An Overview . . .
• Measurement of blood pressure • Cardiac output • Cardiac rate • Heart sound • Respiratory rate • Gas volume • Flow rate of Co2, o2 in exhaust air • pH of blood, • ESR, GSR measurements • Plethysmography.

Cardiac Output
• It is the amount of blood delivered by the heart to the aorta per minute • For normal adults it is 4 -6 litres / minute Any decrease may be due to • Low Blood Pressure • Reduced Tissue Oxygenation • Poor Renal Function • Shock • Acidosis Methods of cardiac output measurements • Fick’s Method • Indicator Dilution Method • Measurement of Cardiac Output by Impedance Change

Fick’s Method : • Based on analysis of gas - keeping of the organism • Cardiac output can be calculated by continuously infusing oxygen into the blood or removing it from the blood and measuring the amount of oxygen in the blood before and after its passage

Fick’s Method for Cardiac Output Measurement Oxygen uptake by Ventilation Heart Catheter Q2 Vena Cava Aorta Q Heart and Lungs Mixed Venous Blood Arterial Blood .

Volume of oxygen uptake by ventilation in millilitres of blood .• • Let I be the amount of infused or removed oxygen per unit time It is equal to the difference between the amounts in the blood arriving at and departing from the site of measurement I = CAQ – CVQ Q= I CA – CV where Q – cardiac output in litres / minute CA .Concentration of oxygen in the mixed venous blood in millilitres of oxygen per litre of blood I .Concentration of oxygen in the arterial blood in millilitres of oxygen per litre of blood CV .

lungs and the left heart. the indicator appears in the arterial circulation • The presence of the indicator in the peripheral artery is detected by a detector • The output of the detector is directly proportional to the concentration of the indicator .Indicator Dilution Method Principle • A known amount of dye or radioisotope is introduced as an indicator in the blood circulation • The concentration of the indicator is measured with respect to time and the volume of blood flow is estimated • Let M mg of an indicator be injected into a large vein or preferably into the right heart itself • After passing through the right heart.

t M = 0 Q c dt . c = dv dt Now But Therefore dM = c dV dt dt dV dt dM = Q = Q c dt Integrating over the time of the experiment.Let an increment volume dV pass through the sampling site in time dt Let the mass of the indicator in dV = dM herefore the concentration of the indicator.

the area of the curve gives directly the value of the denominator in the above equation Thus Q = M Area of the curve .Considering the flow as constant. t M Q = = Q 0 c dt M (or) t 0 c dt Here concentration of the indicator ‘c’ is a function of time By drawing a curve between concentration and time.

Block Diagram of the Thermo Dilution System Timer/Control Linearity Amplifier Thermistor for Blood Temperature Integrator Linearising Amplifier Microcomputer . Cardiac Output Display Thermistor for Thermoindicator Temperature Preset Adjustment Control . .

a meter reads the cardiac output .• A bolus of about 10 millilitres of 5% Dextrose in water at room temperature is injected as a thermal indicator into the right atrium • After mixing it is detected in the pulmonary artery by means of a thermistor mounted at the tip of a miniature catheter probe • The temperature difference between the injectate temperature and the circulating temperature in the pulmonary artery is measured • The reduction in temperature is integrated with respect to time • After applying proper corrections.

Cardiac Output Measurement by Impedance Method Potential Electrodes Oscillator f = 100kHz A1 A2 d S Current Electrodes Amplifier and Demodulator Differentiator z .

• Electrodes 1 and 4 are used as current electrodes • Electrodes 2 and 3 are used to pick up the voltage across the thorax If p .resistivity of the patient’s haematocrit A .separation between the potential electrode 2 and 3 pL2 pL2 pL = = R= Then the resistance of the thorax is given by AL V A (or) V = pL2 R (V – volume of the thorax) .cross – sectional area of the thorax L .

excitation is used.c.During ejection of stroke volume. the change in volume is dV and the corresponding decreasing in resistances is dR Differentiating the above expression.pL2 R 2 dR Since a. dV = . R should be replaced by impedance Z Therefore dV = .pL2 Z 2 dZ Taking dZ = t dZ dt max .

pL2 Z 2 t. dZ dt max . dZ dt max corresponds to the peak negative value of (dZ/dt) found during systole and t corresponds to the interval between (dZ/dt) = 0 and the second heart sound Thus dV = .where.

• The voltage signal due to changes in impedance is amplified and demodulated to obtain impedance ‘Z’ of the thorax • The value of (dZ/dt) is calculated using a differentiator and its output is recorded on a recorder • From that (dZ/dt)max can be noted • By determining dV. the cardiac output can be measured by multiplying dV with heart rate per minute .

Spirometer Linkage o L VOL h kR R VBB + r VOUT Patient air into Bellows . .

