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- Frank`s Hospital Workshop

1. uo1vinaowaa n C SnONOH HaldlidWVv SSVd MOT 2 1 5 HONAS ANOO V Gd 18 5 aoNvaadi zoe 5 3NIS i 19313 5 5 TANNVHO OMI H LIMS aval anya 1531 z wW 2 1 1 dS3H S a IE 91715 53 8 q W31SAS d 5 1 S3HOIIMS ssva SdWV _ jNowoatas X3HOML3N VI avi s MENT NOILO310Hd 3 MO 434410 5 78 7 1 21 29 440 523 SOVJH3INI Mowe NOILV 1OSI LNAlLWd Figure 1 11 M1002A B ECG RESP Module Block Diagram 1 24 Basic Plug In Modules Theory of Operation ECG RESP Module As ECG and RESP signals pass from the patient to the monitor they progress through stages corresponding to the four logical sections of the module as shown in the block diagram Module related faults can generally be isolated to one of the four stages 1 Signals are received through patient
2. s gt lt a c Xx NO 7 x lt a exe 2 gt d vol 1 11 2 CN a 72 J p oues l ca Dh x aum Ow es C3 E D 7 Figure 3 27 Module Racks CMS Patient Monitoring System 3 57 Plug in Parameter Modules Plug in Parameter Modules The parameter modules are used to derive physiologic measurements from patients Several modules do not take measurements but print or transfer data among monitors or external equipment Plug in modules use a variety of accessories for obtaining physiologic data from patients These may be electrodes probes or other types of transducers The accessories used by each module are color coded to match the module s connectors for easier identification Types of Module The following types of plug in module are available for the CMS Some modules have more than one model for different patient groups or options Table 3 17 Plug In Parameter Modules Module Name Measurement ECG Electrocardiogram ECG RESP Electrocardiogram Respiration ECG RESP Option 01 Electrocardiogram Respiration with Analog Respiration Output PRESS Invasive Blood Pressure NBP Non invasiv
3. 7 UP 68000 ROM FW SRAM SRAM Hi Z 64k x 16 32k x8 32k x 8 Buff B UP CTRL J2 L UP_ADDR UP DATA Jem eee SMEC e i VID BUF v a 1 x lg NE e 174 S Serial H gt Mux VRAM Data a Address ARRAY gt fg ipn Shift amp CLK d 5 SLIP to SMEC CTRL OSZ 32MHz OSZ VIDEO 32k x 8 LOC BUS SYSCLK 5 from Backplane gt Remote ON OFH from Display to external PS J3 Figure 3 37 DSPC FLAT Card Block Diagram A summary of the features of the DSPC FLAT card follows Displays up to 8 overlapping waves in 7 colors with horizontal scrolling Two alphanumeric graphic planes 640 x 480 pixels x 3 color buffers for displaying text figures and simple graphics One wave plane with resolution 640 x 480 pixels x 3 color buffers that can display up to 8 overlapping waves with horizontal scrolling e Three character sizes large 20 x 36 pixels standard 10 x 18 pixels dense 7 x 14 pixels e Attributes resolution 320 x 480 cells Candrive a master flatscreen e Color luminance equalization e 60 Hz operation 3 88 CMS Patient Monitoring System D
4. M1165A 66A 75A 76A Philips CMS Patient Monitoring System CRT System Overview Figure 3 2 Philips CMS Components CMS Patient Monitoring System 3 9 CMS Patient Monitoring System Bus Structure CMS Patient Monitoring System Bus Structure Introduction The bus structure of the CMS includes three distinct signal buses a Message Passing Bus a Local Bus and a Utility Bus The overall structure of the CMS is shown in Figure 3 3 CRT DISPLAY mono color Power Supply Human Interface I DC DC SDN Utility Rack Display Converter Interface CPU Interface Controller MPB MPB Message Pass ng Bus 40 viz Fu l MPB EPROM Interfaces CPU e g SDN 10 MHz RS232 or 15 MHz PORE MPB Bus Rack with Parameter Modules Local Bus Figure 3 3 Philips CMS Bus Structure 3 10 CMS Patient Monitoring System Physical Backplane Message Passing Bus Data Transfers Local Bus Utility Bus Addressing CMS Patient Monitoring System Bus Structure The backplane of the computer module contains the buses used to interconnect the pieces of the CMS system This backplane is made up of 24 connectors 23 are for various function cards one is dedicated to the DC to DC converter The conn
5. UP 68000 ROM FW SRAM SRAM 64k x 16 32kx 8 32k x 8 UP_CTRL 4 UP ADDR UP DATA ur CTRL DATA BUF e i VID BUF l SLIP SYNC Serial gt VRAM Data 1 v Address ARRAY meu Lp A 1 gt gt i Shift VIDEO i OUT i SLIP to SMEC SRAM OSZ 32MHz OSZ VIDEO 32k x 8 1 LOC BUS SYSCLK Figure 3 38 DSPC XGA Card Block Diagram A summary of the features of the DSPC_XGA card follows Displays up to 8 overlapping waves in 7 colors with horizontal scrolling Two alphanumeric graphic planes 1024 x 512 pixels x 3 color buffers for displaying text figures and simple graphics One wave plane with resolution 1024 x 512 pixels x 3 color buffers that can display up to 8 overlapping waves with horizontal scrolling e Three character sizes large 20 x 36 pixels standard 10 x 18 pixels dense 7 x 14 pixels e Attributes resolution 320 x 480 cells Can drive a master XGA compatible display e Color luminance equalization e 60 Hz operation 1 The resolution 1024 x 512 is made XGA compatible 1024 x 768 via repeating every second row CMS Patient Monitoring System 3 91 Utility CPU Utility CPU Introduction Connections or Interfaces Components 68000 Microprocessor EPROM EEP
6. 4 3 Figure 1 12 ECG RESP Module Controls and Connectors User Controls 1 ECG Setup single press key used to enter the ECG setup screen 2 ECG Setup Indicator A green LED lit when the ECG setup screen is activated 3 RESP Setup Key A single press key used to enter the Respiration setup screen 4 RESP Setup Indicator A green LED lit when the Respiration setup screen is activated Connectors 5 The standard 12 pin connector will accept either a 3 lead or 5 lead ECG cable ECG Modes In auto mode the QRS complexes are detected automatically In manual mode the QRS detection level appears on the screen as a horizontal line across the ECG wave This enables the user to see exactly what is causing the heart rate counter to count In non paced mode no pace pulses are expected and no pace pulse rejection occurs In paced mode pace pulses are annotated with a small dash on the screen 1 26 Basic Plug In Modules ST Segment Analysis RESP Modes Safety ECG RESP Module ST segment analysis is an optional feature ST segment measurements can be recorded on up to three channels and three leads of a patient s ECG The measurements are shown as numerics on the standard display graphically in the ST analysis task window and as part of patient vital signs and trend graphs They can be recorded with reference beats at the bedside or without beats at
7. Red Yellow Confirm Alarm Alarm Silence Other Monitor Trends Module gt Reset Alarms Patients Setup Procedures Calcs Setup Main Realtime Delayed Q Suspend Screen Record Record OFF 0 Figure 4 2 Philips V24 and V24C Front Keypanel Layout Shown below is the front bezel keypad for the V24CT The 24 front panel contains additional battery and power indicators Red Yellow Confirm Alarm Alarm Silence Oth Monit Trends Modul Reset Alarms Por Senis Procedures 21 Sb Suspend Soreen Record Reseed v ON 7 1 Battery Battery AC OFF 0 Charging Charged Power Figure 4 3 Philips 24 Front Keypanel Layout The V24 V26 Front The function of front panel hardkeys and softkeys as they pertain to V24 V26 are Panel Keys presented here Differences between these keys as they operate within V24 V26 compared with CMS are discussed where appropriate Suspend Key Pressing this key reverses the Alarms Suspend state This key is functionally identical to CMS Silence Reset Key Pressing this key silences an alarm If the cause of the alarm has been eliminated pressing this key resets the alarm This key is functionally identical to
8. sna 18201 AND 1d 288 Gd SING Td yD BJO LEBL3N 39 31615 LIUM 21901 2832009 Mem SS3edad 1 0 gt Saira 42081300 4 415154 5 IBNDIS 1 4 gt 7ONLNOD LNd LNO Sa 8190 1 CO3er3d4 38 563400 WHYS gigd O loei LNOO 553400 5 a Hadt 5 WO2ld3 nes arene ee J TOALNOD TOYLNOD SUIAIG eooss SSdeaug 8jO LBSENGD I 5 2 HW SI 1041 02 OAIA 5340 J3OBJe3LNIT B3ZINONHONAS TOY LNOD YO LOANNOD NId 86 Figure 3 31 15 Mhz Application CPU 3 72 CMS Patient Monitoring System LEDs Summary of Functions Application CPU The Application CPU card contains three LEDs The function of each is listed in Table 3 20 One MPB Error LED red Table 3 20 Application CPU LEDs Description Used to indicate a problem with a device on the board Two Error Status LEDs green Controlled by software and may be implemented to indicate a hardware failure on the card during the boot phase when no MPB messages can be sent When the system is running they may also be used to reflect the status of the card The functions of the Application CPU Card are summarized as follows Performs data processing for the system Large volatile SRAM up to 448 kilobyt
9. Harii nsa MYOMLAN NOILO31OHd Ta HOLO3NNOO 1fidNI VH 4019313 51 TANNVHO OML IWNOIS SONDE HOLIMS 1 19 a P d ISJHO LIMS WALSAS 5991115 NolLoaTas H3TIOHINO Xn SSVd 9 ava _ perd v MOT 434410 d 440 savat 994 SOVJH3LNI 42 Mov NOILV IOSI AN3llVd Figure 1 8 M1001A ECG Module Block Diagram 1 14 Basic Plug In Modules Theory of Operation M1001A M1002A ECG Module As ECG signals pass from the patient to the monitor they progress through stages corresponding to the four logical sections of the module as shown in the block diagram of Figure 1 8 Module related faults can generally be isolated to one of the four stages 1 Signals are received through patient electrodes and lead cables by the input connector 2 The input protection network and ESU Filter eliminate extraneous signals 3 The signals are processed by two circuits the ECG Application Specific Integrated Circuit ECG ASIC and the Pace Pulse Detector PPD ASIC At this point the analog signals from each lead are selected amplified filtered and converted to digital form During the process the output of each input amplifier is checked for a leads off electrode cond
10. cclo24 tif Figure 2 24 EEG Module controls and connectors User Controls 1 Setup Key This is a single press key used to enter the EEG setup screen 2 Setup Indicator This is a green LED which will be lit when in the EEG setup screen Connectors 3 The EEG M1027A uses a standard 12 pin connector for use with an EEG trunk cable and EEG electrodes Safety To ensure the safety of the patient the patient applied parts are isolated from ground by optical isolators and a transformer In addition the entire module is encapsulated in plastic This module complies with UL544 CSA No 125 M1984 for use with model M1165 66 75 76 and UL2601 1 CAN CSA C22 2 No 601 1 M90 for use with model M1167 77 IEC 601 1 IEC 601 2 26 Patient leakage current is less than at 120V 60Hz It has an isolated patient connection to Class I protection Type Cardiac Floating CF There is also protection against damage from defibrillation and electro surgery Advanced Plug In Modules 2 85 BIS Measurement BIS Module Concepts BIS Measurement Introduction Depth of Anesthesia The Bispectral Index BIS9 is a continuous processed EEG parameter that provides a measure of the state of the brain during the administration of anesthetics and sedatives BIS was designed to correlate with hypnotic clinical endpoints sedation lack of awareness and memory and to track changes in the effects
11. 1 troduction s 225i orna sec Deco one sor ette dores Reape ode eda 1 aed ie ve eda 1 Objectives cat sedan toto xt Ee ues ux eee eR SUE 1 TOPICS ep NU EU REFER ENS EE mee eee ass AS 1 Definitions fie EUR S 2 CMS Patient Monitoring System Overview 4 Introduction iV AA ELLA iu 4 Objectives 4 Contents 9 CONnCe PIS I A 4 TODIGS ue pepe teen e epe s f ore ree degree aren ree erret ir rer die Ies 5 CMS Patient Monitoring System Description 6 TntrOGUGHON ys DI CMS 1 1 113 OMS Features 2 venu eur pr e Re SA Rn IU D o IUS BL ORE CES ee 7 CMS F rclions Ue Re e ds eae dx pua n earn 7 CMS Patient Monitoring System 8 CMS Patient Monitoring System Bus Structure 10 Introduction 1 Pub es bed Cte dc em I edes 10 Physical Backplane sc Sorta eat bre nere MK RII ERES RID e ede 11 Message Passing 11 reu 11 Utility Bus acca E
12. 22 V24 and V26 Patient Monitors Theory of 23 OVOEVIG Wa ots esee SR ORI Du RN eA a pat ao sedo tien qn tete e 23 V24 V24C V26C Power Supply 2b V24CT V26CT Power 25 System Board tee e RE bk each ENIM aang 32 Application Subsystem 32 Utility Subsystems iiec be na ee en x ers Nhe ath qu 32 Front End Interface Subsystem 32 Common Subsystem 32 Front Panel Keyboard 32 Flat Panel Display cence es eb A Pe ue RE E 33 Display Adapter 33 3 Board Assembly e teats Qu HH RR te 33 Service Port Connectors 33 Six slot Rack Eight slot 33 V24 V26 Theory of Operation Exercises 33 Philips Monitoring Network 1 Introduction ede es ULP ERA ER NT AQUA 1 Goals Hc toh 1 Objective
13. 65 Blood Analysis Module Software Update 5 66 Blood Analysis Module 5 5 67 VueLink Module 68 Vuelink Module ete aio D EU RS 68 Descriptions 3 Baa BARRE 68 Measurements e tee eR tette Sub ean ee Roue DURS Pagine 68 Cornmponents cse AG 69 Block Diagram RR 69 Theory of Operation ccce dA E s 71 M1032A VueLink Module Features 71 VueLink Module 1 73 Contents 8 EEG Module Concepts CMS only 74 EEG Measur nient innert erts ete bic gee UR URS RD CR ea dea 74 a at 74 BEG Channels anos se acts oa E ate RUE 74 74 Bran Waves eoi USC Ehe eU 74 Frequency 112 pet eem URINE REA URSINI eae 75 Amplitude e uei NER AS NUN UU URS 77 Symmetry Ss ERR US VERA a a Sa ea seed 77 Palt
14. 89 Introd cese Mecsas bs DAR SERO a ROC ARR 89 Connectors e oor Re E ies a a D tee ad s t Rn 89 DSPC FLAT ASIA Components 89 Theory of OperatiOn PA CR ee bb A E 89 Summary of 89 DSPC XGA Display Controller 90 InttOdUCLiOI s ce y rte i enc Roe pee ace ds 90 gt xe ha be Rep geb vitm mtb e ETAT a dA 90 DSPE XGA 90 Theory of OperatiOri eA YS 90 DSPC XGA Functional Block 91 Summary of DSPC XGA Card Features 91 EDU MN 92 Introduction WORT ae ee ARAM Eod ne ERE e e 92 Connections or 5 92 Components beg tee E HE VIR REA 92 Theory of 2 4 2 93 Functional Block Diagram 96 Utility Card LEDS iris wasn ARE ERE ee aa wes NETS RU area 97 Summary of Utility CPU Features
15. 3 Measurement 4 Criteria for Proper 4 Plug In Modules cse ue OA OP tare 4 Invasive Blood Pressure Measurement 5 5 5 Invasive Blood Pressure Module 1006 6 Description a dl eiu IE UU ER 6 Measurements sk See d Pal Pa 6 mundane 6 Block Diagram eM SEE DEAL t VERUM 6 Theory of 8 PRESS 1006 22 2 24 8 PRESS M1006A Module 10 Invasive Blood Pressure Module M1006A Option C01 11 Description ier deep ea 11 Measurements ettet ete re e 11 eee Eee gore PES MERE 11 Block Diagram 2 crate 11 Theory of 1 13 Contents 5 PRESS M1006A Option 01 Module 14 PRESS M1006A Option C01 Module 15 Invasive Blood Pressur
16. REE gu 129 Remote Switch Card Shia tb em ed we tena 129 Introduction ne bere Ree eR eX Wa e HE WEG A 129 CONNECHONS unos RE LE a a SCA UR SLE SIR EAR RES 129 V24 and V26 Patient Monitors 1 Introduction 1 V a eu P pe Era e bod 1 Goals oni derat qu 1 Objectives 1 TOPICS sisal sn 2 V24 and V26 Patient Monitors Description and 3 Introduction OSE em EC dace 3 Objectives dt det dt bedeutete setatis npe tata 3 Em 3 Chmnical UJses ues e euet 3 Product Releases 2 3 Contents 15 V24 and V26 Patient Monitors Standard Package 3 Reatutesi i reve ren Re aC E te ERA A IE ERES 3 Mainframes em petu ees esie eb bs ve en bl e 5 Rack Features e ree ECL UP Ine res v d ets 5 Parameter Modules LUPA ehuLbIe EE iex IE e Vds 6 Philips Patient Care 7 Data Management ei 7 Vital Signs Recording
17. OHNE 454 82 Recorder Module 83 Contents 4 Recorder Module Exercises M1116B 85 Data Transfer Module 86 Data Transfer Modules nas esee Rr Rame gle e ene e ha 86 Description issi c e 86 Comporernts deter Re i e iren 86 Block Diagram eH eg dre reete wie rae RN Ee dte 86 Theory of eere ter eher Ree We e 88 Data Transfer Module Features 89 Data Transfer Module Exercises 90 Introduction cet GR Ne en FRI EROS RE LE Fit E RA RE ER At 1 Goals cise EHE 1 o e ORC tea E 1 TOPICS HEN pesi qiii 2 Invasive Blood Pressure Module Concepts 3 Invasive Blood Pressure 3 Descriptionot oho L os ere br neo eva stus 3 Concepts cepere de dae hd ere RW e deem 3 Measurement 3 Measurement Acquisition
18. Philips V24 PHYSIOLOGICAL MAINFRAME a MONOCHROME _ Module Rack SYSTEM Six or eight Board App LCD Adaptor Parameter Modules 60 SED BE SENTO DISPLAY Depending upon rack used FE Util CPU CPU 5Vde 2Vde 60Vdc CONTROL AC INPUT nominal POWER PANEL 90 TO 250 VAC gt SUPPLY 48 TO 66 Hz V24 and V26 Patient Monitors 4 23 24 and 26 Patient Monitors Theory of Operation Philips V26C V24C Module Rack Six or eight Parameter Modules Depending upon rack used PHYSIOLOGICAL DATA 60 VDC 78 KHz AC INPUT nominal 90 TO 250 VAC 48 TO 66 Hz MAINFRAME LCD Adapter Board COLOR SYSTEM DSPC Board App BON LIQUID FLAT PANEL DISPLAY FE Util CPU CPU 5Vdc 2Vde 60Vdc CONTROL POWER PANEL SUPPLY 4 24 V24 and V26 Patient Monitors 24 and V26 Patient Monitors Theory of Operation Philips V26CT V24CT MAINFRAME PHYSIOLOGICAL LCD DATA Adapter Board COLOR Raek SYSTEM DSPC Six or eight Board Am Board LIQUID CDCI Parameter Modules 60 VDC
19. 7 Split Screen Capability 7 Clinical Calculation 7 Drug Cale lato esnai E 7 Arrhythmia 8 Anesthetic Gas 8 Alarms cu ERA RO ELI SM EM Re 8 oT segment AnalySlSz E ENDE DUC era es 9 OXYCRG erre mu St Kn dte dotem dedu tute 9 Neonatal Event 9 Settings Transfer ele Resp dee e Ie e Tace qe SR Ere ea tg 9 V24 and V26 Patient Monitors Features 10 V24 and V26 Patient Monitors 11 Introd clion etse SAN ALAS SI VLA 11 Objectives e s 11 CONCEPTS c CK EE AS 11 usua P 11 V24 V26 Patient Monitors Interfaces 5 5 13 V24 and V26 Patient Monitors User Controls and 14 Introduction ee rer Ere eas tab e erii e uud Brat 14 IU unu t 14 CODlCeDLs t a uet nee e pb M LAT betont 14
20. 49 Descriptio A E ORE 49 Concepts due ees ute aed anaes eite a einen re Sa Sa 49 Measurement 49 Measurement Acquisition 49 NEN qnte ang Voter qd ner CN pU d s b Seu Pate scene rd e 50 Injectate Temperature and Volume C10 CCO Module CMS 52 Description eie E C ELS 52 Measurenientis sii a ee E RI E NI EUR 52 Components esu ERA eran ER HET PLE RENE rmi CREE ide 52 Block Diagram eem metet Ren Re m e ane bean Re e ins 52 Theory of Operation LEER EE utes 54 C10 CCO Module Features 55 Arterial Oxygen Saturation Plethysmography SpO2 Pleth Module Concepts 56 SpO2A Measurement ve EU A ed yis 56 Description i Haat RENS dor redo e P RR ST 56 to PERI E C Son 56 Measurement 57 Measurement Acquisition 57 Output c Om
21. OPIA X40m38N uoi428302gd 48459 dS sai1nqir41318 49 O043u07 Ir waisdg 553500 215 101 2 ude 15 9 SSBIA SMa 18201 SNH TOME 1 Men 1 2 yoy td 5533000 E Ulud 9 7081309 Se3snag ig HONd3 BINOS geass Se3uddd SNE eRe 708100 0313 SEGMIGU IOMINOO 80123NNOO NId 96 Figure 3 34 DSPC Card Block Diagram 3 80 CMS Patient Monitoring System Summary of DSPC Card Features Color Display Controller Cards The features of the DSPC card are as follows Two alphanumeric graphic planes 1024 x 512 pixels for display text figure and simple graphics One wave plane with extended resolution 2048 x 512 pixels that can display up to six overlapping waves with horizontal scrolling Three character sizes large 32 x 40 pixels normal 16 x 20 pixels and dense 12 x 16 pixels e Attributes resolution 256 x 256 bytes e Can drive slave displays e 60 Hz operation Color Display Controller Cards Intr
22. 7 33 Criteria for Proper 34 Plug In Modules o IER NET red 34 FIO2 Respiratory Measurement 34 FIOZ Module MIOIT7A ERR pA EE S RUN 35 Description ivo ek athe PEE Ee Eee Ee Boeke oie E RTI ETE 35 Measurements ACE UE DAC ER EUER Pd eic A 35 COMPONENtS rA C Wee EA 35 Block Diagram acis eRe ge ee NS GU NER RU IU 35 Theory of Operations E EY ERA OA ENTE TAA 37 FIO2 M1017A Module 39 Transcutaneous Gas tcpOs tepCOs Module 40 tepO2 tcpCO2 Measurement 40 Description Ra egeo 40 Concepts eoe eR abe ere he e e E ORDEN RAUS 40 Measurement 40 Measurement Acquisition 41 Measurement 41 Criteria for Proper 41 Plug In Modules 41 tcpOZ tcpCO2 Measurement 5
23. 25 ECG RESP Module Features 26 ECG RESP Module Exercises 28 Non invasive Blood Pressure NBP Module Concepts 30 NBP Measurement gh ea E 30 e eun ee Wine hate Ree e RAN RRS Re Ae 30 as Baie 30 Measurement 30 Measurement 31 UEP Ub 81 Criteria for Proper Measurement 31 Plug In Modules or OA NC NA RU US 31 NBP Measurements 5 32 NBP MOdUul6S RUE EROR oad a oda Sid a Ba A RG UU 34 Description 5 a ale See ae bee Se 34 Measurements ewe Eee tar at CP m PET boot 34 COMP ONENS Id ee Ce RO EE ie 34 Block Diagram in Am Lu INS 34 Theory of Operation 36 NBP Module 11 Dee ES 36 NBP Module 5 39 Cardiac Output C O Modul
24. I 4 8 H3lV3H HO1VHvdWOO LOGS qunaivuadial laee AI dal a ni lt lt HOSN3S ael dal Alddns NOLIVZIHV Od ANaHHno lt e 5 H31H3ANOO E er an ea any 5 jg s m 2 au m u3MOd 8 o uaonaswvuL 8 ADVLIOA ee 200 S39VLIO 1531 ES 5 dv T le X x 202 Figure 2 14 M1018A Transcutaneous Gas Module Block Diagram 2 46 Advanced Plug In Modules 2 2 Module M1018A Theory of Operation The major actions that the electrical signal must pass through in order to reach the Monitor interface 1 The microprocessor which controls the overall functions of the module and also controls transducers safety tasks and all application software e g calibration value calculation Additionally the microprocessor performs the following functions serial communication via optocouplers with the rack interface card in the Computer Module calculation of the calibration constants calculation of the tcpO tcepCO numerics transducer temperature control 2 heater control which heats the transducer to improve the diffusion of gases from the blood to the skin surface by maintaining constant absolute temperature The transducer temperature is measured by two independent sensors simul
25. DIS ALISOTAd We SNMOC NOII23L3d IOMINOS xoa AIHOI d WHILST 4 7CIONINO2 2IS Wide NOIS SeIO LO3NNOO UHNUd S553224 AIIIN Wee DIS yasana 4 9 OSLNODS 3009 1016 YO LEeJBdINOO ssawcau 553810 80123NNO2 NId 96 H1 Figure 3 49 SDN Interface Card Block Diagram CMS Patient Monitoring System 3 125 Rack Interface Rack Interface Introduction FE LINK Connections Components Theory of Operation Polling Defibrillator Sync Out The Rack Interface RACK IF card supports the Front End Link protocol front end mode for communications between the system and the Module Racks which house up to 32 Plug In Parameter Modules Communication is through the Utility CPU The function of the card is to acquire data and status from the plug in modules in the racks and send back control signals It does this using the Front End high speed serial link FE LINK One FE LINK can support 32 plug in modules which can be located in the internal rack and up to three remote or satellite racks The Rack Interface card also does the following 1 routes an ECG sync signal to a phone jack on the internal rack 2 routes the power from the DC to DC converter to all the racks and 3 provides a special tool protocol tool mode for communication with externa
26. B o i 1 11 22 11 34 11 42 11 48 11 54 12 02 12 08 12 14 12 20 12 26 12 30 12 33 F 12 36 In this example of BIS directed anesthesia the propofol infusion rate is incrementally reduced in order to achieve a BIS increase to about 55 60 and then maintained at the minimum dose 70 ug kg min required to stay in this range until the last 15 minutes of the case when a BIS target of 60 70 is used Since sufficient analgesia is provided by the opioid and relatively low propofol infusion rates i e 100 ug kg min are often sufficient to maintain adequate hypnosis In this case significantly less drug was used and the patient was awake and responding to questions within minutes This clinical research demonstrated that BIS monitoring can consistently allow cost effective intraoperative management of anesthetic drug delivery resulting in significantly faster recovery and earlier eligibility for discharge from the PACU 2 92 Advanced Plug In Modules BIS Module Description Measurement Components BIS Module The method for measuring Bispectral Index BIS is based on an algorithm developed by Aspect Medical Systems The Bispectral Index BIS is a continuous processed EEG parameter that provides a measure of the hypnotic state of the brain during the administration of anesthetics and sedatives The technology enables anesthesia providers to track a patient s
27. Yellow Red Bue e UP Green ES ad ro en Red Strips ap Blue Strips d p e Green Strips 2 4 DC DC Converter Figure 3 4 Backplane Configuration with Local Clusters The rules associated with placement of the cards in the backplane are as follows The DC to DC converter must be placed in the unnumbered slot cluster 1 The Rack Interface card is placed in slot 18 If used the DSPC LANG card for Asian languages is placed in slot 3 not required if the DSPC FLAT ASIA card is used in slot 1 Master cards can be used only once within any cluster Local cards must be placed in the same cluster as their associated master card they may be placed in any free slot within that cluster Cards with external connections must be placed in the rear part of the backplane The DSPC monochrome display controller has a connection to the local bus although no local cards may be required for its operation It must be located in the rear of the backplane for easy access M1046B only Aux Connector card must be placed in slot 24 and connected to the Rack Interface card 3 14 CMS Patient Monitoring System CMS Patient Monitoring System Bus Structure e MI1046B only Remote Switch card must be placed in slot 8 Table 3 6 Master Cards and their Associated Local Cards Master Card Associated Local Cards Utility CPU SDN Interface and Rack
28. 46 External Alarm Device Connectors and Controls 47 CRT Display Rear Panel Connectors and 48 Switch Mode Power Supply SMPS 50 Remote Displays o ner a We eR RED OS uU Des 53 Control EO PUE REDE ERE lee 53 Remote Keypad sassis tesis ere Dex ode awa ee ee hea QR ATH PACA RAIN 54 Introduction ee eek GR IU Ade s 54 CONNECHONS i 9 le SPERA dC ERE P hee 54 Data Entry sesh ach ete du e c e ODE Qu ga 54 Module Racks E Rr eee tube e S EO 55 Introduction Ak AREAS REN ERRARE 55 Types of e REX WP AC ETIN DUE des 55 Integral Rack 5 55 Satellite Module Rack 56 Module Rack Theory of 56 Module Rack Block Diagram 56 Plug in Parameter Modules 58 Types of Module ERES PR PEN OI IRE AR 58 Alarms 56 Sane tace teca tuos E ier nd inibi ME E 59 Installing a Parameter Module 59
29. 5592 YOLVEVdWO3 aay nins elf 3003 1015 c sna 5535007 NNO2 96 YOL3 Figure 3 50 Rack Interface Card Block Diagram 3 128 CMS Patient Monitoring System Aux Connector Card Aux Connector Card Introduction The Aux Connector card provides access to the connector on the Rack Interface card behind the sheet metal cover of the M1046B Computer Module Connections The Aux Connector card is placed in slot 24 of the M1046B Computer Module The Aux Connector card has two circuit boards connected by a flex board The larger board is placed in slot 24 of the M1046B Computer Module and the smaller board has a connector that plugs into the Rack Interface card in slot 18 The larger of the two boards has two connectors an ECG connector for defibrillator synchronization and an FE Link connector to attach satellite module racks The FE Link connector has the cable to the satellite rack attached behind the Computer Module s plastic cover and the cable is routed under the Computer Module to the back The ECG connector has an ECG adaptor so that it can be accessed through a hole in the plastic cover Remote Switch Card Introduction The Remote Switch card provides connection and the remote switching of the DC power to the computer module the module racks and the flatscreen display Connections The Remote Switch card is placed in slot 8 of the M1046B Compu
30. 57 Criteria for Proper 57 Plug In 2 UA RADO barnes Lane etic 58 SpO2 Measurement Exercises 59 Contents 3 SpO2 PLETH Module enr cte entia 60 Description etu Rd 60 Measurements i nd D eg p Re 60 Components eee o re eps ce re 60 Block Diagram o Li SIE IU UAR RR RAISES ue 60 Theory of Operation 62 SpO2 PLETH Module Features 63 SpO2 PLETH Module Exercises 65 Temperature TEMP Module Concepts 66 TEMP Measurement eorr xq POSU PM ER RET SENA EE RR 66 Description Ede PEE 66 COnCeptS isa cte ees mix i du NATUR hoec t enda SU Rd 66 Measurement 66 Measurement 66 Outputs iius eir Re RAS YR TA 66 Criteria for Proper Measurement 66 Pl g In Module5 oes vereri ewe se a ed 67 References s du ELE
31. CO Respiratory Gas Measurement Description Concepts Measurement Principle Measurement Acquisition Measurement Output CO respiratory gas measurements indicate the efficiency of the transfer of oxygen from alveolar air into pulmonary capillary blood and the elimination of carbon dioxide from pulmonary capillary blood and its transfer into alveolar air The CO respiratory gas measurements are an indication of the patient s overall respiratory status Blood Gas concepts important to this section are Airway Respiration Rate AWRR The number of inspirations and expirations per minute End Tidal Volume The total volume of air expired in one breath End Tidal ETCO The total volume of CO expired in one breath Inspired Minimum CO IMCO The minimum amount of CO inspired in one breath Instantaneous The measurement at any instant Ventilation The movement of air in and out of the lungs by inspiration and expiration The End Tidal Carbon Dioxide measurement for Carbon Dioxide uses technique based on the absorption of infrared radiation by certain gases Infrared light is absorbed by The amount of absorption varies according to the concentration in the gas mixture By using an infrared detector to measure the absorption the concentration in a gas can be derived respiratory gas measurements are evaluated as gas passes thr
32. NN Ei MU ERES 67 TEMP Measurement Exercises 68 5s e AK ed 69 DescriptlOFi iex cea at A ib Eee RES 69 Measurements ut e hex Pe ete Nb eet Re 69 Corniponents oes x epe eoe HENS A E REA PRG 69 Block Diagram AO UD ERU a EB edt a 69 Theory of Operation Ade AIRE E 71 TEMP Module Features 71 TEMP Module 72 Recorder Module Concepts 73 Recorder Module M1116A 78 Description dee 78 BlockDiagram i NA RR RU REN te p ES 73 Theory of cue Ba ir eg Se bs 75 Recorder Module 77 Recorder Module Exercises 116 79 Recorder Module M1116B 80 Descriptions uo eR PR e ean ens e dele AR IA t ase 80 Block Diagram usse e t ER EMEN UIROS ES 80 Th ory of Operation 2 eee
33. 97 RS232 RS422 Dual Interface 98 Contents 13 Introduction aueh re be ER 98 Software Release 5 98 etd 98 Components 99 Theory of Operation 99 Functional Block Diagram 101 Summary of RS23Z R8422 Features 102 HDLC Interface Card metre naeh eedem 102 Introduction sU eR ee ou 102 Components E e Re e I en e Ae XR Ete 102 Theory of Op ration pire E ROREM ERR ERE s 102 5 103 Functional Block Diagram 104 Summary of HDLC Features 104 Analog Interface Card pes 105 fx Rm 105 COMPONENts a oer ee ih ena pd ROLES UE 105 Theory of Operation 106 Functional Block Diagram 108 Summary of Analog Card
34. Figure 1 27 Recorder Module Controls and Connectors User Controls The M1116A and M1116B Recorder Modules have the same controls 1 Continue Indicator An LED that is lit steadily during continuous recordings It blinks twice when the module is first plugged in indicating that the recorder self test has been completed successfully 2 Run Continue Key If the recorder is not running it starts a time delayed recording If the recorder is running it makes the current recording continuous if possible 3 Stop Key Stops the current recording Recordings The M1116A Recorder can produce several types of recordings e delayed real time monitoring procedure Basic Plug In Modules 1 77 Recorder Module M1116A 1 78 Basic Plug In Modules 4 vital signs alarm generated automatically when clinical criteria are violated Recordings are made on 50mm wide recording strip paper Delayed recordings are recordings of waveforms whose measurement began before the recording was initiated For example if a waveform is being displayed on the monitor user can set the recording to start from an earlier time Delayed recordings run for a preset time They can be initiated manually by the user or automatically when an alarm occurs Real time recordings begin immediately at the time they are requested and are stopped manually They can also be preset to begin recording pre selected waveforms at a specific time For pre selecte
35. 42 tcpOZ tcpCO2 Module 018 43 D SCEIPUHON PC 48 Measurements ER IT m iR CR Ro e pre e oe Re Rd 43 Calibration Algorithm 43 Components RC HR PE repe bete rege eem I ree ere 45 Block Diagram sarete A 45 Theory of 2 47 tcpOZ tcpCO2 M1018A Features 48 tcpO2 tcpCO2 M1018A Module 5 49 SvO2 Blood Gas Module Concepts CMS 50 SvO2 Blood Gas 50 Description a ad PE Ee Pate ens 50 CONGO PIS a cake UTC E DIEI NUR RC QUEE IP es EY 50 Measurement 50 Measurement Acquisition 50 Contents 7 Measurement 50 Criteria for Proper Measurement 50 Plug In Modules ooterkenenr eter eR E RS EU Ue eue 50 SvO2 Blood Gas Measurement 5 51 SvO2 Module 021 2 Descript
36. Dual Slope Analog to Digital Digitizes the analog signals from both the blood and injectate Converter channels Block Diagram Figure 1 15 shows the block diagram of the C O Module M1012A 1 44 Basic Plug In Modules Module daria XIH1VIN SSVd 390N3H3H3H XLV SSVd NOILV IOSI LNAlLWd 1 45 Basic Plug In Modules Module Theory of Operation 1 46 Basic Plug In Modules Figure 1 15 M1012A C O Module Block Diagram The module has two separate circuits for measuring blood and injectate temperatures The signals progress through the module as follows 1 Blood Channel The temperature sensor distal in the catheter is connected to a reference switching matrix that continuously compares the input to reference resistors for continuous calibration of the measurement The sequentially produced voltages across the reference and sensor resistors are amplified before being input to a low pass filter The filtered signals are then passed through the multiplexer to the analog to digital converter Injectate Channel The temperature sensor Tinjectate Which is either a flow through or bath probe is connected to a separate reference switching matrix on its own circuit The matrix compares the signals to the same reference resistors used for the blood circuit The output is amplified filtered and then multiplexed with the blood temperatu
37. Receives all SDN messages alarms and data parameters and waves e Transmits wave and parameter data acquired by CMS over the SDN For example an ECG wave acquired by the CMS may be sent to an arrhythmia computer which adds annotated notes to the wave Then the output from the computer can be relayed back to the CMS for display under application software control e Synchronizes the system frame interrupt with the SDN poll cycle performed by the Utility CPU card Detects primary bedside unit mode either SDN or Auto poll and terminates the line as necessary Controls transmit data from the primary bed unit and another instrument for example a local recorder using a priority wire e Data be selectively acquired with no CPU intervention by placing tune headers in the SIGN RAM of the SIC Chip Incoming data synchronized using 28 8 MHz oscillator e SIC RAM consists of two 2 Kbyte buffers 1 transmit 1 receive e Latch controls error LED SIC Chip reset multiplexer switch and multiplexer disable enable 3 124 CMS Patient Monitoring System Serial Distribution Network Interface Functional Block Diagram DNAS MOLWTIIDSO HINO WB3BISNWE M3AI32 SNYAL WEGMISdI
38. CDSPC 3 GED or DSPC_FLAT 3 only model 88 Ta AGED rs232 IF 2 EFD RACK IF D ELD spN ir 15 MHz APP AUX GRD vec converter For future use if upgraded CMS Patient Monitoring System Hardware Configurations M1046A Computer Module Systems with M1066 66531 or 1066 66643 DSPC or 1072 66531 or 1072 66543 CDSPC or M1074 66501 DSPC FLAT or M1074 66502 DSPC FLAT FRONT REAR DSPC 1 or e P CDSPC 1 or DSPC FLAT 1 LANG 1 POL 40 MHz ED RUS CZE DSPC 2 or ED CDSPC 2 or DSPC_FLAT 2 CP EID 40MHzCPC 1 ANALOG IF or DSPC 3 or CDSPC 3 vr or DSPC FLAT 3 only model 88 GRD 5 210 2 ra EFD RACK 9 ELP spN ow HDLC IF 15 MHz APP QD GD DC DC converter For future use if upgraded with these controllers no DSPC_LANG is required M1046B Computer Module Systems with M1074 66501 DSPC FLAT or M1074 66502 DSPC FLAT FRONT REAR EB DSPC_FLAT lor DSPC 1 DSPC LANG 1 AP PRC ROC GRK 40 MHz CPC 2 ED POL RUS CZK Lg PSPC 2 or CDSPC 2 or REMOTE _ DSPC FLAT 2 q RS232_1F 1 40 MHz 1 ANALOG IF or DSPC 3 or CDSPC 3 GED or DSPC_FLAT 3 only model 88 ERD rs232 IF 2 qr
39. Configurable Processor Card Monochrome Display Controller Color Display Controller Cards Color Display Controller Card New Version Flatscreen Display Controller Card Utility CPU RS232 RS422 Dual Interface Card HDLC Interface Card Analog Interface Card Master Card Overview Introduction The CMS contains two types of function card master cards and local cards Master cards have a microprocessor and connect to the Message Passing Bus MPB most also have a connection to the Local Bus Local cards perform supporting functions for the master cards and connect to only the Local Bus Master cards communicate with the system over the MPB and with their corresponding local cards over the Local Bus Refer to CMS Bus Structure in the System Overview section for a description of the bus architecture 3 64 CMS Patient Monitoring System Master Card Functions Master Card Overview The following table describes the functions of the master cards Table 3 19 Master Cards Card Name Function Application CPU APP CPU Executes software held on an EPROM Card an SRAM card or on the CPU s SRAM Data to be processed are taken from either the CPU s SRAM an SRAM or the MPB The number of Application CPUs that may be used by the Computer Module is limited only by the number of local clusters on the backplane Monochrome Displ
40. Both the application and utility processors have dedicated service ports Both are upgradeable by the CPC service tool The front end rack software is not externally upgradeable A standard CEE connector IED Type 320 is located at the rear of the V24 V26 Mainframe A detachable country specific line cord is supplied The connector has the same form fit and functionality as in CMS This three circuit phono jack connector is located on the upper left side of the V24 V26 Mainframe 4 12 V24 and V26 Patient Monitors V24 and V26 Patient Monitors Interfaces 24 and V26 Patient 1 The Philips monitoring network SDN connector used with the V24 V26 is Monitors Interfaces Exercises a both an upstream and downstream connector b a downstream connector c an upstream connector only 2 Digitized patient information transmitted over the Philips monitoring network SDN may be either a waveforms b parametric information c both a and b 3 The standard CEE connector is located at a the front of the V24 V26 mainframe b the rear of the V24 V26 mainframe c on the left side of the V24 V26 mainframe Answers l c 2 c 3 b V24 and V26 Patient Monitors 4 13 V24 and V26 Patient Monitors User Controls and Connectors 24 and V26 Patient Monitors User Controls and Connectors Introduction The following section describes the V24 V26 and its User Controls and Connectors Objectives After completing this section you sh
41. HOLO3NNOO LNdNI 1 61 Basic Plug In Modules SpO2 PLETH Module Theory of Operation 1 62 Basic Plug In Modules Figure 1 20 M1020A SpO PLETH Module Block Diagram The signals progress through the module as follows Light Transmission Two LEDs in the transducer generate red and infrared light that is transmitted through a well perfused capillary bed in the patient s finger or toe The LEDs are controlled by the software and are supplied with a chopped current of 375 Hz Sensor detection circuitry detects both the presence and type of transducer connected To optimize the amplitude in the pulse sequence the chopped current source is independently controlled by the digital to analog converter A test signal can be generated in the input stage by switching the sensor signals off A photodiode directly opposite the LEDs detects the amount of light passing through the tissue and generates a current that represents the intensity of the light detected for each wavelength The current consists of a DC part representing ambient light modulated with a small AC signal from the pulsatile blood flow The current passes through the input protection network and is converted to voltage Over range Detection The over range detector checks the input voltage for overload due to an excessively high current from ambient light It also checks the pulsatile signal for overload from the transducer light source Ambient Light Rejection The
42. Theory of Operation There are four major sections that the electrical signal must pass through in order that it reach the Monitor interface 1 The Microprocessor is in overall control of the CO Module functions and also performs the following functions Serial communication via optocouplers with the rack interface card in the Computer Module Calculation of the calibration constants Calculation of the raw data of the waveform Data are passed from the microprocessor to other areas of the module over an internal data bus 2 The temperature of the transducer is maintained at approximately 33 C to prevent condensation and to negate any discrepancies due to temperature changes Signals from the temperature sensor in the transducer are amplified and then passed through an Analog to Digital converter The microprocessor then adjusts the output of the motor drive circuitry accordingly The microprocessor derives the measurement timing from the motor drive circuitry 3 Signals from the infrared detector are amplified and passed through a dual slope Analog to Digital converter This converter is controlled by the microprocessor via the counters The conversion is started at a predefined time and is performed synchronously with the motor rotation The Zero GZ Sample GS and Reference GR signals are produced and used as the input values for the CO algorithm An auto zero signal AZ which is deriv
43. There are two fuse holders for the line protection fuses one for the higher operating voltage range and one for the lower operating voltage range A 3 pin connector used to input the local line voltage The display is powered directly from the main power source through a 3 pin IEC power inlet plug A voltage selector is not necessary the voltage is detected and selected automatically by the display This works for a voltage range of 90V AC to 264V AC The French ICU version has a mains operated relay with one pair of contacts connected to a mini phone jack socket When the power is present the contacts are closed Therefore loss of power breaks the circuit which can be used to control an alarm When the display is used as a main display the 60V output at the 15 pin System Power connector is used to power the DC to DC converter in the Computer Module The System Power connector is not present on remote displays A grounding stud connector used to connect the display module to an equipotential grounding system if required The overall system is normally grounded at the grounding terminal on the Computer Module The Philips HIL connector on the rear of the display provides the connection to the Utility CPU in the Computer Module Another Philips HIL connector on the bezel of the display allows a handheld keypad to be connected When this connector is not in use it may be covered with a blanking plug The horizontal sync vertical sy
44. Basic Plug In Modules 1 83 Recorder Module M1116B Recordings 1 84 Basic Plug In Modules The M1116B Recorder can produce the same recordings as the M1116A Module plus the additional type delayed real time monitoring procedure e vital signs alarm generated automatically when clinical criteria are violated oxygen cardiorespirogram oxyCRG recordings cannot be made by the M1116A Module Recordings are made on 50mm wide recording strip paper Delayed recordings are recordings of waveforms whose measurement began before the recording was initiated For example if a waveform is being displayed on the monitor a user can set the recording to start from an earlier time Delayed recordings run for a preset time They can be initiated manually by the user or automatically when an alarm occurs Real time recordings begin immediately at the time they are requested and are stopped manually They can also be preset to begin recording pre selected waveforms at a specific time For pre selected waveforms three separate recording modes can be configured A preset recording begins printing when the preconfigured recording key 18 pressed Monitoring procedure recordings can be made during cardiac output and pulmonary artery wedge pressure measurements and during ST analysis They are accomplished with soft keys during the procedures Vital sign recordings can be initiated automatically by an NBP measurem
45. CMS Patient Monitoring System 3 45 Display Module Rear of Main The rear of the M1092A and M1094A main displays is shown in Figure 3 21 The Display rear of the M1094B main display is shown in Figure 3 22 and rear of M1095A in Figure 3 23 Equipotential ounding Terminal Human Interface Connector System Power Connector Video Out witc Connector To Termination m Video IN Connector Local Power Connector Fuses mar5b Figure 3 21 Rear of M1092A and M1094A Main Displays Local Power Connector 7 gt Human Interface Line Connector System Power Connector 11 8 M Fuses 6 Equipotential Grounding Terminal 12 9 gt Video Termination Switch 1 Video Out Connector 10 0 Video In Connector 9 rearl Figure 3 22 Rear of M1094B Main Display 3 46 CMS Patient Monitoring System Display Module Combined Video In Power Connector Brightness A Control HIL HIL Standby Switch Human Interface 7 Link Connector In 9 Human Interface pe Link Connector Out r d M10953d tif Figure 3 23 Rear of M1095A 10 4 Flatscreen Display External Alarm The
46. Figure 3 20 Front Panel of 15 Flatscreen Display 3 44 CMS Patient Monitoring System Front Panel Controls and Connectors On Off Switch Power On Indicator Contrast Control Brightness Control Human Interface Link Connector Control Panel On Off Switch Brightness Control Power On Indicator Control Panel Display Module The following is a description of the control panel on the front of the CRT display A push button switch used to turn the complete system on and off The switch is pushed in for power on A green LED which is lit when the system is switched on A rotary control used to vary the contrast of the display not available on the Flatscreen Display A rotary control used to vary the brightness of the display A Philips HIL connector used to input information from a remote keypad connected to the master display This connector may be covered by a plastic insert when not in use see rear of flatscreen display for this connector The user interface of the Display Module See the following section The following is a description of the control panel on the front of the M1095A 10 4 Flatscreen display A push button switch used to turn the display on and off The switch is pushed in for power on A rotary control used to vary the brightness of the display A green LED which is lit when the system is switched on The user interface of the Display Module See the following section
47. Figure 3 35 CDSPC CTRL Card Block Diagram Summary of CDSPC A summary of the features of the CDSPC cards follows Cards Features Displays up to 8 overlapping waves in 7 colors with horizontal scrolling Two alphanumeric graphic planes 1024 x 512 pixels x 3 color banks for displaying text figures and simple graphics One wave plane with extended resolution 2048 x 512 pixels x 3 color banks that can display up to 8 overlapping waves with horizontal scrolling Three character sizes large 32 x 40 pixels normal 16 x 20 pixels dense 12 16 pixels e Attributes resolution 256 x 256 bytes e Can drive a master and up to 3 remote displays e Color luminance equalization 60 Hz operation CMS Patient Monitoring System 3 83 Color Display Controller Card New Version Color Display Controller Card New Version Introduction Connections CDSPC Components 68000 Microprocessor MPB Interface FIFO SRAM PROM The Color Display Controller CDSPC card is used by the system to output display data to a color monitor The CDSPC card is similar in operation to the DSPC card with the exception that the Video RAM is three times larger The CDSPC was introduced as a direct replacement for two cards CDSPC and CDSPC VIDEO and has the same functionality as these cards The CDSPC is fully backwards compatible The CDSPC card must be inserted into the rear of the Computer Module so that it can be conne
48. RACK GED ELD lt ir D OJD IF 15 MHz APP CPU QV 9 DC DC CONVERTER For future use if upgraded CMS Patient Monitoring System 3 29 CMS Patient Monitoring System Hardware Configurations Plug in Parameter Modules Figure 3 12 Software Release A 0 to C 0 Backplane Configuration The number of Plug in Parameter Modules that can be used with a system depends on the model and software revision Please refer to Appendix A Product Information in the Philips CMS Patient Monitoring System Service Guide for detailed information If too many modules are plugged in a message is displayed in the system message field on the screen as follows Currently ignored module in rack position R P where R the number of the rack 1 internal 2 first satellite and so P the slot number in that rack 1 left most slot 8 right most slot The following message is displayed if an unknown module is plugged into the rack Unrecognized module in rack position R P 3 30 CMS Patient Monitoring System CMS Patient Monitoring System Software Configurations CMS Patient Monitoring System Software Configurations Introduction The CMS display module shows one of three types of screen depending on the level of operation taking place The screens are the Standard Display the Selection Window and the Task Window Standard Display This display shows the parameter information that pr
49. lt DCDCCONVERTER Figure 3 6 Software Release B Backplane Configuration Software Upgrade Release C 10 MHz CPU CMS Patient Monitoring System Hardware Configurations Models 54 S 64 S and Models 56 S 66 S without C26 FRONT REAR DSPC 1 or BLANK or CDSPC_VID 1 CDSPC_CTRL 1 e BS CETANG EPROM MASTER D KANJI TAI or PRC E 15 arr cru CDSPC_CTRL 2 qe n CDSPC VID 2 15 MHz APP CD 9 ET 15 EPROMsLAVE or EED ir cru RACKIF ceu DC DC CONVERTER Models 56 S 66 S with C26 and Model 68 S FRONT REAR 9 DSPC 1 BLANK or CDSPC VID 1 CDSPC CTRL 1 e EN EPROM MASTER D KANJI TAI or PRC _ 15 coo CDSPC 2 Wqe ED DSPC 2 or 15 MHz APU TD CDSPC_VID 2 5 2 x ru sram GI ETD 15 app cov EPROM SLAVE amm 2 or 3 15 MHz APU DSPC 3 only 68 S EED rr cru Ir B 79 o 15 MHz APP DCDC converter Figure 3 7 Software Release Backplane Configuration 10MHz CPU CMS Patient Monitoring System 3 23 CMS Patient Monitoring System Hardware Configurations Release C without CPC Upgrade Backplane The table below shows the slot locations and quantity of 10 MHz M1054 66501 and 15 MHz M1051 66501 APP C
50. wall box The LDCs provide the ability to move systems to different bedsides by connecting the systems to the wall boxes at the new locations How the Philips Monitoring Network SDN Works The Philips monitoring network SDN uses a network configuration called a star topology The Philips care hub SCC is the center of the star with up to 32 individual branches extending from the center These branches can accommodate up to 24 bedside monitors such as CMSs and V24 V26 monitors with one patient per branch up to six central stations and two computer monitoring systems Figure 5 2 illustrates a sample Philips monitoring network SDN configuration 5 4 Philips Monitoring Network SDN How the Philips Monitoring Network SDN Works SICU SDN SDN SDN 78574 Bedside Bedside Bedside M T M T M T SDN SDN SDN 78574 Bedside Bedside Bedside M T M T M T Branch Wall Box w Face Plate Sables
51. 109 CMS Local Function Cards 110 Introduction eer eR P Ue A teer D Pes 110 m 110 CONCEPTS 3 aio eure o cta tute Rar pets ette pt eu vos tutos 110 TOPICS m et a e to qao ac dee aret a re er el aede 111 LEocal Overview ux REN 111 Introduction he Rid 111 Local Card Functions 111 EPROM AMI DD ee sve de arg tue s 113 unciarum 113 COMP OMENS cc 113 Theory of Operation LR IA 114 Functional Block Diagram 114 Summary of EPROM 115 SRAM EE 115 Introd ction LR re de Lt 115 Components de e Ret ape 115 Theory of Operation eus essendi Pere din RR RIDE 115 Functional Block Diagram 117 Contents 14 Summary of SRAM 117 Color Display Video 118 Introdu ction niesi eser dee sedere ede 118 Gonnectlorns unns AE ROG RUNE 118 CDSPC VIDEO Co
52. 66 S 68 S ACMS Models 74 S 76 S 84 S 86 S 88 S NCMS Models 36 S 44 S 46 S 48 S 2 Type of processor cards used 10 MHz CPU cards M1054 66501 15 MHz CPU cards M1051 66501 40 MHz CPC card M1053 66515 3 Type and combination of display controllers used M1066 66501 DSPC Monochrome M1066 66531 DSPC Monochrome e M1066 66543 DSPC Monochrome with integrated DSPC lang M1072 66521 CDSPC CTRL Color together with M1072 66501 CDSPC VIDEO M1072 66531 CDSPC Color M1072 66543 Color with integrated DSPC lang M1074 66501 DSPC FLAT Flatscreen color M1074 66502 DSPC FLAT Flatscreen color M1074 66503 DSPC FLAT Flatscreen Color with integrated DSPC lang M1075 66503 XGA DSPC XGA with integrated DSPC lang 3 20 CMS Patient Monitoring System Software Release 10 and 15 MHz APP CPUs CMS Patient Monitoring System Hardware Configurations Using 10MHz Application CPUs FRONT REAR AND DSPC or BLANK or CDSPC VIDEO CDSPC CTRL e c EPROM MASTER B EB r cru CDSPC_CTRL 2 QD DSPC 2 or APP_CPU CDSPC VID 2 f present ETB r cru EPROMSLAVE APP CPU c RS232 IF if present Model 68 only cru SDN IF if present APP_CPU _ vewc converter Using 15MHz Application CPUs FRONT REAR DSPC or BLANK or D CDSPC VIDEO
53. Depending on cartridge configuration the concentration of a combination of electrolytes blood gases and other analytes in whole blood is determined A detailed description of each analyte and its clinical relevance can be found in the i STAT System Manual in the Cartridge and Test Information section Blood analysis concepts important to this section are Plasma the fluid component of blood a solution of proteins approx 7 salt approx 0 9 and glucose approx 0 196 in water e Whole blood blood that has not been separated into its components such as leukocytes red blood cells plasma or platelets Electrolyte a substance that yields ions in solution so that its solutions conduct electrolytes There are three types of electrodes incorporated into the cartridges Potentiometric Amperometric Conductometric These are all thin film electrodes microfabricated onto silicon chips Sensing functionality is imparted to each electrode by a number of chemically sensitive films coated over the active region of the electrodes Potentiometry is the measurement of the difference in potential that exists between an indicator electrode and a reference electrode Ion selective electrodes ISE are examples of potentiometric systems The indicator electrode is designed to be sensitive to a particular ion in a solution In cases where other ions are sensed by the System selectivity coefficients can be used to correct for this in
54. 10 9euuo eDpuieo preog eoepelu 105095 uleis g jeoiueuoe u gt jeubis reypa 2 1010 jeuBis 1010JA 8 epis 1894 1 Q JOJOOUUOD a gt 8 k 8 18Jo0Au05 nous ov o euy JojyeeHn 5 5 041u02 JouoAuo 105599014019 01 Cartridge Temperature Signals AC Conductivity Amperometric Signals Potentiometric Signals Boyeuy Module Key LEDs eoenelu pue 1015 9 INOHd3a ARINO 998 Jeju ur uniuirT Jomo eDpuueo SUEJ eJnsseJd puejuo4 20100 Jamod Bojeuy Jeu ig yur pusjuol4 jonuog PIEPUE 49geAuo2 SINO yor 09 oq og yon 59 Ajddns 19 4 Advanced Plug In Modules 2 63 Figure 2 19 BAM Module Hardware Block Diagram Blood Analysis Module M1022A Theory of Operation 1 Electrical signals from
55. 4 26 V24 and V26 Patient Monitors to DC Converter Battery Charging Circuit 24 and V26 Patient Monitors Theory of Operation The AC to DC converter subcircuit converts the AC line 90 to 250 VAC 47 to 66 HZ into a safety isolated DC output The input AC voltage is directly rectified to create a high voltage DC rail 100 to 350 VDC The voltage rail feeds a high frequency 100 khg switching connector This generates a safety isolated 18 VDC Vch at pin 30 of connector J3B used to power the battery charger and DC to DC converter AC INPUT FORWARD TO RECTIFIER EM CONVERTER CONVERTER Y TO BATTERY CHARGER The battery charging circuit contains two identical battery charger circuits which control the charge of the two sealed lead acid batteries through four distinct states These states are State Description On power on reset or if the battery voltage is less than 12 33 V at 25 a constant current is sourced to the 1 battery The current has value of 0 83 amps if the monitor is switched off or 0 19 amps if the power switch is on When the battery voltage reaches 14 7V at 25 C the voltage is regulated to this value and charge current tapers off When charge current tapers off to 42mA the charging circuit switches to the next state A four to five hour time is started and battery voltage is 3 regulated to 13 7V at 25 C A signal indicating the battery is more than
56. CEU Board_ FLAT PANEL 78 KHz Depending upon rack used FE Util DISPLAY CPU CPU 5Vdc 12Vde 60Vde CONTROL AC INPUT nominal POWER PANEL 90 TO 250 VAC gt SUPPLY 48 TO 66 Hz A A equ 2 LEAD ACID BATTERIES V24 V24C V26C The V24 V24C V26C power supply provides the following power outputs Power Supply V24 V24C V26C 5 Volts 2 0 Amps max 5 Volts 2 5 Amps max 12 Volts 2 0 Amps max 12 Volts 0 75 Amps max 60 Volts 0 35 Amps max 60 Volts 0 35 Amps max V24CT V26CT The V24CT operates from an internal battery power supply or from an external AC Power Supply source The internal power is provided by one or two lead acid batteries The 24 can operate on 90 to 250 VAC 48 to 66 Hz depending on local power sources The Power Supply converts input power into three DC voltages for use in the transport mainframe and for the plug in modules in the transport rack The power board communicates its status and the status of the internal batteries to the processors on the System Board The V24CT power supply provides the following power outputs V24CT V26CT Power Outputs 5 Volts 2 8 Amps max 12 Volts 0 65 Amps max 60 Volts 0 3 Amps max V24 and V26 Patient Monitors 4 25 V24 and V26 Patient Monitors Theory of Operation Subcircuits The Power Supply consists of four subcircuits AC to DC converter Battery charger e DC to DC converter e Power Logic CPU Interface
57. P 25232 IF 1 ED ANALOG IF or DSPC or DSPC_FLAT 3 or CDSPC 3 only model 88 RS232 IF 2 ELD OJD CDSPC CTRL 2 REMOTE SWITCH 40 MHz CPC RACK IF 15 MHz APP CPU 25922285299 AUX CONNECTOR baconel tif EP DC DC CONVERTER Figure 3 11 Software Release Backplane Configuration CMS Patient Monitoring System 3 27 CMS Patient Monitoring System Hardware Configurations Software Releases A 0 to C 0 3 28 CMS Patient Monitoring System M1046A Computer Module Systems with M1066 66501 DSPC or M1072 66521 CDSPC M1072 66501 CDSPC VIDEO FRONT REAR DSPC 1 or CDSPC CTRL 1 B CDSPC VIDEO 1 E lt LANG ROC 40 MHz 2 ED CDSPC_CTRL 2 4 40 1 qr RACK IF D 15 MHz APP Q9 OZD OD DCDC CONVERTER P 5232 IF 1 EID 3 only model 88 ERP 25232 1F 2 EFD cru ED lt OJD For future use if upgraded M1046B Computer Module Systems with M1075 66503 XGA DSPC or M1074 66503 DSPC FLAT FRONT REAR XGA DsPC 1 or DCPC FLAT 1 ED 40 gt 2 QUI XG DSPC 2 DSPC 2 or CDSPC 2 or DSPC FLAT 2 52218 EID 40 ANALOG IF or XGA_DSPC or
58. T Parameter 59 Connection to the 59 Connection to the 59 Contents 11 PRECAUTIONS ss RO Rp CAP ATS itat a 59 CMS Patient Monitoring System Module 60 CMS Master Function Cards 63 Introductions e RU Au RARE oU AU AR UR E INA eR ER 63 dn M PI ERI 63 COnCeDis eva ORE oes 63 TOPICS ter Vua 64 Master Card 64 Introduction COP Cbr a BAV eee aan d 64 Master Card F rictions 252 if ace dae e E ER UD qq EXER 65 Communication with the 66 DG3Xo DC Converter vias an ta RU Ae AUD RE Xe XR Y ES 67 Functional Block Diagram 67 Theory of Operation 68 Application x Edu x MA REET EE 9 Introduction ese ERG AES Ae ERO 69 Components aaa RU Ee PR EFE UR REX d eR 69 Theory of Operation 24 bi ket be ve eme e De er RO er UR
59. The Control Panel controls are used to display screens of data respond to alarms and access various functions of the system s software Module Rack This connects the Plug In Parameter Modules to the Computer Module The rack may be an integral rack which is connected to the front of the Computer Module or a satellite rack which is connected remotely An integral rack can support up to eight single width plug in modules and up to three satellite racks A satellite rack can support either six or eight plug in modules and one additional satellite rack The integral rack also has a connector for defibrillator synchronization Plug In Parameter Module Collects most of the patient data and processes patient measurements three of the modules do not take measurements Fourteen types of module are available Some of them have transferable settings that are retained when the module is transferred from one rack to another Each module has a connector on the back for the rack most have front connectors for accessories that are connected to the patient 3 34 CMS Patient Monitoring System Topics Computer Module This section contains the following topics Table 3 11 Topics in the Function Modules Section Computer Module 3 35 Integral Power Supply Computer Module M1046B 3 40 Remote Power Supply M1047A 3 41 Display Module 3 43 Remote Keypad 3 54 Module Racks 3 55 Plug in Paramet
60. The M1116B Recorder Module can write different waveforms at speeds 2 The two printed circuit boards in the module are referred to as the board and the board 3 Which component supplies the power for the digital circuits and recorder mechanism a DC to DC converter b opto isolators c motor control circuits d microcontroller 4 Which component converts the waveforms and annotation into a dot matrix for printing a DC to DC converter b microcontroller c thermal printhead d motor control circuits 5 The M1116B provides that is not available on the M1116A Answers 1 three ten 2 power supply digital 3 a 4 b 5 ten recording speeds versus 8 or oxygen cardiorespirogram OxyCRG recordings Basic Plug In Modules 1 85 Data Transfer Module Data Transfer Module Concepts Data Transfer Module Description The 1235 Data Transfer Module provides data transfer capability for the CMS including the Anesthesia CMS the Component Transport System and 24 26 It is designed to transfer a patient s vital signs and demographics between monitors in a range of critical care environments The module retains patient information for an hour or longer when not plugged into a monitor Components The following components carry out the major functions within the module Table 1 15 Major Components Component Function Power Supply Generates power for the digital circuitry and LEDs Microco
61. Wer Controls IER RED pce 14 OVOTVIQW oeste serai d eR pea 14 DISplayis idet ex Eun SE e UE vede n a SU UR RARE 14 Front Panel Controls VER EERE mE mr e ERA Ese 15 The V24 V26 Front Panel 15 V24 V26 User Controls Exercises 17 Connectorsc sede itus Ma Dr ee Ae pA ste Mere 18 Overview c dato teas ucc ee RR OE Na aS ERAT doe Wes oce ats 18 Eiglitslot Rack sees obe ER PU dE EU e RE dh D Rue EM 18 Six slot Rackw ss cbr eque cee brewed Weeds eee ds ER A EXP 18 Connectors Exercises iss ERE URGERE E RA EN EYE 19 Contents 16 V24 and V26 Patient Monitors Software Configurations 20 Introduction isa EUR e E E ERR PEE EE AR 20 Objectives 20 CODCODIUS A caste ette ais 20 Overview PEE 20 Modules Partitioning E NOU IUS AO e Re ARR 21 Application CPU Architecture 21 Utility CPU 21 Front End Microcontroller 21 V24 V26 Software Configurations 5 5
