5 units
UNIT I
ELECTRO-PHYSIOLOGY AND BIO-POTENTIAL RECORDING
UNIT I PART A
1.1)Define a) Resting Potential
b) Action Potential
May/June 2009, Nov/Dec 2008
1.2)Define Conduction Velocity Apr/May 2008, Nov/Dec 2008, May/June 2007
1.3)State all or none law in respect of cell bio potential.
Apr/May 2008
1.4)Name the electrodes used for recording EMG and ECG. Nov/Dec 2012
1.5)List the lead systems used in ECG recording.
Apr/May 2010
1.6)What is PCG?
May/June- 2012, Nov/Dec 2012
1.7)Compare the signal characteristics of ECG and PCG. Nov/Dec 2011
1.8)What is EOG?
Nov/Dec 2011
1.9)Draw typical ECG waveform. Nov/Dec 2009, May/June 2007
1.10What are the peak amplitude and frequency response for ECG, EEG and EMG.
1.11) Write down the Nernst equation ? (Nov/Dec 07 )
1.12) What is Phonocardiogram ? (Nov/Dec 07 )
UNIT I-PART B
1.1) Discuss in detail the origin of bioelectric potentials with necessary diagrams. (Nov/Dec 07 )
1.2)Draw an Electrocardiogram, labeling the critical features. Include typical amplitudes and
time intervals for a normal person(Nov/Dec 07 )
1.3)With neat diagrams explain the 12 lead system in ECG measurement (Nov/Dec 07 )
1.4). Draw the waveform of the ACTION POTENTIAL and explain
: (i) Depolarization
(ii) Repolarization
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1.5) Draw the waveform of the ACTION POTENTIAL and describe Resting Potential ,
Depolarization, Repolarization, action potential, Absolute Refractory period and
Relative Refractory Period (APR/MAY 2005)
1.6)Write down Goldman Equation and write the constants indicate. (APR/MAY 2005)
1.7)Draw a typical single channel ECG machine and give justification for the inclusion of each
circuit block of the machine. ( Nov.Dec.2003)
1.8)Write about standard lead system for ECG recording. Also draw a typical ECG waveform and
mark the various complexes of ECG and give their durations. ( April /May 2004)
1.9)Write briefly about the recording devices for EMG. ( April /May 2004)
1.10) Draw the equivalent circuit of a pair of electrodes in electrolytic contact with a human being
to measure bio-potential. Name the components. (4)
1.11).Draw a typical 8 channel EEG machine and discuss about its function. (12)
Resting potential is defined as the electrical potential of an excitable cell relative to its
surroundings when not stimulated or involved in passage of an impulse. It ranges from -60mV
to
-100mV
Action potential is defined as the change in electrical potential associated with the passage of
an impulse along the membrane of a cell.
Conduction velocity is defined as the rate at which an action potential mo ves down a fiber or
is propagated from cell to cell. It is also called as Nerve conduction rate.
3. Write down the Nernst equation of action potential.
An equation relating the potential across the membrane and the two concentrations of the ion
is called Nernst equation.
RT
C1 f1
E
ln
Where,
nF
C2 f 2
7
R
gas constant(8.315 x 10 ergs/mole/degree Kelvin)
T
absolute Temperature, degrees Kelvin
n
valence of the ion (the number of electrons added or removed to ionize the atom)
F
Faraday constant (96,500 coulombs)
C1, C2 two concentrations of the ion on the two sides of the membrane
f1, f2 respective activity coefficients of the ion on the two sides of the membrane
4. What is meant by sodium pump?
Sodium pump is an active process in which sodium ions are quickly transported to the outside
of the cell and the cell again becomes polarized and assumes its resting potential.
Apr/May 2008
Regardless of the method by which a cell is excited or the intensit y of the stimulus, the
action potential is always the same for any given cell.
6. List the types of bioelectric potentials.
Bio electric potential related to
Heart
ElectroCardioGram (ECG)
ElectroEncephaloGram (EEG)
Brain
Muscle
ElectroMyoGram (EMG)
ElectroRetinoGram (ERG)
Eye (Retina)
Eye (Cornea - Retina)
ElectroOculoGram (EOG)
BIO
BIO-POTENTIAL ELE
ELECTRODES
Nov/Dec-2012
BIO
BIOLOGICAL AMPLIFIERS
Apr/May 2010
Bio signals such as ECG, EMG, EEG, EOG have low amplitude and low frequency.
So, amplifier is used to boost the amplitude level of bio signals.
12. What are the requirements for bio-amplifiers?
Bio amplifiers must have
a) High input impedance
b) Isolation and protection
circuit c) High voltage gain
d) Constant gain throughout required
bandwidth e) Low output impedance
f) High CMRR
ECG, EEG, EMG, PCG, EOG LEAD SYSTEMS AND
AND RECORDING METH
ETHODS,
TYPICAL WAVEFORMS AND SIGNAL CHARACTERISTICS.
Prepared by A.Devasena., Asso. Prof.,
Dept/ECE
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Apr/May 2010
Nov/Dec 2008
Latency is defined as the elapsed time between the stimulating impulse and the muscle
action potential. In other words it is the time delay between stimulus and response
Wave
Amplitude (mV)
0.25
1.06
0.1 0.5
-
P
R
T
QRS Complex
Duration (sec)
0.12 0.22 (P R interval)
0.07 0.1
0.05 0.15 (S T segment)
0.09
22. What are the important bands of frequencies in EEG and state their importance.
Nov/Dec 2004
Waves
Frequency (Hz)
Observation
Delta()
0.5 4
Theta()
48
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Alpha()
8 13
Beta()
13- 22
23. What are the peak amplitude and frequency response for ECG, EEG and EMG.
Bioelectric potential
Function
Peak
amplitude
0.1 to 4mV
ElectroCardioGram
(ECG)
Records
electrical
activity of heart
ElectroEncephaloGram
(EEG)
Records
electrical
activity of
brain
2 to 200V
ElectroMyoGram
(EMG)
Records
muscle
potential
50V to
1mV
Observation
Frequency
response
0.05 to
Used to measure
120 Hz
heart rate,
arrhythmia and
abnormalities
0.1 to 100 Used to analysis
Hz
evoked potential,
certain patterns,
frequency
response
5 to 2000
Used as indicator
Hz
of muscle action
for measuring
fatigue
UNIT II
2.1) What are the typical values of blood pressure and pulse rate of an adult? (Nov/Dec.2012)
2.2) What are systolic and diastolic pressures?
( Nov/Dec 2011)
2.3) What is the reason for decrease of cardiac output?
2.4) Define Cardiac Output.
2.5) State the principle behind the indicator dilution method.
2.6)What is residual volume?
( May /June 2007)
2.7) What is electrophoresis?
(April / May 2010)
2.8) What are the applications of flame photometer?
( Nov/Dec2009)
2.9) How is auto analyzer useful in medical field?
( April /May 2010)
2.10)What are korotkoff sounds?
( Nov/Dec 2008)
2.11) Name the four physical principles based on which blood flow meters are constructed?
(Nov/Dec 07 )
2.12) Define Mean Arterial Pressure ? (Nov/Dec 07)
2.11)Explain :
(i) ultrasonic Blood flow meter (Doppler type) (May/ June
2006) (ii) Plethysmograph. (May/ June 2006)
2.12) Draw the block diagram of ultrasonic blood flow meter. Explain the method
of measuring the velocity of blood flow using (i) transit time principle (ii) Doppler Effect
(Nov/Dec 07 )
2.13)Describe a procedure for the measurement of pH in blood . (Nov/Dec 07 )
2.14)Explain the principle and the working of Electrophoresis apparatus (Nov/Dec 07 )
1.
2.
3.
4.
5.
6.
7.
8.
maximal inspiration.
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methods. They are Ficks Method, Indicator dilation method, Measurement of cardiac output by
impedance change.
20. What are the two methods of pulse measurement?
The methods used for measuring pulse are transmittance and reflectance
methods.
1.
2.
3.
4.
5.
6.
7.
8.
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methods. They are Ficks Method, Indicator dilation method, Measurement of cardiac output by
impedance change.
20. What are the two methods of pulse measurement?
The methods used for measuring pulse are transmittance and reflectance
methods.
1.
2.
3.
4.
5.
6.
7.
8.
methods. They are Ficks Method, Indicator dilation method, Measurement of cardiac output by
impedance change.
20. What are the two methods of pulse measurement?
The methods used for measuring pulse are transmittance and reflectance
methods.
UNIT III
3.1) With respect to the Defibrillator draw the following waveform :(Nov/Dec 07 )
3.14)How is atrial defibrillation arrested? Explain with neat diagrams of the setup
used. ( April /May 2004)
Give two important factors that demand internal pace makers usage. [A/M2005]
The two important factors that demand internal pace makers usage are
(i). Type and nature of the electrode used
(ii). Nature of the cardiac problems.
(iii). Mode of operation of the pacemaker system.
[N/D 2008]
Internal Pacemakers
External Pacemakers
It requires open chest minor surgery It does not require open chest surgery
to place the pacemaker
It is used for
regularity
There is no safety for the pacemaker, There is 100% safety for circuit from
particularly in case of child carrying the external disturbances.
the pacemaker
DC DEFIBRILL
ILLATOR
5
What are the three types of exchangers used in HEMODIALYSIS system? [M/J
2005]
The three types of exchangers used in HEMODIALYSIS systems
are i)Parallel Flow dialyzer,
(ii).Coil Hemodialyser,
(iii). Hollow Fiber Hemodialyser
=(1/2) 16 10
=200 Joules
9
25
10
Draw the defibrillator output waveform and indicate the output energy level. [M/J
2012]
FREQUENCY SELEC
LECTION AND BIO-TELEM
LEMETRY
10 What is the modulation techniques used for biotelemetry? Mention the reason for
adopting that modulation scheme.[N/D 2004]
The two different modulation techniques used for biotelemetry are
i)Double Modulation
ii)Pulse Width Modulation
The reason for adopting such a scheme
i)Double modulation gives
a) better
The purpose behind this double modulation, it gives better interference
free performance in transmission, and this enables the reception of low frequency
biological signals. The sub modulators can be a FM (frequency modulation) system,
or a PWM
Biological
signal(ECG,EEG)
Transducer
Amplifier &
Filter(Conditioner)
Transmisssion
channel
12 What are the advantages of biotelemetry system? [M/J 2007] [M/J 2009]
Output unit
The advantages of biotelemetry systems are (Video recorder
Tape recorder,
(i). It is used to record the biosignals over long
periods and while the
C.R.O)
ies.
Patient is engaged in his normal
activit
(ii). The medical attendant or computer can easily diagonise the nature
of Disease by seeing the telemeter biosignals without attending
patient Room
(iii). Patient is not disturbed during recording.
(iv). For recording on animals, particularly for research, the biotelemetry
is greatly used.
13 Specify the frequencies used for biotelemetry.[N/D 2012]
Wireless telemetry system uses modulating systems for transmitting
biomedical signals. Two modulators are used here. A lower frequency sub-carrier is
employed in addition to very- high frequency (VHF). This transmits the signal from the
transmitter.
RADI
ADIO-PILL
ILL AND TELE-STIM
TIMULATION
14 What is a radio-pill? [N/D 2009][A/M 2010][M/J 2012]
The radio pill is capable of measuring various parameters that are available in
the tract. With the help of radio pill type devices, it is possible for us to measure or
sense temperature, pH, enzyme activity, and oxygen tesion values. These measurements
can be made in associated with transducers. Pressure can be sensed by using variable
inductance, temperature can be measured by using temperature-sensitive transducer.
15 What is principle of telestimulation? [A/M 2008]
Telestimulation is the measurement of bio logical signals over long distance.
UNIT IV
RADIOLOGICAL EQUIPMENTS
UNIT IV- PART A
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19
May/June 2012
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19
4.3)In what way X-ray equipments are useful for diagnostic purpose?
4.4)Distinguish between hard X-ray and soft X-ray.
4.5)What is angiography?
Apr/May 2010
Nov/Dec 2009
Nov/Dec 2008
4.6)State few radio isotopes used for diagnostic purpose. Apr/May 2010, May/June 2009, Nov/Dec 2011
4.7)Differentiate between radiography and fluoroscopy. May/June 2007, Nov/Dec 2008
4.8)List out safety precaution to be taken while handling radio isotopes.
Nov/Dec 2009, Apr/May 2008
4.9)Name two equipments used in radiation therapy.
4.10)What is radiation therapy?
May/June 2007
Apr/May 2008
4.18) What is the principle of Cryogenic technique? Give any two medical applications of the
same. ( April /May 2004)
4.19)Mention the scheme of modulation techniques used for biotelemetry. Also mention the reason
for such scheme ( Nov.Dec.2003)
4.20)What is the frequency of operation of ultrasound diathermy ?What is the reason for this
frequency selection ? ( Nov.Dec.2003)
UNIT IV- PART B
4.1) Explain in detail an X-ray Image Intensifier with appropriate diagram (Nov/Dec 07 )
4.2)Discuss in detail the Scintillation detectors for gamma radiations with necessary diagrams
(Nov/Dec 07 )
4.3)With a neat block diagram explain the instrumentation system for radioisotope procedures.
(Nov/Dec 07 )
4.4)Write short notes on Fluroscopy. (Nov/Dec 07 )
4.5) Write down the salient features of Frequency Selection with respect to Biotelemetry.
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May/June
iv.
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30
ii.
iii.
May/June 2007
UNIT V
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Introduction
Introduction:
The human body is the most deeply studied and frequently portrayed object in the
history. Despite its familiarity, it is instinctively absorbing and eternally fascinating.
The number of humans in the world is racing towards seven billion. More than
5 babies are born every minute, while 150,000 people die daily. With the population increasing
by almost three humans per second. Each of these people lives, thinks, worries, and day
dreams with and within the most complex and marvelous of possessions- a human body. An
enduring feature of this body and its behavior is self-curiosity. We continually look inside
ourselves in enormous and ever-increasing detail in order to comprehend the action within.
Levels of organization:
The body is viewed to be a series of integrated systems. Each system carries out one
major role or task. In the cardiovascular system, for example the heart pumps blood
through
vessels, to supply every body part with essential oxygen and nutrients. The systems are in
turn composed of main parts known as organs. The stomach, intestines and liver are the
organs of digestive system. Moving through further levels in the hierarchy the organs consist of
tissues and tissues made up of cells.
Cells are often called the microscopic building blocks of the body. However they
are active and dynamic, they continually grow and specialize function die and replenish
themselves by the millions every second. The whole body contains 200 different kinds.
Science in increasingly able to deliver deeper than cells to the organelles within them and
onwards and inwards to the ultimate components of ordinary matter molecules and atoms.
Anatomy:
The study of the bodys structure and how it cells, tissues and organs are assembled is
known as human anatomy. In reality, the inside of the body is a crowded place. Tissues
and organs push and press against one another. There is no free space, and no stillness either.
Body parts shift continually in relation to each other. We move about, breathe, pump
blood shift digestive matter and eat. For example, swallowed food does not simply fall
down inside the gullet {oesophagus}. The gullet is normally pressed flat by internal chest
pressure so that food must be forced down into the stomach by waves of muscular contraction.
Physiology:
The anatomical drawing of a large factory or orifice would show the arrangement of
rooms, location of machinery and furniture, and service ducts for electricity water and
service
ducts for electricity, water and air-conditioning. For a rounded understanding we need to see
the premises in action, with people goods and information on the move. Similarly human
anatomy is combined with its twin; physiology focuses on the dynamic chemical minutiae at
atomic ionic and molecular level. It investigates the working of such processes as enzyme
action, hormone stimulation, DNA synthesis and how the body stores and uses energy from
food. As researchers stare harder and more physiological secrets are unlocked. Much of
this work is directed at preventing, treating or alleviating disease and allows us to appreciate
the latest wonder drug or take a meditation
Body Cell:
Everyone is made up of Billions of cells, which are the basic structural units of the body.
Bones, muscles, nerves, skin, blood and all other tissues are formed from different types of
cells.
Each cell has a specific function but works with other types of cells. Each cell has a
specific function but works with other types of cells to perform the enormous number of tasks
needed to sustain life. Most body cells have a similar basic structure. Each cell has an outer
layer (called cell membrane) and contains a fluid material (cytoplasm). Within the
cytoplasm are many specialized structures(organelles). The most important organelle is the
nucleus which contains
vital generic material and acts as the cells control centre.
The structure of DNAs is like spiral ladder DNA contains all the vital generic
information and instruction codes necessary for the maintenance and continuation of
life.
Skeleton:
The skeleton is a mobile frame work made up of 201 bones, approximately half of which
are in the hands and feet. Although individual bones are rigid, the skeleton as a whole
is remarkably flexible and allows the human body a huge range of movement. The Skelton
serves
as an anchorage for the skeletal muscles and as protective cage for the bodys internal organs.
Female bones are usually smaller and higher than male bones, and the female pelvis is
shallower and has wider cavity.
Head:
In a new born body, the head accounts for one quarter of total body length, by adulthood,
the proportion has reduced to one eighth contained in the head are the bodys main sense organs,
eyes, ears, olfactory nerves that defect smells, and the taste buds of the tongue. Signal from
these
organs pass to the bodys great coordination centre. The brain housed in the protective bony
dome of the skull. Hair on the head insulates against heat loss, and adult males also grow
thick facial hair. The face has three important openings two nostrils through which air passes
and the mouth which takes in the nourishment and helps from speech. Although all heads are
basically similar, differences in the size, shape and color of features produce an infinite
variety of appearances.