Spirometer • • • • Used for respiratory volume measurements All lung volumes and capacities can be measured Consists of light weight bellows These bellows are mechanically articulated to a biased potentiometer such that the wiper voltage is proportional to volume of the bellows • The maximum volume of the bellows is given by VOLmax = L(Pi)r2 • If k is the proportionality constant giving the fractional position of the wiper arm on the potentiometer ‘R’ such that k = Vout = VOL VBB VOLmax Therefore VOL = Vout (VOLmax) VBB • Better Linearity can be obtained in measuring respiratory volumes .

based on paramagnetic behaviour of oxygen • Thermal Conductivity Gas Analyser – based on thermal conductivity of carbon dioxide .Gas Analysers Used to • Determine the quantitative composition of inspired and expired gas • Assess the lung function Types • Infrared Gas Analyser – based on infrared absorption of carbon dioxide • Paramagnetic Oxygen Analyser .

Block Diagram of Infrared CO2 Analyzer Mirror Infra – red Source o Mirror Sample Tube Motor Reference Tube Sample Cell Detector Unit Diaphragm Amplifier Panel Meter Recorder .

the beam falls on the balanced condenser microphone detector after passing the gas • The sample beam falling on the detector will be weaker than the reference beam since there is absorption in the sample cell by the component of interest • The heating of the gas in the detector situated in the reference beam side will cause rise in pressure • • • The diaphragm vibrates at the chopping frequency The diaphragm forms one half of the capacitor Thus. the change in position of the diaphragm produces a periodic change in the capacity of the capacitor • This change is amplified and demodulated and the output is displayed on a meter or a recorder in terms of concentration of the wanted component .• • By means of mirror assembly two infrared beams with same intensity are produced A high speed rotating chopping disc is present which occludes each beam twice per motion • • The chopped lights pass through the reference and sample tubes When the opaque portions of the choppers are not in the way.

Simplified Block Diagram of Oxygen Analyzer SCALE MIRROR o N DUMB CELL S O2 .

displacing the diamagnetic dumb – shell • The resulting rotation of the suspension turns a small mirror and deflects a small beam of light over a scale calibrated in percentages by volume of oxygen or partial pressure of . the oxygen molecules experience a force.• There is a small glass dumb – cell shaped assembly containing a weakly diamagnetic gas such as nitrogen • It is suspended from a platinum – iridium thread between the poles of a powerful permanent magnet • The pole pieces are wedge shaped in order to produce a non linear field • If the gas surrounding the dumb – shell is also nitrogen there will be no force acting on the dumb – shell • If oxygen is added to the gas.

Hot Wire Cell Thermal Conductivity Analyzer Reference Gas Flow S1 Sample Gas Flow R1 uA S2 R 2 A .

the temperature of the filaments in those cells are changed • If the thermal conductivity of the sample gas is more. then cooling of the filaments takes place • This changes the resistances of the filaments • The bridge becomes unbalanced and a current flows through the meter .• There are four platinum filaments as heat sensing elements • Each of these is placed in a brass black • These are maintained at constant temperature and form the four arms of a bridge • Two filaments R1 and R2 act as reference gas arms • S1 and S2 act as sample gas arms • Initially reference gas is made to flow through all the filament cells and the bridge is balanced • When the sample gas flows through the sample gas filament cells.

VOUT Digital Voltmeter Buffer Solution Glass Membrane VOUT = Er – EIN .Digital pH Meter -Er ( From Reference ) + EIN ( From Solution ) Reference Electrode Electrical Conductor o YT -10 mV / oC From Temperature Sensor + + .YT Analyzed Solution .

• Used to measure pH at a given temperature and also at different temperature • Consists of a glass electrode terminal and reference terminal • The calomel or silver – silver chloride in potassium chloride electrolyte acts as the reference terminal • A salt bridge consisting of a fiber wick saturated with KCl is at the tip of the reference electrode • This keeps the reference terminal potential the same regardless of the solution under test • The active terminal is sealed with common glass except for the tip • The tip is made of sensitive glass consisting of hydrated gelatinous glass layer • Its membrane potential is proportional to the pH of the solution under test .

a voltage from the temperature regulator circuit corresponding to a given temperature is also added with the output from pH electrode • The operational amplifiers amplify these voltages in the required manner • The final output is given to a digital voltmeter • In the digital voltmeter the display is obtained in terms of pH as discrete numerals .• The electronic circuitry is adopted to increase the sensitivity and accuracy • It consists of an external reference voltage to compensate the various errors • To determine the pH at different temperatures .

Plethysmography • Used to measure the volume changes in any part of the body that result from the pulsations of blood occurring with each heart beat • • Used to measure Total Lung Capacity (TLC) Consists of a rigid cup or chamber placed over any part of the body in which the volume changes are to be measured • • The cup is tightly sealed The changes in the volume reflect the pressure changes of air inside the chamber • The pressure change is measured at constant volume or vice versa Types based on nature of sensor • • • • Capacitance Plethysmograph Impedance Plethysmograph Photoelectric Pltehysmograph Mercury Strain Gauge Plethysmograph .