62. for example amp PCO3 2 60 Advanced Plug In Modules Blood Analysis Measurement Blood Analysis Results N 02 0 35 ield 2 9 45 8 Field 3 Art Auto Transmit in 9 7 415 Na 4 mmo 4 60 kPa K 4 48 mmo 27 kPa amp 1 43 1 24 mmo 40 mmol l Toat 34 6 EC 17 mmol l 0 39 41 mmol L Hb 13 y dl 302 95 9 DUE 2 2 indicates a calculated result Press CONFIRM to transmit results as displayed J S E Hanges Hecord Re ec Blood Units Undo Revie Negative Factors Affecting Proper Measurement Figure 2 18 Blood Analysis Results Window The main factors affecting accurate blood analysis results are e Notremixing the sample If the cartridge is not filled immediately after drawing blood the blood must be remixed thoroughly Mix tubes by gentle inversion 7 times and syringes by rolling between the palms for at least 5 seconds in two directions Exposing the sample to air when measuring pH and Time delays before filling the cartridge Drawing a sample from an arm with an e Samples collected in vacuum tubes with anticoagulant other than lithium or sodium heparin Syringe for pH PCO and PO with air bubbles in sample Advanced Plug In Modules 2 61 Blood Analysis Module M1022A Blood Analysis Module M1022A Description Measurements Measured Calculated Compon
63. no alarm recording digital ground high output alarm recording active for 20 sec digital port 5 low output no INOP digital ground high output INOP digital port 4 low output no active alarm digital ground high output active alarm digital port 3 low output main alarms on digital ground high output all alarms suspended digital port 2 low output 2 no ECG INOP digital ground high output ECG INOP digital port 1 low output no active ECG alarm digital ground high output active ECG alarm digital port 0 low output ECG alarms on digital ground high output ECG alarms off shield chassis ground analcon mif Figure 3 43 Analog Interface Output Connector CMS Patient Monitoring System 3 107 Analog Interface Functional Block SLINDYID 9 didWvs 1519394 5 E Mol 5 gt gt E M 1UOd 1 imo 4 5 YOLOINNOD TANVd uv3d en emm IN3A3UnSV3IA HOHH3 ova NOLLVSN3dIAO2 l4 avd M 239 SNLTdLETYA AS H3TIOH1NOO e OHAIN SS3udav viva lt TOHINOO HO123NNO 96 wou Figure 3 4
64. parameter unit It is designed to be used with adult neonatal or pediatric patients in Critical Care environments The M1002A B ECG RESP Module possesses the same ECG functionality as the ECG Module and adds respirograph functions as well The ECG produces up to 3 continuous real time waveforms of the patient s cardiac electrical activity It also generates numerics for the average heart rate HR derived from either the ECG or a remote arrhythmia computer The following components carry out the major signal processing functions within the module Table 1 1 Major ECG Module Components Component Function Input Protection Network and ESU Filter Protects the input amplifiers from defibrillation and high frequency interference signals Lead Selection Switches Selects channels 1 and 2 for patient leads with EASI also channel 3 Right Leg Drive Minimizes interference from the 50 60Hz power line Highpass and Lowpass Filters Allow independent selection of diagnostic monitoring or filter bandwidths for each channel Test Signal Generates a calibration voltage on each channel and tests the circuitry of the module Pace Pulse Detector Detects pace pulses for channels land 2 Figure 1 8 shows the module s logical structure Basic Plug In Modules 1 13 ECG Module
65. respiratory gas measurement is displayed as a a numeric value b waveform c percentage amount d aandb 4 What factors can influence the accurate measurement of CO respiratory gas a temperature of patient s breath b amount of water vapor in patient s breath c aandb Answers 2 22 Advanced Plug In Modules CO2 Respiratory Gas Module M1016A CO Respiratory Gas Module M1016A Description The M1016A Module is a carbon dioxide measurement parameter unit It is designed to be used with adult pediatric or neonatal patients in a range of Critical Care environments Measurements The M1016A Module produces a real time waveform together with numeric readings for the End Tidal CO Inspired Minimum CO and Airway Respiration Rate During the calibration of the module the numeric value for instantaneous CO is displayed Components The M1016A Module consists of the following major functional components Table 2 4 Major Module Components Component Description Microprocessor Controls the overall Module functions Heater Control Maintains the temperature of the transducer Motor Control Responsible for rotating the filter wheel at a speed of 40 rotations per minute Infrared Detector Signal Transfer Amplifies signals from the infrared detector and passes it through a dual slope Analog to Digital converter EEPR
66. some of the parameter settings may be transferable when that module is moved from rack to rack There is a special service mode setting that is made by either a Philips service engineer or the biomedical engineering department to allow this function The parameter modules can be plugged into two types of rack integral and satellite The integral rack is connected to the front of the Computer Module The satellite rack is a free standing rack that can be attached to an pole the bedside or the wall The front of the parameter module has a connector socket which is the same color as the corresponding connector plug on the transducer or patient cable If a satellite rack is located in close quarters with intravenous solutions such as saline severe damage can occur to the equipment if the saline solution is spilled onto the connectors of either the parameter modules or the satellite rack CMS Patient Monitoring System 3 59 CMS Patient Monitoring System Module Exercises CMS Patient Monitoring System Module Exercises 1 Which CMS module distributes the power clocks and data to the rest of the system a Computer Module b Display Module c Module Rack d Plug In Parameter Modules 2 How many main displays can be used with one CMS a one b two c three d four 3 Which module has a connector for the SDN Interface a Computer Module b Display Module c Module Rack d Plug In Parameter Modules 4
67. 10 shows the user controls and connectors for the M1015A Sidestream CO Module Refer to this figure for the User Controls and Connector descriptions 1 M1015A 1 gt 3 amp o cy Figure 2 10 Sidestream C0 Module Controls and Connectors Gas Outlet Connector The gas outlet connector lets out the gas after it has been sampled Gas inlet Connector The gas inlet connector provides the connection for the sample tubing and bacterial filter which receives the patient s gas sample Slide Cover The cover protects the gas inlet connector when the module is not in use Sample Cell The transducer is mounted on the sample cell of the sidestream module The transducer plug is connected to the M1015A Plug in Module Switch The switch activates the Sidestream pump when the transducer is mounted on the sample cell Mounting Clamp The mounting clamp holds the transducer in place To ensure the safety of the patient the patient applied parts are isolated from ground by optical isolators and a transformer In addition the entire module is encapsulated in plastic This module complies with UL544 IED 601 1 CSA C22 2 No 125 Patient leakage current is less than 0
68. 2 3 Major PRESS Module M1006B Components Component Description Input Protection Network Protects the module from extraneous signals i e defibrillation and electro surgery Analog to Digital Converter Amplifies filters and digitizes the input signal Microcontroller Unit Sets all control information Block Diagram Figure 2 6 shows the block diagram of the patient s recorded signal flow through the PRESS M1006B Module 2 16 Advanced Plug In Modules Invasive Blood Pressure Module M1006B SIND PATIENT ISOLATION 16 MHz CLOCK OSCILLATOR EEPROM 256 BYTES WATCHDOG MICRO CONTROLLER RANSDUCER DETECTION SIGNAL CONDITIONING A D CONVERTER EXCITATION CIRCUITS MYOMLAN NOILOALOWd SYOLOANNODO LNNI Figure 2 6 M1006B Invasive Pressure Module Block Diagram Advanced Plug In Modules 2 17 Invasive Blood Pressure Module 1006 Theory of Operation PRESS M1006B Module Features There are four major sections that the electrical signal must pass through in order to reach the Monitor interface The amplitude modulated signal from the patient is received electrically through the input connector from the 5uV V mmHg transducer connected to the patient s catheter The signal then gets passed through the Input Protection Network where extraneous signals are filtered out This network provides protection against defibrillation spikes The signal then t
69. 384 heater elements for printing the dots oriented perpendicular to the direction of paper travel It also contains a 384 stage shift register which serves as a data holding buffer for one column of dots to be printed Each heater element has is own driver circuit When a column of data is received the shift register is loaded the dots are printed as their respective heater elements are turned on Print density is controlled by the width of the strobe applied to each dot and by the temperature of the printhead The signals to the paper drive motor are sent through the motor control circuits on the power supply board These circuits regulate the speed of the paper motion Recorder Module Figure 1 29 shows the user controls for the M1116B Module Features gt REC M1116B 1 RUN CONT 2 STOP 3 V Figure 1 29 Recorder M1116B Module Controls User Controls The M1116A and M1116B Recorder Modules have the same user controls 1 Continue Indicator An LED that is lit steadily during continuous recordings It blinks twice when the module is first plugged in indicating that the recorder self test has been completed successfully 2 Run Continue Key If the recorder is not running it starts a time delayed recording If the recorder is running it makes the current recording continuous if possible 3 Stop Key Stops the current recording
70. 90 charged is given After a time out the charger is disabled The charger is 4 re enabled into state 1 if the battery voltage drops below 12 33V at 25 C or if power is cycled V24 and V26 Patient Monitors 4 27 V24 and V26 Patient Monitors Theory of Operation The following figure shows a graphical representation of the battery charging circuit states I N UN 2 N CURRENT ox ieri as conteste lt VOLTAGE 222 Eos 4897 4 290V 13 4 STATE I STATE STATE STATE IV 4 1 2 hours 1 1 2 hours 5 6 hours Figure 4 4 Battery Charging States 4 28 V24 and V26 Patient Monitors 24 and V26 Patient Monitors Theory of Operation Charger Operation State 1 The charger circuit receives input from the non switchable 18 Vdc output of the AC DC power supply The charging circuit contains two identical battery charger circuits The following description applies to either battery charger circuit The Sealed lead acid battery charging circuit regulates the charge to the battery The circuit contains a temperature sensitive voltage reference tuned for optimum regulation of charge voltage to lead acid batteries When the battery is inserted a mechanical sense contact pulls the input to a debounce circuit low This allows the charger circuit to proceed with the first state Charger Operation State 2 The charging circuit enters the second state when th
71. CMS Patient Monitoring System 3 49 Display Module Switch Mode Power The SMPS supplies all the power for the operation of the local equipment and the Supply SMPS integral and satellite module racks including the Plug in Parameter Modules Three types of SMPS are used one for the M1092A display one for the 1094A display and one for the M1094B display The differences are noted and covered separately in Table 3 16 Table 3 16 SMPS Characteristics M1092A and M1094A M1094B Display A 28V supply is provided for the deflection board of the M1092A Monochrome Display Line voltage is routed through the SMPS One SMPS for all voltages required to another SMPS on the deflection board of the M1094A Color Display Supplies the de gausing coils for the display screen M1094A B only Supplies the power on LED and the Philips HIL board on the bezel of the display For the main display it also provides 60V for the Computer Module The DC to DC converter receives the 60V and produces the voltages for the function cards The SMPS in the The SMPS is connected to the line voltage through a line filter With the 1094 1092 and color display the line filter is located externally With the M1092A monochrome 1094 Displays display the line filter is located internally Although difficult to see light from a red LED can be seen through the rear of the SMPS case to show that the 60V is present SMPS in the The SMP
72. Description Concepts 1 56 Basic Plug In Modules SpO is a measure of arterial oxygen saturation obtained using the pulse oximetry method Pulse oximetry is a continuous non invasive method of measuring the oxygen content of the arterial hemoglobin It measures the amount of light transmitted from a light source through a patient s tissue to the receiving sensor The following concepts are important to the measurement of arterial oxygen saturation SaO Arterial oxygen saturation or the percentage of oxygen carried by the red blood cells within the arteries Approximately 97 per cent of the oxygen is normally carried on the red blood cells the rest is dissolved in the plasma A decrease in hemoglobin will decrease the amount of oxygen available to the tissues SpO The arterial oxygen saturation measurement obtained from pulsations in the arterioles using pulse oximetry Hemoglobin The protein in red blood cells that transports oxygen and carbon dioxide molecules to and from the body s tissues A hemoglobin molecule Hb attaches to oxygen molecules in the pulmonary alveoli and releases them to other systemic tissue cells When carrying oxygen it forms oxyhemoglobin HbO Oxygen saturation can be measured by calculating the percentage of HbO to Hb Ventilation The volume of air that reaches the pulmonary alveoli through breathing Ventilation refers to the process in which air enters the alveoli enabling th
73. EPROM card consists of the following functional areas Data and Address Buffers Identifier EPROM Address Decoder and Timing Control The EPROM has its internal data and address buses buffered at the connection to the local bus The identifier contains information that allows the CPU in the cluster to identify that this is an EPROM card The EPROM is a memory array of up to 1 28 Mbytes in steps of 256 Kbytes The EPROM card holds the data in two chips One chip holds the higher byte of the 16 bit word and the other chip holds the lower byte of the 16 bit word CMS Patient Monitoring System 3 113 Address The address is decoded and sent to the EPROM to allow the data at the specified Decoder address to be accessed Theory of Operation At start up the CPU in the cluster looks at all the slots in its local cluster and identifies the local cards and their location If an EPROM card is detected the CPU jumps to the code area of this card and begins executing the code Any problem with the EPROM card is handled by the master card This board does not have any on board tests or error LEDs Programming There are no removable devices on the card When the software is updated or changed the card is programmed as a whole Functional Block Diagram x x Ed O Uc Le tr 0 E P Yo z
74. External Alarm Device for use with XGA displays provides visual and audible Device Connectors alarm indicators It has a bracket to hold the Handheld Keypad It also provides an on and Controls off switch to remotely control the M1046B CMS Computer Module CAUTION Always locate this device in such a way that the speaker at the rear and the lights on the front are not blocked Yellow Alarm indicator Red Alarm Alarms Off indicator indicator Green T On Off Switch Remote On Off si to Computer Module LL to Computer Module n 9 HIL to Keypad Universal Mounting Clamp eadevice hpg Figure 3 24 External Alarm Device controls and connectors CMS Patient Monitoring System 3 47 Display Module CRT Display Rear Panel Connectors and Controls Video Termination Switch Fuse Holders Local Power Connector System Power Connector Equipotential Grounding Terminal Human Interface Link Connector Input and Output Signals The following is a list of the controls and connectors on the rear of the CRT display A switch used to terminate the video signal at this display it must be switched to the 75 Ohm position if only a main display is used When a remote display is connected the video termination switch on the main display must be switched to High Imp However the last display in the chain must be switched to 75 Ohm
75. M1008A Basic Plug In Modules 1 31 NBP Measurement NBP Measurements Exercises 1 32 Basic Plug In Modules W The oscillometric method uses occluding cuff to sense variations in which of the following a Cardiac output b Ventricular contraction c Arterial blood flow d Capillary blood supply What is the highest pressure of blood against the arterial wall called a Diastolic Pressure b Systolic Pressure c Mean Arterial Pressure d Pulse Pressure What is the lowest pressure of blood against the arterial wall called a Diastolic Pressure b Systolic Pressure c Mean Arterial Pressure d Pulse Pressure What is the term for the difference between the highest and lowest blood pressure measurement a Diastolic Pressure b Systolic Pressure c Mean Arterial Pressure d Pulse Pressure What does the highest amplitude oscillation on a non invasive blood pressure waveform represent a Diastolic Pressure b Systolic Pressure c Mean Arterial Pressure d Pulse Pressure False blood pressure readings that are too high can be produced by which of the following circumstances a A cuff that is too narrow b A cuff that is too wide cuff applied too tightly NBP Measurement Answers Qv de opo p ES Basic Plug In Modules 1 33 NBP Modules NBP Modules Description Measurements Venous Puncture Components Block Diagram 1 34
76. Module Maximum of one per monitor bundle specific 1029 Temperature Maximum of two per monitor bundle specific M1032A VueLink Maximum of one VueLink A and VueLink B per monitor except Anesthesia option H03 VueLink B only MI1116A or Thermal Array Recorder Maximum of one per monitor MI116B 1026 Anesthetic Gas Module Maximum or one per monitor only with Anesthesia options 4 6 V24 and V26 Patient Monitors Philips Patient Care System Data Management Vital Signs Recording Split Screen Capability Clinical Calculation Set Drug Calculator V24 and V26 Patient Monitors Description and Features A single upstream Philips monitoring network SDN connector allows connectivity to a Philips patient care system This allows the V24 V26 to access waveforms numbers and alarms from other networked patient monitoring bedsides It also allows connection to a Component Central Station Philips Information Center and extended Philips Arrhythmia Monitoring Systems The V24 V26 supports the CMS Rev E Beta Inter SDN Gateway functionality which includes e Overview e VCP Virtual Circuit Protocol e VTP Virtual Terminal Protocol e DBQ Database Query e Central recorder s e Centralized arrhythmia e nter SDN Gateway compatibility 224 beds The V24 V 26 features Patient Data Management This consists of continuous 24 hour storage of patient related parameter information This allows you to e manage pat
77. Monitoring System Module Exercises CMS Master Function Cards Introduction Objectives Concepts This section provides detailed information on the master function cards contained in the Computer Module of the CMS The information includes connections theory of operation functional block diagrams and testing information Information on local function cards is contained in another section Refer to the Computer Module description in the CMS Modules section for details on card configurations After successfully completing this module you should be able to e Identify the master function cards used by the CMS e Describe the function and operations of each card The following concepts are important to the operation of master function cards Bus Arbitration A method of determining which card may have access to a bus at any given time for transmitting messages Master function cards arbitrate their own access to the Message Passing Bus through an Arbiter function The Arbiter uses the data s priority level which is set by the CPU to gain access to the bus Bus Error Logic A timer that watches the microprocessor s address strobe for an unusually long activity indicating that a memory address may be invalid The logic then asserts a Bus Error to tell the processor that the memory was not accessed correctly FIFO First In First Out This term indicates the way in which a memory buffer works With a FIFO buffer the fir
78. OA LNOD 5 5524008 398 3831NI Bled NId 96 Figure 3 39 Utility Card Block Diagram 3 96 CMS Patient Monitoring System Utility Card LEDs Summary of Utility CPU Features Utility CPU The utility card has six LEDs Three of these are for error status and the other three are for the voltage These are described in Table 3 26 1 MPB Error LED red Table 3 25 Utility Card LEDs Description When lit indicates there is a problem with the MPB Interface Chip 2 Error Status LEDs green Connected to the processor through the output latch these LEDs are under software control They may be lit to indicate a hardware failure on the card during the boot phase when no MPB messages can be sent When the system is running they may reflect the status of the card 3 Voltage Indicator LEDs green Used to monitor the presence of the DC to DC converter voltages 12V DC 12V DC and 5V DC on the Utility Bus The functions of the Utility CPU card are as follows e Real Time Clock buffered power supply 2100 hours Nurse Paging Relay System Clock 32 millisecond Frame Clock 2millisecond Sample Clock Power On Reset e Voltage indicator LEDs for 12V 12V and 5V e EEPROM 8 Kbytes for system configuration e Philips HIL Master Controller SDN Synchronization e Rack Interface with excitation signals for plug in mo
79. SDC amp XSDC ICU CCU Local Displa Display Distribution SCC ney Cables LDC 78581 Patient Patient ___ Information SDN Information Bedside Center 78504 8 78504 8 SDN Bedside M T Recorder Recorder 78571B 2B SDN 78571B 2B Bedside Recorder EET 78571B 2B 85 SDN Bedside 78574 Bedside M T M T Display SDN Bedside M T 780 780 SDN Patient Bedside Information M T SSH 78504 8 Bedside 78574 780 780 Figure 5 2 Sample Philips Monitoring Network SDN Configuration Philips Monitoring Network SDN 5 5 How the Philips Monitoring Network SDN Works The Philips monitoring network SDN transmits patient information serially at regular intervals called polling cycles to the Philips care hub SCC The Philips care hub SCC sequentially synchronizes and rebroadcasts the received patient information to all instruments connected to the Philips monitoring network SDN The Philips care hub SCC works in conjunction with the Philips monitoring network SDN interface circuitry located within each CMS and V24 V26 monitor connected to the Philips monitoring network SDN The Philips monitoring network SDN interface circuitry sends and receives Philips monitoring network SDN data over the branch cables for Philips care hub SCC instrument to system communications The Philips monitoring network SDN interface circ
80. Switchable baud rate under control of application software HDLC Interface Card Introduction Components MPB Interface FIFO HSCX 68000 CPU Theory of Operation The HDLC Interface card provides the Computer Module with an interface to any real time wave recorders which use the Standard Recorder Interface Protocol STRIP Two recorders linked in a daisy chain can be connected to the Computer Module using this card The HDLC is a master card and therefore connects to the MPB The card does not require any local cards in its cluster Therefore it does not have a connection to the local bus This card may be located in any unused slot in the computer module even a slot that is part of another master card s cluster The HDLC card consists of the following functional areas MPB Interface FIFO HSCX Driver 68000 CPU EPROM SRAM Test Loop Register and Address Decoder and Dtack Logic The MPB Interface provides the interface between the MPB and the card For more information refer to the beginning of the Master Functional Cards section of this chapter Master Card Overview on page 3 64 First In First Out buffer This is the HDLC Controller It is controlled by the CPU in interrupt mode The HDLC card contains a 68000 Microprocessor This processor controls the operation of the card The HSCX can control two identical independent synchronous serial channels A and B These channels are built up using trans
81. The V24 V26 software is modular and divided among 3 CPUs Application CPU Utility CPU and the Front End microcontroller The Application CPU contains the interface managers monitoring managers and monitoring algorithms The Utility CPU contains the low level interface controllers The Front End microcontroller serves as a high speed intelligent UART to the CMS front end modules The software architecture of the V24 V26 application CPU is the same as in the application CPUs in the other monitors The software consists of the application software and the Operating System The application software consists of Application SoftWare modules ASWs Each module implements a certain function i e the pressure ASW implements the pressure function and the alarm handler ASW implements the alarm functions The modules communicate over the message passing bus MPB The Operating System manages the hardware resources and schedules the routines of the application modules based on times routines and on MPB messages received The Utility CPU functions as the display controller FE interface controller Philips monitoring network SDN controller human interface controller real time clock controller and EEPROM controller All of the software runs under the control of OS 1 operating system Communication with the Application processor is through the MPB Message Passing Bus Communication with the Front End CPU is through a shared memory buffer The FE micr
82. UART RS232 RS422 Drivers RS232 RS422 Receivers The MPB Interface is the interface between the card and the MPB For more information refer to the beginning of the Master Function Cards section First In First Out buffer The interface uses an 8051 Microprocessor which provides one of the serial ports This provides the second serial port on the card The following defines the operations of the dual interface card Data are passed between the MPB and the interface On data being sent out of the RS232 port 1 or 2 the data are converted from parallel to serial format On data being received from the RS232 port 1 or 2 the data are converted from serial to parallel format CMS Patient Monitoring System 3 99 RS232 RS422 Dual Interface Card Transmission RS232 Data Reception RS232 Baud Rate The data are loaded into the MPB Interface s RAM The processor reads these data and writes it into the serial port register Port 1 uses the microprocessor s internal serial port register and port 2 uses the UART Data are then shifted out of the registers at the chosen baud rate The RS232 422 drivers transform the TTL voltages into those suitable for the RS232 and RS422 transmission The RS232 voltages received are converted to TTL levels The data are written into the serial port input registers for each port and then buffered in the MPB Interface RAM before being output to the MPB Note the RS422 interface is not used The inter
83. Utility CPU or the Front End CPU The parameter module interface subcircuit also has an analog section that allows an external defibrillator to be synchronized to an ECG signal The ECG signal goes from the Front End CPU to a digital to analog converter and its filtering circuitry The conditioned ECG signal goes to the defibrillator which responds by sending a marker pulse to the Front End CPU which processes it along with the ECG signal This subsystem provides both the application and utility subsystem with reset signals power fail interrupts master clock and other miscellaneous clocks The V24 V26 keypad provides the operational interface The front panel interface circuit on the System Board scans the front panel keypad controls the LEDs and produces the analog waveforms to drive the speaker The Front Panel CPU performs the processing for the circuit 4 32 V24 and V26 Patient Monitors Flat Panel Display Display Adapter Board 3 Board Assembly Service Port Connectors Six slot Rack Eight slot Rack V24 V 26 Theory of Operation Exercises 24 and V26 Patient Monitors Theory of Operation The V24 liquid crystal display LCD subassembly is a 640 pixel x 480 pixel full dot monochrome graphic display unit consisting of the LCD panel a fluorescent tube for backlighting and LCD driver row and column circuits 2 2 and V26C V26CT The V24C V24CT and V26C V26CT flat panel display subassembly is a 640
84. a central monitor or recorder Up to 242 sets of real time algorithm outputs can be graphed stored and recalled each with up to three channels of data All stored waves are cleared after a discharge procedure when the monitor is turned off for more than three hours or when monitoring mode is reset In auto mode the monitor measures respiration and adjusts the detection level automatically depending on waveform height presence of cardiac artifact and absence of valid breaths In manual mode the user sets the detection level for measuring respiration To ensure the safety of the patient the patient applied parts are isolated from ground by optical isolators and a transformer The module is also encapsulated in plastic Basic Plug In Modules 1 27 5 ECG RESP Module Exercises 1 28 Basic Plug In Modules 1 The ECG generates numerics for which physiologic measurement a pulse b pace pulses c heart rate 2 Which module component prevents interference from the 50 60 Hz power line a Input protection network b Right leg drive c Highpass and lowpass filters 3 Which channels does the PPD check for pace pulses a Channels 1 and 2 b Channels 2 and 3 c Channels 1 2 and 3 4 The RESP signal is detected by which component a Differential amplifier b Impedance subtracter c Measurement bridge d Synchronous demodulator 5 The impedance subtracter subtracts which part of the RES
85. a set pressure which is determined by the mode Thereafter the cuff is inflated by the pressure pump to a cuff pressure above the patient s systolic pressure Depending on the measurement method used inflation occurs once or repeatedly When the cuff pressure is greater than the systolic pressure the artery is occluded the pressure sensor then detects only the cuff pressure Cuff Deflation Cuff pressure is automatically released by the deflation system in steps of approximately 8 mmHg until the artery is only partially occluded At that point measurement and processing of arterial pressure oscillations begin and continue as the cuff pressure is progressively released 2 Detection As arterial pressure oscillations are detected they are superimposed on the cuff pressure within the module s circuitry After being extracted by the bandpass filter they are passed to the microcontroller and measured 3 Measurement As the cuff is deflated the magnitude of the oscillations as a function of cuff pressure increases until the mean arterial pressure is reached When cuff pressure falls below the mean arterial pressure oscillation magnitude begins to decrease The systolic and diastolic blood pressure values are deduced from the oscillometric signal by extrapolation resulting in empirical values Extrapolation uses the attenuation rate of the signal on both sides of the maximum readings Invasive pressure measurement are also used as a reference to
86. ambient light is then subtracted by the high pass filter The signal amplitude is optimized in the variable amplifier and passed to a low pass filter where the dark signal representing the ambient light current is subtracted from the red signal The high pass and low pass filters act as a demodulator The pulse sequence representing red infrared and plethysmogram voltages is then amplified multiplexed and digitized Signal Processing From the digitized signal the microprocessor derives the oxygen saturation value and the plethysmogram waveform for display It can also derive a pulse value from the PLETH signal if configured to do so SpO2Z PLETH Module SpO PLETH Figure 1 21 shows the user controls and connector for the module The parts are Module Features described following the figure Dag mace mag ey SpO PLETHT M1020A 2 1 5 4 3 Figure 1 21 SpO PLETH Module Controls and Connectors User Controls 1 SpO Setup Key A single press key used to enter the SpO setup screen 2 SpO Setup Indicator A green LED lit when the SpO setup screen is activated 3 PLETH Setup Key A single press key used to enter the PLETH setup screen 4 PLETH Setup Indicator A green LED lit when the PLETH setup screen is activated Connectors This is a standard 12 pin connector for use with an SpO PLETH tra
87. and reference manual While it does not cover every aspect of the monitoring systems in detail it covers the functional descriptions that are provided in the Service Manuals for the individual systems To help you plan and assess your learning it provides goals for each chapter learning objectives for each section within a chapter highlights of important concepts as well as topic lists at the beginning of each section practice exercises within each chapter afinal self assessment test at the end of the book Your approach to this book will likely depend on your personal preference and job needs You can use the book as a self paced training course a reference document or both Although the book has a logical information flow the chapters are independent units that do not have to be read in any particular order Here are some suggested approaches e Ifyou unfamiliar with the products and would like to use the book as a training document start at the beginning and work your way through at your own pace using the learning aids provided e If you already have some knowledge of the systems and want to identify the areas in which you need to learn more you may want to start by taking the test at the end of the book The questions are grouped to correspond with specific sections of the book By identifying the questions you were not able to answer correctly you can focus your learning on only those areas You ll also hav
88. at 120V 60Hz Isolated patient connection to Class 7 protection Type Cardiac Floating CF There is also protection against damage from defibrillation and electro surgery Advanced Plug In Modules 2 31 Sidestream 2 Module M1015A M1015A Sidestream Module Exercises 1 What does the M1015A Sidestream Module measure a Invasive Blood Pressure b Cardiac Output c Output 2 What component of the M1015A Sidestream Module controls the offset compensation for the pressure sensors a Flow Channel b Pressure Channel c Power Supply 3 The M1015A Sidestream Module is used in conjunction with the a PRESS M1006B Module b M1016A Module c PRESS M1006A Module 4 What does the slide cover on the M1015A Sidestream Module do a provides the connection for the sample tubing b activates the sidestream pump c protects the gas inlet connector Answers 1 2 3 4 2 32 Advanced Plug In Modules FIO2 Respiratory Measurement FIO Module Concepts CMS only FIO Respiratory Measurement Description Concepts Measurement Principle Measurement Acquisition Measurement Output FIO respiratory measurements indicate the percentage of oxygen that is inspired The respiratory measurement is an indication of the percentage of oxygen a patient is breathing Respiratory concepts important to this section are e Fractional Conce
89. atmospheric pressure Three of Philips plug in modules can measure invasive blood pressure the PRESS Module M1006A PRESS Module M1006B and the PRESS Module M1006A Option C01 2 4 Advanced Plug In Modules Invasive Blood Pressure Measurement Exercises Invasive Blood Pressure Measurement 1 Invasive blood pressure measurement is an indication of a the force of a patient s blood within the blood vessels b the amount of oxygen present in the blood vessels c the force of exerted within the blood vessels 2 Invasive blood pressure measurement uses a technique based on a absorption of infrared radiation b temperature of measurement being collected c blood force being transported by a fluid column in the pressure line to a transducer 3 Invasive blood pressure measurement is displayed as a a blinking light b percentage amount c waveform with numerics 4 What factor can influence the accurate measurement of invasive blood pressure a temperature of patient s blood b amount of dissolved Oxygen in the patient s blood c going from a reclining position to a standing position Answers l a 2 c 3 c 4 c Advanced Plug In Modules 2 5 Invasive Blood Pressure Module M1006A Invasive Blood Pressure Module M1006A The Pressure PRESS M1006A Module is an invasive blood pressure measurement parameter unit It is designed to be used with adult pediatric or neonatal patients in a The PRESS M1
90. card refer to the Local Functional Cards section of this chapter Local Card Overview on page 3 111 CMS Patient Monitoring System 3 81 Color Display Controller Cards CDSPC CTRL Components 68000 Microprocessor MPB Interface FIFO SRAM PROM Theory of Operation Data Transfer Character Sets The video controller card consists of the following functional areas 68000 Microprocessor MPB Interface FIFO SRAM PROM Extension PROM and buffer The CDSPC CTRL card is based on the 68000 Microprocessor The MPB Interface is used to pass data back and forth between the card and the MPB For more information refer to the beginning of the Master Functional Cards section Master Card Overview on page 3 64 First In First Out buffer The SRAM contains code for communications with the VIDEO card The PROM contains the firmware for communications with the CDSPC VIDEO card The CDSPC CTRL card acts as an interface between the system and the video card The CDSPC VIDEO card connects the Computer Module to the display The CDSPC cards only control the mechanism of actually displaying information on the screen AII display data including local language characters and color information are produced by the Application CPUs or CPCs More than one CPU may produce data for the display The CDSPC controller card receives display data waves lines numerics display attribute data and control messages from
91. connection of more than one rack 1 What is the purpose of the LCD Adapter Board V24 and V26 Patient Monitors 4 33 V24 and V26 Patient Monitors Theory of Operation a provides an interface to the LCD b eliminates the shock mounting feature Answers l a 4 34 V24 and V26 Patient Monitors 24 and V26 Patient Monitors Theory of Operation V24 and V26 Patient Monitors 4 35 V24 and V26 Patient Monitors Theory of Operation 4 36 24 and V26 Patient Monitors Chapter 5 Philips Monitoring Network SDN Introduction This chapter describes the Philips monitoring network SDN and the Inter SDN Gateway Philips monitoring network SDN provides network connectivity for the Philips patient monitoring system The Inter SDN Gateway expands the number of bedside monitors that can be accessed by connecting SDNs together This chapter assumes that you have completed the first four chapters of this manual and that you are familiar with the concepts and workings of the CMS and V24 V26 bedside monitors Goals After successfully completing this chapter you should be able to e Describe the Philips monitoring network SDN system s features Describe the Philips monitoring network SDN system s functions Describe the Philips monitoring network SDN system s components Objectives In order to meet the chapter s goals you should be able to Describe the Philips monitoring network SDN Identify the Philips monito
92. connector is not used 11 Video Out Connector Used to output information to be displayed on the Flatscreen Display Module and also to Flatscreen output 60V DC to the Flatscreen Display Module NOTE No connection can be made to the following cards Application CPU CDSPC Control EPROM or SRAM CMS Patient Monitoring System 3 39 Integral Power Supply Computer Module M1046B Integral Power Supply Computer Module M1046B The M1046B Computer Modules use a flatscreen M1095A as the main display The power supply previously located in either the main CRT display or the Remote Power Supply is replaced by an Integral Power Supply located in this Computer Module M1046B Integral Power Supply Connectors and Controls Power Indicator Power Connector 4 Remote Switch Card Connector 2 Figure 3 15 Integral Power Supply Connectors and Controls 3 40 CMS Patient Monitoring System Remote Power Supply M1047A Table 3 13 Integral Power Supply Controls and Connectors Controls and Connectors Function 1 LED mains power indicator This indicates that the Integral Power Supply is connected to the local power 2 REMOTE SWITCH card This is a cable end connector used to connect the Integral Power Supply to connector the REMOTE SWITCH card in the Computer Module 3 Fuse Holders Two fuse holders for the line protection fuse
93. consists of DOS executable files and does not require any other files to run The software can be run on a Central Data Station or another IBM compatible PC The connection to the module requires a with CDS connecting one of the RS232 cables for IR Links to the module b with an IBM compatible PC connecting a special adapter connector M3663A for standard PC and modular data cable e g M3642A 03 to the module 2 66 Advanced Plug In Modules Blood Analysis Module Exercises Blood Analysis Module M1022A What type of sample does the Blood Analysis module require a Plasma b Diluted whole blood c Undiluted whole blood How are calculated results indicated on the results screen a Marked with b Marked with c Marked with In amperometric measurements a current is generated by oxidation or reduction processes in the test system Is the current generated a Directly proportional to the concentration of analyte b Inversely proportional to the concentration of analyte c Inversely proportional to the concentration of red blood cells The connector for making software updates is situated a On the front of the module b On the module rack c On the rear of the module Answers gt Advanced Plug In Modules 2 67 VueLink Module VueLink Module Concepts VueLink Module Description Measurements The VueLink Module is used to connect an external de
94. converter EEPROM The calibration constants for the module are stored in the EEPROM along with other data Calibration Chamber The calibration chamber determines whether the transducer has been positioned in the calibration chamber on the module or is actually being used on a patient Power Supply All necessary supplies for the tepO tcpCO Module are generated in an internal power supply The 60V output from the Computer Module is used to generate the required voltages within the module Block Diagram Figure 2 14 shows the block diagram of the recorded patient signal flow through the tcpO tepCO M1018A Module Advanced Plug In Modules 2 45 tcpO2 tcpCO2 Module M1018A 52 gt H3MOd SWO OL INOYS SANddNS AlddNS IVNH3lNI ONILVO T4 WNOHdd3 lt gt oido 5SOGQHOIVM 55 FINGOW NI Y8LOLN H3OnasNvul Y8L6LN 2 M 3009 H3TIOHLNOO gt INSHHNO L ANAND AMLINOUIO 7 1 1831 HOLIMS
95. data and address buffers are used to buffer the data between the local bus and the SRAM card The address decoder is used to specify the address of the data in the SRAM that is either to be written or read The identifier is used by the CPU in the cluster during start up to identify this card The back up power supply is a two cell Nickel Cadium battery that provides power to the SRAM in the event of a power failure The following describes the operations of the SRAM card Data are is transferred between the master card and the RAM array using the Local Bus The data are is placed on a 16 bit data bus and the address is placed on a 23 bit address bus along with some control lines CMS Patient Monitoring System 3 115 Switch to Back Up Power Data Retention Time Back Up Power Supply Over Discharge Protection When a power loss is sensed the System Reset signal SYSRES SYRES locks the RAM from further access This prevents any access to the SRAM and keeps the contents from being corrupted The switch from the DC to DC converter to the battery is made when both the supplies deliver the same voltage The ratio of the data retention battery charging time to the battery charging to the data retention time is a minimum of 2 5 For example if the battery is charged for three hours the data would be retained 7 5 hours The back up power supply is a two cell Nickel Cadmium battery with some switch logic to switch
96. depicted as continuous waveforms that show real time changes in impedance Both the respiratory rate and heart rate are shown as numeric values Factors affecting accurate measurement of RESP are e Proper placement of electrodes in order to optimize the measurement of impedance changes Since ECG waveforms may require more precise placement ECG waveform results may have to be considered when repositioning leads and electrodes to optimize respiratory wave size e Good skin contact to maintain a good signal Hlimination of external interference A patient s movements bones or organs can interfere with the signal as can pacemaker activity and electrical interference from electrosurgical units ESU Respirogram monitoring is not recommended for active patients because false alarms may occur Normal cardiac activity is filtered out However artifacts from pulsating blood can interfere if the liver or cardiac ventricles are between the electrodes The ECG RESP Module M1002A B provides respirogram and electrocardiogram functions It can be used with most of the monitoring systems in the Philips patient monitoring family Check the documentation for the system being used for determination of module usability Ahrens Tom Respiratory Monitoring in Critical Care in AACN Clinical Issues in Critical Care Nursing For bibliography Susan Osguthorpe ed Philadelphia JB Lippincott 1993 Philips Part No 78834 90090 Neonatal Monitorin
97. determining the hypnotic state at any given point in time Surgical Stimulation Baseline Hypnotic Level E 6 tj Aro Modulated Hypnotic State BIS ation Figure 2 26 Factors influencing the modulated hypnotic state during surgery Painful surgical stimulation can be attenuated by local anesthetics or analgesics at several levels of the sensory pathway The resulting amount of stimulation reaching the brain can then be thought of as the perceived stimulus A net increase in the perceived stimulus can lead to a lightening in the patient s hypnotic state while a net decrease can result in a return to deeper hypnotic levels This phenomenon can often be seen by observing real time changes in BIS when constant anesthetic levels are being maintained Oscillations in BIS can potentially provide a direct measure of the brain s response to stimulation and an alternative measure of responsiveness reactiveness similar to other vital sign endpoints The following example case illustrates several different patterns of 5 changes that can occur during a typical anesthetic regimen BIS Propofol Inf Rate HR BP Map 100 pt movement 200 2 Y 180 3 pt movement 160 70 Y 140 f 60 120 5 50 100 8 40 808 60 20 40 Q 40d 20 mut 2 tre eee cu EE At the start of the case following rapid se
98. e 81 CONMECHONS x 81 Contents 12 CDSPC CTRL Components 82 Theory of Operation ee pes dn ep er erm rr CE ER RAE ee Soe 82 CDSPC Functional Block 83 Summary of CDSPC Cards Features 83 Color Display Controller Card New 84 InttOGUCLOTi sere iE VER EN e Rae ea OR 84 Connections PS 84 CDSPC Components bie ead and GL EN E ORE Ni EE 84 Theory of Operation ee ler e t Aere er ere epe 85 CDSPC Functional Block 86 Summary of CDSPC Cards Features 86 Flatscreen Display Controller 87 Introduction ssnin Eee tal 87 COnnecons 0 SED UR NOE EI ect de 87 DSPC FLAT 5 87 Theory of 25 4 3 87 DSPC FLAT Functional Block 88 Summary of DSPC FLAT Card Features 88 DSPC FLAT ASIA Flatscreen Controller
99. electrical activity of the brain EEG monitoring assists in diagnosing many neurological illnesses and diseases such as epilepsy tumor cerebrovascular lesions e g seizures ischemia and problems associated with head trauma In the Operating Room EEG monitoring provides a record of the adequacy of anesthesia and information about cortical blood flow The EEG module produces two channels of EEG realtime waves which can be displayed and recorded They are labeled EEG1 and EEG2 For each channel the following eight numerics are calculated Spectral Edge Frequency SEF The frequency below which a defined percentage configurable of the total power lies Mean Dominant Frequency MDF e Peak Power Frequency PPF The frequency with the highest power Total Power TP Power content of a channel i e the voltage squared over an impedance of 1 ohm Percentage of total power in each frequency band e Alpha Alpha waves represent the EEG in a normal awake adult Their frequency is defined as 8 13 Hz e Beta Beta waves represent the EEG during periods of conscious effort Their frequency is defined as 13 to 30 Hz e Theta Theta waves are usually seen in the presence of pathology Their frequency is defined as 4 to 8 Hz Delta Delta waves are seen in the presence of pathology coma and certain stages of anesthesia Their frequency is defined as 0 5 to 4 Hz Two of these numerics can be selected for continuous display
100. for the connection of the Module Racks A locally generated 78 clock is also passed over this interface 1 for power synchronization for the Plug In Parameter Modules and 2 as an excitation frequency for the invasive pressure transducers Also refer to the Rack Interface Card FE LINK in the Local Function Cards section of this chapter Local Card Overview on page 3 111 The digital Serial Distribution Network SDN connects to bedside units within an ICU CCU environment This allows the CMS to access all the data and status signals on the network Refer to the SDN Interface in the Local Function Cards section for more information The following describes the operations of the Utility CPU card There is a support chip to encode interrupts so the processor can react to interrupts For example power fail PFAIL and external interrupt EXINT from the local bus The address decoding logic is used to generate enable signals for the on board devices such as the MPB SRAM and EPROM The bus error logic is a timer that watches the microprocessor s address strobe When the processor outputs an address on its bus it asserts the address strobe to indicate that a valid memory address is available However if the signal is asserted for too long then the logic assumes that the access was not terminated correctly that is the address strobe was not negated or removed The logic then asserts a Bus Error to tell the processor that it could
101. four slot c four or six slot 4 Patient Data Management is the a 18 hour tracking of patient information b 12 hour tracking of patient information c 24 hour tracking of patient information 5 What rack 15 standard with the V24 V26 a four slot rack b six slot rack c eight slot rack 6 The current release of V24 V26 supports a subset of the functionality of which monitor a CMS Release 0 b CMS Rev C Answers QV po CH aes 4 10 V24 26 Patient Monitors V24 and V26 Patient Monitors Interfaces V24 and V26 Patient Monitors Interfaces Introduction Objectives Concepts Overview Philips Monitoring Network SDN Interface The following section describes the V24 V 26 and the interfaces it uses After completing this section you should be able to describe the interfaces used with the V24 V26 Concepts important to the V24 V26 interfaces Alert information Information that signals an alarm e Parametric information Information that is presented as numerics Philips monitoring network SDN Serial Distribution Network Upstream Accepts information from another source e Waveform Information that is presented as waves Connectors are provided for various functionality These functions are further explained below Philips monitoring network SDN interface e RS232 Interface Front End Link Protocol for Racks FELP Service Ports e P
102. from the DC to DC converter power to the back up supply There are two test points for measuring the battery voltages They are TP1 Battery Voltage and 2 Supply Voltage of the RAM array The back up supply has a circuit to protect the battery from being over discharged This prolongs the useful life of the battery 3 116 CMS Patient Monitoring System Functional Block Diagram Summary of SRAM Features SRAM gt Es qr Le 1 1 0 gt 8 w 1 lt T n 1 Y T Z T 5 T gv 9 Dr 2 e 0 L 212 Li JA Pe SE a eo E nt Q 1 fr F4 m m 2 TA Bo T E 2 E Y C 2 5 Qr T em 22 wO Z DO LCA BLS Figure 3 47 SRAM Card Block Diagram The features of the SRAM card are as follows e 320K word capacity e Loadable in steps of 32K words e Buffered RAM using 2 cell Nickel Cadmium battery e Back up Retention Time is minimally 2 5 times the charging time A fully charged battery retains the data for at least three days Battery over discharge protection for improved long term reliability e No wait state operation allows use of a 10 MHz
103. gas measurements indicate the partial pressures of oxygen and carbon dioxide in a patient s blood system as measured through the skin The transcutaneous gas measurement is an indication of the amount of oxygen a patient is getting and how well the heart is working Concepts Transcutaneous gas concepts important to this section are e Transcutaneous Through the skin Measurement Different measurement principles exist for the and parameters One or Principle both can be implemented with the transducer and when both are implemented they are implemented by a combined transducer Both measurement principles require the use of a topical electrolyte For tcpO measurement a silver platinum Clark electrode is used When a constant voltage is applied to the electrode it produces a very small electrical current proportional to the tcpO pressure This current is converted into a voltage and amplified in the transducer plug For measurement a solid state pH glass electrode is used This electrode produces a voltage related to the electrolyte s pH value The pH value is dependent on the CO pressure The electrode voltage and the CO pressure are logarithmically related The electrical signal from the electrode is amplified within the transducer plug The and in the patient s blood diffuses through the skin and then passes through the sensor s membrane into the electrolyte The O5 mole
104. is automatically adjusted to fit inside the channel This setting adjusts the amplitude of the wave but not its offset Gainx The amplitude of the wave is magnified by 1000 Gain x 2 The amplitude of the wave is magnified by 2000 Because the QRS complex is the most prominent part of the ECG waveform it is used by clinicians to determine the strongest ECG signals QRS detection can occur in auto or manual mode In auto mode QRS complexes are detected automatically In manual mode the QRS detection level appears on the screen as a horizontal line across the ECG wave In non paced mode no pace pulses are expected and no pace pulse rejection occurs In paced mode pace pulses are annotated with a small dash on the screen ST segment analysis is an optional feature ST segment measurements can be recorded on up to three channels and three leads of a patient s ECG The measurements are shown as numerics on the standard display graphically in the ST analysis task window and as part of patient vital signs and trend graphs They can be recorded with reference beats at the bedside or without beats at a central monitor or recorder Up to 242 sets of real time algorithm outputs can be graphed stored and recalled each with up to three channels of data All stored waves are cleared after a discharge procedure when the monitor is turned off for more than three hours or when monitoring mode is reset To ensure the safety of t
105. it was developed to offer enough information on the functions and operations of the monitoring systems so that engineers who repair them will be able to better understand how they work The book provides a bird s eye view of the product family in the context of the clinical settings and measurements for which they are used It covers the physiological measurements that the products were designed to provide the modules that acquire those measurements the three systems that use those modules and the network that ties all of the pieces together into an integrated whole Who Should Use This Book If you are a biomedical engineer or a technician responsible for troubleshooting repairing and maintaining Philips patient monitoring systems this book was designed for you If you are new to Philips product line or monitoring systems you may find it helpful as an orientation to the equipment If you have been working on the systems for awhile and now want further details on how they work you are likely to find much of the information you need here If you want to learn about patient measurements and the principles by which they are derived this is a good place to start Introduction 1 What The Book Contains What The Book Contains Intro How the Book is Structured How the Content Is Organized Introduction 2 The CMS amp V24 V26 and their families of products are powerful flexible patient monitoring systems that
106. level of consciousness and administer the appropriate amount of anesthesia for each patient leading to improved drug titration faster and more predictable patient wake up times after surgery and improved patient recovery from anesthesia The 5 technology uses a sensor placed on the forehead to capture the EEG signals which are translated into a single number ranging from 100 for wide awake to zero indicating absence of brain electrical activity The BIS application displays three numerical values on the main screen of the CMS or V24 V26 e Bispectral Index Signal Quality Index e Electromyography Additionally the Suppression Ratio can be configured to be displayed in the lower right corner of the EEG wave sector Total Power and the Spectral Edge Frequency are only displayed in the BIS Task Window The BIS Module consists of the following major functional components Table 2 12 Major BIS Module Components Component Description Digital Signal Converter DSC A sensor placed on the patient s head transmits EEG signals to the DSC The DSC amplifies and digitizes signals from the sensor BIS Engine Filters the raw data from the DSC analyzes it for artifact and processes data to calculate the BIS index BIS Module Connects the BIS Engine to the monitor Advanced Plug In Modules 2 93 BIS Module Theory of Operation Bispectral analysis is a computational method which examines the relationships o
107. model 15MHz APP CPU in Backplane A display controller card Utility CPU Rack Interface M1046B only Aux Connector Card M1046B only Remote Switch Card 3 16 CMS Patient Monitoring System CMS Patient Monitoring System Power System CMS Patient Monitoring System Power System Introduction The power system in the CMS uses the facility s AC source voltage and converts this AC line voltage to the DC voltages required for the CMS computer module and the various plug in modules Components The components in the power system network and their functions are as follows Table 3 10 Power Systems amp Distribution Components and Functions Component Function Power Cord Used to plug into the main power source Source Voltage Source voltage is from 92 to 262V AC The voltage is self selected DC to DC converter Generates the voltages 45 12 and 12V DC for the cards located in the computer module Display Module Switch Mode Power Supply _ Remote Power Supply Integral Power Supply in the M1046B Computer Module Generates the 60V DC input to the DC to DC converter Utility Bus Used to distribute the voltages 5 12 12 and 60V DC CPU Theory of Operation Performs a hardware test identifies the cards in the cluster and starts executing the application software The CMS system is connected to the facility source voltage with
108. modules while the M10414A Satellite Rack holds eight modules satellite Racks are identical in function to the integral rack However no defibrillator connector is provided and the input connector connects to either another satellite rack or to the Computer Module The blank rack is used when the Plug In Parameter Modules do not require close placement to the Computer Module The blank rack has only two functions These are 1 to provide a path for the Rack Interface connection to the front of the computer module and 2 to provide a defibrillator connection on the front of the computer module The internal rack has connectors for e Eight single width plug in modules e Three satellite racks A defibrillator connector for synchronizing the defibrillator firing and receiving a marker pulse CMS Patient Monitoring System 3 55 Module Racks Satellite Module Rack Connectors Module Connectors Rack Input Connector Rack Output Connector Module Rack Theory of Operation Power Supply Data Transfer Module Rack Block Diagram There are three types of connector on the satellite racks These are described as follows i These are female module connectors used to input the information from the plug in modules to the rack This is a male rack interface connector used to connect the rack to the Computer Module or to the previous rack in the chain This is a female rack interface connector used to connect the r
109. on user request 4 The signal is then passed through the patient isolation to the rack interface and then to the receiving rack Advanced Plug In Modules 2 13 Invasive Blood Pressure Module M1006A Option C01 PRESS M1006A Option C01 Module Features User Controls Connectors The features User Controls Connectors Safety and Accessories for the PRESS M1006A Option 01 Module are the same as those for the PRESS M1006A Module with the exception of the analog output jack Figure 2 5 shows the user controls and connectors for the PRESS M1006A Option 1 Module Refer to this figure for the User Controls and Connector descriptions 1 4 PRESS 1006 T 2 PRESS OUT PRESS ZERO 5 9 3 CAUTION OUTPUT HAS 4 1 OFFSET 6 AND 10 SCALE CAUTION 5uv V mm Hg 4 TRANSDUCERS ONLY Figure 2 5 PRESS Module M1006A Option C01 Controls and Connectors Pressure Setup Key a single press key which is used to enter the Pressure Setup Screen Pressure Setup Indicator a green LED light which is lit when user is in the Pressure Setup Screen Zero Key a single press key which is used to zero the transducer without using the master display controls The PRESS M1006A C01 uses a standard 12 pin connector with a pressure transducer that has a sensitivity of 5uV 10 Analog Output Jack This is standard 1 4 inch phone jack used to provide analog signa
