Mr.

Ghufran Ullah
Bio-Medical Engineer (RMI)
BS ELECTRONICS(Hons)
University of Peshawar
MS Electrical Engineering
Iqra National University Peshawar
 BASIC PARAMETERS

1. Electrocardiogram <ECG>
2. Respiration <RESP>
3. Non Invasive Blood Pressure <NIBP>
4. Oxygen saturation <SpO2>/Pulse Wave
5. Temperature <TEMP>
 Electrocardiogram

1. What is ECG?

2. Principle

3. Purpose
When is ECG measured?
During anesthesia
/ Effect of hypocapnia /
operation hypoxia/hypercapnia 　　
　　　　　　　
Effect of Anesthetic / Effect of
Muscular relaxant Operation

Arrhythmia
tends to occur

ECG monitor is essential!

ICU/CCU
Patients with serious Condition of patient
cardiac disease are with serious disease
monitored in CCU. changes every second
 2. Principle
Electrodes attached to the chest detect the action potential generated by excitation
of cardiac muscle. The potential is amplified and displayed on the monitor.

Red Yellow
3 leads, 5 leads, 12 leads
(-) (N)
II
3 leads are the basic method.

黄
(+)Green

緑黒

BSM-6701
 3. Purpose
Purpose of ECG monitoring is…
・ Abnormal HR
・ Arrhythmia Early detection
・ Myocardial ischemia

ECG waveform tells us … R

・ Heart rate is counted based on QRS Q

wave
・ Myocardial ischemia
S

ST change
Angina pectoris ST elevation or depression ST elevation

Cardiac infarction Abnormal Q wave, ST elevation,

coronary T wave
Normal

・ Arrhythmia ST depression

・ Arrhythmia decides the shapes of waveform

・ RR interval changes
・ QRS width and amplitude change
 2. Respiration

1. What is respiration?
2. Purpose
3. Measurement method
- Impedance method
- Thermister medhod
1. What is RESP? RESP (Respiration)
Oxygen is taken into the lungs and carbon dioxide is
expired.
The respiration rate, depth and rhythm are normally stable. Abnormal changes are
symptoms of disease conditions.
Normal rate: 15-20 breaths/min
The rate, depth and rhythm are important for
monitoring Respiration. Tidal volume: 400-500 ml

2. Purpose
Monitor whether patient is breathing or not = Apnea monitoring

3. Measurement method
Impedance Method
Body impedance (Electric resistance) changes with diaphragm or thoracic movement
and can be calculated as respiration. Cannot be used with an ESU (electric knife).

Thermistor Method
Temperature changes with breathing and difference in the respiration circuit or
nasal passage can be calculated as respiration. Can be used with an ESU.
 Impedance Method Hard for electric current to pass through air
A weak high frequency constant current is directed through the electrodes attached to the
chest. The impedance change induced by capacity change of the lung in response to
respiration is shown on the monitor as a waveform.

More air = Less air =

High Low resistance
resistance

Hard to pass through = High Impedance Easy to pass through = Low Impedance
Inhale Exhale Rest Inhale Exhale Rest Inhale Exhale
Voltage

= (Impedance)

Time
 Theremistor is a heat sensitive resistor that
Thermistor Method changes electric resistance depending on
Characteristics of Thermistor the temperature
As temperature rises, more electrical current passes = electric impedance decrease
Temperature change is converted Electrical resistance is converted into
into electrical resistance voltage level

Patient breathing can be monitored by measuring temperature of inspired and expired air.

Temperature change is
detected by a thermistor
probe, and respiration is
measured.

Inspired air
= Cold
Expired air
= Warm
Inhale Exhale Rest Inhale Exhale Rest Inhale Exhale

Voltage

(= electrical resistance)
TIME
 3. Blood Pressure

1. What is blood pressure?

2. Purpose
3. Measurement method and
principle of NIBP
 1. What is Blood Pressure?
Force which makes blood to flow to every part of the body
Measures the pressure of the pumped blood against the blood vessel walls
Maximum pressure from left
ventricle contraction Highest Blood Pressure: Systolic Pressure
Blood pressure when left Lowest Blood Pressure: Diastolic Pressure
ventricle is at rest
Unit is mmHg. BP = CO  SVR
O2 Nutriment
2. Purpose
Artery Vein
Evaluate if enough blood is circulating Periphery
Evaluate burden on heart
CO2

3. Measurement Vascular
resistance
Method
Indirect Method: 　Blood Pressure (NIBP)
Noninvasive
Wrap cuff around upper arm and measure. Heart

Direct Method: Invasive Blood Pressure (IBP)

Inseart catheter into artery and measure the CO
blood pressure through transducer.
3-1. NIBP （ NIBP = Non 　 Invasive 　 Blood 　
Pressure ）
Measures blood pressure non-invasively – usually by a cuff on the upper arm.

Advantages Disadvantages
Easy and noninvasive Cannot measure venous pressure.
for patient Difficult to measure BP of patients with
hypotension generated by shock.

Measurement Method
Stethoscopy Place a manchette over the upper arm or thigh, apply air pressure
with the rubber bulb, and listen to the sound (korotkoff sound)
through a stethoscope placed under the edge of the manchette
while releasing the air from the manchette.

Oscillometric Blood pressure is measured from very slight oscillations generated

within the cuff when pressure is applied.
NIBP measurement_1
Listening to the sound (korotkoff sound) through a
Stethoscopy stethoscope placed under the edge of a a while releasing the
air from the manchette.
CUFF

Cuff pressure > Systolic pressure Cuff pressure < Systolic pressure

Blood stops while blood vessel Blood vessel opens and blood flow
is pressed by cuff pressure goes to peripheral.