Body organs:
All the body organs except for the brain are enclosed within the trunk or torso(the body
apart from the head and limbs). The trunk also contains two large cavities separated by
a muscular sheet called the diaphragm. The upper cavity contains the st omach, intestines, liver
and pancreas which all play a role in digesting the food. Also within the trunk are the
kidneys and bleeder, which are part of the urinary system, and the reproductive organism
which hold the seeds of new human life. Modern imaging techniques such as contrast X-rays
and different types of scans make it possible to see and study body organs without eh need
to cut through their protective covering of skin, fat, muscle and bone
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allows the femur a wide range of movement, whereas finger joints are simple hinge joints that
allow only bending
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and straightening. Joints are held in place by bands of tissue called ligaments. Movement of
joint is facilitated b the smooth hyaline cartilage that covers the bone ends and by the
synovial membrane that lines and lubricates the joint.
Muscles:
There are three main types of muscles skeletal muscle (also called voluntary muscle
because it can be consciously controlled); smooth muscle (also called involuntary
muscle because it is not under voluntary control) and specialized muscle tissue of the heart.
Humans have more than 600 skeletal muscles which differ in size and shape according to the
jobs they do. Skeletal muscles are attached directly or indirectly (via tendons) to bones and
work in opposing pairs (one muscle in the pair contracts while the other relaxes) to produce
body movements as diverse as making threading a needle and an array of facial expression.
Smooth muscles occur in the wall of internal body organs and perform actions such as forcing
food through the intestines, contracting the uterus (womb) In child birth and pumping blood
through blood vessels some other muscle in the body.
Iris:
The muscle fibers contract and dilate (expand) to alter pupil size.
Tongue:
Interacting layer of muscle allow great mobility
Ileum:
Opposing muscle layers transport semi-digested food.
Muscles 2:
Muscles of facial expression:
A single expression is the result of movement of many muscles.
H a nds :
The human hand is an extremely versatile root, capable of delicate manipulation as well
as powerful gripping actions. The arrangement of its 27 small bones, moved by 37
skeletal
muscles that are connected to the bones by tendons, allows a wide range of movements.
Out ability to bring the tips of out thumbs and fingers together combined with the extra
ordinary sensitivity of our fingertips due to their rich supply of nerve endings, makes out
hands uniquely dextrous.
Feet:
The feet and toes are essential elements in body movement. They bear and propel the
weight of the body during walking and running and also help to maintain balance during
changes
of body position. Each foot has 26 bones, more than 100 ligaments and 33 muscles some
of which are attached to the lower leg. The heel pad and the arch of the foot act as shock
absorbers, providing and cushion against the joints that occur with every step.
Physiological system
2.1.Information Processing
The human body is alive with information. Being a complex, dynamic mechanism, its
interacting and interdependent parts require control and co-ordination. This is done by passing
information
between them. Two body systems are responsible for command-control and data management
The language of the nervous system is tiny electrical impulses. They are small and fast each
just one-tenth of a volt in strength and lasting hardly one-thousandth of a second and
numerous. Every second millions pass through the networks of long pale, string like
pathways called nerves. Informations from the senses flow to the brain as electrical impulse. Here it is
shifted,
analyzed and evaluated causing millions more signals to pass around and within the
brain between numerous, complex areas. Decisions are reached and command messages are
produced
in the form of electrical impulses. The brains electrical output travels along motor nerves to the
muscles to stimulate and co-ordinate their contraction for movements. Different
information carriers-hormones-instruct the endocrine glands on the timing and quantity of
secretion required for the desired effect. More than 50 hormones circulate in the blood
stream. The specific molecular structure of each hormone stimulates only cells with
suitable receptors on their
surface, instructing the cells to carry out certain procedures. In general nerves work fast
within
fraction of a second. Most hormones function over longer times within minutes, days or
even
months. Long-lasting effects as in growth of hormones are continuously secreted over
many years, as individual dose would last only few days.
As can be seen by the workings of the body clock, feeding information into the brains
processing center relies on more than the five senses. The continuing environmental adjustment
of the body
clock is one example of more subtle and complex sensory input within the body, There
are
thousands of micro receptors that continually monitor variables, for example oxygen,
waste carbon dioxide and blood glucose. These data feed to automatic or subconscious parts
of the brain, which make decision that, do not register in the conscious mind. In this way
a huge amount of information processing occurs, of which we are hardly ever aware.
2.3.1.Types of Neurons
The shapes and sizes of the bodies of neuron cells vary greatly as do the type,
number and length of their projections. Neurons are classified according to the number of
process that
extends from the cell body. Bipolar neurons are the original neuronal design in the embryo,
but
adulthood, they are found in only a few locations, such as the eyes ret ina and the olfactory nerve
in the nose. Most neurons in the brain and spinal cord are multipolar, unipolar neurons
are present mainly in the sensory nerves of the peripheral nervous system.
Unipolar Neuron: - A single short process, an axon extends from the cell body and splits
into tow.
Bipolar Neuron: - The cell body is located between two processes-an axon and a
dendrite.
Multipolar Neuron: -These have three or more processes several dendrites and one
axon.
2.4.ORIGIN OF BIOPOTENTIALS:
Nerve cells or neurons are excitable. When stimulated, they undergo chemical changes
that produce tiny traveling waves of electricity.- nerve signals or impulses. These pass to
other neurons, eliciting similar response from them.
Throughout the nervous system, information is conveyed as tiny electrical signals called
nerve impulses or action potentials. These impulses are the same all over the body about
100
milli volts in strength and lasting just 1 millisecond. The information carried depends on
their position in the nervous system, and their frequency from one impulse every few
seconds to several hundreds per second. Typically when a neuron receives enough pulses
from other neurons it fires one of its own as wavelike movements of ions (electrically
changed particles) impulses jump from one neuron to another at junctions known as synapses.
(myelinated),axons in which the action potential jumps along successively myelincoated sections from one node to the next.
2.4.5.Repolarization
Positively charged potassium ions flow in the opposite direction, restoring the charge
membrane and the next and so on. The impulse moves along the membrane as a wave of
depolarization and repolarization.
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2.4.6.4.Schwann cell: Sheet-like cell that grows around a portion of axon (fiber) to
form the
myelin sheath.
2.4.6.5.Myelin Sheath: Also called neurilemma or Schwann sheath; spiraling structure
of fatty myelin that helps to speed an impulse and prevent it fading or leaking.
2.4.6.6.Axon: Main nerve fiber of the neuron conveys impulses away from the cell body.
2.4.6.7..Neurotubule: Specialized micro tube that works as a conveyer
belt to bring synaptic vesicles from the cell body to the axon terminal.
2.4.6.8.Synaptic Knob: Enlarged end of axon terminal.
2.4.6.9Membrane Channel Protein: Complex protein embedded in cell membrane;
when enough ions flood through the channel they cause a response in the receiving cell.
2.4.6.9.Receptor: - Sits in membrane channel into which neurotransmitter molecules
slot, altering the shape of the channel to admit charged ions.
2.4.6.10.Synaptic Cleft: - Fluid-Filled gap between the sending and receiving neuron just 25
nanometers wide.
2.4.6.11.Microfilament: - Thinnest element of the flexible, supporting scaffolding found
in most cells.
Presynaptic Membrane: Membrane of sending cells axon.
Postsynaptic Membrane: Membrane of receiving cells dendrite.
2.5.Respiratory system
Respiratory system a pneumatic systeman air pump (diaphragm ) alternately creates negative and positive pressures in a
sealed chamber (thoriac cavity) and causes air to be sucked into and forced out of a
pair of
elastic bags (lungs).
The respiratory system supplies the oxygen needed by the body cells and carries off
their carbon dioxide waste.
Inhaled air passes via the trachea (windpipe) through two narrower tubes, the bronchi
to the lungs.
chambers called alveoli
Each lung comprises many fine, branching tubes called bronchioles that end in
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tiny clustered
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2.6.Urinary system
The urinary system filters waste products from the blood and removes them from
the body via a system of tubes.
Blood is filtered in the two kidneys which are fist-sized. Bean-shaped organs.
The renal arteries carry blood to the kidneys.
The renal veins remove blood after filtering
Each kidney contains about one million tiny units called nephrons.
Each nephron is made up of tubule and a filtering unit called glomerulus, which consists
of a collection of tiny blood vessels surrounded by the hollow Bowmans capsule.
The filtering process produces a watery fluid that leaves the kidney as urine.
The urine is carried via two tubes called ureters to the bladder where it is stored until
its release from the body through another tube called urethra.
2.7.Nervous system
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2.7.3.Brain stem
Brain stem- connects the spinal cord to the center of the brain just below the
cerebral cortex.
Essential parts
medulla oblongata
The pons
Midbrain
Diencephalon thalamus, hypothalamus.
2.7.4.spinal cord:
The spinal cord is a downward continuation of medulla oblongata
The cord consists of white matter on the surface and gray matter inside.
The cord containing motor and sensory fibres running between the brain and the
body and reflex action
Billions of specialized cells neurons are functionally active as signal transmitters
Fundamental property of neuron- is the ability to transmit electrical signals,
called nerve impulses in response to the changes in their environment
2.7.4.5.Neuron
A typical neuron consists of a nucleated cell body and has several processes or branches.
The size and distribution of these branches vary greatly at different sites in cells
with different functions, but two main kinds are the axon and the dendrite.
2.8.Endocrine system
The endocrine system works by using harmones which are carried through
circulatory system.
The harmones are generated in the endocrine glands.
The principal endocrine gland is PITUTIARY which governs several other
endocrine glands.
The pitutiary is controlled by hypothalamus.
The thyroid gland secretes thyroxin which increases the metabolism in the body.
The deficiency of thyroid gland secretes thyroxin which increases the metabolism
of the body.
The adrenal gland secretes corticoids and they regulates the metabolism of glucose.
A deficiency of insulin results in increase glucose in the blood which leads
the condition called diabetes.
2.9.Ear
The inner ear consist of the spiral-shaped cochlea and also the semicircular canals and
the vestibule which are the organs of balance.
Sound waves entering the ear travel through the auditory canal to the
tympanic membrane (ear drum) where they are converted to vibrations that are
transmitted via the ossicles to the cochlea.
Here the vibrations are converted by millions of microscopic hairs into electrical
nerve signal to be interpreted by the brain.
2.10.Eye
2.11.Body cells
Every one is made up of billions of cellsWhich are the structural units of the
body.bones, muscles, nerves, skin blood, and all other body tissues are formed from
different types of cells.Each cell has
an outer layer
(cell membrane)
and contains
fluid material(cytoplasm)Within the
cytoplasm
many specialized structures
called organelles.The
most important is the nucleus which contains vital genetic material.The structure of
DNA is like a spiral ladder.DNA contains genetic information and instruction codes
necessary for maintenance and continuation of life.In DNA we have four basic
materials.
They are - adenine, guanine, thymine and cytocine.Nucleus is centrally located.It
is separated from surrounding fluids by cell membrane.Protoplasm is present in
the cell.This
protoplasm
is composed
by
water,
electrolytes, protein,
lipids
and carbohydrates.
The principal fluid medium of the cell is water.Its concentration is about 7085 percent.Water serves as solvent for various chemicals to produce chemical
reactions.The inorganic chemicals for chemical reactions are provided by electrolytes.In
the electrolytes we have sodium ions, potassium ions, phosphate ions, sulphate ions,
bicarbonate ions and a small quantity of proteins.Proteins- structural proteins,
globular proteins.Lipids are composed of different types of phospho lipids and
Page
53
cholesterol.Carbohydrates play a major role in the nutrition of the cell. They are stored
in the cells in the form of glycogen
Page
54
which supplies energy needs for the cells. Ribosomes are also present in
the cystol.Lysosomes are vesicular organelles.
They provide an intracellular digestive system that allows the cell to digest and
thereby remove unwanted substances and damaged foreign structures such as
bacteria. The mitochondria organelles are called power house of the cell. The cell
extract significant amounts of energy from the nutrients and oxygen by means of
mitochondria. Nucleolus is present inside the nucleus. The size of the cell is in the range
of 5-10 micrometer.
Fluid is present inside the cell and outside the cell. This fluid is called intracellular
fluid and extra cellular fluid respectively. The extra cellular fluids contain large
amount of sodium ions and small amount of potassium ions. But in the intra cellular
fluid it is vice versa.
The concentration of phosphates and proteins are more in intracellular fluid.
Concentration of chloride ions are more in extra cellular fluid. a lipid bilayer is present in
the cell membrane. This consists of large number of protein molecules are present in
the cell membrane.
The cell membrane constitutes a barrier for the movement of the water soluble su
bstances between the extra cellular and intracellular fluid organs. With the help of
diffusion process transport of substances take place. This type of transport is
called passive transport. Ions like sodium potassium, calcium, chloride and most
amino acids are actively transported through cell membrane..
The active transport can be subdivided into two types according to the source of energy used
to cause the transport. They are primary active transport and secondary active transport.
Roughly (2/3) of the body is composed of water and the various essential
substances dissolved within it. These fluids have innumerable vital roles within many body
systems. They
are found in cells, around the bodys tissue and most obviously in blood and lymph.
Most body parts are largely composed of water. Tissues are 70-80% fluid which means
that organs such as the brain and intestines are typically three quarters water. Blood plasma is
over
90% water while bones contain almost 25%. Fat has 10-50% water composition.
3.2.Fluid Compartments
Prepared by A.Devasena., Asso. Prof.,
Dept/ECE
Page
55
The bodys different fluids can be grouped into physiological categories that are known
as compartments. There are two major fluid compartments intracellular and extra cellular.
Intracellular fluid (also known as cytoplasm) is found within the bodys cells. Extracellular fluid
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56
accounts for all other fluids in the body. Its sub compartments are interstit ial fluid,
which occupies the spaces between cells and tissues; blood plasma and lymph. The fluids
found in
bones, joints and dense connective tissue; and Trans cellular fluid which includes saliva and
other digestive juices, mucus, sweat and urine.
3.3.Function of fluids
Water is excellent solvent. Thousands of substances that are dissolved in it are used in the
bodys biochemical reactions. These reactions are the very basis of life. Water is also an
effective transport system. It moves around the body distributing nutrients and collecting
and delivering waste materials. Fluids spread heat from active parts of the body, such as
exercising muscles, to cooler areas and in doing so they aid I thermoregulation. The body
uses fluid as shock absorbers to cushion sensitive areas such as brains, the eyes and the spinal
cord. Fluid also works as lubricants within the body, so that tissues and organs slip past each
other with minimal friction. Small amount of specific fluids that specialize in this role
include the pleural fluid around the lungs, the pericardial fluid around the heart and the
synovial fluids inside joints.
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41
Blood plasma
and lymph
cycle:Blood plasma
leaks out from
capillaries to
become
interstitial fluid.
Page
58
3.6.2.What is Blood?
th
Blood forms about 1/10 of the body weight of an adult amounting to 5 liters in
volume. Roughly 50-55% of blood plasma consists of the liquid-only portion in
which cellular components are distributed. Plasma is 90% water containing dissolved
substances such as glucose (blood sugar) hormones, enzymes and also waste products such as
urea and lactic acid. Plasma also contains proteins such as albumins, fibrinogens (important
in blood clotting) and globular proteins or globulins. Alpha and beta globulins help to
transport lipids, which are fatty substances such as cholesterol. Gamma globulins are mostly
the disease fighting substances known as antibodies. The remaining 45-50% of blood is
made up of three types of specialized
cells. Red cells or erythrocytes carry oxygen; various white cells known as leucocytes are part
of the defense system; and cellular fragments (platelets or thrombocytes) are involved in
the process of clotting.
3.6.3.Parts of Blood
Blood is made up of liquid portion (plasma) red blood cells, a small band of platelets and white
blood cells.
Red Blood Cell Structure:
A biconcave disc with no nucleus or discrete nibble inner structure, each red blood cell
contains 300 millions hemoglobin molecules.
Role of Hemoglobin:
Hemoglobin is composed of hem, an iron-rich pigment and globins, ribbon-like
protein chains. Oxygen in the lungs latches onto hem to make oxyhemoglobin. In this
conjoined form, oxygen travels through the blood stream to all parts of the body.
3.7.Blood Groups
Every individual belongs to one of four blood groups which are determined by markers or
red blood cells known as antigens (agglut inogens). The antigens may be either A, B, both
(AB)
or neither (O) and blood groups are named correspondingly. Plasma contains different
ant ibodies (isohemoagglustinins). For example, a person with blood group A has plasma
containing B antibodies. If mixed with type B blood with A antibodies in its plasma) A
antibodies clump
(agglutinate) with A antigens. This is the reason why blood types must be matched to transfuse
blood safely from donor to
recipient.
Blood Group A
A Antigen; B - Antibody
Blood Group B
A - Antibody; B - Antigen
Blood Group AB
A & B Antigen with neither
A or B in Plasma
Blood Group O
Lack of A & B antigen but plasma
contains both A & B antibodies.
3.7.1Arteries
Arteries carry blood away from the heart towards organs and tissues. Apart from the
pulmonary arteries, all arteries carry oxygenated blood. Their thick walls and muscular and
elastic layers can withstand the high pressure that occurs when the heart contracts. An
artery narrows when the heart relaxes, helping to push blood onwards. The largest artery is
aorta.
3.7.2.Veins
A vein is more flexible than an artery and its walls are considerably thinner. The blood
inside
a vein veins
is under
relativelythe
lowlong
pressure
as alegs
result,
it flows
slowly
Many
particularly
veinsand
in the
contain
valves
thatand
aresmoothly.
formed from
pouch larger
like pockets of single cell lining tissue (endothelium). These prevent blood flowing back
down the legs; a job helped by muscles around the veins that contract during movement. The
two main veins returning from the upper and lower halves of the body are known as the
superior and inferior vena cava.