110. or 15 MHz Application CPU CMS Patient Monitoring System 3 117 Color Display Video Card Color Display Video Card Introduction Connections CDSPC VIDEO Components Color Register Video System Controller The Color Display Controller CDSPC cards are a set of two cards used by the system to output display data to a color monitor The CDSPC VIDEO card is a local card that supports the CDSPC CTRL card The video card contains the Video RAM and output circuits to the Display Module The video card is connected to its master card by the Local Bus Both cards must be placed in the same cluster in the Computer Module The CDSPC VIDEO card must be inserted into the rear of the Computer Module so that it can be connected to the display It is connected with a cable between the 9 pin D type connector on the card edge and a similar connector on the rear of the display The video output on the rear of the display may be used to connect a remote display If Kanji characters are to be supported the DSPC_KANJI card must also be inserted into the same cluster as the two CDSPC cards Each pair of CDSPC cards supports either one master display and three remote displays or four remote displays If the system is required to produce two different color displays a second pair of CDSPC cards must be used in a separate cluster For details on the components and operations of the CSDPC card refer to the Master Functional Cards sec
111. oxygen saturation is derived based on the relative signal intensity ratio of each reflected wavelength The resulting value is passed to the data communication processing circuitry of the module The Algorithm CPU is also responsible for managing light intensity data and generating light intensity alarms 6 Data Communication Processing The parallel signal 5 value from the Algorithm CPU is converted to a serial signal This signal is passed via the data communication processing circuitry to the rack interface of the CMS The EEPROM stores the settings transfer data which it receives from the CMS for module transport purposes SvO 1021 Figure 2 17 shows the user controls and connectors for the SvO M1021A Module Features Refer to this figure for the User Controls and Connector descriptions SVO miona T Figure 2 17 SvO Module Controls and Connectors User Controls 1 Setup Key This is a single press key used to enter the SvO setup screen 2 Setup Indicator This is a green LED which will be lit when in the SvO setup screen If after pressing the setup key the LED is not lit the system is busy and the SvO setup screen cannot be entered The setup key must be pressed again 3 CAL key This is a single press key used to enter the module s calibration screen and initiate SvO calibration procedures Advanced Plug In Modules 2 55 SvO2 Module M1021A 4 CAL Indicator This is a green LED which is lit duri
112. pixel x 480 pixel color graphic display unit consisting of the flat panel display a fluorescent tube for backlighting and driver row and column circuits The V24 LCD Adapter Board provides alocation for the backlight inverter assembly e interface to the LCD alocation for LCD bias and contrast brightness circuitry encoded data about panel type and dot pitch The V24C V24CT and V26C V26CT 3 board assembly provides anLCD Adapter Board for interfacing to the flat panel display e a DSPC board for display control e a CDCI board for interfacing to the System Board The backlight inverter circuitry for the V24C V24CT NOTE V26C V26CT is integral to the flat panel This note does not apply to the new flat panel assembly which was introduced with Rel A 0 Here the inverter is a separate assembly The latest hardware provides only one driver board instead of a 3 board assembly The Service Port Connectors on the System Board align with the cover on the right side of the mainframe to provide access for programming the Utility and Application software The six slot rack holds up to six single width parameter modules The eight slot rack holds up to eight single width parameter modules Parameter modules can be either single width or double width There are two connectors for external connections a downstream connection for multiple rack configurations and an upstream connector The V24 V26 does not support the
113. preset limits once or repeatedly depending on the measurement method used Pressure Sensor Measures cuff and arterial pressures using solid state technology Overpressure Safety Triggers alarms at given pressures and time limits and System deflates the cuff Bandpass Filter Extracts arterial pressure oscillations from the cuff pressure Deflation System Automatically deflates the cuff at steps of a given magnitude Figure 1 13 shows the NBP module s logical structure NBP Modules WALSAS HOSN3S 3unssaud 39v4H31ND 39VJH3INI WALSAS SSVdaNva 9vu H3T110HLNOO HOSN3S d died 3unss3ud 3unssaud Figure 1 13 M1008A B NBP Module Block Diagram 1 35 Basic Plug In Modules NBP Modules Theory of Operation NBP Module Features 1 36 Basic Plug In Modules As NBP signals pass from the patient to the monitor they progress through stages corresponding to logical sections of the module as shown in the block diagram Module related faults can generally be isolated to one of the stages 1 Signals from the patient are received by the pressure sensor through the cuff which is connected to the module by a single tube The cuff is inflated deflated and monitored by a pump deflation system and safety system controlled by a microprocessor Cuff inflation During the initial cuff inflation the cuff is inflated by the pressure pump to
114. provide a wide range of data acquisition and processing functions for all types of patients in both critical care and routine care settings Although these patient monitors are highly reliable and easy to use its high degree of flexibility and functionality may seem daunting to users and technicians who do not work with it on a regular basis The information in this book will we hope make the systems easier to understand The book contains five chapters each of which may be used independently of the others Chapters in This Book Chapter Title Description Basic Plug In Modules The measurements taken by the basic set of plug in parameter modules used by Philips patient monitoring systems and the functional descriptions of the modules themselves Advanced Plug In Modules The measurements taken by the advanced set of modules along with the functional descriptions of the modules A functional description of the CMS including its components and operations V24 and V26 Patient Monitors A functional description of the V24 V26 including its components and operations Philips Patient Network An overview of the Philips Patient Network SDN including its major components functions and the services it provides The flow of information proceeds from the patient inward toward the system The chapters begin with the measurements that are taken from patients and the plug in modules that are designed to acquire and proce
115. rack The eight slot rack is shipped with each standard V24 V296 This rack is the same 1041 Satellite rack used with the CMS It accommodates up to 8 single width modules and is attached to the mainframe by a standard Front End Link cable to the V24 V26 Mainframe The V24 V26 does not support the connection of more than one rack and displays an error prompt if another rack with a parameter module inserted is attached This rack accommodates up to six single width modules and is attached to the mainframe by a standard front end cable The six slot rack is dockable to the V24CT Mainframe The six module rack provides an optimized rack solution for monitoring This rack matches the user s need for up to six single width CMS compatible modules 4 18 V24 and V26 Patient Monitors Connectors Connectors 1 Which rack is shipped with the V24 V26 Exercises a eight slot rack b six slot rack c four slot rack 2 The 6 module rack matches the user s need for a a smaller piece of hardware b up to 6 CMS compatible modules c 8 CMS compatible modules Answers l a 2 b V24 and V26 Patient Monitors 4 19 V24 and V26 Patient Monitors Software Configurations V24 and V26 Patient Monitors Software Configurations Introduction The following section describes the V24 V26 software and hardware configurations Objectives After completing this section you should be able to e Identify the V24 V26 s software configuration
116. read and write data to the MPB For more information refer to the beginning of the Master Function Cards section First In First Out buffer The EPROM is used to hold the code to be executed at powerup The SRAM holds data during operation of the card The video RAM has four parts Table 3 22 Video RAM Functionality Plane Map Description Alphanumerics Each plane is 1024 x 512 pixels The two alphanumeric Graphics plane 1 graphics planes display text figures and basic graphics lines boxes etc Alphanumerics Graphics plane 2 3 78 CMS Patient Monitoring System Theory of Operation Data Transfers Wave Plane Character Sets Monochrome Display Controller Table 3 22 Video RAM Functionality Plane Map Description Wave Plane 2048 x 512 pixels This higher resolution wave plane displays the parameter waves such as ECG Attribute Map 256 x 256 bytes The attribute map enables parts of the screen and selects between full half brightness and blinking The DSPC only controls the mechanism of actually displaying information on the screen More than one CPU may be required to produce data for the display display data including local language characters are produced by the CPUs and transferred using the MPB Display data waves lines numerics display attribute data and control messages are transferred from the CPUs using the MPB to the DSPC The microprocessor on the DSPC places
117. selected with the correct cable sets to measure the appropriate electrical activity Selecting the wrong leads could result in misdiagnosis of the heart s condition Hlimination of external interference A patient s movements or bones can interfere with the signal as can pacemaker activity and electrical interference from electrosurgical units ESU In the OR application for example electrodes should be placed equidistant from the surgical site to improve the ESU suppression Other extraneous sources of electrical interference can be electrical appliances around the patient Two of Philips plug in modules can measure ECG the ECG Module M1001A B and the ECG RESP Module M1002A B Check the documentation for the system being used for determination of module usability Basic Plug In Modules 1 11 ECG Measurement ECG Measurements 1 An ECG measures both the magnitude and of the heart s Exercises electrical signals 2 Specific electrodes that measure specific cardiac vectors are called 3 The right leg electrode serves as a 4 The part of the ECG waveform that plays a critical role in diagnosing serious heart conditions is the a P wave b QRS complex c ST segment Answers 1 direction 2 leads 3 ground 4 c 1 12 Basic Plug In Modules Description Measurements Components Block Diagram ECG Module The M1001A B ECG Module is a three channel electrocardiogram measurement
118. staff can monitor patients whose CMS or V24 V26 monitor is connected to one Philips monitoring network SDN from any CMS or V24 V26 monitor connected to the other Philips monitoring network SDN The CMS provides automatic alarm overview across two Philips care hubs SCCs and manual alarm overview across three Philips care hubs You can only connect two Philips care hubs to an Inter SDN Gateway but you can connect a Philips care hub SCC to more than one Inter SDN Gateway Connecting a Philips care hub SCC to more than one Inter SDN Gateway expands the number of bedsides that can be monitored at one CMS or V24 V26 monitor from 24 to 72 Figure 5 4 illustrates a sample Inter SDN Gateway configuration CMS ANY LOGICAL SDN BED VIEWED AT CMS REV 3 5 OR HIGHER GATEWAY BROADCAST DATA TERMINAL DATA VECTRA SCC 1 L SCC 2 CMS PROTOCOL VTP PROTOCOL 788608 BOARDS E E CMS 1 Figure 5 4 Inter SDN Gateway Configuration The Inter SDN Gateway receives bedside broadcast data from one Philips monitoring network SDN formats the data into virtual terminal data and sends those data to a specific CMS
119. supply board contains a DC to DC converter optical isolators and motor control circuits for the paper drive motor The digital board contains only one microcontroller and a single port RAM The front panel controls and lamps are mounted directly on the board as they are on the M1116A Signal processing through the module proceeds as follows Power Supply Board Power and data signals enter the module from the monitor through the power supply board The DC to DC converter converts the 60V DC from the front end rack into 5V DC for the digital board and 15 DC for the motor drivers and printhead Data signals from and to the rack are passed through infrared optical isolators for noise suppression Digital Board Signals enter the board through the single microcontroller s built in serial data port The serial data link between the monitor and Recorder Module operates asynchronously on two separate lines providing full duplex communication at a 500 KB baud rate The microcontroller interprets messages from the monitor and sends back identification and status messages through the power supply board The microcontroller is responsible for receiving and responding to commands and data from the monitor sensing and reporting on the state of the control keys and switches converting waveforms and annotation into a format suitable for driving the printhead The user controls door open switch and paper out sensor are mounted directly on th
120. system is switched on The EEPROM capacity of 8 Kbytes stores the current configuration of the system Non Buffered static RAM with a capacity of 128 Kbytes 3 92 CMS Patient Monitoring System HIL Rear Panel Connector Phone Jack Rear Panel Connector Nurse Paging MPB Interface FIFO Main Clock Local Bus buffers Rack Interface SDN Interface Theory of Operation Interrupts Address Decoding Bus Error Logic Utility CPU Philips HIL is the Philips Human Interface Link This is a proprietary interface for any human interface Examples of supported devices are Human Interface Board for the Control Panel of the Display Module Remote Keypad and the Touchscreen The phone jack used for nurse paging is intended to give some type of alarm that is either visual audio or both This is a single closure relay with its contacts connected to a stereo trs phone jack on the card edge of the Utility CPU Card This is the interface between the card and the MPB For more information refer to the beginning of the Master Function Cards section First In First Out buffer The main clock provides the clock signals to the rest of the CMS The clocks provided are 20 MHz 16 MHz and 10 MHz The local bus buffers are between the Local Bus and the rest of the utility card They act as a buffer for information passing back and forth between the bus and the card This is a high speed serial Front End Link FE LINK
121. the signal to reveal the oxygen saturation of the arterial flow The measurement is derived using two wavelengths of light one in the red region and one in the infrared to measure maximum and minimum absorption differences between the two molecules The SpO measurement is taken by means of an optical cuff that is placed on the patient s fingertip From the transmitting side of the transducer red and infrared light is scattered through the capillary bed and detected by a photo diode on the receiving side The measurement is independent of skin permantation tissue absorbtion and other constants The resulting measurement is plotted as a plethysmogram The waveform is proportional to the blood volume changes the pulse rate and the relative perfusion of the skin and transducer A number of factors can affect the accuracy of the measurement or the ability to obtain it Incorrect positioning may cause incorrect measurement The light emitter and the photodetector are directly opposite each other and all the light from the emitter passes through the patient s tissues when it is positioned correctly Pushing the transducer on too far or not far enough may result in inaccurately low or high 5 readings respectively The measurement requires pulsatile activity When pulses drop below a certain threshold no measurement can be taken This situation might arise from conditions such as shock hypothermia vasoactive drugs inflated bl
122. the stimulation is consistent For example patients with BIS levels of 60 are unlikely to respond to verbal command but may become aroused when given a painful stimulation These clinical arousals waking up of a patient can be followed by observing increases in the hypnotic BIS level In general opioids do not have a significant influence on the patient s state of consciousness or BIS at concentrations used to achieve adequate analgesia in routine general surgery Opioid analgesics or regional blocks can be very effective at attenuating sensory input thereby substantially reducing the intensity of stimulation and preventing subsequent patient responses If low levels of hypnotics are used in this situation patients could be awake or lightly sedated hypnotically BIS 70 80 without exhibiting any signs of inadequate anesthesia as measured by traditional signs Like cardiovascular and somatic responses the hypnotic state of patients undergoing surgery is influenced by the intensity of stimulation that is applied In the absence of stimulation relatively little drug is required to induce and maintain loss of consciousness During the course of a surgical procedure however the balance between the intensity of stimulation and sensory suppression may be constantly changing Figure 2 presents a simplified diagram outlining how stimulation and 2 88 Advanced Plug In Modules BIS Measurement anesthetic suppression may contribute to
123. the CPU over the MPB The microprocessor on the controller card sends the data over the Local Bus to the video card The Video System Controller on the video card places the data into the dual ported Video RAM Display attributes such as half brightness are also placed in the Video RAM The pixel data is clocked out of the Video RAM by the on chip shift registers This data then passes through the SLIP Chip which contains all the video and addressing logic before passing it to the video buffers The data then passes through the protection network for output to the display An oscillator is used to synchronize the picture sweep The Japanese Taiwanese and Chinese character sets are too large to be stored on the standard EPROM cards These characters are therefore stored on a dedicated card the DSPC Language card which is placed in the same cluster as the display controller cards 3 82 CMS Patient Monitoring System Color Display Controller Cards CDSPC CTRL Functional Block Diagram PIN CONNECTOR CONTROL MPB INTERFRCE RDDRESS gt CONTROL MPB FIFO DIETE 2 ADDRESS CONTROL SRAM ADDRESS CONTROL DATA AppRess PROM CONTROL AE DATA RDDRESS PROM Extension ADDRESS 4 BUFFER 4 CONTROL
124. the Display Module It converts this input to the 5 12 and 12V DC required for the operation of the system These voltages along with the 60V DC are output onto the Utility bus Between the input of the 60V DC and the output of the 5 12 and 12V DC voltages is a delay of between one to two seconds to make sure that the SYSRES and PFAIL signals are in the proper state SYSRES SYSRES is the system reset signal This signal is usually activated when the system first comes up or when the reset button on a system is pressed Activating the signal initiates a sequence of events that results in the system clearing out necessary registers and reloading appropriate software to start operations PFAIL PFAIL is the powerfail signal This signal is usually activated very shortly before the power goes down This is done to initiate a graceful shutdown rather than an abrupt ceasing of operations This allows cards to save required information or in some cases to shut access to their memories in order to prevent corruption of data during the stages of a powerfail Power Fail If the power fails the PFAIL signal is asserted by the DC to DC converter to alert the Process Utility CPU that power is going down The Utility CPU would then activate the SYSRES on the MPB This is to allow the system to reset all the cards synchronously 3 68 CMS Patient Monitoring System Application CPU Application CPU Introduction Components MPB Int
125. the chapter contains specific objectives that are focused on enabling you to meet these goals This chapter contains the following sections Table 3 1 Chapter Topics CMS Patient Monitoring System Overview CMS Patient Monitoring System Description CMS Patient Monitoring System Modules CMS Patient Monitoring System Bus Structure CMS Patient Monitoring System Power System CMS Patient Monitoring System Hardware Configurations CMS Patient Monitoring System Software Configurations CMS Patient Monitoring System 3 1 Introduction Table 3 1 Chapter Topics CMS Patient Monitoring System Functional Modules 3 34 Computer Module 3 35 Remote Power Supply M1047A 3 41 Display Module 3 43 Remote Keypad 3 54 Module Racks 3 55 Plug in Parameter Modules 3 58 CMS Master Function Cards 3 63 Master Card Overview 3 64 Application CPU 3 69 Configurable Processor Card 3 74 Monochrome Display Controller 3 78 Color Display Controller Cards 3 81 Color Display Controller Card New Version 3 84 Flatscreen Display Controller Card 3 87 DSPC_FLAT_ASIA Flatscreen Controller Card 3 89 Utility CPU 3 92 RS232 RS422 Dual Interface Card 3 98 HDLC Interface Card 3 102 Analog Interface Card 3 105 CMS Local Function Cards 3 110 Local Card Overview 3 111 EPROM 3 113 SRAM 3 1
126. these data into the dual ported Video RAM using a Video System Controller Display attributes for example half brightness are also placed in the Video RAM The pixel data are clocked out of the Video RAM by the on chip shift registers These data then pass through the SLIP Chip which contains all the video and addressing logic before passing it to the video buffers The data then pass through the protection network for output to the display an oscillator is used to synchronize the picture sweep The wave plane used for displaying up to six overlapping parameter waves is implemented in a different way than for the other planes The reason for this is that the wave plane must display waves that scroll horizontally on the monitor The scrolling logic moves a pointer indicating the left of the screen through the video RAM and new data are written directly behind it This has the result of moving the trace by adding new data onto the right of the screen as old data are displaced on the left The Japanese Taiwanese and Chinese character sets are too large to be handled by the standard EPROM cards These characters are therefore stored on a dedicated EPROM card the DSPC Language card which is placed in the same cluster as the Display Controller CMS Patient Monitoring System 3 79 Monochrome Display Controller Functional Block Diagram capi ureyg Asieg Ld 11250 Ae ds
127. trending and recording The selected numerics are displayed in large digits next to their respective wave If one of the selected numerics is a frequency i e SEF MDF or a trend line for this frequency will be displayed in the Compressed Spectral Array CSA See section below for details Advanced Plug In Modules 2 79 EEG Module Components The EEG Module consists of the following major functional components Table 2 11 Major EEG Module Components Component Description Input Preamplifiers The input preamplifiers provide high impedances to the electrodes connected to the patient s head They pre amplify the input lead signals analogically They achieve pre filtering of the input lead signals in order to perform an anti aliasing function prior to digitizing the signals Analog to Digital Converter The analog to digital converter converts each single electrode voltage delivered from the input preamplifiers into digital form and transmits the results to the system central processing unit CPU Impedance Measurement Signal The impedance measurement signal generator is Generator made up of two AC currents of different frequency The CPU generates said frequencies The voltages are converted into two very small currents fed into the electrodes Central Processing Unit CPU The central processing unit CPU processes all input signals from the EEG electrodes It filters said signals calculates the compressed
128. voltages This delay is used to ensure that the SYSRES system reset and PFAIL powerfail signals are in the correct state If the condition is determined to be a power up the DC to DC converter outputs the converted voltages 5 12 and 12 along with the 60V DC input voltage onto the Utility bus Before the CMS system can be powered up it must have a base configuration of cards including an application processor card a display controller a Utility CPU and a Rack Interface After the power up is complete the CPU performs a hardware test After the hardware test is finished the CPU locates and identifies the other cards in the cluster This is done by sending out an address that identifies the slot s and an ACCESS signal that results in the local card placing an identifier onto the local bus If an EPROM card is connected the CPU begins executing application software code from the EPROM card If an EPROM card is not present the CPU begins execution of the application software code from the CPCs flash EPROMS Note Depending on the type of configuration the CPU is either an APP CPU ora CPC CPU The APP CPU is available as either a 10 or 15 MHz card The CPC is 40 MHz Both a CPC and a 15 MHz APP CPU can be present on the backplane If the CPU detects an error in the system or the watchdog timer detects a failure on the CPU the signal PFAIL is generated by the CPU and sent to the Utility CPU The Utility CPU in turn gen
129. 006A Module produces a real time waveform together with the pulse rate and numeric readings for the systolic diastolic and mean blood pressure values The PRESS Module M10064 consists of the following major functional components Table 2 1 Major PRESS Module M1006A Components Description Protects the module from extraneous signals i e defibrillation and electro surgery Amplifies the signal before it is sent to the microcontroller Demodulates the amplifier carrier signal before it is input to the low pass filter To compensate for an input pressure offset an offset compensation signal is generated by the Digital to Analog converter The Digital to Analog converter also generates the calibration staircases CAL2 for the recorder calibration and the test signal Description range of Critical Care environments Measurements Components Component Input Protection Network Input Amplifier Demodulators Zeroing Calibration Test Block Diagram 2 6 Advanced Plug In Modules Figure 2 2 shows the block diagram of the recorded patient signal flow through the PRESS Module 1006 Invasive Blood Pressure Module M1006A ova Mov ZH j NOILV10SI Ang Ot SLINOUIO 5 uaona NOILVLI
130. 15 Color Display Video Card 3 118 Serial Distribution Network Interface 3 122 Rack Interface 3 126 Aux Connector Card 3 129 Remote Switch Card 3 129 Definitions Concepts important to the Philips patient monitoring system CMS CMS Patient Monitoring System Models 54 through 68 These models are the bedside monitors with full displays for the critical care environment ACMS Anesthesia CMS Patient Monitoring System Models 74 through 88 These models are the anesthesia monitors with full displays for the operating room 3 2 CMS Patient Monitoring System Introduction NCMS Neonatal CMS Patient Monitoring System Model 36 through Model 48 These models are the neonatal monitors with customized displays and parameter combinations for the Neonatal Intensive care unit V24 V26 This model is a bedside monitor with an LCD display for most critical and acute patient care areas of a hospital patient monitoring system A system that measures various aspects of a patient s medical condition SDN Serial Distribution Network monitoring network that allows monitors to display their patient information and data at other monitors on the network CMS Patient Monitoring System 3 3 Introduction CMS Patient Monitoring System Overview Introduction Objectives Concepts This section of the chapter provides an overview of the CMS including its hardware and software components Subsequent sectio
131. 2 CARTRIDGE LOCKE D 7 i STAT i statt tif I Figure 2 20 Blood Analysis Module Controls and Connectors 1 Blood Analysis Setup Key This is a single press key used to enter the Blood Analysis setup screen If no measurement is running when the key is pressed you will enter the Blood Analysis window where the results of the last measurement are displayed 2 Blood Analysis Setup Indicator this is a green LED which will be lit when in the Blood Analysis screens 3 Cartridge Locked Indicator This green LED will be blinking when a cartridge is being processed in the module The cartridge must remain in the module until the LED goes off showing that the analysis is complete 4 Thecartridge slot where a cartridge is inserted for processing Advanced Plug In Modules 2 65 Blood Analysis Module M1022A 5 Rear Panel RS232 connector for upgrade purposes Safety There are no patient applied parts in the Blood Analysis Module This module complies with UL544 IEC 601 1 CSA C222 No 125 84 Blood Analysis The software is divided into two parts the application software and the Module Software standardization software CLEW Software updates are required regularly to re Update establish standardization values Each update is delivered to the customer with full Requirements instructions for performing the update on the module The delivered software
132. 3 Which component supplies the power for the digital circuits and recorder mechanism a DC to DC converter b front end rack c motor control circuits d I O Microcontroller 4 Which component converts the waveforms and annotation into dot matrix for printing a DC to DC converter b I O Microcontroller c Motor and Print Format Microcontroller d motor control circuits The recorder mechanism consists of the and components 6 Which type s of recording can be set to begin automatically a delayed b delayed and vital sign c delayed real time and vital sign d delayed real time monitoring procedure and vital sign Answers 1 three eight 2 power supply digital 3 a 4 b 5 thermal printhead paper drive motor 6 b Basic Plug In Modules 1 79 Recorder Module M1116B Recorder Module M1116B Description Block Diagram 1 80 Basic Plug In Modules The M1116B Recorder Module provides thermal array recording capability for the Philips patient monitoring family including the V24 V26 Like the M1116A Recorder Module it can write up to three overlapped waveforms and three lines of annotation The M1116B has several additional capabilities not offered by the M1116A It provides ten recording speeds two more than the M1116A It can also provide oxygen cardiorespirogram recordings The following components carry out the major functions within the M1116B Recorder Module Tab
133. 4 Y Y Y ZHWS1 0 YOLVTTOSO uoss3o0udoHolN tava 5 9 wouva sng viva Advanced Plug In Modules 2 70 VueLink Module Theory of Operation The electrical signal must pass through three major sections of the Vuelink module which are 1 The Microprocessor which in conjunction with the ROM RAM EPROM and control logic performs the following functions Controls the input signal paths the input switches connect the digital signals to the RS232 UART and the analog signals to the multiplexer Controls the analog multiplexer and the Analog to Digital converter Communicates with the RS232 UART Communicates with the rest of the CMS via the module link Converts external device specific protocols to the internal standardized CMS protocol by using Device Drivers which are device specific protocol translators Controls the downloading and Flash EPROM programming of device drivers via the built in RS232 interface A Flash EPROM is used instead of a ROM or EPROM the capacity of the EPROM supports several device drivers and up to three device drivers can be selected by the user 2 The RS222 Digital Interface which acquires data from external devices ventilators gas analyzers etc Typically the data consist of waveforms measured values device settings alarm status and alarm and INOP information The specific device drivers are converting these vendor type speci
134. 4 Analog Interface Card Block Diagram 3 108 CMS Patient Monitoring System Analog Interface Card Summary of Analog The features of the Analog Interface card are as follows Card Features Provides an interface to devices with analog inputs needing real time waves or slowly changing trend data e Provides eight digital alarm INOP status lines to trigger alarm recorders or other data collection instruments Provides eight analog signals output on 37 pin connector Incorporates an error compensation loop to compensate for component tolerances and component drift CMS Patient Monitoring System 3 109 Analog Interface CMS Local Function Cards Introduction Objectives Concepts This section provides detailed information on the local function cards contained in the Computer Module of the CMS The information includes connections theory of operation functional block diagrams and testing information Information on master function cards is contained in another section Refer to the Computer Module description in the CMS Modules section for details on card configurations After successfully completing this module you should be able to e Identify the local function cards used by the CMS e Identify the master cards they support e Describe the function and operations of each card The following concepts are important to the operation of local function cards Local Card Identifier A mechanism that
135. 8 BOOT FLASH SRAM S T ROM ROM 3 HOUR LOCAL 18 SRAM 3 1 FLASH e BUS DRAM SRAM 3 HOUR O MPB MPR O INTERFACE 4 Figure 3 32 CPC Card Block Diagram The daughter card contains the following functional areas Output Enable Decoder Memory Select PAL Address Buffer and the ROM Banks RON BANK 256 52 Bits ESM 512Kx32 Bits Address Buffer Outeut Enable Decoder ROMO gt Figure 3 33 Daughter Card Block Diagram 3 76 CMS Patient Monitoring System LEDs Summary of CPU Features Configurable Processor Card The LEDs on the CPC are defined inTable 3 21 One MPB Error LED red Table 3 21 CPC LEDs Description Used to indicate a problem with a device on the card Two Error Status LEDs green Controlled by software and may be implemented to indicate a hardware failure on the card during the boot phase when no MPB messages can be sent When the system is running they may also be used to reflect the status of the card The following is a summary of the CPC CPU features Processes the application data Contains a large SRAM and DRAM work area for the processor Includes a watchdog timer to detect errors on the CPU and report to the system using a PFAIL signal e Status LEDs hardware is tested every time the system is reset e Power fail protection i
136. 9 me JOVA 38 WVA Ode qo a VOVA jonuog OI INOWH 4 Sopuy loyjoH 16208 lt dl fid gt iera TE uS Eran prewed T Y 2 069 prount Dgo mme oSv y e 0 pur Jos Y y SKAZE lt 2 INOSdHH L a lt 1 lt le ge v 0 rondo oL 22 180815 Figure 2 16 SvO M1021A Module Block Diagram 2 53 Advanced Plug In Modules SvO2 Module M1021A Theory of Operation The major actions that the electrical signal must pass through in order to reach the Monitor interface 1 The signal is obtained by the Abbott catheter and processed by the Abbott Optical Module 50131 04 used with the M1021A SvO Module There are three light emitting diodes in the Optical Module Each diode emits a light with a specific wavelength at a frequency of 244 pulses per second through a single fiber optic filament within the catheter The light illuminates the blood at the fiber tip The blood absorbs refracts and reflects the light The reflected light is collected by the aperture of a second fiber optic filament within the catheter and returned to the photodetector in the Optical Module The photodetector converts the light sample into an analog signal This signa
137. B the card s CPU assigns the transmit FIFOs a priority level for gaining access to the bus Each FIFO may have a priority level of Low Mean or High Access to the bus is gained by the Arbiter on the MPB Interface This task performed by all the cards connected to the MPB is how the Computer Module performs bus arbitration for the MPB 3 66 CMS Patient Monitoring System Master Card Overview a TUNE RAM RECEIVE 1 SLOW DATA x 2 RECEIVE 2 lt FAST DATA CPU 3 MPB TRANSMIT 1 a SLOW DATA TRANSMIT 2 FAST DATA CONTROL ARBITER Figure 3 28 Master Card MPB Interface MPB Messages MPB messages consist of words that are each 16 bits in length Each message has a header describing the content of the message such as ECG Wave Lead 1 and the length of the message The second part of the message after the header is the data DC to DC Converter The DC to DC converter is a card used in the Computer Module to provide the operating voltages for the rest of the system Functional Block The functional block diagram of the DC to DC converter is shown in chapter 3the Diagram following figure 5 60 V 12V 12V 60 V Figure 3 29 DC to DC Converter Block Diagram CMS Patient Monitoring System 3 67 Master Card Overview Theory of Operation The DC to DC converter receives 60V DC as an input from
138. Basic Plug In Modules The M1008A and M1008B NBP Modules are non invasive blood pressure measurement parameter units for Philips patient monitoring devices The M1008A Module is designed to be used with adult or pediatric patients in both OR and ICU environments The M1008B Module is designed to be used with adult pediatric or neonatal patients in OR and ICU environments The M1008A and M1008B Modules cannot be used simultaneously in a patient monitor The modules produce numerics for the systolic diastolic and mean blood pressure values No waveform is associated with these modules Three different methods can be used to obtain the measurements Manual For each request one measurement of systolic diastolic and mean pressures is taken Auto Repeated measurements of the three values are taken at timed intervals specified by the user Stat Measurements of the three values are taken immediately and repeatedly over a period of five minutes This method uses a faster measurement procedure but produces a less accurate reading This is not a measurement mode rather the cuff is inflated to and held at a preset pressure to help you find a vein to puncture The cuff deflates automatically after a fixed time or you can deflate it manually The following components carry out the major signal processing functions within the module Table 1 5 Major NBP Module Components Component Function Pressure Pump Inflates the cuff to
139. C DP 11 Function Card Description 5 12 Funetion Cards rupe ce e Rer PA eee e EET 13 Local e dbi IERI ee UNCIAS 13 Card PlaceMent olde ee hdc hc LER e idu 14 Minimum System Requirements 15 CMS Patient Monitoring System Power 17 Introd cLion 3 Lee tei ie ure 17 GOMPONENtS EE 17 Theory of Operation PNEU RR US 17 CMS Patient Monitoring System Hardware Configurations 19 Introduction 25 4 eds i mei ERN RUM E desc wie ele ie 19 Application CPUS eve dauerte ee da 19 x eg Sous poet e tactu PURI a ee te i a eii pi ette edd 19 Function Card 20 Plug in Parameter Modules 30 CMS Patient Monitoring System Software 5 31 IniroOdUucLiOT z iie ntes ute RE e e eoe a eR ve e nae RPM Patre 31 Standard Displays Maine RO ASAP ER ENDE NM UA 31 selection Window sis a eh wo UI nee en is ree Er ne 31 Task TES ed boire REN e ata NM COCA Y or aec Pre E 31 Screen MeSsages csp onge ee Hoe edem NS 31 System Overvi
140. CDSPC CTRL pP EPROM MASTER EEB P cru CDSPC_CTRL 2 QD DSPC 2 APP CPU D CDSPC_VID 2 Model 68 only ED HDLC IF if present SRAM EPROM SLAVE 52 2 or cru ETD SDN IF if present APcu O DC DC CONVERTER Figure 3 5 Software Release A Backplane Configuration CMS Patient Monitoring System 3 21 CMS Patient Monitoring System Hardware Configurations Software Release B 10 and 15 MHz APP CPUs 3 22 CMS Patient Monitoring System Using 10MHz Application CPUs FRONT REAR EBD DSPC or BLANK or CDSPC VIDEO CDSPC_CTRL EEI 5 if present EPROM MASTER B SED rr cru CDSPC_CTR 2 DSPC 2 or CDSPC VID 42 cif present sram 9 ETD rr cru EPROMSLAVE APP CPU RS232 IF if present Model 56 with c10 66 with C10 or 68 E ANALOG IF if present ETD or cru RACKIF B P SDN IF if present APOU O 790 pec converter Using 15MHz Application CPUs FRONT REAR DSPC or BLANK or D CDSPC_VIDEO CDSPC_CTRL ED if present EPROM MASTER v cru CDSPC_CTR 2 APP CPU e CDSPC VID 2 Model 68 Mone only HDLC IF if present sram GI Ar EPROMSLAVE RS232 IF if present ANALOG ir if present ETD cru RACK Ir SDN IF if present ar
141. CMS Alarm Key The Volume Control softkey has been eliminated from V24 V26 s Alarm Array of Choices due to the availability of standard display volume controls All other Alarm Control options are unchanged V24 and V26 Patient Monitors 4 15 User Controls Other Patients Key Monitor Setup Key Procedures Key Trends Cales Module Setup Key Main Screen Key Realtime Record Key Delayed Record Key Blank or Minus Key Confirm Key This key formerly called Overview in CMS is functionally identical to CMS This key formerly Instrument Config in CMS is functionally similar to CMS with the following differences There are three display modes for the V24 V26 display and up to six waves non overlapped and overlapped There is a background selection for the monochrome LCD black text on a white background for older versions or white text on a black background Background is not selectable on the color flat panel display This key formerly Monitoring Procedures in CMS is functionally identical to CMS A softkey for the Ht Wt entry for Cardiac index calculation is in the Array of Choices for this key This key formerly Patient Data in CMS and Trends in V24 provides access to the Data Management functionality The title on the Array of Choices is changed to Trend Calcs to reflect the new key label This key formerly Parameters in CMS is functionally identical to CMS It enables you to chan
142. CO2 Module M1018A Calibration Transducer Signal mV Calibration complete if x x lt 1 nn I Acceptance Range if within acceptance range cal value displayed in task window not in standard display A time min Warmu Range Check Stability Check 0 3 min 10 sec 1min 15min Figure 2 13 Graphic Representation of the Calibration Algorithm 2 44 Advanced Plug In Modules 2 2 Module M1018A Components The tcpO j tcpCO M1018A Module consists of the following major functional components Table 2 7 Major tcpO2 tcpCO2 Module Components Component Description Microprocessor Controls overall functions of the Module Heater Heats the transducer to improve diffusion of gases Polarization Supply Produces a polarization voltage of 680 mV for the O sensor via the O5 amplifier The polarization voltage is monitored by the microprocessor Relay The relay replaces raw signals from the transducer with test signals designed to test the two separate analog signal paths for O and Identifier The identifier circuitry identifies which transducer is being used a tcpO transducer transducer or the Philips combined transducer Multiplexer The multiplexer collects the analog signals interleaves them and feeds them to the dual slope analog to digital
143. CR OR ORC EN 70 Functional Block Diagram 71 Td UE uud andi Margin Bae 73 Summary of Functions lev I e be ere 666 6 73 Configurable Processor Card 74 Introduction eur euet SIC eT RCM Ep 74 Components 2 aires CERE e ERN ME 74 Theory of Operation ur a ERE AE AIR NE 75 Functional Block Diagram 76 Daughter Card Block 76 LER LE Et RUSSE ETE Red 77 Summary of CPC CPU Features 77 Monochrome Display Controller 78 Introduction 78 Connection to Display 78 RR RU ER ete ert ee 78 Theory of Operation i esenee Sede a ase wae sean 79 Functional Block Diagram 80 Summary of DSPC Card 81 Color Display Controller 81 Introduction e uit AIME PIU P De ote ice
144. Care environments The FIO M1017A Module produces a numeric display for the fractional inspired oxygen The FIO M1017A Module consists of the following major functional components Table 2 6 Major FiO2 Module Components Component Description Polarization Circuitry The polarization voltage is derived from the power supply of the module when the power is ON When the power is OFF this voltage is derived from a built in battery for a minimum of four days Low Battery and Test Signal The voltage of the built in polarization battery is sensed so that a failed battery can be detected For testing purposes a test signal is generated in the current to voltage converter circuitry The numeric 0 21 FIO indicates that the module is working correctly This battery is rechargeable Figure 2 11 shows the block diagram of the recorded patient signal flow through the FIO M1017A Module Advanced Plug In Modules 2 35 FIO2 Module M1017A lt JOVA HOVHIH LNI MOV TOULNOD 5 IVNDIS LSAL NOLLV IOSI LNAILVd WALSAS HHTIOWLNOO UALYAA NOD lt Ua Id NV VAL TA SSVd MOT UALYAANOD ADVLTIOA OL LNSWPHCOO ALLIQOIIO NOLLVZDI3IV IOd INPUT CONNECTOR Figure 2 11 M1017A FIO Module Block Diagram Advanced Plug In Modules 2 36 Theory of
145. Ceu LJ cn 2 ga e Li zo LL a Hr THE L gt gt _ Mie m 5 2 4 0 Y T Z E 2 x E 5 Y 5 O M Co 2 DIE LOA BLS Figure 3 46 EPROM Card Block Diagram 3 114 CMS Patient Monitoring System Summary of EPROM Features SRAM The features of the EPROM Card are as follows Large memory array 256 Kbytes steps up to 1 28 MB Contains the complete application software operating system e Card programming allows easy exchange or upgrade of software e Label for software part number Oorl wait state options e Automatic execution of the software when the system is started SRAM Introduction Components Data and Address Buffers Address Decoder Identifier Back Up Power Supply Theory of Operation Data Transfer The SRAM card is a local card connected to the local bus It is used by a master card such as the Application CPU to store data both before and after processing The SRAM contains a buffered static RAM array with a data retention time of up to three days The type of data stored on the SRAM card is dependent on the software For example data management software may store trends and numeric data as well as other processed results The SRAM card consists of the following functional areas Data and Address Buffers Address Decoder Address Input Circuit Timing Control Identifier SRAM and Back up Power Supply The
146. DSPC 2 40 MHz CPC RACK IF 15 MHz APP CPU 292222029999 9099990009 REAR DSPC 1 or CDSPC VID 1 DSPC LANG KANJI TAI or PRC DSPC 2 or CDSPC VID 2 RS232 IF ANALOG IF UTIL CPU SDN IF HDLC IF DC DC CONVERTER Models 56 Sy 66 S with 26 and Model 68 S FRONT BLANK or CDSPC CTRL 1 15 MHz APP CPU CDSPC CTRL 2 40 MHz CPC RACK IF 15MHz APP CPU 0000000200100 0900090000 REAR DSPC 1 or CDSPC VID 1 DSPC LANG KANJI TAI or PRC DSPC 2 or CDSPC VID 2 RS232 IF 1 RS232 IF 2 or DSPC 43 only 68 S ANALOG IF UTIL CPU SDN IF HDLC IF N d DC DC CONVERTER An extra CPU may be left in for future use Figure 3 8 Software Release C and D Backplane Configuration CMS Patient Monitoring System 3 25 CMS Patient Monitoring System Hardware Configurations Software Release E or Eg Software Release F 3 26 CMS Patient Monitoring System FRONT BLANK or CDSPC CTRL 1 e 15 MHz APP cpu ED CDSPC_CTRL 2 GB em 40 cec CD P RACK IF GED en 15 MHz APP DSPC 1 or CDSPC VIDEO 1 src Lanc 1 KANJI TAI or PRC ED DSPC 2 or CDSPC_VIDEO 2 P 25032 E an d 88 SES 31 0 EFD unu cru ER spn ir ir ES CONVERTER Figure 3 9 Software Release E or Back
147. Interface CDSPC Control CDSPC Video Application CPU EPROM SRAM Table 3 7 Rear Card Connections Utility CPU HIL to the Monitor and Nurse Paging System RS232 Interface Printers or computer systems SDN Interface SDN network HDLC Interface M1117A Strip Recorder Analog Interface Analog device CDSPC Video Color monitor DSPC Monochrome monitor DSPC_FLAT LCD monitor and Remote Switch to Remote Power Supply Table 3 8 Display Interface and Slot Location Type of interface Slot Location Monochrome DSPC 1 in slot 1 DSPC 2 in slot 7 Color CDSPC_CTRL 1 in slot 2 CDSPC_CTRL 2 in slot 6 CDSPC_VIDEO 1 in slot CDSPC_VIDEO 2 in slot 7 Minimum System Requirements The minimum card requirements to start up the system are defined in Table 3 8 CMS Patient Monitoring System 3 15 CMS Patient Monitoring System Bus Structure Table 3 9 Required Cards for System Start up System Required Cards Systems with 10MHz Application CPU cards 3 4 or 5 cards depending on and or 15MHz CMS model and CPU type Application CPU s in Backplane A display controller card EPROM MASTER and EPROM SLAVE SRAM Utility CPU Rack Interface Card M1046B only Aux Connector Card M1046B only Remote Switch Card Systems with 40MHz CPC Card CPC or combined 40MHz CPC and Application CPU card s depending on CMS
148. LW is not available in U S A 1 52 Basic Plug In Modules C10 CCO Module CMS only NOILV IOSI LNAlLVd daria SSVd Halarid wv 309N3H3H3H SSVd uairiduv aood Figure 1 18 M1012A C O C10 Module Block Diagram 1 53 Basic Plug In Modules 10 CCO Module CMS only Theory of Operation 1 54 Basic Plug In Modules The module has two separate circuits for measuring blood and injectate temperatures The signals progress through the module as follows 1 Blood Channel The temperature sensor distal in the catheter is connected to a reference switching matrix that continuously compares the input to reference resistors for continuous calibration of the measurement The sequentially produced voltages across the reference and sensor resistors are amplified before being input to a low pass filter The filtered signals are then passed through the multiplexer to the analog to digital converter Injectate Channel The temperature sensor Which is a flow through probe is connected to a separate reference switching matrix on its own circuit The matrix compares the signals to the same reference resistors used for the blood circuit The output is amplified filtered and then multiplexed with the blood temperature signal before the signals are digitized for the microcontroller The cardiac output measurement is obtained by first c
149. Measurement CMS only Based on the injectate temperature and the patient s cardiac output the necessary volume should be used C O l min A 25 0 15 0 12 5 7 50 2 50 1 50 1 25 0 75 0 25 Tblood 37 injectate volume differs The following graphic is a guideline on which injectate Tinj TC Tinj lt 25 p 20 Injectate Volume ml The dilution of injectate is also influenced by the extravascular tissue The Extravascular Thermovolume Index ETVI is a quality indicator which quantifies this influence ETVI is calculated based on the patient s body weight and only applies to the current single transpulmonary thermodilution measurement For patients with high ETVI values the accuracy of the transpulmonary thermodilution measurement may be reduced It is recommended to use a higher injectate volume and or colder injectate in these patients based on the following table Cold Injectate Room Temp Injectate Patient Weight ETVI 10 ETVI gt 10 ETVI 10 ETVI 10 lt 3kg 2 2 3 ml Use cold injectate lt 10 kg 2ml 3ml 3ml lt 25 kg 3 ml 5 ml 5 ml 50 kg 5ml 10 ml 10 ml lt 100 kg 10 ml 15 ml 15 ml 2 100 kg 15 ml 20 ml 20 ml Basic Plug In Modules 1 51 10 CCO Module CMS only C O 10 CCO Module CMS only This section describes the Transpulmonary Thermodilution
150. Monitor t Trends Module Reset Volume Patients Setup Procedures Cales Setup gt 3 4 5 Softkeys Hardkeys wclo12a7 tif Hardkeys 6 16 Arrow Keys 17 Figure 3 26 Standard Control Panel The function of the control panel softkeys is defined by the application that is current on the display The label of the key actually appears on the screen and flows to the appropriate softkey If there is no label on the screen pointing to a softkey then that key has no function in that application The function of a control panel hardkey is defined by the label on the key The first row of keys labeled in blue moves the user to another level of functionality The second row of keys labeled in grey performs actions such as recording a waveform The hard key descriptions are as follows Remote Keypad Introduction Connections Data Entry Keys The Remote Keypad is used to enter data The keypad has the same softkeys and hardkeys as the Control Panel It also has data entry keys for entering letters numbers punctuation and arithmetic symbols The Suspend hardkey is only present on newer versions of the handheld keypad The Remote Keypad is connected to the Philips HIL connector on the right corner of the bezel on the master display module or to the outer Philips HIL connector on the rear of the flatscreen display The data entry keys are located at the bottom half of the keypad To enter the value that is on th
151. Monitoring System Flatscreen Display Controller Card Can drive a master and up to 3 remote slave displays e Color luminance equalization e 60 Hz operation Flatscreen Display Controller Card Introduction Connections DSPC_FLAT Components Theory of Operation Data Transfer The Flatscreen Display Controller DSPC_FLAT card is used by the system to output display data to the Flatscreen The DSPC_FLAT card must be inserted into the rear of the Computer Module so that it can be connected to the flatscreen display It is connected to the display by using a cable between the 25 pin SCSI connector on the card edge and a similar connector on the rear of the display If Asian characters are to be supported the DSPC_LANG card must also be inserted into the same cluster as the DSPC_FLAT card Each DSPC_FLAT card supports one master display no remote slave displays can be connected If the system is required to produce two different flatscreen displays a second DSPC_FLAT card must be used in a separate cluster 60 power for the flatscreen display itself is fed through the DSPC_FLAT via a fuse The remote on off connection from the flatscreen display to the external power supply is fed directly from J2 to J3 The DSPC_FLAT card consists of the following functional areas 68000 Microprocessor MPB Interface SRAM PROM buffer VRAM and Video Control Logic The DSPC_FLAT card is based on the 68000 Microprocessor
152. O calibration mode 5 This is a standard 3 pin connector for use with a Transducer Advanced Plug In Modules 2 37 FIO2 Module M1017A Safety To ensure the safety of the patient the patient applied parts are isolated from ground by optical isolators and a transformer In addition the entire module is encapsulated in plastic This module complies with UL544 IEC 601 1 CSA C22 2 No 125 Patient leakage current is less than at 120V 60Hz Isolated patient connection to Class 7 protection Type Cardiac Floating CF There is also protection against damage from defibrillation and electrosurgery 2 38 Advanced Plug In Modules FIO M1017A Module Exercises FIO2 Module M1017A 1 The FIO M1017A Module measures a Fractional inspired Oxygen b Carbon Dioxide c Oxygen concentration 2 The FIO M1017A Module produces a a Numeric display b Waveform c Blinking light 3 The FIO M1017A Module low battery and test signal performs which of the following functions a Controls the FIO Module overall functions b Detects a failed battery c regulates temperature 4 The FIO M1017A Module has all but the following user controls a CAL Indicator b Setup Key c Partial Pressure alarm key Answers Advanced Plug In Modules 2 39 tcpO2 tcpCO2 Measurement Transcutaneous Gas tcepO tcpCO Module Concepts tcpO2Z tcpCO2 Measurement Description Transcutaneous
153. OM Calibration constants for the module are stored in the EEPROM during power down This makes it possible to transport the module together with the sensor without requiring recalibration Power Supply Generates all necessary supplies for the module and the high voltage supply for the infrared detectors The 60V output from the Computer Module is used to generate the required voltages within the module Block Diagram Figure 2 7 shows the block diagram of the patient s recorded signal flow through the M1016A Module Advanced Plug In Modules 2 23 CO2 Respiratory Gas Module M1016A SHalNnoo quvo Mov OL 9 La OldO uaonasNvul TOH1NOO ualvaH U3lV3H HOSN3S NV aisi 14119 3514 NOILISOd 4109 uo1vuvdWoo 3SVHd HOLOW HOLON NOlLv1093u svig dO14ONOW asind ZY a 40193130 ul 055300 du aas 1 C D 7 7 M AOYNOS ul iagram de 2 Module Block D 10X1 Figure 2 7 M1016A Carbon D Advanced Plug In Modules 2 24 CO2 Respiratory Gas Module M1016A
154. OX3 SNYHL UL E 9 H31H3A 2 WOuda3 NOD 1S3L z1v9 OH3Z 3 m c Be 9 o 5 WalSAS H31H3A 9 H3TIOHINOO NOD SSVd 71 77 NE z n MOT ONAS z d g 2 ANG Ot NIVO NOILO313G ANS 1VNOIS HADNGSNVEL gonasNvul ANG Ob E Figure 2 2 M1006A Invasive Pressure Module Block Diagram 2 7 Advanced Plug In Modules Invasive Blood Pressure Module M1006A Theory of Operation There are four major sections that the electrical signal must pass through in order to reach the Monitor interface 1 The amplitude modulated signal from the patient is received electrically through the input connector from the transducer connected to the patient s catheter The signal then gets passed through the Input Protection Network where extraneous signals are filtered out This network provides protection against defibrillation spikes The signal together with the zero compensation signal then travels from the Input Protection Network to the input amplifier The signals are received from the Input Protection Network The sensitivity of the transducer is corrected by the 40 V 5u V Transducer Sensitivity circuitry and is then transmitted to the microcontroller The gain of the Input Amplifier for either 40uV or 5uV sensitivity is set by the microcontroller The amp
155. Operation FIO M1017A Features User Controls Connectors FIO2 Module M1017A The major actions on the electrical signal before it reaches the Monitor interface are as follows The FIO signal is generated when the current produced by the electro reduction of oxygen at the cathode is converted to a voltage This voltage is then input to a low pass filter and the filtered signal is amplified before being passed through the multiplexer to the Analog to Digital converter Figure 2 12 shows the user controls and connectors for the FIO M1017A Module Refer to this figure for the User Controls and Connector descriptions FIO M107A T FIO 21 CAL 1 4C J LC _ H 8 Figure 2 12 FIO Module Controls and Connectors 1 FIO Setup Key This is a single press key used to enter the setup screen 2 FIO Setup Indicator This is a green LED which will be lit when in the FIO setup screen If after pressing the setup key the LED is not lit the system is busy and the FIO setup screen cannot be entered The setup key must be pressed again 3 21 CAL Key This is a single press key used to initiate the 21 calibration procedure The key must be pressed for at least one second to start calibration The calibration task window is not displayed when the calibration is initiated using this key 4 CAL Indicator This is a green LED which is lit when in the FI
156. P signal a heart rate b respiratory rate c cardiac impedance d basic thoracic impedance 6 The number of ST segment measurements that can be stored and retrieved 18 7 Respiration is monitored from which two lead paths a LA and RA b LA and RL c LL and LA d LL and RA ECG RESP Module Answers 242 Basic Plug In Modules 1 29 NBP Measurement Non invasive Blood Pressure NBP Module Concepts NBP Measurement Description Concepts Measurement Principle 1 30 Basic Plug In Modules Blood pressure is the pressure exerted by the blood against the walls of the blood vessels Blood pressure measurement indicates the status of a patient s overall cardiac condition Most frequently blood pressure is measured in the arteries as they are the vessels that carry blood from the heart to the body s major organs Non invasive blood pressure measurements are taken by indirect methods of obtaining arterial blood pressure values rather than by direct sampling of the blood stream Various techniques can be used for measuring blood pressure non invasively all are based on compressing the artery by means of an occluding cuff and measuring the effect of the compression on blood flow The method used by Philips patient monitoring systems is the oscillometric method That is the monitor measures the oscillation or changes in the volume of the arteries accompanying the heart
157. PUs for those CMS that have been upgraded from software release A or B with 10 MHz CPU s exclusively to software release C without CPC APP CPU Slot Location and Quantity A54S A66S 51 8 11 14 22 A56S A66S 51 8 11 14 22 A56 S A66 S C10 51 8 11 14 167 22 A56 S A66 S 26 51 8 11 14 161 22 1 This is a 15 MHz CPU 2 The systems that have been upgraded from software release B to software release C with existing C10 will contain a 10 MHz processor in slot 16 If C10 is added to a Software Release C monitor there will not be a 10 MHz processor in slot 16 Rel C to Rel G 15 MHz APP_CPU Requirements Model Slot 22 Slot 4 Standard CMS A68 S Required Extra card A56 S A66 S Required Extra card A54 S A64 S Extra Extra card Anesthesia CMS from Rel 88 5 Required Required 76 5 86 5 25 Required Required A76 S A86 S without C25 Extra card Extra card 74 5 84 5 C24 Required Extra card 74 5 84 5 w o C24 Extra card Extra card Neonatal CMS from Rel F A36 S A46 S A48 S Required Extra card 1 Not required in certain earlier releases 3 24 CMS Patient Monitoring System Software Release with CPC and Release D CMS Patient Monitoring System Hardware Configurations Models 54 S 64 S and Models 56 S 66 S FRONT BLANK or CDSPC CTRL 1 15 MHz APP CPU C
158. Philips CMS Patient Monitoring System amp V24 and V26 Patient Monitors Concepts Guide PHILIPS Part No M1046 9421L Printed March 2003 This document contains proprietary information which is protected by copyright Rights Reserved Reproduction adaptation or translation without prior written permission is prohibited except as allowed under the copyright laws Philips Medical Systems Cardiac and Monitoring Systems 3000 Minuteman Road Andover MA 01810 1 800 934 7372 Publication number M1046 9421L Printed September 2002 Warranty The information contained in this document is subject to change without notice Philips Medical Systems makes no warranty of any kind with regard to this material including but not limited to the implied warranties or merchantability and fitness for a particular purpose Philips Medical Systems shall not be liable for errors contained herein or for incidental or consequential damages in connection with the furnishing performance or use of this material 2002 Philips Medizin Systeme B blingen GmbH rights are reserved Reproduction in whole or in part is prohibited without the prior written consent of the copyright holder Printing History New editions of this document will incorporate all material updated since the previous edition Update packages may be issued between editions and contain replacement and additional pages to be merged
159. Plug In Modules 41 Transcutaneous Gas Module M1018A Block Diagram 45 Calibration Algorithm 43 Components 45 Description 43 Features 48 Measurements 43 Theory of Operation 47 V VueLink Module Block Diagram 69 81 Components 69 Description 68 Exercises 73 Features 71 Connectors 72 Safety 72 User Controls 72 Measurements 68 Theory of Operation 71
