INTRODUCTION TO LABTUTOR

OBJECTIVE
To become familiar with the PowerLab hardware and the features in LabTutor by performing
simple recordings using a finger pulse transducer.

INSTRUMENTS
1. PowerLab and computer
2. Finger pulse transducer

PROCEDURES
LabTutor can be previewed from the students’ computer within the Rumpun Ilmu
Kesehatan’s network (Hotspot-UI). You can download the LabTutor client from
http://www.adinstruments.com/support/downloads/windows/labtutor-4-teaching-
suite. The software currently is only available for W indows OS and can only be
performed in Internet Explorer.

1. Prepare the PowerLab as instructed in the LabTutor experiment.

2. Follow the instructions written in the LabTutor experiment.
3. There are four exercises that you will complete during this Lab:
(1) Connecting a transducer. You will learn how to connect a simple finger pulse
transducer to the PowerLab.
(2) Recording a signal. Here you will record a signal and do some basic analysis of it.
(3) Annotating a record. You will learn how to add comments to a recording at specific
times.
(4) Analysis. In this exercise you will become familiar with some of the key analysis
features in LabTutor. These include:
(a) making measurements with the waveform cursor;
(b) using the marker and the waveform cursor;
(c) inserting your data into a table;
(d) overlaying your data.
4. You may do the analysis later after you have finished all of the experiment by logging in
to the LabTutor IP address within the Rumpun Ilmu Kesehatan’s network (Hotspot-UI).
5. Complete your lab report and submit it when you’re finished. Make sure that your work is
final as you cannot revise the report once it’s submitted.

BACKGROUND

ADInstruments provides hardware and software to acquire, store, and analyze data. Figure
ILT-1 shows a summary of this acquisition. First, the signal of interest (blood pressure, body
temperature, etc.) must be converted into an analog voltage. This is done by a transducer.
This voltage, whose amplitude usually varies continuously over time, is monitored by the
hardware, which can modify it by amplification and filtering, processes called ‘signal
conditioning’. Signal conditioning may also include zeroing, for example the removal of an
unwanted steady offset voltage from a transducer’s output. After signal conditioning, the
analog voltage is sampled at regular intervals and converted from analog to digital form
before transmission to the attached computer where it is displayed appropriately.


Figure ILT-1. A summary of data acquisition using a PowerLab system.

The PowerLab hardware unit

The basic hardware is a PowerLab unit, a recording instrument that measures electrical
signals, through the inputs on its front panel. It can also generate output signals. Added
hardware such as front-ends and pods can extend its capabilities. There are various
PowerLab models with different numbers of channels and other variations; some have front-
ends built in. The PowerLab 26T described here is one designed especially for the teaching
laboratory. This four-channel recording instrument has built-in front-ends called Bio
Amplifiers that allow optimal recording of biological signals. A built-in Isolated Stimulator
provides human-safe electrical stimuli that you will use in selected exercises.

Figure ILT-2. The PowerLab 26T.

In your experiments, you simply attach appropriate cables to connectors on the front of the
PowerLab, and measure the signals in LabTutor. The hardware is controlled through the
software, so there are no knobs or dials to fiddle with.

LabTutor software
LabTutor is a web-based software package designed specifically for laboratory teaching. It
controls the hardware sampling, and, in the LabTutor panel, displays the sampled and
digitized data points and reconstructs the original waveform by drawing lines between the
points. The display format resembles a traditional chart recorder, with the scrolling area of
the LabTutor panel acting as the paper.
Your digital data is stored for later retrieval. The software allows you to manipulate and
analyze the data very simply in a variety of ways.


Organization of LabTutor laboratories

Every LabTutor experiment is organized in basically the same way. From the master index
you will find a link to the index page of the assigned experiment which may already be pre-
loaded onto your computer.

Every experiment begins with an index page. On this page there is a brief introduction and a
link to background material that may already have been given to you by your instructor prior
to your laboratory. This page also includes a list of learning objectives. The subsequent
exercises allow you to accomplish the specified learning objectives. Each exercise includes
highlighted text with links to pop-up windows containing additional information, helpful tips,
and useful references to LabTutor features. Each exercise page contains a LabTutor panel
in which data is recorded.
Following each Exercise page is an Analysis page. Data that you recorded during the
exercise is available here for you to make measurements on and you complete any tables or
graphs that are required.
At the end of the experiment is the Report section. Any recordings that are required for your
report are reproduced here, along with the tables and graphs that you have completed. This
section also contains questions that you can answer by typing into the spaces provided.
Your instructor will advise you how to submit your completed lab report.