3.7.4.Capillaries
The smallest and most numerous of the blood vessels capillaries convey blood between arteries
and veins. Many capillaries enter tissue to form a capillary bed, the area where oxygen and other
nutrients are released. Capillary bed connects small arteries (arterioles) to veins (venules).
3.8.Cellular Respiration
Glucose (blood sugar) is the bodys main energy source. Cellular respiration occurs in
every body cell when oxygen reacts with glucose to free its energy in chemical fo rm. The
end products are carbon dioxide and water, which is known as metabo lic water and amounts to
about
300ml daily throughout the body. The whole process is called aerobic (oxygen requiring)
cellular or internal respiration.
3.8.Respiration Reaction
Cells take up oxygen to drive the key respiration reaction that release energy from glucose.
Page
62
Page
63
Step5: Bright red, oxygenated blood leaves heart along the aorta (the bodys main artery) and
circulates through a network of arteries to the bodys tissues.
Step6:
Oxygenated blood is carried through the tissues in capillaries thinner than hair.
Step7:
Arriving red blood cells are rich in oxygen, which is bound to hemoglobin in the
body of
e
a
c
h
c
e
ll
.
S
t
e
p
8
:
Oxygen leaves the hemoglobin within the red blood cells, diffuses across
the blood
capillary walls and into
tissue cells. Step9:
Carbon dioxide diffuses out of tissue cell, across wall of blood capillary and
into blood plasma.
3.9.Blood Pressure
The heart is a dynamic, untiring, precisely adjustable double-pump that forces blood
around the bodys immense network of blood vessels, perhaps more than three billion times
during lifetime. The hearts power comes from its two lower chambers (ventricles) which have
thick muscular
walls. That contact to squeeze blood out into the arteries. The upper chamber
(arter
ial)
have
thinn
er
walls
and
functi
on
partly
as
passi
ve
reser
voirs
for
blood
oozin
g in
from
the
main
veins.
Each
heart
beat
has
two
phase
s. In
the
first
phase
(diast
ole)
the
heart
relax
es
and
refills
with
blood
;
durin
g the
secon
d
stage
(syst
ole)
it contracts, forcing the blood out. The whole cycle takes on average less than second.
During vigorous activity or stress, both beating rate and the volume of blood pumped
out of the heart increases greatly.
3.9.1.Relaxation
Diastole)
(Late
During this phase of the heart beat sequence, the muscular walls of the heart
relax the
arteri
al
cham
bers
ballo
on
slight
ly as
they
fill
with
blood
comi
ng
under
quite
low
press
ure
from
the
main
veins.
Deox
ygena
ted
blood
from
the
body
enter
s the
right
atriu
m,
while
oxyg
enate
d
blood from the lungs enters the left atrium. Some of the blood in the atria flows down into
the ventricles. By the end of this phase, the ventricles are filled to 80% of capacity.
3.9.3.Contraction
Systole)
of
the
ventricles
(Ventricular
During this most active and powerful stage of the heartbeat, the thick cardiac muscle in
the ventricle walls contracts stimulated by electrical impulses relayed by the atrio
-ventricular node, this cause a rise in ventricular pressure, which opens the aortic and
pulmonary valves at the exits of the ventricles. Blood is force out into the main arteries,
making the atrio -ventricular valves snap shut.
Page
67
Electrical Impulses
Electrical impulses spread over surface of both atria, stimulating them to
contract.
Page
68
important role in the blood coagulation process. There are usually 250,000 750,000
platelets in every cubic mm of blood. They are colorless and have no nucleus.
By spinning blood in a centrifuge, the blood cells can be sedimented. The
blood plasma with the blood cells removed is a slightly viscous, yellowish liquid that
contains large amounts of dissolved proteins. One of the proteins fibrinogen,
participates in the process of blood clotting and forms thin fibers called fibrin. The
plasma from which the fibrinogen has been removed by precipitation is called blood
serum.
Blood clotting can be inhibited by the injection of
natural anticoagulant extracted from the liver and lungs of cattle.
heparin,
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71
When whole blood is centrifuged, the blood cells sediment and form a
packed volume at the bottom of the test tube. Most of this column consists of the red
blood cells, with the other cells forming a thin buffy layer on the top of the red cells.
The volume of the packed red cells is called the hematocrit. This is expressed as a
percentage of the total blood volume.
The hematocrit can be determined by aspirating a blood sample into a
capillary tube and closing one end of the tube with a plastic sealing material. The tube is
then spun for 3 to 5 minutes in a special high-speed centrifuge to separate the blood
cells from the plasma. Because the capillary tube has a uniform diameter, the blood
and cell volumes can be compared by measuring the lengths of the columns. This is
usually done with a simple nomogram.
The red blood cells have a much higher electrical resistivity than the blood plasma
in which they are suspended and so the resistivity of the blood shows a high correlation
with the hematocrit.
Manual blood cell counts are performed by using microscope. For this, the blood is
first diluted 1 :100 or 1:200 for counting of red blood cells (RBC) and 1:10 or 1:20 for
white blood cell count (WBC). For counting WBC, a diluents is used that dissolves the
RBCs, whereas for counting RBCs, an isotonic diluent preserves these cells. The diluted
blood is then brought into a counting chamber of 0.1mm deep, which is divided by
marking lines into a number of squares, when magnified about 500 times, the cells in a
certain number of squares can be counted.
Today simple RBC and WBC counts are normally performed by automatic or
semiautomatic blood cell counters. The most commonly used devices of this kind
are based on the conductivity(coulter) method, which makes use of the fact that blood
cells have a much lower electrical conductivity than the solution in which they are
suspended. Such a counter contains a beaker with the diluted blood. A closed glass tube
that contains a very small orifice is placed inside the diluted blood. The
conductance between the solution in the glass tube and the solution in the beaker is
measured with two electrodes. The result is a pulse at the output of the conductance
meter, the amplitude of which is proportional to the volume of the cell.
1. First Contact
2. Second Contact
3. Suction Pump
4. Electrodes
( Platinum)
Conductivity
meter
Threshold unit
2
1
Pulse gate
BLOCK gives
start stop signal to
counter
counter
A threshold circuit lets only those pulses pass that exceed a certain amplitude
gate. The first contact and closes when it reaches the second contact. Thus counting
the number of cells contained in a given volume, of the solution passing through the
orifice. A count is completed in less than 20 seconds. With counts of upto 100,000 the
result is statistically accurate. Care must be taken to keep the aperture from clogging.
From these measurements, the mean cell volume, the mean cell hematocrit and mean
cell hematocrit concentration are calculated and the corresponding results are taken out
on a preprinted report form.
Blood gas analyzers are used to measure the p , partial pressure of carbon dioxide
(pCO2) and partial pressure of oxygen (pO2) of the body fluids with special reference to
H
the human blood. A sudden change in the p and pCO2 could result in cardiac arrhythmias
, ventricular hypotension and even death.
4.2.2.Acid- base balance:
H
The normal p of the extra cellular fluid lies in the range of 7.35 to 7.45 indicating
H
that the body fluid is slightly alkaline. When the p below 7.35, it indicates acidosis. When
H
the p
exceeds 7.45, the body is considered to be alkalosis. With the help of three physiological
mechanisms as
Respiration
Excretion into urine by kidneys
Buffering by chemical means
H
it is possible for us to analyze the deviation of p of the blood.
The blood and tissue fluids contain chemical buffers, which react with added acids
and bases and minimize the resultant change in hydrogen ions.
The respiratory system can adjust sudden changes in carbon dioxide, tension back
to normal levels in just a few minutes. Carbon dioxide can be removed by increased breathing
and therefore hydrogen concentration of the blood can be effectively modified. The kidney
requires many hours to readjust hydrogen ion concentration by excreting highly acidic or
alkaline urine to enable body conditions to return towards normal condition.
Arterial blood has a pH of approximately 7.40. Venous blood acquires carbon
H
dioxide forms carbonic acid and hydrogen ions, the venous blood p falls to approximately
7.36. this pH drop of 0.04 units occurs when the CO2 enters the tissue capillaries. When CO2
diffuses from pulmonary capillaries into the alveoli, the blood pH rises 0.04 units to bring
the normal atrial
value of 7.40. it is difficult to measure the pH of fluids inside the tissue cells, but from
estimates based on CO2 and HCO3 ion concentration, intracellular pH probably ranges from 7.0
to 7.2.
The three important chemical factors regulating alveolar ventilation are the
+
arterial concentration of CO2, H and O2. Carbon dioxide tension in the blood stream and
cerebrospinal fluid (CSF) is the major chemical factor regulating alveolar ventilation.
4.2.3.Gas exchange and distribution:
Once air is in the lungs, oxygen and carbon dioxide must be exchanged between the air
and the blood in the lungs and between the blood and the cells in the body tissues. These
gases must be transported between the lungs and the tissue by the blood.
The mixing of gases within the lungs ventilation of the alveoli and the exchange
of oxygen and carbon dioxide between air and blood in the lungs takes place through a
process
called diffusion. Diffusion is the movement of gas molecules from a point of higher pressure
to a point of lower pressure to equalize the pressure difference. This process can occur when
the gas is unequally distributed in a chamber on two sides of membrane permeable to that gas.
Measurements required for determining the amount of diffusion involve the
partial pressures of oxygen and carbon dioxide, pO2, pCO2, respectively.
Methods for analyzing pO2, pCO2
Chemical analysis method
Diffusing capacity using CO infrared analyzer
Gas chromatograph.
4.2.4.1.Gas Chromatograph:
The quantities of various gases in the expired air can also be determined by means of
a gas chromatograph, an instrument in which the gases are separated as the air passes
through a
column containing various substances that interact with the gases. The reactions cause
different gases to pass through the column at different times. The quantity of each gas is
measured as it
emerges. To identify the gases in the expired air other than oxygen nitrogen or CO 2, a
mass spectrometer is used in conjunction with the gas chromatograph. The mass
spectrometer identifies the ions according to their mass/charge ratio.
With the help of this analyzer, it is possible to measure O 2,CO2,p and bicarbonate
in arterial blood. If we try to measure the diffusion of oxygen from the aleovli, into the blood,
it is
usually assumed that all alveoli have an equal concentration of oxygen. Actually this
condition does not exist because of the unequal distribution of ventilation in the lung,
hence the terms
diffusing capacity or transfer factor (rather than diffusion) is used to describe the transfer
of oxygen from the alveoli into the pulmonary capillary blood.
Carbon mono oxide (CO) resembles oxygen in its solubility and molecular weight
and also combines with hemoglobin reversibly. Its affinity for hemoglobin is about 200 to 300
times that of oxygen. Carbonmonooxide can thus be used as a tracer gas in measuring the
diffusion capacity of the lung. It passes from the alveo lar gas into the alveolar walls, then into
the plasma from which it enters the red blood cells where it combines with hemoglobin
1 / TF = 1/ Dm + 1/Vc
Where TF = diffusing capacity for the lung for CO.
Dm = diffusing capacity for alveolar membrane
Vc = volume of blood in the capillaries.
= reaction rate of CO with oxyhemoglobin.
TF, the diffusing capacity for the whole lung in normal adults ranges from 20 to 38 ml/min/mm
HG during exercise, and decreases with anemia or low hemoglobin.
In the single-breath method, the last 75 to 100 ml of the expired air is collected so
that enough end-tidal air containing CO is available for the measurement. CO in the
blood is negligible, for it combines with the hemoglobin I the red blood cells and exerts no
significant back pressure. The commonly used carbon mono oxide analyzer utilizes an
infrared energy source, a beam chopper, sample and reference cells, plus a detector and
amplifier. A milli ammeter or a digital meter may be used for display. Two infrared beams are
each measured by a differential infrared detector. The output signal is proportional to the
amount of monitored gas in the sample cell. The signal is amplified and presented to the
output display meter or to a recorder.
4.3.1.Parts of Lung :
Nasal cavity:
Main route for air to and from the lungs, lined with a sticky mucus covered
membrane that traps dust particles and germs; divided into two by central plate of cartilage
(nasal septum)
fuzzy looking patches (olfactory epithelia)in roof of cavity are the sensory organs of smell.
Nose hairs:
Situated inside entrance of nostrils help in filter large particles of dust and debries.
Epiglotis:
Cartilage flap that tilts over entrance to larynx when swabling to prevent food and drink
and saliva entering trachea.
Larynx:
Short cartiginous tube joining pharynx with trachea together with vocal cards within the
larynx, it has a vital role in speech production.
Rib:
Twelve pairs of ribs curve around chest and protect lungs and heart from physical
damage.
Intracostal muscles:
Double layer of muscles between each pairs of ribs; external layer lifts ribs up and
out during contraction enlarging the lungs to that air is breathed in; inner layer does the
opposite forcing air out.
Right lung:
Slightly larger than the left lung, averaging 55 -60 percent of total lung volume.
Pleural cavity:
Space occupied by the lings; lined
Pleural membrane:
Sac composed of two thin membrane layer encloses each lung; fluid secreted by one
of the membranes allows them to slide smoothly over each other during breathing.
Diaphragm:
Dome-shaped muscle that divides chest and abdomen and together with inter costal
muscles from bodys main breathing muscle; during contraction it flattens and increases size of
chest cavity.
Nasopharynx:
Allows the passage of air only.
Oropharynx:
Permits passage of foods and fluids.
Pulmonary artery:
Thick-walled vessel that transports deoxygenated blood lungs from right side of heart.
Pulmonary vein:
Vessel carrying bright red oxygenated blood from each lung to left side of heart
for supply to the rest of the body.
Primary bronchus:
One of the five branches of the primay bronchus each one supplies a defined segment
of the lung, bronchus further divides into air ways of diminishing diameter called tertiary
bronchi.
Lobes of Left lung:
Has only two lobes, to make room for heart (right lung is tri-lobed)
Bronchioles:
ends.
Miniscule terminals of the bronchi; gas exchange occurs in tiny sacs (alveoli) at their
Heart :
Nested in the pericardial cavity.
Pericardial cavity:
Formed mainly by a scoop like shape in the left lung.
Alveoli:
The lungs microscopic air sacs, alveoli are elastic thin walled structures arranged in clumps
at the ends of respiratory bronchioles. They resemble bunches of grapes, although the alveoli
are partly merged with each other. White blood cells known as macrophages are always
present on their surfaces, where they in digest and destroy air borne irritants such as
bacteria, chemicals and dust.
Around the alveoli are networks of capillaries. Oxygen passes from the air in the
alveoli into the blood by diffusion through the alveolar and capillary walls. Carbon di oxide
diffuses from blood into the alveoli. There are more than 00 million alveoli in both lungs.
Breathing and vocalization:
The movements of breathing also known as bodily respiration, bring fresh air
containing oxygen deep into the lungs and then remove stale air containing the waste
product carbon di oxide.
4.3.2.Breathing:
The physical movement of air into and out of the lungs is generated by differences in
pressure within the lungs compared to the surrounding atmospheric pressure. The
pressure differences are produced by forcefully expanding the chest and lungs by muscular
action and then passively allowing them to return to their former size. The rate and depth of
breathing can be consciously modified. However the underlying need to breathe is controlled by
ares within the brain stem, where responses to regulate the breathing muscles (of which we
are usually not aware) occur according to the levels of carbon dioxide and oxygen in the blood.
4.3.2.1.Diaphragm movement:
The abdominal contents are flattened by the diaphragm muscle during inhalation and then
rise up during exhalation.
4.3.2.2 Inhalation:
The chief muscles used in respiration at rest are the diaphragm at the base of the chest
and the external intercostal between the ribs. For forceful inhalation, additional muscles assist
in
moving the ribs and sternum to expand the chest further and stretch the lungs even more.
4.3.2.3.Volume and pressure:
Breathing alters the volume of the chest (thoracic activity). The lungs suck onto the inner
chest wall, so that as the cavity expands, they also become larger. The main expanding forces
are provided by the diaphragm and intercostal muscles. At rest, the diaphragm carries out
most of
the work. 0.5 liters of air the tidal volume-shifts in and out with each breath 912 to 1
times
every minute) rate and volume increases automatically if the body needs more oxygen as
during
exercise. Then forced inspiration can suck in an extra liters and forced expiration expels
almost as much leading to a total air shift or vital capacity, of more than .5 liters in a large
healthy adult. The breathing rate can be ripple producing a total air exchange more than times
greater than at rest.
4.3.2.4.Breathing in:
The diaphragm contracts to become less dome like while the ribs swing upward and
outward with a bucket handle action to raise the sternum.
4.3.2..5Breathing out:
The diaphragm relaxes and the elastic stretched lungs recoil to become smaller again,
allowing the sternum and ribs to move down and inward.s
Prepared by A.Devasena., Asso. Prof.,
Dept/ECE
Page
59
Negative pressure:
Page
59
Respiratory Reflexes:
The two important respiratory reflexes are coughing and sneezing. Both aim to
blow out excess mucus, dust irritants and obstructions- coughing from lower pharynx, larynx,
trachea and lung air ways and sneezing from nasal chambers and naso-pharynx. In both
cases, a deep inhalation is followed by sudden contraction of the muscles involved in forceful
exhalation. For a cough, the lower pharynx, epiglottis and larynx close so that air pressure
builds up in the lungs and is released explosively, rattling the vocal cords. In a sneeze, the
tongue closes off the mouth to force air up and out through the nose.
