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Evaluating New Technology

Evaluating New Technology . รศ.นพ.เทพกร สาธิตการมณี ภาควิชาวิสัญญีวิทยา คณะแพทยศาสตร์ มหาวิทยาลัยขอนแก่น. เครื่องมือทางวิสัญญีประเภทต่างๆ. Monitor ECG SpO 2 Capnography Arterial Pressure-based Cardiac Output (APCO) Defibrillator Network ECG & Spirometry. Monitor.

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Evaluating New Technology

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  1. Evaluating New Technology รศ.นพ.เทพกร สาธิตการมณี ภาควิชาวิสัญญีวิทยา คณะแพทยศาสตร์ มหาวิทยาลัยขอนแก่น

  2. เครื่องมือทางวิสัญญีประเภทต่างๆเครื่องมือทางวิสัญญีประเภทต่างๆ • Monitor • ECG • SpO2 • Capnography • Arterial Pressure-based Cardiac Output (APCO) • Defibrillator • Network ECG & Spirometry

  3. Monitor • Adult/Pediatric/Neonate • Basic monitor • ECG • NIBP • SpO2 • Advanced monitor • Capnography (CO2 monitor)

  4. ECG • Lead • 3-lead • 12-lead • EASI method : 5 electrodes • Conventional method : 10 electrodes • Arrhythmia detection • Ventricular arrhythmias, asystole, bradycardia, etc • Ischemia detection • ST-segment analysis

  5. SpO2 • Conventional Pulse Oximetry provides inaccurate monitoring or signal dropout during: • Patient Motion or Movement • Low Perfusion (low signal amplitude) • Intense Ambient Light (lighting or sunlight) • Electro surgical Instrument Interference • Advanced technology : Masimo SET • Masimo SET uses Adaptive Filter, DST, FST and SST, in parallel processing  mode (all patented by Masimo). Masimo SET's four unique algorithms, along  with conventional red over infrared algorithm allows for unprecedented fidelity,  sensitivity and specificity

  6. Masimo SET

  7. Masimo SET

  8. Masimo SET

  9. Masimo SET

  10. Masimo Rainbow SET

  11. Masimo Rainbow SET

  12. Capnography(CO2 monitor) • Mainstream • Sidestream • Microstream

  13. Mainstream Capnography

  14. Mainstream Capnography

  15. SidestreamCapnography

  16. SidestreamCapnography

  17. MicrostreamCapnography

  18. MicrostreamCapnography

  19. MicrostreamCapnography

  20. MicrostreamCapnography

  21. Arterial Pressure-based Cardiac Output (APCO) Measurement of cardiac output • Intermittent CO (ICO) • Swan-Ganzthermodilution catheter • Continuous CO (CCO) • Swan-Ganz continuous cardiac output catheter • Less invasive CCO: APCO • FloTracsensor • Vigileo monitor

  22. Arterial Pressure-based Cardiac Output (APCO)

  23. Arterial Pressure-based Cardiac Output (APCO)

  24. Arterial Pressure-based Cardiac Output (APCO)

  25. Arterial Pressure-based Cardiac Output (APCO)

  26. Arterial Pressure-based Cardiac Output (APCO)

  27. Arterial Pressure-based Cardiac Output (APCO)

  28. Arterial Pressure-based Cardiac Output (APCO)

  29. Arterial Pressure-based Cardiac Output (APCO)

  30. Arterial Pressure-based Cardiac Output (APCO)

  31. Arterial Pressure-based Cardiac Output (APCO)

  32. Arterial Pressure-based Cardiac Output (APCO)

  33. Defibrillator • Monophasicwaveform • vary in the speed with which the waveform returns to the zero voltage point- either gradually (damped sinusoidal) or instantaneously (truncated exponential) • Biphasic waveform • first flows in a positive direction for a specified duration, in the second phase the device reverses the direction of current so that it flows in a negative direction • adjusts the amount and duration of current delivered based on impedance measurements performed twice during every shock • provides equivalent defibrillation success at lower energy levels than those of monophasic shocks and eliminates the need to increase the energy for persistent VF

  34. Defibrillator

  35. Biphasic waveform • Truncated exponential • Rectilinear • MultipulseBiowave

  36. 50 50 40 40 30 30 20 20 10 10 0 0 -10 -10 -20 -20 0 4 8 12 0 4 8 12 50 50 40 40 30 30 20 20 10 10 0 0 -10 -10 -20 -20 12 12 8 8 0 0 4 4 Biphasic waveform Low impedance High impedance Truncated exponential Rectilinear

  37. Biphasic waveform Multipulse Biowave

  38. The Schiller BiphasicDefibrillationWaveform (MultipulseBiowave)

  39. Defibrillator • To be effective the defibrillationshock has to provide • anadequatelevel of current 22 Ampere • in averypreciseperiod of time  4 ms and with • thelowest possible energyEnergy(Joules) isharmfuland causes burns

  40. Current Nocurrent 1 0.5 0 t[s] 0 1000 600 800 400 200 The defibrillationshockispulsed There is NO CURRENT and so NO ENERGY half of the time !

  41. High currentissoobtained but withonlyhalfenergy

  42. The duration of the 2 pulses isalwaysfixed to 4 ms, corresponding to the excitation time of the cardiaccells

  43. Amplitude of the negative pulse isadapted in order to eliminate charges built up by the first phase and willsopreventfrom a possible refibrillation

  44. Electrical charges built up by the positive shock are totally eliminated Negative pulse amplitude is well adjusted Vm Vd t[ms]

  45. Defibrillator: Options • 12 ECG leads on the screen (*with interpretation) • SpO2 • NIBP • Recorder • Pacemaker

  46. Network ECG & Spirometry • Conventional 12-leas ECG with interpretation on thermal paper

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