ECG AND HEART SOUNDS

OBJECTIVES
1. To record and analyze an ECG from a volunteer
2. To examine the relationship between the ECG and the characteristic sounds of the heart

INSTRUMENTS
1. PowerLab and computer
2. ECG limb leads and cables, electrolyte gel
3. Stethoscope

PROCEDURES
LabTutor can be previewed from the students’ computer within the Rumpun Ilmu
Kesehatan’s network (Hotspot-UI). You can download the LabTutor client from
http://www.adinstruments.com/support/downloads/windows/labtutor-4-teaching-
suite. The software currently is only available for W indows OS and can only be
performed in Internet Explorer.

1. Prepare the PowerLab as instructed in the LabTutor experiment.

2. Follow the instructions written in the LabTutor experiment.
3. There are two exercises that you will complete during this Lab:
(1) ECG in a resting volunteer. You will record the ECG, analyze the signal and
observe the effects of slight movement on the signal.
(2) ECG and phonocardiography. You record the heart sounds (phonocardiogram)
together with the ECG.
4. You may do the analysis later after you have finished all of the experiment by logging in
to the LabTutor IP address within the Rumpun Ilmu Kesehatan’s network (Hotspot-UI).
5. Complete your lab report and submit it when you’re finished. Make sure that your work is
final as you cannot revise the report once it’s submitted.

BACKGROUND

The heart is a dual pump that circulates blood around the body and through the lungs. Blood
enters the atrial chambers of the heart at a low pressure and leaves the ventricles at a
higher pressure. The high arterial pressure provides the energy to force blood through the
circulatory system. Figure EHS-1 shows a schematic of the organization of the human heart
and the circulatory system.


Figure EHS-1. A schematic diagram of the human heart and circulatory system.

Blood returning from the body arrives at the right side of the heart and is pumped through
the lungs. Oxygen is picked up and carbon dioxide is released. This oxygenated blood then
arrives at the left side of the heart, from where it is pumped back to the body.

The electrical activity of the heart

Cardiac contractions are not dependent upon a nerve supply. However, innervation by the
parasympathetic (vagus) and sympathetic nerves does modify the basic cardiac rhythm.
Thus the central nervous system can affect this rhythm. The best known example of this is
so-called sinus arrhythmia where respiratory activity affects the heart rate.
A group of specialized muscle cells, the sinoatrial, or sinuatrial (SA) node acts as the
pacemaker for the heart (Figure EHS-2). These cells rhythmically produce action potentials
that spread through the muscle fibers of the atria. The resulting contraction pushes blood
into the ventricles. The only electrical connection between the atria and the ventricles is via
the atrioventricular (AV) node. The action potential spreads slowly through the AV node, thus
allowing atrial contraction to contribute to ventricular filling, and then rapidly through the AV
bundle and Purkinje fibers to excite both ventricles.


Figure EHS-2. Components of the human heart involved in conduction.

The cardiac cycle involves a sequential contraction of the atria and the ventricles. The
combined electrical activity of the different myocardial cells produces electrical currents that
spread through the body fluids. These currents are large enough to be detected by recording
electrodes placed on the skin (Figure EHS-3).

Figure EHS-3. Standard method for connecting the electrodes to a volunteer.

The regular pattern of peaks during one cardiac cycle is shown in Figure EHS-4.


Figure EHS-4. One cardiac cycle showing the P wave, QRS complex and T wave.

The action potentials recorded from atrial and ventricular fibers are different from those
recorded from nerves and skeletal muscle. The cardiac action potential is composed of three
phases: a rapid depolarization, a plateau depolarization (which is very obvious in ventricular
fibers) and a repolarization back to resting membrane potential (Figure EHS-5).

Figure EHS-5. A typical ventricular muscle action potential.