4.4.Spirometry:
Flow-Volume loop showing successful FVC maneuver. Positive Values represent
expiration, negative values represent inspiration. The trace moves clockwise for
expiration followed by inspiration. (Note the FEV1, FEV1/2 and FEV3 values are arbitrary
in this graph and just shown for illustrative purposes, they must be recorded as part of the
experiment).
Page
82
Page
83
The most commonly used guidelines for spirometric testing and interpretation are set by
the
American Thoracic Society (ATS) and the European Respiratory Society
(ERS).
Procedure
The basic FVC test varies slightly depending on the equipment
used.
Generally, the patient is asked to take the deepest breath they can, and then exhale into the
sensor as hard as possible, for as long as possible. It is sometimes directly followed by
a rapid inhalation (inspiration), in particular when assessing possible upper airway
obstruction. Sometimes, the test will be preceded by a period of quiet breathing in and out
from the sensor (tidal volume), or the rapid breath in (forced inspiratory part) will come
before the forced exhalation.
During the test, soft nose clips may be used to prevent air escaping through the nose.
Filter mouthpieces may be used to prevent the spread of microorganisms, particularly for
inspiratory maneuvers.
Limitations of test
The maneuver is highly dependent on patient cooperation and effort, and is normally repeated
at least three times to ensure reproducibility. Since results are dependent on patient
cooperation, FEV1 and FVC can only be underestimated, never overestimated.
Due to the patient cooperation required, spirometry can only be used on children old enough
to comprehend and follow the instructions given (typically about 4-5 years old), and only
on patients who are able to understand and follow instructions - thus, this test is not
suitable for patients who are unconscious, heavily sedated, or have limitations that would
interfere with vigorous respiratory efforts. Other types of lung function tests are available
for infants and unconscious persons.
Related tests
Spirometer can also be part of a bronchial challenge test, used to determine bronchial
hyper responsiveness to either rigorous exercise, inhalation of cold/dry air, or with a
pharmaceutical agent such as methacholine or histamine.
Sometimes, to assess the reversibility of a particular condition, a bronchodilator is
administered before performing another round of tests for comparison. This is commonly
referred to as a reversibility test, or a post bronchodilator test (Post BD), and is an important
part in diagnosing asthma versus COPD.
Explanation of common test values in FVC tests Abbreviation
Name Description
FVC Forced Vital Capacity This is the total amount of air that you can forcibly blow out
after
full inspiration, measured in
liters.
4.5.Temperature Measurements:
Body temperature is one of the oldest known indicators of the general well being of a
person. Techniques and instruments for the measurement of temperature have been
common
place in home. Two basic types of temperature measurements can be obtained from the
human body. Systematic and skin surface measurements. Both provides valuable diagnostic
information although the systematic temperature measurement is much more commonly used.
4.5.1.Temperature Regulation:
One of the skins functions is to contribute to thermo regulation maintenance of a
constant body temperature. It does this in three main ways: Widening and narrowing of
blood
vessels, sweating and hair adjustments, if the body becomes hot, blood vessels in the
dermis widen (vasodilate) to allow extra blood flow so more warmth can be lost from the
surface. The skin may look flushed, and sweat oozes from sweat glands and evaporates ,
drawing away body heat. If the body is cold, the peripheral blood vessels (vasoconstrict) to
minimize heat loss and
sweating is reduced. Tiny body hairs are pulled upright by the erector pili muscles to trap air
as an insulating.
Feeling cold ( Hair stands more upright)
Tiny body hairs, raised by the contraction of the erector pili muscles, create small
mounds known as goose pimples at their bases, the peripheral blood vessels constrict and
sweat reduce their activity.
Feeling Hot (Hair Lies Flatter)
Tiny body hairs lie flatter as the erector pili muscles relax, and the small mounds at their
bases disappear. Dermal blood vessels dilate , increasing blood flow and the sweat glands
raise their o/p.
Ultraviolet Defences:
The suns rays include a spectrum of colour wavelength including infra red or IR rays (
the warming component) and ultraviolet, UV rays. Both UV-A and UV-B wavelengths
are invisible to human eyes, but exposure to the latter in particular is linked to forms of skin
cancer.
Skins self-defence is its dark colouring substance or pigment, melanin. This forms a screen in
the upper epidermis that shields the actively multiplying cells in the base of the epidermis.
Melanin Production:
Melanocytes are melanin- producing cells in the base of the epidermis, They make parcels of
melanin granules melanosomes which pass inti surrounding cells.
Skin Pigmentation:
Skin colour depends on the type and quantity of two main melanin pigmentsreddish
pheomelanin and brown-black eumelanin. Darker skin has layer melanocytes with
more melanosomes which break down to give even pigmentation through skin cells. Lighter
skin has smaller melanocytes and grouped melanosomes. Exposure to UV light stimulates
melanocytes so the skin becomes darker or tanned.
4.6.Systematic Temperature:
It is the temperature of the internal regions of the body. This temperature is maintained through
a
carefully controlled balace between the heat generated by the active tissues of the body
mainly
the muscles and the liver and the heat lost by the body to the environment. Measurement
of systemic temperature is accomplished by temperature sensing devices placed in the mouth,
under the arm pits or in the rectum. The normal oral (mouth) temperature of a healthy person
Prepared by A.Devasena., Asso. Prof.,
Dept/ECE
Page
63
is about
31 C . The under arm temperature is about 1 degree lower, whereas the rectal temperature
is about 1 degree higher than the oral reading.
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63
Systemic temperature is not affected by the ambient temperature, even if the latter
drops to as low as - 18 C(0 F ) or rises to over 38 C(100 F ) . This balance is upset only
when the metabolism of the body cannot produce heat as rapidly as it is lost or when the
metabolism of the body cannot produce heat as it is lost or when the body cannot rid itself of
heat fast enough.
The temperature control center for the body is located deep within the brain . Here the
temperature of the blood is monitored and its control functions are coordinated. In
warm, ambient temperatures cooling of the body is aided by production of perspiration due to
secretion of the sweat glands and by increased circulation of the blood near the surface. In this
manner, the body acts as a radiator. If the external temperature becomes too low, the body
conserves heat by reducing blood flow near the surface to the minimum required for
maintenance of the cells. At the same time metabolism is increased. If these measures are
insufficient , additional heat is produced by increasing the tone of skeletal muscles and
sometimes by involuntary contraction of skeletal muscles(shivering) and of the arrector muscles
in the skin (gooseflesh).
In addition to the central thermostat for the body, temperature sensors at the surface
of the skin permit some degree of local control in the event a certain part of the body is
exposed to local heat or cold. Cooling or heating is accomplished by control of the surface
blood flow in the region affected.
Derivation from the temperature control is a rise in temperature. This is known as fever,.
This fever can be experienced with cerrain types of infection. If the heat elimination
mechanism gets affected means, we will get fever. The body temperature increases due to the
thermostat in the brain were suddenly turned up. Because of this, additional metabolism
occurred, this will accelerate the chemical reactions of the body. The increase in
temperature can be analysed through the skin. The skin is often pale and dry shivering
usually takes place and the skin muscles react to coolness. Finally as the body
temperature is lowered to normal increased sweating (breaking of the fever) is observed as
the means by which the additional body heat is eliminated. Surface or skin temperature is
also a result of balance. The skin temperature is a function of the surface circulation in a
local area and the cooling of that area by conduction, radiation convection and evaporation.
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90
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91
Thermocouple and thermistor are the two types of electronic temperature sensing
devices used in thermocouple, a junction of two dissimilar metals that produce an o/p
voltage nearly proportional to the temperature at that junction with respect to a reference
junction.
Thermistor a semiconductor element whose resistance varies with temperature.
Thermistors are used more frequently than thermocouples. This preference is primarily
because of the greater sensitivity of the thermistor in the temperature range of interest
and the requirement for a reference junction for the thermocouple.
Thermistors are variable resistance devices formed into disks, beads , rods or other
desired shapes. They are manufactured from mixtures of oxides (sometimes sulphates
or silicates) of various elements such as nickel, copper, magnesium, manganese, cobalt,titanium
and aluminium. After the mixture is compressed into shape, it is sintered at a high temperature
into a solid mass. The result is a resistor with large temperature coefficient. The relationship
betwee n
resistance change and temperature change is nonlinear. The
Rt1 of a thermistor at a
resistance,
1
1
given temperature T1 can be determined by Rt1 Rt 0e the non linear characteristics of
T1 T0
the thermistor can be overcome by the instrumentation circuit in which the resistance
is measured often incorporates special linearizing circuits. Some of the other problems occur
when we use
thermistors, as the danger of error due to self heating, the possibility of hysterisis and
the
changing of characteristics because of aging. If the power dissipation of the thermistor can
be kept to about a milliwatt, the error should not be excessive, even when temperature
differences as small as 0.01 C are sought. Self heating effect can be reduced by limiting
the amount of
current used in measuring the resistance of the
thermistor.
Skin Temperature Measurements:
The systemic temperature remains constant throughout the body, skin temperatures can
vary several degrees from one point to another. The range is usually from about 30
to
35 C(85to95 c) . The purpose of using skin temperature measurements is to detect or
locate defects in the circulatory system by showing differences in the pattern from one side of
the body to the other.
Skin temperature measurements from specific locations on the body are frequently made
by using small flat thermistor probes taped in the skin. The simultaneous readings from a
number of these probes provide a means of measuring changes in the spatial
characteristics of the circulatory pattern over a time interval or with a given stimulus.
The human skin also emits infrared radiation. With the help of infrared thermometer, it
is
possible to measure the infrared radiation. For measuring this infrared radiation, the patient
has to be allowed to remain in a room at about 21 C(70 F ) without clothing over the area
to be measured. Infrared thermometers can be used to detect the areas of poor circulation a
nd other sources of coolness. They can also be used to locate breast cancer other unseen sources
of heat.
An extension of this method of skin temperature measurement is the thermograph. A
thermograph is a device in which an infrared thermometer is incorporated into a scanner so
that the entire surface of a body or some portions of the body is scanned in much the same way
that a television camera scans an image, but the process is little bit slower. The scanner scans
the body
the infrared energy is measured and used to modulate the intensity of a light beam that
produces a map of the infrared energy on photographic paper. This presentation is known as
thermogram. The advantage of this method is that relatively warm and cool areas are
immediately evident.
4.7.Measurement of pulse:
When the heart muscles contracts, blood is ejected from the ventricles and a pulse of
pressured is transmitted through the circulatory system. A vessel-wall displacement is caused
by
vessels when the pressure pulse is traveling. The pulse can be measured at various points of
the peripheral circulatory system. We can analyze the pulse rate if we keep the finger tip
over the radial artery in the wrist or some other location where an artery seems just below the
skin. The timing and wave shape of the pressure pulse are diagnostically important because
they provide correct information.
The pulse gives the measure of pulse wave velocity and can be reduced and
compared with the ECG signal. The pulse wave travels at 5 to 15 m/s depending on the size
and rigidity of
the arterial walls, the larger and more rigid the artery walls, the greater the velocity. The
velocity is 10-15 times faster than blood flow and is relatively independent of it.
The methods used for the detection of volume(pulse) changes due to blood flow
are: (i) optical changes (changes in density)
(ii)
Electrical impedence changes
(iii)
Strain gauge or microphone (mechanical)
The most common used method to measure plusatile blood volume changes is by
the
photoelectric method . Two methods are common : Reflectance method and
transmittance method.
In the transmittance method, a light emitting diode (LED) and photoresistor are
mounted in an enclosure that fits over the tip of the patients finger. Light is transmitted through
the finger
tips of the subjects finger and the resistance of the photoresistor is determined by the amount of
light reaching it. With each contraction of the heat, blood is forced to the extremities and
the
amount of blood in the finger increases. This alters the optical density with the result that
the light transmissions through the finger reduce and the resistance of the photo resistor
increases accordingly. The photo resistor is connected as part of the voltage divider circuit and
produces a voltage that varies with the amount of blood in the finger. This voltage that
closely follows the pressure pulse and its waveshape can be displayed on an oscilloscope or
recorded on a strip chart.
An electric impedance method measures the impedance change between two
electrodes caused by the changes in blood volume between them. The change in impedance
(0.1 ohm) may be small as compared to the total impedance (several hundred ohms) . An
alternating current is applied between electrodes that are attached to the body. With this set
the impedance can be measured. An alternating signal (10- 100khz) is used (rather than dc) in
order to polarization of the electrodes.
The mechanical method involves the use of a strain gauge connected to a rubberband placed around a limb or finger. Expansion in the band due to change in blood volume
causes a
change in resistance of the strain gauge. In some other technique, a sensitive crystal microphone
is placed on the skins surface to puck-up the pulsation.
A piezo electric crystal can also be used to detect the pulse wave at certain places of
the peripheral system, where considerable displacement of the tissue layer above the
artery is involved. A piezo electric crystal is clamped in a hermetically sealed capsule
subject to displacement stresses. The displacement can be transmitted to the crystal through a
soft rubber diaphragm. The crystal can be connected to an ECG recorder for recording the
pressure pulse measurement.
4.8.Cardiac output:
The blood flow at any point in the circulatory system is the volume of blood that passes
that point during a unit of time. It is normally measured in millimeters per minute or liters
per minute. Blood flow is highest in the pulmonary artery and the aorta, where these blood
vessels leave the heart. The flow at these points called cardiac output is between 3.5 and 5
litres/min in a normal adult at rest. On the other hand in the capillaries blood flow can be slow
, that the travel of individual blood cells can be observed under a microscope.
With the help of cardiac output or the blood flow in a given vessel, it is possible for us to
calculate so many other variables. The cardiac output divided by the number of heart beats
per minute gives the amount of blood that is ejected during each heart beat, it is known as
stroke volume. If the total amount of blood circulation is known and this stroke volume is
divided by the cardiac output, the mean circulation time is obtained. From the blood flow
through a vessel , divided by the cross sectional area of the vessel, the mean velocity of the
blood at the point of measurement can be calculated.
In the arteries, blood flow is pulsatile. In fact, in some blood vessels, a reversal of
the flow can occur during certain parts of the heart beat cycle. Because of the elasticity of their
walls the blood vessels tend to smooth out the pulsations of blood flow and blood
pressure. Both pressure and flow are greatest in the aorta where the blood serves the heart.
Blood flow is a function of the blood pressure and flow resistance of the blood vessels
in the same way as electrical current flow depends on voltage and resistance. The flow
resistance of the capillary bed can vary ever a wide range. The body reduces the blood flow
through the skin by means of vasoconstriction (narrowing) of the capillaries . This symptoms
occur whenever a body is exposed to low temperatures or under the influence of certain drugs
(eg: nicotine)
Vasodilation (widening) of the capillaries occur when heat excitement or
local inflammation among other things, this increases the blood flow locally. Wide variations
that are possible in the flow resistance, the determination of blood pressure along is not
sufficient to access the status of the circulatory system.
The velocity of blood flowing through a vessel is not constant throughout the
cross section of the vessel but is a function of the distances from the wall surface. A thin layer
of blood actually adheres to the wall, resulting in zero velocity at this place, whereas the
highest velocity occurs at the centre of the vessel. Some blood flow meters do not actually
measure the blood flow but measures the mean velocity of the blood.
The laminar flow of blood has been changed to turbulent flow pattern , when the local
blood velocity exceeds a certain limit, it is difficult to determine the flow
rate.
Based on the flow of blood to all parts of the organs, the body has to be
functioned properly. If there is a reduction of blood occurs by a narrowing of the blood vessels,
the function of that organ can be severely limited. When the blood flow in a certain vessel
is completely obstructed (by a blood clot or thrombus) the tissue in the area supplied by this
vessel may die. Such an obstruction in a blood vessel of the brain is one of the causes of a
cerebrovascular accident (CVA) or stroke. An obstruction of part of the coronary arteries that
supply blood for the heart muscle is called a myocardial ( or coronary) infarct or heart attack,
whereas merely a reduced flow in the coronary vessels can cause a severe chest pain called
angina pectoris . A blood clot in a vessel in the lung is called an lubolism. Blood clots can also
afflict the circulation in the lower extremities (Thrombosis)
Page
99
typically in the low audio frequency range. Because of the velocity profile of the blood, the
Doppler signal is
Page
100
not a pure sinewave, but has more the form of marrow-band noise. Doppler frequency can
be calibrated directly in flow-rate units.
4.10.Colorimeter
Colorimeter :
Introduction:
Filters
Changeable optics filters are used in the colorimeter to select the wavelength of light which
the solute absorbs the most, in order to maximize accuracy. The usual wavelength range is from
400 to 700 nanometres (nm). If it is necessary to operate in the ultraviolet range (below
400 nm) then some modifications to the colorimeter are needed. In modern colorimeters
the filament lamp and filters may be replaced by several light-emitting diodes of different
colors.
Page
73
Cuvettes
In a manual colorimeter the cuvettes are inserted and removed by hand. An aut
omated colorimeter (as used in an AutoAnalyzer) is fitted with a flowcell through which
solution flows continuously.
Output
The output from a colorimeter may be displayed by an analogue or digital meter and may
be shown as transmittance (a linear scale from 0-100%) or as absorbance (a logarithmic
scale from zero to infinity). The useful range of the absorbance scale is from 0-2 but it is
desirable to keep within the range 0-1 because, above 1, the results become unreliable due to
scattering of light.
In addition, the output may be sent to a
computer.
Graphic
design
In graphic design, colorimeters are used to generate color profiles for equipment in
the workflow. Accurate color profiles are important to ensure that screen displays match the
final printed products.