160. ROM SRAM The Utility CPU is responsible for interfacing to several devices and providing the synchronization and clock signals for the rest of the CMS Some of the interfaces connect to the MPB others connect to the same cluster as the Utility CPU Therefore these interfaces are kept separate from the CPUs The individual applications do not have to handle their own interfaces such as the SDN The Utility CPU supports a number of interfaces for the CMS These are either on the card itself or on local cards in its cluster Table 3 24 Utility Card Interfaces Location Description On the CPU board Philips HIL Used for the user inputs integral and remote keypads and touchscreen Nurse Paging Relay Used for connecting to a light or other alarm Connects to the Module Racks maximum of 2 interfaces On local cards Rack Interface SDN Interface Connects to an ICU CCU Serial Distribution Network The Utility Card contains the following functional areas 68000 Microprocessor EPROM EEPROM CERBERUS Output Register Address Decoder and Dtack Logic SRAM Real Time Clock Relay HIL Rear Panel Connector Phone Jack Rear Panel Connector Nurse Paging MPB Interface FIFO Pull Up Arrays Reset Logic 32 millisecond synchronizer Main Clock and the Local Bus buffers The 68000 Microprocessor is used on the Utility CPU card The EPROM capacity 64 Kbytes contains firmware that is executed when the
161. S is connected directly to the line voltage M1094B Display Human Interface Board The Human Interface board shown in Figure 3 25 controls the interface between the user and the system This board includes the following functions Philips HIL control sound generation and audio power amplification lamp LED control and driver key pad scanning key encoding key code transmission to the Computer Module through the Philips HIL and brightness and contrast controls 3 50 CMS Patient Monitoring System Display Module TANVd AJH AV1d510 01 gm 313400 N31 0d SS NIHUME 1 AY 1dSI0 OL 1051 YSN dW 40SS 304d Ov dA 39 450 01 E s 3501 190 157 8 VIVO OVdA 34 1510 N33H 5H2n01 01 1041N0 XLXY YIYO IMAJO TH Ylva v1v LGN 01 E NOBWHI 1 3 JWH t 143299 105 8510 1938 1d3338 305 AG AW1dSI0 AOL SE CMS Patient Monitoring System 3 51 Figure 3 25 Human Interface Board of the Display Unit Display Module Data Transfer Sound Generation Volume Control Lamp Control Key Switches Brightness and Contrast Data transfer to and from the Computer Module in the CMS is performed serially This is done by the Philips HIL using the transmit receive circuit called CHARON This device sends data in response to a POLL command and receives d
162. SPC FLAT ASIA Flatscreen Controller Card DSPC FLAT ASIA Flatscreen Controller Card Introduction Connections DSPC FLAT ASIA Components Theory of Operation Summary of Features The DSPC FLAT ASIA controller card is a replacement for the DSPC_FLAT controller card This improved controller is backwards compatible and can be used to replace the DSPC_FLAT in M1046A Computer Modules that have a flatscreen as a main display and use the M1074A Remote Power Supply to power the system Additionally the remote switch path is also connected to the backplane so that it can be used with the M1046B Computer Module that is powered by its integral power supply The original DSPC FLAT cannot be used in the M1046B for the main flatscreen display This controller provides an Asian Eastern Europe language option consisting of a 4 way DIP switch and a Multilanguage ROM allowing character sets for Japanese Taiwanese Chinese Russian Greek Polish and Czech to be selected Therefore this controller does not need a LANG card All connections are the same as that for the DSPC_FLAT controller In addition the remote switch is also routed to the backplane for M1046B compatibility The circuit design for the flatscreen controller remains unchanged from the original DSPC FLAT controller Additional components have been added to route the remote switch to the blackplane These two parts of the circuit communicate over the local bus as
163. Serial Distribution Network Interface The SDN card consists of the following functional areas Address and Data Buffer Comparator Identifier MUX SIC RAM SIGN RAM SIC Chip Data Sync Last Box Detection Oscillator and SDN Transceiver The operations of the SDN Interface card are defined in the following System timing is governed by the 32 millisecond frame interrupt Frame Int When an SDN Interface card is installed the Frame Int signal must be synchronized to the SDN Sync signal on the Utility CPU The SDN Sync signal indicates the start of a 32 millisecond poll cycle for data transfer Data can only be written to or read from the SIC RAM when both the Frame SYNC and SDN SYNC signals are low during the 4 millisecond dead time If there is no SDN Interface card installed then the 32 millisecond clock in the system is free running All data for transmission on the SDN are placed into the SIC RAM by the Utility CPU in the 4 millisecond dead time The SIC Chip then automatically sends the data over the SDN during the 28 millisecond period Wait cycle logic guarantees the timing between the Utility CPU and the SIC Chip The Utility CPU can select SDN data by placing a signature for selected data in the SIGN_RAM Received data are placed in the other half of the SIC RAM and can be read by the Utility CPU in the 4 millisecond part of the poll cycle A clock using a 28 8 MHz oscillator is generated by the DATA_SYNC gate array and is
164. Subsequent Inflations Above Systolic Pressure Pediatric Neonatal Table 1 7 shows the measurement ranges for each mode Adult Table 1 7 Measurement Ranges in mmHg Systolic Diastolic Pediatric Neonatal Safety Table 1 8 Maximum Safety Limits Maximum Measurement Time 100 seconds Maximum Time Pressure 120 seconds for pressure 10 mmHg Table 1 8 gives the maximum limits that ensure patient safety Over pressure Maximum 330 mmHg for 2 seconds Pediatric 100 seconds 120 seconds for pressure 10 mmHg 220 mmHg for 2 seconds Neonatal 1 38 Basic Plug In Modules 60 seconds 60 seconds for pressure 5 mmHg 165 mmHg for 2 seconds NBP Module Exercises NBP Modules 1 The NBP Modules provide numerics for which measurements a systolic diastolic and mean arterial pressures b pulse rate c heart and respiration rates d a and b e a b 2 The M1008B Module provides the same functions as the M1008A Module with the addition of a mode for a Adults b Pediatrics c Neonates d Pediatrics and Neonates 3 In which mode are measurements taken repeatedly over a period of five minutes a Manual mode b Auto mode c Stat mode 4 What is the function of the bandpass filter a It filters artifact from the mean arterial pressure b It extracts the arterial pressure oscillations from the cuff pressure
165. The MPB Interface is used to pass data back and forth between the card and the MPB For more information refer to the beginning of the Master Functional Cards section The DSPC_FLAT card controls the mechanism of actually displaying information on the screen All display data including local language characters and color information are produced by the Application CPUs or CPCs More than one CPU may produce data for the display The DSPC_FLAT controller card receives display data waves lines numerics display attribute data and control messages from the CPU over the MPB The Microprocessor places the data into the dual ported Video RAM Display attributes such as half brightness are also placed in the Video RAM The pixel data is clocked out of the Video RAM by the on chip shift registers This data then passes through the SLIP Chip which contains all the video and addressing logic before passing it to the video buffers The data is transmitted differentially to the Flatscreen CMS Patient Monitoring System 3 87 Flatscreen Display Controller Card Character Sets DSPC FLAT Functional Block Diagram Summary of DSPC FLAT Card Features The Japanese Taiwanese and Chinese character sets are too large to be stored on the standard EPROM cards These characters are therefore stored on a dedicated card the DSPC Language card which is placed in the same cluster as the DSPC FLAT card
166. The SvO M1021A Module is a mixed venous oxygen saturation measurement parameter unit It is designed to be used with adult pediatric or neonatal patients in a range of Critical Care environments Measurements 5 M1021A Module produces the numerics trends and a displayed light intensity for the mixed oxygen saturation value Components The SvO M1021A Module consists of the following major functional components Table 2 8 Major SvO Module Components Component Description Analog to Digital Converter Converts the signal from the Optical Module Data Flow Manager Receives and processes signal from the A D converter Analog CPU and checks the heater LED current and fuse functions Data Processor Receives the first level averaged data and calculates Algorithm CPU the SvO measurement Data Communication Circuitry Processes the signal and sends it to the rack interface Block Diagram Figure 2 16 shows the block diagram of the recorded patient signal flow through the SvO M1021A Module 2 52 Advanced Plug In Modules SvO2 Module M1021A STOMINOO S gt 195 asensi ze gt AT IATI OG PO INO 3I4A09 Teondo lt S08
167. Waveform The parts of a wave are labeled P QRS and T as shown in Figure 1 7 For patients with artificial pacemakers small dashes called pace pulses appear at the beginning of each wave The QRS complex may actually be composed of only Q and R waves only R and S waves or only an R wave R P T DIFFERENCE ST VALUE Q S Normal QRS Complex E pe EY J 17 IDEAL NO Q WAVE NO S WAVE NO R WAVE ONLY QRS Q amp 5 COMBINE R WAVE Figure 1 7 The QRS Complex ST Segment The ST segment is the part of the waveform between the S and T waves This part of the waveform plays a critical role in diagnosing cardiac abnormalities ST segment analysis is an important function in patient monitoring systems An elevated or depressed ST segment can indicate a serious condition 1 10 Basic Plug In Modules Criteria for Proper Measurement Plug In Modules ECG Measurement Factors affecting accurate measurement of ECG are e Proper placement of electrodes In order to record the strongest signals from the appropriate angles electrodes must be placed precisely Failure to do so may result in erroneous readings e Good skin contact Because ECG signals are small low voltages millivolts the electrodes must make good contact with the patient s skin in order to get an accurate reading Good contact requires proper skin preparation and periodic electrode replacement e Proper selection of leads Leads must be
168. Which module provides physiologic measurements from patients a Computer Module b Display Module c Module Rack d Plug In Parameter Modules 5 Which connector is common to both the Computer Module and the Display Module a Analog Interface connector b Local Power connector c System Power connector 6 Which module supports an integral rack in its front a Computer Module b Display Module c Module Rack d Plug In Parameter Modules 7 Which module contains a DC to DC converter a Computer Module b Display Module 3 60 CMS Patient Monitoring System CMS Patient Monitoring System Module Exercises c Module Rack d Plug In Parameter Modules 8 Which module includes a Switch Mode Power Supply a Computer Module b Display Module c Module Rack d Plug In Parameter Modules 9 Which module has a Control Panel on its front panel a Computer Module b Main Display Module c Independent Display Module d Plug In Parameter Modules 10 What is the maximum number of single width plug in modules that an integral module rack can hold a four b six c eight d twelve 1 Which module provides communication path called the Front End Link a Computer Module b Display Module c Module Rack d Plug In Parameter Modules CMS Patient Monitoring System 3 61 CMS Patient Monitoring System Module Exercises Answers l a 10 c ll c 3 62 CMS Patient Monitoring System CMS Patient
169. ack to the next rack in the chain The following section details the operations of the Module Rack The Module Rack power supply supplies the 45V for the decoding and addressing logic of the rack as well as for the opto couplers in the plug in modules One secondary winding of the power supply transformer provides the SYNC Signal for the individual power supplies of the plug in modules The internal module rack provides a communication path or Front End Link FE LINK between the Rack Interface card in the Computer Module and the satellite racks as well as the plug in modules in the internal rack Each of the eight plug in connectors is addressed by the addressing and decoding logic and then polled by the Rack Interface Card If the connector has a module present then the plug in module places data about its identity on the Tx line This Tx line is connected to the Rack Interface card The Rack Interface places the identities of the plug in modules into a scan table For more information about the FE LINK and module polling see Rack Interface Card in the section on Local Function Cards The rack s differential receiver and transmitter ensures the fast and reliable passage of data over the FE LINK for up to 30 minutes The module rack consists of the power system decoding logic input output and the module connectors 3 56 CMS Patient Monitoring System Module Racks AM_LOGIC
170. agram 86 Components 86 Description 86 Exercises 90 Features 89 Capabilities 89 Safety 89 User Controls 89 Theory of Operation 88 E ECG Measurements Exercises 12 Electrocardiogram ECG Measurement Concepts 3 Criteria for Proper Measurement 11 Description 3 Measurement Acquisition 3 Chest Leads 6 Five Electrode Placements 8 Limb Leads 4 Modified Chest Lead MCL1 7 Measurement Principle 3 Output 9 ECG Waveforms 10 ST Segment 10 Plug In Modules 11 Electrocardiogram ECG Module Block Diagram 13 Components 13 Description 13 Exercises 18 Features 16 Connectors 16 Paced vs Non Paced Mode 17 QRS Detection 17 Safety 17 ST Segment Analysis 17 User Controls 16 Waveforms 16 Measurements 13 Theory of Operation 15 Electrocardiogram Respiration ECG RESP Module Block Diagram 24 Components 23 Description 23 Exercises 28 Features 26 Connectors 26 ECG Modes 26 RESP Modes 27 Safety 27 ST Segment Analysis 27 User Controls 26 Measurements 23 Theory of Operation 25 F FIO2 Module M1017A Block Diagram 35 Components 35 Description 35 Exercises 39 Features 37 Connectors 37 Safety 38 User Controls 37 Measurements 35 Theory of Operation 37 FIO2 Respiratory Measurement Concepts 33 Criteria for Proper Measurement 34 Description 33 Exercises 34 Measurement Acquisition 33 Measurement Output 33 Measurement Principle 33 Plug In Modules 34 I Inva
171. an AC power cord to the AC outlet This AC cord is connected to a connector on the back of the Display Module the Remote Power Supply or the Integral Power Supply in the M1046B Computer Module Computer Module M1046A When the power is turned on the Display Module or the Remote Power Supply receives the 120V AC depending on the source voltage and converts this voltage to 60V DC The 60V DC is output through a connector on the back of the display or Remote Power Supply and is fed to the computer module through the 15 pin connector of the DC to DC converter Computer Module M1046B When the power is turned on the Computer Module M1046B receives the 120V AC depending on the source voltage and converts this voltage to 60V DC The 60V DC is output through a connector on the back of the Integral power supply to the Remote CMS Patient Monitoring System 3 17 CMS Patient Monitoring System Power System NOTE DC to DC Converter Power Up and Diagnostics System Reset Switch card in slot 8 of the Computer Module This 60 V DC is routed internally to the DC to DC converter As no connection is made to the 15 pin connector of the DC to DC converter a shorting stub MUST be connected to it so that the system operates correctly A delay of between one to two seconds occurs between the time that the 60V DC arrives at the input to the DC to DC converter and the time that the DC to DC converter outputs the regulated
172. any number of Identifier times in a CMS or in a particular cluster Each local card has a unique identifier used to specify the type of card and its position in the cluster This identifier contains the board type hardware revision and the version The identifier may also be used to test the compatibility of the local card with the master card When a master card requests the identifier it is placed on the Local Bus by selecting that card done by the comparator matching the high address bits along with the slot number and at the same time sending an Access Identifier ACC to the card On the local card the identifier information is hardwired onto the card by using a pair of octal bus drivers The output of the drivers is connected to five lines on the Local Bus 3 112 CMS Patient Monitoring System AUG Ser CARD ID 2 z eu HW REV p p6 E gt SLOT 5 ADDRESS tr lt x amp gt 227106 ERI Figure 3 45 Local Card Identifier EPROM Introduction Components Data and Address Buffers Identifier EPROM The EPROM card is a local card that connects to the Local Bus It is used by a master card such as the Application CPU to store executable code of the application software and the operating system It may also be used by a display controller DSPC or CDSPC for language dependent display characters The
173. ards use both EPROM and SRAM cards Two types of SRAM card are available e M1055 66501 SRAM LO standard for 10 and 15 MHz systems e M1056 66501 SRAM HI used with option in 10 and 15 MHz systems contain their own memory arrays including four types of memory Two versions of CPC are available the M1053 66514 and M1053 66515 These CPCs are discussed in the Master Cards section of this document Models which use the CPC cards will not have EPROM and SRAM cards CMS Patient Monitoring System 3 19 CMS Patient Monitoring System Hardware Configurations Function Card Placement The function cards are interconnected by the backplane within the Computer Module The function cards are mounted on both sides of the backplane and may be located either in the front of the Computer Module even numbered connectors or the rear odd numbered connectors The local clusters of the backplane are color coded on the Computer Module so that they can be easily identified On the rear of the backplane to the left of connector 21 there is a triple sized gap This is the only place where the dc dc converter can be located The newer Computer Module M1046B has an integral power supply As a result these Computer Modules have additional function cards Function Card Placement in the backplane of the monitor is dependent upon the following 1 The monitor model 5 indicates the non US models CMS Models 54 S 56 S 64 S
174. areas of the patient s trunk and limbs The information carried by the signals varies according to where and how the electrodes are placed Measurement An ECG is recorded using lead cables connected to a monitoring device ECG leads Acquisition are single electrodes or arrays of electrodes placed at specific anatomical positions that detect the electrical voltage of a specific cardiac vector Each lead monitors the heart s electrical activity from a different perspective Unipolar leads detect signals moving from the heart to the skin s surface bipolar leads detect the surface electrical activity moving from one electrode to another The EASI 12 lead ECG uses a special lead positioning that detects electrical activity which does not correspond directly to Basic Plug In Modules 1 3 ECG Measurement Limb Leads 1 4 Basic Plug In Modules the standard ECG vectors but from which all 12 of the standard vectors can be derived Lead cable sets are available with various numbers of lead wires common types are three five and twelve lead sets The end of each wire is attached to an electrode and is color coded to facilitate anatomical placement Electrodes can be placed in many different arrangements depending on factors such as clinical application type of patient and suspected diagnosis Three bipolar limb leads are called leads and Electrodes are placed on the patient s right arm left arm and left leg forming a pattern kn
175. as when the patient has abnormal total protein or lipid levels it is due to an interference on the indirect method At normal levels of protein and lipids the systematic offset between methods is often corrected for in commercial direct measuring instruments so that the normal ranges for all instruments are in agreement Sensor outputs have been set so that normal ranges are in agreement with indirect reference methods at normal levels of total protein and lipids Direct measurement of hematocrit by the conductometric technique gives a result related to the non conducting excluded volume fraction of the sample fluid Red blood cell volume is the predominant component of the non conducting volume but proteins lipids and white blood cells also contribute Elevated hematocrit readings are expected at abnormally elevated levels of these components Decreased hematocrit readings are expected at abnormally low levels of protein such as found in samples taken from patients on perfusion pumps Osmotic imbalance causes a discrepancy between direct conductometric spun and indirect Coulter measurements because of variation in mean cell volume in vivo The analysis results are depicted as a numerics listing with the cartridge type and sample type shown at the top The measured parameter results are displayed together with the corresponding units Calculated results are marked with a for example HCO Temperature adjusted values are marked with an 42
176. asurement of Continuous Cardiac Output CCO Stroke Volume SV Systemic Vascular Resistance SVR and Stroke Volume Variation SVV by means of Pulse Contour analysis of the arterial blood pressure waveform The PiCCO method is a combination of the transpulmonary thermodilution technique and blood pressure waveform analysis to measure Cardiac Output C O Intrathoracic Blood Volume ITB V and Extravascular Lung Water EVLW The thermodilution method is based on the principle that the flow rate of an unknown quantity of liquid can be determined by adding a known quantity of indicator and measuring its concentration downstream Thermodilution involves injecting a cooled solution at a known temperature into the heart The injectate solution mixes with and cools the warmer surrounding blood When the blood leaves the heart its temperature as a function of time indicates the rate of blood flow The thermodilution measurement is also used for the calibration of the Continuous Cardiac Output CCO derived by pulse contour analysis from the arterial blood pressure wave The measurement of transpulmonary thermodilution cardiac output and blood pressure requires a central venous line and an arterial thermal dilution catheter placed downstream from the heart in or near the aorta e g the femoral or the axillary artery The injectate is injected through the central venous line The temperature of the injectate solution is measured by a flow throug
177. ata from the HIL master using the WRITE REGISTER command The data received are used to control the various LEDs on the keypad for example visual alarms and key back lighting activate or trigger the audible tones for example alarms QRS tick and prompts and enable or disable on board functions The Human Interface board generates an audible tone for various conditions To prevent ambiguity each condition has its own tone Each tone has its own control word which controls it When this control word is sent to the processor it generates the required tone The tones for non alarm conditions are derived directly from the processor The alarm tones are processor generated based on variable frequency steps The Human Interface board has three volume controls Alarms QRS tick and Miscellaneous three controls function in the same manner The analog tone is applied to the Vref input of a digital to analog converter DAC The digital input to the DAC is the volume control The attenuated tone DAC output is summed and input to the power amplifier for the loud speaker The click tone has a fixed volume and is routed to the summing amplifier The Human Interface board controls and drives seven keypad lamps The processor receives the lamp ON OFF data and latches a control register driver The processor scans the 25 keys records a change in switch position and performs a key bounce function When a switch position change is regist
178. ation Alarms can be indefinitely suspended or suspended for 1 2 or 3 minutes after which alarms will automatically reactivate To prevent unwanted alarm strip recordings it is possible to configure which parameters will trigger an alarm strip 4 8 V24 and V26 Patient Monitors ST Segment Analysis oxyCRG Neonatal Event Review Settings Transfer 24 and V26 Patient Monitors Description and Features ST Segment Analysis software allows you to measure the elevation or depression of the ST Segment on up to three leads of a patient s ECG The ST measurements are shown as numerics on the flat panel and are available in table and graphic trend displays in Patient Data Management The V24 V26 uses the CMS Rev E Beta version of the ST application The Oxygen CardioRespiroGram oxyCRG display provides a simultaneous presentation of 3 waves beat to beat heart rate DtbHR compressed respiration rate e oxygenation parameter trend 5 or Each waveform shows a 6 minute interval allowing you to compare patterns related to physiological or pathophysiological processes and detect respiratory conditions typical of neonates Neonatal Event Review provides automatic documentation and review of up to 24 events from the last 24 hours At one glance you can see and review the number of events and categories such as bradycardia apnea with associated bradycardia or isolated desaturation event Plug in mod
179. atory activity that indicates the strength and efficiency of a patient s respiratory pulmonary muscles The measurement can be accomplished using various techniques the method employed by Philips patient monitoring devices is the impedance method Concepts Respiration is the metabolic process by which the body obtains oxygen expels carbon dioxide and regulates its acid base pH balance This process is carried out by a respiratory system composed of the lungs the respiratory muscles notably the diaphragm and intercostal muscles and the organs that carry gas into and out of the lungs Respiratory monitoring techniques measure either the nature of the gas exchange within the lungs or the efficiency of the pulmonary muscles respirogram is concerned with the latter An important concept for respirogram monitoring is Respiratory rate The timing and rhythm of inspiration and exhalation If any of these measurements is above or below the normal range other respiratory monitoring techniques may be needed to assess the patient s overall respiratory condition Measurement Within the thorax chest the lungs are surrounded by a moist pleural membrane Principle which produces a lubricating fluid that enables the lungs to move easily during respiration This fluid along with the change in volume of air allows the measurement of electrical impedance when the lungs expand and contract A respirogram measures the change in electrical i
180. atures 83 Recordings 84 User Controls 83 Theory of Operation 82 Respirogram RESP Measurement Concepts 19 Criteria for Proper Measurement 21 Description 19 Exercises 22 Measurement Acquisition 20 Measurement Principle 19 Output 21 Plug In Modules 21 References 21 S Sidestream CO2 Module M1015A Block Diagram 28 Components 28 Description 28 Exercises 32 Features 31 Connectors 31 Safety 31 Measurements 28 Theory of Operation 30 SvO2 Blood Measurement Concepts 50 Criteria for Proper Measurement 50 Description 50 Exercises 51 Measurement Acquisition 50 Measurement Output 50 Measurement Principle 50 Plug In Modules 50 SvO2 Module M1021A Block Diagram 52 Components 52 Description 52 Exercises 57 Features 55 Connectors 56 Safety 56 User Controls 55 Measurements 52 Theory of Operation 54 T Temperature TEMP Measurement Concepts 66 Criteria for Proper Measurement 66 Description 66 Exercises 68 Measurement Acquisition 66 Measurement Principle 66 Output 66 Plug In Modules 67 References 67 Temperature TEMP Module Block Diagram 69 Components 69 Description 69 Exercises 72 Features 71 Connectors 71 Safety 71 User Controls 71 Measurements 69 Theory of Operation 71 Transcutaneous Gas Measurement Concepts 40 Criteria for Proper Measurement 41 Description 40 Exercises 42 Measurement Acquisition 41 Measurement Output 41 Measurement Principle 40
181. ay e Any off the shelf XGA Display The 10 47 14 and 15 and off the shelf XGA displays can be used as main displays independent displays or slave displays The 21 display is a remote display The following figures show the front of the main display which contain a Control Panel and various switches controls and connectors From Rel any XGA display can be used as main display Since these displays do not provide a Control Panel operation is possible with either the Remote Keypad or from Rel C 0 via touchscreen or mouse The External Alarm Device is required for connections and alarm lights and sounds please refer to Figure 3 24 External Alarm Device controls and connectors NOTE CMS Patient Monitoring System 3 43 Display Module 1 mar2bb mif m m lt cnc JC 3 Gu Control J m E Panel ON OFF Switch Contrast Bu Power ON Control Interface Indicator Brightness Connector Control Figure 3 18 Front Panel of Main Display Unit Power Indicator Light Screen Brightness Control Control Panel Power On Off switch also remote on off for power supply Figure 3 19 Front Panel of 10 4 Flatscreen Display On Screen Display Operation Keys Power Switch OSD On Off Power On Indicator LED
182. ay Controller DSPC Controls the monochrome video display In addition to this card the cluster may also contain a language specific local card such as the DSPC LANG for Asian character set Color Display Controller CDSPC CTRL Controls the color video display along with the local card CDSPC VIDEO if present DSPC FLAT Controls the Flatscreen Display Utility CPU UTIL CPU Generates the system clocks for system synchronization and provides the interface to the Philips HIL devices The Utility CPU uses the local bus to interface with the SDN and with the Module Racks through the SDN Interface and Rack Interface local cards RS232 Interface RS232 IF Allows the computer module to be connected to external equipment through the use of an RS232 or RS422 interface This would include equipment such as a local printer or PC HDLC Interface HDLC IF Provides an interface to real time wave recorders that use the Standard Recorder Interface Protocol STRIP This card does not connect to the local bus Configurable Processor Card CPC Responsible for all application data processing for the CMS The CPC receives data from the MPB processes the data and places the results back on the MPB Analog Interface Provides eight channels of analog output that can be connected to recorders and other data collection instruments CMS Patient Monitoring System 3 65 Master Card Overview Communica
183. beat Blood pressure results from interactions between the heart s pumping force the circulatory system s blood volume and the body s vascular resistance to blood flow Blood pressure measurements are related to cardiac output measurements in that both types are concerned with pumping force and vascular resistance Cardiac output is a major determinent of blood pressure Concepts important to non invasive blood pressure measurement are e Systolic pressure The highest pressure of the blood against the arterial wall following ventricular contraction It is a measure of how hard the heart is working and how much oxygen it requires e Diastolic pressure The lowest pressure of the blood against the blood vessel wall following closure of the aortic valve just before ventricular contraction It is one measure of how much oxygen the heart is getting from the pulmonary capillaries I Pulse pressure The difference between the systolic and diastolic readings This is the range of the pressure in the arteries Mean arterial pressure The average pressure used to push blood through the circulatory system This measurement is an important index of blood flow and gas exchange in the capillaries In the oscillometric method blood pressure is measured as oscillations superimposed on cuff pressure The cuff inflated around the patient s limb senses arterial pulses as oscillations whose amplitude changes as the cuff is deflated The initial o
184. by a revision date at the bottom of the page Note that pages which are rearranged due to changes on a previous page are not considered revised The documentation printing date and part number indicate its current edition The printing date and part number change when a new edition is printed This guide combines the former CMS Patient Monitoring System Concepts Guide with the former Viridia 26 24 Series Concepts Training and Reference Guide to one manual therefore this guide is in its first edition The printing histories of both Concepts Guides are listed below Printing histories of former Concepts Guide Versions Edition CMS V24 and V26 Patient Monitors First January 1996 November 1996 Second May 1997 December 1996 Third January 1998 February 1998 Fourth April 1999 First Edition June 2000 Contents Introduction ce e ER Ur ves etes of This Book ito stein ee oak es eret E Ree delere 1 Who Should Use This 1 What The Contains ERAN ERRAT E 2 DR eA ie ee Re 2 How the Book is 2 How the Content Is 2 Howto Use This BOOK ci
185. by adding a known quantity of indicator and measuring its concentration downstream Thermodilution involves injecting a cooled solution at a known temperature into the heart The injectate solution mixes with and cools the warmer surrounding blood When the blood leaves the heart its temperature as a function of time indicates the rate of blood flow The measurement is taken with a pulmonary artery PA Swan Ganz catheter The catheter is inserted into the heart with the proximal lumen opening positioned in the right atrium for introducing the injectate and the thermistor used for monitoring temperature positioned in the pulmonary artery Positioning of the catheter is gauged by using pressure measurements and X rays of the catheter location small amount of thermal indicator is introduced into the right atrium The indicator mixes with the blood in the right ventricle and approaches a temperature equilibrium When the diluted blood reaches the pulmonary artery the thermistor measures the decrease in blood temperature over time The temperature of the injectate solution can be measured either indirectly or directly Indirectly the temperature of the cooling bath is measured Direct measurement uses a flow through temperature probe to measure the injectate temperature as it is being Measurement introduced into the catheter The probe is positioned where the syringe injects the indicator into the proximal lumen port Basic Plug I
186. c It protects the circuitry from high frequency interference 5 The systolic and diastolic blood pressure values are deduced from the oscillometric signal by resulting in empirical values Answers l a 2 c 3 c 4 b 5 extrapolation Basic Plug In Modules 1 39 Measurement Cardiac Output Module Concepts C O Measurement Description Concepts Measurement Principle Measurement Acquisition 1 40 Basic Plug In Modules Cardiac output is an important measure of cardiac performance It measures the volume of blood pumped into the circulatory system by the heart over a specified period of time Cardiac output is closely related to blood pressure Several methods can be used for determining cardiac output The method used by Philips patient monitoring systems is the thermodilution method With thermodilution cardiac output is measured as the liters of blood pumped per minute into the pulmonary artery by the right ventricle of the heart Cardiac output is determined by heart rate and stroke volume as defined below Heart rate The number of times the heart beats in one minute Stroke volume The amount of blood pumped per beat Cardiac index A measure of an individual s cardiac output adequacy calculated by dividing the cardiac output by the body surface area The thermodilution method is based on the principle that the flow rate of an unknown quantity of liquid can be determined
187. c status of patients rather than their hypnotic state Despite the absence of a reliable depth of anesthesia measure the practice of anesthesia remains one of the safest and most effective in medicine However a quantitative measure which differentiates brain responses from somatic autonomic and hemodynamic responses can provide useful information which contributes to improved safety effectiveness and efficiency in anesthetic delivery Monitoring the hypnotic effects of anesthetics with BIS in combination with current monitored parameters and clinical signs has been shown to allow better balancing of hypnotic and analgesic administration Demonstrated benefits include e Continuous monitoring for the risk of awareness Better management of responses to surgical stimulation More rational selection of drugs Additional studies have shown that monitoring with BIS can also aid the anesthetic provider in delivering the most appropriate doses of hypnotics and analgesics resulting in Faster wake up and recovery More cost effective use of drugs e Fewer unwanted intraoperative responses Advanced Plug In Modules 2 87 BIS Measurement The Bispectral Index BIS and Depth of Anesthesia BIS Response to Commonly Used Anesthetic Drugs Changes in the Bispectral Index in Response to Drugs and Stimulation Because BIS reflects changes in anesthetic dosing it might be assumed that this information can be used in is
188. cenario the capacitor would supply power for at least 255 hours or approximately 11 days Function Card Description Summary Table 3 5 Function Card Summary Component Description DC DC Converter Provides the voltages for the system Application CPU One of the CPU types responsible for processing the data Configurable Processor Card One of the CPU types responsible for processing the data DSPC Card Outputs display data to the monochrome display CDSPC Cards Outputs display data to the color displays Utility CPU 3 12 CMS Patient Monitoring System Provides interfacing to several devices Function Cards Local Clusters CMS Patient Monitoring System Bus Structure Table 3 5 Function Card Summary Component Description RS232 RS422 Dual Provides the CMS with an interface to the outside world Interface Card EPROM Card Stores the executable code and or language dependent characters SRAM Card Stores data before and after processing SDN Interface Card Interfaces the CMS to the Serial Distribution Network Rack Interface Card Interfaces the CMS with the module racks HDLC Interface Card Interfaces the CMS with real time recorders using STRIP Analog Interface Card Provides eight channels of analog output which can be connected to data collection instruments Remote Switch Card M1046B only Provides connection and the remote switching of the DC pow
189. ces a Graphical and numeric trend information b Waveform c Numeric Value 3 The tepO tcpCO M1018A Module Relay performs which of the following functions a Manages light intensity b Routes the and CO signals to the multiplexer 4 The tcpO tcpCO M1018A Module uses which kind of connector a Standard 12 pin b Standard 3 pin c 20 pin Answers Advanced Plug In Modules 2 49 SvO2 Blood Gas Measurement SvO Blood Gas Module Concepts CMS only SvO Blood Gas Measurement Description Concepts Measurement Principle Measurement Acquisition Measurement Output Criteria for Proper Measurement Plug In Modules SvO blood gas measurements indicate the amount of mixed venous oxygen saturation in a patient The SvO blood gas measurement is an indication of the amount of oxygen a patient is consuming and how well the heart is working Blood gas concepts important to this section are Oxygen Saturation The amount of dissolved oxygen in a blood sample The SvO measurement is based on the progressive change in color of the blood from scarlet to purple as oxygen saturation decreases Light of different selected wavelengths illuminates the blood The light is absorbed refracted and reflected by the blood The amount of light detected depends on the blood s color and from this information the venous oxygen saturation is obtained The mixed venous oxygen satu
190. ch is used to zero the transducer without using the master display controls 4 The PRESS uses a standard 12 pin connector with a pressure transducer that has a sensitivity of either 5uV 10 or 4A0u V 40 To ensure the safety of the patient the patient applied parts are isolated from ground by optical isolators and a transformer In addition the entire module is encapsulated in plastic This module complies with UL544 IED 601 1 CSA C22 2 No 125 Patient leakage current is less than at 120V 60Hz It has an isolated patient connection to Class I protection Type Cardiac Floating There is also protection against damage from defibrillation and electro surgery Advanced Plug In Modules 2 9 Invasive Blood Pressure Module M1006A PRESS M1006A 1 The PRESS M1006A Module measures Module Exercises a cardiac output b invasive blood pressure c blood oxygen concentration level 2 The PRESS M1006A Module produces a waveform along with all but a systolic numeric value b instantaneous numeric value c diastolic numeric value 3 The PRESS M1006A Module Input Amplifier performs which of the following functions a amplifies the signal before it is sent to the microcontroller b demodulates the signal before it is sent to the microcontroller protects the module from extraneous signals 4 The PRESS M1006A Module has all but the following user controls a Zero Key b Press
191. conduction system ECG is also referred to as EKG the abbreviation for the German spelling of the term Concepts ECG concepts important to electrocardiogram measurement are Lead A specific electrode or array of electrodes used to record changes in electrical potential created by activity of an organ such as the heart QRS complex The portion of an ECG waveform that represents the depolarization of the cardiac ventricles ST segment The portion of an ECG waveform that represents the time period between the end of ventricular depolarization and the start of ventricular repolarization Pace pulse On an ECG waveform the marks indicating the initiation of cardiac depolarization and contraction generated by an artificial pacemaker Measurement The electrical cells of the heart generate conduct and coordinate electrical impulses Principle that cause the heart s mechanical cells to contract As these impulses move through the various parts of the heart s conduction system small electrical currents also move toward the body s surface An ECG measures the heart s electrical activity as the heart contracts and relaxes by recording the electrical signals on the patient s skin The measurement represents the changing electrical potentials and their progression through the heart the ECG records data on both the direction of electrical activity and its magnitude The electrical signals are detected by electrodes placed on various
192. corded Logic tell us that the more channels you record the more information you derive The EEG signal is extremely low voltage measured in microvolts compared to the ECG which is measured in millivolts The EEG voltages are very minute and must be amplified Since 60 Hz noise is approximately 10000 times stronger the signal is also filtered The EEG varies with alterations in the function and metabolism of the brain but there are classic characteristics e Waves The electrical potentials change in a rhythmic repeating fashion These changes are recorded as waves e Frequency The pattern of waves or rhythm is called the frequency and is expressed in Hertz Hz or cycles per second e Amplitude This is the voltage measurement of the EEG wave from the top of the peak to the bottom of the peak e Spike A spike is a fast wave with steep slopes on each side that may appear randomly or in bursts It is an abnormal sign which can indicate the location of pathology It s often seen with epilepsy or enflurane overdose 2 74 Advanced Plug In Modules Frequency Alpha EEG Measurement 1 9 yi I elg 1 m MULTIPLE SPIKES The changes in the EEG waves can be e Background The pattern indicating what the brain is doing all the time Transient A single wave such as a spike that differs from the background pattern e Paroxysmal A sudden burst of change such as multiple spike
193. correlate non invasive pressure Figure 1 14 shows the user controls and connector for the modules The parts are described following the figure NBP Modules NBP 7 7 2 4 5 START STOP D OD 4 6 3 4 T eclol0c tif I Figure 1 14 NBP Module Controls and Connectors User Controls 1 NBP Setup Key A single press key used to enter the NBP setup screen 2 NBP Setup Indicator A green LED lit when the NBP setup screen is activated 3 Start Key A single press key used to start the measurement cycle 4 Start Indicator a green LED lit when the measurement cycle is entered 5 Stop Key a single press key used to stop the measurement cycle 6 Stat Key A single press key used to start a static measurement cycle 7 Stat Indicator A green LED lit when the static measurement cycle is entered 8 Venous Puncture Symbol indicates that the module supports the Venous Puncture function Connectors 9 standard NBP connector connects to the cuff NPB Modes The M1008A Module offers adult and pediatric modes The M1008B Module offers adult pediatric and neonatal modes Basic Plug In Modules 1 37 NBP Modules Table 1 6 shows the cuff inflation limits for each mode Adult Table 1 6 Cuff Inflation Limits in mmHg First Inflation
194. cted to the display It is connected to the display by using a cable between the 9 pin D type connector on the card edge and a similar connector on the rear of the display The video output on the rear of the display may be used to connect a remote display If Asian characters are to be supported the DSPC LANG card must also be inserted into the same cluster as the CDSPC card Each CDSPC card supports either one master display and three remote displays or four remote displays If the system is required to produce two or three slave different color displays a second or third CDSPC card must be used in a separate cluster The video controller card consists of the following functional areas 68000 Microprocessor MPB Interface FIFO SRAM PROM Extension PROM and buffer The video component of the card consists of Color Register Buffer Horizontal Wave Scroll Logic Video System Controller Attributes Oscillator Video Buffers Color Mapping Circuit Protection Network and the Color Planes The CDSPC card is based on the 68000 Microprocessor The MPB Interface is used to pass data back and forth between the card and the MPB For more information refer to the beginning of the Master Functional Cards section First In First Out buffer The SRAM contains code for communications with the VIDEO card The PROM contains the firmware for communications with the CDSPC VIDEO card 3 84 CMS Patient Monitoring System Theory o
195. ction on the HDLC cable to STRIP devices the cable shield is only connected at one end of the cable For this reason the signal ground and safety ground in each HDLC device must be tied together Additionally there must be a connection between the safety ground of all devices and the power cord safety ground or additional grounding cables Testing Diagnostics available on the HDLC card are detailed in the following An internal loop test checks HSCX operation The HDLC drivers are tested by an HSCX external loop which can be opened or closed by resetting setting the test loop register CMS Patient Monitoring System 3 103 HDLC Interface Card Functional Block Diagram S3OIA3d OL O4I4 1501 5534005 TONLNOD STHNDIS 3151938 CONINOO a007 isa Grud COMINOO T 5535000 9 1 se 7ONLNOD wd 22533808 i I9 CJONINOO 22089 7 JTONINOD v AJAA ssaaddu BIB 5535006 ZHW21 dd 4 ANG 14088 Figure 3 42 HDLC Interface Card Block Diagram The features of the HDLC card are detailed in the following Summary of HDLC Features Provides an interface
196. cuffs that are applied too loosely e Artifacts caused by shivering bumping or other rhythmic or external pressure The oscillometric measurement has limitations in certain clinical situations When a patient s condition makes regular arterial pressure pulses difficult to detect the measurement is unreliable and takes longer to derive The following conditions can interfere with the measurement e Patient Movement If the patient is moving shivering or having convulsions reliable measurement is difficult or impossible to obtain e Cardiac Arrhythmias Irregular heart beats during arrhythmias make measurements unreliable or impossible e Pressure Changes If the patient s blood pressure changes rapidly during the measurement period measurements are unreliable e Severe Shock Severe shock or hypothermia reduces blood flow to the peripheries and thus reduces arterial pulses making pressure measurement unreliable e Obese Patients A thick layer of fat surrounding the limb can muffle arterial pulses and prevent them from reaching the cuff thus reducing the measurement s accuracy Heart Rate Extremes Measurements cannot be made if the heart rate is less than 15 bpm or greater than 300 bpm e Heart lung Machine Measurements are not possible if the patient is connected to a heart lung machine Movement of the tube Philips M1008A and M1008B NBP Modules measure non invasive blood pressure The M1008B module replaced the
197. cules are reduced on the platinum electrode and generate a small current proportional to the pressure The CO molecules alter the pH of the electrolyte until an equilibrium is obtained The change pH is converted into a voltage proportional to the To establish that the voltage or current levels correspond to the or partial pressures the transducer is calibrated The transducer is exposed to a calibration gas of defined values for pCO and pO The transducers require calibration due to the fact that transducers have an unknown offset and transducers have an unknown sensitivity Any transducer not calibrated regularly will misread and the measurement is inhibited until a calibration is performed 2 40 Advanced Plug In Modules Measurement Acquisition Measurement Output Criteria for Proper Measurement Plug In Modules tepO2 tcpCO2 Measurement The transducer is heated to improve the diffusion of CO and from the patient s skin and to maintain an absolute constant temperature Any change in the transducer s temperature changes its characteristics so the user must make a new calibration if and after the set temperature has been changed The transcutaneous gas measurement is noninvasive using a transducer attached to the patient s skin The transcutaneous gas readings are depicted as numerics on the display and as graphical and numeric trend information for the partial O and CO mea
198. d V26C V26CT for display of up to six waveforms Eight slot or optional six slot Plug in Satellite Rack to hold plug in modules V24 and V26 Patient Monitors 4 3 V24 and V26 Patient Monitors Description and Features Optional battery operation V24CT V26CT All parameter modules supported by CMS except FiO 5 and EEG Network Compatible through the Philips patient care system interface Patient Data Management software which provides 24 hour storage of patient related parameter information ST Segment analysis software e OxyCRG display software Neonatal Event Review software e Extended arrhythmia detection when networked to one of Philips Arrhythmia Systems Allows transfer of patient related settings and transfer of patient cables and lines without recabling or recalibration Figure 4 1 Philips V24 and V26 Patient Monitors Standard Package 4 4 24 and V26 Patient Monitors V24 and V26 Patient Monitors Description and Features Mainframe The mainframe contains the display unit and the processing capabilities for the V24 V26 A computer subsystem is responsible for parameter processing display control and interfacing The display section consists of a 9 5 diagonally measured monochrome display V24 mainframe with 10 4 color display V26C V26CT and V24C V24CT Rack Features There are two rack options for the V24 V26 either the eig
199. d mean pressure values An invasive blood pressure measurement is collected through a pressure transducer that is connected to a pressure line by means of a catheter which is invasively placed in the patient s blood stream Advanced Plug In Modules 2 3 Invasive Blood Pressure Measurement Measurement Output Criteria for Proper Measurement Plug In Modules Blood pressure is depicted as a pressure wave with the numerics for systolic diastolic and mean pressure values The blood pressure shows the cycles of contraction and release within the heart and the resultant pressure that is generated to move the blood through the vessels 135 72 94 34 16 23 Figure 2 1 An Example of a Typical Invasive Pressure Wave Factors affecting accurate measurement of invasive blood pressure are Proper connection between the pressure transducer pressure line and patient catheter e Systolic pressure readings in lower extremities are usually higher than readings in higher extremities Moving from a reclining position to a standing position can cause the systolic pressure to fall and the diastolic pressure to rise slightly e The positioning of both the patient and the pressure transducer can influence the pressure measurement It is normal practice to position the transducer at heart level 4th intercostal space and the midaxillary line known as phlebostatic axis and to zero the system to compensate for the static and
200. d used to synchronize the SDN Interface with the Utility CPU A 32 millisecond frame interrupt on the SDN interface is synchronized with the SDN synchronization signal on the Utility CPU The utility card s signal is used to indicate the start of a poll cycle for data transfer This section contains the following topics Table 3 27 Topics in this Section Local Card Overview SRAM Color Display Video Card Serial Distribution Network Interface Rack Interface Aux Connector Card Remote Switch Card Local Card Overview Introduction Local Card Functions The CMS contains two types of function card master cards and local cards Master cards have a microprocessor and connect to the Message Passing Bus MPB most also have a connection to the Local Bus Local cards perform supporting functions for the master cards and connect to only the Local Bus Master cards communicate with the system over the MPB and with their corresponding local cards over the Local Bus Refer to CMS Bus Structure in the System Overview section for a description of the bus architecture The local cards do not interface with the MPB bus rather they connect to the Local Bus A local card is never used alone in a cluster there is always a master card in a cluster CMS Patient Monitoring System 3 111 Local Card Overview Table 3 28 Local Cards Card Name Function Pre Re
201. d waveforms three separate recording modes A B and can be configured preset recording begins printing when the preconfigured recording key is pressed Monitoring procedure recordings can be made during cardiac output and pulmonary artery wedge pressure measurements and during ST analysis They are accomplished with soft keys during the procedures Vital sign recordings can be initiated automatically by an NBP measurement by an internal timer in the monitor or by a user The NBP measurements can be taken by the NBP plug in module or by an NBP monitor connected through VueLink Vital sign recordings are made only at the bedside by the M1116A and M1116B Recorder Modules they are not re routed to a central recorder if the bedside recorder is not available Alarm recordings a type of delayed recording They include waveform information from before the alarm was initiated so clinicians can see the change in the patient s condition When a patient goes into an alarm condition an alarm recording is generated automatically according to the monitor s configuration Settings for alarm severity level as well as for enabling or disabling alarm recordings are possible for each individual parameter Recorder Module Exercises M1116A Recorder Module M1116A 1 The M1116A Recorder Module can write different waveforms at speeds 2 The two printed circuit boards in the module are referred to as the board and the board
202. de banks of 1 MB each The fast SRAM is used primarily for program execution speed enhancement The fast SRAM is configured as one 32 bit wide bank 3 74 CMS Patient Monitoring System Buffered SRAM SRAM 3 Hour Daughter Board Interface Address Decoding Theory of Operation Interrupts Bus Error Logic PFAIL and SYSRES DRAM Refresh Configurable Processor Card The buffered SRAM stores application data in the event of a power failure The buffered SRAM is configured as one 32 bit wide 512 Kbytes bank and four 8 bit wide 256 Kbytes banks banks are backed up by a super capacitor to provide a minimum of three hours of storage The interface consists of two 42 pin connectors which is connected to the daughter board The address decoding logic generates strobes and select signals for the on board devices MPB SRAM EPROM Access acknowledge signals are also generated for all the devices except the MPB Interface Chip which generates its own acknowledge signal The following defines the operations of the Configurable Processor Card The CPC contains a support chip to encode interrupts and to present the interrupts to the processor The bus error logic consists of a timer that monitors the microprocessor s address strobe When the processor outputs an address on its bus it asserts the address strobe to indicate that a valid memory address is available However if the signal is asserted for too long the l
203. dule Module Exercises 1 The M1012A C O Module can be used with which patients a adults b adults and pediatrics c adults pediatrics and neonates 2 Which component of the C O Module calibrates the measurement using reference resistors a Differential amplifier b Reference switching matrix c Dual slope analog to digital converter d Digital to analog converter 3 Which component converts the measurement to degrees C a Reference Switching Matrix b Dual Slope Analog to Digital Converter c Digital to analog converter d Application software Answers l a 2 b 3 d 1 48 Basic Plug In Modules C10 CCO Measurement CMS only Cardiac Output C10 CCO Module Concepts CMS only This chapter describes the Transpulmonary Thermodilution method of measuring the Cardiac Output For information regarding the Right Heart method please refer to chapter Cardiac Output C O Module Concepts on page 1 40 C O C10 CCO Measurement CMS only Description Concepts Measurement Principle Measurement Acquisition The transpulmonary thermodilution method requires the M1012A C10 Cardiac Output Module Option C10 is Philips implementation of Pulsion Medical Systems method which offers the following features Measurement of Cardiac Output C O Intrathoracic Blood Volume ITBV and Extravascular Lung Water EVLW using transpulmonary thermodilution Me
204. dules Error LEDs 3 CMS Patient Monitoring System 3 97 RS232 RS422 Dual Interface RS232 RS422 Dual Interface Card Introduction Software Release Changes Software Release C Connections The RS232 RS422 Dual Interface card is used to interface the CMS with the outside world Computer interface communication is only possible with RS232 The interface uses the RS232 standard The RS422 standard is currently not available The RS422 hardware has been included on the interface card for possible future applications This card connects to the MPB and is therefore a master card This card does not have any associated local cards Therefore it does not have any connection to the Local Bus This card can be placed in any vacant slot of the CMS even a vacant slot in another master cards s cluster The following is information on software releases that affect the functionality of the card With Software Release C the card provides a computer interface that allows connection through two independent ports to a printer for example the HP ThinkJet and HP LaserJet series equipped with an RS232 interface and computer system The port is driven from firmware associated with an Application CPU or CPC card Refer to the Computer Interface Programming Guide for further details on this capability The interface card is designed to be connected to equipment that has a compatible RS232 interface using one of the two 25 pi
205. dult except in the presence of pathology coma and certain stages of anesthesia Delta frequency is defined as 0 5 to 4 Hz DELTA PP D 2 76 Advanced Plug In Modules Amplitude Symmetry Patterns Drugs Seizures Coma Cerebral Ischemia EEG Measurement Amplitude refers to the height of the EEG and is measured in microvolts Low Amplitude 20 microvolts e Medium Amplitude 20 to 50 microvolts e High Amplitude 50 microvolts The EEG is generally symmetrical over both hemispheres Anesthetics and metabolic problems affect the hemispheres symmetrically Where there is a loss of symmetry there may be pathology or ischemia in one of the hemispheres Many things can change the EEG The most common things that change the EEG are drugs seizures cerebral ischemia and coma Most anesthetics have an effect on the EEG since the target organ of their action is the brain Typically as the dose increases the EEG initially slows and the amplitude increases followed by a decrease in amplitude until the EEG becomes isoelectric However some anesthestics cause the normally continuous EEG to break up into successive bursts with periods of almost flat EEG in between This is called burst suppression and is seen with barbituates used for brain suppression e nitial amplitude increases and frequency slows e Decreases in amplitude e isoelectric and or burst suppression EEG is the definitive way to diagnose a se
206. e 40 Measurement nae RM UR ER URN AER eee CER 40 Descriptions 2 t ER 40 hie sige Senda ed 40 Contents 2 Measurement 40 Measurement Acquisition 40 coe Inr ne highs SONT deme eeu eq e edd s 42 Criteria for Proper 42 Plug In Modules ehe zov e Nes aeg oe ded e 42 Measurement Exercises 43 C0 Module uev Uo e AIR MR 44 D SGCEIDUOID oues Ee ERO Exe EE 44 Measurements oy ERIS E EAS pnt RI RUEDA 44 Components be ce eb e and e x DUE PEN PARET 44 Bl ck Diagram seie ette eer eU m EHE NUR 44 Theory of 2 4 0 46 Module Features 2 47 C O Module Exercises er dee gt NE EE EN E EPIS 48 Cardiac Output C10 CCO Module Concepts CMS only 49 C10 CCO Measurement CMS only
207. e Subsystem Common Subsystem Front Panel Keyboard The System Board contains the microprocessors and circuitry to acquire and process physiological data from the plug in modules It consists of four subsystems Application subsystem 4 Utility subsystem Front End Interface subsystem Common subsystem The Application subsystem uses the Application CPU to work with parameter modules to process the physiological signals It also processes the system core applications The Application subsystem has its own dedicated memory and an MPB interface chip The Utility subsystem uses the Utility CPU to perform all non application based tasks such as display communication interface to the parameter modules and front panel control of the EEPROM and reading and writing to real time clock The EEPROM is used for system configuration storage The Front End Interface subsystem contains a front end interface CPU which allows the Utility subsystem to communicate to the front end rack mounted parameter modules The Utility subsystem accomplishes this by sharing RAM space between the Application CPU and the Front End Interface CPU Two physical RAMs multiplexed between the two CPUs The Front End CPU communicates over a serial link to a selected module using a polling scheme The Front End CPU then places the appropriately formatted data in the shared RAM so it can be accessed by the Utility CPU RAM selection can be generated by either the
