident Wave ³Scattering´ of Ultrasound

Surface

REFLECTED ULTRASOUND (ECHO)

Two quantities measured : (a) Time delay between sound transmission and reception of reflected echo. (b) Intensity of reflected signal High echo reflection - white Less reflection - grey No reflection - Black

A - MODE (AMPLITUDE)
Brief ultrasound pulses in one direction. Reflected ultrasound amplitude plotted Against time
Peaks = reflective interface Amplitude

Time (distance) Time & distance from probe

B - MODE (BRIGHTNESS)

Brief ultrasound pulse in one direction Reflected ultrasound measured Amplitude = Brightness of reflected ultrasound

M ± MODE (MOTION)

 Repeated B-Mode pulses graphed against time base.  > 1000 pulses per second  Good resolution  Provides one-dimension image against time.  useful for value motion

2-D ULTRASOUND

 Multiple crystals (linear or phased array) or moving crystals  Sequential B-mode pulses across 90o  Single image displayed  Real time movement

DOPPLER PRINCIPLE



Frequency of transmitted sound from a moving object alters depending on velocity and direction of object.



Change in frequency proportional to a) ultrasound frequency b) Cosine of angle between ultrasound beam direction and moving object.

DOPPLER SIGNAL



Maximal signal when sound moves towards probe ± higher pitch (frequency). Lower pitch when sound moves away from probe. Pitch change is due to compression and rarefaction of sound waves.

 

USES OF DOPPLER
 Examine direction and velocity of blood flow in vessels and heart Estimate velocities and therefore measure pressure gradients, using Bernoulli equation P = 4V2  Types of Doppler used ; a) Pulse wave b) Continuous Doppler



PULSED-WAVE DOPPLER
  Depends on Doppler shift Doppler shift frequency of reflected waves which depends on velocity or reflected wave. Used to measure velocity of red blood cells V = FDC 2fo Cos Q V = Velocity of red blood cells FD = Doppler shift Fo = Ultrasound frequency Q = angle between flow and sound wave.



PULSED-WAVE DOPPLER - Limitations -



Large angles - results inaccurate



High velocity flows > 0.6m/s cannot be accurately

measured by intermittent pulses (causes ³aliasing´)

CONTINUOUS WAVE DOPPLER

Separate crystals - emit & receive ultrasound continuously along 1 axis Frequency Spectrum & velocity of interfaces Graph of Velocity range vs time plotted

CONTINUOUS WAVE DOPPLER

Disadvantages : Small incident angle required

COLOURED DOPPLER

Pulsed wave used on 2 D scan Velocity depicted as colour Advantage : Easy visualisation Disadvantage : high velocity ± colour reversal rapid turbulent flow produce colour ³jets´

TOE PROBE

Phase array 2 D probe 64 piezo-electric crystals Mounted on gastroscope (9mm) Can be monoplane biplane (2 array) multiplane (rotating array)

CLINICAL APPLICATIONS OF ULTRASOUND
1. Examination of structure Brain Neck Chest - pleural fluid Obstetrics Abdominal structures Blood vessels 2. Interventional Procedures Guide placement of needles

CLINICAL APPLICATIONS - DOPPLER

1. Sense blood flow in blood vessels e.g. Thrombo-embolism Thrombosis

2. Measurement of blood pressure a) sense onset of blood flow b) sense movement of arterial wall

CLINICAL APPLICATIONS ±DOPPLER (CONT¶D)
3. Cardiac output measurement a) mean velocity b) cross-sectional area of aorta or left ventricular outflow tract. 4. Fetal Heart movements and heart rate 5. Valve functional, Myocardial wall movement 6. Transcranial Doppler - Velocity of blood flow in cerebral vessels.