Flame photometer:
A flame photometer is used to analyze urine or blood in order to determine
the concentration of potassium (K) sodium (Na) calcium(Ca) lithium (Li). Sometimes lithium is
used as a calibration substance in the analysis of the other three substances. A known
amount of lithium is added to the sample and the emitted light intensity of the sample
under analysis is measured relative to that of the lithium. By this way, any error due to varying
flame temperature is eliminated.
The sample whose concentration is to be analyzed is taken in a beaker. This sample
is sprayed into fine droplets using an atomizer. This fine droplets are passed through oxygen or
air past opening in it.
4.11.Electrophoresis
Electroporesis Introduction:
Page
104
Electrophoresis may in general be defined as the movement of solid phase with respect
to a liquid movement of solid phase with respect to a liquid (the buffer solution) the main
H
functions of the buffer solution are to carry the current and t keep the P of the solution
constant during migration. The buffer solution is supported by a solid solition called medium.
In th\is technique, the sample is applied to the medium and under the effect of the electric field,
groups of particles that are similar in charge, size and shape migrate at similar rates. This
results in migration of the particles in the field.
Magnitude of charge:
The mobility of the given particle is directly related to the net magnitude of the
particles charge. Mobility is defined as the distance in centimeters a particle moves in unit
time per unit field strength, expressed as voltage drop per centimeter.
Ionic strength of the buffer:
The more concentrated the buffer, the slower the rate of migration of the particles. This
is because the greater the properties of buffer ions present,the greater the proportion of the
current they carry. It is also due to interaction between the buffer ions and the particles.
Time:
The distance of migration is directly related to the time the electrophresis takes. Other
factors that influence migration include electrophoresis chromatography,particle shape.
Applications
There are many applications of electrophoresis for measurements and various operations
with particulates
Measurement
Electrophoresis is used for studying properties of dispersed particles.
Gel electrophoresis
Gel
electromacromolecules
phoresis is an application
in molecular
Biological
usually proof
teinelectrophoresis
s, DNA, or RNA
are loadedbiology.
on a gel and
separated on
the
basis of their electrophoretic mobility. (The gel greatly retards the mobility of all
molecules present.)
Electrophoretic displays
Electrophoretic displays (EPD's) are a class of information display that form images
by electrophoretic motion of charged, colored pigment particles.
Electrophoretic fingerprinting:
Electrophoresis is also used in the process of DNA fingerprinting. Certain DNA segments
that vary vastly among humans are cut at recognition sites by restriction enzymes (
restriction endonuclease). After the resulting DNA fragments are run through electrophoresis,
the distance between bands are measured and recorded as the DNA "fingerprint."
Electrophoretic deposition:
Coatings, such as paint or ceramics, can be applied by electrophoretic deposition.
The technique can even be used for 3-D printing.
4.12. pCO2 (Partial Pressure of Carbon Dioxide) reflects the amount of carbon
dioxide gas dissolved in the blood.
Indirectly, the pCO2 reflects the exchange of this gas through the lungs to the outside
air. Two factors each have a significant impact on the pCO2. The first is how rapidly
and deeply the individual is breathing:
Someone who is hyperventilating will "blow off" more CO2, leading to lower
pCO2 levels
Someone who is holding their breath will retain CO2, leading to increased
pCO2 levels
The second is the lungs capacity for freely exchanging CO2 across the alveolar
membrane:
With pulmonary edema, there is an extra layer of fluid in the alveoli that
interferes with the lungs' ability to get rid of CO2. This leads to a rise in pCO2.
With an acute asthmatic attack, even though the alveoli are functioning
normally, there may be enough upper and middle airway obstruction to block
alveolar ventilation, leading to CO2 retention.
Pulmonary edema
Obstructive lung disease
Hyperventilation
Hypoxia
Anxiety
Pregnancy
Pulmonary Embolism (This leads to hyperventilation, a more important
consideration than the embolized/infarcted areas of the lung that do not
function properly. In cases of massive pulmonary embolism, the infarcted or
non-functioning areas of the lung assume greater significance and the pCO2
may increase.)
4.12.1.Measurement of PCO2
The measurement of PCO2 is based on the fact that the relationship between log PCO2 and pH is
linear over the range of 10 to 90 mm Hg which includes essentially all the values of clinical
interest. This result can be established by examining some fundamental chemical
+
relationships among H , H2CO3, and PCO2. The first three quantities are related by the
equilibrium equation
H2O + CO2
H2CO3
+
H + HCO3 - ------------
In addition, the relationship between PCO2 and the concentration of the CO2 dissolved in the
blood, [CO2] is given by
[CO2] = a(PCO2) ------------------------------------------(2)
Where a = 0.0301 mmol/liter per mm Hg PCO2. The mass relationship corresponding to eq(1)
k' =
---------------------------------------------------------(3)
Next we use the fact that [H2CO3] is proportional to [CO2] to obtain the result
k=
--------------------------------------------------------------(4)
where k represents the combined values of k' and the proportionality constant between [H2CO3]
and [CO2] using eq(2) we obtain the following result
k=
----------------------------------------------------------------(5)
next taking
the base-10
logarithm of eq(5) and rearranging, we obtain
+
log[H ] + log[HCO3 ] log k log a log PCO2 = 0 ---------------------(6)
Prepared by A.Devasena., Asso. Prof.,
Dept/ECE
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108
Exit
H +
Glass
Voltmeter
HCO3 +
AgCl Ag
H2CO3
k
For blood
Or calibrating
Entrance
CO2
H2CO3
k
CO2
(Dissolve
Sample Chamber
Buffer
Reference
Glass
Exit
e
For blood
Or calibrating
Cathode
Voltmeter
O2
Anode
O2
AgCl Ag
(Dissolve
Entrance
Sample Chamber
Reference
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80
Lactic Acidosis
Ketoacidosis
Ingestion of acids
Cardiopulmonary collapse
Shock
Page
81
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81
When the cell fires however, the outside of the cell becomes momentarily negative with
respect to the interior. A short time later, the cell regains the normal state in which the inside
is again negative with respect to outside. The discharging and recharging of the cell is
known as depolarization and repolarization.
Regardless of the method of excitation of cells or the intensity of the stimulus, this is assumed
to greater than the threshold of stimulus. The action potential is always- the same for any given
cell. This is known as all- or nothing law.
Absolute refractory period is the time duration of the cell non response to further stimuli. It
is about 1 millisecond in nerve cell. Following the absolute refractory period there is a brief
period of time during which another action potential can be triggered but a much stronger
stimulation is required. This period is called relative refractory period.
The rate at which an action potential moves down a fiber of a nerve cell or is propagated
from cell to cell is called the propagation rate or conduction velocity. The conduction velocity
varies in nerves depending on the type and diameter of the fiber and is from 20 n/s to 140 m/s.
But in heart muscle, it is very slower ranging from 0.2 to 0.4 m/s.
Due to the difference in permeability the concentration of sodium ions inside the cell
becomes much lower than the outside the cell. Since the sodium ions are positive, the outside of
the cell is more positive than inside. The concentration of potassium and chloride ions is
negative on the inside and positive on the outside.
An equation relating the potential across the membrane and the two concentrations of the ion
is called Nernst equation.
RT
C1 f1
E
ln
Where,
nF
C2 f 2
7
R
gas constant(8.315 x 10 ergs/mole/degree Kelvin)
T
absolute Temperature, degrees Kelvin
n
valence of the ion (the number of electrons added or removed to ionize the
atom) F
Faraday constant (96,500 coulombs)
C1, C2 two concentrations of the ion on the two sides of the membrane
f1, f2 respective activity coefficients of the ion on the two sides of the membrane
The approximate value of the resting potential for living cell is 70mV. The resting potential
ranges from -60 to -100nV.
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113
ElectroCardioGram (ECG)
ElectroEncephaloGram (EEG)
ElectroMyoGram (EMG)
ElectroRetinoGram (ERG)
ElectroOculoGram (EOG)
Bioelectric potential
Function
ElectroCardioGram
(ECG)
Records
electrical
activity of heart
ElectroEncephaloGram
(EEG)
Records
electrical
activity
brain
ElectroMyoGram
(EMG)
Records
muscle
potential
Peak
amplitude
0.1 to 4mV
2 to 200V
of
50V
1mV
to
Frequency Observation
response
0.05 to
Used to measure
120 Hz
heart
rate,
arrhythmia
and
abnormalities
0.1 to 100 Used to analysis
Hz
evoked potential,
certain patterns,
frequency
response
5 to 2000 Used as indicator
Hz
of muscle action
for
measuring
fatigue
4.14. Pacemaker
Inroduction
Pacemaker is an electrical pulse generator for starting /maintaining the normal heart
beat.
The output of the pacemaker is either externally to the chest or internally to the
heart muscle. In the case of cardiac stand still, the use of the pacemaker is temporary
just long enough to start a normal heart rhythm. In the cases requiring long term
pacing, the pacemaker is surgically implanted in the body and its electrodes are in direct
contact with
the heart. The contraction of heart (cardiac) muscle in all animals with hearts is
initiated by electrical impulses. The rate at which these impulses fire controls the heart
rate. The cells that create these rhythmical impulses are called pacemaker cells, and
they directly control the heart rate. The normal heart rate is 60-100 beats per minute.
A higher rate than this ( above 100 beats per minute) is called Tachycardia.
slower rate(Below 60 beats per minute) than this is called Bradycardia .
IMPLANTING THE PACEMAKER
Definition of Pacemaker
A small battery powered device, implanted into a patient Paces the heart when
normal rhythm is slow, when there is a heart block not allowing the ventricles to contract
when the SA
node fires, or any arrhythmia causing a slow rate.
Determining Pacemaker Types
The sinoatrial node (SA node) is a group of cells positioned on the wall of the right
atrium, near the entrance of the superior venacava. These cells are modified
cardiomyocyte. They possess rudimentary contractile filaments, but contract relatively weakly.
Primary Pacemaker
Cells in the SA node spontaneously depolarize, resulting in contraction, approximately 100
times
per minute. This native rate is constantly modified by the activity of sympathetic
and parasympathetic nerve fibers, so that the average resting cardiac rate in adult humans is
about 70 beats per minute. Because the sinoatrial node is responsible for the rest of the
heart's electrical activity, it is sometimes called the prima ry pacemaker.
Secondary Pacemaker
If the SA node does not function, a group of cells further down the heart will become the
ectopic pacemaker of the heart. These cells form the atrioventricular node(or AV node), which
is an area
between the left atrium and the right ventricle, within the atrial septum. The cells of the AV
node normally discharge at about 40-60 beats per minute, and are called the secondary
pacemaker.
Pacemaker Potential
The pacemaker potential (also called the pacemaker current) is the slow, positive increase
in
voltage across the cells membrane (the membrane potential) that occurs between the end of
one action potential and the beginning of the next action potential. This increase in
membrane potential is what causes the cell membrane, which typically maintains a resting
membrane potential of -70 mV, to reach the threshold potential and consequently fire the
next action potential;
thus, the pacemaker potential is what drives the self-generated
rhythmic firing (automaticity) of pacemaker cells, and the rate of change (i.e., the slope)
of the pacemaker potential is what determines the timing of the next action potential and thus
the intrinsic firing rate of the cell.
In a healthy sinoatrial node (SAN, a complex tissue within the right at rium containing
pacemaker cells that normally determine the intrinsic firing rate for the entire heart), the
pacemaker potential is the main determinant of the heart rate. Because the pacemaker
potential represents the non- contracting time between heart beats ( diastole), it is also called
the diastolic depolarization. The amount of net inward current required to move the cell
membrane potential during the pacemaker phase is extremely small, in the order of few pAs,
but this net flux arises from time to time changing contribution of several currents that
flow with different voltage and time dependence
Artificial Cardiac Pacemaker
A pacemaker (or artificial pacemaker, so as not to be confused with the heart's
natural
pacemaker) is a medical device that uses electrical impulses, delivered by electrodes
contracting the heart muscles, to regulate the beating of the heart. The primary purpose of a
pacemaker is to maintain an adequate heart rate, either because the heart's natural pacemaker is
not fast enough, or there is a block in the heart electrical conduction system. Modern
pacemakers are externally programmable and allow the cardiologist to select the optimum
Prepared by A.Devasena., Asso. Prof.,
Dept/ECE
Page
86
defibrillator in a
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86
Pacemaker Pulses
These Pulses should have the pulse to space ratio 1:10000.
It should be negatively going pulses to avoid the ionization of the muscles.
The pulse voltage is made variable to allow adjustments in the energy delivered by
the pacemaker to the heart during each pulse.
Methods of stimulation
External stimulation
Internal stimulation
External stimulation is employed to restart the normal rhythm of the heart in the case of
cardiac standstill. Internal stimulation is employed in cases requiring long term pacing
because of permanent damage that prevents normal self triggering of the heart.
External Stimulation
It is employed to restart the normal rhythm of the heart in the case of cardiac stand
still.
Stand still can occur during openheart surgery or whenever there is a sudden physical shock
or accident.
Internal Stimulation
Internal stimulation is employed in cases requiring long term pacing because of
permanent
damage that prevents normal self triggering of the heart.
Prepared by A.Devasena., Asso. Prof.,
Dept/ECE
Page
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87
External pacemaker
It does not necessitate open heart surgery
The skin near the chest or abdomen with its
output leads are connected directly to he
heart muscle
These are used for temporary heart
irregularities. There is no safety or
pacemaker.
Internal pacemaker
The pacemaker is surgically implanted
beneath
It requires open chest minor surgery to
place the circuit
These are used for permanent heart
damages. There is cent percent safety for
circuit from external disturbances
Disadvantages:
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.
The R- Wave inhibited pacemaker also allows the heart to pace at its normal rhythm when it
is able to . However if the R- wave is missing for a preset period of time, the pacer will supply
the stimulus. Therefore if the heart rate is below a predetermined minimum, pacemaker will
turn on and provide the heart a stimulus. For this reason it is called demand pacemaker.
The sensing electrode pickup R wave. The refractory circuit provides a period of time
following
an output pulse or a signals. The sensing circuit detects the R wave and resets the oscillator.
The reversion circuit allows the amplifier to detect the R- wave in low level signal to noise
ratio. In the absence of R wave, it allows the oscillator in the timing circuit to deliver pulses at
its preset rate. The timing circuit consists of an RC network, a reference voltage source and a
comparator which determines the basic pulse rate of the pulse generator. The output of the
timing circuit is fed into pulse delivered to the heart. Then the output of the pulse width circuit
is fed into the rate limiting circuit which limits the racing rate to a maximum of 120 pulses per
minute.
Atrial synchronous pacemaker
This type of pacing is used for young patients with a mostly stable block. Atrial pacing as
a temporary pacing is used in stress testing and coronary artery diseases. It is used to
terminate atrial flutter and in the evaluation of various conduction mechanisms. The atrial
activity is picked
up by a sensing electrode placed in a tissue close to the dorsal wall of the atrium. The detected
P
wave is amplified and a delay of 0.12 second is provided by the AV delay circuit. This
is
necessary corresponding to the actual delay in conducting the P wave to the AV node in
the heart. The signal is then used to trigger the resetable multivibrator and the output of
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the multivibrator is given to the amplifier which produces the desired stimulus to be applied
to the heart
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127
Heart
5.1.Electrical conduction system of the heart
5.2.SA node:
5.2.1P wave
Under normal conditions, electrical activity is spontaneously generated by the SA node,
the physiological pacemaker.
This electrical impulse is propagated throughout the right and left atria, stimulating
the
myocardium of the atria to contract.
The conduction of the electrical impulse throughout the atria is seen on the ECG as the P
wave.
5.2.2.INTERNODAL TRACTS,
As the electrical activity is spreading throughout the atria,
it travels via specialized pathways, known as inter nodal tracts,
from the SA node to the AVnode.
The P wave is the electrical signature of the current that causes atrial depolarization.
Both the left and right atria contract simultaneously. Its relationship to QRS complexes
determines the presence of a heart block.
Irregular or absent P waves may indicate arrhythmia.
The shape of the P waves may indicate atrial problems.
5.3.Bundle of His
The two bundle branches taper out to produce numerous Purkinjie fibers,
which stimulate individual groups of myocardial cells to contract.
The spread of electrical activity through the ventricular myocardium produces the QRS
Complex on the ECG.
The QRS complex corresponds to the current that causes contraction of the left and right
ventricles,
which is much more forceful than that of the atria and involves more muscle mass,
thus resulting in a greater ECG deflection.
The Q wave, when present,
represents the small horizontal (left to right) current as the action potential travels
5.6.ST Segment
5.7.Ventricular repolarization: T wa ve
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5.9.USES OF ECG :
It is the gold standard for the evaluation of cardiac arrhythmias .
The 12 lead ECG stands at the center of risk stratification for patients with suspected
acute myocardial infraction .
It can be useful for detecting electrolyte disturbances (e.g. potassium or calcium).
Allows the detection of conduction abnormalities (e.g. right and left bundle
branch
block).
As a screening tool for ischemic heart disease during an cardiac stress test.
Can suggest non-cardiac disease (e.g. pulmonary embolism or hypothermia).
5.10.Normal ECG
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96
In standard leads the potentials are tapped from four locations of our body.
They are
Right arm
Left arm
Right leg
Left leg.
Usually right leg electrode is acting as ground reference electrode.
Ground electrode RL
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Einthoven triangle.
Lead I
Right arm
Lead II
+
+
Left leg
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The ECG potentials are measured with color coded leads according to the convention:
White right arm
Black left arm.
Green right leg.
Red left leg.