208. e capillaries to receive oxygen and release carbon dioxide Perfusion Passage of blood through a vascular bed Perfusion facilitates gas exchange in the capillary beds of the lung and the tissue In well perfused organs blood flows evenly through the capillaries ensuring a steady supply of available oxygen Perfusion also enables the body to release carbon dioxide Photo plethysmography A method of measuring oxygen saturation in relation to blood volume using the principle of light absorption Also called absorption plethysmography Pulse oximetry A method of measuring arterial oxygen saturation using two wavelengths of light and the pulsatile activity of the blood Measurement Principle Measurement Acquisition Output Criteria for Proper Measurement SpO2 Measurement Pulse oximetry is based on the principle that red blood cells absorb different amounts of light depending on the amount of oxygen they contain When light is transmitted through body tissue such as a finger it is absorbed differently by skin pigments tissue cartilage bone arterial blood and venous blood Most of these substances absorb light at a constant rate The blood in the arteries and arterioles however is pulsatile As the blood vessels expand and contract the length of the light path is altered affecting its absorption Because the only significant variable is due to pulsing blood the ratio of HbO to Hb can be measured in the pulsatile part of
209. e digital board near the front of the module The paper out sensor is an optical device that aims a pulsed infrared beam at the paper as it passes around the paper drive roller When paper is present the infrared light is strongly reflected back to a phototransistor connected to the microcontroller The M1116B Module has an infrared sensing circuit to determine if the paper loading door is open If the door is closed a tab on the door interrupts the light beam Software routines control the infrared beam for the optical interrupt The door open sensor is absent from the M1116A The microcontroller translates waveform and annotation data into a row and column format merges the data into a matrix that represents the dot pattern to be printed and writes the matrix to the RAM The RAM is maintained as a rotating buffer so that memory locations can be reloaded as soon as a column of dots is sent to the printhead The microcontroller maintains uniform print contrast by monitoring the printhead s temperature and watt consumption and modulating the strobe width that is applied to the dots during printing The microcontroller also sends signals to the motor control circuits for regulating the paper drive motor speed Recorder Mechanism This unit contains the thermal printhead and paper drive motor Both components receive signals generated by the microcontroller on the digital board Recorder Module M1116B The printhead assembly contains a column of
210. e BOOT ROM capacity 64 kilobytes the EPROM contains firmware start up code which locates and identifies the rest of the cards in the cluster The Application CPU Card is based around a 68000 Microprocessor When the system is turned on the on board microprocessor starts to execute code in the EPROM The code instructs the microprocessor to perform a hardware test of the CPU card After the hardware test is complete the Application CPU locates and identifies the other cards in its cluster by using a local card identifier The microprocessor on the card then starts to execute the application software The application software is located on either the EPROM card if one exists in the cluster or on the buffered SRAM card Each memory location on either the CPU card or local memory cards is addressed using the processor s 23 bit address bus There is a support chip to encode interrupts so the processor can react to interrupts Signals such as power fail PFAIL and external interrupt EXINT from the Local Bus are treated as interrupts There are two LEDs connected to the processor through an output latch These LEDs are controlled by software and are generally used to indicate either errors during the boot phase or the status of the board during normal operation The rest of the latch is used to generate test signals and identifier access ACC signals The PFAIL signal is used to inform all other function cards that a SYSRES should be
211. e Blood Pressure C O Cardiac Output COJ SSCO Carbon Dioxide Side Stream Carbon Dioxide FIO Fractional Inspired Oxygen tcpO tepCO Transcutaneous Oxygen and Carbon Dioxide Pressures SpOj PLETH Arterial Oxygen Saturation Plethysmogram SvO5 Mixed Venous Oxygen Saturation TEMP Temperature BLOOD ANALYSIS Blood Analysis VueLink This module does not take measurements It provides data from external devices Recorder This module does not take measurements It prints measurements that are being displayed Data Transfer 3 58 CMS Patient Monitoring System This module does not take measurements It transfer measurements between monitors Alarms Installing a Parameter Module Parameter Module Connection to the Rack Connection to the Patient Precautions Plug in Parameter Modules The front of the parameter module has a setup key labeled with the name of the module For example the setup key on the ECG module would be labeled ECG Depending on the module there may be more keys in addition to the setup key Pressing the Setup key on a parameter module results in a light appearing above the Setup key The parameter module slides into the rack until the lever on the base of the module clicks into place To remove a module push the lever upwards and pull the module out If a is present on the front of the parameter module
212. e Module M1006B 16 Description met ette tee RU 16 Measurements LUE RE mE AE au 16 dee e cerner psa AY 16 Block Diagram pA o has dat ebbe us oie eS 16 Theory of Operation 2 2 18 PRESS M1006B Module Features 18 PRESS M1006B Module Exercises 19 CO2 Respiratory Gas Module Concepts 20 CO2 Respiratory Gas 20 DescriptiOtiz CERA Ee e qe IRE EA E 20 CONCEP US gis es pal eet re er EE uei mete dee voe sete OD e n bend 20 Measurement 20 Measurement 20 Measurement 2 1 20 Criteria for Proper Measurement 21 Plug In eiae RA EROR ADRESSE IG RR RUE 21 CO2 Respiratory Gas Measurement Exercises 22 CO2 Respiratory Gas Module M1016A 23 e oet ere ergo E ERO T ER eR Ne pA en 23 Measurements ci
213. e Paging Relay output 6 Analog Interface Connector Module or the Remote Power Supply Module if a flatscreen is used as the main display For M1046B The 60V dc is supplied from an integral power supply A shorting stub MUST installed in this connector or the system will not function correctly Used to connect the Computer Module to the hospital s grounding system Philips connectors used to input output information to from a SDN network Human Interface Link HIL connector used to input the information from the Control Panel in the Main Display Module and the Remote Keypad Mini phone jack used to connect to the hospital s Nurse Paging System 37 pin D type connector used to output information to analog devices 3 38 CMS Patient Monitoring System Computer Module Table 3 12 Computer Module Rear Connectors Continued Connector Function 7 RS232 Connectors Two 25 pin D type connectors used to output information to a printer or computer RS232 Interface systems Only the upper connector port 2 can be used to output RS232 information to printers 8 HDLC Connector Used to connect to a STRIP recorder M1117A 9 Video Out Connector 9 pin D type connector used to output information to be displayed on the CDSPC Video or DSPC Display Module 10 PS ON OFF connector Used to control remotely the 60V DC output of the Remote Power Supply Module DSPC Flat For M1046B with an integrated power supply this
214. e State the principle by which each measurement is derived Recognize the forms in which the data for each measurement are represented e Identify the criteria and influencing factors which relate to the proper acquisition of the measurement e Describe the methods components and mechanisms by which the measurement s electrical signals are processed by the corresponding module e Identify and describe the features and accessories of the plug in module Advanced Plug In Modules 2 1 Introduction Topics This chapter contains the following topics Chapter Topics Measurements and Modules Invasive Blood Pressure Measurement 2 3 Invasive Blood Pressure Module M1006A 2 6 Invasive Blood Pressure Module M1006A Option C01 2 11 Invasive Blood Pressure Module M1006B 2 16 CO2 Respiratory Gas Measurement 2 20 CO2 Respiratory Gas Module M1016A 2 23 Sidestream CO2 Module M1015A 2 28 FIO2 Respiratory Measurement 2 33 FIO2 Module M1017A 2 35 tcpO2 tcpCO2 Measurement 2 40 tcpO2 tcpCO2 Module M1018A 2 43 SvO2 Blood Gas Measurement 2 50 SvO2 Module M1021A 2 52 Blood Analysis Measurement 2 58 Blood Analysis Module M1022A 2 62 VueLink Module 2 68 EEG Measurement 2 74 EEG Module 2 79 BIS Measurement 2 86 BIS Module 2 93 2 2 Advanced Plug In Modules Invasive Blood Pressure Measurement Invasive Blood Pressure Module Concepts Invasive Blood Pressure Mea
215. e a better idea of how much you already know Then take the test again at the end to reinforce your knowledge e You may want to use the book as a reference as you study the troubleshooting guides for the systems or as a pre course to help prepare yourself for troubleshooting e If you already know a lot about the hardware and want to focus on the measurement principles exclusively you may want to pull out those sections and put them together in whatever order would be useful to you Introduction 3 How to Use This Book Introduction 4 Chapter 1 Basic Plug In Modules Introduction Goals Objectives This chapter covers the basic set of plug in parameter modules used by the patient monitoring systems and the measurement principles on which they are based The next chapter covers the more advanced modules and their measurements The categorization of basic and advanced modules is based on the complexity of their data processing functions rather than on the ease or difficulty of taking the measurements Engineers who maintain and repair the equipment may want to become familiar with the basic modules before moving on to the more complex ones After successfully completing this chapter you should be able to Describe the physiologic measurements that can be acquired and processed by Philips basic plug in parameter modules Explain how Philips plug in modules acquire and process physiologic measurements In order
216. e battery voltage reaches 14 7V At this point a voltage amplifier regulates the battery at that value The battery voltage is sensed and divided and applied to a current sense comparator which senses when the voltage reaches 25 mV and trips internal state latches to state three The battery charge current falling to 42mA marks the end of state 2 Charger Operation States 3 and 4 In the third state the battery voltage is regulated to 13 7V for 4 to 5 hours Also in the third state a state level control line is pulled high This lowers the voltage regulation point It also causes the FLT1 FLT2 signal to go low When both FLT1 and FLT2 are low the LEDCRGD line is pulled low turning on the front panel BATTERY CHARGED LED The low state of FLT1 FLT2 also enables the timer for the third state The timer circuit disables the third state after approximately 5 hours The fourth state is entered when the third state is disabled The charger would be re enabled into the first state if the battery voltage drops below 12 33V at 25 or if the AC line cord is disconnected then reconnected During the charging cycle the Battery Charging and Battery Charged LEDs are controlled by a PAL in the charging circuit When at least one battery is present and greater than 9 0 Vdc open circuit the Battery Charging LED flashes at a slow rate and the Battery Charged LED is off If two batteries are present and the both chargers enter state 2 the Battery Charg
217. e entire module is encapsulated in plastic This module complies with UL544 IED 601 1 CSA C22 2 No 125 Patient leakage current less than at 120V 60Hz Isolated patient connection to Class protection Type Cardiac Floating CF There is also protection against damage from defibrillation and electro surgery 2 26 Advanced Plug In Modules M1016A Module Exercises CO2 Respiratory Gas Module M1016A 1 The CO M1016A Module measures a Cardiac Output b Carbon Dioxide c Oxygen concentration 2 The CO M1016A Module produces a waveform along with all but a Airway Respiration Rate b Instantaneous CO c End Tidal Nitrogen 3 The M1016A Module Microprocessor performs which of the following functions a overall controls the Module functions b regulates temperature c regulates the filter wheel at 40 rpms 4 The CO M1016A Module has all but the following user controls a Partial Pressure alarm key b Setup Key c CAL Indicator Answers l b 2 c 3 a 4 a Advanced Plug In Modules 2 27 Sidestream CO2 Module M1015A Sidestream Module M1015A Description The 1015 Sidestream CO SSCO Module is designed for use with the M1016A CO Module to provide a solution for measuring in long term intubated patients weighing more than 7 kg Use of the module means that the transducer is not directly placed on the patient s breathing circuit Mea
218. e key simply press that key To enter the value that is above the key press shift and then the key Once you are done entering the letters or punctuation marks press the Shift key Note When the Shift key is pressed the shift light goes on and stays on until the Shift key is pressed again 3 54 CMS Patient Monitoring System Module Racks Module Racks Introduction Types of Racks Internal Rack Satellite Racks Blank Rack Integral Rack Connectors The Module Racks are used in the CMS to connect the Plug In Parameter Modules to the Computer Module The racks can either be integral to the Computer Module or connected remotely as satellites Racks can support either six or eight single width plug in modules The Rack Interface card in the Computer Module can support up to four racks a CMS may have up to two rack interface cards The maximum number of Plug In Modules a CMS can use is 32 There are three types of rack integral satellite and blank The internal rack is attached directly to the Computer Module It can contain up to eight single width modules and a defibrillator synchronization output connector It has a satellite rack connector for connecting up to three satellite racks A satellite rack is mounted away from the Computer Module usually by the bedside or on an IV pole It holds either six or eight single width modules and has a connector for another satellite rack The M1276A Satellite Rack holds six
219. e other usually at 2 second intervals Hidden lines are removed for clarity This way it s easy to pick up changes in the frequency and amplitude of each sample over longer periods of time i Ce A 7 w N OHz 1 30 Figure 2 23 Compressed Spectral Array CSA 2 82 Advanced Plug In Modules Impedance Electrode Application EEG Electrode Location Terminology EEG Module The main quality indicator for the measured EEG signal is the electrode to skin impedance During normal EEG monitoring electrode to skin impedance is measured continuously and disconnected electrodes are detected An INOP message is displayed if the user adjustable impedance threshold is exceeded The impedance value for each single independent electrode is displayed in the Electrode Impedance Task Window and the Electrode Montage Task Window The International 10 20 System of Electrode Placement is a procedure for the measured location of equally spaced electrodes on the scalp This system is based on the relationship between the cortical areas of the brain and the location of the EEG electrodes that reside directly above them Traditionally there are 21 electrode locations in the 10 20 system of these are needed for diagnostic recordings however in EEG monitoring a sub set of these electrodes may be used to determined the neurological status of the patient Each location is marked with a unique letter
220. e plasma conducts electricity while the cellular Advanced Plug In Modules 2 59 Blood Analysis Measurement Measurement Acquisition Measurement Output constituents red and white blood cells and platelets do not As the number of cells per unit volume of plasma increases the conductivity of the sample decreases Cell concentration can be calculated using theknown electrolyte concentration of the calibrant the measured electrolyte concentration of the sample the measured conductivity of the calibrant and the measured conductivity of the sample Measurements are performed on undiluted specimens of whole blood Undiluted methods are also called direct methods while methods requiring dilution of the sample are called indirect methods It is known that direct methods read up to 7 higher than indirect methods for electrolytes because of the excluded volume occupied by plasma protein and lipids Typically however the elevation of results is less than the full 790 because some of the analyte is bound to protein and other ions and is not assayed by direct methods Indirect methods measure the total molar concentration of analyte per unit volume of plasma Direct methods measure the total molar activity of analyte apparent or free ion activity per unit volume of plasma water It is understood that the direct method result is the clinically significant result for electrolytes and when there is disagreement between methods such
221. e softkeys can be used to select one of the options that appears at the bottom of the display Screen Messages At any time two types of message can appear on the display prompt messages which instruct the user to perform an action or status messages which give information about a current situation An example of a status message is as follows sync output not available plug in ECG module The previous message would be displayed as long as the ECG module was not plugged in Depending on the operating level the message would be displayed either in the appropriate Task window or at the top of the Standard Display screen CMS Patient Monitoring System 3 31 System Overview Exercises System Overview Exercises 1 The types of patient data collected and processed by the CMS are and data 2 Which CMS module uses integral or external keypads to accept user input a Computer Module b Display Module c Module Rack d Plug in Parameter Modules 3 Which bus transfers data and control signals among its users a Message Passing Bus b Local Bus c Utility Bus 4 Which bus connects master and local cards into clusters a Message Passing Bus b Local Bus c Utility Bus 5 Which component of the power system generates 60V DC from the facility s main power a Computer Module s DC to DC converter b Computer Module s Utility Bus c Computer Module s central processor d Display Module s power supply 6 W
222. eLink Figure 2 22 VueLink Module Controls and Connectors User Controls 1 Setup Key A single press key used to enter the VueLink setup screen 2 VueLink Setup Indicator a green LED which will be lit when in the VueLink Setup screen 3 Labels giving names of the external devices to which the VueLink Module can be connected and an LED beside each label indicating the selected device Connectors 4 12 pin connector for use with external devices Safety To ensure the safety of the patient the patient applied parts are isolated from ground by optical isolators and a transformer In addition the entire module is encapsulated in plastic This module complies with UL544 IED 601 1 CSA C22 2 No 125 Patient leakage current is less than 10uA at 120V 60Hz Isolated patient connection to Class 7 protection Type Cardiac Floating CF There is also protection against damage from defibrillation and electro surgery 2 72 Advanced Plug In Modules VueLink Module Exercises VueLink Module 1 The VueLink Module options can be all but which of the following a Liquid b Gas c Ventilator 2 The Type A VueLink Module can show up to a one wave and six numerics b one wave and two numerics two waves and two numerics 3 The VueLink Module RS232 Digital Interface acquires data from the a microprocessor b analog interface c ext
223. easurement Five Electrode Electrodes for five lead sets can be placed in various positions One arrangement is Placements shown in Figure 1 4 The right leg RL lead serves as a ground European colors in brackets Angle of Lewis BLACK YELLOW WHITE RED BROWN WHITE RED BLACK DOS e o GREEN Figure 1 4 Five Electrode Placement 1 8 Basic Plug In Modules ECG Measurement For EASI 12 lead ECG derivation the leads should be placed as shown in Figure 1 5 European colors in brackets BRE AN i NELLOW BLACK EE BROWN GREEN E 7 WHITE 7 E SE N 2 GREEN BLACK gbodySc tif Figure 1 5 EASI 12 lead Electrode Placement Output ECG signals are depicted as continuous waveforms that show real time changes in lead voltages The ECG shows the cycles of depolarization and repolarization of various parts of the heart enabling practitioners to localize cardiac pathology It interprets the electrical potentials as positive or negative and plots them on a graph as upward and downward deflections from a baseline Basic Plug In Modules 1 9 ECG Measurement ECG Waveforms Many variations of the basic waveform are possible depending on which leads are being measured and the condition of the patient s heart Figure 1 6 shows the basic ECG wave Jd s a Figure 1 6 Basic ECG
224. ectors are mounted on both sides of the backplane dividing the computer module into two halves The function cards are plugged into the connectors located either in the front of the computer module 2 24 even numbered connectors or the rear 1 21 odd numbered connectors The Message Passing Bus MPB is used to pass data among the processors in the system The processors are located in the CPU cards and the interface cards such as the RS232 Interface These data are passed as messages Functionally the MPB transfers data performs arbitration to determine the next bus owner and provides control signals Data are transferred as a message on the MPB Addresses are not used on this bus because data are not sent to a specific card rather it is broadcast to all cards on the bus In addition it is not necessary that a card know where the data have originated from because any required information is in the message The message contains a one word header describing the type of data for example ECG lead 1 and the length Other cards on the bus read the header and determine whether they require the data Arbitration is necessary because there is more than one participant on the bus The Local Bus is used to connect a processor card such as a CPU with its supporting card or cards such as a memory card The functions of the Local Bus are to provide data transfers addressing and controls for data and address cycles The Local Bus is ca
225. ed from the output of the motor phase comparator controls the bias regulation of the infrared detector The AZ signal is enabled or disabled by the microprocessor M1016A Figure 2 8 shows the user controls and connectors for CO M1016A Module Features Refer to this figure for the User Controls and Connector descriptions Advanced Plug In Modules 2 25 CO2 Respiratory Gas Module M1016A CO M1016A 4 CAL 1 3 5 1 1 PIN Figure 2 8 C0 Module Controls and Connectors User Controls 1 Setup Key This is single press key used to enter the CO setup screen 2 Setup Indicator This is a green LED which will be lit when in the setup screen If after pressing the setup key the LED is not lit the system is busy and the CO setup screen cannot be entered 3 CAL key This is a single press key used to enter the CO calibration screen and calibration mode The calibration screen can be exited by pressing this key a second time and calibrations already in progress will not be influenced 4 CAL Indicator This is a green LED which is lit when in the calibration mode Connectors 5 This is a standard 12 pin connector for use with a CO Transducer Safety To ensure the safety of the patient the patient applied parts are isolated from ground by optical isolators and a transformer In addition th
226. electrodes and lead cables by the input connector 2 The input protection network and ESU filter eliminate extraneous signals 3 ECG The signals are processed by two circuits the ECG Application Specific Integrated Circuit ECG ASIC and the Pace Pulse Detector PPD ASIC At this point the analog signals from each lead are selected amplified filtered and converted to digital form During the process the output of each input amplifier is checked for a leads off electrode condition so that any individual lead whose electrode has fallen off can be identified The leads for channels 1 and 2 are selected using two identical lead selection circuits channel 3 always carries the chest lead The signals from the three channels are summed in the differential amplifiers To prevent interference from the 50 60Hz power line the common mode signal derived from behind the lead selectors is used to drive the right leg drive amplifier The output from the amplifier is then returned to the patient via the RL electrode The PPD checks for pace pulses on channels 1 and 2 for cardiotach rejection or marking of the display The high and low pass filters allow the independent selection of diagnostic monitoring or filter bandwidths for each channel For calibration a 1mV calibration signal is generated on each channel This is done by a bandgap voltage reference from a precision voltage divider in front of the filtering circuitry The complete module can be
227. ent by an internal timer in the monitor or by a user The NBP measurements can be taken by the NBP plug in module or by an NBP monitor connected through VueLink Vital sign recordings are made only at the bedside by the M1116A and M1116B Recorder Modules they are not re routed to a central recorder if the bedside recorder is not available Alarm recordings a type of delayed recording They include waveform information from before the alarm was initiated so clinicians can see the change in the patient s condition When a patient goes into an alarm condition an alarm recording is generated automatically according to the monitor s configuration Settings for alarm severity level as well as for enabling or disabling alarm recordings are possible for each individual parameter OxyCRG recordings are delayed recordings that begin six minutes prior to the most recent data on the screen The time delay enables the clinician to have a printout of events leading up to the current situation Recordings can be requested manually or configured as alarm recordings In an alarm recording six minutes of pre alarm data and two minutes of post alarm data are produced When a recording is stopped the most recent six minutes of patient data are not recorded The oxyCRG is recorded in Recorder Module Exercises M1116B Recorder Module M1116B three distinct non overlapping channels on the strip Three speeds are possible for recording the data 1
228. ents Block Diagram The Blood Analysis Module M1022A uses blood analysis technology from i STAT Corporation The module is used together with i STAT single use disposable cartridges for point of care determination of specific analytes in whole blood Depending on the cartridge configuration a subset of the following measured and calculated values will be displayed pCO pO pH Glucose Sodium Potassium Chloride Ionized Calcium BUN or Urea Hematocrit HCO Base excess BE Oxygen Saturation sO5 Anion Gap Hemoglobin Hb Total Carbon Dioxide The Blood Analysis Module M1022A consists of the following major functional components Table 2 9 Major Blood Analysis Module Components Component Description Mechanical System A DC gear motor drives all mechanical system parts Sensor Interface Amplifies the signals from the sensors so that they can be further processed by the main electronic circuits Analog to Digital convertor An A D convertor converts all analog signals into digital form for input to the microprocessor An analog signal multiplexer makes it possible for the microprocessor to measure eight different types of analog signals Figure 2 20 shows the block diagram of the blood analysis module 2 62 Advanced Plug In Modules Blood Analysis Module M1022A AIC uolyenjoy uonenioy uejs sqng jeuueu L 10 99 09 8 6 peuueu 1 1
229. ents carry out the major signal processing functions within the module Table 1 3 Major ECG Components of ECG RESP Module ECG Component Function Input Protection Network and Protects the input amplifiers from defibrillation and high ESU filter frequency interference signals Lead Selection Switches Selects channels 1 and 2 for patient leads Right Leg Drive Prevents interference from the 50 60Hz power line Highpass and Lowpass Filters Allow the independent selection of diagnostic monitoring or filter bandwidths for each channel Test Signal Generates a calibration voltage on each channel and tests the circuitry for the module Pace Pulse Detector Detects pace pulses for channels land 2 Table 1 4 Major RESP Components of ECG RESP RESP Component Function Input Protection Network and Protects the input amplifiers from defibrillation and high ESU filter frequency interference signals Measurement Bridge Detects and modulates the RA and LL ECG signals with a 39 kHz sine wave Generates a calibration and test signal Synchronous Demodulator Demodulates the output from the input amplifier Impedance Subtracter and Subtracts the basic thoracic impedance from the signal and Digital to Analog Converter converts it to digital form Basic Plug In Modules 1 23 5 Figure 1 11 shows the ECG RESP module s logical structure Block Diagram
230. equency and accuracy of calibration e Appropriateness of the reference standard against which the thermometer is calibrated e Choice of anatomic site for taking the measurement Plug In Modules References TEMP Measurement Environmental conditions e Activity and movement of the patient The M1029A TEMP Module provides the temperature measurement I Holtzclaw Barbara Monitoring Body Temperature in AACN Clinical Issues in Critical Care Nursing For bibliography Susan Osguthorpe ed Philadelphia JB Lippincott 1993 Basic Plug In Modules 1 67 TEMP Measurement TEMP Measurement Exercises 1 68 Basic Plug In Modules 1 Thermistors thermocouplers and infrared reflectors are an integral part of which measurement technique a Thermodilution b Thermometry c Pulse Oximetry 2 The resistance of the temperature thermistor is proportional to its temperature 3 How many temperature measurements are taken to calculate an individual s temperature difference a one b two c three 4 Factors affecting accurate measurement of temperature include and Answers 1 5 2 inversely 3 b 4 Any of the following Calibration Reference standard Anatomic site Environmental conditions Patient s Activity TEMP Module Description Measurements Components Block Diagram TEMP Module The M1029A TEMP Module is a temperature measurement parameter unit It is designed to be used wit
231. er Modules 3 58 Computer Module Introduction Front of the Computer Module Front Connectors The Computer Module is the heart of the CMS It distributes all of the power clocks and data for the entire system The Computer Module receives data on patient measurements from the Plug In Parameter Modules processes the data and sends it to the Display Module to be displayed as waveforms and numeric values All of the functional cards for the CMS reside within the Computer Module which manages their operations For details on the bus architecture and configuration of the module refer to CMS Bus Structure in the System Overview Section CMS Patient Monitoring System Bus Structure on page 3 10 For details on the operations and of the function cards see the Master Card section Master Card Overview on page 3 64 and Local Card section Local Card Overview on page 3 111 of this document The front of the Computer Module is shown in the following figure The module can have an integral module rack at the front where the plug in modules are connected If the module uses a satellite rack instead of an integral rack the front panel is blank The front of the Computer Module contains two function cards with connectors the Rack Interface card connector in slot 18 and the CPC card connector in slot 12 in later releases The Rack Interface connector is used to collect output for the Computer Module from the plug i
232. er to the computer module the module racks and the flatscreen display Aux Connector Card M1046B only Provides access to the Rack Interface behind the Computer Modules integral power supply The function cards that reside on the backplane are grouped into two basic types master cards and local cards Master cards which perform processing functions connect to the MPB Bus they may also connect to the Local Bus Local cards connect to only the local bus The backplane is divided into ten clusters to accommodate groupings of specific function cards Each slot in the backplane belongs to a local cluster Each cluster has its own dedicated portion of the local bus for connecting the cards in that cluster Clusters have between one and five card slots with predefined slot numbers A cluster contains one master card and zero to four local cards depending on the cluster With the exception of the SDN Interface card SRAM and Rack IF card more than one of each local card may be used on the backplane Figure 3 4 shows how the clusters are grouped on the backplane Note that the DC to DC converter is located in a triple sized gap on the rear of the backplane to the left of connector 21 The connectors within each cluster have the same color coding for easy identification CMS Patient Monitoring System 3 13 CMS Patient Monitoring System Bus Structure Card Placement Front Slots Rear Slots GD E ED Gray e
233. er with Philips monitoring network SDN interface circuitry Figure 5 5 illustrates the front and rear view of the Inter SDN Gateway model M1272A 5 4 Figure 5 5 Front and Rear View of the Inter SDN Gateway 5 10 Philips Monitoring Network SDN Defining the Inter SDN Gateway Exercises Defining the Inter SDN Gateway Exercises 1 The Philips monitoring network SDN is a a system to which parameter modules are connected for translating patient physiological parameters and other data b non local area communication network for sharing patient physiological parameters and other data c local area communication network for sharing patient physiological parameters and other data 2 The Philips care hub SCC is the a intelligent interface between Philips monitoring network SDN and the host microprocessor b central component of the Philips monitoring network SDN c local serial connections from the wall boxes 3 Philips monitoring network SDN uses a network configuration called a star topology b planet topology c branch topology 4 How many Philips care hubs SCCs can you connect to an Inter SDN Gateway a two b four C SIX Answers l c 2 b 3 a 4 Philips Monitoring Network SDN 5 11 Defining the Inter SDN Gateway Exercises 5 12 Philips Monitoring Network SDN Arterial Oxygen Sat
234. erates the SYSRES signal which resets all the cards in the computer module 3 18 CMS Patient Monitoring System CMS Patient Monitoring System Hardware Configurations CMS Patient Monitoring System Hardware Configurations Introduction Application CPUs Memory The CMS is available in different models each configured differently The monitor s configuration determines the CPU and function cards it can include as well as their arrangement The configuration of cards in the CMS depends on both the model of the system and the type of application CPU used Several types of CPU cards are used in the system for processing application data e M1054 Application CPU 10 MHz e M1051 Application CPU 15 MHz e M1053 Configurable Processing Card CPC 40MHz CMS models delivered with Releases A or B software may use either 10 or 15 MHz Application CPUs Models delivered with Release C software use only 15 MHz Application CPUs However models with 10 MHz cards that upgrade to Release C software use a combination of 10 and 15 MHz cards Releases C and subsequent software provide support for models with a CPC in slot 12 In these models additional 15 MHz Application CPUs may be required depending on the model or may be left in for future use Beginning with Rel A 0 two 40 MHz CPC cards in slot 4 and 12 are required for all models Figure 3 5 through Figure 3 12 show the backplane configurations for these systems Application CPU c
235. ered the corresponding key code is transmitted to the Philips HIL master Two rotary controls are provided to adjust the display The brightness and contrast have part of the control exposed through two holes in the bezel The brightness control is on the left and the contrast control is on the right The brightness control for the flatscreen display is on the rear of the display 3 52 CMS Patient Monitoring System Remote Displays Video Termination Switch Control Panel There are three types of remote slave display 14 inch color 14 inch monochrome and 21 inch color The controls and connections for the 14 inch monochrome and color remote displays are identical The only control on the rear panel of the 14 inch remote display is the Video Termination switch It is a push button switch used to terminate the video signal at this display This switch must be ON in if the remote display is the last in the chain Otherwise the switch must be OFF out There are also two fuse holders for the line protection fuses one for the low operating voltage range and one for the high operating voltage range The M1094B is shipped with fuses for 3V and 1 5V Control Panel Alarm Lamps The main display module contains a Control Panel or integral keypad located on the bezel of the main display module It is used to allow the user to display different screens on the main and independent displays respond to alarms and access the vari
236. erface FIFO Bus Error Logic Local Bus Buffers Address Decoder and Dtack The Application CPU APP CPU card is one type of CPU used to process data in the CMS This CPU would receive data process it and then place the results of the data operation back onto the MPB The data could be received from its internal SRAM an SRAM card connected by the Local Bus or the MPB Two versions of Application CPU card are available the M1054 10 MHz card and the M1051 15 MHz card The only functional difference in the two versions is that the 15Mhz has increased processing speed Even though these CPUs are very similar they are not interchangeable A 10 MHz card must be replaced with another 10 MHz card and a 15 MHz card must be replaced with a 15 MHz card The model of the CMS determines which CPU is used whether both are used and how many are used Both types of Application CPU contain the following functional areas MPB Interface FIFO Local Bus Buffers Address Decoder and Stack Output Register SRAM buffered EPROM and the 68000 Microprocessor In addition the 15 Mhz CPU contains a Synchronizer Wait State Generator and Clock Generator Divider The MPB Interface is used to interface to the MPB This is covered in greater detail in the Master Card Overview in this section of the document This is a First In First Out buffer The data written to the buffer first are the data that are read out first The bus error logic is simp
237. ernal devices 4 The labels on the VueLink show the names of a VueLink Setup Screen options b external devices to which the Vuelink Module can be connected c internal VueLink Module components Answers l a 2 b 3 c 4 b Advanced Plug In Modules 2 73 EEG Measurement EEG Module Concepts CMS only EEG Measurement Basics EEG Channels EEG Signal Brain Waves The electroencephalogram EEG is the measurement of the electrical activity of the brain This activity creates an electrical signal that depending on the person s state of consciousness or well being produces characteristic waveforms Although its origin is unclear there is strong evidence that the signal is a summation of the tens of billions of active nerve cells neurons in the brain The waves seen are generated from electrical potentials located on the surface of the brain These potentials are recorded by placing electrodes on the scalp The following terms and concepts are important to understanding EEG monitoring Standard EEG machines are capable of recording many channels 16 to 32 or more These channels are produced by electrode placement see electrode placement Routinely the electrode pairs are placed over specific areas of the brain frontal temporal parietal occipital etc Then just like ECG monitoring the voltage differences between the electrodes are measured With most bedside EEG monitors fewer channels 2 to 8 are re
238. ernal lithium battery is used for temporary storage of sensor signals measured during operation and for storage of test records Another EEPROM stores factory calibration information the instrument serial number and a cumulative count of uses Neither of the EEPROMS rely on the lithium battery for maintaining information The module creates and applies two types of signals to the sensors a digital to analog convertor generates a voltage which is applied to amperometric sensors and the AC conductivity circuit generates an AC excitation signal which is applied to the conductivity sensors The digital to analog convertor also provides voltages to the motor driver circuit 5 ADC motor drives all the mechanical system components 2 64 Advanced Plug In Modules Blood Analysis Features User Controls Connectors Blood Analysis Module M1022A a connection actuator which brings the module internal connector into contact with the contact pads on the cartridge a calibrant delivery system a sample delivery system a thermal system actuator which brings the module s thermal controller into contact with heater elements on the back of the cartridge In addition a latching mechanism locks the cartridge in place upon insertion Figure 2 20 shows the user controls and connectors for the Blood Analysis M1022A module The descriptions of the numbered items are below the figure BLOOD ANALYSIS SETU P 102
239. erns Shee et co aia etch 77 EEG dades E eene rA E IDE PER HR 79 SR ER e ERI edi 79 csi 79 ARE ER E Ra e mE 80 Block Diagram ree he Me wee DETUR VR RA bee aA TRE ERA 81 Theory of 2 81 Electrode Application 83 EEG Module 85 BIS Module Concepts 86 BIS Measurement 4 tu ed etre e a e eet seed ed Ele 86 Tritroduction zi leds nr Race rete year oa 86 Depth of Anesthesia steres tereni e een ber repre Me ea Remi dor ere dmg 86 The Bispectral Index BIS and Depth of Anesthesia 88 BIS Module Miche PUER NAMEN dae 93 Description E UE EUR RE aA 93 Measurement ees eeno eel een Gree TAM Dre de RUP te ees 93 Components 55 secs C 93 Theory of Operations 2 525 6 4 etu Ex utes 94 BIS Module Features 95 CMS Patient Monitoring System
240. es work area for processor e Application software is held on an EPROM for the master CPU the Application CPU card which is placed in the lowest numbered slot For subsequent CPUs the application software is held in SRAM e Watchdog facility to detect errors on the CPU Card and report to the system using a PFAIL signal Large parameter trends and other data management results may be stored on a buffered local SRAM Card Three Error Status LEDs Board Hardware is tested every time the system is reset e Power fail protection inhibits access to the on board buffered SRAM 64 kilobytes Data retention is better than five hours using a special capacitor CMS Patient Monitoring System 3 73 Configurable Processor Card Configurable Processor Card Introduction Components 68030 Microprocessor MPB Interface Flash EPROM DRAM Fast SRAM The Configurable Processor Card CPC is a CPU card It is used to process the application data for the CMS The CPC receives data from the MPB processes the data and places the results of the data processing back on the MPB The CMS has two CPC versions available The first version is a CPC with Flash EPROM which contains on board flash EPROM for the application memory PROM packs and the boot ROM The second version is a CPC with UV EPROM Daughter Card which contains on board flash EPROM for the boot ROM and a piggyback daughter card connected to the CPC through t
241. eviously had been selected to be monitored The information is displayed as waveforms and numeric readouts In addition alarms INOP messages bed labels date and time and arrhythmia messages when assigned are displayed The numeric values associated with each waveform are displayed with the waveform Numeric information is updated every two seconds If a color display is being used the waveform and its associated parameter value are displayed in the same color Pressing the Standard Display key or Main Screen in later versions returns the display to Standard Display Selection Window The selection window is used to select an activity or function The window is entered by pressing one of the blue labeled hardkeys on the control panel or the keypad When the selection window appears the last line is highlighted indicating that it is active The highlight can be moved to a different row by using the arrow keys on the control panel or the handheld keypad if they are highlighted or by pressing the same hardkey that was used to open the window Then pressing the softkey associated with the desired function invokes the task window for that function Task Window The task window is used to make changes to parameters or screen displays or to perform functions Each parameter or procedure has a task window The task window is entered either by using the selection window or by pressing the setup key on the module Once in a task window th
242. ew Exercises 32 CMS Patient Monitoring System Functional Modules 34 Introduction i4 nee ree 34 In CCV ES P 34 Contents 10 25 EE ER ra E EUR UR 35 Computer Module iex ne RR A ese RUE EIE AH 35 Introduction lt et ROC cea eee BER RUD HIR Rees 35 Front of the Computer 35 Rear Connectors oe ede que EUR os ARR hee ees Pea ae we 38 Integral Power Supply Computer Module M1046B 40 Integral Power Supply Connectors and 5 40 Remote Power Supply 047 41 Front Panel Controls Remote Power Supply 41 Remote Power Supply Rear Controls and 5 42 Display Module Re pex Rats pln a p t aig e 43 Introduction ans ete ER E CRY RENE In I OESTE P ERR 43 Display Models ev ee EE ECUR E ERR NND EEEN GU C eR CE Hg 43 Front of Main Display 43 Front Panel Controls and 5 45 Rearot Display
243. expected from the Utility CPU The SYSRES signal is used to reset all the cards The PFAIL signal is placed on the Utility Bus by the CPU output latch The PFAIL signal is asserted by the Application CPU for two reasons 1 the CPU detects that a serious error has occurred in the system and 2 the watchdog timer detects a failure in the Application CPU The PFAIL signal can also be asserted by the DC to DC converter when the power is about to fail 3 70 CMS Patient Monitoring System Application CPU The functional block diagram of the 10MHz and 15MHz Application CPUs are in Figure 3 30 and Figure 3 31 Functional Block Diagram 21901 DHIG 4 9938008 1081309 mms 210023004 N318193M S IJNDIS Ani apes inano Soe en OS LNOD SS3sadg FT 9 WHYS LUG ION LNOO l 55394005 5535006 H 5 SIE e COMINOO TONLNOD p asg sam 1 ON LNOD 0414 SS3BUdB 308 3H31NI H160 H FONLNOD YOLOANNOD HI Figure 3 30 10 MHz Application CPU CMS Patient Monitoring System 3 71 Application CPU
244. f Operation Color Register Video System Controller Video RAM Data Transfer Character Sets Color Display Controller Card New Version The color register chooses the color The three color banks of the Video RAM are controlled by the Video Controller chip The video RAM has four parts as shown in the following table Table 3 23 Video RAM Components Pane Map Description Alphanumerics 1024 x 512 pixels x 3 color banks The two alphanumeric Graphics plane 1 graphics planes are used to display text figures and basic graphics lines boxes etc Alphanumerics Graphics plane 2 Wave Plane 2048 x 512 pixels x 3 color banks The higher resolution wave plane is used for displaying the parameter waves such as Attribute Map 256 x 256 bytes The attribute map is used to enable parts of the screen and select between full brightness half brightness and blinking The CDSPC card controls the mechanism of actually displaying information on the screen display data including local language characters and color information are produced by the Application CPUs or CPCs More than one CPU may produce data for the display The CDSPC card receives display data waves lines numerics display attribute data and control messages from the CPU over the MPB The microprocessor on the controller card sends the data over the Local Bus to the video card The Video System Controller places the data i
245. face can be switched under control of application software in the DEV CONFIG command of the session to accommodate a range of devices that use fixed data transmission speeds The baud rates available for the interface are as follows 150 300 600 1200 2400 4800 9600 19200 and 38400 port 1 only 3 100 CMS Patient Monitoring System RS232 RS422 Dual Interface Functional Block Diagram SYO LIANNOD I3N8d AHAA d4AT AD ecbSa 5 asATad HOLIMS JAINA 2 254 SAIdOdN i 100 HOLIMS SEATS S3 TIOSLNOO 0414 Big WON dIHO I 8 010 3NNOO Nid dl Figure 3 41 RS232 RS422 Dual Interface Card Block Diagram CMS Patient Monitoring System 3 101 HDLC Interface Card Summary of RS232 RS422 Features The Features of the RS232 RS422 are as follows e Provides 2 serial ports using 8051 microprocessor with an additional UART Communicates directly between external devices and the MPB e Translates MPB parallel data broadcast on a 16 bit bus to serial data over RS232 and RS422 standard interfaces e Translates received serial data from the RS232 to MPB parallel data e
246. ference junction potential can also be minimized Activity versus Concentration Ion selective electrodes measure activity rather than concentration Activity a is related to concentration c through the activity coefficient a y c While ion activities which reflect free rather than total ion concentrations are physiologically important activity values are converted to conventional concentration units so that values obtained by direct ISE can be compared to values obtained from indirect diluted ISE methods which have activity coefficients close to unity or one and to flame photometric atomic absorption and titration methods all of which measure total ion concentration In amperometric measurements a potential is applied to the measuring electrode while current generated by the oxidation or reduction reactions in the test system is measured The current generated is directly proportional to the concentration of the analyte Concentration can be calculated using e known value of the analyte in the calibrant the measured current generated by the analyte in the calibrant the measured current generated by the analyte in the test solution The conductometric measurement involves the application of an alternating current to the test solution In aqueous solutions conductivity is dependent upon the concentration of electrolytes with an increase in the electrolytes causing an increase in conductivity In whole blood th
247. fic data to the standardized CMS data types representing waveforms numeric values settings alarm status alarms and INOPs 3 The Analog Interface which provides eight analog channels consisting of up to two wave channels five numeric channels and one alarm channel Each channel can be adapted individually to the output voltage level of the external device The adaptation is executed by hardware gain switching and or software scaling controlled by the specific device driver The alarm channel is also used to identify a cable disconnect status as long as the active level is different to zero Volts The analog input signals are fed from the input connector via the input protection network the input switches and an analog multiplexer to an input amplifier input signals are digitized sequentially using the dual slope Analog to Digital converter 1032 VueLink Figure 2 22 shows the user controls and connectors for the VueLink Module Refer to Module Features this figure for the User Controls and Connector descriptions Advanced Plug In Modules 2 71 VueLink Module VueLink M1032a VueLink VueLink Mios2a VueLink M1032A VueLink AUXILIARY VENTILATOR GAsANAYZ ANES MACH PB 7200 M1025A B m S AUX PLUS NELLCOR N 100C m CRITIKON 1846 VueLink VueLink Vu
248. g Conversion Error Compensation Loop Analog Channels Analog Interface Output Connector Analog Interface Card The 5 reference signal is input to the 12 bit multiplying DAC to regulate the DAC output A second 8 bit DAC unit provides gain error correction of the conversion process Continuous error compensation is used to improve analog accuracy by compensating for component tolerances and drift Gain and offset error are measured by the error measurement unit while all sample and hold circuits are switched to Hold Firmware adjusts the values for offset correction and the Gain Error Correction DAC accordingly Each analog channel is built up by sample and hold circuits and a low pass filter The ground for the analog circuit is derived from the Computer Module s digital ground which in turn is connected to the safety ground in the Display Module The signals available on the Analog Interface output connector are shown below shield chassis ground analog ground analog channel 8 analog ground analog channel 7 analog ground analog channe analog ground analog analog ground analog analog ground analog analog ground N t analog channe analog ground analog channe reserved reserved reserved digital port 7 low output alarm recording active for 20 sec digital ground high output no alarm recording digital port 6 low output
249. g The ABCs of ECG and Resp Philips Part No 5954 2304 Application Note Basic Plug In Modules 1 21 RESP Measurement RESP Measurement 1 Respiratory monitoring generally measures two types of pulmonary functioning Exercises the effectiveness of and efficiency of 2 RESP uses a technique that allows electrical impedance to be measured using ECG electrodes 3 RESP uses ECG electrodes placed in which positions a Left arm and right arm b Left arm and right leg c Right arm and left leg 4 The data displayed in a respiration wave are a Impedance change from breathing activity b Respiratory rate c Heart rate as a numeric d all of the above Answers 1 Gas exchange pulmonary muscles 2 Modulation 3 c 4 d 1 22 Basic Plug In Modules ECG RESP Module ECG RESP Module Description Measurements Components The M1002A ECG RESP Module is a three channel electrocardiogram and respiration measurement parameter unit It is designed to be used with adult neonatal or pediatric patients in an ICU environment The module possesses the same ECG functionality as the M1001A and adds respirogram functions as well The ECG RESP Module produces continuous real time waveforms for both cardiac and pulmonary electrical activity It also generates numerics for the average heart rate HR derived from either the ECG or a remote arrhythmia computer and for the respiration rate RR The following compon
250. g called frequency analysis is the method of choice Frequency analysis takes the raw EEG waves mathematically analyzes them and breaks them into their component frequencies The method of doing this is called Fast Fourier Transform or FFT FFT In Fourier analysis changes in the EEG are more easily detected because the original complex signal is digitized for computer analysis and converted into a simplified waveform called a spectrum It is then separated into frequency bands delta 4 Hz theta 4 to 8 Hz alpha 8 to 13 Hz and beta 213 Hz The redistribution of electrical activity in the brain among certain frequency bands or the predominance of one band over the others correlates with specific physiologic and pathologic conditions FFT Computation To compute the FFT the module samples the continuous EEG signal periodically and stores the value Then by using a number of samples the distribution of energy at each frequency is computed This results in a frequency spectrum for each sample Advanced Plug In Modules 2 81 EEG Module Compressed Spectral Array FFT Prism Analogy U 18 Hz MW AEE 9 oh After processing the EEG by the resulting spectrum is displayed The method of display is Compressed Spectral Array CSA CSA compresses a large amount of data into a compact easy to read trend The CSA stacks each sample s spectrum one right below th
251. ge or adjust parameter settings switch parameters on or off or set up parameters This key formerly Standard Display in CMS is functionally identical to CMS Pressing this key displays a Selection Window that gives choices for real time recording which is a recording of the waveforms from the time of the request Pressing this key generates a delayed recording which is a recording of waveforms that are no longer on the monitor screen The function of these programmable softkeys varies with the application currently being used by the user This key is functionally identical to CMS It only functions when it is illuminated prompt message CONFIRM appears on the screen when you need to use it 4 16 V24 and V26 Patient Monitors User Controls V24A V 26 User 1 The main distinctions of the V24 V26 from CMS are Controls Exercises a number of waveforms and the size of the display and keys b the size of the monitor c the number of user keys on the front panel 2 The V24 V26 front panel is a scaled down version of a CMS Rev E front panel b CMS Rev C front panel 3 Which key provides access to the Data Management functionality a Procedures key b Module Setup key c Trends Calcs key Answers l a 2 a 3 c V24 and V26 Patient Monitors 4 17 Connectors Connectors Overview Eight slot Rack Six slot Rack The V24 V26 supports either a six slot or eight slot parameter
252. h adult pediatric or neonatal patients in an ICU or OR environment The TEMP Module produces numerics in degrees Celsius for the temperature Different labels can be selected for temperature readings from different measurement sites The following components carry out the major signal processing functions within the module Table 1 12 Major TEMP Module Components Component Function Reference Switching Matrix Calibrates the measurement using reference resistors Differential Amplifier Amplifies the signals from the reference switching matrix Dual Slope Analog to Digital Digitizes the analog signals from the temperature and Converter thermistor calibration Figure 1 23 shows the block diagram of the TEMP Module 1029 Basic Plug In Modules 1 69 TEMP Module 10H1NOO 39N3H343H W31SAS uar ustariduv sovsuaunt 1 A ii3T1081NO2 seva audi 7 9NIHOLIMS xovH OWE NOLLY10SI sf 3ON3u343H 1 Figure 1 23 TEMP Module Block Diagram 3ounos INauuno 1 70 Basic Plug In Modules TEMP Module Theory of Operation The signals progress through the module as follows The thermistor in the temperature probe is connected to a reference switching matrix that continuously compares the input to reference resistors for continuous calibration of t
253. h other in different locations The components are as follows Computer Module contains all of the function cards The front of the unit may contain a module rack or a cover piece for the module rack opening The computer module also consists of the mechanical covers guides and backplane bus The function of this module is to process the data and to distribute the power data and clocks to the appropriate locations in the system Display Module s used to display patient data The main display for the system is either a 14 inch CRT display monitor monochrome or color or a 10 4 inch Flatscreen LCD color display Up to two independent displays controlled from the main display can be set up Remote or slave displays can also be used these are either 14 or 20 inch color or monochrome units The main display contains an integral keypad called the Control Panel An optional remote keypad is also available Flatscreen Display Setup The setup requirements for the Flatscreen are different from those of the CRT Display Modules since no power supply is integrated into the flatscreen assembly Possible setups for the Flatscreen are as follows Flatscreen as Main Display either a separate power supply or an integral power supply in the M1046B computer Module provides power for the system including up to two Flatscreens Flatscreen as Independent Display when the Main Display is a CRT display this module can provide power for one Fla
254. h temperature probe as it is being introduced into the central venous line The injectate mixes with the blood in the right ventricle and approaches a temperature equilibrium When the diluted blood reaches 1 EVLW is not available in U S A Basic Plug In Modules 1 49 10 CCO Measurement CMS only the artery with the arterial catheter the thermistor measures the decrease in blood temperature over time The blood pressure wave acquisition is achieved with the M1006A B Invasive Pressure module For details regarding this module please refer to Invasive Blood Pressure Module Concepts on page 2 3 C 0 Module Roger essen Pressure Module M1012A 410 1006 Sterile Injectate t Solution Interface Cable M1643A Temperature Injectate Syringe Probe w Central Venous Pulsion Pressure 3 Way Transducer Stopcock Cooling Container Pulsion Arterial Catheter Figure 1 17 Setup for Transpulmonary Thermodilution and Continuous Cardiac Output 1 50 Basic Plug In Modules Injectate Temperature and Volume C10 CCO
255. he CPU card or local memory cards is addressed absolutely using the processor s 23 bit address bus There are buffers on the processor bus to connect to the local bus of the cluster This allows data to be passed between the processor and the local memory cards This is performed by the Utility CPU Card Refer to the SDN Interface functional description in the Local Functional Cards section of this chapter Local Card Overview on page 3 111 CMS Patient Monitoring System 3 95 Utility CPU Functional Block Diagram COBLNOO SH SH ALT MAI 994 yang 253000 uut 21501 pa hg 3300230 SS3elddg 5533008 5755 9 ONAS NOS TINAS Eed ON31NO3 N3ISIO3M 30070 auey ve 13 1 77 NIBW ZHW at S INNDIS WYLNOS 40329440 e 5539486 M3ZINOBHONASI Ie Loa ze BUR 5 I su 26 A am su E fp 9939080 21501 cas 19539 fg SSde da SS3a dag 9 85 HONJ3 JOMINOO FOaLNOD 08083 5534008 4
256. he measurement The sequentially produced voltages across the reference and probe resistors are amplified filtered and digitized The continuous calibration linearization control and conversion to degrees C is performed by the software TEMP Module Figure 1 24 shows the user controls and connector for the TEMP Module The parts Features are described following the figure gue 1029 2 1 3 Figure 1 24 TEMP Module Controls and Connectors User Controls 1 TEMP Setup Key A single press key used to enter the temperature output setup screen 2 TEMP Setup Indicator A green LED lit when the temperature setup screen is activated Connectors 3 This is a 2 pin connector for use with standard 217xx series temperature probes yellow spring series 400 characteristics and 218xx series disposable temperature probes the 218xx series probes are not sold in Germany Safety To ensure the safety of the patient the patient applied part is isolated from ground by opto couplers and a transformer The module is also encapsulated in plastic Basic Plug In Modules 1 71 TEMP Module TEMP Module Exercises 1 72 Basic Plug In Modules 1 The M1029 TEMP Module can be used with which patients a adults b adults and pediatrics c adults pediatrics and neonates 2 To which component is the temperature probe connec