P * (VOL) = k1T where k1 is a constant Since the patient is made to sit inside an air tight chamber whose .Measurement of Total Lung Capacity The principle operation is the Boyle’s Law which states that at a Kelvin Temperature. the pressure of a given mass of gas is inversely proportional to its volume i.e.

Partially Differentiating the above equation d (P VOL) = (PVOL) P dP + (PVOL) VOL dVOL (or) VOL dP + dP dVOL P dVOL P VOL = 0 = - Now the door of the air tight chamber is sealed with the patient inside and the valve on the mouthpiece is closed .

so the air pressure in the mouthpiece is equal to the lung pressure PT In the body. d TLC d PT = TLC PT where TLC = Thorax Volume PT = Thorax Pressure VOLC PC In the chamber. d (VOLC) d PC = - .The patient cannot breathe with the valve closed.

any increase in the thoracic volume causes a decrease in the chamber volume of air .e. PC = PT Therefore TLC = . i.d (TLC) VOLC PC d PT = - d PC Since the changes in pressure induced by breathing motions are small when the patient is sitting normally.VOLC d PC d PT .where VOLC = Chamber Volume PC = Chamber Pressure Since the chamber is closed. d (VOLC) TLC PT = .

TLC = VOLC d PC d PT . the TLC can be calculated using the formula.Procedure • First mouthpiece valve is closed when the patient is sitting inside the sealed chamber • Now the patient is asked to make breathing motions • The change in pressure reading in the pressure gauge 1 is noted down. this gives dPT • The change in pressure reading in the pressure gauge 1 is noted down. this gives dPC • Thus knowing the value of VOLC.

• For each heartbeat. which occurs near the beginning of the cardiac cycle when the ventricles are filled with blood. which occurs near the end of the cardiac cycle when the ventricles are contracting. BP varies between systolic and diastolic pressures. • Diastolic pressure is minimum pressure in the arteries. • Systolic pressure is peak pressure in the arteries. • A person's BP is usually expressed in terms of the systolic pressure .Blood Pressure • Blood pressure (BP) is a force exerted by circulating blood on the walls of blood vessels • The term blood pressure usually refers to the pressure measured at a person's upper arm.

Measurement • Noninvasive measurement • Palpation method • Auscultatory method • Oscillometric method • White-coat hypertension • Home monitoring • Invasive measurement .

Auscultatory method • • Uses a stethoscope and a sphygmomanometer Comprises an inflatable (Riva-Rocci) cuff placed around the upper armat roughly the same vertical height as the heart. the examiner slowly releases the pressure in the cuff • When blood just starts to flow in the artery. attached to a mercury or  aneroid manometer • The mercury manometer measures the height of a column of mercury giving an absolute result • A cuff of appropriate size is fitted smoothly and snugly. • • The pressure at which this sound is first heard is the systolic BP. then inflated manually by repeatedly squeezing a rubber bulb until the artery is completely occluded. the turbulent flow creates a "whooshing" or pounding (first Korotkoff sound). The cuff pressure is further released until no sound can be heard (fifth . • Listening with the stethoscope to the brachial artery at the elbow.

Auscultatory method aneroid sphygmomanometer with stethoscope Mercury manometer .

Invasive measurement • Arterial blood pressure (BP) is most accurately measured invasively through an arterial line.dorsalis pedis  or brachial) • The cannula must be connected to a sterile. fluid-filled system. anesthesiology. femoral. and a waveform (a graph of pressure against time) can be displayed • Regularly employed in human and veterinary  intensive care medicine. • Involves direct measurement of arterial pressure by placing a cannula needle in an artery (usually radial. and for research purposes . which is connected to an electronic pressure transducer • The advantage of this system is that pressure is constantly monitored beat-by-beat.

 mmHg < 60    and 60 – 80    or 81 – 89   or 90 – 99   or ≥ 100   . mmHg < 90  90 – 120 121 – 139 140 – 159 ≥ 160 diastolic.Classification of blood pressure for adults Category Hypotension Normal Prehypertension Stage 1 Hypertension Stage 2 Hypertension systolic.

there are two normal heart sounds often described as a lub and a dub (or dup). resulting in turbulence as blood flows through it. a variety of other sounds may be present including heart murmurs. which may occur inside or outside the heart. • Abnormal murmurs can be caused by stenosis restricting the opening of a heart valve.Heart sounds • The heart sounds are the noises (sound) generated by the beatingheart  and the resultant flow of blood through it. • In healthy adults. These are produced by the closing of the AV valves and semilunar valves  respectively • In addition to these normal sounds. • Abnormal murmurs may also occur with valvular insufficiency which allows backflow of blood when the incompetent valve closes with only partial . and gallop rhythms  • Heart murmurs are generated by turbulent flow of blood.adventitious sounds. that occur in sequence with each heart beat.

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