Brown - chest
Atrial fibrillation: Due to fast beating rate (300-500 beats/minute) of the atrium. Here
ventricles beat very slowly.s
Ventricular fibrillation: due to fast beating rate of the ventricles. No pumping of the
blood to different parts of the body.
5.13.Heart Transplantation
5.13.1.allo graft
Heart transplantation or cardiac transplantation, is a surgical transplant procedure
performed on patients with end-stage heart failure or severe coronary artery disease.
The most common procedure is to take a working heart from a recently deceased organ
donor (allo graft) and implant it into the patient.
The patient's own heart may either be removed (orthotopic procedure) or, less commonly,
left in to support the donor heart (heterotopic procedure).
5.13.2.xenograft
It is also possible to take a heart from another species ( xenograft), or implant a
manmade artificial one,
although the success of these two procedures has been less successful in comparison to
the far more commonly performed allograft
5.13.3.Indications
In order for a patient to be recommended for a heart transplant they will generally
have
advanced, irreversible heart failure with a severely limited life expectancy.
Other possible treatments, including medication, for their condition should have
been
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Cardiomyopathy
Congential heart disease
Coronary artery disease
Heart valve disease
Life-threatening arrhythmias.
current.
Power amplifier circuit used to drive ECG chart recorder stylus. It is push pull
type. Furtehr it is provided with crossover distortion compenstation and offset control. It
consists of two silicon power transistors such that the emitters of the transistors are joined
together and
5.15.7.POWER SWITCH:
The power switch of the recorder has three positions. In the on position the powet to the
amplifier is turned on; but the paper drive is not running. In order to start the paper drive
the
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switch must be placed in the RUN position. In the off position, the ECG unit is in switched
off condition.
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An echocardiogram. Image shows that the human heart has four chambers. Apical view left side of the heart to the right. Right side-up - heart's apex at bottom. The trace in the
lower left shows the cardiac cycle and the red mark the time in the cardiac cycle that the
image was captured.
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regurgitation), and calculation of the cardiac output as well as the ejection fraction.
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is
usually
performed
by
cardiologists
or
cardiac
5.16.1.Transthoracic echocardiogram
The standard echocardiogram is also known as a transthoracic echocardiogram, or TTE.
In this case, the echocardiography transducer (or probe) is placed on the chest wall (or thorax)
of
the subject, and images are taken through the chest wall. This is a non-invasive, highly
accurate and quick assessment of the overall health of the heart. A cardiologist can
quickly assess a patient's heart valves and degree of heart muscle contraction (an
indicator of the ejection fraction).
Transesophageal echocardiogram
Another way to perform an echocardiogram is to insert a specialised scope containing
an echocardiography transducer (TEE probe) into the patient's esophagus, and record pictures
from there. This is known as a transesophageal echocardiogram, or TEE (TOE in the
United Kingdom). The advantages of TEE over TTE are usually clearer images. The transducer
is closer to the heart and doesn't have the ribs and lungs to deflect the ultrasound beam. Some
structures are better imaged with the TEE. These structures include the aorta, the pulmonary
artery, the valves of the heart, and the left and right atria. While TTE can be performed easily
and without pain for the patient, TEE may require light sedation and a local anesthetic
lubricant for the esophagus. Children are anesthetized. Unlike the TTE, the TEE is
considered an invasive procedure.
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In some centers, sedation is used to ease the discomfort to the individual. The use of
local anesthetic agents and sedation can decrease the gag reflex, making the ultrasound probe
easier to pass into the esophagus. The transducer and cable are then coated in a lubricant,
placed in the
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6.1.3.EEG
By placing electrodes on the scalp one can record the summed electrical activity of the cortex
in a technique known as electroencephalography (EEG). EEG measures the mass changes
in electrical current from the cerebral cortex, but can only detect changes over large areas of
the brain with very little sub-cortical activity.The abbreviation of electroencephalograph is
called EEG. It deals with the recording and study of electrical activity of the brain. EEGs are
recorded by means of electrode attracted to the skull of a patient the brain waves can be
picked up and recorded. Graded potentials are variations around the average value of the resting
potential. Thus the EEG potentials originate within the dendrite.
.6.1.4.MEG
Apart from measuring the electric field around the skull it is possible to measure the
magnetic field directly in a technique known as magnetoencephalography (MEG). This
technique has the same temporal resolution as EEG but much better spatial resolution,
although admitedly not as good as fMRI. The main advantage over fMRI is a direct
relationship between neural activation and measurement.
6.2.ElectroEncephaloGraphy (EEG)
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are attenuated to levels from 1v to 100 v,which are picked up by EEG electrodes. They
are in the frequency range from 0.5 to 3000hz.. These potentials vary with respect to
position of electrode on the
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106
surface of skull. The waveform varies greatly with the location of the measuring
electrodes on the surface of the scalp. EEG potentials measured at the surface of the
scalp, actually represent the combined effect of potentials from a fairly wide region of the
cerebral cortex and from the various points beneath. During recording the electrodes are
placed around the frontal, parietal, temporal and occipital lobe of the lobes, the EEG
waveforms is generally affected by the mental activity of a person.
Evoked potentials are the potentials developed in the brain as the responses to external
stimuli like light, sound etc. the external stimuli is detected by the sense organs, which cause
changes in the electrical activity of the brain. Nowadays the term event related potential
has been used instead of evoked potential.
6.2.1.Brain Waves:
Wide variation among individuals and the lack of repeatability in a given
person from one person to another make the establishment of specific relationships.
But some
characteristics EEG waveforms can be related to epileptic seizures and sleep. The
EEG waveforms obtained with the help of intensity and patterns of this electrical activity
due to overall level of excitation of the brain. This includes various activities of a person
when in alert condition, sleepy condition, tension condition etc.
Normally the brain waves are irregular, no general patterns can be discerned in the
EEG. But during abnormal conditions we can obtain the specific wave
form.
The normal Brain waves that occur in the human being can be classified into Alpha,
Beta, delta and theta waves.
Brain waves
Delta wave
Theta wave
Alpha wave
Beta wave
Frequency
below 3 hz
from 3 hz to about 8hz .
from about 8hz to about 13hz .
above 13hz .
Activity types
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Historically four major types of continuous rhythmic sinusoidal EEG activity are
recognized (alpha, beta, delta and theta). There is no precise agreement on the frequency
ranges for each type.
Delta is the frequency range up to 4 Hz and is often associated with the very young
and certain encephalopathies and underlying lesions. It is seen in stage 3 and 4 sleep.
Delta waves.
Theta waves.
Alpha waves.
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sensorimotor rhythm (SMR) is a middle frequency (about 1216 Hz) associated with
physical stillness and body presence.
Beta is the frequency range above 12 Hz. Low amplitude beta with multiple and
varying frequencies is often associated with active, busy or anxious thinking
and active concentration. Rhythmic beta with a dominant set of frequencies is
associated with various pathologies and drug effects, especially benzodiazepines.
Beta waves.
Gamma is the frequency range approximately 26100 Hz. Gamma rhythms appear to
be involved in higher mental activity, including perception, problem solving, fear,
and consciousness.
Gamma waves.
Rhythmic slow activity in wakefulness is common in young children, but is abnormal
in adults. In addition to the above types of rhythmic activity, individual transient waveforms
such as sharp waves, spikes, spike-and-wave complexes occur in epilepsy, and other
types of transients occur during sleep.
In the transition from wakefulness, through Stage I sleep (drowsiness), Stage II (light) sleep,
to Stage III and IV (deep) sleep, first the alpha becomes intermittent and attenuated,
then disappears. Stage II sleep is marked by brief bursts of highly rhythmic beta activity
(sleep spindles) and K complexes (transient slow waves associated with spindles, often
triggered by an auditory stimulus). Stage III and IV are characterized by slow wave activity.
After a period of deep sleep, the sleeper cycles back to stage II sleep and/or rapid eye
movement (REM) sleep, associated with dreaming. These cycles may occur many times during
the night.
EEG under general anesthesia depends on the type of anesthetic employed. With
halogenated anesthetics and intravenous agents such as propofol, a rapid (alpha or low
beta), nonreactive EEG pattern is seen over most of the scalp, especially anteriorly; in some
older terminology this was known as a WAR (widespread anterior rapid) pattern, contrasted
with a WAIS (widespread slow) pattern associated with high doses of opiates. Anesthetic
effects on EEG signals are beginning to be understood at the level of drug actions on
different kinds of synapses and the circuits that allow synchronized neuronal activity
6.3.Co
ma
In medicine, a coma (from the Greek - koma, meaning deep sleep) is a profound state
of unconsciousness. A comatose patient cannot be awakened, fails to respond normally to
pain or light, does not have sleep-wake cycles, and does not take voluntary actions. Coma
may result from a variety of conditions, including intoxication, metabolic abnormalities,
central nervous system diseases, acute neurologic injuries such as stroke, and hypoxia.
It may also be deliberately induced by pharmaceutical agents in order to preserve
higher brain function following another form of brain trauma.
The difference between coma and stupor is that a patient with coma cannot give a
suitable response to either noxious or verbal stimuli, whereas a patient in a stupor can
give a crude response, such as screaming, to an unpleasant stimulus.
Some psychiatric diseases appear similar to coma. Some forms of schizophrenia, catatonia,
and extremely severe major depression are responsible for behaviour that appears comatose.
Coma is also to be distinguished from the persistent vegetative state which may follow it. This
is a condition in which the individual has lost cognitive neurological function and awareness of
the environment but does have noncognitive function and a preserved sleep-wake
cycle. Spontaneous movements may occur and the eyes may open in response to external
stimuli, but the patient does not speak or obey commands. Patients in a vegetative state
may appear somewhat normal and may occasionally grimace, cry, or laugh.
Likewise, coma is not the same as brain death, which is the irreversible cessation of all
brain activity. One can be in a coma but still exhibit spontaneous respiration; one who is
brain-dead, by definition, cannot.
Coma is different from sleep; sleep is always
reversible.
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There are several levels of coma, through which patients may or may not progress.
As coma deepens, responsiveness of the brain lessens, normal reflexes are lost, and the
patient no
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longer responds to pain. The chances of recovery depend on the severity of the underlying
cause. A deeper coma alone does not necessarily mean a slimmer chance of recovery,
because some people in deep coma recover well while others in a so-called milder coma
sometimes fail to improve.
The outcome for coma and vegetative state depends on the cause, location, severity
and extent of neurological damage: outcomes range from recovery to death. People may emerge
from a coma with a combination of physical, intellectual and psychological difficulties
that need special attention. Recovery usually occurs gradually, with patients acquiring more
and more ability to respond. Some patients never progress beyond very basic responses, but
many recover full awareness. Gaining consciousness again is not instant: in the first days,
patients are only awake for a few minutes, and duration of time awake gradually increases.
Comas generally last a few days to a few weeks, and rarely last more than 2 to 5
weeks. After this time, some patients gradually come out of the coma, some progress to a
vegetative state, and others die. Many patients who have gone into a vegetative state go on
to regain a degree of awareness. Others may remain in a vegetative state for years or
even decades. Predicted chances of recovery are variable due to different techniques used to
measure the extent of neurological damage. All the predictions are statistical rates with some
level of chance for recovery present: a person with a low chance of recovery may still
awaken. Time is the best general predictor of a chance for recovery, with the chances for
recovery after 4 months of brain damage induced coma being low (less than 15%), and full
recovery being very low.
The most common cause of death for a person in a vegetative state is secondary infection such
as pneumonia which can occur in patients who lie still for extended periods.
6.5.ELECTROMYOGRAPHY:
Electromyography is the science of recording and interpreting the electrical activity of the
muscles action potentials. Meanwhile the recording of the peripheral nerves action potentials is
called electroneurography. The electrical activity of the under lying muscle can be measured
by placing surface electrodes on the skin. To determine whether the muscle is contracting or
not, or displaying on the CRO and loud speaker the action potentials spontaneously present in
a muscle or induced by voluntary contraction as a means of detecting the nature and location of
the motor unit lesions. So to record the action potentials of individual motor units, the needle
electrode is inserted into the muscle. The EMG indicates the amount of activity of a given
muscle or a group of muscles and not an individual nerve fiber.
The action potentials occur both positive and negative polarities at a given pair
of electrodes, so they may add or cancel each other. Thus EMG appears, very much like a
random noise waveform. The contraction of a muscle produces action potentials. Where
there is stimulation to a nerve fiber, all the muscle fiber contract simultaneously
developing action potentials. In a relaxed muscle, there is no action potential. EMG is
usually recorded by using surface electrodes or more often needle electrodes inserted directly
into the muscle. The surface electrodes pick-up the potentials produced by the contracting
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be amplified and displayed on the screen of an audio amplifier connected to the loud
speaker. The oscilloscope displays EMG waveforms. The tape recorder is included in the
system to facillate play-back and study of the EMG sound waveforms at a later
convenient time. the waveform can also be photographed from the CRT screen by using a
synchronized camera.
Oscilloscope
Tape recorder
Input
EMG
amplifier
Speaker
A.F.Amplifier
The surface electrodes or needle electrodes pickup the potentials produced by the
contracting muscle fibers. The surface electrodes are from Ag-Agcl and are in disc shape.
The
surface of the skin is cleaned and electrode paste is applied. The electrodes are kept in place
by means of elastic bands. By that way, the contact impedance is reduced below 10kiloohms.
There are two types of conventional electrodes: bipolar and unipolar type electrodes. In the
case of bipolar electrode, the potential difference between two surface electrodes resting on
the skin is measured. In case of unipolar electrode, the reference surface electrode is placed on
the skin and the needle electrode which acts as active electrode, is inserted into the muscle.
Because of small contact area, these unipolar electrodes have high impedances ranging from 0.5
to 100mega ohms. With needle electrodes, it is possible to pickup action potentials from the
selected nerves or muscles and individual motor units. In the case of coaxial electrode
which consists of an insulated wire threaded through a hyperdermic needle with a oblique tip
for easy penetration, the surrounding steel jacket acts as reference and the metallic wire acts as
exploring electrode. The needle is inserted into the muscle further to record the action
potentials for a single nerve microelectrodes are used.
The amplitude of the EMG signals depends upon the type and placement
of electrodes used and the degree of muscular exertions. That is the surface electrode pick up
many
overlapping spikes and produces an average voltage from various muscles and motor units.
The needle electrodes pick up the voltage from a single nerve fiber. Generally EMG signals
ra nge from 0.1 to 0.5 mv. They may contain frequency components from 20 Hz to 10 KHz.,
which are in the audio range, but using low pass filter, the electromyography restricts this
frequency range fro 20 Hz to 200 Hz for clinical purposes. The normal frequency of EMG
is about 60 Hz. Therefore the slow speed strip chart recorders are not useful and the signals
are displayed on a cathode ray oscilloscope and photographic recordings are made. Normally
there are two cathode ray tubes, one for viewing and other one for recording. A light sensitive
paper moves over the recording cathode ray tube and the image is produces on that paper. After
developing it, one can see the visible image. For continuous recording, the paper speed is about
5 to 25 cm/second. For short duration it is about 50 to 400 cm/second. The paper width is
about 10 cm. treading a needle, and an array of facial expressions. Smooth muscles occur in
the walls of internal body organs and perform actions such as food through the intestines
contracting the uterus (Womb) in child birth and pumping blood through blood vessels.
6.6.ELECTRORETINOGRAPHY:
The recording and interpreting the electrical activity of eye
is called
electroretinography. All sense organs are connected to the brain but the eye has a special
relationship as the retina is an extension of the cerebral cortex. Potentials within the eye may
be recorded relatively easily because of its exposed position. The cornea is about 20mv
positive relative to the fundus of the eye. The fundus is the back of the interior of the eye
ball. If the illumination of the retina is changed, the potential changes slightly in a complex
manner. The recording of these changes is called retinogram. A silver- silver chloride electrode
on a contact lens and a distinct electrode on the cheek are used to record the eye potential
changes.
Electrode placement:
The bipolar recording technique is used. The exploring electrode is placed on a
saline filed contact lens. The contact lens is placed on a saline filled contact lens. The contact
lens is tightly attached to the eye. During eye movement there is no slip of contact lens
by using negative pressure (between the corneal cavity and the cornea) attachment
techniques. The common contact lenses used for corrections or cosmetic purposes ride on a
tear film over the cornea, do not follow eye movements well and are unsuitable for recording
purposes. Therefore specially made contact lenses used to record the action potentials of eye
during flash of light incident on eye.
Recording Techniques:
When light falls on the retina, the absorption of photons by photo pigments localized in
the outer segment of the retinas photoreceptors is taking place. This causes the breakdown or
bleaching of photo pigments which results in the liberation of ions that cause a change in
the membrane potential. This in turn results in the development of action potential that is
transmitted down the optic nerve. This action potential is picked up the electrodes and are
fed to the bio amplifier and then to the recorder. The recording set up is similar to the ECG
recorder.
Electroretinogram waveform
B
D
Action
potential
1 Sec
1 mV
Light on
Time
Figure shows the typical eletroretinogram. Before the flash of light is incident on eye, there is
a
constant d.c. horizontal line in the recorder. In response to a 2 seconds flash of light, a
retinogram is developed. Probably the curve originates from the pigment layer beyond
photo receptors (extra retinal).
The first part A of the response to a brief flash of light is due to the early receptor
potential (ERP) generated by the incident light which induces changes in the photo
pigment molecules. The second component part B with a delay of 1 to 5 milliseconds is
due to later receptor potential (LRP) produced
by
syruptic
ending
of
the
photoreceptors. This is the maximum output of the receptors. The part C wave recorded with
the off response of ERP and LRP.
In the earlier recording of the eye potentials, the corneal electrodes were not used.