The components of the ECG can be correlated with the electrical activity of the atrial and
ventricular muscle:
• The P-wave is produced by atrial depolarization.
• The QRS complex is produced by ventricular depolarization; atrial repolarization also
occurs during this time, but its contribution is insignificant.
• The T-wave is produced by ventricular repolarization.

Heart valves and heart sounds

Each side of the heart is provided with two valves, which convert the rhythmic contractions
into a unidirectional pumping. The valves close automatically whenever there is a pressure
difference across the valve that would cause backflow of blood. Closure gives rise to audible
vibrations (heart sounds). Atrioventricular (AV) valves between the atrium and ventricle on
each side of the heart prevent backflow from ventricle to atrium. Semilunar valves are
located between the ventricle and the artery on each side of the heart, and prevent backflow
of blood from the aorta and pulmonary artery into the respective ventricle.
The closure of these valves is responsible for the characteristic sound produced by the
heart, usually referred to as a ‘lub-dup’ sound. The lower-pitched ‘lub’ sound occurs during
the early phase of ventricular contraction. This is produced by closing of the atrioventricular
(mitral and tricuspid) valves. These valves prevent blood from flowing back into the atria.
When the ventricles relax, the blood pressure drops below that in the artery, and the
semilunar valves (aortic and pulmonary) close, producing the higher-pitched ‘dup’ sound.
Malfunctions of these valves often produce an audible murmur, which can be detected with a
stethoscope.


The cardiac cycle

The sequence of events in the heart during one cardiac cycle is summarized in Figure 6.
During ventricular diastole blood is returning to the heart. Deoxygenated blood from the
periphery enters the right atrium and flows into the right ventricle through its open AV valve.
Oxygenated blood from the lungs enters the left atrium and flows into the left ventricle
through its open AV valve. Filling of the ventricles is completed when the atria contract (atrial
systole). In the resting state, atrial systole accounts for some 20% of atrial filling. Atrial
contraction is followed by contraction of the ventricles (ventricular systole). Initially, as the
ventricles begin to contract the pressure in them rises and exceeds that in the atria. This
closes the AV valves. But, until the pressure in the left ventricle exceeds that in the aorta
(and in the right ventricle exceeds that in the pulmonary artery), the volume of the ventricles
can not change. This is the so-called isovolumic phase of ventricular contraction. Finally,
when the pressure in the left ventricle exceeds that in the aorta (and the pressure in the right
ventricle exceeds that in the pulmonary artery), the aortic and pulmonary valves open and
blood is ejected into the aorta and pulmonary arteries. As the ventricular muscle relaxes,
pressures in the ventricles fall below those in the aorta and pulmonary artery, and the aortic
and pulmonary valves close. Ventricular pressure continues to fall and once it has fallen
below that in the atria, the AV valves open and ventricular filling begins again.

Figure EHS-6. The cardiac cycle.

Changes in a variety of parameters during one cardiac cycle are summarized in a figure
introduced by Wiggers. A modified form of this is shown in Figure EHS-7. The importance of
this representation is that it allows you to see the temporal relationships between the
different parameters.


Figure EHS-7. A Wiggers' diagram.



PENGUKURAN TEKANAN DARAH ARTERI MANUSIA

TUJUAN
Mampu melakukan pengukuran tekanan darah a. brachialis secara auskultasi dengan benar

ALAT YANG DIPERLUKAN

1. Sfigmomanometer air raksa.
2. Stetoskop

TATA KERJA
1. Orang Percobaan (OP) dalam keadaan duduk dengan tenang.
2. Pasang manset sfigmomanometer pada lengan kanan atas OP.
3. Syarat pemasangan manset:
• Lengan baju digulung setinggi-tingginya sehingga tidak terlilit oleh manset.
• Tepi bawah manset letaknya ± 2-3 cm di atas fossa cubiti.
• Balon dalam manset harus menutupi lengan atas di sisi ulnar (di atas a. brachialis).
• Pipa karet manset jangan menutupi fosa kubiti.
• Manset diikat cukup ketat.
Kriteria manset yang tepat: Ukuran lebar balon dalam manset 20% lebih besar dari
diameter lengan dan panjangnya cukup melingkari ½ lengan.
4. Dengan cara palpasi, carilah denyut a. brachialis pada fossa cubiti dan denyut a.
radialis pada pergelangan tangan OP.
Catatan : Perabaan denyut a. brakhialis diperlukan untuk memperoleh tempat yang
sesuai dengan peletakan stetoskop. Perabaan denyut a. radialis atau a.
brachialis sangat diperlukan untuk proses pengukuran tekanan darah secara
palpasi.
5. Setelah duduk tenang, siapkan stetoskop di telinga saudara. Pompa manset sambil
meraba a. radialis pada pergelangan tangan atau a. brachialis pada daerah lipat siku
(fosa kubiti) sampai denyut nadi tidak teraba lagi (=tekanan sistolik).