Blood vessel open and close according to relationship between cuff

pressure and blood pressure

Systolic Pressure Diastolic Pressure

korotkoff sound
NIBP measurement_2
Blood pressure is measured from very slight oscillations
Oscillometric generated within the cuff when pressure is applied
Cuff pressure is increased until it exceeds the systolic pressure. Then it is decreased
slowly. The amplitude of pressure oscillation in the cuff gradually increases and reaches a
peak. The relationship between the changes of cuff pressure and its oscillation is stored
in memory and used to determine blood pressure value.

Systolic and Diastolic value are calculated by Mean Arterial Pressure (MAP)

Blood pressure value

- MAP: when the oscillation reaches a peak.
- Systolic value: X% of MAP and higher point of it.
- Diastolic value: Y% of MAP and lower point of it.
* X and Y are different by manufacturer
170
162
154 146
138 130
122 114
106 98
Cuff pressure 90 82
Oscillation 74 66
amplitude Mean Arterial Pressure 58

Time
Basic knowledge for correct mesurement
For accurate value (Oscillometric method)
1) Make sure whether cuff is proper size or not.
2) Set arm to the height of heart
3) Other oscillating motion (like body movement)
4) Make sure that measurement mode (adult/infant, neonate) is correct.

The cuff size

Adult Child Infant Neonate
Cuff
Cufffor
forarm
arm

12 – 16 cm 7 – 9 cm 　　 6 2.5 – 5 cm
cm
Wrong cuff size leads to inaccurate value
Wide cuff can stop blood flow with low pressure
and narrow cuff can stop it with high pressure.
Therefore measuring with a very wide cuff may
result in measured values lower than the actual
values and measuring with a very narrow cuff
may result in measured values higher than the
actual values.
 4. SpO2

1. What is SpO2?
2. Purpose
3. When is it used?
4. Principle and measurement
method
 Arterial Oxygen Saturation
The ratio of Oxygenated Hemoglobin in the artery. (Unit is %.)
(Ratio of Oxygenated Hemoglobin and Reduced Hemoglobn.)

Oxygen Saturation = Oxygenated Hemoglobin

(SpO2) Oxygenated Hemoglobin +
Amount of Hemoglobin
Reduced Hemoglobin
Normal 　 96-99%
Rate 　　　
* Pulse waveform and Pulse rate can also be measured.

Purpose
Indication for ventilation Monitoring
Most important mechanism of respiration, “oxygenation of blood” can be evaluated.

Where is it used?
1) OR
2) Recovery Room
3) Patient with ventilator
4) Patient with respiratory failure
5) Transport, etc.
Measurement method Arterial oxygen saturation is measured by
light.
Measured by different absorption ratio of oxygenated hemoglobin
and reduced hemoglobin and calculate the value. 　　

Oxgenated Hemoglobin: Absorbs infrared light (940 nm)

Absorption
of light Reduced Hemoglobin: Absorbs red light (660nm)

Two different wavelengths of light are applied on the finger. SpO 2 is

measured from the ratio of how much of each light is absorbed by the
blood.

By putting a sensor on the finger,

you can measure SpO2
Measurement Red
Light
Infrared
Light

SpO2

Receiver

Light Emission

Infrared Red Infrared Red

Absorbs infrared
light Absorbs red light

Oxgenated Hemoglobin Reduced Hemoglobin

After transmission, After transmission,

Receiver red light decreases
infrared light decreases
Infrared light : Red light, ratio after transmission =
Oxygenated Hemoglobin : Reduced Hemoglobin
6. Temperature

1. What is temperature?
2. What does it tell?
3. Measurement types
4. Principle and method
 1. What is temperature? Average (adult)
36.0–37.0C
Temperature of thermoregulatory center = Central temperature

Temperature of body surface

2. What does it tell?

- Status of disease by comparing other vital signs (especially PR and resp)
- For checking hypothermia (it tends to occur during anesthesia.)

Surrounding
temperature hyperthermia Late awakening
from anesthesia.
During
anesthesia Increasing O2
hypothermia consumption.
 3. Types of temperature measurement
Temperature of body surface. It is easy to measure but is
Peripheral temperature influenced by outside air.
Axillary temperature - Measured under arm. About 0.5C
lower than rectal temperature. mercury thermometer
- Measured in mouth. About 0.3C /electronic thermometer
Oral temperature
lower than rectal temperature.

Central temperature Temperature of heat regulatory center. It is difficult to

measure its temperature because it is in the hypothalamic
area. Temperature which is related to the heat regulatory
center is regarded as central temperature.
Ear drum temperature - The value that is the closest to Measured by infrared light
central temperature
Esophagus temperature - Reflects the aorta temperature and
is related to blood temperature Thermistor probe
Rectal temperature - Close to central temperature, highest
value body temperature
Pulmonary artery temperature Measured by Swan-Ganz catheter

The difference between peripheral and center temp = differential temperature

*You can predict pumping function of heart.
fever is carried by blood.
Decreasing Peripheral blood volume decrease Difference between
CO before main organ’s blood flow peripheral and central
decrease. temperature become wide.
4. Measurement method
1) Peripheral temperature
Mercury thermometer 　 - Content of mercury is changed by temperature
Electronic thermometer - Electrical resistance of a thermistor changes with
temperature
2) Central temperature
Infrared thermometer Ear drum temperature
- Amount of infrared light which is emitted from a person or animal increases as its
body temperature increases.
Thermistor probe Esophageal, rectal, bladder temperature etc.
- Electrical resistance of a thermistor changes with temperature.

* This image is not available on current model.

Infrared thermometer