257. he patient the patient applied parts are isolated from ground by optical isolators and a transformer The module is also encapsulated in plastic Basic Plug In Modules 1 17 ECG Module ECG Module Exercises 1 18 Basic Plug In Modules 1 The ECG generates numerics for which physiologic measurement a pulse b pace pulses c heart rate 2 Which ECG Module component prevents interference from the 50 60 Hz power line a Input protection network b Right leg drive c Highpass and lowpass filters 3 Which channels does the PPD check for pace pulses a Channels 1 and 2 b Channels 2 and 3 c Channels 1 2 and 3 4 The number of ST segment measurements that can be stored and retrieved is 5 For EASI 12 Lead Monitoring you need a a 3 lead or a 5 lead cable b a 5 lead cable 6 With a standard lead set and five electrode cable set the leads that can be monitored are a 3 limb or chest leads on Channels 1 2 and 3 b 3 limb or chest leads on Channels 1 and 2 and 1 chest lead on Channel 3 c 7 limb or chest leads on both Channel 1 and Channel 2 and 1 chest lead on Channel 3 7 With an EASI lead set the leads that can be monitored are a 3 limb or chest leads on Channels 1 2 and 3 b any lead out of 12 for all 3 channels c 7 limb or chest leads on both Channel 1 and Channel 2 and 1 chest lead on Channel 3 Answers RESP Measurement RESP Measurement Description A respirogram is a recording of respir
258. hich component of the power system distributes the required voltages to the monitor s other components a Computer Module s DC to DC converter b Computer Module s Utility Bus c Computer Module s central processor d Display Module s power supply 7 Which component performs diagnostics when the system is powered up a Computer Module s DC to DC converter b Computer Module s Utility Bus c Computer Module s central processor d Display Module s power supply 3 32 CMS Patient Monitoring System Answers System Overview Exercises 8 Which software releases support both 10 and 15 MHz CPU cards a Release A and B b Release A B and C c Release A B C and D 9 Which processor contains its own memory array for the application software code a Configurable Processor Card b Application CPU c Utility CPU 10 Which of the following will get a user directly to the task window for performing a function a The Standard Display key b A blue labeled hardkey c The plug in module s setup key d a and b e band c 1 physiologic management 2 b CMS Patient Monitoring System 3 33 System Overview Exercises CMS Patient Monitoring System Functional Modules Introduction This section of the chapter covers the functional modules of the CMS in more depth It includes details on the physical and functional components and operations for several of the modules Information on the components and operation of the Compute
259. hich of the following measurements a Mean arterial blood pressure b Core body temperature c Rate of blood flow d Blood gas exchange 2 Which term refers to the amount of blood pumped per heartbeat a Cardiac index b Cardiac output c Heart rate d Stroke volume 3 Using thermodilution at what location does the cold injectate solution leave the catheter and enter the heart a Right atrium b Right ventricle c Pulmonary artery d Left atrium 4 The graph of the cardiac output measurement resembles a A RESP waveform b A bell shaped curve c Blood pressure oscillations d An inverted QRS wave Answers l c 2 d 3 a 4 b Basic Plug In Modules 1 43 Module Module Description The M1012 C O Module is a cardiac output measurement parameter unit It is designed to be used with adult patients in an ICU or OR environment It uses the thermodilution method to generate the measurement Measurements The C O Module produces a thermodilution curve together with numerics for the cardiac output cardiac index blood temperature and injectate temperature values Components The following components carry out the major signal processing functions within the module Table 1 9 Major C O Module Components Component Function Reference Switching Matrix Calibrates the measurement using reference resistors Differential Amplifier Amplifies the signals from the reference switching matrix
260. ht slot or six slot rack can be used The standard eight slot rack attaches to the monitor by a front end cable It houses up to eight standard single width CMS modules The six slot rack comes equipped with a standard front end link connector for attachment to the V24 V26 or to other CMS models The V24CT V26CT supports docking the six slot rack directly to the monitor mainframe V24 and V26 Patient Monitors 4 5 V24 and V26 Patient Monitors Description and Features Parameter Modules The V24 V26 provides 6 or 8 slots to support the following parameter modules Table 4 1 Compatible Philips Plug In Modules Model Parameter Module Number Supported Number M1001A B ECG Maximum of one M1001A or M1002A per monitor M1002A B ECG RESP M1006A B Pressure Maximum of three per monitor bundle specific M1006A B Pressure Module with Maximum of one per monitor total of two invasive Option 01 Analog Pressure Output pressure modules possible 1008 Maximum of one per monitor 1008 NBP Adult Pediatric Neonatal 1012 Cardiac Output Maximum of one per monitor bundle specific 1015 Side Stream Maximum of one per monitor bundle specific M1016A CO Maximum of one per monitor bundle specific M1018A tcpO2 tcpCO2 Maximum of one per monitor only with Neonatal options M1020A SpO PLETH Maximum of one per monitor M1022A Blood Analysis
261. identifies the type of card in a cluster and its position It may also be used to test the compatibility of the local card with the master card in the cluster The identifier is hardwired onto the card and contains the board type hardware revision and version EPROM Erasable Programmable Read Only Memory This type of memory is used on local cards to store executable code and data for master cards The card stores operating and application software for Application CPU cards The Display Language EPROM stores language dependent display characteristics Front End Link A high speed serial communications link used by the Rack Interface card to transfer data between the Computer Module and the Module Racks The CMS receives a patient s measurement data from the plug in modules over this link Polling A mechanism by which a communications device identifies the presence location and identities of connected devices and whether they have data to transfer The Rack Interface card polls the Plug In Parameter Modules over the Front End Link The modules place data onto the link in response to being polled SRAM Static Random Access Memory This type of memory is used on local cards to store data for a master card before and after processing The type of data stored depends on the application software used 3 110 CMS Patient Monitoring System Topics Local Card Overview SDN Synchronization The timing metho
262. ient information e view patient data in graphs or tables e print patient information reports to a local printer or via a Philips central station transfer data between V24 V26 and CMS monitors via the Data Transfer Module This standard feature allows you to print out all active parameter labels numerics physiological and technical alarms on the M1116A B Recorder Module Vital signs are sequentially printed each time an NBP measurement has been taken or automati cally at user defined time intervals The Split Screen capability can display up to 30 minutes of trend data 1 minute resolution next to configured waves on the display In addition related alarm limits are shown graphically and numerically providing an early indication of upcoming problems Stored and manually entered data can be used to perform hemodynamic ventilation and oxygenation calculations Calculated data is displayed in both indexed and non indexed format The Drug Calculator allows you to calculate various drug infusion variables for a selected drug at the bedside The Drug Calculator contains 16 pre configured drugs and 8 any dose formats A titration table can be displayed and printed V24 and V26 Patient Monitors 4 7 V24 and V26 Patient Monitors Description and Features Arrhythmia Detection Anesthetic Gas Monitoring Alarms Graded Alarms Red Alarms Yellow alarms Technical Alarms INOPS Resetting and Suspending Alarms Ala
263. if they were two separate cards on the same cluster This is the same as the original DSPC FLAT controller card All the features of the original DSPC FLAT are supported Additional features for the DSPC FLAT ASIA controller are as follows e Compatible with the M1046B Computer Module e Provides an Asian and Eastern Europe multi language package e Selectable Asian languages Japanese Taiwanese and Chinese The language package can be disabled e Selectable Eastern Europe languages Russian Greek Polish Czech The language package can be disabled CMS Patient Monitoring System 3 89 DSPC XGA Display Controller Card DSPC XGA Display Controller Card Introduction Connections DSPC XGA Components Theory of Operation Data Transfer The XGA Display Controller DSPC FLAT card is used by the system to output display data to a XGA compatible display The DSPC card must be inserted into the rear of the Computer Module so that it can be connected to the display It is connected to the display by using a cable between the 15 pin XGA connector on the card edge and a similar connector on the rear of the display Each DSPC FLAT card supports one master display no remote slave displays can be connected If the system is required to produce two different XGA displays a second DSPC XGA card must be used in a separate cluster The remote on off connection from the Remote Alarm Device to the M1046B integral powe
264. ing LED remains illuminated It is important to note that if only one battery is present the Battery Charging LED continues to flash when the charger for that battery enters state 2 the Battery Charging LED can only be illuminated constantly when two batteries are present and both have entered state 2 When both batteries are present and both chargers enter state 3 both the Battery Charging and Battery Charged LEDs remain illuminated When the chargers enter state 4 the Battery Charging LED extinguishes and the Battery Charged LED remains illuminated The Battery Charged LED remains illuminated until the AC power cord is disconnected V24 and V26 Patient Monitors 4 29 V24 and V26 Patient Monitors Theory of Operation DC to DC Circuit DC to DC converter receives input from the lead acid batteries or from the output of the AC to DC power supply depending on the operating mode The converter provides three DC outputs 60 VDC power supply connection to front end rack and parameter modules 12 VDC the general purpose analog supply e VDD the general logic supply 5V nominal AC to DC Ja 60 VDC 412 VDC VDD 45 VDC LEAD ACID BATTERY Dy DC TO DC CIRCUIT 1 LEAD ACID BATTERY y 2 4 30 24 and 26 Patient Monitors Power Logic CPU Interface 24 and V26 Patient Monitors Theory of Operation The power logic CPU interface circuit consists of three circuits which comm
265. ion UR S 52 Measurements 2 Sed ae RE AE RE ES 52 COMPONENtS T 52 Block Diagram 4 et pl AME EAR Chet as 52 Theory of Operation 54 5vO2 MI021A Features esie qu ES ENDE RR Rd 55 SvO2 M1021A Module 57 Blood Analysis Module Concepts 58 Blood Analysis Measurement 58 Description i oon Sure geo duse ted eae E 58 o euros oec LAUR TERRA Pel RICH d a a Ar 58 Measurement 58 Measurement 60 Measurement 2 2 2 60 Negative Factors Affecting Proper 61 Blood Analysis Module 022 62 D scrptlott s ote e eee OTT tur iode CR EA OS 62 Measurements 4 20 02 argc paid EUH CS eT HCM ED DEES 62 Components cs vec e o D E Mp EA RR pe aont 62 Block Diagram ec e V RE SHOE IRE AS EE dat S 62 Theory of Operation i E RAT E eeu EDU DAE UR ROCA NOE I e Ea e n 64 Blood Analysis
266. is provided by the internal power supply which receives 78 MHz and 60 V DC through the rack interface 5 Inthe case of EASI 12 lead ECG the signal is processed to derive any 3 of the standard 12 vectors Basic Plug In Modules 1 15 ECG Module ECG Module Figure 1 9 shows the user controls and connector for the ECG Module The parts are Features described following the figure ECG 00 2 ECG 1 3 Figure 1 9 ECG Module Controls and Connectors User Controls 1 Setup single press key used to enter the ECG setup screen 2 Setup Indicator A green LED lit when the ECG setup screen is activated Connectors 3 standard 12 pin connector will accept either a 3 lead or 5 lead ECG cable For EASI a 5 lead cable is required Waveforms The size of the waveforms can be adjusted automatically or manually Four configuration settings are possible to control the size and position of the waveform 1 16 Basic Plug In Modules QRS Detection Paced vs Non Paced Mode ST Segment Analysis Safety ECG Module Table 1 2 Waveform Settings Setting Description Autoadjust The wave size is automatically adjusted to fit inside the channel The position of the wave is optimized so that the middle of the wave occupies the middle of the channel unless ST monitoring is switched on Autosize The wave size
267. ition so that any detached electrode can be identified The leads for channels 1 and 2 are selected using two identical lead selection circuits channel 3 always carries the chest lead The signals from the three channels are summed in the differential amplifiers To prevent interference from the 50 60Hz power line the common mode signal derived from behind the lead selectors is used to drive the right leg drive amplifier The output from the amplifier is then returned to the patient via the RL electrode The PPD checks channels 1 and 2 to detect pulses from a pacemaker for display or cardiotach rejection The high and low pass filters allow the independent selection of diagnostic monitoring or filter bandwidths for each channel For calibration purposes a 1mV calibration signal will be generated on each of the channels in front of the filtering circuitry The complete module can be tested from in front of the first amplifier on user request That means switching the patients lead off selecting lead V for all channels and feeding in a test signal 4 The microprocessor which connects to the patient isolators and rack interface through a front end link passes control signals for lead selection and pulse detection from the monitor to the module components through the control lines It extracts the requested physiologic features from the cardiac signals and passes them on to the monitor Meanwhile all needed voltage for the module s operation
268. izure Seizures come in many different varieties but many start with a rhythmic pattern in one or a few channels and progress to a very high amplitude pattern and then back to the pre seizure EEG Some seizures have a period of almost flat EEG following the seizure e Rhythmic pattern e Gradual build e Multiple channels with high amplitude e Return to normal or a brief isoelectric period There are several patterns that can be seen in coma depending on the etiology depth and prognosis of the coma In most comatose states there is a diffuse slowing of the EEG In general a variable EEG is a good prognostic sign and monotonous EEG is considered a poor prognostic sign e Patterns depend on the etiology depth and prognosis of coma e Generalized slowing e Variable EEG Good prognosis e Monotonous invariable EEG poor prognosis Lack of oxygen or hypoxia to the entire brain causes a generalized slowing over the entire cerebral cortex Slowing of the EEG one area of the brain is seen in embolic Advanced Plug In Modules 2 77 EEG Measurement phenomenon such as stroke or clamping of the carotid artery If prolonged the EEG becomes isoelectric or flat e Generalized slowing if hypoxic e Focal slowing if ischemic event Progresses to isoelectric if prolonged 2 78 Advanced Plug In Modules EEG Module Description Measurements EEG Module The M1027A EEG Module monitors the patient s cerebral function by measuring the
269. l RS232 devices The RS232 protocol is NOT provided by this card Any communication with RS232 devices is routed through a level converter The FE LINK is a high speed 500 kilobaud serial link for passing digital data status and control between the parameter modules and the Rack Interface card The Rack Interface card must be placed in slot 18 on the front of the Computer Module This ensures that when the rack is mounted on the front of the Computer Module the 20 pin connector on the back of the internal rack aligns with the connector on the edge of the interface card The Rack Interface card consists of the following areas Comparator Identifier Buffer Multiplexer Control Switched RAM Address Latch Processor Line Driver and LineDriver Receiver The operations of the Rack Interface card are detailed in the following The plug in modules place their data onto the FE LINK in response to a poll from the Rack Interface card The module IDs are placed into a Scan Table when the system is first switched on This scan table is used to decide when to poll each module A scan table entry consists of a complete description of the module to be polled including ID rack address and number of bytes to receive and transmit The modules are polled at different rates for example the ECG is polled every two milliseconds while others such as TEMP or PRESS are polled every eight milliseconds One of the three ECG waves which are sampled ever
270. l is then amplified and transmitted to the SvO Module by the signal amplifier An EEPROM in the Optical Module stores up to 15 minutes of parameter related physiological data This stored data can be recalled and displayed all calibration constants 2 The signal gets processed in the SvO Module by going through four distinct stages Signal Conversion analog to digital Data flow manager Analog CPU Data Processing Algorithm CPU Data communication processing Module rack interface 3 Signal Conversion the analog signal that represents the three reflected wavelengths from the Optical Module is amplified by a variable gain stage and then converted into a digital signal by the analog to digital A D converter This digital signal is passed via the Data Flow Manager Analog CPU 6805 for the Data Processor Algorithm CPU 6303 4 Data Flow Manager Analog CPU The primary functions of the Analog CPU 6805 are as follows collection and first level averaging of the data received from the A D Converter gain Control of the analog processing channel low level EEPROM memory for driver functions performs self test which checks the heater LED current and fuse functions of the module 2 54 Advanced Plug In Modules SvO2 Module M1021A 5 Data Processor Algorithm CPU the Algorithm CPU 6303 receives the first level averaged data from the Analog CPU and calculates the SvO measurement value The
271. l to the RS232 level and vice versa Digital Interface Acquires data from external devices ventilators gas analyzers etc Analog Interface Provides eight analog channels consisting of up to two wave channels five numeric channels and one alarm channel Figure 2 21 shows the block diagram of the signal flow through the VueLink Module Advanced Plug In Modules 2 69 VueLink Module 1 8 ANALOG amp DIGITAL INPUT SIGNALS Figure 2 21 M1032 VueLink Module Block Diagram H9IH 439 4 1 1 438 no s aNo o onas 3 gt gt L L 9 A09 L_ m v INXL NXH gt 55409 qv 3d01S Ivna 139440 DOWNY 0140 S3HO1IMS 4 9 lt SNILVOT3 NON puvo B x lt 5 lt 9 E m E zezsu 2 lt 5 NOISH3ANOO NOLLVOINNWWOO 1HV1S SONILL3S 1N oQv 905 oav ZHIN 8 ANI 18Vn 2 HO1VM ZHN 8 Y 7H 8 140
272. le 1 14 Major Recorder Module M1116B Components Component Function DC to DC Converter Generates power for the digital circuitry and printing mechanisms Motor Control Circuits Control the operation of the paper drive motor Microcontroller Manages the I O and print operations for the module Random Access Memory Provides storage for data accessed by the microcontrollers Paper Drive Motor Feeds the paper through the printer Thermal Printhead Provides the printing mechanisms for the recorder Figure 1 28 shows the block diagram of the Recorder Module M1116B Recorder Module M1116B i BUD IUOS SPI OR oc Ier Mi 1 II IL ESTINNd NOS ATddNS YAMOd INSINVHOHN YALYAANOO SINDAO od OLOd JOXINOO YOLOW tun i 1 0140 Les LASS ig c mu OdAS S IVNDIS rv GVHSHINDId SdNVT S IOXLLNOO THNVd Figure 1 28 M1116B Recorder Module Block Diagram 1 81 Basic Plug In Modules Recorder Module M1116B Theory of Operation 1 82 Basic Plug In Modules The M1116B Recorder Module contains a power supply circuit board a digital circuit board and a recorder mechanism unit The components for the M1116B Module are slightly different from those of the M1116A The power
273. lease C Software Contains software used by a master CPU card For example in the case of an Application CPU the card would contain the application software Post Release C Software The application software is integrated into the CPU card Display Language An EPROM card that is used to store the Asian characters EPROM used by the Japanese Chinese and Taiwanese systems DSPC LANG These characters require more memory capacity than is available on the display controller s ROM Static RAM Used to hold data before and after processing SRAM Color Video Card Contains the pixel Video RAM for the color display CDSPC VIDEO Used in CMS delivered prior to Release G Serial Distribution Used to acquire serial data messages and alarms from the Network Interface SDN Messages and data may also be broadcast back onto SDN IF the SDN for use by bedside monitors arrhythmia computers or the System Communications Controller SCC at the hub of the SDN star network Rack Interface Provides access to the Module Racks RACK IF Auxiliary Connector M1046B Only Provides access to the Rack Interface AUX CONNECTOR behind the Computer Modules integral power supply Remote Switch M1046B Only Provides connection and the remote REMOTE SWITCH switching of the DC power to the computer module the module racks and the flatscreen display Local Card With the exception of the SDN card local cards can generally be used
274. lifier carrier signal is synchronously demodulated before being input to the lowpass filter The filter is then optimized by a variable amplifier before being digitized by the Analog to Digital converter To compensate for input pressure offset caused by static or atmospheric pressure at the pressure transducer an offset compensation signal is generated by the Digital to Analog converter The offset values are stored in an EEPROM The Digital to Analog converter also generates the calibration staircases CAL2 for the recorder calibration and the test signal Both the calibration signal and the test signal are generated on user request The signal is then passed through the patient isolation to the rack interface and then to the receiving rack PRESS M1006A Figure 2 3 shows the user controls and connectors for the PRESS Module M1006A Features Refer to this figure for the User Controls and Connector descriptions 2 8 Advanced Plug In Modules User Controls Connectors Safety Invasive Blood Pressure Module M1006A PRESS M1006A T PRESS ZERO 28 4 Figure 2 3 PRESS Module M1006A Controls and Connectors 1 Pressure Setup Key a single press key which is used to enter the Pressure Setup Screen 2 Pressure Setup Indicator a green LED light which is lit when user is in the Pressure Setup Screen 3 Zero Key a single press key whi
275. ll current clinical signs ongoing stimulation drug delivery and raw EEG signal quality As discussed above BIS provides ongoing information about the hypnotic state which can be useful in determining patient response to anesthetics and stimulation Since there is no single anesthetic technique that is appropriate for everyone optimum use of the BIS will depend on clinical goals of the anesthetist Based on this consideration there is no single BIS value or range that can be recommended or is appropriate for all patients or conditions For those who prefer to keep their patients deeply anesthetized to suppress all unwanted responses BIS can provide an opportunity for reducing the relative overdosing of the hypnotic state BIS 40 which may occur with this approach Clinicians who seek to keep their patients light can utilize the BIS response to help determine the minimum effective dose of anesthetic required by each individual to reduce the risk of awareness For sedation during MAC cases with regional blocks prevention of unnecessary sedation BIS lt 70 may be the monitoring goal Because of this diversity in clinical need most new users of 5 monitoring benefit from first characterizing their standard practice using the BIS in an observational fashion During this initial evaluation phase typical practice ranges and 5 responses to various interventions can be observed in the context of the individual s own practice In this
276. ller The I O Microcontroller translates waveform and annotation data into row and column format merges the data into a matrix that represents the dot pattern to be printed and writes the matrix to the dual port RAM The RAM is maintained as a rotating buffer so that memory locations can be reloaded as soon as a column of dots is sent to the printhead The Motor and Print Format Microcontroller sends each column of dots to the thermal printhead at 2 msec intervals through its built in serial communications port and directs reloading of the printhead s shift register at a 3MHz clock rate The Motor and Print Format Microcontroller maintains uniform print contrast by monitoring the printhead s temperature and watt consumption and modulating the strobe width that is applied to the dots during printing The Motor and Print Format Microcontroller Basic Plug In Modules 1 75 Recorder Module M1116A 1 76 Basic Plug In Modules also sends instructions to the motor control circuits on the power supply board to regulate the paper drive motor speed Recorder Mechanism This unit contains the thermal printhead and paper drive motor Both components receive signals generated by the Motor and Print Format Microcontroller on the digital board The printhead assembly contains a column of 384 heater elements for printing the dots oriented perpendicular to the direction of paper travel It also contains a 384 stage shift register which serves as a da
277. lock diagram of the patient s recorded signal flow through the 2 28 Sidestream CO M1015A Module Advanced Plug In Modules Sidestream CO2 Module M1015A 44 Sensor Adapter IPUI suOTIOUUOD 0129 ser seiddng so ns woy Sjuouramseo A MOJA gt 2 8 4 WONdHH Josuog 2 gt 5 14 D anjosqy Q x SIND L ue dnooodo9 a 2 a 5 J9 19AUO gt 105 95 E q v duo FL mug gt gt dung Tm sep JOALIG ospnd RA ka Ser Figure 2 9 Sidestream CO2 Module M1015A Block Diagram 2 29 Advanced Plug In Modules Sidestream CO2 Module M1015A Theory of Operation 2 30 The four major sections that the electrical signal must pass through in order to reach the Monitor interface are 1 The Microprocessor which is in overall control of all calculations and communications with the CMS function box The Microprocessor perfo
278. ls to an intra aortic balloon pump Philips recommends that a molded phone plug cable Product Number M1181A A62 be used with this output jack 2 14 Advanced Plug In Modules Invasive Blood Pressure Module M1006A Option 01 PRESS M1006A 1 What does the PRESS M1006A Option 01 Module Measure Option C01 Module Exercises a Output b Invasive Blood Pressure c Cardiac Output 2 What component of the PRESS M1006A Option 01 Module provides the analog output signal a Analog Output Jack b Analog to Digital Converter c Microcontroller Unit 3 The PRESS M1006A Option C01 Module uses the following a 40 uV V mmHg transducers b 40 uV V mmHg and 5u V V mmHg transducers c 5 uV V mmHg transducers Answers 1 5 2 Advanced Plug In Modules 2 15 Invasive Blood Pressure Module 1006 Invasive Blood Pressure Module M1006B Description The PRESS M1006B Module is an invasive blood pressure measurement parameter unit It is designed to be used with adult pediatric or neonatal patients in a range of Critical Care environments It contains the same functionality of the M1006A except it has no 40 mmHg sensitivity Measurements The PRESS M1006B Module produces a real time waveform together with the pulse rate and numeric readings for the systolic diastolic and mean blood pressure values Components The PRESS Module M1006B consists of the following major functional components Table
279. ly a timer that watches the microprocessor s address strobe When the processor outputs an address on its bus it asserts the address strobe to indicate that a valid memory address is available However if the signal is asserted for too long the logic assumes that the access was not terminated correctly that is the address strobe was not negated or removed The logic then asserts a Bus Error to tell the processor that it could not access the memory correctly The local bus buffers are used to buffer the address between the card and the Local Bus The data are is also buffered between the bus and the card These bus buffers connect to the Local Bus which allows data to be passed between the processor and the local cards in that cluster The address decoder generates the strobes and select signals for the other devices on the card such as the SRAM EPROM and the MPB Interface Access acknowledge signals are also generated for all devices except the MPB Interface chip which generates its own acknowledge signal CMS Patient Monitoring System 3 69 Application CPU SRAM buffered and SRAM EPROM 68000 Microprocessor Theory of Operation Memory Location Addressing Interrupts LEDs Power Failure amp System Reset The Static RAM capacity 512 Kbytes is used for data storage such as trends and may also hold the application software Note 64 Kbytes of the 512 Kbytes are buffered by a special capacitor Also called th
280. method of measuring the Cardiac Output For information regarding the Right Heart method please refer to chapter Cardiac Output C O Module Concepts on page 1 40 Description The M1012 10 Module is a cardiac output measurement parameter unit It is designed to be used with adult pediatric or neonatal patients down to 2kg of weight in the range of hospital environments It uses the transpulmonary thermodilution method and the pulse contour analysis to generate the measurement Measurements The 10 Module produces a thermodilution curve together with numerical values for the transpulmonary thermodilution Cardiac Output C O IntraThoracic Blood Volume ITBV and ExtraVascular Lung Water EVLW The thermodilution measurement is also used for the calibration of the Continuous Cardiac Output CCO derived by pulse contour analysis from the arterial blood pressure wave Components The following components carry out the major signal processing functions within the module Table 1 10 Major C10 Module Components Component Function Reference Switching Matrix Calibrates the measurement using reference resistors Differential Amplifier Amplifies the signals from the reference switching matrix Dual Slope Analog to Digital Digitizes the analog signals from both the blood and injectate Converter channels Block Diagram Figure 1 18 shows the block diagram of the Module M1012A 10 1 EV
281. mit and receive FIFOs and control registers which can be accessed asynchronously by the processor without wait states 3 102 CMS Patient Monitoring System Data Transfer CAUTION WARNING Testing Diagnostics Loop Tests HDLC Interface Card Only channel B is used for the HDLC link and it is connected to the operational port The inverted RTS output of the HSCX controls the direction of the HDLC driver The HDLC Interface communicates with the connected devices in a Master Slave configuration with the HDLC Interface as the Master Commands and data from the MPB are received by the CPU on the HDLC Interface The CPU interprets the commands and rearranges the data into the format required by the HSCX and STRIP protocol It then loads the data into the HSCX to be transmitted to the external HDLC devices Data received from the devices are reformatted by the CPU and transmitted via the MPB The CPU can also be commanded to poll the connected devices automatically every 32 milliseconds for synchronization ESD Protection The HDLC connector shields all ESDs when a cable is not connected to the port on the HDLC link However ESDs into the unconnected end of an HDLC cable which is connected to the HDLC Interface on the Computer Module will result in driver damage Always disconnect the HDLC cable at the Computer Module end when other equipment is not attached to the cable Ground Safety Connection There is no signal ground conne
282. mpedance between two electrodes placed on the patient s skin as the patient breathes in and out By using a modulation technique for measuring the impedance with a carrier frequency that is far outside the ECG bandwidth the same electrodes that are used for the ECG measurement can be used for respiration Although the ECG and RESP signals are obtained using the same electrode set the measurement principles are fundamentally different Basic Plug In Modules 1 19 RESP Measurement Measurement RESP is measured by placing two electrodes right arm RA and left leg LL on the Acquisition patient s skin as shown in Figure 1 10 For EASI 12 Lead ECG the positions are different see Figure 1 5 Angle of Lewis BLACK 2 YELLOW 3 02 WHITE e N Y RED cm gt S 2 GREEN BLACK TUS o RED GREEN Figure 1 10 Electrode Placements for RESP The impedance measurement contains several signals basic impedance of the thorax The change in impedance caused by breathing e The change in impedance caused by cardiac activity The impedance change caused by breathing activity is extracted from the basic impedance and displayed as a respiration wave Impedance changes caused by cardiac activity are discarded and are not included in the respiration rate 1 20 Basic Plug In Modules Output Criteria for Proper Measurement Plug In Modules References RESP Measurement RESP signals are
283. mpensation DAC Sample and Hold Register Sample and Hold Circuits Low Pass Filters and Digital Port The MPB interface provides the interface between the MPB and the card For more information refer to the beginning of the Master Function Cards section of this chapter First In First Out buffer The microprocessor used on the Analog Interface card is the 8051 This is one of the two digital to analog converters DACs that provide eight analog output channels CMS Patient Monitoring System 3 105 Analog Interface Gain Error Compensation DAC Digital Port Theory of Operation Absolute Wave Handling Noise Remote Installations Output Delay WARNING Digital Output Analog System This is one of the two DACS that provide eight analog output channels The Digital Port is an 8 bit port The operations of the Analog Interface card are defined in the following When switching the scale or size of an absolute wave the analog output may be affected for up to two seconds This is due to the internal handling of scaled waves by the CMS The Analog Interface has grounded inputs Ground loops in the installation through grounded inputs at the receiving device may introduce additional noise to the analog signals Lowest noise is obtained when the external analog device is connected with floating inputs or to devices with differential inputs When the Display Module is installed remotely from the Computer M
284. mponents 118 Theory of Operations ces er Ur ERR E ER EE AUR ER 119 CDSPC VIDEO Functional Block Diagram 121 Summary of CDSPC Cards Features 122 Serial Distribution Network Interface 122 Introduction PUR CERE EU E eR 122 Connections pex 04 tee ote Revista Vivi ee pU Ridin an 122 CompoOnents ese NER CREE BU AS Pace NO RU BURN 123 Theory of rosenc derece RR er t Re yr hers 123 Summary of SDN Features 124 Functional Block Diagram 125 Rack Interface 2i nor oe eeu ARN EU DL a a PEERS 126 Introd ction i ER EXIRET RUE WO PENES 126 Connections i eode Dunia NOM Iam UE IS 126 Components 2 2 o e acte Rettore EX e ER Ie 126 AUR Sl Ed 126 Summary of Rack Interface Features 127 Functional Block Diagram 128 Aux Connector Card os ante QI NDA AA EPA 129 Introduction DRE PARES 129 15
285. n D type connectors The ability to output to computer systems using the RS232 standard can be switched on or off in the Configuration Mode for both ports The differences between the ports is outlined in Table 3 26 Table 3 26 Port Description Port 2 upper connector Can be used to output RS232 information to printers or computer systems If you only require an output to a printer port 2 the configuration for port 2 should be CompOff Older models allow connection to a printer through the upper port only Port 1 lower Is exclusively used as the output to computer systems connector Does not provide an output for printers Provides faster configurable baud rates than port 2 3 98 CMS Patient Monitoring System Pinouts Components MPB Interface FIFO Microcontroller UART Theory of Operation Data Transfers RS232 RS422 Dual Interface Card The connector is wired as a standard RS232 connector with the additional data lines used for RS422 data transmission Shield n c Transmitter TXD n c Receiver RXD n c Request To Send RTS Clear To Send CTS 422 Data Set Ready DSR is GND Data Terminal Ready DTR Data Carrier Detect DCD n c T422A Ring Indicator RI 422 n c n c n c n c R422A n c Figure 3 40 Connector Pin Signals The RS232 RS422 Dual Interface card consists of the following functional areas MPB chip FIFO Micro Controller
286. n the screen All display data including local language characters and color information are produced by the Application CPUs or CPCs More than one CPU may produce data for the display The wave plane displays up to eight overlapping parameter waves This plane is implemented in a different way than for the other planes because the wave plane must display waves that scroll horizontally on the screen The scrolling logic moves a pointer indicating the left of the screen through the Video RAM and new data are written directly behind it This has the result of adding new data onto the right of the screen as old data are displaced on the left The CDSPC controller card receives display data waves lines numerics display attribute data and control messages from the CPU over the MPB The microprocessor on the controller card sends the data over the Local Bus to the video card The Video System Controller on the video card places the data into the dual ported Video RAM Display attributes such as half brightness are also placed in the Video RAM The pixel data are clocked out of the Video RAM by the on chip shift registers These data then pass through the SLIP Chip which contains all the video and addressing logic before passing it to the video buffers The data then pass through the protection network for output to the display An oscillator is used to synchronize the picture sweep The seven colors produced by the color display have thei
287. n Modules 1 41 Measurement Output Criteria for Proper Measurement Plug In Modules 1 42 Basic Plug In Modules The time temperature curve resulting from the measurement resembles a bell shaped curve except that it has an exponential decay The data are integrated to calculate the area beneath the curve By convention the y axis of the graph shows decreasing temperature THERMODILUTION CURVE 360C P A BLOOD agsc 4 INJECTION TEMP 370 EXPONENTIAL DECAY Factors affecting accurate measurement of cardiac output include e Physiological conditions Variations in cardiac rate and rhythm cardiac abnormalities or patient anxiety or movement can cause errors in measurement e Catheter conditions damaged or incorrectly positioned catheter or a prematurely inflated balloon will cause measurement errors Injectate factors Inaccurate timing volume or temperature of injectate as well as use of the wrong catheter port will result in errors The M1012A Module provides the thermodilution cardiac output measurement References Woods Susan and Susan Osguthorpe Cardiac Output Determination in AACN Clinical Issues in Critical Care Nursing For bibliography Susan Osguthorpe ed Philadelphia JB Lippincott 1993 Measurement Exercises C O Measurement 1 The time it takes for cooled blood to change temperature in the thermodilution method is used to derive w
288. n module rack integral or blank and the CPC Flash port is used by the CPC Programming Tool for programming functions Most models contain a Sheet Metal Cover over the front function cards The cover has two ports for access to the front connectors CMS Patient Monitoring System 3 35 Computer Module FRONT FUNCTION CARDS SIT BEHIND SHEET METAL COVER CPC FLASH PORT SHEET METAL COVERING THE FRONT FUNCTION CARDS RACK INTERFACE CONNECTOR PORT INTEGRAL RACK Figure 3 13 M1046A Computer Module Front Connectors 3 36 CMS Patient Monitoring System Computer Module Front Connectors new There are extra connectors on the front of the M1046B Computer Modules with an Computer Modules integral power supply M1046B Remote Switch This connects the integral power supply to the backplane of the computer module and allows the flatscreen display to control the power for the Computer Module FE Link amp ECG sync These connectors found on the AUX CONNECTOR card in slot 24 to allow access to the RACK IF card in slot 18 behind the power supply An ECG adapter allows you to connect to the ECG sync connector through a hole in the front plastic cover CPC Connector ECG Adaptor FE Link Connector Remote Switch Connector Rack IF Connector ECG Connector FE Link Connector Aux Connector Rack IF Function Card Remote Switch Function Card Function Card Figure 3 14 M1046B Computer Module Fron
289. n signal is generated by the Digital to Analog converter The Digital to Analog converter also generates the calibration staircases CAL2 for the recorder calibration and the test signal Block Diagram Figure 2 4 shows the block diagram of the patient s recorded signal flow through the PRESS M1006A Option C01 Module Advanced Plug In Modules 2 11 Invasive Blood Pressure Module M1006A Option C01 WNOHud33 Zpvc NOLLO313Q Ly 9 1 NOLIVLIOX3 NOILWLIOXA H OVAYALNI OLIV1OSI AN3llvVd WALSAS H3TIOHLNOO n P d 1591 OH3Z NOLIVLIOX3 100 5534 Z LU IS 25 YANO 2 aAA SN Har dv SNVUL 2 NIV SSYd 74 1 QN ONAS 5 m po NIVO NOILOALAG YAONGSNVYL TVNDIS HSONGSNVYL Y SSdud lOH1NOO Figure 2 4 M1006A Invasive Pressure Module Option 01 Block Diagram 2 12 Advanced Plug In Modules Invasive Blood Pressure Module M1006A Option 01 Theory of Operation There are four major section
290. nc and video input signals enter the display through the Video In plug on the rear of the display For main displays the input signals are delivered by the video controller card in the Computer Module For slave remote displays the signals are from the main display The Video Out connector allows a remote display to be daisy chained to a main or remote display Up to three remote displays may be connected to the system The Video Termination switch allows you to select the correct impedance for the display 1 kOhm if a slave display is connected within the chain and 75 Ohm for the last display in the chain The switch is a push button on the M1092A and M1094A displays a two pole on the M1094B display 3 48 CMS Patient Monitoring System Brightness Control Standby Switch Combined Video In Power Connector Human Interface Link Connector In Human Interface Link Connector Out Display Module The following is a list of the controls and connectors on the rear of the Flatscreen display A rotary control used to vary the brightness of the display Controls the M1047A Power Supply 60 V DC output This is a male SCSI connector with 25 pin pairs used to input the video signal and the 60 V dc line voltage This is a Philips HIL Connector used to connect the handheld keypad This is a Philips HIL Connector used to output the information from the keypad and control panel to the Utility CPU function card in the computer module
291. nced Plug In Modules Chapter CMS Patient Monitoring System Introduction Goals Objectives Topics This chapter is organized into four sections Each section contains its own introduction objectives and topics list This chapter covers the CMS Philips comprehensive modular system for monitoring the entire range of a patient s clinical data The CMS contains the superset of functions for the products in its family The V24 and V26 offer many but not all of these functions and is described in chapter 4 The CMS is also available in an Anesthesia specific model and a Neonatal specific model for Anesthesia the Anesthesia CMS ACMS and for Neonatal the Neonatal CMS NCMS The components and parameter modules of the ACMS and NCMS are the same as those found in the Standard CMS with the exception of the Anesthesia Gas Module which is an Anesthesia specific module This chapter presents an overview of the CMS ACMS NCMS describes the modules it contains and provides details on the individual function cards that carry out its operations Important concepts are previewed at the beginning of each section Exercises on the content of each section are included at the end of the first two sections and after each of the function cards After successfully completing this chapter you should be able to e Describe the system s features Describe the system s functions Identify the system s components Each section of
292. nced Plug In Modules 2 33 FIO2 Respiratory Measurement Criteria for Proper Measurement Plug In Modules FIO Respiratory Measurement Exercises Factors affecting accurate measurements of FIO are e Proper connection between the measurement module and the patient s ventilation system The 1017 FIO Plug in Module measures fractional inspired oxygen Automatic compensation for interference when measuring respiratory CO is achieved when the FIO Module is in use 1 respiratory measurement is an indication of a the percent of inspired oxygen b the percent of expired oxygen c the percent of inspired 2 respiratory measurement uses a technique based on a the polographic method b amount of partial pressure exerted c absorption of infrared radiation 3 respiratory measurement is displayed as a a blinking light b waveform c numeric value 4 What factors can influence the accurate measurement of FIO a temperature of patient s breath b proper connection between the module and the patient s ventilation system c amount of water vapor in patient s breath Answers 2 34 Advanced Plug In Modules FIO2 Module M1017A FIO Module M1017A Description Measurements Components Block Diagram The FIO M1017A Module is an inspired oxygen measurement parameter unit It is designed to be used with adult pediatric or neonatal patients in a range of Critical
293. nchronize the plug in module power supplies The Nurse Paging Relay is a single closure relay used to control an external device such as a light or buzzer It is operated under software control The contacts of the relay are connected to a stereo phone jack on the edge of the Utility CPU card When the relay is operated a loop connection is closed between the tip and the ring of the phone jack The sleeve is at ground This allows control over an external device For example a lamp or buzzer and a power supply connected through a power relay can be used to give an alarm that is either visual audible or both Connecting power voltages to the phone jack results in a hazard to personnel when removed The Philips HIL is Philips Human Interface Link Devices supported by this link are the keypads and touchscreen used by the Display Module The Philips HIL is a serial digital link that uses a two wire bus The devices it connects are daisy chained to the HIL Master on the Utility CPU card Each device tags its data with its identity Before data are placed on the bus by a device the device looks downstream to see if there are any other data on the bus If data are present on the bus the device adds its 3 94 CMS Patient Monitoring System Memory Addressing Data Transfers SDN Synchronization Utility CPU own data to the end of the data stream The data stream is interpreted by the HIL Master Each memory location on either t
294. ndex are registered trademarks of Aspect Medical Systems 2 86 Advanced Plug In Modules BIS Measurement observation of hemodynamic autonomic and somatic responses as endpoints for anesthetic titration Unfortunately none of these parameters is a direct measure of how asleep or awake hypnotic the patient is While these physiological signs may correlate with the hypnotic state in some instances many factors can interfere with this relationship e The combination of multiple agents with varying effects and sites of action e Synergistic effects of the drugs e The cardiovascular and hemodynamic status of the patient The use of drugs that attenuate cardiovascular responses e g vasodilators alpha and beta blockers etc The varying amounts of noxious stimulation to which the patient is subjected Hemodynamic autonomic and somatic measures of anesthetic effect react when stimulus strength significantly exceeds the level of sensory suppression provided by hypnotics and analgesics but this dynamic balance can vary considerably during surgery e Dissociation between the dose required to achieve the therapeutic effect hypnosis versus undesired cardiovascular effects Traditional vital signs provide a measure of cardiovascular tolerance and indicate when significant autonomic responses have occurred but often do not accurately reflect the state of the brain This sometimes results in the use of anesthetics to manage the hemodynami
295. ne raryan rye eee e PX SC ONE RM EC eer Rd 13 Block Diagram toG RUNE RR RR EBENE RAE ENS 13 Theory of Operation 1001 1002 15 ECG Module 16 ECG Module 18 RESP 19 Contents 1 Descriptions Niis ERR e Re e SORA IER EA ME 19 Concepts eee e s enu 19 Measurement 19 Measurement 20 OUP UG sse ELLE VET beu teu e D rd a A 21 Criteria for Proper Measurement 21 Plug In Modules oer UC QE Ra E se dd CR SR bal aes 21 References iere eer nie RIGHE ea hte are hen re ert mte 21 RESP Measurement 22 ECG RESP Module nee BR ba end Bde em I ace RI ERR RR Rot eR de 23 DescriptiOnz inmate terret tea eue be d a le D ote foe 23 8 P 28 Conmpornents c CU ales AI RT eL VS 23 Block Diagram ee tU RAI eR e UR eR UR eee Wi gre m eee 24 Theory Of Operation rt ors E RAH
296. ng an SvO calibration procedure Connectors This is a customized 20 pin connector for use with the Abbott Optical Module Safety To ensure the safety of the patient the patient applied parts are isolated from ground by optical isolators and a transformer In addition the entire module is encapsulated in plastic This module complies with UL544 IEC 601 1 CSA C22 2 No 125 Patient leakage current is less than 10p A at 120V 60Hz Isolated patient connection to Class protection Type Cardiac Floating CF There is also protection against damage from defibrillation and electrosurgery 2 56 Advanced Plug In Modules SvO 1021 Module Exercises SvO2 Module M1021A 1 The SvO M1021A Module measures a Carbon Dioxide b Mixed Venous Oxygen c Oxygen concentration 2 The SvO M1021A Module produces a Fraction Value b Waveform c Numeric Value 3 The SvO M1021A Module Data Flow Manager performs all but which of the following functions a Manages light intensity b Performs self tests to check the heater c Receives data from the A D Converter 4 The SvO M1021A Module uses which kind of connector a Standard 12 pin b Customized 20 pin c Standard 3 pin Answers pur Advanced Plug In Modules 2 57 Blood Analysis Measurement Blood Analysis Module Concepts Blood Analysis Measurement Description Concepts Measurement Principle Potentiometric Measurements
297. nhibits access to the on board buffered SRAM Provides a minimum of three hours of data retention in SRAM using a super capacitor CMS Patient Monitoring System 3 77 Monochrome Display Controller Monochrome Display Controller Introduction Connection to Display Module Components 68000 Microprocessor MPB Interface FIFO EPROM SRAM Video Ram The Display Controller DSPC card is used by the system to output display data to a main monochrome display and up to three remote displays A second DSPC card is required if the system has to produce two different displays The second DSPC card is plugged into a separate cluster The DSPC card is a master card based on a 68000 Microprocessor with a connection to the local bus The DSPC card must be connected to the display therefore it is plugged into the rear of the Computer Module rather than into the front The DSPC card has a 9 pin D type connector on the card edge which is used to connect to a similar connector on the rear of the Display Module Note the video output connector on the display can be used to connect to a remote display The DSPC card contains the following functional areas a 68000 Microprocessor MPB Interface FIFO EPROM SRAM Horizontal Wavescroll Logic Video System Controller Pixel Maps SLIP Chip Video Buffer and Protection Network and Oscillator The 68000 is the microprocessor used on this card The MPB Interface is used to
298. not access the memory correctly CMS Patient Monitoring System 3 93 Utility CPU PFAIL and SYSRES Real Time Clock Timing Generation Nurse Paging Relay WARNING Philips HIL Interface The PFAIL signal is used to inform all other function cards that a SYSRES should be expected from the Utility CPU This is to allow the system to reset all the CPU cards synchronously One bit of the CPU output latch is used to place PFAIL on the utility bus The PFAIL signal is asserted by the CPU if the CPU detects that a serious error has occurred in the system or the watchdog timer detects a failure in the CPU The PFAIL is also asserted by the DC to DC converter when the power is about to fail There is a real time clock chip that outputs a one second clock to the MPB This chip receives its power from a special capacitor when power is lost The worst case would power the chip for 100 hours but more typically the supply would last 255 hours or over 10 days The Utility CPU generates the clock signals from a 40 MHz oscillator The oscillator output is fed to a divide by 2 network to produce the main 20 MHz system clock The Utility CPU provides for internal use the 16 MHz and 10 MHz CPU clocks and an inverted 10 MHz local clock An 8 MHz clock signal is produced for the Philips HIL Chip 78 kHz clock signal is sent to the Rack Interface This clock is an excitation signal for the invasive pressure transducers and is used to sy
299. ns go into more detail on the individual parts of the system After successfully completing this section you should be able to Describe the purpose of the CMS and the clinical settings in which it can be used Describe its significant features and capabilities Identify its major components and their functions Describe its bus architecture and power system Identify its possible hardware configurations Describe its software operating levels and displays The following concepts are explained in this section of the chapter The CMS is a fully modular computer system dedicated to acquiring and processing patient physiologic data It is used in a range of clinical settings for all types of patients A comprehensive set of patient parameters can be measured by this one system The system can also connect to external monitoring devices for data integration The system s modules can be easily configured and expanded to match the specific needs of clinicians and patients The system consists of four types of modules the Computer Module Display Module Module Rack and Plug in Parameter Modules The Computer Module contains the function cards for the system and is responsible for distributing the power data and clocks throughout the system The Display Module provides the power and the human interface for the system and for the CRT version of the Display as well The Module Racks are the interface between the monitor and the measurement pa
300. nsducer Safety To ensure the safety of the patient the patient applied part is isolated from ground by opto couplers and a transformer The module is also encapsulated in plastic Basic Plug In Modules 1 63 SpO2 PLETH Module PLETH Waveform 1 64 Basic Plug In Modules The waveform can be configured for either of two settings Perfusion or SpO SQI Mode These settings control the way the PLETH wave is adjusted for display on the screen The Perfusion Indicator if configured functions independently from the selected wave presentation and gives additional information about arterial blood perfusion It is a scaled ratio between two different light absorbing volumes one that varies with time and one that is constant The perfusion indicator is directly related to the amount of blood perfusion at the transducer site 5 SQI Mode is the factory default It automatically and continuously adjusts the size of the wave which represents the quality of the SpO measurement signals Manual wave adjustments in this mode are not possible If the signal quality becomes weak the waveform becomes progressively smaller and the perfusion indicator reading typically falls below 1 If the signal degrades below an acceptable level the wave becomes flat and an INOP alarm results A poor signal may be caused by poor perfusion at the transducer site or by the transducer it is not related to low oxygen saturation Figure 1 22 contains an example of a
301. nto the dual ported Video RAM Display attributes such as half brightness are also placed in the Video RAM The pixel data is clocked out of the Video RAM by the on chip shift registers This data then passes through the SLIP Chip which contains all the video and addressing logic before passing it to the video buffers The data then passes through the protection network for output to the display An oscillator is used to synchronize the picture sweep The Japanese Taiwanese and Chinese character sets are too large to be stored on the standard EPROM cards These characters are therefore stored on a dedicated card the DSPC Language card which is placed in the same cluster as the display controller cards CMS Patient Monitoring System 3 85 Color Display Controller Card New Version Wave Plane The wave plane displays up to eight overlapping parameter waves This plane is implemented in a different way than for the other planes because the wave plane must display waves that scroll horizontally on the screen The scrolling logic moves a pointer indicating the left of the screen through the Video RAM and new data is written directly behind it This has the result of adding new data onto the right of the screen as old data is displaced on the left Color The seven colors produced by the color display have their intensities equalized so Equalization that they appear similar in intensity to the human eye This is done by using a resi
302. ntration of Oxygen in the inspired air FIO The percent of Oxygen in the inspired air Total Inspired Gas The total volume of gas inspired during one inspiration Ventilation The movement of air in and out of the lungs by means of inspiration and expiration The measurement method used to determine the fractional oxygen is called the polarographic method The transducer comprises an anode and a cathode mounted in an electrolyte and protected by a gas permeable membrane A polarization voltage is applied between the anode and cathode Oxygen passing through the membrane is reduced consumed at the cathode resulting in an output current proportional to the amount of consumed The fraction of can then be derived from the measured current As the transducer is placed in the inspired pathway of a ventilated patient the measurement provides a value for the O concentration expressed as a fraction of the inspired air The temperature dependency of the polarographic method is compensated by an internal thermistor in the sensor Normal values for FIO are ambient air 21 or 0 21 Depending on the patient s condition the percentage of Oxygen sent to the patient may vary from this amount The FIO respiratory measurement is collected by way of an airway adapter on the patient s intubation system The respiratory reading is depicted as a numeric value expressed as a fraction of the total inspired gas Adva
303. ntroller Manages the operation of the module Memory Provides storage for data and instructions Back Up Power Supply Provides power for one hour or longer when the main power supply is unavailable Real Time Clock Tracks the time the module is removed from a monitor during data transfer Block Diagram Figure 1 30 shows the block diagram of the Data Transfer Module M1235A 1 86 Basic Plug In Modules Data Transfer Module dVO 2 ANIL Y WVA e gt MOST Y 5 1 NON h N gt 1 SANIT TVINHS My ZOLLE YATIONLNOD lt ONIN AS Ne ATddns MAMOd QIVA OL l 15 SNOLLO amp ACI aN LNOWA 1 87 Basic Plug In Modules Data Transfer Module Theory of Operation 1 88 Basic Plug In Modules Figure 1 30 Data Transfer Module Block Diagram The module contains two circuit boards on one assembly the boards are referred to as the front panel board and the main board The front panel board consists of the indicator LEDs and control keys The main board consists of the major functional components which are described in more detail below Power Supply The power supply receives 60V synchronized to 78KHz from the front end link and generates 5V and 12V unregulated The 5V i
304. number combination The letters correspond to the cortical areas of the brain where they are located The numbers are odd for the left positions even for the right positions and increase as they move away from the midline which is designated as Z for zero When using a EEG monitor locating the proper place for electrodes can be simplified The electrode pair can be marked using landmarks on the head such as the hairline ears and top of the head to approximate the 10 20 locations A pattern of electrodes on the head and the channels they are connected to is called a montage There are many different combinations of electrode pairs However when dealing with a small number of channels there are only a few things you need to know Central Sulcus Sylvian Fissure i 3 Advanced Plug In Modules 2 83 EEG Module Back International 10 20 They are e Montages are always symmetrical e Choose a montage based on clinical setting e A reference electrode is generally placed on a non active site such as the forehead or earlobe Front Reference Fpz Channel 1 Fp1 Channel 2 Fp2 P4 Back Montage 2 84 Advanced Plug In Modules EEG Module EEG Module Figure 2 24 shows the user controls and connector for the EEG Module The parts are Features described following the figure pr m EEG M10274 EEG 3
305. ocontroller is a CMOS 87C51 and is primarily responsible for communication with the Front End Rack The FE microcontroller communicates with the Utility CPU through shared RAM In addition to Front End Link communication the FE microcontroller is responsible for generating analog ECG output by an 8 bit D A converter Analog ECG output is accessed through a phono jack on the V24 V26 V24 and V26 Patient Monitors 4 21 V24 and V26 Patient Monitors Software Configurations V24 V 26 Software 1 The monitoring manager modules include Configurations a alarm Exercises b trend database c both a and b 2 The FE microcontroller is primarily responsible for a data management b communication with the Front End rack c trend setting Answers l c 2 b 4 22 V24 and V26 Patient Monitors 24 and V26 Patient Monitors Theory of Operation V24 and V26 Patient Monitors Theory of Operation Overview The V24 V26 consists of the following aninternal power supply which supplies all of the voltages required for V24 V26 operation System Board which performs all of the processing functions aLCD Adaptor Board V24 e a3 board assembly consisting of LCD Adapter Board DSPC Board and CDCI Board V24C V24CT and V26C V26CT only afront panel keypad aflat panel display e Service Port Connector e six slot or eight slot racks