P-TD.1. Mengapa saat manset dipompa a. radialis/a. brachialis perlu diraba?

6. Naikkan lagi tekanan dalam manset sebesar ± 30 mmHg di atas tekanan sistolik
palpasi.
Catatan : Bila denyut sudah tidak teraba lagi, kita telah melampaui tekanan sistolik.
7. Letakkan stetoskop di daerah lipat siku (fossa cubiti) sesuai dengan letak a. brachialis

P-TD.3. Perlukah kita menekan stetoskop sekuat-kuatnya pada fosa kubiti?

8. Sambil melakukan auskultasi pada a. brachialis, turunkan tekanan manset secara

perlahan-lahan (+ 2-3 mmHg/detik) dan tetapkan ke-5 fase Korotkoff.

P-TD.4. Bagaimana kecepatan penurunan tekanan di dalam manset? Apa akibatnya

bila diturunkan terlampau cepat/lambat?


Keterangan:
Sound of Korotkoff. Best & Taylor's Physiol. Basis of Medical Practice, edisi ke 9, 1973,
halaman 150.
Ph.I Sudden appearance of clear, but often faint, tapping sound growing louder
during the succeeding 10 to 14 mmHg fall in pressure.
Ph.II The sound takes on a murmuring in quality during the next 15 to 20 mmHg fall in
pressure.
Ph.III Sound changes little in quality but becomes clearer and louder during the next 5
to 7 mmHg fall in pressure.
Ph.IV Muffled quality lasting throughout the next 5 to 6 mmHg fall in pressure. After
this all sound disappears.
Ph.V Point at which sound disappear.

Gambar TD-1. Posisi lengan, manset, dan stetoskop yang benar pada pengukuran
tekanan darah

9. Catatlah hasil pengukuran saudara (Tekanan sistolik/Tekanan diastolik mmHg).

Menurut penilaian dengan metode baru, tekanan sistolik sesuai dengan fase I dan
tekanan diastolik sesuai dengan fase V.
10. Ulangi kembali pengukuran butir 5 - 8 sehingga diperoleh 2 hasil pengukuran. Nilai
tekanan darah adalah nilai rata-rata ke-2 pengukuran.
Perhatian : Sebelum mengulangi pengukuran tekanan darah, air raksa dalam
sfigmomanometer harus dikembalikan pada angka 0. Hal ini untuk
menghindari terjadinya pembendungan yang dapat mempengaruhi hasil
pengukuran. Berilah waktu istirahat selama 1-2 menit antara tiap
pengukuran, untuk memulihkan aliran darah di bagian distal
pembendungan.


JAWABAN PERTANYAAN

P-TD.1. Untuk menghindari kesalahan pengukuran bila terdapat silent gap.

P-TD.2. Apa yang dimaksud dengan silent gap?
P-TD.2. Baca buku Ganong ed. 22, 2005, bab 30, halaman 590: Palpation Method.
P-TD.3. Tidak perlu, bahkan tekanan tidak boleh terlalu kuat sehingga terjadi pembendungan.
Yang penting meletakkan stetoskop dengan cermat agar tidak terjadi kebocoran
(seluruh tepi corong stetoskop merapat pada kulit).
P-TD.4. Dianjurkan untuk menurunkan tekanan dengan kecepatan + 2-3 mmHg per interval
denyut nadi. Bila terlampau cepat, nilai yang dicari dapat luput/lebih rendah daripada
seharusnya. Bila terlampau lambat, darah terlalu lama terbendung di lengan sehingga
mengakibatkan terjadinya vasodilatasi, yang juga akan mempengaruhi hasil
pengukuran.

Diadaptasi dari: Penuntun Praktikum Fisiologi FKUI