Instead the rotation of the contact lens was measure by means of a mirror (on contact lens)
which reflects the incident light on a moving photographic film or photo cell. After
developing the
photographic film, we can see the image and from that we can get some informations about the
eye potentials. In the case of photocells, the output from the photocell was amplified and
then given to the recorder. There was also a nonoptical method for measuring contact lens
rotation. Two sets of magnetic coils, normal in the space and oscillating in phase quadrature
at 4.8kHz create crossed magnetic fields which excite two small search coils embedded in the
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contact lens. Rotations of the eye cause induced voltages of few millivolts, which can give
information about the eye potential.
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TELEMEDICINE
7.1 Introduction :
7.1.1 Wireless telemetry:
Wireless telemetry gives analysis of the physiological data of man or animal under
normal conditions and in natural surroundings without any discomfort or obstruction to
the person or animal
Biotelemetry is the branch of biomedical instrumentation that deals with the
measuring physiological variables to a method of transmission of resulting data.
Telemetry is most convenient during transportation within the hospital area as well for the
continuous monitoring of patients sent to other wards or clinics for check-up or therapy.
Biotelemetry is the measurement of biological parameters over a distance. The means
of transmitting the data from the point of generation to the point of reception can take many
forms.
Measurements can be applied to two categories.
Biological variables such as EEG, ECG and EMG.
Physiological variables that require transducers such as
gastrointestinal pressure, blood flow and temperatures.
blood pressure,
In first category, a signal is obtained directly in electrical form, whereas the second
category requires a type of excitation. The physiological parameters are eventually measured as
variations of resistance, inductance or capacitance. The differential signals obtained from
these variations can be calibrated to represent pressure, flow, temperature and so on.
The analog signal that is obtained from the electrodes (the signal may be in the form of
voltage, current etc) is converted into a form or code capable of being transmitted at
the transmitter end with the help of transmitter set up.
The transmitter end comprises of transducer that converts physical signals into
analog electrical signal. That electrical signal has to be amplified with the help of
preamplifier set up. The amplified signal has been modulated with the help of modulator and
encoder, this processed signal is transmitted through the multiplexer circuit.
At the receiver end the signal is converted back into its original form. The receiver
end comprises of demultiplexer, decoder, and demodulator circuit.
The demultiplexer circuit
demultiplexes the received
signal.
Now this
demultiplexed signal is passed through the decoder and demodulator. Finally the original
signal is retrieved back for analyzing purpose.
Currently the most widespread use of biotelemetry for biotelemetric potentials is in
the form of the electrocardiogram. A simple set up is sufficient in the transmitting end. That
set up comprises of only electrodes and amplification circuit that is needed to prepare the
signal for transmission.
7.1.2 Telemedicine:
It is the application of telecommunications and computer technology to deliver health
care from one location to another. This telemedicine uses the modern information technology
to deliver timely health services to those in need by the electronic methods. The patient may
be present at the remote location. In that location, the specialized doctors are not there means,
we can give protection to the life of the patient with the help of this telemedicine.
Nowadays for investigation purpose only, we are using this telemedicine. In future with the
help of this set up and robot, the doctor can able to do operation for the needed patient who
is present in remote location.
Direct
biopotential
Subject
Amplifier
Processor
Transducer
Modulator
Exciter
Carrier
Block Diagram of a Biotelemetry transmitter
Tuner
Demodulator
Chart Recorder
or Oscilloscope
Tape Recorder
In the above diagram, the tuned oscillator serves as a frequency modulator. The diode used here
is a varactor diode. The varactor diode is operating in a reverse biased mode, because of this;
the varactor diode gives a depletion layer capacitance to the tank circuit.
This capacitance is a function of the reverse biased voltage across the diode and therefore
produces an FM wave with modulating signal applied.
7.2.1 Pulse width Modulation (PWM):
PWM method has an advantage of being less perspective to distortion and noise.
Figure shows a typical pulse width modulator, transistor q1 and Q2 from free running
multivibrator. Transistors Q3 and Q4 provide constant current sources for charging the
timing capacitors
C1 and C and driving transistors Q1 and Q. when Q1 is off and Q is on , capacitor C21
chrges
through
R1 to the
of the modulating
e m . the other zero
side of
capacitor
to amplitude
the base voltage
of Q2 dropsvoltage
from approximately
to this
em.
transistor is
Q2connected
will
remain off until the base voltage charges to zero volt. Since the charging current is constant at
I, the time required to charge C2 and restore the circuit to the initial stage is
T2 = (C2/I ).em
Similarly, the time that the circuit remains in the original stage is
T1 = ( C1/I ).em
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quality
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when a patient with a telemetry transmitter moves in an environment with a concrete wall
or behind a structure. Reception may also get affected by radio frequency reception or null
spots. One of the important problems can be minimized by the careful selection of
transmitter frequencies by the use of suitable antenna system and by the equipment design.
Based on the output power and frequency obtained, it is possible for us to decide
the range of the radio system. Care should be taken for designing the receiver and antenna.
Only the transmitted signal from the remote location can be analyzed properly otherwise it is
difficult for the doctor to give proper medicine.
The transmitter:
The commonly used FM transmitter is shown below. This circuit can be used for medical
telemetry also. The circuit comprises of a transistor, feedback circuit, and a tank circuit.
The transisytor used here is a grounded base colpitts R.F. oscillator with L 1, C1, C2 as the tank
circuit.
Transmitter circuit diagram:
Inductor
A capacitive divider circuit is plced in the collector circuit, that is formed with the
help of C1 and C2. inductor L1 functions both as a tuning coil and a transmitting
antenna.
With the help of this set up, a positive feedback is provided to the amplifier circuit. We can
able
to set the transmission frequency to a precise level. This can be done by adjusting the
trim capacitor C2. with this set up, we can able to set the frequencyrange of 88 to
188 MHz.
Frequency modulation can be achieved by variation in the operating point of the
transistor, which in turn varies its collector capacitance, thus changing the resonant
frequency of the tranistor circuit. The operating point can be changed by the subcarrier input. Thus the transmitter,s output consists of an RF signal, tuned in the FM broad
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cast band and frequency modulated by the sub-carrier oscillator (SCO), which in turn is
frequency modulated by the physiological signals of interest.
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The Receiver:
The receiver can be a common broadcast receiver with a sensitivity of 1 microvolt. The
output of the hf unit of the receiver is fed to the sub cab-modulator HF unit of the receiver is
fed to the sub-modulator to extract the modulating signal. In a FM/FM system, the submodulator first converst the FM signal into an AM signal. This is followed by an AM
detector, which demodulates the newly created AM waveform. With this arrangement, the
output is linear with frequency deviation only for small frequency deviations. Other types of
detectors can be used to improve the linearity. Two major problems that has been faced in
biotelemetry at the system interfaces. The first problem is the interface between the
biological system and the electrical system.
The second problem is the interface between transmitter and
receiver.
7.3.Radio Pill
The earliest biotelemetry units was the endoradiosonde, developed by Mackay and
3
Jacobson. The pressure sensing electrode is a radio pill less than 1 cm .in volume. This radio
pill can be swallowed by the patient. Radio pill now travels through the gasterointestinal tract
on the
way of passing into the gastrointentinal tract, the radio pill is capable of measuring
various parameters that are available in the tract. With the help of radio pill type devices, it is
possible
for us to measure or sense temperature, pH, enzyme activity, and oxygen tesion values.
These measurements can be made in associated with transducers. Pressure can be sensed
by using
variable inductance, temperature can be measured by using temperature-sensitive
transducer.
7.4.1.STIMULATION OF NERVES:
There is normally a potential difference of about 100mv across a nerve membrane. if this
potential is reversed for more than about 20 milliseconds, the nerves will be stimulated and
an action potential will be propagated along the nerve fiber.
the nervous system is the body's internal, electrochemical, communication network.
its main poarts are the brain and spinal cord from the central nervous system (CNS) the body's
chief
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controlling and coordinating centres. Billions of long neurons, many grouped as nerves, make
up the peripheral nervous system, transmitting nerve impulses between the CNS and other
regions
of the body. Each neurons has threee parts: a cell body, branching dendrites that receive
chemical signals from other neurons, and a tube -like axon that conveys these signals
as
electrical impulses.
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Types of neurons:
Three types of neurons are there. they are Multipolar, unipolar, bipolar.
Types of nerve ending:
free nerve ending, Meissner's corpuscle. Merkel's disc. Ruffini corpuscle, Pacinian
corpuscle.
7.4.2.ACCUPUNCTURE:
Accu-means needle, puncture- means making a highly concentrated presssure over the
skin, in order to relief the pain over the partiular area of the skin. This kind of treatment
is
popular in CHINA from 2600B.C. onwards. in accupuncture, care should be taken for
the patient, not for the diseases. iin our body electric energy is there. It is possible for us to
adjust the electric energy in proper way. 12 paths are there in our body. in these 12 paths 900
needle points are there. in these points, with the help of stainless steel needle we are
puncturing our body. by doing like this we can increase or decrease the electric energy in our
body. In olden days people had used this acupuncture in place of anasthesia. With the help of
these acupunctre we can stop the poain information, which passes to our brain. In our heart
there are no nerves. so if we are acupuncturing our heart means, we dont feel no pain. With the
help of this accupunctur , we can stimulate our nerves. nowadays with the help of electric
current these nerves are stimulated.
7.4.3.DIFFERENT
TYPES
OPF
STIMULATOR(ELECTROTHERAPY)
WAVEFORMS
USED
IN
Various types of waveforms are used for stimulation of nerves and muscles to carry
out
treatment of various diseases.
(i) Galvanic current:
galvanic current is a constant or direct current. the maximum amount of current passed
through the body is about 0.3 to 0.5 mA/cm2 of electrode surface. the duration of the passage
of current is about 10 to 20 minutes. The passage of current creates the movement of ions. it is
used for the preliminary treatment of atonic paralysis and for the disturbance of blood flow
in the arteries.
(ii) Interrupted galvanic current:
Interrupted galvanic current pulses are a series of negative going rectangular pulses.
the pulse duration is about 100 milliseconds with a repetition rate is between 12 per minute
and 70
per minute. A silghtly different form of interrupted galvanic pulses is the triangular
wavepulses.
fig shows the unidirectional interrupted galvanic pulses which create ionization of the skin of
the patient and produce discomfort and inflammation. it is overcome by the application of a
positive current in between the negative pulses proportional to the time interval.
Radiation therapy
Radiation therapy:
Radiation therapy (also called radiotherapy, x-ray therapy, or irradiat ion) is
the
use of a certain type of energy (called ionizing radiation) to kill cancer cells and
shrink tumors. Radiation therapy injures or destroys cells in the area being treated (the target
tissue) by damaging their genet ic material, making it impossible for these cells to
continue to grow and divide. Although radiation damages both cancer cells and
normal cells, most normal cells can recover from the effects of radiation and function
properly. The goal of radiation therapy is to damage as many cancer cells as
possible, while limiting harm to nearby healthy tissue.
For some types of cancer, radiation may be given to areas that do not have evidence
of cancer. This is done to prevent cancer cells from growing in the area receiving
the radiation. This technique is called prophylactic radiation therapy.
Radiation therapy also can be given to help reduce symptoms such as pain from
cancer that has spread to the bones or other parts of the body. This is called palliative
radiation therapy.
in a
small holder called an implant . Implants may be in the form of thin wires,
plastic tubes called catheters, ribbons, capsules, or seeds. The implant is put
directly into
the body. Internal radiation therapy may require a hospital stay.
Cancer patients receiving radiation therapy are often concerned that the treatment
will make them radioactive. The answer to this question depends on the type of
radiation therapy being given.
External radiation therapy will not make the patient radioactive. Patients do not need
to avoid being around other people because of the treatment.
Internal radiation therapy (interstitial, intracavitary, or intraluminal) that involves
sealed implants emits radioactivity, so a stay in the hospital may be needed. Certain
precautions are taken to protect hospital staff and visitors. The sealed sources deliver
most of their radiation mainly around the area of the implant, so while the area around
the implant is
radioactive, the patients whole body is not radioactive.
Systemic radiation therapy uses unsealed radioactive materials that travel throughout
the body. Some of this radioactive material will leave the body through saliva,
sweat, and urine before the radioactivity decays, making these fluids radioactive.
Therefore, certain precautions are sometimes used for people who come in close
contact with the patient.
The patients doctor or nurse will provide information if these special precautions are
needed.
Dosage of radiation:
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The amount of radiation absorbed by the tissues is called the radiation dose (or
dosage). Before 1985, dose was measured in a unit called a rad (radiation absorbed
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dose). Now the unit is called a gray (abbreviated as Gy). One Gy is equal to 100 rads;
one centigray (abbreviated as cGy) is the same as 1 rad.
Different tissues can tolerate various amounts of radiation (measured in centigrays).
For example, the liver can receive a total dose of 3,000 cGy, while the kidneys can
tolerate only 1,800 cGy. The total dose of radiation is usually divided into smaller
doses (called fractions) that are given daily over a specific time period. This maximizes
the destruction of cancer cells while minimizing the damage to healthy tissue.
The doctor works with a figure called the therapeutic ratio. This ratio compares
the damage to the cancer cells with the damage to healthy cells. Techniques are
available to increase the damage to cancer cells without doing greater harm to healthy
tissues.
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127
rays and gamma rays, some particle beams can penetrate only a
short distance into tissue. Therefore, they are often used to treat cancers
located on the surface of or just below the skin.
cancer). It can also be used to treat other conditions (for example, Parkinson disease
and epilepsy). In addition, stereotactic radiosurgery can be used to treat metastatic
brain tumors (cancer that has spread to the brain from another part of the body)
either alone or along with whole-brain radiation therapy. (Whole-brain radiation
therapy is a form of external radiation therapy that treats the entire brain with
radiation).
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185
tumor
with radiation beams (using width, height, and depth).
Many
can beradiat ion onco logists use this technique. A 3D image of a tumor
obtained using computed tomography (CT), magnet ic resonance
imaging (MRI), positron emission tomography (PET), or single photon
emission computed tomography (SPECT). Using information from
the image,
special computer programs design radiation beams that conform to the
shape of the tumor. Because the healthy tissue surrounding the tumor
is largely spared by this technique, higher doses of radiation can be used
to
treat the cancer. Improved outcomes with 3D conformal radiation
therapy
have been reported for nasopharyngeal, prostate, lung, liver, and
brain
cancers.
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188
If the patient will have external radiation, the radiation oncologist uses a process
called simulation to define where to aim the radiation. During simulation, the patient
lies very still on an examining table while the radiation therapist uses a special x-ray
machine to
define the treatment port or fieldthe exact place on the body where the radiation will
be
aimed. Most patients have more than one treatment port. Simulation may also involve
CT
scans or other imaging studies to help the radiation therapist plan how to direct
the
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radiation. The simulation may result in some changes to the treatment plan so that
the greatest possible amount of healthy tissue can be spared from receiving radiation.
The areas to receive radiation are marked with either a temporary or permanent
marker,
tiny dots or a tattoo showing where the radiation should be aimed. These marks are also
used to determine the exact site of the initial treatments if the patient should
need radiation treatment later.
Depending on the type of radiation treatment, the radiation therapist may make
body molds or other devices that keep the patient from moving during treatment.
These are usually made from foam, plastic, or plaster. In some cases, the therapist will
also make shields that cannot be penetrated by radiation to protect organs and
tissues near the treatment field.
When the simulation is complete, the radiation therapy team meets to decide how
much radiation is needed (the dose of radiation), how it should be delivered, and
how many treatments the patient should have.
Radiosensitizers and Radioprotectors
Radiosensitizers and radioprotectors are chemicals that modify a cells response to
radiation. Radiosensitizers are drugs that make cancer cells more sensitive to the
effects of radiation therapy. Several compounds are under study as radio sensitizers.
In addition, some anticancer drugs, such as 5-fluorouracil and cisplat in, make cancer
cells more sensitive to radiation therapy.
Radioprotectors (also called radioprotectants) are drugs that protect normal
(noncancerous) cells from the damage caused by radiation therapy. These agents
promote the repair of normal cells that are exposed to radiation. Amifost ine (trade name
Ethyol) is the only drug approved by the U.S. Food and Drug Administration
(FDA) as a radioprotector. It helps to reduce the dry mouth that can occur if the
parotid glands (which help to produce saliva and are located near the ear) receive
a large dose of radiation. Additional studies are under way to determine whether
amifostine is effective when used with radiation therapy to treat other types of cancer.
Other compounds are also under study as radioprotectors.
Both agents are given intravenously (by injection into a vein), usually on an outpatient
basis; sometimes they are given in addition to external beam radiation. Other
types of
radiopharmaceuticals, such as phosphorous 32, rhodium 186, and gallium nitrate, are
not used as frequently. Still other radiopharmaceuticals are under investigation.
THERMOGRAPH:
Need for the Thermography:
Thermograph has a number of distinct advantages over other imaging systems. It
is completely non- invasive, there is no contact between the patient and system as with
echography, and there is no radiation hazard as with x-rays. A thermograph is a real-time
system, changes can be followed as fast as at a rate if one study per second.
Classification of thermography:
Based on detection of the thermal radiation from the skin sreas, we can classify
the thermograph into three methods. They are
Infrared thermograph
Liquid crystal thermograph
Microwave themograph.
Thermo gram:
Thermo gram is a record of the infrared heat waves that are emitted by the body. it gives a
visual display of the hot and cold areas of the whole body. The technique of obtaining a thermo
gram is known as thermograph.