306. oduction Connections The Color Display Controller CDSPC cards are a set of two cards used by the system to output display data to a color monitor The CDSPC cards are similar in operation to the DSPC card with the exception that the Video RAM is three times larger Therefore two cards are required CDSPC_CTRL and CDSPC VIDEO The CDSPC CTRL card the video controller is a master card connected to the MPB Bus and the Local Bus The CDSPC VIDEO card is a local card that contains the Video RAM and output circuits to the Display Module The two cards are connected by the Local Bus Both cards must be placed in the same cluster of the Computer Module The CDSPC VIDEO card must be inserted into the rear of the Computer Module so that it can be connected to the display It is connected to the display by using a cable between the 9 pin D type connector on the card edge and a similar connector on the rear of the display The video output on the rear of the display may be used to connect a remote display If Kanji characters are to be supported the EPROM and DSPC KANJI cards must also be inserted into the same cluster as the two CDSPC cards Each pair of CDSPC cards supports either one master display and three remote displays or four remote displays If the system is required to produce two different color displays a second pair of CDSPC cards must be used in a separate cluster For details on the components and operation of the CSDPC VIDEO
307. odule the analog interface ground digital and analog ground shows a DC voltage with respect to safety ground approximately 3 mV m of cable length between the Computer Module and the Display Module When connecting the Analog Interface to devices with grounded inputs this voltage leads to an additional offset error at the inputs of the connected devices The offset can be compensated for either at the connected device or by adjusting the offset for the analog channels The offset can be avoided by connecting the Analog Interface to devices with floating or differential inputs The waves available from the Analog Interface are filtered and processed by the parameter specific algorithms in the CMS The processing delay from parameter input to analog output is approximately 250 milliseconds This delay is constant for each channel and between channels Do not synchronize balloon pumps or defibrillators using the Analog Interface on the CMS An output delay of approximately 250 milliseconds is present on the signal s output from the Analog Interface The digital output port comprises an eight bit register with ESD and short circuit protection The low output impedance of the port guarantees proper TTL output levels for up to 1 6 mA output current The analog system consists mainly of a 12 bit multiplying DAC a precision 5V reference an error compensation loop and eight analog channels 3 106 CMS Patient Monitoring System Digital to Analo
308. of anesthetics on the brain To properly interpret the clinical relevance of responses users should familiarize themselves with this new parameter and its dynamic changes in response to common interventions This section briefly describes the use of BIS for monitoring the effects of anesthetics and sedatives The goal is to provide a concise summary of factors to consider about 5 monitoring in order to assure appropriate interpretation and use of the information provided by this new parameter Previous research on neurophysiological monitors of depth of anesthesia has often suffered from lack of a clear definition of what constitutes adequate anesthetic depth It has been proposed that there are various distinct clinical goals of optimum balanced anesthesia hypnosis lack of recall analgesia and muscle relaxation areflexia Figure 2 25 Awareness Hecall Consciousness Hypnosis Analgesia Areflexia Autonomic and Somatic Reflex Movement Figure 2 25 Components of Anesthesia Given these multiple goals the concept of a unitary depth of anesthesia may need to be revised to reflect the separate clinical components of the ideal anesthetic state Consequently monitoring of anesthesia may require separate measures of each of these components i e hypnosis obtunding of responses to noxious stimulation and neuromuscular blockade Current clinical practice relies primarily on vigilant 1 BIS and Bispectral I
309. ogic assumes that the access was not terminated correctly that is the address strobe was not negated or removed The logic then asserts a Bus Error to tell the processor that it could not access the memory correctly The PFAIL signal is used to inform all other function cards that a SYSRES should be expected from the Utility CPU This is to allow the system to reset all cards synchronously One bit of the CPU output latch is used to place PFAIL on the utility bus The PFAIL signal is asserted for two reasons by the CPU 1 if the CPU detects that a serious error has occurred in the system and 2 if the watchdog timer in the MPB chip detects a failure in the CPU Note the PFAIL signal may also be asserted by the DC to DC converter The DRAM refresh is controlled by the microprocessor A 3 2768 millisecond timer interrupts the processor at set intervals to do the refresh cycle The refresh cycle is accomplished by the processor writing to a single address The DRAM chips cycle through the banks each time a refresh is performed CMS Patient Monitoring System 3 75 Configurable Processor Card Functional Block Diagram Daughter Card Block Diagram DAUGHTER BOARD INTERFACE TEMP SERVICE SENSOR 8 PORT 68EC030
310. olation to gauge depth of anesthesia However utility of the BIS depends on the users expectations of depth of anesthesia monitoring and the goals of the particular anesthetic regimen being used It is recommended that users integrate the information provided by BIS with other commonly used indicators of anesthetic effect to achieve their clinical objectives In order to facilitate this process several performance characteristics must be taken into consideration As a measure of the hypnotic state of the patient or depth of hypnosis BIS will usually decrease when doses of anesthetics are increased and increase when doses are being reduced If the drug being used has good hypnotic properties e g propofol potent inhalational agents thiopental etc lower BIS levels will be observed at concentrations typically used for general anesthesia e g 1 isoflurane 150 ug kg min propofol In the presence of a constant level of stimulation BIS thus provides an excellent pharmacodynamic measure of the individual s brain response to a given drug concentration which tracks the clinical state This means that sensitive patients will show bigger decreases in BIS than those who are more tolerant to a given dose as demonstrated in an extensive series of volunteer and patient trials Lower BIS values are associated with progressive suppression of brain activity and a correspondingly lower probability of response to a given stimulus assuming that
311. ompensating for the blood temperature by the digital to analog converter The difference signal is then amplified by a variable amplifier with a high gain which increases the sensitivity for measuring the thermodilution curve The continuous calibration linearization control and conversion to degrees C is performed by the software C10 CCO Module CMS only C10 CCO Figure 1 19 shows the user controls and connector for the 10 Module The Module Features parts are described following the figure C O M1012A T 10 2 gt START 1 ae ONERE 3 4 Figure 1 19 C O C10 Module Controls and Connectors User Controls 1 C O Setup Key A single press key used to enter the cardiac output setup screen 2 C O Setup Indicator A green LED lit when the cardiac output setup screen is activated 3 Start Key A single press key used to enter the measurement cycle Connectors 4 This is a standard 12 pin connector for use with a catheter thermistor and start stop switch Safety To ensure the safety of the patient the patient applied part is isolated from ground by opto couplers and a transformer The module is also encapsulated in plastic Basic Plug In Modules 1 55 SpO2 Measurement Arterial Oxygen Saturation Plethysmography SpO Pleth Module Concepts SpO Measurement
312. on CPU cards which are either 10 or 15 MHz and Configurable Processor Cards CPCs which are 40 MHz Application CPU cards require separate memory cards CPCs contain their own memory arrays Topics This section contains the following topics Table 3 2 Topics in this Section CMS Patient Monitoring System Description CMS Patient Monitoring System Modules CMS Patient Monitoring System Bus Structure CMS Patient Monitoring System Power System CMS Patient Monitoring System Hardware Configurations CMS Patient Monitoring System Software Configurations CMS Patient Monitoring System 3 5 CMS Patient Monitoring System Description CMS Patient Monitoring System Description Introduction The CMS is a modular patient monitoring system that can 1 receive patient management data and physiologic measurements 2 process the data in a variety of ways and 3 display the results in multiple formats The CMS is designed to be used in a wide range of clinical settings from nursing stations to critical care units Its power and flexibility enable it to accommodate everything from basic monitoring requirements to complex and highly specialized applications The system s modular nature splits all major patient monitoring functions into individual modules that can be added as needed interchanged between systems and serviced as required This modularity enables clinicians to put together sy
313. on dioxide partial pressures The tepO tcpCO M1018A Module produces graphical and numeric trend information for the partial and partial pressure measurements The tcpO tcpCO M1018A Module uses a calibration algorithm consisting of four check procedures Warm up Check The transducer temperature is tested in this check Under normal conditions the temperature will be heated to the preset temperature within 2 minutes The test allows a maximum of 3 minutes for the transducer to warm up to the preset temperature Range Check The tcpO and tcpCO signals are checked in this test If they are not within the acceptable range in 1 minute the monitor rejects the calibration and displays the calibration failed message Stability Check The stability of the electrode is checked in this test The stability check is activated on successful completion of the range check The calibration is completed when the transducer signal fluctuation is less than 1 per minute maximum of 15 minutes is allowed for this check tcpCO Post Calibration Check This check ensures that the CO element of the transducer responds to the change in the level that occurs when removing the transducer from the calibration chamber If the signal does not change within 10 seconds after removing the transducer from the chamber the message tepO tepCO transducer Cal Unit Malf will be displayed Advanced Plug In Modules 2 43 tcpO2 tcp
314. on the other Philips monitoring network SDN This extended overview has the following features 5 8 Philips Monitoring Network SDN Defining Inter SDN Gateway support for 24 bedsides on the local Philips monitoring network SDN and access to as many as 48 remote bedsides e user configurable access key at each local Philips monitoring network SDN bedside one wave cascaded in two four second segments e softkey to select specific waves for display upto seven parameter numerics alert text messages support for up to eight simultaneous remote access sessions in each direction depending on availability of each Philips monitoring network SDN bandwidth The Philips monitoring network SDN bandwidth is shared equally among six sending devices such as Careport 78360A and 78360B thus limiting the number of active sending devices on a Philips monitoring network SDN to six If the Inter SDN Gateway identifies less than six devices the gateway takes all available bandwidth This can limit the number of simultaneous overview sessions that is the more sending devices on the Philips monitoring network SDN the fewer the simultaneous overview sessions permitted Furthermore the type of overview session manual or automatic alert affects the number of simultaneous overview sessions permitted For manual overview Table 5 1 lists the number of simultaneous overview sessions the Inter SDN Gateway permits based on
315. onitoring network SDN The Philips care hub SCC establishes the Philips monitoring network SDN data polling cycles and controls the flow timing synchronization and distribution of data throughout the network The Philips care hub SCC also performs some basic fault detection routines to maintain the reliability of the Philips monitoring network SDN communications The Philips care hub SCC includes self diagnostic routines for fault detection troubleshooting and servicing The Philips care hub SCC is a metal chassis with cover and cable clamps a power supply and two PC boards The Philips monitoring network SDN interface circuitry is the intelligent interface between the Philips monitoring network SDN and the host microprocessor located in the CMS and the V24 V26 This interface circuitry sends and receives messages to and from other systems over the Philips monitoring network SDN Wall boxes are of standard size NEMA 1 or 2 gang switch wall boxes with conduit knockouts KOs The face plates are prepunched NEMA 1 or 2 gang faceplates for Philips monitoring network SDN connectors Branch cables are permanently installed cables that provide the long distance connection between the Philips care hub SCC and the wall box The local distribution cables LDC are used for local serial connections from the wall box to CMS or V24 V26 systems The LDCs can also be used to connect up to four separate instruments to
316. ood pressure cuffs or any condition in which tissue perfusion is impaired Conversely situations may exist in which venous blood is pulsatile such as from venous obstructions or certain cardiac conditions In such cases the measurement will be erroneously low due to the inclusion of the venous blood in the pulsatile signal Optical interference can cause inaccurate measurements Pulse oximetry assumes that only two light absorbers will be measured HbO and Hb However other elements may be present in the blood with similar absorption properties thus causing falsely low readings Examples of these are carboxyhemoglobin HbCO methemoglobin MetHb and several dyes used in clinical tests Interference from ambient lights can be prevented by covering the finger cuff with an opaque material e factor that affects the transmission of light through the tissue such as nail polish can affect the measurement Basic Plug In Modules 1 57 SpO2 Measurement Motion artifact may interfere with the accuracy of the measurement as it has the same frequency range as pulse activity Plug In Modules The M1020A SpO PLETH Module provides the arterial oxygen saturation measurement References Ahrens Tom Respiratory Monitoring in Critical Care in AACN Clinical Issues in Critical Care Nursing For bibliography Susan Osguthorpe ed Philadelphia JB Lippincott 1993 1 58 Basic Plug In Modules SpO Measurement Exercises S
317. ork SDN is a half duplex network using shielded twisted pair cables All data is transmitted differentially and serially using block code modulation Within the connected instruments the Philips monitoring network SDN interface circuitry provides the link between the serial digital network and the rest of the instrument Each instrument connected to the Philips monitoring network SDN except Philips care hub SCC has basically the same interface circuitry most of which is contained on a custom integrated circuit called the SDN Interface Circuit Chip SIC Chip This chip has been redesigned for the V24 V26 for more integration of circuitry within the SIC chip The optional RS232 interface has 1 port that permits connection to the M1026A AGM connection to a personal computer via MECIF MEdical Computer InterFace or local printing capability The RS232 interface subsystem consists of the physical interface to the RS232 network and controlling firmware The connector type used is a 9 pin D sub female and is located at the rear of the V24 V26 mainframe The parameter rack generally located near the patient is connected to the mainframe by a serial front end link a Philips proprietary front end link connector is on the left side of the V24 V26 for attachment to a rack by a cable This front end link operates identically to the front end link used in the CMS There is a four meter maximum length for the cable length rack to mainframe
318. ough the airway adapter on the patient s intubation system Respiratory gas readings are depicted as a real time waveform together with numerics for Airway Respiration Rate AWRR and Inspired Minimum Carbon Dioxide IMCO During calibration the value for instantaneous CO is also obtained 2 20 Advanced Plug In Modules Criteria for Proper Measurement Plug In Modules CO2 Respiratory Gas Measurement Factors affecting accurate measurements of CO respiratory gas are Proper connection between the measurement module and the patient s respiratory system Temperature of the patient s breath Amount of water vapor in the patient s breath e Barometric pressure at the site of measurement acquisition e Other gases most notably and in the gas mixture Two of Philips plug in modules can measure respiratory CO the M1016A CO Module and M1015A Sidestream Module The M1015A module requires the M1016A module to measure sidestream CO Advanced Plug In Modules 2 21 CO2 Respiratory Gas Measurement CO Respiratory 1 respiratory gas measurement is an indication of Gas Measurement Exercises a overall cardiac status b overall pulmonary status c overall respiratory status 2 respiratory gas measurement uses a technique based on a absorption of infrared radiation b amount of partial pressure exerted c temperature of measurement being collected 3 CO
319. ould be able to Identify the User Controls on the V24 V26 Identify the Connectors used with the V24 V26 Concepts Concepts important to the V24 V26 user controls and connectors Front Panel The panel where the User Controls are located e Hardkey A key on the front panel which has a permanent function and label e Softkey A key on the front panel that has a dynamically changing function and label which corresponds to a label displayed on the screen User Controls Overview The V24 V26 display and control structure looks very similar to the CMS The main functional distinctions from CMS are the number of waveforms 4 versus 4 6 8 and the size of the display and keys Display In addition to the obvious dimensional differences between the CMS and V24 V26 displays the number of pixels in both the horizontal and vertical axis differ as well The attributes in CMS cover a 4x2 pixel area The blinking rate may appear to differ between CMS and the V24 V26 due to the slower response times of the flat panel displays 4 14 V24 and V26 Patient Monitors Front Panel Controls User Controls The V24 V26 front panel is a scaled down version of CMS Revision E front panel with a similar key layout The V24 V26 key layout maintains consistency for the most part with the CMS user interface Shown below is the front bezel keypad for the V24 and 24
320. ous functions of the system The keypad comprises 25 keys and lamps for the alarms on off and key back lighting The controls and indicators on the Control Panel fall into one of three categories a softkey hardkey or an alarm lamp as shown in Figure 3 26 The hardkeys are engraved with black letters and their function is always the same The softkeys which are the seven keys nearest the screen are blank Their function changes during the operation of the system The current function of each key is displayed as a highlighted block at the bottom of the screen directly over each softkey On the right of the keypad are four blank keys arranged as a diamond They are used to move the highlighted block cursor around the screen On the left of the keypad is the alarm status indicator and the Silence Reset and Suspend hardkeys The Suspend key is only present on the M1106B and M1106C versions of the integral keypad Three alarm lamps are located in the upper left corner of the Control Panel These lamps are lit when a red or yellow alarm condition exists CMS Patient Monitoring System 3 53 Remote Keypad Alarm Indicators 2 Softkeys 1 18 Suspend Main Change Realtime Delayed Airway Gases SP Screen Screen Record Record Ventilation 7 Confirm Silence Alarms Other
321. ower Connector Defib Sync ECG Output Connector A single Philips monitoring network SDN connector upstream only no downstream connector is available to allow connection to a Philips monitoring network SDN This allows the V24 V26 to show waveforms and alarms of interest from other networked bedsides It also allows connection to a Central Station as well as centralized arrhythmia systems V24 V26 s single Philips monitoring network SDN connector means it must be the last instrument on a Philips monitoring network SDN branch The Philips monitoring network SDN interface subsystem consists of the physical interface to the Philips monitoring network SDN and controlling firmware The interface communicates with the Philips monitoring network SDN interface module and physical network Digitized patient information displayed over the Philips monitoring network SDN may be either waveforms for ECG pressure respiration parametric information for V24 and V26 Patient Monitors 4 11 V24 and V26 Patient Monitors Interfaces RS232 Interface Front End Link Service Port AC Power Connector Defib Sync ECG Output Connector heart rate pulse pressure values and respiration rate or alert information for alarms and assorted status information The Philips monitoring network SDN data transmission rate of 3 6 Mbits sec can provide 7700 usable 12 bit data words per 32 millisecond poll cycle The Philips monitoring netw
322. own as Einthoven s triangle For convenience the electrodes can also be placed on the patient s trunk near the shoulders and hip The unipolar leads are called aVR aVL and aVF they can be monitored by the same three electrodes When selected on the monitor these leads measure the current from the heart out to the specified limb Figure 1 1 shows the electrode placements and direction of the signals for limb leads European colors in brackets ECG Measurement BLACK YELLOW WHITE RED HED BLACK Figure 1 1 Electrode Placement for Limb Leads Basic Plug In Modules 1 5 ECG Measurement Chest Leads 1 6 Basic Plug In Modules Chest leads also called precordial leads are unipolar Leads labelled V with a number or letter designation can be placed around the entire circumference of the chest as well as the back The most common clinical objective in matching V leads is ischemia detection Figure 1 2 shows an example of the placement of these leads Figure 1 2 Electrode Placement for Chest Leads ECG Measurement Modified Chest Lead MCL is a bipolar chest lead in which two electrodes are placed over the chest as MCL shown in Figure 1 3 Other modified leads are also commonly used The position and index of the chest electrode corresponds to the V positions in Figure 1 2 European colors in brackets ED GREEN Figure 1 3 Modified Chest Lead MCL1 Basic Plug In Modules 1 7 ECG M
323. pO2 Measurement 1 Which measurement method is based on principles of light absorbing properties of blood a Plethysmography b Pulse Oximetry c Thermodilution 2 What factor determines the difference in definition between SaO and SpO a The site where the measurement is taken b The method used to take the measurement c The clinical application for which the measurement is needed 3 The molecule in the blood that transports oxygen to the cells of the body is a Hb b HbCO HbO d MetHb 4 Which term refers to the process of gas exchange in the cells by means of capillary blood flow a Perfusion b Transmutation c Ventilation 5 Which condition does pulse oximetry require in order to measure SpO5 a Adequate ambient light b The absence of CO in the blood c Pulsatile blood activity d An unconscious patient Answers 1 5 2 b 3 c 4 a 5 Basic Plug In Modules 1 59 SpO2 PLETH Module SpO PLETH Module Description Measurements Components Block Diagram 1 60 Basic Plug In Modules The M1020A SpO PLETH Module is pulse arterial oxygen saturation and plethysmogram measurement parameter unit The module produces numerics for the arterial oxygen saturation value and the pulse rate along with a real time waveform for the plethysmogram The module also provides a perfusion indicator value for the pulsatile arterial blood flow The following components carry out the major
324. pable of accessing specific addresses in memory The memory is contained on cards such as Static Random Access Memory SRAM or Erasable Programmable Read Only Memory The Utility Bus distributes the power and clock signals for the system CMS Patient Monitoring System 3 11 CMS Patient Monitoring System Bus Structure System Power The power is placed on the bus by the DC to DC converter which produces the required voltages from the Display Module s 60V DC output The following voltages are placed on the Utility bus Table 3 3 Utility Bus Voltages Voltage 12V Power Supply from the DC to DC converter 12V Power Supply from the DC to DC converter 5V Power Supply from the DC to DC converter 60V Power Supply from the display module or separate power supply via the DC to DC converter System Timing The clock signals are placed on the bus by the Utility CPU and are used to clock the rate of data acquisition The clock used are as follows Table 3 4 Clocks on the Utility Bus Clock Speed Type of Clock 20MHz System Clock from the Utility CPU 32ms Frame Clock C32MS from the Utility CPU 2ms Sample Clock C02MS from the Utility CPU The system clock is derived from an IC on the Utility CPU If power is lost this chip is powered by a special capacitor In a worst case scenario the capacitor can supply power for at least 100 hours In a typical s
325. patients in most critical and acute patient care areas of the hospital as well as in transport situations 24 As bedside monitor the V24 V26 is most commonly seen mounted to a wall channel with a six or eight slot Plug in Satellite Rack mounted below it It can also be mounted on a table mount and a roll stand As a transport monitor V24CT a six slot rack can be docked directly to the mainframe The V24 V26 supports a network connection to the Philips monitoring network SDN The V24 24 V26C s source of power is a local power connection The V24CT is powered by either internal rechargeable batteries or from an AC power connection Product Releases The 24 26 is in its fifth release and currently supports a subset of the functionality of the CMS at 0 24 and V26 Patient The V24 V26 bedside monitor standard package includes Monitors Standard Mainframe with 9 5 passive matrix monochrome flat panel display V24 Package mainframe with 10 4 color flat panel display V24C V24CT capable of displaying four or in the case of the V26C V26CT six waveforms simultaneously e Eight slot Plug in Satellite Rack with front end link cable e Parameter Modules predefined combinations of ECG Resp NBP SPO InvPRESS CO VueLink and Recorder Patient Monitoring supplies Features The V24 V26 has the following general features Mainframe with monochrome display V24 mainframe with color display V24C V24CT an
326. pectrum of clinical applications Some modules can be transferred from one system to another without losing their parameter settings The VueLink module allows vital sign measurements to be imported from other monitors and auxiliary devices for correlation with other patient data The system offers networking and database management capabilities as well as several useful analyses calculations and presentation capabilities such as a drug calculator and an oxycardiorespirogram It comes with a set of default configurations for four different patient care categories and it has online help Its open architecture enables it to use a number of standard interfaces to connect to external devices and also allows for easy upgrades Among the functions that the CMS can perform are the following Retrieve and display physiologic signals such as ECG waveforms Determine numeric values such as heart rate e Check values against user programmable limits and generate alarms e Detect life threatening events such as apnea e Collect store and retrieve long term data to provide trends of patient data Communicate patient information to the Serial Distribution Network SDN and to printers CMS Patient Monitoring System 3 7 CMS Patient Monitoring System Modules CMS Patient Monitoring System Modules The CMS is made up of individual modules that can either be assembled together in the same location or positioned apart from eac
327. plane Configuration FRONT BLANK 15 MHz APP B 0 GB GEB D 15 MHz APP 6 CA REAR DSPC 1 or CDSPC 1 or DSPC_FLAT 1 DSPC_LANG 1 KANJI TAI or PRC SD DSPC 2 or ED CDSPC 2 or DSPC_FLAT 2 P 25232 FH EID or lt or DSPC_FLAT 3 or CDSPC 3 only model 88 RS232 IF 2 SD cru ELD spN ir DC DC CONVERTER baconel tif Tf upgraded to F may sti 1 CDSPC_CTRL 1 Figure 3 10 Software Release F Backplane Configuration Software Release CMS Patient Monitoring System Hardware Configurations M1046A Computer Module FRONT REAR DSPC 1 or Pure e CDSPC 1 or DSPC FLAT 1 E DSPC LANG 1 15 MHz APP KANJI TAL or PRC nons ED CDSPC 2 or DSPC_FLAT 2 25232 IF 1 E EID 40 MHz CPC 17 ANALOG IF or Dspc 3 or DSPC_FLAT 3 14 3 only model 88 RS232 IF 42 urn cru RACK ELD spN ir gD OJD ir 15 MHz APP 6 3 GZD GD DC DC converter baconel tif If upgraded to may still have CDSPC CTRL 1 M1046B Computer Module FRONT REAR 9 DSPC FLAT NON ASIA 1 or DSPC FLAT ASIA 1 BLANK ED 15 MHz APP_CPU DSPC 2 or ED CDSPC 2 or DSPC_FLAT 2
328. pression ratio SR is computed as the percentage of suppressed EEG in the non artifact data 2 94 Advanced Plug In Modules BIS Module Features User Controls Connectors Safety BIS Module Figure 2 27 shows the user controls and connector for the BIS Module The parts are described following the figure gt BIS Mt034A Bis BIS 1 jJ 2 3 cclo25 tif Figure 2 27 BIS Module controls and connectors 1 Setup Key This is a single press key used to enter the setup screen 2 Setup Indicator This is a green LED which will be lit when in the BIS setup Screen 3 The BIS M1034A uses 12 pin connector for use with the BIS Module Cable and the subsequent components To ensure the safety of the patient the patient applied parts are isolated from ground by optical isolators and a transformer In addition all components are encapsulated in plastic This module complies with UL544 CSA No 125 1984 for use with model M1165 66 75 76 and UL2601 1 CAN CSA C22 2 No 601 1 M90 for use with model M1167 77 IEC 601 1 IEC 601 2 26 Patient leakage current is less than at 120V 60Hz It has an isolated patient connection to Class I protection Type Body Floating BF There is also protection against damage from defibrillation and electro surgery Advanced Plug In Modules 2 95 BIS Module 2 96 Adva
329. quence induction with propofol and alfentanil BIS falls rapidly from an awake value of 98 to below 50 Conversely a rapid rise in the BIS after propofol is discontinued occurs at the end of the case just prior to the time when the patient opens her eyes and becomes responsive In both instances BIS clearly tracks the expected changes in propofol effect which occur at these times Intraoperatively however additional types of responses are evident Aslow upward trend 210 points over several minutes prior to the two movement events Asudden rise 5 30 seconds such as the increase associated with the second movement response Advanced Plug In Modules 2 89 BIS Measurement e Cyclical oscillations which occur during apparent steady state anesthetic delivery conditions A slow upward trend in BIS usually is associated with a progressive lightening of the hypnotic state This can be due to one or more of the following factors pharmacokinetic redistribution of a drug from its effect site in the brain as might occur following a rapid bolus drug administration a reduction in hypnotic effect due to a disruption in drug delivery increased tolerance to the drug effect or a slow increase in the level of stimulation Conversely a slow downward trend in BIS can indicate a deepening of the hypnotic state of the patient Possible causes include reduction in surgical stimulation hypnotic or analgesic drug accumulation inadvertent or un
330. r coupling among the frequency components of the EEG signal Specifically Bispectral analysis quantifies the level of synchronization in the EEG along with the traditional amplitude and frequency parameters Aspect Medical Systems has reduced the complex data arrays generated from Bispectral analysis using a sophisticated algorithm to generate a composite numerical Bispectral Index which tracks changes in the cerebral state Therefore Bispectral analysis determines the components of the EEG that are due to harmonic and phase relationships and thus can provide more information regarding interactions between cortical and subcortical neural generators These bicoherence patterns in the EEG have been found to change with increasing amounts of hypnotical drugs The Bispectral Index is computed real time using a combination of three analysis steps first step is an EEG preprocessor which breaks the EEG signal down second by second and marks those segments containing artifact that might arise from movement EMG or electrocautery equipment Segments of suppressed EEG are also identified These segments are excluded from further processing e second step is the calculation of the hypnosis sedation index by combining selected EEG features using the algorithm which was developed as previously described Inthe third step the hypnosis sedation index is modified to better reflect the level of suppression in the EEG The sup
331. r Module is covered in the two Functional Card sections of this document Information on the components and operation of the Plug in Parameter Modules is covered in Chapters 1 and 2 Objectives After successfully completing this section you should be able to identify the e Purpose and functions of each major functional module of the CMS e Physical components including controls and connectors Functional components and operations of the Display Module Concepts The following concepts are covered in this section of the chapter Computer Module This receives and processes data from the Plug In Parameter Modules and sends it to the Display Module to be displayed as waveforms and numeric values The front of the Computer Module can have either an integral module rack or a blank panel The Computer Module contains connectors on the front for a rack and other external devices such as defibrillators The rear of the module contains connectors for power ground network video and several interfaces Display Module This provides the video display and in the case of the CRT display power for the CMS Several models are available displays may be the main displays independent displays or slave displays Up to three slave displays may be connected Main displays have a Control Panel on the front but independent and slave displays do not The number and type of controls and connectors depend upon whether a display is a main display or not
332. r intensities equalized so that they appear similar in intensity to the human eye This is done by using a resistor network in combination with some transistors red and green are added to lighten the CMS Patient Monitoring System 3 119 Color Display Video output of the blue output on the display The red output has a slightly higher full intensity voltage to get brighter alarms Character The Japanese Taiwanese and Chinese character sets are too large to be stored on the Sets standard EPROM cards These characters are therefore stored on a dedicated card the DSPC Language card which is placed in the same cluster as the display controller cards 3 120 CMS Patient Monitoring System Color Display Video Functional Block CDSPC VIDEO Diagram andino urey sieg A AA YOUR 1950 04 ardlla LLL CLL AT 2 2 S NA AIH e 4 5 48 043105 7 5533009 5 6 BIBA TOXLNOD 2 ude 97 uaig28104g er6xe2d1 2 1 4 9 2160 2 2 sia 110495 ___ 4 1 BLEA 31n3412 aue ore Buiddey
333. r receive automatic alarms for any patient being monitored by a CMS or a V24 V26 connected to the Philips monitoring network SDN Any type of patient information can be transmitted including waveforms such as pressure and respiration and parametric information such as heart rate pulse pressure values and respiration rate The Philips monitoring network SDN transmits this information at a rate of 3 6 Mbits 5 2 Philips Monitoring Network SDN Philips Monitoring Network SDN Components Philips Monitoring Network SDN Components The Philips monitoring network SDN components include Philips care hub SCC Philips monitoring network SDN interface circuitry branch cables local distribution cables LDC e wall boxes and face plates Figure 5 1 illustrates some of the Philips monitoring network SDN components SCC WALL BOX BRANCH CABLES Figure 5 1 Philips monitoring network SDN System Components Philips Monitoring Network SDN 5 3 How the Philips Monitoring Network SDN Works Philips Care Hub SCC Philips Monitoring Network SDN Interface Circuitry Wall Boxes and Face Plates Branch Cables Local Distribution Cables LDC The Philips care hub SCC is the central component of the serial distribution network The Philips care hub SCC provides the physical system communications link to the instruments and systems connected to the Philips m
334. r supply is fed directly from J2 to J3 The DSPC XGA card consists of the following functional areas 68000 Microprocessor MPB Interface SRAM PROM buffer VRAM and Video Control Logic The DSPC XGA card is based on the 68000 Microprocessor The MPB Interface is used to pass data back and forth between the card and the MPB For more information refer to the beginning of the Master Functional Cards section The DSPC card controls the mechanism of actually displaying information on the screen display data including local language characters and color information are produced by the Application CPUs or CPCs More than one CPU may produce data for the display The DSPC XGA controller card receives display data waves lines numerics display attribute data and control messages from the CPU over the MPB The Microprocessor places the data into the dual ported Video RAM Display attributes such as half brightness are also placed in the Video RAM The pixel data is clocked out of the Video RAM by the on chip shift registers This data then passes through the SLIP Chip which contains all the video and addressing logic before passing it to the video buffers The data is converted to analogue XGA video signals 3 90 CMS Patient Monitoring System DSPC XGA Functional Block Diagram Summary of DSPC XGA Card Features DSPC XGA Display Controller Card
335. rameter units The Plug In Parameter Modules provide the measurements and the patient interface The Computer Module contains a backplane with three distinct buses The Message Passing Bus distributes data and control signals among the processing cards on the backplane The Local Bus groups the function cards into clusters and connects processor cards with their supporting cards The Utility Bus distributes the power and clock signals through the system The backplane has 24 slots for a variety of function cards of two types processor cards called master cards and supporting cards called local cards Power for the CMS is provided by the Display and Computer Modules or in some combinations with the Flatscreen display the Remote Power Supply The power supply in the Display Module or the Remote Power Supply connects to the facility s main power source and generates 60V DC for the system s use Within the Computer Module the DC to DC converter generates the voltages needed by the function cards those voltages are distributed to the cards by the Utility Bus 3 4 CMS Patient Monitoring System Introduction On power up the CPU first initiates diagnostics and then executes the application software e Several models and software releases for CMS in use as of this writing The configuration of the model determines which CPU and function cards it uses as well as the card placement on the backplane Two types of CPU are in use Applicati
336. ranch of the SDN In the event of an SDN failure or the branch becoming disconnected from the SDN the instruments on the same branch can still communicate with each other using the autopoll circuitry in the SIC Chip along with the priority wire The last box detection circuitry checks for a downstream connection If there is no downstream connection the line is terminated using a relay The SDN is a serial digital network for communications between bedside monitors and central stations such as arrhythmia computers The data are passed over a two wire bus Each data type has its own associated signature similar to the way that the MPB messages have a header that identifies the information This allows the data to be available to any device that requires it In addition devices do not need to know which other devices require the data Any devices that require the information from the SDN including the CMS can choose the data it requires using the data signature All communications within the SDN are controlled by the System Communications Controller SCC This card is located at the center of the SDN star configuration The SCC uses a 32 millisecond poll cycle to send instructions to the monitors on the SDN branches it controls The poll cycle is divided into 4 milliseconds of dead time and 28 milliseconds for transferring data 3 122 CMS Patient Monitoring System Components Theory of Operation SDN Synchronization Data Transfer
337. ration measurement is continuous and invasive using a fiber optic catheter The catheter is usually combined with the C O pulmonary artery catheter Swan Ganz and routed via the right side of the heart into the pulmonary artery The 5 reading is depicted as a numeric value A trend and a displayed light intensity are displayed in the Task Window Factors affecting accurate measurements of 5 are Proper connection between the measurement module and the patient s blood catheter Positioning of the catheter The M1021A SvO Plug in Module measures mixed venous oxygen saturation 2 50 Advanced Plug In Modules SvO Blood Gas Measurement Exercises SvO2 Blood Gas Measurement 1 5 blood measurement is an indication of a amount of CO in the blood b amount of mixed venous oxygen saturation c amount of Fractional Oxygen in the blood 2 SvO blood measurement uses a technique based a the polographic method b progressive change in blood color c amount of partial pressure exerted 3 SvO blood measurement is displayed as a a numeric value b waveform c fraction 4 What factors can influence the accurate measurement of SVO7 a temperature of patient s blood b amount of water vapor in patient s blood C proper connection between the measurement module and the patient Answers Te peur c Advanced Plug In Modules 2 51 SvO2 Module M1021A SvO Module M1021A Description
338. ravels from the protection network to the Analog to Digital Converter The signals are received from the Input Protection Network The Analog to Digital Converter amplifies filters and digitizes the input signal and sends it to the Microcontroller Unit The Microcontroller sets all information needed by the converter and receives the converter s data An EEPROM stores the information needed for correct converter setup The timing of the Microcontroller is regulated by the clock oscillator The signal is then passed through the patient isolation to the rack interface and then to the receiving rack The features User Controls Connectors Safety and Accessories for the PRESS M1006B Module are the same as those for the PRESS M1006A Module except the M1006B has no 40 u V V mmHg sensitivity 2 18 Advanced Plug In Modules Invasive Blood Pressure Module M1006B PRESS M1006B 1 What does the PRESS M1006B Module Measure Module Exercises a Invasive Blood Pressure b Cardiac Output c Output 2 What component of the PRESS M1006B Module sets all control information a Input Protection Network b Analog to Digital Converter c Microcontroller Unit 3 The PRESS 1006 Module uses the following a 40 uV VmmHg transducers b 5 uV VmmHg transducers c 40 u V VmmHg and 5uV VmmHg transducers Answers l a 2 c 3 b Advanced Plug In Modules 2 19 CO2 Respiratory Gas Measurement CO Respiratory Gas Module Concepts
339. re signal before the signals are digitized for the microcontroller The cardiac output measurement is obtained by first compensating for the blood temperature by the digital to analog converter The difference signal is then amplified by a variable amplifier with a high gain which increases the sensitivity for measuring the thermodilution curve The continuous calibration linearization control and conversion to degrees C is performed by the software Module Module Figure 1 16 shows user controls and connector for the Module The parts Features described following the figure SRI wc 5 C O 1012 T 2 5 1 3 4 Figure 1 16 Cardiac Output Module Controls and Connectors User Controls 1 C O Setup Key A single press key used to enter the cardiac output setup screen 2 C O Setup Indicator A green LED lit when the cardiac output setup screen is activated 3 Start Key A single press key used to enter the measurement cycle Connectors 4 This is a standard 12 pin connector for use with a catheter thermistor and start stop switch Safety To ensure the safety of the patient the patient applied part is isolated from ground by opto couplers and a transformer The module is also encapsulated in plastic Basic Plug In Modules 1 47 Mo
340. recognized increases in drug delivery or progressive hypothermia especially as might occur during long cardiac procedures When large abrupt changes in BIS occur it is important to rule out that they are not triggered by artifact Assuming that there is no obvious artifact such changes are usually caused by significant changes in stimulation resulting in patient arousal Users should be cautious about using a particular BIS value in isolation as a predictor of such patient responsiveness because arousal can potentially occur from any hypnotic level Anesthetic techniques that rely heavily on hypnotics and use little or no opioid allow highly variable levels of perceived stimulation which can arouse the patient even if the BIS is low This causes a rapid hypnotic lightening reflected by a significant increase in the 1 Such increases in BIS can occur prior to the appearance of other clinical signs such as hypertension or movement but in some cases the 30 second time averaging used in the display of BIS data may result in some lag in tracking this response In contrast a sudden reduction in stimulation for example tourniquet release or completion of a stimulating surgical dissection can lead to a significant drop in BIS especially if high doses of hypnotics and analgesics were used to maintain adequate hypnosis and hemodynamic autonomic status while the stimulus was large Cyclic oscillation in BIS under steady state condition
341. rface standard PC ov lif Remote Displays color or monochrome 8 Channel Analog Output Interface E Digital Recorder Fem wma Interface 4 Channel LaserJet Recorder Fa Vuelink M1032A link to external devices Y M1167A 77A Philips CMS Patient Monitoring System Flatscreen or XGA System Overview Independent Display Main Display 6 channels in monochrome 4 or 8 channels in color 8 Channel DIE EX Tm coles exe ca poo i Stat Central Data Station uu invi EM MB Gateway Analog Recorder RS 232 Interface Go Ks Co Caf ej ER s Integral Rack 8 slots Digital Recorder Interface laserJet 4 Channel Recorder Satellite Racks 10 8 or 6 slots il Vuelink M1032A link to external devices
342. ring network SDN components e Describe how the Philips monitoring network SDN works Describe the Inter SDN Gateway Philips Monitoring Network SDN 5 1 Defining the Philips Monitoring Network SDN Topics This chapter contains the following topics Chapter Topics Defining the Philips Monitoring Network SDN 5 2 Philips Monitoring Network SDN Components 5 3 How the Philips Monitoring Network SDN Works 5 4 Defining the Inter SDN Gateway 5 8 Defining the Philips Monitoring Network SDN The Philips monitoring network SDN is a local area communications network for sharing patient physiological parameters and other data between CMS and V24 V26 bedside monitors central stations recorders and computer systems The Philips monitoring network SDN is a digital communications network that transfers patient data between connected instruments and systems The Philips monitoring network SDN uses a proprietary network protocol that digitizes patient information collected at each monitor The Philips monitoring network SDN collects patient information from each individual monitor and rebroadcasts that information out to the other monitors and systems connected to the Philips monitoring network SDN The Philips monitoring network SDN performs the collection and rebroadcast of patient information without any user intervention From the rebroadcast patient information nursing staff can display information o
343. rm Recording The V24 V26 will present all arrhythmia status messages delayed annotated waveforms and all arrhythmia data management functions when networked to a Philips arrhythmia monitoring system listed below e Philips 78504 508 with Philips 78720 Philips 78560A with arrhythmia option Philips M2340A Philips M2350A Philips M2360A e Philips M3150A M3153A The optional M1026A Anesthetic Gas Module AGM provides a non dispersive infrared measurement of respiratory and anesthesia gases It is intended for measurement of airway gases of ventilated patients within the anesthesia workplace during induction maintenance of and emergence from anesthesia When an alarm limit is exceeded it is presented in 3 ways e Alarm tone graded according to severity e Alarm Message color coded according to severity e Alarming parameter value flashes alarms are transmitted on the Philips patient care system Alarms are graded and prioritized according to severity Identifies asystole ventricular fibrillation apnea bradycardia in neonates and pedi atrics and pressure disconnect conditions Alert clinicians when alarm limits are exceeded Are triggered by signal quality problems equipment malfunction a measurement that is not set up or an ongoing calibration The Silence Reset key on the display control panel allows you to silence alarm tones while retaining visual alarm messages depending on the monitor s configur
344. rms the following functions Serial communication via optocouplers with the rack interface card in the Computer Module Data Acquisition for the differential pressure sensors Control of the pump driver and valve The flow control algorithm Data are passed from the microprocessor to other areas of the module over an internal data bus The flow channel which consists of a differential pressure sensor and a variable gain amplifier The flow channel controls the offset compensation for the pressure sensors The following two types of sensors may be used Motorola MPX 10 Sensym SX 01 The offset compensation is set up so that both types of sensor can be used without changing the software The pressure channel no offset adjustment is necessary for the pressure channel The following two types of sensor can be used Motorola MPX 100 Sensym SX 15 The pump driver and valve which are driven by a pulse width modulation signal Both drivers contain a comparator and level switch and a power MOSFET The pump driver is driven by the positive 7 volt power supply the valve is driven by the negative 7 volt power supply Both the pump driver and the valve current can be measured across a resistance R154 R164 The pump driver contains a safety switch off which is tested cyclically Advanced Plug In Modules 1015 Sidestream Module Features Connectors Safety Sidestream CO2 Module M1015A Figure 2
345. rocessing through the module proceeds as follows Power Supply Board Power and data signals enter the module from the monitor through the power supply board The DC to DC converter converts the 60V DC from the front end rack into 5V DC for the digital circuits and 15V DC for the motor drivers and printhead Data signals from and to the rack are passed through infrared optical isolators for noise suppression Digital Board Signals enter the board through the I O Microcontroller s built in serial data port The serial data link between the monitor and Recorder Module operates asynchronously on two separate lines providing full duplex communication at a 500 KB baud rate The I O Microcontroller interprets messages from the monitor and sends back identification and status messages through the power supply board The I O Microcontroller is responsible for receiving and responding to commands and data from the monitor sensing and reporting on the state of the control keys and switches converting waveforms and annotation into a format suitable for driving the printhead The user controls door open switch and paper out sensor are mounted directly on the digital board near the front of the module The paper out sensor is an optical device that aims an infrared beam at the paper as it passes around the paper drive roller When paper is present the infrared light is strongly reflected back to a phototransistor connected to the I O Microcontro
346. ry c back up power supply and clock d power supply and front end link 4 The module contains kB of RAM and kB of ROM The module can transfer patient trends for up to hours Answers 1 V24 and V26 Patient Monitors 2 3 a 4 256 kB RAM 128 kB ROM 24 hours 1 90 Basic Plug In Modules Data Transfer Module Basic Plug In Modules 1 91 Data Transfer Module 1 92 Basic Plug In Modules Data Transfer Module Basic Plug In Modules 1 93 Data Transfer Module 1 94 Basic Plug In Modules Chapter 2 Advanced Plug In Modules Introduction Goals Objectives This chapter covers the advanced set of plug in parameter modules used by Philips patient monitoring system and the measurement principles on which they are based The categorization of advanced modules is based on the complexity of their data processing functions rather than on the ease or difficulty of taking the measurements Engineers who maintain and repair the equipment may want to familiarize themselves with the basic modules before moving on to the more advanced ones After successfully completing this chapter you should be able to Describe the physiologic measurements that can be acquired and processed by Philips advanced plug in parameter modules e Explain how the Philips plug in modules acquire and process measurements In order to meet the chapter s goal you should be able to Define each of the physiologic measurements
347. s PLE Lbs 1 TOPICS e A e RR A 2 Defining the Philips Monitoring Network SDN 2 Philips Monitoring Network SDN 5 3 Philips Care Hub S6 4 ee AR ERR Lote butt es 4 Philips Monitoring Network SDN Interface Circuitry 4 Wall Boxes and Face Plates 4 Branch Cables eget egere rece ee mea ete ete dee eR e le 4 Local Distribution Cables LDC 4 How the Philips Monitoring Network SDN 5 4 Contents 17 Defining the Inter SDN Gateway Defining the Inter SDN Gateway Contents 18 Exercises 6 Ae ALAIN and Ru 11 Introduction The Purpose of This Book Philips Medical Systems CMS Patient Monitoring System amp V24 and V26 Patient Monitors Concepts Guide is a companion volume to the Service Guides of both the CMS and V24 V26 patient monitors This volume contains conceptual information and technical details on both patient monitoring families The purpose of this book is to provide a conceptual foundation for the monitoring systems in order to support effective troubleshooting and repair The book is not intended to be a comprehensive in depth explanation of the product architecture or technical implementation Rather
348. s See eee Meas BARR hea nee es 3 Learning and Reference 2 3 Choose Your 2 2 2 1 3 Basic Plug In Modules Introductio ei eda DECR etel AA 1 ure 1 Objectives m ea 1 TODICS 42 dn LA 2 Electrocardiogram Respirogram ECG RESP Module Concepts 8 ECG Measurement ed iaces adi be RA ed e eoe iR due 3 Descriptions T NUES EAS p patat deals ion x sere UR 3 Concepts EP 3 Measurement 3 Measurement 3 codo qe cea CAR ope RE SAU UE NAMES 9 Criteria for Proper Measurement 11 Plug n Modules NUR MER 11 ECG Measurements 5 12 ECG eek eR EIRG E dE 13 Description ex cep Re mae eee tere qoe A eet A ee edite 13 Measuret ents sues eee et esed oum bie Rt E sec e 13 Components ros
349. s 2 x 3 15 A H 4 Local Power Connector This is a 3 pin connector used to input the local line voltage Remote Power Supply M1047A The CMS can use the flatscreen 1095 as the main display instead of a CRT display In this case the power supply usually located in the main CRT display has to be replaced by a Remote Power Supply Front Panel Controls controls on the front panel of the Remote Power Supply are shown below Remote Power ct Supply Figure 3 16 Remote Power Supply Front Panel Table 3 14 Remote Power Supply Controls and Connectors 1 ON OFF Switch Used to turn the Remote Power Supply ON OFF 2 Power ON indicator Green LED which is lit when the power supply is switched ON CMS Patient Monitoring System 3 41 Remote Power Supply M1047A Remote Power The controls on the rear panel of the Remote Power Supply are shown below Supply Rear Controls and Connectors Qo 2 7 r M d e 4 Figure 3 17 Remote Power Supply Rear Panel Table 3 15 Remote Power Supply Rear Panel Controls and Connectors Controls and Connectors Function 1 Remote ON OFF Input This cable connects the Power Supply to the video interface board located in the CMS Computer Module It is a female modular jack connector with 6 pins used to input the power supply output ON OFF signal from the Flatscreen Display 2 60V DC 120 ma
350. s e Identify the V24 V26 s hardware configurations Describe the major components of the Theory of Operation Concepts Concepts important to the V24 V26 description e ASW Application SoftWare modules Operating System The software that performs data management and communications functions Overview The software is divided into 4 major conceptual layers 4 first layer consists of the operating system that performs management functions and accomplishes intermodule communications The operating system passes messages between the various manager modules The operating system also performs system initialization background error checking and run time checking 5 second layer consists of the monitoring manager modules This layer includes the alarm record trend database and heart rate selector 6 The third layer consists of the interface manager modules and interface controllers This layer consists of the display operator date time recorder and Philips monitoring network SDN managers 7 The last layer consists of the monitoring algorithms and related CMS plug in modules acquiring the physiological signals This layer includes the standard CMS plug in modules and monitoring algorithms 4 20 V24 and V26 Patient Monitors Modules Partitioning Application CPU Architecture Utility CPU Architecture Front End Microcontroller Architecture V24 and V26 Patient Monitors Software Configurations
351. s which return to normal Though it takes significant training to provide a clinical interpretation of the EEG some basic techniques used to describe the EEG can be mastered and used to communicate changes in the EEG The four areas used to describe the EEG are frequency amplitude symmetry and patterns Specific brain wave patterns are recognized by analyzing the EEG signal in relationship to its frequency and amplitude Most EEG signals are in the 1 to 30 Hz range The four most common frequency bands for classifying EEG signals are Beta Alpha Theta and Delta Alpha waves are what the spontaneous EEG looks like in the normal awake relaxed with eyes closed adult It has the appearance of rather large smooth and rhythmic waves These waves suggest a high degree of electrical coordination even in the idle brain Alpha frequency is defined as 8 to 12 5 Hz ALPHA a Advanced Plug In Modules 2 75 EEG Measurement Beta During periods of conscious effort the EEG rapidly desynchronizes and is replaced by the low amplitude high frequency jumbles of Beta Beta frequency is defined as 13 to 30 Hz BETA B MA ety n uf Theta Theta waves are usually not seen in the awake alert adult except in the presence of pathology They can also be seen in certain stages of anesthesia Theta frequency is defined as 4 to 8 Hz THETA NALA Delta Likewise Delta waves are usually not seen in the awake alert a
352. s and Connector descriptions User Controls 1 Connectors 5 tepO tcpCO T MIO0I8A Figure 2 15 tcpO2 tcepCO2 Module Controls and Connectors O CO Setup Key This is a single press key used to enter the tepO tcpCO setup screen Setup Indicator This is a green LED which will be lit when in the tcpO tcpCO Setup Screen CAL key This is used to start the calibration process directly when in the Task Window CAL Indicator This LED will be lit when the CAL key is pressed and during calibration Calibration chamber with gas inlet 20 pin connector for use with the tcpO tcpCO transducer Safety To ensure the safety of the patient the patient applied parts are isolated from ground by optical isolators and a transformer In addition the entire module is encapsulated in plastic This module complies with UL544 IED 601 1 CSA C22 2 No 125 Patient leakage current is less than at 120V 60Hz Isolated patient connection to Class 7 protection Type Cardiac Floating CF There is also protection against damage from defibrillation and electro surgery 2 48 Advanced Plug In Modules tcpO tcpCO M1018A Module Exercises tepO2 tcpCO2 Module M1018A 1 The tcpO tcpCO M1018A Module measures a Partial pressures of oxygen and carbon dioxide b Mixed Venous Oxygen c Oxygen concentration 2 The tcpOJ tcepCO M1018A Module produ
353. s eid epe Ke CST ORTA RE EDI DOGS 23 Components cs vence ae EM p AERA A RU eR UA 23 Block Diagram eec 28 REG CUN NI REO 25 2 1016 Features 5 hd ge EE X GRABAR 25 CO2 M1016A Module 27 Sidestream CO2 Module 015 28 Description eame ee Pe baie bi deci d I dade Rp 28 e hne en ee ene Sepe Ere ea e 28 Components e oo i uS ERU WM RSEN A MESS 28 Block beoe Eh etre RR 28 Theory of Operation esse ae eos RE ua 30 M1015A Sidestream CO2 Module Features 31 M1015A Sidestream Module 32 FIO2 Module Concepts CMS only 33 FIO2 Respiratory 33 D ScEIpDpUOLD sede orte ree os eda doma e ce AENEAM APO 33 Contents 6 Conlncepls a UA 98 Measurement 33 Measurement Acquisition 33 Measurement