Thermographic equipment:
Thermographic equipment incorporate scanning systems which enable the infrared
radiation emitted from the surface of the skin with in the field of view to be focused on to
an infrared detector. The equipment used in the thermography basically consists of two
units. A special infrared camera that scans the object and a display unit for displaying the
thermal picture on the screen.
NETD:
NETD is nothing but Noise Equivalent Temperature Difference (NETD). It is the
figure of merit for the thermographic imaging system. This is usually called minimum
resolution.
Resolution
system:
of
the
thermographic
analysis
medicalThermo
With thermo vision 780M, there are many possibilities of analog analysis of the gray tone
images including the following (i) isotherm function (ii) lever analysis (iii) sample are a
selector and thermal profile analysis.
Digital
analysis
Thermography:
of
medical
SOFIA
SOFIA is a general image processing program which can be used in nearly all
applications written in FORTRAN IV, it is specially designed to operate with digital data
in OSCAR (Off-line: system for computer Access and Recording)
Lasers
Laser
The light emitted from an ordinary light source is incoherent, because the
radiation emitted from different atoms do not have definite phase relationship with each
other. For interference of light coherent sources are required. Two independent sources
cannot act as coherent sources. For experimental purposes, from a single source, two
coherent sources are obtained. In recent years certain highly coherent sources were developed
namely LASER. The word LASER is an acronym for Light Amplification by Stimulated
Emission of Radiation. The difference between ordinary light and LASER beam is pictorially
depicted as follows:
Characteristics of LASER:
The LASER beam is
1. Monochromatic
2. Highly coherent with waves exactly in phase with each other.
3. Doesnt diverge.
4. Extremely intense.
Spontaneous
radiation:
and
Stimulated
An atom may undergo transition between two energy states E 1 and E2 if it emits
or absorbs a photon of the appropriate energy E1-E2 =h .
In a system of thermal equilibrium the number of atoms in the ground state(N 1)
is greater than the number of atoms in the excited state(N2).This is called Normal
population. Consider a sample of free atoms, some of which are in the ground state with energy
E 1 and some
in the excited state with energy E 2. If the photons of energy E 1-E2 =h are incident on the sample,
the photons can interact with the atoms in the ground state and are taken to excited state. This
is
called Stimulated or Induced absorption. The process by which the atoms in the ground state
are
taken to the excited state is known as pumping. If the atoms are taken to the higher energy
levels with the help of light it is called Optical pumping. If the atoms in the ground state are
pumped to the excited state by means of external agency, the number of atoms in the
excited state(N 2) becomes greater than the number of atoms in the ground state(N 1) then this
condition is called
-8
population inversion. The lifetime of the atoms in the excited state is normally 10
seconds.
-3
Some of the excited energy levels have greater life times for atoms (10 seconds). These
levels are called as Metastable state.
If the excited energy level is an ordinary level the excited atoms return to a lower
or ground energy state immediately without the help off any external energy. During this
transition
a photon of energy E1-E2 =h is emitted. This is called spontaneous emission. If the excited state
is a metastable state, the atoms stray for some time in these level and then are brought to a
lower level by the help of the photons of energy E 1-E2 =h . During this process a photon of energy
E1- E2 =h is emitted. This is known as Stimulated radiation and the photon produced is called as
stimulated photon or secondary photon. The secondary photon is always in phase with
the stimulating photon. These photons in turn stimulate further emission of photons and hence
this results in a chain reaction. This is called laser action and by this action all the emitted
photons having same energy and same frequency and also in phase with each other. Hence
a highly monochromatic and perfectly coherent intense radiation is obtained.
Conditions to achieve LASER
action:
There must be inverted population.
The excited state must be a metastable state.
The emitted photon must stimulate further emission.
This is achieved by the use of the reflecting mirrors at the ends of the system.
Absorbing Energy
Consider the illustration from the previous page. Although more modern views of the atom
do not depict discrete orbits for the electrons, it can be useful to think of these orbits as
the different energy levels of the atom. In other words, if we apply some heat to an atom, we
might expect that some of the electrons in the lower-energy orbitals would transition to
higher-energy orbitals farther away from the nucleus.
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198
Absorption
of
energy:
An atom absorbs energy in the form of heat, light, or
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199
sitting in excited levels. The excited electrons have energies greater than the more relaxed
electrons.
Just as the electron absorbed some amount of energy to reach this excited level, it can
also release this energy. As the figure below illustrates, the electron can simply relax, and in
turn rid itself of some energy. This emitted energy comes in the form of photons (light
energy). The photon emitted has a very specific wavelength (color) that depends on the state
of the electron's energy when the photon is released. Two identical atoms with electrons in
identical states will release photons with
Ruby LASER: The Ruby laser was first developed by T.Maiman in 1960. It consists of a single
crystal of ruby rod of dimensions 10cm and 0.8cm. A ruby is a crystal of aluminium oxide
3+
3+
Al 2O3 in which some of aluminium ions (Al ) are replaced by chromium ions (Cr ). The
opposite ends of the ruby rod are made flat and parallel, one end is fully silvered and the
other end is
partially silvered. The ruby rod is surrounded by a helical Xenon flash tube which provides
the pumping light to raise the chromium ions to upper energy level. In the Xenon flash tube
each flash lasts several milliseconds and in each flash a few thousand joules of energy is
consumed.
In normal state most of the chromium ions are in the ground state E 1. When the ruby rod
is irradiated by a flash of light 5500 radiation (green colour) photons are absorbed by
the chromium ions which are pumped to the excited state E 3. The excited ion gives up part
of its energy to the crystal lattice and decay without giving any radiation to the metastable
-3
state E 2. Since the state E2 has a much longer lifetime (10 seconds) the number of ions on this
state goes on increasing. Thus population inversion is achieved between the states
E2 and E1. When the excited ion from the metastable state E 2 drops down spontaneously to
the ground state E1 it emits a photon of wavelength 6943.
This photon travels through the ruby rod and is reflected back and forth by the silvered ends
until it stimulates other excited ion and causes it to emit a fresh photon in phase with
stimulating
photon. Thus the reflections will amount to the additional stimulated emission, the socalled
Amplification by Stimulated emission. This stimulated emission is the LASER transition.
Finally
a pulse of red light of wavelength 6943 emerges through the partially silvered end of
the crystal.
Ruby Lasers
A ruby laser consists of a flash tube (like you would have on a camera), a ruby rod and
two mirrors (one half-silvered). The ruby rod is the lasing medium and the flash tube pumps it.
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2. The flash tube fires and injects light into the ruby rod.
The light excites atoms in the ruby.
When an electric discharge passes through the gas, the electron in the discharge
tube collide with He and Ne atoms and excite them to metastable states of energy
20.61eV and
20.66eV respectively above the ground level. Some of the excited helium atoms transfer
their energy to unexcited Ne atoms by collision. Thus He atom helps in achieving a
population
inversion in Ne atoms. When an excited Ne atom drops down spontaneously from the
metastable state at 20.66eV to lower energy state at 18.7eV it emits a 6328
Photon in the visible region. This photon traveling through the mixture of the gas is
reflected back and forth by the reflector ends, until it stimulates an excited neon atom and
causes it to emit
a fresh 6328 photon I phase with the stimulating photon. This stimulated transition
from
20.66eV to 18.7eV is the laser transition. The o/p radiation atoms drop down from the 1837eV
to
lower state E1 through spontaneous emission emitting incoherent light. From this level E 1 the
Ne atoms are brought to the ground state through collision with the walls of the tube. Hence the
final transition is radiationless.
Laser Light
Laser light is very different from normal light. Laser light has the following
properties:
The light released is monochromatic. It contains one specific wavelength of light
(one specific color). The wavelength of light is determined by the amount of energy
released when the electron drops to a lower orbit.
The light released is coherent. It is organized -- each photon moves in step with the
others. This means that all of the photons have wave fronts that launch in
unison.
The light is very directional. A laser light has a very tight beam and is very strong
and concentrated. A flashlight, on the other hand, releases light in many directions,
and the light is very weak and diffuse.
To make these three properties occur takes something called stimulated emission. This does
not occur in your ordinary flashlight -- in a flashlight, all of the atoms release their
photons randomly. In stimulated emission, photon emission is organized.
The photon that any atom releases has a certain wavelength that is dependent on the
energy difference between the excited state and the ground state. If this photon (possessing
a certain energy and phase) should encounter another atom that has an electron in the same
excited state, stimulated emission can occur. The first photon can stimulate or induce atomic
emission such that the subsequent emitted photon (from the second atom) vibrates with the
same frequency and direction as the incoming photon.
The other key to a laser is a pair of mirrors, one at each end of the lasing medium. Photons,
Prepared by A.Devasena., Asso. Prof.,
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with a very specific wavelength and phase, reflect off the mirrors to travel back and forth
through the lasing medium. In the process, they stimulate other electrons to make the downward
energy jump and can cause the emission of more photons of the same wavelength and phase. A
cascade effect occurs, and soon we have propagated many, many photons of the same
wavelength and phase. The mirror at one end of the laser is "half-silvered," meaning it reflects
some light and lets some light through. The light that makes it through is the laser light.
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You can see all of these components in the figures on the following page, which illustrate how
a simple ruby laser works.
Types of Lasers
There are many different types of lasers. The laser medium can be a solid, gas, liquid or
semico nductor. Lasers are commonly designated by the type of lasing material
employed:
Solid-state lasers have lasing material distributed in a solid matrix (such as the ruby
or neodymium:yttrium-aluminum garnet "Yag" lasers). The neodymium-Yag laser
-9
emits infrared light at 1,064 nanometers (nm). A nanometer is 1x10 meters.
Gas lasers (helium and helium-neon, HeNe, are the most common gas lasers) have a
primary output of visible red light. CO2 lasers emit energy in the far-infrared, and
are used for cutting hard materials.
Excimer lasers (the name is derived from the terms excited and dimer s) use reactive
gases, such as chlorine and fluorine, mixed with inert gases such as argon, krypton or
xenon. When electrically stimulated, a pseudo molecule (dimer) is produced. When
lased, the dimer produces light in the ultraviolet range.
Dye lasers use complex organic dyes, such as rhodamine 6G, in liquid solution
or suspension as lasing media. They are tunable over a broad range of
wavelengths.
Semiconductor lasers, sometimes called diode lasers, are not solid-state lasers.
These electronic devices are generally very small and use low power. They may be
built into
larger arrays, such as the writing source in some laser printers or CD players.
A ruby laser (depicted earlier) is a solid-state laser and emits at a wavelength of 694 nm. Other
lasing mediums can be selected based on the desired emission wavelength (see table below),
power needed, and pulse duration. Some lasers are very powerful, such as the CO2 laser, which
can cut through steel. The reason that the CO2 laser is so dangerous is because it emits laser
light in the infrared and microwave region of the spectrum. Infrared radiation is heat, and this
laser basically melts through whatever it is focused upon.
Other lasers, such as diode lasers, are very weak and are used in todays pocket laser pointers. These
lasers typically emit a red beam of light that has a wavelength between 630 nm and 680 nm.
Lasers are utilized in industry and research to do many things, including using intense laser
light to excite other molecules to observe what happens to them.
Here are some typical lasers and their emission wavelengths:
Laser Type
Wavelength (nm)
248
308
Nitrogen (UV)
337
Argon (blue)
488
Argon (green)
514
543
633
570-650
694
Nd:Yag (NIR)
1064
10600
of Radiation. The working of maser is similar to that of laser. The maser action is based on
the principle of Population Inversion followed by Stimulated emission. In maser the emitted
photon during the transition from the metastable state belongs to the microwave
frequencies. The paramagnetic ions are used as maser materials. Practical maser materials are
often chromium or gadolium ions doped as impurities in ionic crystals. Ammonia gas is
also a maser material. Maser provides a very strong tool for analysis in molecular
spectroscopy.
LASER SURGERY
Examples include the use of a laser scalpel in otherwise conventional surgery, and
soft tissue laser surgery, in which the laser beam vaporizes soft tissues with high
water
content. Laser resurfacing is a technique in which molecular bonds of a material
are dissolved by a laser. Laser surgery is commonly used on the eye. Techniques
used
include LASIK, which is used to correct near and far-sightedness in vision, and
Laproscopic surgery
Laparoscopic surgery, also called minimally invasive surgery (MIS), bandaid surger
y, or
keyhole surgery, is
a modern surgical
technique
in which
operations
in
the abdomen are performed through small incisions (usually 0.51.5 cm) as opposed
to
the larger incisions needed in laparotomy.Keyhole surgery makes use of images
displayed on TV monitors to magnify the surgical elements. Laparoscopic
surgery includes operations within the abdominal or pelvic cavities, whereas keyhole
surgery performed on the thoracic or chest cavity is called thoracoscopic surgery.
Laparoscopic and thoracoscopic surgery belong to the broader field of endoscopy. The
key element in laparoscopic surgery is the use of a laparoscope. There are two types:
(1) a telescopic rod lens system, that is usually connected to a video camera (single chip
or three chip), or (2) a digital laparoscope where the charge coupled device is placed
at the end of the laparoscope, eliminating the rod lens system.
DIATHERMY:
Diathermy therapy is generally contra-indicated for pacemaker patients.the operation of
a pulse generator subject to the intense fields of energy involved in diathermy cannot be
predicted;
reversion to fixed rate pacing is likely, to copmplete inhibition is possible. Although damage
to either pulse generator circuitry or cardiac tissue is highly improbable, it cannot be
positively
ruled out. If diathermy therapy must be used, it should be applied away from the
immediate vicinity of the pulse generator/ lead system.
INTRODUCTION:
Operation theatre equipment are very useful both diagnostically and therapeutically.
they are mainly useful for monitoring and treatment purposes. during operation or intensive
care or
intensive treatment, the patient's condition is followed carefully by repeated measurement
of many variables, like blood flow velocvity, cardiac output, blood pressure. PH value
and so
on.The above variables are also measured and monitored by operation theatre equipment.
Desiccation:
The needle point electrodes are stack into the tissue and kept steadily while
passing electric current. This creates a high local increase in heat and drying of tissues is
taking place. This is called desiccation.
Blending:
When the electrode is kept above the skin, an electrical arc is sent. The developed
heat produces wedge shaped narrow cutting of the tissue on the surface. By increasing the
current level, deeper level cutting of the tissues takes place. Normally continuous RF current is
used for cutting.
Hemostasis:
The concurrent use of continuous RF current for cutting and a RF wave burst
for coagulation is called Hemostasis mode.
Electrical Shock
8.1 Introduction:
Electric shock is a traumatic state caused by the passage o f electric current can
flow through the human body either accidentally or intentionally. The kind and amount of
damage depends on the intensity, type and duration of the current, the point where the
electricity first touched the body and the path it took through the body. Burns may be
superficial or very deep with widespread tissue death. Severe shock may cause muscle
contractions, respiratory paralysis, unconsciousness and cardiac arrest. A high voltage
electric shock may cause sudden muscle spasm that may through the victim away from the
power source with extreme force, resulting in further injuries, such as fracture. Lightening
causes injuries similar to those sustained from a high voltage electric shock. Electrical
currents are administered intentionally in the following case.
For measurement of respiration rate by impedance method, a small current at
high frequency is made to flow between the electrodes applied on the surface of the
body.
High currents are also passed through the body for therapeutic and surgical
purposes.
When recording signals like ECG, and EEG, the amplifiers used in the preamplifier
stage may deliver small currents themselves to the patient. These are due to bias
currents.
Accidental transmission of electrical current takes place because of defect in
the equipment; excessive leakage and simultaneous use of other equipment on the
patient
which may produce potentials on the patient circuit.
A patient may not be usually able to react in the normal way. He/she is either ill,
unconscious anaesthetized or strapped on the operating table. He/she may not be able to
withdraw him/herself from the electrified object, when feeling tingling in his/her
skin, before any danger of electrocution occurs.
The patient or the operator may not realize that a potential hazard exists. This is
because potential differences are small and high frequency and ionizing radiations are
not directly indicated.
Considerable neutral protection and barrier to electric current is provided by human skin.
In certain applications of electro medical equipment, the natural resistance of the
skin may be passed. Such situations arise when the tests are carried out on the subject
with a
catheter in his/her heart or an large blood vessels.
Electro medical equipment, example : pacemakers may be used either temporarily
or permanently to support or replace functions of some organs of the human body.
The interruption in the power supply or failure of the permanent injuries or even prove
fatal for the patient.
Medical instruments are quite often used in conjunction with several other
instruments and equipment. These combinations of high power equipment and
extremely sensitive low signal equipment. Each of these devices may be safe in
itself, but can become dangerous when used in conjunction with others.
Environmental conditions in the hospitals particularly in the operating theatres
cause explosion or fire hazards due to the presence of anesthetic agents, humidity and
cleaning agents etc.
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Let go 8-20
Threshold of involuntary muscle contraction paralysis >20.
Respiratory paralysis and heart fibrillation 80-1000, ventricular and heart defibrillation 1,000
to
10,000 sustained myocardial contraction, temporary respiratory paralysis and possible
tissue
burns.
Let-go current is the minimum current to produce muscular contraction. For men it
is about 16 mA and for women it is about 10.5 mA.
8.4.2 Microshock:
A physiological response to a current applied to a surface of the heart that results
in unwanted stimulation like muscle contractions or tissue injury is called microshock.
Micro
shock is most often caused when currents in excess of 10 microamperes, flow through
an insulated catheter to the heart. The catheter may be an insulated, conductive-fluid filled tube,
or a solid wire pacemaker cable. The micro shock results because the current density at the
heart become high in the situation depicted there, in which the catheter touches the heart.
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