354. s may provide an indication of the shifting balance between sensory suppression and stimulation Clinical experience suggests that smaller volatile changes are seen when sufficient levels of narcotics are used as part of the anesthetic regimen to reduce the effects of stimulation In volunteer studies higher variability was observed when sedatives were used alone compared to when alfentanil was used concurrently Several other physiological factors may also alter the hypnotic state of the patient As a result changes in BIS may occur even when all obvious determinants of hypnosis remain unchanged Some of these additional factors include 1 Ischemia or severe hypoxia resulting in a decrease in the BIS if severe enough to cause global EEG slowing or outright suppression It is important to bear in mind however that the frontal montage used for monitoring usually will not detect episodes of focal ischemia caused by embolic events 2 Hypothermia 33 will generally result in a corresponding decrease in BIS levels as brain processes slow More profound hypothermia used during cardiac bypass procedures will cause suppression of the EEG and consequently a very low BIS 2 90 Advanced Plug In Modules Using BIS to Optimize Anesthetic Delivery Minimum Effective Dose Paradigm BIS Measurement 3 Artifact Therefore in order to properly interpret unexpected 5 changes it is important to consider a
355. s regulated to provide power for the digital circuitry the 12V unregulated drives the LEDs Circuit ground throughout the Data Transfer Module is common for both power and digital circuitry Microcontroller The 37702 microcontroller manages the operation of the Data Transfer Module It has a 16MB address range multiple configured I O ports and two UART ports that can be used in either asynchronous or synchronous mode The microprocessor is responsible for addressing the 256KB RAM and 128KB ROM in basic read and write cycles communicating in asynchronous serial mode to the monitor through the front end link driving the LEDs and receiving key pushes from the front panel accessing the serial RTC chip Memory The Data Transfer Module contains 256KB of RAM and 128KB of ROM The RAM is implemented using two banks of 128 x 8 low standby power SRAM which are specifically designed for low power consumption in battery back up mode When power is disconnected the RAM goes into battery back up mode and its power supply is switched over to the back up source Program storage for the Data Transfer Module consists of 128 OTP ROM Back Up Power Supply The digital circuitry uses a 0 1F super capacitor to provide back up power to the RAM and RTC Back up power is supplied whenever main power is unavailable such as when power fails the monitor is turned off or the module is removed from the monitor for transfer The back up power
356. s that the electrical signal must pass in order to reach the Monitor interface 1 Theamplitude modulated signal from the patient is electrically received through the input connector from the 5uV V mmHg transducer connected to the patient s catheter Only 5n V V mmHg transducers may be used with this module 2 signal then gets passed through the Input Protection Network where extraneous signals are filtered out This network provides protection against defibrillation spikes The signal then goes from the protection network to the Input Amplifier 3 The signals are received from the Input Protection Network The sensitivity of the transducer is corrected by the 5uV Transducer Sensitivity circuitry and transmitted to the microcontroller The gain of the Input Amplifier for a 5uV sensitivity is set by the microcontroller The amplifier carrier signal is synchronously demodulated before being input to the lowpass filter The filter is then optimized by a variable amplifier before being digitized by the Analog to Digital converter To compensate for input pressure offset caused by static or atmospheric pressure at the pressure transducer an offset compensation signal is generated by the Digital to Analog converter The offset values are stored in an EEPROM The Digital to Analog converter also generates the calibration staircases CAL2 for recorder calibration and the test signal Both the calibration signal and the test signal are generated
357. s the block diagram of the Recorder Module M1116A Basic Plug In Modules 1 73 Recorder Module M1116A WSINVHOUN YOLOW JATA IHdVd OCA 01 OCA 91 ayog ATddNS YAMOd E GVHHINDPId 01 91 HLHHANOO m MOVH 530181910 Od OL JOXINOO 21403 YOLOW C SUOLV IOSI 0140 TOPOLONd NIT STYN IS Sty TvLIDId A AMONNHIA IVAWHOJ lx 5 YOLOW YATIOULNODOAIIN SdNV T 29 S IOWLNOO THNVd LNOW 1 74 Basic Plug In Modules Theory of Operation Recorder Module M1116A Figure 1 25 M1116A Recorder Module Block Diagram The functional components for the M1116A Recorder Module are contained on two printed circuit boards and in a recorder mechanism unit The circuit boards are referred to as the power supply board and the digital board The power supply board runs parallel to the back of the module It contains a DC to DC converter optical isolators and motor control circuits for the paper drive motor The digital board runs along the length of the module from the front panel to the power supply board It contains two microcontrollers a shared data RAM and the front panel controls and lamps Signal p
358. scillations are roughly equivalent to systolic pressure the larger oscillations represent mean pressure and the diastolic pressure is then derived from the mean pressure Measurement Acquisition Output Criteria for Proper Measurement Limitations Plug In Modules NBP Measurement To take the measurement the cuff is placed around the patient s limb and inflated until the artery is occluded at a point just above systolic pressure Blood movement ceases when cuff pressure is greater than arterial pressure As cuff deflation commences blood begins to flow through the artery at the systolic pressure and the resulting pulsations are detected as oscillations The cuff continues to deflate and the amplitude of arterial oscillations increases until it reaches a maximum value which represents mean arterial pressure As cuff deflation continues arterial pressure drops due to decreased resistance from the cuff pressure Diastolic pressure is measured when the oscillations begin diminishing rapidly Oscillometric blood pressure measurements are displayed as numerics Factors affecting accurate measurement of non invasive blood pressure are e Cuff size A cuff that is too narrow may produce false BP readings that are too high Conversely a cuff that is too wide may produce false low readings Cuff placement The cuff should be placed on the arm at the level of the heart for a true zero reading False high readings may be produced by
359. send information at the same time Also any monitor can listen to the information being sent by the other systems A complete detailed description of the Philips monitoring network SDN communications cycle can be found in the SDN SCC Service Manual supplied with your Philips monitoring network SDN Network 5 6 Philips Monitoring Network SDN How the Philips Monitoring Network SDN Works SYSTEM CYCLE SYSTEM CYCLE SYSTEM CYCLE SYSTEM SYSTEM CYCLE 446 1 024 SECONDS 32 POLL CYCLES IN EACH SYSTEM CYCLE MASTER POLL CYCLE POLL CYCLE 6 32 5 TALK TIME 4 MSEC DEAD TIME TALK TIME FIRST FEW CYCLES DATA FROM ONE BRANCH TIME VARIES TALK TAP sti FLUSH DELIMITER STATUS ONE MESSAGE SYNCH TAP 3 TIME VARIES pet FLUSH DELIMITER STATUS DELIMITER DELIMITER Figure 5 3 SCC Polling Philips Monitoring Network SDN 5 7 Defining the Inter SDN Gateway Defining the Inter SDN Gateway The Inter SDN Gateway provides data exchange between two Philips care hubs SCC using the virtual terminal protocol VTP a proprietary protocol of the Philips monitoring network SDN With the Inter SDN Gateway nursing
360. signal processing functions within the module Table 1 11 Major SpO PLETH Module Components Component Function Input Protection Network Protects the module against defibrillator spikes Current to Voltage Converter Converts the current from the photodiode and removes ESU interference Ambient Light Rejection Circuitry Subtracts ambient light from the signal Over range Detector Detects overload voltages caused by strong ambient light and high LED currents Dark Light Subtracter Subtracts the dark voltage from the red and infrared voltage Analog to Digital Converter Converts the signal for processing Figure 1 20 shows the block diagram of the SpO PLETH Module M1020A SpO2 PLETH Module H31H3A NO9 vid H31H3A aounos WALSAS M 7 LNALLWd IWNOIS 1531 HOSN3S e MORE Matis Svd we Sana SSvd M Nyo JHDIT 39vL00 7 IN3IBINV 1 LINDUID 40193134Q TOHLNOD 39NVH HU3AO
361. sive Blood Pressure Measurement Concepts 3 Criteria for Proper Measurement 4 Description 3 Exercises 5 Measurement Acquisition 3 Measurement Output 4 Measurement Principle 3 Plug In Modules 4 Invasive Blood Pressure Module M1006A Block Diagram 6 Components 6 Description 6 Exercises 10 Features 8 Connectors 9 85 95 Safety 9 85 95 User Controls 9 Measurements 6 Theory of Operation 8 Invasive Blood Pressure Module M1006A Option C01 Block Diagram 11 Components 11 Description 11 Exercises 15 Features 14 Connectors 14 User Controls 14 Measurements 11 Theory of Operation 13 Invasive Blood Pressure Module M1006B Block Diagram 16 Components 16 Description 16 Exercises 19 Features 18 Measurements 16 Theory of Operation 18 N Non invasive Blood Pressure NBP Measurement Concepts 30 Criteria for Proper Measurement 31 Description 30 Exercises 32 Measurement Acquisition 31 Measurement Principle 30 Output 31 Plug In Modules 31 Non invasive Blood Pressure NBP Modules Block Diagram 34 Components 34 Description 34 Exercises 39 Features 36 Connectors 37 NPB Modes 37 Safety 38 User Controls 37 Measurements 34 Theory of Operation 36 R Recorder Module M1116A Block Diagram 73 Description 73 Exercises 79 Features 77 Recordings 77 User Controls 77 Theory of Operation 75 Recorder Module M1116B Block Diagram 80 Description 80 Exercises 85 Fe
362. spectral array data and derives the single electrode impedance measurement values The CPU provides a small multi tasking internal operating system to control internal and external appliances It controls the non volatile read write storage device and ensures the system integrity i e it detects possible failure conditions and generates appropriate error messages All system events are handled and it acts as an interface between the plug in module and the CMS Isolation Two functions are performed by the isolation block It delivers the necessary power from the CMS to the plug in module and its optical communication path for the data transfer from the CMS and to the CMS It isolates the patient electrically from the CMS 2 80 Advanced Plug In Modules EEG Module Block Diagram Figure 2 21 shows the block diagram of the signal flow through the EEG Module Electrode and Analog to Digital Impedance Signals inputrPreamplifiers Converter v Impedance Measurement 4 System CPU Isolation To CMS Signal Generator Theory of Operation Introduction There are drawbacks to continuously monitoring the raw EEG signals with conventional EEG machines These include the need for constant analysis of the waves by a skilled technician and the acquisition of volumes of recording paper Therefore the use of computerized processin
363. ss of treatment Careful monitoring of body temperature is vital for critically ill patients Thermometry can include a broad range of temperature sensing devices such as mercury thermometers thermistors thermocouples and units that reflect infrared light Because heat increases the movement of molecules thermometry uses scales based on the thermodynamic properties of given substances The temperature measurement used by Philips patient monitoring systems is based on a thermistor whose resistance is inversely proportional to its temperature By measuring the thermistor s resistance its temperature can be calculated The resistance of the thermistor is measured by passing a current through it and measuring the voltage developed across it The delta temperature measurement reflects two different temperature probe values and calculates the difference in temperature between the two measurements A temperature delta from different sites can be diagnostic of an altered physiologic state Temperature can be measured by a variety of temperature probes designed for use with different anatomic sites The choice of site is determined by the type of information needed by the clinician Temperature measurements can be graphed over time or represented as numerics depending on the application A thermometer should provide a quick accurate and reliable measurement of temperature Factors affecting accurate measurement of temperature include Fr
364. ss those data The module information is organized based on the technical complexity of the device not on the characteristics of the measurements The first set of modules from a technical perspective are simpler in operation The next set of modules performs more complex data processing operations Following the plug in modules are chapters that cover the monitoring systems with which the modules can be used These are the CMS Anesthesia CMS ACMS the Neonatal CMS NCMS and the V24 V26 The CMS is Philips premier modular monitoring system with full functionality and the ability to use all of the modules The V24 and V26 are designed to be used with patients who are being monitored in a Critical Care environment The V24CT V26CT can also be used during patient transport between units It can use most but not all of the plug in modules of the Philips patient monitoring system How to Use This Book The final chapter covers the Philips monitoring network SDN also called Philips patient care system which enables the monitoring systems to be connected to central station With Philips monitoring network SDN central monitoring stations can be connected to bedside monitors external computers and measurement instruments to provide clinical staff with the configuration that meets their needs How to Use This Book Learning and Reference Choose Your Approach The book was designed as a combination self paced training course
365. st data put into the buffer is the first data pulled out In contrast a LIFO buffer works the opposite way the last data put in is the first data pulled out EPROM Erasable Programmable Read Only Memory The EPROM card holds the operating software for the Master Application CPU If the CPU is a Configurable Processor Card the EPROM 15 a Flash EPROM The Application CPU card is placed in the lowest numbered slot on the backplane At system start up this CPU executes the diagnostics and application software SRAM Static Random Access Memory CMS Patient Monitoring System 3 63 Master Card Overview Topics Tune RAM A type of RAM used by master cards to listen for data on the Message Passing Bus It matches message headers that it is storing with headers being transmitted on the bus in order to determine which messages to read into receive buffers on the bus interface Wait State The devices that a microprocessor may be required to receive information from or write information to may not be as fast as the microprocessor If the device is slower the microprocessor can go into a wait state so that the device can complete its current operation before more data are transferred Wait states are implemented by additional clock cycles being placed into the data sequence This section contains the following topics Table 3 18 Topics in the Master Function Card Section Master Card Overview Application
366. stems to suit both the physical layouts of their units and the special needs of individual patients Display Module Plug in Computer Modules Module Module Rack Figure 3 1 Philips CMS CMS Functionality The CMS is connected to the patient by means of electrodes probes transducers or pressure catheters The accessories attached to the patient are connected to individual modules that take specific measurements The system is switched on by pressing the On Off switch on the front of the Main Display Module After approximately 20 seconds a display is shown on the screen The number of waveforms displayed depends on the model of the system and how it is configured Alongside each waveform a corresponding numeric value for a measured parameter is also displayed 3 6 CMS Patient Monitoring System CMS Features CMS Functions CMS Patient Monitoring System Description The patient s vital signs are shown on the screen The screen is set up according to either the default settings stored in the module or those settings made during installation Changes can be made to the screen display or to the parameter settings Alarms are set to on by pressing the Suspend key which enables the system to announce alarms as it monitors the patient The CMS has a wealth of features that make it flexible powerful and easy to use It provides a comprehensive set of patient measurements for use in a broad s
367. stor network in combination with some transistors red and green are added to lighten the output of the blue output on the display The red output has a slightly higher full intensity voltage to get brighter alarms CDSPC Functional Block Diagram UP 68000 ROM FW SRAM SRAM 64k x 16 32kx 8 32k x8 UP_CTRL 4 UP ADDR UP DATA pte De ode SMEC CTRL DATA BUF lg Your SLIP SMEC Serial SENE MPB Mux Data CLK Address ARRAY ie a 4 BNA gt Shift VIDEO i OUT Y 5 v H SLIP to SMEC CTRL SRAM OSZ 32MHz OSZ VIDEO s2kx8 I LOC BUS SYSCLK Figure 3 36 CDSPC Card Block Diagram Summary of CDSPC A summary of the features of the CDSPC cards follows Cards Features Displays up to 8 overlapping waves in 7 colors with horizontal scrolling e Two alphanumeric graphic planes 1024 x 512 pixels x 3 color banks for display text figures and simple graphics One wave plane with extended resolution 2048 x 512 pixels x 3 color banks that can display up to 8 overlapping waves with horizontal scrolling Three character sizes large 32 x 40 pixels normal 16 x 20 pixels dense 12 16 pixels e Attributes resolution 256 x 256 bytes 3 86 CMS Patient
368. supply charges in less than 20 seconds and provides at least one hour of data retention and RTC operation in back up mode Real Time Clock The RTC keeps track of how long the module is disconnected from a monitor for data transfer The RTC is located in a semi isolated area of the main board to ensure low noise The RTC oscillator timing pulse which is configured to 0 1 is used as an interrupt to the microcontroller to measure the RTC for accuracy If the pulses fall outside of the tolerance limit an error is flagged Data Transfer Module Features User Controls Safety Capabilities Data Transfer Module Figure 1 31 shows the user controls and connector for the module Two versions of the front panel are available universal and English The parts are described following the figure UNIVERSAL ENGLISH 1235 DATA TRANSFER 1235 2 4 1 otee o gt Figure 1 31 Data Transfer Module Controls 1 Transfer to Module Key A single press key used to transfer data from the monitor to the module 2 Transfer to Module Indicator A green LED that indicates several functions It is lit steadily when a Data Transfer setup screen is active It blinks rapidly when initial data are being transferred to the module It blinks slowly when contin
369. surement Description Concepts Measurement Principle Measurement Acquisition Blood pressure is the measured force of the movement of a patient s blood within the blood vessels The first measurement registers ventricular contraction and the second measurement registers closure of the aortic valve When the measuring device is in the patient s blood stream the measurement is called an invasive blood pressure This information indicates the status of the patient s overall cardiac condition Blood Pressure concepts important to this section are Normal Blood Pressure The blood s pressure within the systemic arterial system e Systolic Pressure The greatest pressure of the blood against the blood vessel walls following ventricular contraction Diastolic Pressure The east pressure of the blood against the blood vessel walls following closure of the aortic valve e Pulse Pressure The difference between the systolic and diastolic readings This is the range of the pressure in the arteries Mean Arterial Pressure The average pressure pushing blood through the circulatory system When measuring invasive blood pressure the force of movement of the blood in the patient s systemic arterial system is transported by a fluid column in the pressure line to the transducer This pressure causes an electrical signal to be generated which is then amplified to display the pressure wave and the numerics for the systolic diastolic an
370. surements Factors affecting accurate measurements of transcutaneous gas are proper connection between the measurement module and the patient s transducer anychange in the transducer s temperature which changes its characteristics and may affect accurate measurement The M1018A tcpO tcpCO Plug in Module in conjunction with a transducer measures transcutaneous O and carbon dioxide partial pressures Advanced Plug In Modules 2 41 tcpO2 tcpCO2 Measurement tcpO2 tcpCO2 1 measurement is an indication of Measurement Exercises a partial pressure of oxygen b partial pressure of carbon dioxide c both a and b 2 measurement requires the use of a an electrode b an invasive catheter a respiration transducer 3 measurement is displayed as a a numeric values and as graphical and numeric trend information b waveform c fraction 4 What factors can influence the accurate measurement of tcpO tcpCO a temperature of patient s blood b amount of water vapor in patient s blood c any change in the transducer s temperature Answers l c 2 a 3 a 4 c 2 42 Advanced Plug In Modules 2 2 Module M1018A tcpOZ tcpCO2 Module M1018A Description Measurements Calibration Algorithm The Transcutaneous Gas tcpO tcpCO Module M1018A is a measurement parameter unit measuring transcutaneous oxygen and carb
371. surements The 1015 Sidestream Module when used with the CO M1016A Module produces a real time waveform together with numeric readings for the End Tidal CO Inspired Minimum CO and Airway Respiration Rate During the calibration of the module the numeric value for instantaneous is displayed Components The M1015A SSCO Module consists of the following major functional components Table 2 5 Major SSCO2 Module Components Component Description Microprocessor Controls the overall calculations and communication with the CMS function box EEPROM A peripheral to the Microprocessor and where the calibration constants error codes and pump driver renting data are stored Power Supply The Floating Power Supply generates the necessary voltage and ensures that there is an electrical separation between the circuitry Flow Channel Controls the offset compensation for the pressure sensors Pressure Channel Uses no offset adjustment Pump Driver and Valve The pump driver and valve are driven by a pulse width modulation signal Temperature Sensor The temperature sensor is used to compensate for the semi conductor and pressure drives Multiplexer and A D Converter The multiplexor measures the ground signal 2 5 volt reference and the 5 volt power supply voltages are switched by the multiplexer to the A D Analog to Digital converter Block Diagram Figure 2 9 shows the b
372. t Connectors CMS Patient Monitoring System 3 37 Computer Module Rear Connectors The rear panel of the Computer Module will have several connectors The number and the type of connectors present is dependent upon which function cards are fitted in the Computer Module backplane Any unused rear backplane function card slots are fitted with blank slot covers A typical Computer Module rear panel is shown below Equipotential Human Analog Flatscreen Grounding interface Interface HDLC Remote Power Supply Terminal Connector Connector Connector On Off 2 4 6 8 10 System Nurse Powet SDN Paging R3232 Connector Connectors Connector Connectors Video Out Video Qut a 3 5 7 3 1 N E 3 3 5 S n to 5 m eel a 5 EPON ZE 3 E ic SDN AF UTIL_CPU JANALOG IF RS23241F HDLC IF CDPO WDEO DSPC RAT U 1052 66501 1059 65501 84 66501 11108566501 IMD 86 64501 MIQT2 8650 7 mar6e tif Table 3 12 Computer Module Rear Connectors Connector Function 1 System Power Connector 15 pin D type connector used to input the 60V dc from either a Main CRT Display DC DC Convertor 2 Equipotential Grounding Terminal 3 SDN Connectors SDN Interface 4 Human Interface Connector Utility CPU 5 Nurs
373. ta holding buffer for one column of dots to be printed Each heater element has its own driver circuit When a column of data is received from the Motor and Print Format Microcontroller the shift register is loaded the dots are printed as their respective heater elements are turned on Print density is controlled by the width of the strobe applied to each dot and by the temperature of the printhead The signals to the paper drive motor are sent through the motor control circuits on the power supply board These circuits regulate the speed of the paper motion Altering Power Consumption During frequency response tests or when the recorded waveform exhibits rapid vertical transitions the Recorder Module may decrease its power consumption by reducing the intensity of the thermal array head When this occurs a lighter waveform segment may appear in brief intervals on the recorder output strip An example of such output is shown in Figure 1 26 Reduced Intensity PE LL ELLE AM KAAS SP NM qp DLE E EEE E ILE E dL E Recorder Module M1116A Figure 1 26 Example of Reduced Intensity Waveform Segments Recorder Module Figure 1 27 shows the user controls for the module Features REC 1 RUN CONT STOP 2 3 2
374. taneously Power is supplied to the heater by the heater current controller which in turn is controlled by the microprocessor the microprocessor derives this control signal from the measured temperature The heater can be switched off using the safety switch whenever any abnormal conditions occur this safety switch is controlled by both the microprocessor and the temperature comparator Test circuitry provides both the switch and the current controller with a continuous self test 3 The Relay which routes the CO signal to the input amplifier which in turn amplifies the signal and passes it on to the multiplexer The relay reroutes the signal directly to the multiplexer 4 The Calibration Chamber The calibration chamber circuitry determines whether the transducer has been positioned in the calibration chamber on the module or is actually being used on a patient A standby mode is initiated when the transducer has been placed in the chamber for more than 30 minutes for example the heater is switched off to minimize transducer dehydration therefore extending the time between remembraning The tcpO tcpCO limit alarms are suspended automatically when a transducer is inserted into the calibration chamber Advanced Plug In Modules 2 47 tcpO2 tcpCO2 Module M1018A tepO tcpCO Figure 2 15 shows the user controls and connectors for the tcpO tcpCO M1018A M1018A Features Module Refer to this figure for the User Control
375. ted a Current source b Reference switching matrix 3 The module can be used with YSI Series temperature probes a 100 b 200 c 400 4 What isolates the patient from the module s current a Opto couplers b Input Connector c Input Protection Network Answers l c 2 b 3 c 4 a Recorder Module Concepts Recorder Module M1116A Recorder Module M1116A Description The M1116A Recorder Module provides thermal array recording capability for the Philips patient monitoring family including the V24 V26 Like the M1116B Recorder Module it can write up to three overlapped waveforms and three lines of annotation The M1116A offers eight recording speeds the M1116B offers ten speeds The following components carry out the major functions within the M1116A Recorder Module Table 1 13 Major Recorder Module M1116A Components Component Function DC to DC Converter Generates power for the digital circuitry and printing mechanisms Motor Control Circuits Control the operation of the paper drive motor Microcontroller Manages the I O operations for the module Print Microcontroller Regulates print speed and contrast Random Access Memory Provides storage for data accessed by the microcontrollers Paper Drive Motor Feeds the paper through the printer Thermal Printhead Block Diagram Provides the printing mechanisms for the recorder Figure 1 25 show
376. ter Module A cable from the M1046B Computer Module s integral power supply is connected to the Remote Switch card connector CMS Patient Monitoring System 3 129 Remote Switch Card Metal Cover ECG Adaptor Remote Switch FE Link Cable Integral Power Supply Connector Connector _ FE Link Connector Rack Interface Aux Connector Card Card Figure 3 51 Remote Switch and Aux Connector Function Cards 3 130 CMS Patient Monitoring System Chapter 4 V24 and V26 Patient Monitors Introduction Goals Objectives This chapter provides an overview on the operations functions and components of the Philips M1205A V24 and V26 Patient Monitors hereafter referred to as V24 V26 or the monitor After successfully completing this chapter you should be able to e Describe the system s operations e Describe the system s functions Identify the system s components In order to meet the chapter s goals you should be able to Describe the purpose of the V24 V26 and the clinical settings in which it is typically used e Describe the major features and functions of the V24 V24C V24CT Describe the V24 V26 system processes and interfaces Identify the standard and optional Plug in modules used by V24 V26 e Identify the user controls and connectors on the V24 V24C V24CT e Identify the V24 V26 possible software configura
377. terference An enzyme can be added to an ISE to produce ions from other analytes The Nernst Equation The Nernst equation relates the measured potential to the activity of the ion being measured E E RT nF In a 2 58 Advanced Plug In Modules Amperometric Measurement Conductometric Measurement Blood Analysis Measurement Where E is the potential E is a constant dependent on the electrode sensor system R is the gas constant T is the absolute temperature F is Faraday s constant and n is the valance or charge either positive or negative for the ion being measured and a is the activity of that ion The Nernst equation can be rewritten as E E S log a Where S replaces the constant terms which define the slope of the sensor The slope is the change in millivolts per tenfold change in activity For a positively charged monovalent ion the theoretical slope would be 59 16mV at 25 C When the potential for a calibrant with known activity and a sample are measured the activity of the sample can be calculated from Esample 7 Ecalibrant S log asampie Acalibrant Complex solutions such as blood deviate slightly from Nernstian behaviour due to interfering ions and matrix effects which result in junction potentials By including selectivity coefficients in the Nernst equation Nikolsky equation these effects can be minimized By characterizing the reference electrode in different solutions effects of matrix on the re
378. tested on user request RESP The measurement bridge driven by a 39kHz sine wave detects and excites the ECG signals from the RA and LL lead paths behind the Input Protection Network The modulated output is amplified by the differential input amplifier demodulated by the synchronous demodulator and input to a low pass filter The impedance subtracter subtracts the basic thoracic impedance to derive the respiration wave signal The signal is then multiplexed with the ECG signals amplified and converted to digital for use by the microprocessor For calibration and testing purposes a 1 ohm test signal is generated by the bridge circuitry 4 microprocessor which connects to the patient isolators and rack interface through a front end link passes control signals for lead selection and pulse detection from the monitor to the module components through the control lines It extracts the requested physiologic features from the cardiac signals and passes them on to the monitor Meanwhile all needed voltage for the module s operation is provided by the internal power supply which receives 78 MHz and 60 V DC through the rack interface Basic Plug In Modules 1 25 5 ECG RESP Module Figure 1 12 shows the user controls and connector for the ECG RESP Module The Features parts are described following the figure 2 1 5 Lin stat ECG RESP 002 ECG RESP
379. the number of sending devices installed on a Philips monitoring network SDN Table 5 1 Number of Overview Sessions Using Manual Overview Number of sending devices Number of sessions Four to six Four simultaneous overview sessions in each direction for a total of eight overall sessions Two or three Six simultaneous overview sessions in each direction for a total of 12 overall sessions Eight simultaneous overview sessions in each direction for a total of 16 overall sessions Philips Monitoring Network SDN 5 9 Defining the Inter SDN Gateway For automatic alert overview Table 5 2 lists the number of simultaneous overview sessions the Inter SDN Gateway permits based on the number of sending devices installed on a Philips monitoring network SDN Table 5 2 Number of Overview Session Using Automatic Alert Overview Number of sending R Number of sessions devices Three or fewer Four simultaneous overview sessions in each direction for a total of eight overall sessions Four to six Two simultaneous overview sessions in each direction for a total of four overall sessions With four to six sending devices the Inter SDN Gateway can permit two simultaneous sessions if less than nine alerts are generated If the number of alerts increases above eight no overviews are permitted If overview sessions are in progress they are automatically dropped off The Inter SDN Gateway is an HP Vectra personal comput
380. the sensors on the cartridge are conducted from the contact pads through the internal connector in the module to the sensor interface circuits These circuits amplify the signals from the sensors so that they can be further processed by the main electronic circuitry Four signals are relayed to the main electronic circuits amultiplexed potentiometric signal line amultiplexed amperometric signal line an AC fluid conductivity signal e a digital identification code for the type of cartridge 2 An analog to digital convertor converts all analog signals into digital form so that the microprocessor can process the signals An analog signal multiplexer makes it possible for the microprocessor to measure eight different types of analog signals the potentiometric signals from the sensor interface the amperometric signals from the sensor interface a DC conductivity signal the power supply voltage athermistor signal representing the internal temperature of the module a motor feedback signal used to control the speed of the mechanical motion cartridge temperature signals used to control the cartridge temperature to 37 apressure transducer signal representing the barometric pressure of the environment 3 The microprocessor control system manages all functions of the module It accesses three types of memory storage devices FLASH EPROM stores the software in the module The RAM which is backed up by an int
381. ther intervention by the Utility CPU Serial data received from the plug in modules through the FE LINK is converted to parallel data and placed into the RAM by the on board 8051 The RAMs are then switched allowing the Utility CPU to exchange data again When the system is first switched on the interface card polls the racks to identify the parameter modules that are plugged into the racks The features of the Rack Interface card are as follows Translates serial parameter data from the FE LINK to parallel data for transmission to the Utility CPU over the 8 bit local bus e Translates parallel data from the 8 bit local bus to serial data for transmission over the FE LINK RAM multiplexing eliminates intervention of the Utility CPU during data transfer Routes the power from the DC to DC converter to the internal and satellite racks e Digital to analog converter produces a sync output for defibrillator firing and senses a marker pulse CMS Patient Monitoring System 3 127 Rack Interface Functional Block Diagram 508 1081802 Y4XITdLL NW 791 J3MOd 1 viva U3AID3H uvas SANG HOSS3J0Nd kcu ssayaay Wa 15308 L 7NV8 7 30123NNO2 sng 73 ssaNaay 2 Sh8 10 1 02 43448 508 V1VO
382. tion of this chapter Master Card Overview on page 3 64 The CDSPC Video card consists of the following functional areas Color Register Buffer Horizontal Wave Scroll Logic Video System Controller Attributes Oscillator Video Buffers Color Mapping Circuit Protection Network and the Color Planes The color register chooses the color The three color banks of the Video RAM are controlled by the Video Controller chip 3 118 CMS Patient Monitoring System Video RAM Theory of Operation Wave Plane Data Transfer Color Equalization Color Display Video Card The video RAM has four parts as shown in the following table Table 3 29 Video RAM Components Pane Map Description Alphanumerics 1024 x 512 pixels x 3 color banks The two alphanumeric Graphics plane 1 graphics planes are used to display text figures and basic graphics lines boxes etc Alphanumerics Graphics plane 2 Wave Plane 2048 x 512 pixels x 3 color banks The higher resolution wave plane is used for displaying the parameter waves such as ECG Attribute Map 256 x 256 bytes The attribute map is used to enable parts of the screen and select between full brightness half brightness and blinking The CDSPC controller card acts as an interface between the system and the video card The video card connects the Computer Module to the display The CDSPC cards only control the mechanism of actually displaying information o
383. tion with the MPB Taking Data from the MPB Bus Placing Data on the MPB Bus Arbitration master cards contain as part of their functional components an MPB Interface that is used to pass data back and forth from the MPB The MPB Interface consists of custom and an external SRAM The external SRAM is a pair of receive and transmit FIFO buffers as shown in Figure 3 28 Data on the MPB are broadcast to all attached cards for use by any card that requires it The broadcast message has a header that identifies the type of data contained in the message The MPB does not designate a particular master card to be solely responsible for bus arbitration rather arbitration is determined by the cards themselves The master card prepares to receive messages by designating desired message types in a memory area called a Tune RAM The MPB interface reads the header from each message on the bus If the message header on the bus matches a header in its Tune RAM the MPB Interface reads the entire message and places the data into one of the receive FIFOs The data can then be fetched by the CPU The operation of reading data from the bus is independent of any other operation taking place on the card Data to be written to the MPB are placed into two Transmit FIFOs by the CPU When the card receives access to the bus through arbitration the MPB interface writes the data to the bus When a master card wishes to transmit a message on the MP
384. tions Identify the V24 V26 major hardware configurations V24 and V26 Patient Monitors 4 1 Introduction Topics This chapter contains the following topics Chapter Topics V24 and V26 Patient Monitors Description and Features 3 3 V24 and V26 Patient Monitors Interfaces 3 11 V24 and V26 Patient Monitors User Controls and Connectors 3 14 V24 and V26 Patient Monitors Software Configurations 3 20 V24 and V26 Patient Monitors Theory of Operation 3 23 4 2 V24 and V26 Patient Monitors 24 and V26 Patient Monitors Description and Features V24 and V26 Patient Monitors Description and Features Introduction The V24 and V26 are highly flexible patient monitoring systems which are based on a variety of components that enable easy customization to a hospital s requirements It utilizes a subset of the same parameter modules as the CMS with similar operator controls and waveform display Objectives After completing this section you should be able to Describe the purpose of the V24 V26 e Identify the clinical settings in which the V24 V26 is used e Identify the V24 V26 general features Concepts The V24 V26 is a flexible bedside monitor for critical and acute care units and for patient transport between units 24 It contains a user interface similar to the Standard Control Panel of CMS ACMS and supports a subset of the functionality of the CMS ACMS Clinical Uses The 24 26 is designed to monitor
385. to meet the chapter s goals you should be able to Define each of the physiologic measurements State the principle by which each measurement is derived Recognize the forms in which the data for each measurement are represented Identify the criteria and influencing factors related to the proper acquisition of the measurement Describe the method components and mechanisms by which the measurement s electrical signals are processed by the corresponding plug in module Identify and describe the features of the module Basic Plug In Modules 1 1 Introduction Topics This chapter contains the following topics Chapter Topics Measurements and Modules ECG Measurement 1 3 ECG Module 1 13 RESP Measurement 1 19 ECG RESP Module 1 23 NBP Measurement 1 30 NBP Modules 1 34 C O Measurement 1 40 C O Module 1 44 C10 CCO Measurement CMS only 1 49 10 CCO Module CMS only 1 52 SpO2 Measurement 1 56 SpO2 PLETH Module 1 60 TEMP Measurement 1 66 TEMP Module 1 69 Recorder Module M1116A 1 73 Recorder Module M1116B 1 80 Data Transfer Module 1 86 1 2 Basic Plug In Modules ECG Measurement Electrocardiogram Respirogram ECG RESP Module Concepts ECG Measurement Description The skin surface electrocardiogram ECG measures the electrical activity of the patient s heart or myocardium This information indicates the condition of the heart s electrical
386. to real time wave recorders 3 104 CMS Patient Monitoring System Analog Interface Card Performs internal tests to check the operation of the controller and drivers e Controls a maximum of two devices in daisy chain Receives commands and data via the MPB Formats the data to HSCX and STRIP protocol then transmits to connected devices Receives data from devices which it then transmits over the MPB Analog Interface Card Introduction Components MPB Interface FIFO Microcontroller Multiplying DAC The Analog Interface card provides the Computer Module with eight channels of analog output which can be connected to recorders and other data collection instruments This card is a master card but it does not require any connections to the Local Bus as there are no dependent local cards required for its operation Therefore it may be located in any vacant slot in the Computer Module even a slot that is part of another master card s cluster Both wave and numeric outputs are available channels can be controlled individually with respect to wave or numeric display and gain and offset control In addition eight alarm INOP status lines are provided as digital outputs which can be used to trigger alarm recorders or other data collection instruments The Analog Interface card consists of the following functional areas MPB Chip FIFO Micro Controller Multiplying DAC Error Measurement Unit Gain Error Co
387. tscreen independent display The Flatscreen does not support any Remote slave displays Module Rack s used to hold the parameter modules The rack s can be integral connected to the front of the computer module or external for locating away from the monitor If the rack is external it is called a satellite rack Plug in Parameter Modules used to acquire and process the patient data Each module is dedicated to a specific set of measurements or functions These modules are placed in the module racks Most use accessories to attach to patients A few such as the Recorder VueLink and Data Transfer modules have no patient connections 3 8 CMS Patient Monitoring System Remote Displays color or monochrome Independent Display CRT color only Flatscreen 4 or 8 channels in color E Defib Sync CMS Patient Monitoring System Modules ems x i Stat color and monochrome Main Display Display Central Data Station Defibrillator Display 8 Channel Analog Output Interface gt BEEE lterdatie rer rn 4 8 Analog Recorder E RS 232 Inte
388. typical waveform in 5 SQI Mode PLETH Figure 1 22 Waveform in 5 SQI Mode Perfusion Mode automatically adjusts the waveform but also allows manual adjustment by the user In this mode the size of the waveform is not related to the quality of the 5 signal SpO2Z PLETH Module SpO PLETH 1 Which component controls the current to the chopped current source Module Exercises a Current to voltage converter b Digital to analog converter c Input protection network d Over range detector 2 Which component removes ESU interference a Current to voltage converter b Digital to analog converter c Input protection network d Low pass filter 3 Which setting produces a waveform that indicates the quality of the SpO measurement signal a Perfusion mode b Pulse mode 5 SQI mode Answers l b 2 a 3 c Basic Plug In Modules 1 65 TEMP Measurement Temperature TEMP Module Concepts TEMP Measurement Description Concepts Measurement Principle Measurement Acquisition Output Criteria for Proper Measurement 1 66 Basic Plug In Modules Temperature is the measurement of the amount of heat present in a region of the body Various regions and tissues within the body have widely divergent temperatures and many factors can influence temperature change Body temperature can indicate conditions such as infection inflammation and antigenic responses as well as effectivene
389. uitry also sends and receives Philips monitoring network SDN data over the LDCs for instrument to instrument communications Only one CMS or V24 V26 monitor can broadcast patient information at any one time The Philips care hub SCC rebroadcasts that information to the other branches on the Philips monitoring network SDN The Philips care hub SCC functions as a rotary switch allowing each branch to transmit information to the other branches The Philips care hub SCC polls each branch 32 times per second Figure 5 3 illustrates the poll cycle when the Philips care hub SCC polls a branch The system on branch 0 sends all of its available information until the system is done As branch 0 transmits its information the Philips care hub SCC simultaneously rebroadcasts the information to the other 31 branches When the Philips care hub SCC senses the end of transmission from branch 0 the Philips care hub SCC turns off the branch 0 receiver The Philips care hub SCC polls branch 1 and repeats the polling activity for each branch until all 32 branches have been polled If a branch has more than one monitor the monitor connected closest to the Philips care hub SCC sends information first When that monitor is finished it signals permission to the next monitor so that it can send information This process continues for each monitoring system on the branch Each system gets the opportunity to send information but no two monitors can
390. ules which are labeled on the front with a T can be transported from one rack to another or from one Philips system to another and still keep their parameter settings The settings such as alarm limits are stored inside the module You could even unplug a satellite rack full of these modules from one monitor and plug it into another monitor without losing the parameter settings This behavior permits fast and easy transport and is called Parameter Settings Transfer For Parameter Settings Transfer to work on your monitor it must be set ON in a special Service Mode either by the biomedical engineering department or the Philips service engineer V24 and V26 Patient Monitors 4 9 V24 and V26 Patient Monitors Description and Features 24 and V26 Patient 1 What is the V24 V26 Monitors Features Exercises a an eight channel color monitoring system with the capability of processing up to eight single width parameter modules b a four channel monochrome or a six or four channel color monitoring system with the capability of processing up to eight single width parameter modules c a six channel monochrome monitoring system with the capability of processing up to six double width parameter modules 2 The V24 V26 has the following general features a Allows transfer of patient related settings b Philips monitoring network SDN compatible c both a and b 3 The rack options for the V24 V26 are a six or eight slot b two or
391. unicate the state of the DC to DC converter and the batteries to the System PCB The three circuits are power fail reset battery detection and battery voltage analog to digital converter DCON CHARGING ise Vunsw POWER PSRESE CIRCUI FAIL RESET CHARGING CIRCUIT BATIPRES SYSTEM VDD BATTERY PCB DETECTION m CIRCUIT BAT2PRES CHARGINC CIRCUIT A TO D E CONVERTER BAT2CON BATSTAT 0 6 The power fail reset circuit alerts the System PCB that DC to DC conversion will halt in 2ms during power down via the PSRESET signal The battery detection circuit determines whether either battery is inserted If a battery is present the circuit routes a low BATIPRES or BAT2PRES2 signal to the System PCB If a battery is not present BATIPRES or BAT2PRES is set high logic high on either of these lines also goes to the battery charger to disable the charger for the appropriate battery The battery voltage analog to digital converter converts each battery voltage sequentially into a seven bit word The System PCB selects which battery to sample using the BATICONV and BAT2CONV lines The seven bit words BATSTAT 0 6 go to the System PCB for state of charge determination and low battery detection V24 and V26 Patient Monitors 4 31 V24 and V26 Patient Monitors Theory of Operation System Board Application Subsystem Utility Subsystem Front End Interfac
392. uous updates are being transferred to the module 3 Transfer to Monitor Key A single press key used to transfer data from the module to the monitor 4 Transfer to Monitor Indicator A green LED that is lit steadily when a Data Transfer setup screen is active It blinks rapidly when blocks of data are being transferred to the monitor The Data Transfer Module complies with UL 544 IEC 601 1 and CSAC22 2 No 125 The Data Transfer Module transfers patient demographics and up to 24 hours of trend data between patient monitors It can transfer up to 32 continuously monitored vital signs from one monitor to another Vital signs transferred to the module from a monitor are updated continuously Data transfers can be accomplished in as few as 30 seconds The module provides a minimum of one hour of back up power when removed from a monitor to transfer data Data in the module are erased after transfer to the monitor is complete Basic Plug In Modules 1 89 Data Transfer Module Data Transfer Module Exercises 1 The Data Transfer Module transfers data between the CMS Release E Component Transport System Release E Anesthesia CMS and 2 Which types of data are transferred by the module a patient demographics only b trends only c vital signs only d a and c e a b 3 Which two components reside on a separate circuit board from the other components a LEDs and control keys b microcontroller and memo
393. uration and Plethysmography SpO2 PLETH Module Block Diagram 60 Components 60 Description 60 Exercises 65 Features 63 Connectors 63 PLETH Waveform 64 Safety 63 User Controls 63 Measurements 60 Theory of Operation 62 Arterial Oxygen Saturation via Pulse Oximetry SpO2 Measurement Concepts 56 Criteria for Proper Measurement 57 Description 56 Measurement Acquisition 57 Measurement Principle 57 Output 57 Plug In Modules 58 References 58 Arterial Oxygen Saturation via Pulse Oximetry SpO2 MeasurementExercises 59 Cardiac Output C O Measurement Concepts 40 49 Criteria for Proper Measurement 42 Description 40 Exercises 43 Measurement Acquisition 40 49 Measurement Principle 40 49 Output 42 Plug In Modules 42 References 42 Cardiac Output C O Module Block Diagram 44 52 C O Module Features 47 55 Components 44 Description 44 52 Exercises 48 Features Connectors 47 55 Safety 47 55 User Controls 47 55 Measurements 44 52 Theory of Operation 46 54 CO2 Respiratory Gas Measurement Concepts 20 Criteria for Proper Measurement 21 Description 20 Measurement Acquisition 20 Measurement Output 20 Measurement Principle 20 Plug In Modules 21 CO2 Respiratory Gas Module M1016A Block Diagram 23 Components 23 Description 23 Exercises 27 Features 25 Connectors 26 Safety 26 User Controls 26 Measurements 23 Theory of Operation 25 Data Transfer Module Block Di
394. ure Setup Indicator c CAL Indicator Answers l b 2 b 3 a 4 c 2 10 Advanced Plug In Modules Invasive Blood Pressure Module M1006A Option 01 Invasive Blood Pressure Module M1006A Option C01 Description The PRESS M1006A Option 01 Module is an invasive blood pressure measurement parameter unit It is designed to be used with adult pediatric or neonatal patients in a range of Critical Care environments Measurements The PRESS M1006A Option 1 Module produces a real time waveform together with the pulse rate and numeric readings for the systolic diastolic and mean blood pressure values This module provides an analog pressure output signal for use with intra aortic balloon pumps Components The PRESS Module M1006A Option CO1 consists of the following major functional components Table 2 2 Major PRESS Module M1006A Option C01 Components Component Description Input Protection Network Protects the module from extraneous signals i e defibrillation and electro surgery Input Amplifier Amplifies the signal before it is sent to the Microcontroller Analog Output Jack This 1 4 inch phone jack contains three terminals tip ring and sleeve Tip provides the analog pressure output signal Ring and sleeve are connected to analog ground Demodulator Demodulates the carrier signal Zeroing Calibration Test To compensate for an input pressure offset an offset compensatio
395. used to synchronize incoming data This gate array is then used to guarantee that the sample clock is in the middle of the data clock when the data are stable DTCK is used to acknowledge a RAM_ACCESS command from the Utility CPU so the Utility CPU does not have to wait Wait states are not necessary for access to the SIC_RAM Identifier and the 4 bit Latch The Utility CPU uses a 4 bit latch to perform certain operations which are defined in the following table Table 3 30 4 Bit Latch Definition bit 0 databit8 Switches the control signals between the Utility CPU and the SIC Chip bit 1 databit9 Used to reset the SIC Chip Sometimes it is necessary to reset the SIC Chip and not the whole system CMS Patient Monitoring System 3 123 Serial Distribution Network Interface Table 3 30 4 Bit Latch Definition bit 2 databit10 Used to disable the Multiplexer before control of the SIC RAM is passed between the Utility CPU and the SIC Chip and then to enable it after the switch This suppresses spikes and protects the contents of the SIC RAM bit 3 databit11 Used to switch on the error LED while tests are performed on the SDN interface card When all tests are successfully completed the error LED is switched off Summary of SDN The features of the SDN Interface are as follows Features Translates the MPB parallel data that were broadcast on an 8 bit bus to serial SDN data broadcast on a two wire bus
396. vice such as a ventilator gas analyzer or stand alone parameter monitor to the CMS The module provides a combined RS232 and analog interface to collect information from external devices that can be displayed recorded and trended on the system There are three different VueLink Module options 1 Auxiliary connects external stand alone parameters to the monitor 2 Ventilator connects ventilators to the monitor 3 Gas Analyzer connects gas analyzers to the monitor VueLink Modules fall into two basic types Type can show up to wave and 2 numerics Type B can show up to 2 waves and 6 numerics Each module option is a fixed type as shown in the following table Option Aux Aux Ventil Gas Anesthesia e Plus Analyzer Machine ne A B B B B Waves 1 2 2 2 2 Numerics 2 6 6 6 6 Each module enables only one external device to be connected at any one time but supports the connection of several devices within a device group 2 68 Advanced Plug In Modules Components Block Diagram VueLink Module The VueLink Module consists of the following major functional components Table 2 10 Major VueLink Module Components Component Description Controls the overall calculations and Microprocessor communication Input Protection Network Provides ESD protection and protection against defibrillator voltage transients RS232 Driver Converts the internal logic leve
397. way opportunities for possible improvements in anesthetic delivery can be identified while confidence in the information provided by the BIS is established The BIS response can then be incorporated as an additional parameter to help guide appropriate anesthetic dosing adjustments to achieve the desired clinical goals A large multicenter clinical study involved use of the BIS to help determine the minimum effective dose of anesthetics Following induction and intubation anesthesia is initially maintained using infusions of propofol 120 140 ug kg min and alfentanil 0 5ug kg min with 50 As shown in the following example where the user was blinded to the BIS value a relatively deep BIS lt 40 but stable anesthetic profile was maintained resulting in a 11 minute recovery at the end of surgery BIS Propofol Inf Rate HR 200 180 160 140 120g 1066 0 4 60 40 20 IS Propofol Inf Rate 10 12 01 12 37 12 43 12 49 i 12 55 13 01 13 04 Advanced Plug In Modules 2 91 BIS Measurement While this was considered to be a very acceptable anesthetic outcome further improvement in efficiency is possible as shown in the following example BIS Propofol Inf Rate 100 12 r 180 160 140 120 100 HR BP Map Incision Y 2nd Incision 15 Propofol Inf Rate 10 o
398. wehroe 40 02 e 3433 408 MES SH 8 ANH 54 ng oa e eue g anig bled 80102 80 LO3NNOO NId 96 CMS Patient Monitoring System 3 121 Figure 3 48 CDSPC Video Card Block Diagram Serial Distribution Network Interface Summary of CDSPC Cards Features A summary of the features of the CDSPC cards follows Displays up to 8 overlapping waves in 7 colors with horizontal scrolling Two alphanumeric graphic planes 1024 x 512 pixels x 3 color banks for display text figures and simple graphics One wave plane with extended resolution 2048 x 512 pixels x 3 color banks that can display up to 8 overlapping waves with horizontal scrolling Three character sizes large 32 x 40 pixels normal 16 x 20 pixels dense 12 16 pixels e Attributes resolution 256 x 256 bytes e Can drive a master and up to 3 remote displays e Color luminance equalization e 60 Hz operation Serial Distribution Network Interface Introduction Connections Serial Distribution Network SDN The Serial Distribution Network Interface SDN_IF card is used to interface the CMS to the SDN The interface path is through the Utility CPU This card transmits data to the SDN and receives data from the SDN Only one SDN Interface card may be used with each CMS The SDN interface card must be connected to a free b
399. wo 42 pin connectors The daughter card contains the application memory PROM packs The CPC contains the following functional areas an 68030 Microprocessor MPB Interface a Flash ROM DRAM Fast SRAM Buffered SRAM Interface Temp Sensor Service Port and Daughter Board Interface The CPC CPU is based on the 68030 microprocessor chip This is the interface between the CPC and the MPB This interface is covered in greater detail in the opening part of the Master Function Cards section The Flash EPROM contains the operating software The flash EPROM is programmed using the CPC programming tool The EPROM normally has VPP set low between 4 0V and 4 5V and functions as read only memory The tool operates by setting VPP high 12V and writing an appropriate instruction to the EPROM Two versions of the Flash EPROM are available M1053 66515 and M1053 66514 The M1053 66515 contains two types of flash EPROM a 4 Mb 32 bit wide bank containing the application memory PROM packs and a 64 Kbyte 8 bit wide bank containing the boot ROM The M1053 66514 contains a 64 Kbyte 8 bit wide bank containing the boot ROM It also contains a non flash daughter card the M1061 66501 configured as 768K x 32 bits of memory and occupying up to 3 MB of processor space The DRAM is used for two purposes to download programs from the flash for faster execution and to provide unbuffered storage for applications The DRAM is configured as two 32 bit wi
400. x Output This is a female 15 pin Sub D Type connector used to output the 60 V dc line voltage to the Computer Module 3 Fuse Holders Two fuse holders for the line protection fuses 4 Local Power Connector This is a 3 pin connector used to input the local line voltage 5 Equipotential Grounding This is a grounding stud connector used to connect the system to an Terminal equipotential grounding system 3 42 CMS Patient Monitoring System Display Module Introduction Display Models Front of Main Display Display Module The Display Module is the hub of the system s human interface Its video display terminals and keypads enable users to set and change measurement parameters and alarms enter and view data on multiple patients and configure the system s software The Display Module also supplies power to the system through its connection to the main power source and its internal power supply Each CMS may have up to two independent displays For 14 CRT displays each main or independent display can support up to three slave slave displays Main displays have an integral keypad called a Control Panel on the front panel and also support a handheld keypad Several models of the Display Module are available e 1092 14 Monochrome Display e MI1094A 14 Color Display e MI1094B 14 Color Display e 1095 10 4 Flatscreen Color Display e MI097A 15 XGA Flatscreen Color Display e MI234B 21 Color Displ
401. y two milliseconds is selected for input to a digital to analog converter The analog output from the converter is sent with a delay of less than 20 milliseconds to the phone jack on the front of the internal rack This analog signal is used to synchronize the firing of a defibrillator 3 126 CMS Patient Monitoring System Marker Input DC to DC Power Data Transfer System Turn On Summary of Rack Interface Features Rack Interface The marker input is an analog signal applied to the same phone jack for the duration of the defibrillator firing This signal is sensed by the on board microcontroller and merged with the upper part of the ECG wave sample This allows the defibrillator firing to be displayed on the screen The 60V supply from the DC to DC converter is placed on all the rack connectors to supply power to all the racks via the FE LINK cables The method for data transfer used by the Rack Interface is called RAM Multiplexing Two RAMs are used alternately by the on board 8051 Microprocessor and the 68000 on the Utility CPU Every 32 milliseconds the RAMs are switched using the 32 millisecond frame interrupt from the Utility CPU so the RAMs be accessed by the other processor This allows the faster 68000 processor to exchange data with the RAM and then run on before the RAMs are switched The on board 8051 Microprocessor then converts the data into serial data for passing to the racks over the FE LINK with no fur

- Frank`s Hospital Workshop

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